The Aeromedical Isolation Team (AIT, or SMART-AIT) of the US Army Medical Research Institute of Infectious Diseases (USAMRIID) at

Fort Detrick, Maryland Fort Detrick () is a United States Army Futures Command installation located in Frederick, Maryland. Historically, Fort Detrick was the center of the U.S. biological weapons program from 1943 to 1969. Since the discontinuation of that program, it ...

was a military

rapid response team A rapid response team (RRT), also known as a medical emergency team (MET) and high acuity response team (HART), is a team of health care providers that responds to hospitalized patients with early signs of deterioration on non-intensive care units ...

with worldwide airlift capability designed to safely evacuate and manage contagious patients under high-level ( BSL-4)

bio-containment One use of the concept of biocontainment is related to laboratory biosafety and pertains to microbiology laboratories in which the physical containment of pathogenic organisms or agents (bacteria, viruses, and toxins) is required, usually by is ...

conditions. Created in 1978, during its final years the AIT was one of

MEDCOM The U.S. Army Medical Command (MEDCOM) is a direct reporting unit of the U.S. Army that formerly provided command and control of the Army's fixed-facility medical, dental, and veterinary treatment facilities, providing preventive care, medical ...

’s Special Medical Augmentation Response Teams (SMART teams) comprising a portable containment laboratory along with its transit isolators for patient transport. Contingency missions included

bioterrorism Bioterrorism is terrorism involving the intentional release or dissemination of biological agents. These agents are bacteria, viruses, insects, fungi, and/or toxins, and may be in a naturally occurring or a human-modified form, in much the sa ...

scenarios as well as the extraction of scientists with exotic infections from remote sites in foreign countries. The AIT trained continuously and was often put on alert status, but only deployed for “real world” missions four times. The AIT was decommissioned in 2010 and its mission was assumed by one of the

US Air Force The United States Air Force (USAF) is the Aerial warfare, air military branch, service branch of the United States Armed Forces, and is one of the eight uniformed services of the United States. Originally created on 1 August 1907, as a part ...

’s

Critical Care Air Transport Team The Critical Care Air Transport Team (CCATT) concept dates from 1988, when Col. P.K. Carlton and Maj. J. Chris Farmer originated the development of this program while stationed at U.S. Air Force Hospital Scott, Scott Air Force Base, Illinois. Dr ...

s (CCATTs).

History

The AIT was created in 1978 for purposes of contingency air evacuation of a hypothetical USAMRIID researcher who might become exposed to a highly infectious

pathogen In biology, a pathogen ( el, πάθος, "suffering", "passion" and , "producer of") in the oldest and broadest sense, is any organism or agent that can produce disease. A pathogen may also be referred to as an infectious agent, or simply a ger ...

while undertaking endemic surveillance in remote areas of the world where a suspected or known disease outbreak was occurring. At the core of AIT operations was its specialized equipment, notably the Aircraft Transit Isolator (ATI). Developed by

Vickers Vickers was a British engineering company that existed from 1828 until 1999. It was formed in Sheffield as a steel foundry by Edward Vickers and his father-in-law, and soon became famous for casting church bells. The company went public in ...

in the U.K. in the 1970s — and manufactured in later years by Elwyn Roberts Isolators,

Shropshire Shropshire (; alternatively Salop; abbreviated in print only as Shrops; demonym Salopian ) is a landlocked historic county in the West Midlands region of England. It is bordered by Wales to the west and the English counties of Cheshire to ...

, UK, until 2007 — the ATI was a self-contained unit capable of transporting a patient with a highly virulent disease and at the same time providing maximum microbiological security while full nursing care and treatment are rendered. It was designed to minimize the risk of transmission to air crews and caregivers, whether military or civilian. The interior of the isolator was maintained at a pressure negative to the external environment by a

high-efficiency particulate air HEPA (, high-efficiency particulate air) filter, also known as high-efficiency particulate absorbing filter and high-efficiency particulate arrestance filter, is an efficiency standard of air filters. Filters meeting the HEPA standard must s ...

(HEPA) filtered blower. The isolator could be attached directly to a transfer port, situated on the external wall of the main USAMRIID building, to allow movement of the patient into a BSL-4 medical care suite without exposing the environment to the patient. While moving the isolator, team members wore protective suits and positive-pressure, HEPA-filtered Racal hoods (manufactured by Racal Health & Safety, Inc,

Frederick, Maryland Frederick is a city in and the county seat of Frederick County, Maryland. It is part of the Baltimore–Washington metropolitan area, Baltimore–Washington Metropolitan Area. Frederick has long been an important crossroads, located at the inter ...

). Throughout its existence the AIT was associated with a BSL-4 Medical Containment Suite (MCS, called “the Slammer”) at USAMRIID for

ICU ICU commonly refers to: * Intensive care unit, a special department of a hospital ICU may also refer to: Organisations Universities * Information and Communications University, South Korea *Istanbul Commerce University, Istanbul, Turkey * Intern ...

-level patient care under biocontainment. The MCS was built in 1969 and became operational in 1972; it was the destination to which contagious patients were to be removed by the AIT. Over the years the scope of the AIT/MCS mission was expanded to include U.S. military personnel, the U.S.

Centers for Disease Control and Prevention The Centers for Disease Control and Prevention (CDC) is the national public health agency of the United States. It is a United States federal agency, under the Department of Health and Human Services, and is headquartered in Atlanta, Georg ...

, and U.S. citizens or foreign nationals deemed to be in need of service by the

U.S. Department of State The United States Department of State (DOS), or State Department, is an executive department of the U.S. federal government responsible for the country's foreign policy and relations. Equivalent to the ministry of foreign affairs of other natio ...

. Occasionally, the AIT trained with similar teams of foreign allies. In 2007, due to the death of Mr Roberts, the ATI and associated products ceased to be manufactured. During 2008-2010, the AIT began preliminary training with, and testing of, a new transit isolator product — the

Patient Isolation Unit A patient is any recipient of health care services that are performed by healthcare professionals. The patient is most often ill or injured and in need of treatment by a physician, nurse, optometrist, dentist, veterinarian, or other health care ...

(PIU) — developed by the Gentex Corporation under a contract with the U.S. Air Force. The AIT was decommissioned — along with the MCS — in 2010 and its mission was assumed by one of the

’s

s (CCATTs). The Air Force's capabilities, however, do not meet the standard of biocontainment (BSL-4) facilities, but rather represent enhanced

patient isolation In health care facilities, isolation represents one of several measures that can be taken to implement in infection control: the prevention of communicable diseases from being transmitted from a patient to other patients, health care workers, ...

. No BSL-4 ICU facility has replaced the Army's former MCS to date.

Selected AIT alerts and deployments

*Deployed to Reston, Virginia, Ebola outbreak, 1989 *Deployed to Sweden in support of

Marburg virus Marburg virus (MARV) is a hemorrhagic fever virus of the '' Filoviridae'' family of viruses and a member of the species ''Marburg marburgvirus'', genus ''Marburgvirus''. It causes Marburg virus disease in primates, a form of viral hemorrhagic ...

patient management, 1989Covert, Norman M. (1993), ''Cutting Edge: A History of Fort Detrick, Maryland, 1943-1993'', Headquarters, U.S. Army Garrison, Fort Detrick, Maryland, pg 81. *Alerted for Ebola outbreak in

Zaire Zaire (, ), officially the Republic of Zaire (french: République du Zaïre, link=no, ), was a Congolese state from 1971 to 1997 in Central Africa that was previously and is now again known as the Democratic Republic of the Congo. Zaire was, ...

, 1993 *On call for

Yale Yale University is a private research university in New Haven, Connecticut. Established in 1701 as the Collegiate School, it is the third-oldest institution of higher education in the United States and among the most prestigious in the wo ...

researcher with

Sabia virus Brazilian hemorrhagic fever (BzHF) is an infectious disease caused by ''Brazilian mammarenavirus'', an arenavirus. ''Brazilian mammarenavirus'' is one of the arenaviruses from South America to cause hemorrhagic fever. It shares a common progenit ...

exposure, 1994 *Alerted for military physician

Machupo virus Bolivian hemorrhagic fever (BHF), also known as black typhus or Ordog Fever, is a hemorrhagic fever and zoonotic infectious disease originating in Bolivia after infection by ''Machupo mammarenavirus''.Public Health Agency of Canada: ''Machupo Vir ...

exposure, 1994 *Alert for Ebola, Zaire outbreak, 1995 *Deployed to

Wright-Patterson AFB Wright-Patterson Air Force Base (WPAFB) is a United States Air Force base and census-designated place just east of Dayton, Ohio, in Greene and Montgomery counties. It includes both Wright and Patterson Fields, which were originally Wilbu ...

, Bio-bomblets, Dec 1995 *Alerted for deployment to Rwanda/Zaire 1996 *NYC,

Bronx Zoo The Bronx Zoo (also historically the Bronx Zoological Park and the Bronx Zoological Gardens) is a zoo within Bronx Park in the Bronx, New York. It is one of the largest zoos in the United States by area and is the largest metropolitan zoo in ...

West Nile virus West Nile virus (WNV) is a single-stranded RNA virus that causes West Nile fever. It is a member of the family ''Flaviviridae'', from the genus ''Flavivirus'', which also contains the Zika virus, dengue virus, and yellow fever virus. The virus ...

, Oct 1999 *Alerted to support with possible Ebola exposure in

Uganda }), is a landlocked country in East Africa. The country is bordered to the east by Kenya, to the north by South Sudan, to the west by the Democratic Republic of the Congo, to the south-west by Rwanda, and to the south by Tanzania. The south ...

, Dec 2000 *Alerted for support with anthrax mailings, 2001 *Alerted to support WTC attacks, 2001 *On orders to support the Presidential State of the Union Address, 30 January 2002 *On orders to support the Winter Olympics, 17 January to 20 March 2002 *Advisors for SARS outbreak, 2003 *Alerted for

XDR-TB Extensively drug-resistant tuberculosis (XDR-TB) is a form of tuberculosis caused by bacteria that are resistant to some of the most effective anti-TB drugs. XDR-TB strains have arisen after the mismanagement of individuals with multidrug-resis ...

patient, May 2007 *Alerted for

Viral hemorrhagic fever Viral hemorrhagic fevers (VHFs) are a diverse group of animal and human illnesses in which fever and hemorrhage are caused by a viral infection. VHFs may be caused by five distinct families of RNA viruses: the families ''Filoviridae'', ''Flavi ...

outbreak in Congo, Aug 2007

References

{{U.S. biological defense Emergency medical responders Military medical organizations of the United States Biological hazards Intensive care medicine Medical units and formations of the United States Army Emergency medicine Air ambulance services in the United States Military medicine in the United States Aviation medicine 1978 establishments in Maryland 2010 disestablishments in Maryland Fort Detrick

History

Selected AIT alerts and deployments

See also

References