The Covid-19 crisis has forced both helicopter operators and aviation regulators to make significant changes with regard to air ambulance transports. The majority of these involve relaxing the regulatory framework for aircraft modifications used to abate transmission of the virus between passengers/patients and crew as well as changing operational procedures with regard to the use of personal protective equipment (PPE) and aircraft decontamination.
For example, on April 3 the UK Civil Aviation Authority (CAA) published an exemption for regulatory approval covering the installation of temporary cockpit/cabin barriers in unpressurized aircraft used to transport key workers during the pandemic. Some conditions apply, including flammability standards, secure attachment, risk assessment, and air circulation. The move by the CAA, along with similar accommodations from EASA and the FAA regarding barriers and specialized air medical equipment, such as isolated, negative pressure patient transporters, demonstrates a degree of flexibility not typically seen from regulators.
Manufacturers are doing their part as well, providing instructions relating to cockpit cabin barriers and methods to minimize air exchange between cabin and cockpit while maximizing fresh air flow into the aircraft. For instance, Airbus Helicopters has published detailed instructions with regard to attachment hardware for barriers as well as how to maximize cabin airflow and minimize exchange between cockpit and cabin by aircraft model (Information Notice 3492-I-25). Airbus noted that, due to size and design constraints particular to helicopters, “a 100 percent barrier is not possible” but “any additional barrier will increase the level of protection.”
Aircraft already equipped with night vision goggle curtains already provide some protection, but for those without, solutions via “minor change” approval provide a more exigent solution to the problem. According to Airbus, developing and providing factory kits via service bulletin is not practical due to the urgent need to act swiftly “to meet the current crisis demand.”
Airbus is also providing technical assistance and statements to operators developing their own installations in the event minor change approval sheets cannot be applied. Operators need to provide details of the installation to their local Airbus Helicopters support representative. However, Airbus cautions that not all installations will be suitable for technical statement support. The company also said it was available to assist operators with technical statement support regarding the use of patient isolation devices and noted that it had previously issued guidance covering the disinfection of aircraft curtains and other equipment in Information Notice IN 3476-I-12.
For operators with neither the time nor inclination to develop their own separation solutions, there are certified aftermarket options. For example, Macaer Aviation Group has developed a certified medical separation wall for the Airbus MBB-BK117-D2, a twin-engine helicopter very popular with air ambulance providers. Other aftermarket manufacturers, such as Barry USA, are offering “temporary and experimental” protective barriers suitable for medical, commercial, and corporate aircraft.
While cockpit/cabin barriers do not replace the use of PPE by air medical flight crews, they are likely to retard virus spread. However, caution remains the watchword for air medical crews in the era of Covid-19, based on provider comments in electronic town halls that started in March. The meetings are sponsored by the Association of Air Medical Services.
“We’re just working under the assumption that everyone is infected right now,” said Matt Zavadsky, chief strategic integration officer at MedStar Mobile Healthcare in Fort Worth, Texas, explaining that when transporting trauma patients, “you’ve got to assume that they’ve got the virus until proven otherwise.” As far as PPE goes, that means medical transport crews performing “an intervention of any kind” wear N95 masks and flat surgical masks are worn for “everything else.”
“The appropriate use of PPE cannot be overemphasized,” said Tom Baldwin, vice president of safety for Global Medical Response, an amalgamation of ground and air medical transport providers that include American Medical Response, Rural Metro Fire, Air Evac Lifeteam, Reach Air Medical Services, Med-Trans Corporation, AirMed International, and Guardian Flight.
This necessitates, in some cases, the re-use of PPE due to a shortage of masks, gloves, face shields, and gowns in the U.S. For N95 masks, Dr. Shannon Sovndal, the medical director at Med Evac in Boulder, Colorado, recommends the “brown paper bag” method wherein a first responder rotates and reuses multiple masks—generally four—between shifts from brown paper bags, providing them with the ability to naturally decontaminate over the course of 72 hours. N95 masks are generally incompatible with facial hair and are hot and unpleasant to wear over prolonged periods. However, they do not impede a flight crew’s ability to communicate over the radio, according to a study conducted by the Helicopter Association International.
However, even the stringent use of PPE is no guarantee that medical transport crews will not become infected. So crews are being medically screened pre- and post-shift daily by various providers including MedStar. Cleared crews are issued daily medical status wristbands which makes it easier for them to move in and out of medical facilities without the need for secondary screening. It also provides peer counseling and a drive-through testing clinic for crew members exposed to Covid-19 patients.