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Operation Tranquil Shift team members lift simulated patients into the containerized biocontainment system outfitted aircraft on April 17, 2017. The medical evacuation exercise in Freetown, Sierra Leone, was prompted by the 2014 Ebola outbreak in West Africa. (U.S. Department of State photo)

The deadliest Ebola epidemic on record killed more than 13,000 people, mostly in Liberia, Guinea, and Sierra Leone.

It was a wake-up call about the need for a safe, effective, and efficient way to move patients with infectious diseases to overseas locations for treatment.

In April, Sierra Leone’s Lungi International Airport was the host site for the evacuation of 11 mock patients – no small feat – during Exercise Tranquil Shift, the largest overseas biocontainment exercise ever conducted by the U.S. Department of State, in partnership with six U.S. government agencies. This exercise was a testament to the lessons learned and the changes made in the aftermath of the Ebola outbreak in 2014.

“This is about the Middle East respiratory syndrome coronavirus, MERS-CoV, in Qatar, with outbreaks every month for the past several months; Lassa fever in Benin, Togo, and Burkina Faso from February of this year; plague in Madagascar in December of last year,” said Dr. William A. Walters, the U.S. Department of State’s Managing Director for Operational Medicine, about the exercise.

“Infectious disease outbreaks happen all the time. They’re usually contained, largely to the efforts of local health systems augmented by international health responders. The United States government has a responsibility globally and to its citizens to continue to support those ongoing efforts to prevent catastrophe in the future.”

Prior to the exercise, Sean Nedd, the Diplomatic Security Service regional security officer at the U.S. Embassy in Freetown, Sierra Leone, held meetings with the local police force to discuss what would occur should an actual operation occur. He emphasized that communication and traffic control would be key in the event of a medical evacuation.

“The Lungi Airport is located outside of Freetown and people usually travel to and from the airport using water taxis,” educated Nedd. “In the event of an actual contamination, water taxis can’t be used because biocontainment equipment is too large for the boats, so we would have to use the roads, which is a much longer travel time.”

Nedd and the Sierra Leone police mapped out potential routes from Freetown to the airport, and discussed various traffic controls that the police officers could use to support efficient movements. The team focused on identifying intersection check points so movement could be tracked via maps.

Tranquil Shift began April 10 when the interagency task force, jointly led by Walters and the U.S. Department of Health and Human Services’ Office of the Assistant Secretary for Preparedness and Response, initiated the exercise in response to a hypothetical outbreak overseas. On April 11, five American aircraft equipped with specialized biocontainment units flew from Atlanta to Dakar, Senegal, where they prepared for the evacuation. The next day, exercise team members flew to Freetown to pick up 11 “patients” who needed to be safely transported to Ebola treatment centers in the United States. The aircraft then flew to Washington Dulles Airport to clear customs before heading to five receiving facilities across the country.

The aircraft were outfitted with either the Aeromedical Biological Containment System used during the 2014-2016 Ebola outbreaks, or the Containerized Biocontainment System (CBCS), a state-of-the-art infectious disease transport system.

Thanks to a $5 million public-private partnership with Microsoft co-founder Paul G. Allen, MRIGlobal developed the CBCS specifically for the State Department. The CBCS can be loaded aboard non-military aircraft allowing the department to get into places where the U.S. military may not be welcome for the next outbreak.

Two 747-400s outfitted with containerized biocontainment systems were used at Freetown's Lungi International Airport, April 11, 2017, during Exercise Tranquil Shift, the largest overseas biocontainment exercise to date conducted by the U.S. Department of State, in partnership with six other U.S. government agencies. (U.S. Department of State photo)
Operation Tranquil Shift participants return to the U.S. Embassy in Freetown, Sierra Leone, April 17, 2017, after the successful medical evacuation exercise completed. (U.S. Department of State photo)


U.S. Department of State

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