Easy assembly, complete sanitisation, safe transport, and improved patient breathing. How and why biocontainment transport is changing.

One topic that received a lot of attention during this REAS was biocontainment transport. It cannot be denied that in the past the attention of rescuers has been focused more on ambulances, and less on handling equipment, especially anti-covid equipment. This year, however, the focus was on the many interesting solutions proposed to provide patients and carers with greater safety and improved liveability in critical conditions. The 20 months of the Covid-19 pandemic have taught us that attention to personal protection and biocontainment is never enough, and device designs have improved, bringing several new features. Two lines of thought have been standardised throughout the world: the rigid cab transport system and the compact device transport system with a soft or semi-rigid cab.

Before going any further, an overview of the principles of biocontainment

Biocontainment can only be said to exist if the sick patient is transported in adequate isolation from start to finish. There is not just one action involved in applying biocontainment, but a series of actions to ensure the safety of the rescuers and the patients themselves. For this reason, we often speak of biocontainment areas: isolated zones where the air exhaled by the patient is filtered and purified before being released into a larger environment. This principle applies to airtight chambers in hospitals, medical compartments in ambulances, and stretchers. However, before we look at technical solutions to reduce these areas of isolation, we need to look at the fundamentals of this topic. To define a biocontainment transport there must be at least 5 main characteristics that must be guaranteed from the beginning of the transport until the end.

  • The patient must not contaminate the transport vehicle: the air he or she breathes must be 99.9% filtered;
  • He or she must be placed in the biocontainment chamber without loss of time;
  • The device must be 100% sanitised between transports;
  • It must not restrict the safety of patient transport;
  • It must not restrict the comfort of the patient;

Biocontainment levels and spaces to be cleaned

There are different levels of risk you may face when transporting Covid-19 patients: remember that the coronavirus is classified as risk level 3 (BLS-3, see this infographic), which is a pathogen that causes a high risk of airborne infection and can be fatal to humans. It is therefore important to ensure that all spaces where an infected patient has been are sanitised in the best possible way and in the shortest possible time. Rescuers who had to clean up vehicles during the pandemic know this well: disinfectants and other products used to clean the surfaces of the sanitary compartment often compromised the surface of the interior plastics, quickly leading to excessive wear and tear on the ambulances. It is therefore essential to minimise the amount of space to be decontaminated inside the ambulance because this is also the environment in which the rescuers move. In addition, the less air there is to clean, the better the filtration systems work, the less the rescuers are at risk.

The choice: rigid stretcher or semi-rigid stretcher?

Today the market is divided between two completely different solutions. Excluding the choice of airtight chambers, which are needed in hospital wards to isolate cases and patients, there are two alternatives: the rigid biocontainment stretcher, and the semi-rigid biocontainment stretcher. The fully soft systems (those in which the patient is put in and then placed on the stretcher) are good systems, but with one major defect: they are not locked according to EN1789. The differences are not only in the type of structure, but precisely in the concepts of loading, unloading and sanitisation of the transport system. Finally, the price is very different. This is why the shell system is designed for fixed-wing health services, while the semi-rigid system is designed for ambulances.


In the interview, the President of Anpas Nazionale and Medical Director of IRCCS Galeazzi in Milan, Prof. Fabrizio Pregliasco

The semi-rigid biocontainment according to EN1789

At REAS it was possible to see interesting models that are very well suited to the Italian market, where covid transport is not provided by dedicated ambulances but by various vehicles, often activated at short notice. Until now there were three unresolved problems: The position of the patient, the effectiveness of filtering and the safety of transport. Examples of biocontainment stretchers mounted on wooden pallets and then placed on stretchers are still circulating on the web. At REAS, on the contrary, we saw a device that solved all these problems. Ferno Italia, with the STBC, has taken a leap forward in biocontainment systems. Thanks to a rigid lower shell and a semi-rigid upper shell, the device can be transported on any stretcher without ever having to take the patient out of the protection system.

Patient health and safety during transport

The first major advantage of this device is that it complies with EN1789 for patient safety in terms of locking. The lower stretcher is equipped with a steel frame, which is attached to the stretcher being transported. There is no risk of tearing or injury in the event of an accident or sudden braking. The stretcher can be used without any difficulty on any transport stretcher, even without the upper biocontainment structure. Patient comfort is also high because – unlike many other devices – the STBC allows the patient to be placed in a semi-sitting position, thus reducing breathing problems for dyspnoea patients with poor blood oxygenation.

The health of rescuers during transport

The second major problem with soft biocontainment stretchers has always been access to the transport surface. Ferno, using side access with a sealed hinge, allows the patient to be loaded naturally. The air inside the device is filtered more than twenty times per hour, with negative pressure. Filtration safety is ensured in zero time because the volume of filtered air is considerably lower than in a rigid system, or in negative pressure systems inside the ambulance (where rescuers are still exposed to the biohazard). Finally, the STBC has a filtering system that cleans and analyses the air breathed by the patient, providing real-time data on the situation to rescuers and the operations centre.

Sanitisation and management of the medical device

Finally, the great advantage of the semi-rigid stretcher is its transportability. It is not necessary to install the Biocontainment Device on an ambulance before the start of the shift. Rigid systems are difficult to transport and store. A semi-rigid system can be stored in a few square centimeters, quickly installed on the transport stretcher, and quickly sanitised before being put back into storage. In addition, the adaptability of the device to any type of stretcher means that any emergency can be quickly resolved with a single device. Finally, it is worth noting the attention to the certifications and tests dedicated to the device. STBC in fact is a device compliant with EN 143:2007 – EU 2016/425 for the filtration of protective chambers, CE certified according to regulation 2017/745, biocompatible according to ISO 10993-5, and compliant with EN1789-2020 with regard to sealing in case of impacts exceeding 10G. With the STBC, it was therefore possible to see a device designed and built to transport infected patients safely and comfortably, without sacrificing comfort and safety to the filtration and biocontainment requirements that are essential to ensure the health of rescuers.

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