Hostname: page-component-78c5997874-v9fdk Total loading time: 0 Render date: 2024-11-10T10:53:57.342Z Has data issue: false hasContentIssue false

Air Quality Monitoring During High-Level Biocontainment Ground Transport: Observations From Two Operational Exercises

Published online by Cambridge University Press:  28 June 2021

Audrey Dang
Affiliation:
Center for Aerosol Science and Engineering, Department of Energy, Environmental, and Chemical Engineering, Washington University in St. Louis, MO, USA
Brent Williams
Affiliation:
Center for Aerosol Science and Engineering, Department of Energy, Environmental, and Chemical Engineering, Washington University in St. Louis, MO, USA
William D. Warsing
Affiliation:
Abbott Emergency Medical Services, American Medical Response, St. Louis, MO, USA
Michael Noone
Affiliation:
Los Angeles County Emergency Medical Services, Los Angeles, CA, USA
Alexander P. Isakov
Affiliation:
Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, USA
David K. Tan
Affiliation:
Abbott Emergency Medical Services, American Medical Response, St. Louis, MO, USA Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, USA
Stephen Y. Liang*
Affiliation:
Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, USA Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
*
Corresponding author: Stephen Y. Liang, Email: syliang@wustl.edu.

Abstract

Objective:

Stretcher transport isolators provide mobile, high-level biocontainment outside the hospital for patients with highly infectious diseases, such as Ebola virus disease. Air quality within this confined space may pose human health risks.

Methods:

Ambient air temperature, relative humidity, and CO2 concentration were monitored within an isolator during 2 operational exercises with healthy volunteers, including a ground transport exercise of approximately 257 miles. In addition, failure of the blower unit providing ambient air to the isolator was simulated. A simple compartmental model was developed to predict CO2 and H2O concentrations within the isolator.

Results:

In both exercises, CO2 and H2O concentrations were elevated inside the isolator, reaching steady-state values of 4434 ± 1013 ppm CO2 and 22 ± 2 mbar H2O in the first exercise and 3038 ± 269 ppm CO2 and 20 ± 1 mbar H2O in the second exercise. When blower failure was simulated, CO2 concentration exceeded 10 000 ppm within 8 minutes. A simple compartmental model predicted CO2 and H2O concentrations by accounting for human emissions and blower air exchange.

Conclusions:

Attention to air quality within stretcher transport isolators (including adequate ventilation to prevent accumulation of CO2 and other bioeffluents) is needed to optimize patient safety.

Type
Original Research
Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of Society for Disaster Medicine and Public Health, Inc.

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Christopher, GW, Eitzen, EM Jr Air evacuation under high-level biosafety containment: the aeromedical isolation team. Emerg Infect Dis. 1999;5(2):241-246.Google ScholarPubMed
Schilling, S, Follin, P, Jarhall, B, et al. European concepts for the domestic transport of highly infectious patients. Clin Microbiol Infect. 2009;15(8):727-733.CrossRefGoogle ScholarPubMed
Ewington, I, Nicol, E, Adam, M, et al. Transferring patients with Ebola by land and air: the British military experience. J R Army Med Corps. 2016;162(3):217-221.CrossRefGoogle ScholarPubMed
Nicol, ED, Mepham, S, Naylor, J, et al. Aeromedical transfer of patients with viral hemorrhagic fever. Emerg Infect Dis. 2019;25(1):5-14.Google ScholarPubMed
Cieslak, TJ, Kortepeter, MG. A brief history of biocontainment. Curr Treat Options Infect Dis. 2016;8(4):251-258.CrossRefGoogle ScholarPubMed
Dindart, JM, Peyrouset, O, Palich, R, et al. Aerial medical evacuation of health workers with suspected Ebola virus disease in Guinea Conakry – interest of a negative pressure isolation pod-a case series. BMC Emerg Med. 2017;17(1):9.CrossRefGoogle ScholarPubMed
Biselli, R, Lastilla, M, Arganese, F, et al. The added value of preparedness for aeromedical evacuation of a patient with Ebola. Eur J Intern Med. 2015;26(6):449-450.Google ScholarPubMed
Lowe, JJ, Jelden, KC, Schenarts, PJ, et al. Considerations for safe EMS transport of patients infected with Ebola virus. Prehosp Emerg Care. 2015;19(2):179-183.CrossRefGoogle ScholarPubMed
Gisolf, J, Wilders, R, Immink, RV, et al. Tidal volume, cardiac output and functional residual capacity determine end-tidal CO2 transient during standing up in humans. J Physiol. 2004;554(Pt 2):579-590.CrossRefGoogle ScholarPubMed
Smith, D, Pysanenko, A, Spanel, P. The quantification of carbon dioxide in humid air and exhaled breath by selected ion flow tube mass spectrometry. Rapid Commun Mass Spectrom. 2009;23(10):1419-1425.CrossRefGoogle ScholarPubMed
Williams, GW, George, CA, Harvey, BC, Freeman, JE. A comparison of measurements of change in respiratory status in spontaneously breathing volunteers by the ExSpiron noninvasive respiratory volume monitor versus the Capnostream capnometer. Anesth Analg. 2017;124(1):120-126.CrossRefGoogle ScholarPubMed
Taylor, NA, Machado-Moreira, CA. Regional variations in transepidermal water loss, eccrine sweat gland density, sweat secretion rates and electrolyte composition in resting and exercising humans. Extrem Physiol Med. 2013;2(1):4.CrossRefGoogle ScholarPubMed
Zwillich, CW, Sahn, SA, Weil, JV. Effects of hypermetabolism on ventilation and chemosensitivity. J Clin Invest. 1977;60(4):900-906.CrossRefGoogle ScholarPubMed
US Department of Labor, Occupational Safety and Health Administration. Permissible exposure limits – annotated tables. Table Z-1. https://www.osha.gov/dsg/annotated-pels/tablez-1.html#annotated_table_Z-1. Accessed July 22, 2020.Google Scholar
Carrer, P, de Oliveira Fernandes, E, Santos, H, et al. On the development of health-based ventilation guidelines: principles and framework. Int J Environ Res Public Health. 2018;15(7):1360. doi: 10.3390/ijerph15071360 www.mdpi.com/journal/ijerph.CrossRefGoogle ScholarPubMed
Gerlach, G GU, Oelßner, W (eds.). Carbon dioxide sensing: fundamentals, principles, and applications. Weinheim, Germany: Wiley-VCH; 2019.CrossRefGoogle Scholar
Jacobson, TA, Kler, JS, Hernke, MT, et al. Direct human health risks of increased atmospheric carbon dioxide. Nat Sustain. 2019;2(8):691-701.CrossRefGoogle Scholar
Zhang, X, Wargocki, P, Lian, Z. Physiological responses during exposure to carbon dioxide and bioeffluents at levels typically occurring indoors. Indoor Air. 2017;27(1):65-77.CrossRefGoogle ScholarPubMed
Bonino, S. Carbon dioxide detection and indoor air quality control. Occup Health Saf. 2016;85(4):46-48.Google ScholarPubMed
Permentier, K, Vercammen, S, Soetaert, S, Schellemans, C. Carbon dioxide poisoning: a literature review of an often forgotten cause of intoxication in the emergency department. Int J Emerg Med. 2017;10(1):14.CrossRefGoogle ScholarPubMed
Tang, X, Misztal, PK, Nazaroff, WW, Goldstein, AH. Volatile organic compound emissions from humans indoors. Environ Sci Technol. 2016;50(23):12686-12694.CrossRefGoogle ScholarPubMed
American Society of Heating Refrigerating and Air-Conditioning Engineers. Table 7.1. Design parameters – hospital spaces. ANSI/ASHRAE/ASHE Addendum PTO ANSI/ASHRAE/ASHE Standard 170-2017. ANSI/ASHRAE/ASHE Standard 170-2017: Ventilation of health care facilities. 2017. https://www.ashrae.org/file%20library/technical%20resources/standards%20and%20guidelines/standards%20addenda/170-2017/170_2017_p_20200302.pdf. Accessed August 3, 2020.Google Scholar
American Society of Heating Refrigerating and Air-Conditioning Engineers. Table 6.2.2.1. Minimum ventilation rates in breathing zone. ANSI/ASHRAE Addendum P to ANSI/ASHRAE Standard 62.1-2013: ventilation for acceptable indoor air quality. 2015. https://www.ashrae.org/file%20library/technical%20resources/standards%20and%20guidelines/standards%20addenda/62_1_2013_p_20150707.pdf. Accessed August 3, 2020.Google Scholar
Supplementary material: File

Dang et al. supplementary material

Dang et al. supplementary material 1

Download Dang et al. supplementary material(File)
File 100.2 KB
Supplementary material: File

Dang et al. supplementary material

Dang et al. supplementary material 2

Download Dang et al. supplementary material(File)
File 15 KB
Supplementary material: File

Dang et al. supplementary material

Dang et al. supplementary material 3

Download Dang et al. supplementary material(File)
File 13.8 KB
Supplementary material: File

Dang et al. supplementary material

Dang et al. supplementary material 4

Download Dang et al. supplementary material(File)
File 82.7 KB