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CDC Plane Decreases Response Time, Increases Readiness

CDC’s goal of health protection for everyone is taking off—literally. The nation’s premiere health agency has leased a plane, to be ready to respond to any health threat, anywhere, anytime.

Recently, for example, the plane was used to pick up an emergency supply of botulism anti-toxin. Chris Braden, MD, a CDC medical epidemiologist, woke up one Saturday not knowing he’d be on his way to Thailand later that day. Within hours, he was on the CDC plane to northern California, to pick up the anti-toxin. He then flew to Los Angeles and connected with an international commercial flight to rush the much-needed medicine to Thailand, where there was a botulism outbreak.

The day before Braden’s emergency flight, the World Health Organization (WHO) received reports of a possible outbreak of botulism in northern Thailand among guests at a festival who had eaten pickled bamboo shoots. Although anti-toxin for the treatment of botulism is only available in some countries, WHO was able to ensure delivery of anti-toxin to Thailand the following day. CDC helped provide 50 doses of anti-toxin.

Dedicated Aircraft Provides Rapid Response in Public Health Missions

Congress has authorized CDC to hire, operate and maintain an aircraft for such specialized circumstances.

The plane moves specimens and personnel and performs medical evacuations, says Chief Operating Officer Bill Gimson. "One of CDC’s primary missions is to rapidly respond to worldwide public health emergencies. This requires a dedicated emergency public health mission aircraft that can be anywhere in the world in less than 24 hours."

"In times of crisis or public health threat, the immediate availability of an aircraft could actually mean life or death. This measure is one of a series of measures taken by CDC after September 11, 2001, to ensure the agency's readiness and improve its overall response capabilities,” explains Toby Crafton, Lead Emergency Response Specialist.

"Time is a critical factor in our ability to respond to a public health emergency effectively,” Gimson agrees. 'CDC depends heavily on the rapid transport of personnel and the ability to analyze samples and specimens during the early hours of a potential outbreak or emergency. Use of such a plane helps CDC personnel accomplish their mission with even greater speed and efficiency.”

Aircraft Moves Critical Samples, Key Personnel

The plane can do more than speed samples to labs. It can also fly emergency personnel to an event within hours to perform a special needs assessment, collect samples, and triage resources to manage the situation. And it can shuttle staff sent in harm’s way to safety.

The need for an airplane is crucial during health emergencies. Effective early outbreak intervention requires a 24- to 48-hour turnaround. The ability to obtain infectious specimens early in the outbreak of a disease is critical. Unfortunately, commercial aircraft cannot guarantee the job will get done in the time needed.

"International clearances, paperwork required to ship specimens, and availability of a commercial carrier all contribute to delays and sometimes failed receipt of specimens,” explains Crafton. "SARS specimen shipments often took as long as 72-96 hours to arrive at CDC.”

That’s understandable as commercial carrier rules often prohibit timely intervention. Most delays have been a result of rules and regulations that, for the public’s safety, prohibit or restrict the movement of hazardous and infectious materials. Commercial airlines are not always appropriate for the necessary response. Seats may not be available, flights may be cancelled and people or materials may arrive late. And communications are restricted on commercial carriers. The CDC staff needs to maintain constant, secure contact to deal with developing health situations.

"Placing key CDC personnel on the ground early in the discovery of an outbreak provides a direct connection with the outbreak and all of CDC’s resources,” says Crafton. "This can be the difference between an early intervention and therefore a manageable outbreak or an outbreak which extends beyond desirable parameters. Commercial airline schedules cannot guarantee that CDC personnel will be deployed anytime and anyplace on a moments notice.”

Rules Restrict Use of Plane

A policy outlines CDC/federal requirements to travel aboard or use government aircraft—and an aircraft leased by a government agency is considered a government aircraft. The aircraft can be dispatched only for official use. Without going into the entire federal definition, it means CDC will use the aircraft for mission requirements, such as transporting a sampling team or specimens, or other official travel, such as agency business, typically only after a favorable comparison with the cost of commercial travel.

The Aircraft and Anthrax

Jay Gee, PhD, a research biologist, served as a subject matter expert on the environmental survey team that responded to the February 2006 case of inhalational anthrax in Pennsylvania/New York City. "We went to the index case's worksite, apartment, and one of his friend's apartments, to determine if they were contaminated with anthrax spores."

"The dedicated plane was invaluable considering the need to get onsite quickly to survey the areas," says Gee. "The ability to carry specialized equipment safely in the plane was also helpful since on a commercial airline there is the risk of boxes ending up as lost or misplaced baggage, which would delay the ability to investigate the outbreak. Because of the privacy afforded by the plane, we were able to get a full briefing during the flight whereas on a commercial flight it would not be appropriate to talk about the details of the investigation since it may alarm other passengers. It was also expedient to fly the samples back to CDC for rapid processing as soon as the samples were collected instead of waiting for the next commercial flight or relying on a shipping company."

"After our plane touched down at the airport in Newark, we were given a high-speed police escorted ride to the NYPD/FBI joint operations center with lights flashing and sirens blaring," continues Gee. "The NYPD escorted us during the entire investigation and were very helpful and gracious, even when the work went to 4 a.m. into the morning. At one point, they took us by the World Trade Center site since it was between worksites. I was humbled by the sight. It was a privilege to work with the NYPD, FBI, and the NY Deptartment of Health."

Richard F Meyer, PhD, Director, Bioterrorism Rapid Response, Advanced Technology Laboratory, was involved in the anthrax investigations in 2001 and in New York in 2006. "The advantage of the plane is bringing back diagnostic samples and specimens immediately for immediate laboratory analysis. The CDC plane and awaiting local police escorts with sirens blasting brings the fictional movies we watch about public health response to reality."

Mumps and More

Fatma A. Soud, PhD, Epidemic Intelligence Service Officer, traveled to Topeka, Kansas, for the mumps outbreak. "I was among six of the CDC team. My duties were to assist with the epidemiologic investigation and assist with infection control. I did an isolation compliance study among college students at the University of Kansas college campus. It was more cost effective in using the CDC plane than a commercial carrier for the six of us at such a short notice. We were able to get there faster, plus conduct a meeting while enroute covering the logistics for the studies that needed to be conducted."

"I have transported several clinical samples and medicines in emergency situations on the CDC plane," says emergency response specialist Gary Goolsby. "It’s reassuring to know that CDC personnel can be airborne within two hours, 24/7/365. The plane can land at airports that large commercial jets cannot." Goolsby has been involved in missions concerning rabies and Marburgvirus, among others.

Able to Hurry for Hurricane Response

Staff that assisted with Hurricane Katrina relief efforts are enthusiastic about the plane, and its value in public health missions.

Paul Giannone, International Emergency and Refugee Health Branch, was supporting the county and city health departments in Houston, Texas. "Four advance 3-person teams were put on the CDC jet. This option gave the lead teams the ability to rapidly move to our designated sites and give immediate support to our counterparts as well as set the stage for the larger team that followed. It would have taken at least another 12-18 hours to set up this trip through commercial carriers. The plane also gave us an excellent undisturbed work and communications platform that would not have been possible on a commercial jet."

Judith Aguilar, Acting Director, Division of Health Information Dissemination, was deployed to Katrina with a team headed by Henry Falk, MD. They were sent to look at the issues that needed to be addressed prior to the mayor allowing people back into New Orleans. "My role on this team was a managerial and organizational and involved areas in our report including roads, power, and gas status," she explains. It would have been extremely difficult to perform that task without the plane. "There were no flights into New Orleans at the time. In addition due to the superb job that the CDC Director’s Emergency Operations Center does in preparing us to handle anything in the field under those circumstances, we had a lot of gear including backpacks, tents, sleeping bags, etc. that would have been difficult to ship through normal airlines without risk of loss in a critical circumstance."

"The speed with which you can depart and skip all the wasted time through security at the airports really allows you to get to the deployment site much more rapidly and especially in circumstances like Katrina where commercial aircraft are not available," Aguilar adds.

Joshua E. Hardin, RN, Office of Reserve Affairs, Office of the Surgeon General, was on a rapid deployment force to Hurricane Katrina as a clinical nurse. "This private plane allowed us to fly into an area where commercial flights had stopped going," he says.

Nursing informatics specialist Alicia Bradford MS, RN, BC (U.S. Public Health Service), Department of Health and Human Services, Office of the National Coordinator for Health, Information Technology, adds, " Since the whole plane was dedicated to Public Health Service officers we actually had time aboard the plane to meet each other and begin mission planning. Also, the plane was able to leave when we were ready."

David Kim, medical epidemiologist, says he was a clinician, epidemiologist, and "water boy" in the hurricane response in Louisiana. "I was on the first Commissioned Corps team that was deployed or propositioned before the hurricane made landfall. The CDC plane made it possible (as commercial air travel was not available) for the team members from CDC to join up with other team members from the DC area. Even during the brief wait in the terminal and short ride on the plane, the CDC contingent was able to bond because we rode together."

"The use if the CDC sponsored planes was critical to the placement of the Alpha Team prior to the landfall of the storm," says Charles L. McGarvey, Team Leader: Team Alpha Chief, Physical Therapy, U.S. Public Health Service. "Other officers arrived a full three to four days following our arrival which may have been a little late in what was needed by the LSU community in establishing the Federal Medical Facility at the basketball arena."

Valerie Jensen, pharmacist, was part of a pre-staged team sent before the hurricane. "We flew from Dulles to Jackson, Mississippi, the day before Hurricane Katrina hit and we rode out the storm in Jackson before receiving our mission assignment which was to set up the field hospital in the PMAC (LSU basketball arena) in Baton Rouge for Katrina evacuees who needed medical care."

"The advantage of using the CDC plane for our mission is that it got us quickly where we needed to be right before hurricane Katrina hit the Gulf," Jensen explains. "We were then able to quickly do what needed to be done right after the storm to get a field hospital set up and deliver medical care to those affected by the hurricane. Our team of 38 officers was able to start up our field facility at a critical time, right after the hurricane. We had a very successful mission due in part to the fact that the plane got us there when we were needed."

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