Table 1.

Definitions

Highly infectious diseases

Highly infectious diseases (HIDs) are bacterial or viral infections characterized as (a) being easily transmissible from person-to-person; (b) causing life-threatening illness; and (c) presenting a serious hazard in healthcare settings and in the community, requiring specific control measures [1].

National regulations

National regulations are defined as laws and recommendations issued by either Ministries (e.g. Ministry of Health) or national institutions (e.g. for occupational health) that must be adhered to by hospitals included in the analysis.

Local protocols

Local protocols are defined as Standard Operation Procedures (SOPs) defining the operational management of HID transport within, to or from the respective isolation facility including clinical care, infection control, disinfection and team management en route. SOPs are written, regularly updated protocols and instructions covering operations, which lend themselves to a definite or standardized procedure without loss of effectiveness. SOPs should be accessible to all staff at any time-point to allow adherence to established procedures [1].

Specifically designed ambulance

Ground ambulances are defined as ‘specifically designed’ for the transportation of HID patients if the ambulance itself and any fixed equipment used can be effectively decontaminated (by wiping, spraying, or fogging with an effective disinfectant) according to national policy. Specific technical features on board may include controlled ventilation, negative pressure, HEPA filtration, intercom systems, aerosol tight storage containers and separation of driver's cabin from patient's cabin [1], [16], [17].

Reserved standard ambulance

Reserved ground ambulances for the transportation of HID patients are defined as standard ambulances without additional technical features (see above) but available on call when demanded. Reserved ground ambulances may have easy-to-decontaminate cabin walls and equipment. Strategies should be in place to protect both paramedics and drivers from infectious agents, including the availability of appropriate Personal Protective Equipment [16], [17].

Stretcher isolators

Stretcher isolators are defined as portable, self-containment isolation beds, generating negative pressure inside the patient's cabin/area and exhausting HEPA-filtered air (so called ‘Trexler isolators’) [30].