Infection prevention and control recommendations for medical evacuation by aircraft of patients with suspected or confirmed COVID-19 from remote and isolated communities in Canada’s North

October 2, 2020

Prepared by the Public Health Agency of Canada with advice from the National Advisory Committee on Infection Prevention and Control.

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Introduction

The Public Health Agency of Canada (PHAC) develops evidence-informed infection prevention and control (IPC) guidance to complement provincial and territorial public health efforts in monitoring, preventing, and controlling healthcare-associated infections. The purpose of this document is to provide IPC guidance for the medical evacuation of patients with suspected or confirmed COVID-19 by air, based on current PHAC COVID-19 guidance and the PHAC Routine Practices and Additional Precautions guidance. This document should be read in conjunction with relevant provincial, territorial and local legislation, regulations, and policies.  

Recommendations in this document refer to the minimum IPC measures needed for the medical evacuation of patients with suspected or confirmed COVID-19. Existing local public health and airline industry directives (e.g., symptom screening and temperature checks) as well as organizational standard operation procedures (that consider engineering controls such air flow, etc.) may have additional recommendations and requirements.

Assumptions for development of recommendations

  1. The medevac is a non-commercial, medical evacuation flight dedicated for the transport of a patient.
  2. There are pre-existing organizational infection prevention and control (IPC) policies and procedures that align with routine practices and additional precautions, including cleaning and disinfection and waste management.
  3. Medical evacuation personnel are healthcare workers (HCWs) arriving by the air transport and who will have direct contact with the patient.
  4. Medical evacuation personnel follow appropriate precautions based on local public health advice or directives if required to go into the community (rather than the local staff transporting the patient to the aircraft).
  5. All personnel on the aircraft have been trained in putting on and removing personal protective equipment (PPE), and basic IPC principles.
  6. Appropriate personnel on the aircraft (e.g., medical evacuation personnel or flight crew) will be pre-identified to provide instructions on relevant COVID-19 public health measures and PPE to the patient, escort and any ground personnel that may board the aircraft.
  7. The escort may be infected with COVID-19.

Patient (suspected or confirmed COVID-19)

Appropriate flight personnel (e.g., medical evacuation personnel or flight crew) should ensure that the patient:

Escort

Flight crew

Medical evacuation personnel (personnel)

Patient care equipment and environment

Strategies to reduce production of aerosols during aerosol-generating medical procedures

This section was extracted from the PHAC Routine Practices and Additional Precautions guidance.

Strategies should be applied to reduce the level of aerosol generation with suspect or confirmed COVID-19 cases during a Medevac flight. AGMPs should be limited to those that are medically necessary; examples include intubation and related procedures, bronchoscopy, sputum induction, and non-invasive positive pressure ventilation such as continuous positive airway pressure (CPAP) and bilevel positive airway pressure (BiPAP).

Follow provincial or territorial guidance for procedures that require the use of an N95 respirator. This guidance may vary among provinces and territories.

Strategies to reduce production of aerosols during AGMPs include:

Always follow the medevac standard operating procedures for AGMP, as well as federal/provincial/territorial infection prevention and control directives.

Bibliography

Acknowledgements

The National Advisory Committee on Infection Prevention and Control (NAC-IPC) is an external advisory body that provides subject matter expertise and advice to the Public Health Agency of Canada on the prevention and control of infectious diseases in Canadian health care settings.

This guideline was prepared by: Ms. Katherine Defalco, Ms. Adina Popalyar, Ms. Sabrina Chung, Ms. Toju Ogunremi, Dr. Kahina Abdesselam.

NAC-IPC members: Dr. Joanne Embree, (Chair), Dr. Jennie Johnstone (Vice-Chair), Ms. Molly Blake, Ms. Josiane Charest, Dr. Maureen Cividino, Ms. Nan Cleator, Ms. Jennifer Happe, Dr. Susy Hota, Ms. Anne Masters-Boyne, Dr. Matthew Muller, Ms. Patsy Rawding, Ms. Suzanne Rhodenizer Rose, Dr. Patrice Savard, Dr. Stephanie Smith, Dr. Nisha Thampi.

PHAC Healthcare-Associated Infections Prevention and Control Section: Dr. James Brooks (Director), Ms. Kathy Dunn (Manager), Dr. Kahina Abdesselam, Ms. Anna Bottiglia, Ms. Sabrina Chung, Mr. Steven Ettles, Mr. John McMeekin, Ms. Toju Ogunremi, Ms. Adina Popalyar.

The authors gratefully acknowledge the contributions of Dr. Marianna Ofner, the COVID-19 Public Health Working Group on Remote and Isolated Communities, Indigenous Services Canada, and the Northwest Territories Health Authority.

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