Long-Range Air Transportation for High-Consequence Infectious Diseases: Findings from a Global Tabletop Exercise on Patients with Viral Hemorrhagic Fever.

Objectives: Air medical services evacuation of patients with viral hemorrhagic fevers (VHFs) is a complex process. The United States National Emerging Special Pathogens Training and Education Center held an in-person tabletop exercise (TTX) in June 2023 to review and evaluate global processes and plans for long-range VHF air transportation capabilities. The TTX sought to test the coordination, prioritization, capacities, and plans for using VHF transportation capabilities when multiple countries simultaneously request support in air medical services evacuation of their sick or exposed citizens to a high-level isolation unit in their country for care.

Methods: Organizations invited to participate in the exercise (N = 16) were identified based on the TTX planning team's knowledge of their VHF transport capabilities. The TTX included a scenario involving a significant Sudan ebolavirus exposure event of an index case to 18 close contacts of diverse nationalities. Following the exercise, scribes' notes, evaluators' observations, and participant feedback forms were thematically analyzed to develop key findings and opportunities. The After Action Report was reviewed by all participants and finalized with their written approval.

Results: Representatives from 15 organizations in six countries participated in the TTX; the only organization unable to attend was the World Health Organization. Findings indicated many countries rely on the same organization for VHF air transportation resources that would be quickly exceeded in this scenario. There is a need to further define processes for determining global prioritization of transportation assets when requests exceed capacity.

Conclusions: Reliance on the same limited global transportation assets has implications for health security and limits the global response to multiple patients or individuals needing repatriation simultaneously. This indicates the importance of prioritizing resources, enhancing multinational coordination, and highlights the need to elevate these findings and discussions to national and international policy levels to increase air transportation resources and expand global capacity for managing patients with VHFs.