From Runway to ICU: The Critical Role of Air Transport in Special Pathogen Care

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When a patient with a high-consequence infectious disease (HCID) needs advanced care, distance and logistics cannot be barriers. Behind the scenes, a highly coordinated system of air and ground transport teams works to safely move patients from some of the most challenging environments in the world to specialized treatment centers in the United States.

In the latest episode of Transmission Interrupted, leaders in air medical transport, EMS, and healthcare preparedness—many of whom were directly involved in the 2014 Ebola response—share what it takes to move patients safely from runway to ICU.

Built on Experience: Lessons from the 2014 Ebola Response

The 2014–2016 Ebola outbreak in West Africa marked a turning point in global health preparedness. For the first time, patients with Ebola virus disease were transported internationally to specialized treatment centers in the United States and Europe.

These missions required unprecedented coordination between federal agencies, private air transport teams, healthcare systems, and EMS providers. Organizations like Phoenix Air Group developed and deployed innovative containment systems, while institutions such as Emory University Hospital and Nebraska Medicine activated specialized biocontainment units to receive and treat patients.

Many of the professionals involved in those early transports helped shape the protocols, training programs, and systems that are still in use today. What began as an urgent, rapidly evolving response has since become the foundation for a more coordinated national approach to special pathogen care.

Bringing the ICU to the Aircraft

One of the most remarkable advancements to come out of these efforts is the ability to deliver ICU-level care during flight.

Using specialized systems like the Airborne Biological Containment System (ABCS), transport teams can:

• Maintain negative pressure environments
• Filter air through HEPA systems
• Operate ventilators, IV pumps, and monitors
• Provide full patient access for assessment and intervention

All of this takes place in a confined, high-risk environment, with clinicians working in full personal protective equipment under physically demanding conditions.

This is not simply transportation—it is mobile critical care under some of the most extreme circumstances in healthcare.

The Power of Coordination

Air transport is only one piece of a much larger system. Safe and effective patient movement depends on seamless coordination between air crews, EMS teams, hospitals, and public health partners.

Ground teams must be prepared to:

• Receive patients safely from aircraft
• Adapt to unexpected challenges during transfer
• Transport patients securely to specialized treatment units

In many cases, these operations unfold under intense public and media attention, adding another layer of complexity. Success depends on clear communication, defined roles, and strong pre-existing relationships between partners.

Preparing for the Unpredictable

Even with detailed protocols in place, no plan can account for every possible scenario. Real-world operations require teams to think critically, adapt quickly, and rely on their training in the moment.

Preparedness depends on:

• Repeated training and exercises
• Strong situational awareness and risk assessment
• The ability to make informed decisions under pressure

Rather than relying solely on written procedures, successful teams build the skills and confidence needed to respond when conditions change.

Why This Matters Now

As global travel increases and large-scale international events bring people from around the world together, the need for a coordinated national system of care is more important than ever.

The National Special Pathogen System (NSPS) builds on lessons learned from past outbreaks to ensure that:

• Patients can access high-quality care regardless of location
• Healthcare workers are protected
• Systems are ready to scale during emergencies

Transport—whether by air or ground—is a critical link in that system.

Moving Forward

The ability to safely transport patients with high-consequence infectious diseases represents a major advancement in healthcare preparedness. But it requires sustained effort.

Ongoing success depends on:

• Continued investment in training and education
• Strong partnerships across healthcare, EMS, and public health
• Maintaining readiness even between events

At its core, the mission remains clear: deliver high-quality, compassionate care while ensuring the safety of the healthcare workforce.

Listen to the full episode of Transmission Interrupted: “From Runway to ICU: The Role of Air Transport in HCID Patient Care” to hear these stories firsthand.