FAI Client Update #7: Novel Coronavirus COVID-19 / SARS-CoV-2

Dear clients and partners,

with the COVID-19 Pandemic continuing on its path after 6 months of a turbulent year 2020, FAI remains at the forefront in responding to the needs of our Clients.

Here is our seventh COVID-19 Client Update.

COVID-19 Pandemic Summary

Since our last update, the global impact of the pandemic has continued to grow.

Global numbers of new cases have surged during the month of June, with daily records being set, and many countries reporting their highest daily increases in cases to date. On 1st July 2020, the global case volume reached the 10 million mark, with deaths numbering 500 000.

Geographic focus remains centered on the Americas, with the USA battling with surging numbers in many states, as it struggles with re-opening its economy, and Brazil bearing the brunt of a pandemic wave through Latin America.

India and Russia face steadily increasing numbers while African countries are seeing case volumes finally starting to spike, with resource-poor health systems across the continent coming under pressure. Despite this, death rates remain low, reflecting demographic differences in younger age populations, despite widespread poverty and other adverse factors.

Asian and European economies are starting to re-open after prolonged periods of lockdown with return to work across many industries, including selective re-opening of schools, community services and sporting events, although under very different conditions to what used to be normal.

Notably the tourism industry is experimenting with a cautious re-opening for the summer season under stringent public health and hospitality risk-mitigation measures, this is very welcome news for an industry which has been decimated by the pandemic.

Commercial aviation is also starting to resume with domestic air travel across the USA, some sectors within Europe and selective international routes, notably by the GCC carriers.

This is good news for our friends and colleagues across the travel, tourism, travel insurance and assistance industries, and FAI stands by to play its part in supporting the recovery.

Latest FAI Operations Update

At FAI, we remain vigilant, flexible and responsive to these developments.

Our aggregate COVID-19 case experience has continued to grow over the last 5 months despite the multiple variables and case complexities, and this has validated our reputation as the leading provider of COVID-19 aeromedical patient transport services.

This includes our capabilities both in transporting patients in portable isolation units (PMIU) as well as a new option for seated passengers who are COVID-19 positive but with minimal or no clinical symptoms or signs.

The number of destinations continues to increase, and to date FAI has performed PMIU missions from the following locations, to name but a few:
Accra, Baghdad, Bangui, Canary Islands, Djibouti, Dushanbe, Juba, Kabul, Lagos, London, Marrakesh, Menorca, Mogadishu, Munich, Niamey, Pointe Noire, Port Harcourt, Rabil, Rio de Janeiro, and even the island of Sao Tome off the west coast of Africa.

We have recently added a fifth portable medical isolation unit (2 EpiShuttle, 2 Isolation Chamber NP-320, 1 IsoArk N36-2) and expanded our aircraft configuration options for PMIU transport cases.

In addition to our standard configuration on Challenger CL604 aircraft, which we have described in previous Updates, we have now introduced 2 new options:

  • Learjet 60 using Isolation Chamber NP-320 or IsoArk N36-2 PMIU as a transport option for specific stable patients over medium range flight sectors
  • Global Express GLEX using Isolation Chamber NP-320 or IsoArk N36-2 PMIU as a transport option for selected patients over ultra-long range flight sectors

Each of these 2 options is specific for the Isolation Chamber NP-320 or IsoArk owing to size limits of the aircraft access door plus specific loading techniques.

In particular, the GLEX requires patients to be clinically stable, relatively mobile and to be able to board via the aircraft stairs prior to being prepared and loaded into the PMIU once on-board.

In selected cases, our 2 EpiGuard EpiShuttle PMIU units may also be utilised on the GLEX, subject to very specific requirements being met.

Lessons learned from FAI’s COVID-19 PMIU missions to date

Patient selection, fitness to fly, and the timing of the mission in relation to the progression of the underlying illness, are all crucial factors in planning a successful COVID-19 medical transport mission using a PMIU isolation unit. Accurate and timely pre-flight clinical information is absolutely crucial in achieving this acute level of case control and planning.

One of the hardest lessons has been in making decisions on just which patients should NOT be transported, for their own safety, and for the safety of our crews.

Whilst it is true that these units are designed to isolate the patient in order to protect the medical teams and flight crews, there are still significant limitations in access to the patients once inside, in case of emergency. COVID positive patients can deteriorate very quickly at altitude. It is almost impossible to resuscitate patients from cardio-respiratory arrest within a closed capsule.

We’ve also learned through experience just how exhausting these missions can be for both patients and crew alike, and we now implement medcrew changes at mid-point tech stops wherever possible.

Patient preparation, and the close co-operation of our clients and the treating medical teams on the ground, are all critical factors in each and every case.

Transportation of asymptomatic COVID-19 positive persons as normal seated passengers

In response to increasing client requests to repatriate individuals who are COVID-19 positive but clinically well without obvious symptoms or signs, FAI has created an option for transporting persons as normal seated passengers, including patients and accompanying family members.

Using our GLEX Global Express aircraft, with the interior seating cabin space sub-divided into self-contained compartments, we have been able to create an environment where appropriate social distancing is feasible in flight, and where strict hygiene measures can be enforced. Our model can accommodate up to 8 passengers in various configurations, accompanied by FAI medical escort personnel. All persons on board are fitted with appropriate PPE (personal protective equipment).

We have designed these protocols with reference to current international COVID-19 best practice, and to latest IATA and EASA guidelines recently released. These guidelines give direction to air transport operators on safe COVID-19 risk mitigation procedures during air passenger transportation.

We have modified the cabin interior into the following possible configurations with dedicated isolation areas, depending on number of passengers to be transported:

Transport of up to 4 passengers

Transport of 5-6 passengers

Transport of 7-8 passengers

As is well established, COVID-19 disease is a dynamic process, and patients who are relatively well early on in their course may deteriorate quickly over time, especially in the presence of recognised health risk factors.

This places an even higher priority on receiving absolutely accurate and up to date clinical information in good time on all such passengers, and making sure that they remain stable during the planning stages leading up to the execution of the flight. The flight planning stage may take several days for such missions, and great care is needed to track the ongoing well-being of all passengers and their companions.

Client collaboration in flight preparation and planning

Client support has remained a key factor in the smooth execution of COVID-19 aeromedical transport cases, especially as our list of operating routes and destinations has increased over the last 5 months.

Client input is essential in securing a number of case-critical elements in all missions.

We have distributed a complete Client Briefing Pack with specific templates we have drafted to assist Clients to manage their cases with FAI, together via a team approach. Please contact FAI at any time should you have any issues or questions in this regard.

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