» Life Flight deploys robot to sanitize.
Hospital air transport program looks to lead industry with cutting-edge virus protocols
Tom Flanagan spent early March anticipating a dispatch call that he knew would change everything.
When public health officials began identifying community spread in the Houston area, the director of Memorial Hermann Life Flight knew his team would be assigned to transport patients diagnosed with COVID-19. And he wanted to be prepared for anything.
This moment was what tabletop exercises were created for; no other hospital helicopter programs had protocol designed for an outbreak like the novel coronavirus, he said. As the state’s first hospital air transport program, Flanagan knew that others would look to Life Flight for guidance in the burgeoning pandemic.
He pulled together Life Flight medical director Dr. Lesley Osborne, UTHealth epidemiologist Dr. Luis Ostrosky and Brandy Ferguson with the hospital’s emergency management team, as well as the chief flight nurse and chief pilot, to devise a plan.
The plan would keep the flight crew — a nurse, emergency medical technician and pilot — safe while transporting the patient and create a sanitation plan for both the aircraft and everyone inside of it.
In 48 hours, they had a working procedure to dedicate one helicopter in the sixchopper fleet to coronavirus patients, Flanagan said.
This particular helicopter
will remain a 24/7 coronavirus-only aircraft for the foreseeable future, he added.
“Life Flight has always been a pioneer program that sets standards for other programs,” Ostrosky said. “We’re publishing our procedure pretty soon and will be able to share with other programs.”
The helicopter’s equipment was pared down to the absolute essential, Ostrosky said. Anything extraneous that could harbor the virus was removed.
The flight crew has transitioned from wearing flight suits to scrubs, plastic gloves and N-95 face masks for extra safety. Afterward, they shed their scrubs and wash in a decontamination room.
“We told the crew that anyone who was not comfortable with moving on these missions to just let us know,” Flanagan said. “The majority of the team was fine with it. We did some training and have minimized it to one helicopter and one crew a shift. It’s a control group — very specific and intentional.”
Ostrosky, an expert in infectious disease, researched Centers for Disease Control and Prevention protocols for the SARS outbreak in 2003. The rules were updated to fit modern technology and tools as well as the specifics on what makes COVID-19 so infectious. Send in the robot
Cleanliness is a top priority. After each flight, the helicopter is cleaned with a water and bleach solution, and the cloth barrier curtain between the cockpit and the patient area is removed, Flanagan explained.
The crew then initiates its ultraviolet light sanitation robot.
In the hospital, the tubular robot rests on a set of wheels and stands about as tall as a third-grader. But inside the confined space of an aircraft, two crew members hoist the 40-pound clear cylinder from its base.
“It’s pretty heavy, actually,” said Christopher Oliver, a flight nurse.
Crew members place the robot where a patient would be, in the center behind the cockpit’s dividing curtain, before shutting the doors and windows.
Then comes the light show.
Oliver and his colleagues use a WiFi remote to activate the robot, which emits an ocean-blue light as it examines the crevices of the aircraft for evidence of coronavirus. The light blinks on for minutes as it cleans using radioactive UV rays, then blinks off to detect more rogue bacteria. The light doesn’t penetrate glass or plastic, but the crew is quick to seal all the helicopter’s openings as the robot works methodically for 20 to 30 minutes — sending an “allclear” to the handheld device when it’s done.
The crew reopens the helicopter, performs another 40-pound lift, and places the robot back on its wheels for the walk back to the hospital’s decontamination area.
Ultraviolet technology is relatively new in health care settings, Ostrosky said. Coincidentally, the hospital had ordered two sanitation robots months before they were faced with COVID-19.
Flanagan said the hospital had used similar cleaning robots in its operating rooms to disinfect before and after surgeries, and he wondered how they could be used in Life Flight.
“I knew how it worked, but I didn’t know if it would work in an aircraft,” Flanagan said. “I reached out to the manufacturer and vendor (Sky Tron) and found that it did work. So we purchased two.”
The old way of doing things is gone, he said, and that includes how patients are transported between hospitals, coronavirus or not.
On non-COVID-19 calls, every person picked up by a Life Flight aircraft has their temperature taken and is masked for protection.
“This will change the world we know; everyone is trying to figure out what will be the new norm, how to open back up and start moving forward,” Flanagan said. “We want to continue to be a beacon for (emergency medical services) and other hospitals when they need air-medical transport.” ‘Valuable resource’
So far, the COVID-19 aircraft has transported about 15 patients from Memorial Hermann facilities to the main Memorial Hermann campus in the Texas Medical Center. Soon, it will begin moving patients to Houston Methodist, said Joshua Cools, business development liaison for the service.
Life Flight serves a 150mile radius around Houston and makes daily trips to the Beaumont-Port Arthur area to pick up critical patients.
“I think this is a very valuable resource because we can assure that patients in remote and rural areas are going to be able to access the highest level of health care,” Ostrosky said. “We’ve seen in this epidemic the inequalities in rural and urban areas — a disparity according to race and ethnicity. We hope that programs that like this will bring state-of-the-art care to remote communities.”