Table 1 Decision support framework

Selection of patients for transport

Regional risk assessment

Vehicle availability. Availability of alternative platforms.

Risk of occupational infection on different platforms.

HEMS continuity and the impact of suspending HEMS/aeromedical services and redeploying staff.

Planned management of patients without COVID-19 symptoms

Infection control strategies

PPE

PPE supplies

PPE training (including aircrew)

PPE compatibility with aviation safety and communications equipment

PPE compatibility with working environment (eg heat stress, visibility)

Minimise exposure: people

Protecting the flight crew from patient contact (screens, no patient handling)

Reducing flight crew numbers

Aligning medical/aviation shift patterns to avoid exposure of multiple crews

Minimise exposure: equipment

Removal of extra medical/rescue equipment

Removal of some aviation safety gear

Packaging equipment in wipe-down packaging

Choosing a route through the hospital to minimise cross-contamination

At the hospital

Accessing the patient

Time and place for handover and donning PPE

Need for extra staff on ground (e.g. a runner in clean PPE to open doors/operate lifts)

Intubation

Logistics of performing intubation in PPE

Policy for use of PPE during the intubation of non-COVID-19 patients during pandemic COVID-19

Packaging

How to package the patient to reduce their infectivity

At mission completion

Waste disposal

Management of increased clinical waste

Sorting of waste to minimise clinical waste

Decontamination

Suitable aircraft cleaning products, and their availability

Where and by whom the aircraft will be cleaned

Follow-up

Management of PPE breaches

Management of exposed or symptomatic staff

In the community

Base living

Modifications to cleaning schedule

Minimising staff on base

Maintaining morale

Social distancing off-duty