December 12, 2014

Care and safety of personnel responding to the Ebola epidemic is of paramount concern.  From personal protective equipment (PPE) to medical treatment and medical evacuation (MEDEVAC) we are exploring every avenue to ensure the care and safety of responders.  All G-7 countries, including the United States, publicly acknowledged this in a joint statement issued 25 September.

A look inside the 25-bed critical care hospital for all Ebola health care workers in Liberia

Morgana Wingard for USAID

The United States has built a high quality 25-bed hospital in Monrovia (the “Monrovia Medical Unit”, or “MMU”), staffed by licensed physicians and other health care professionals from the U.S. Public Health Service Commissioned Corps. This facility provides Ebola care with the priority given to Liberian and international health care workers and the international UN and NGO staff supporting those efforts. Health care workers include nurses, physician assistants, physicians, epidemiologists, contact tracers, phlebotomists and laboratory staff, persons manning safe burial teams, and those working in ETUs for cleaning, disinfecting and decontaminating areas and items that may put them at high risk of infection with Ebola.

In addition to providing a high-level of care in Liberia, the Department of State has entered into a commercial contract that provides the capability to evacuate up to four patients requiring biocontainment per week based on suspected or confirmed Ebola Virus Disease (EVD), if medically necessary, and on a reimbursable basis.  This capacity has so far met the demand for EVD medical evacuation from West Africa; we expect to add a second MEDEVAC aircraft by early November. 

The Department of State may make this MEDEVAC service available on a reimbursable basis to International Organizations, to partner foreign governments, to private voluntary organizations registered with and approved by USAID, and to the American Red Cross.   There must be a signed binding agreement in place with the Department of State prior to this service being made available.  Signatories to the reimbursable agreements must ensure that all hospital arrangements have been made to receive the patient and that local and national public health officials have been notified and are prepared to support the evacuation mission without delay upon arrival of the medical evacuation aircraft at all stops up to and including the final destination airport.  In addition, signatories must affirm that all security, customs and civil aviation arrangements have been finalized in the destination country and that permissions for overflight and technical stops along the designated flight route have been coordinated.

In addition, private U.S. citizens may be eligible for evacuation as well.  U.S. law authorizes the State Department to evacuate private U.S. citizens "on a reimbursable basis to the maximum extent practicable.”  This means that evacuation costs are ultimately the evacuee’s responsibility.  Evacuees will be asked to sign a form promising to repay the U.S. Government. 

Any non-U.S. national can only be evacuated with the sponsorship of either their own country or their sponsoring organization upon completion of a contract with the U.S. Department of State. 

USAID worked with the European community and the World Health Organization to establish a global coordination facility at the WHO. This facility can assist with the logistic requirements of international medevac.

Evacuees, or their NGOs or employers, must make arrangements for admission to an appropriate hospital facility as part of their medical evacuation plan.  They should also consider how much of the evacuation, and hospitalization and treatment costs, are covered by their existing medical insurance, whether supplemental insurance is available, and any other costs that would need to be covered by the individual, NGO or employer.  They may also be asked to also ensure that there are funds available to meet any costs not covered by insurance.

The cost of evacuating a patient with EVD is high and likely to exceed international MEDEVAC insurance coverage.  To help encourage NGO workers to join the fight against Ebola, the Paul G. Allen Family Foundation with the assistance of USAID and the WHO has established a mechanism to help defray the non-covered costs of evacuation for international personnel responding to the Ebola epidemic who become infected, when the cost of evacuation would exceed insurance or employer-covered amounts.