Transporting Patient with Suspected SARS

To the Editor: The severe acute respiratory syndrome (SARS) outbreak in Taiwan can be traced back to a Taiwanese businessman who returned from mainland China to Taiwan in March 2003 (1). In May 2003, several outer islands belonging to Taiwan reported SARS, and on June 2, 2003, Penghu Army Hospital reported a 40-year-old man with suspected SARS. The patient complained of shortness of breath and a dry cough. He had visited a person with confirmed SARS 7 days earlier. He had a temperature of 38.4°C and leukocyte count of 7,920 cells/µL, and his chest x-ray showed infiltration in both lower lobes. Because medical facilities are limited on these islands, the Department of Health authorized the National Aeromedical Consultation Center (NACC), a physician-based 24-hour control center that coordinates all aeromedical transport of critically ill or injured patients within Taiwan, to coordinate transporting these patients to designated SARS hospitals in Taipei. The NACC dispatched an aircraft (Fokker 50) with a specialized team of two flight physicians, one flight paramedic, and a PIU (portable isolation unit) on board. During the flight, the medical crew prepared equipment and dressed themselves in three layers of personal protective equipment. On arrival at Penghu, only essential equipment was taken into the hospital. One physician took the PIU into the isolation room. The rest of the crew and equipment remained in the pre-isolation room. The patient was briefed about the transport and given 10 mg of metoclopramide to prevent motion sickness. He was asked to get into the PIU. A pulse oximeter was attached to his finger and placed inside the PIU so that it could be read from the outside. A ther-mohydrometer was also placed inside the unit. The patient was given a squeeze-bottle of water, and the unit was sealed and inflated. When leaving the pre-isolation room, the physician and the PIU were sprayed with a sodium hypochloride solution before the first layer of personal protective equipment was removed. At the exit, the entire medical crew removed a layer of personal protective equipment after being sprayed with sodium hypochloride solution. The team returned to the airport for the flight back to Taiwan. No other personnel or family member was allowed to accompany the patient on the flight. The patient remained stable and calm throughout the flight. His oxygen saturation remained 97%–99% with heart rate of 90 to 100 beats per minute. Humidity was maintained at 60% …