The practice of transporting a patient affected by a Highly Transmissible Disease (HTD) with a high risk of fatal evolution using biocontainment isolators requires careful planning and preparation. To date, there is only limited literature regarding aeromedical transport, most of which is military-derived, and it does not address patient transfer by road vehicles. To standardize these practices, or at least some of their most critical aspects, we tried to schematize a few of the improvements each author implemented during their practices as a scaffold, which could eventually be based on operative protocols. In particular, we focused on the series of actions that needed to be performed and planned to guarantee the safety of both the patient and operators during the entire duration of the operations.

Introduzione: il trasporto su strada in biocontenimento è essenziale per la gestione di pazienti affetti da patologie altamente trasmissibili, tuttavia nella letteratura civile mancano strumenti decisionali standardizzati a supporto dei trasferimenti su strada. Questo studio si propone di sviluppare un modello operativo per supportare le decisioni cliniche e logistiche in tali trasporti. Materiali e Metodi: è stato elaborato uno schema decisionale attraverso un'analisi retrospettiva di 1.994 trasferimenti effettuati in regime di biocontenimento in Sicilia tra dicembre 2020 e marzo 2022. Le variabili principali includevano le condizioni del paziente, l’impiego di dispositivi di supporto vitale e le caratteristiche logistiche del trasferimento. Il modello è stato perfezionato attraverso briefing strutturati post-missione, arrivando a classificare i trasferimenti in tre livelli di complessità (C1-C3) in base a criteri clinici e logistici. Risultati: i pazienti sono stati classificati in funzione della capacità di camminare, della necessità di monitoraggio o supporto vitale e del rischio infettivo. Sono stati identificati 590 trasferimenti ad alta complessità eseguiti mediante l’utilizzo di isolatori, mentre 1.403 casi a bassa complessità sono stati gestiti con un minibus di biocontenimento. Non sono stati registrati guasti alle apparecchiature critiche. Lo schema decisionale ha supportato una pianificazione coerente e ha migliorato la sicurezza operativa. Discussione: Il confronto con le principali raccomandazioni presenti in letteratura ha confermato la validità del modello e ha messo in evidenza criticità operative come la comunicazione inefficace e l’integrazione delle apparecchiature. Si propone l'integrazione dell’indice NEWS2 per migliorare la classificazione del rischio clinico. Conclusioni: lo schema decisionale proposto fornisce uno strumento riproducibile per classificare la complessità del trasporto sanitario in biocontenimento. È necessaria una validazione prospettica del modello al fine di garantirne l’applicabilità in contesti sanitari più ampi.

Background/Objectives: The transport of patients with high-consequence infectious diseases (HCIDs) links biosafety science and emergency medicine. The 2026 Bundibugyo virus disease epidemic and the multinational Andes virus outbreak associated with an expedition cruise ship have renewed attention on how such patients are moved safely between the community, hospitals and high-level isolation units. This narrative review synthesises the international literature on biocontainment transport and integrates it into an operational framework for emergency medical systems. Methods: A structured search of PubMed/MEDLINE and Scopus (to 10 October 2026), complemented by guidance from the World Health Organization, the European Centre for Disease Prevention and Control, the US Centers for Disease Control and Prevention and national authorities, was conducted and reported according to the SANRA scale. Evidence was organised across seven operational domains and combined with the operational experience of the Italian Red Cross biocontainment transport service. Results: Of 2432 records identified, 1485 unique records were screened. The literature is dominated by aeromedical case reports, technical evaluations and expert consensus, with few comparative studies. Recurrent findings concern device integrity and air quality within transport isolators, the risk of self-contamination during doffing, heat strain and communication limits imposed by personal protective equipment, decontamination of vehicles and isolators, the maintenance of team readiness during periods of low activity, and the psychological burden on patients and staff. These findings are integrated into a framework comprising a four-link containment chain, a seven-phase operational workflow, a three-tier complexity classification and a role-based responsibility matrix. Conclusions: Biocontainment transport is better understood as an integrated emergency system than as a device-centred intervention. The proposed framework is a structured, consensus-based reference for planning, training and quality assurance; its components require prospective evaluation.

Introduction: Biocontainment transfer represents a complex and delicate phase of care, especially in light of the increased demand for safe handling of patients affected by highly transmissible diseases. The COVID-19 pandemic has highlighted the critical need for structured approaches to ensure quality care and safety during these transfers. Objective: To propose a structured nursing model for managing the care of conscious and communicative patients undergoing biocontainment transport, based on nursing diagnoses and standardized interventions. Methods: A theoretical-conceptual model was developed based on the NANDA-I 2024–2026 taxonomy to identify nursing diagnoses related to perception, cognition, and stress tolerance. These were systematically combined with appropriate interventions from the Nursing Interventions Classification (NIC) and expected outcomes from the Nursing Outcomes Classification (NOC). The model addresses the clinical and psychological needs of patient across the three phases of transport: pre-transport, transport, and post-transport, with particular focus on anxiety management, communication, and adaptation to isolation. Results: In the pre-transport phase, the diagnosis of Excessive Anxiety was addressed with interventions to reduce emotional distress and improve patient cooperation through clear, empathetic communication. During transport, the impairment of verbal communication caused by protective equipment and isolation barriers was mitigated through simplified language, visual aids, and strategies to ensure mutual understanding. In the post-transport phase, the model focused on enhancing the patient's coping capacity and resilience, offering emotional support and structured interventions to manage stress and process the experience. Conclusions: The proposed model provides a comprehensive and systematic framework for nursing care during biocontainment transfers, integrating both clinical and emotional aspects to reduce patient vulnerability and improve the quality of care. As a theoretical model built upon standardized nursing taxonomies, it lays the groundwork for future clinical applications. Prospective and pilot studies will be essential to validate its effectiveness and feasibility in real-world healthcare settings.

Background/Objectives: The transport of patients with high-consequence infectious diseases (HCIDs) links biosafety science and emergency medicine. The 2026 Bundibugyo virus disease epidemic and the multinational Andes virus outbreak associated with an expedition cruise ship have renewed attention on how such patients are moved safely between the community, hospitals and high-level isolation units. This narrative review synthesises the international literature on biocontainment transport and integrates it into an operational framework for emergency medical systems. Methods: A structured search of PubMed/MEDLINE and Scopus (to 10 October 2026), complemented by guidance from the World Health Organization, the European Centre for Disease Prevention and Control, the US Centers for Disease Control and Prevention and national authorities, was conducted, and the review was planned and written using the SANRA quality criteria. Evidence was organised across seven operational domains and combined with the operational experience of the Public Health Unit of the Italian Red Cross (CRI). Results: Of 2432 records identified, 1485 unique records were screened. The literature is dominated by aeromedical case reports, technical evaluations and expert consensus, with few comparative studies. Recurrent findings concern device integrity and air quality within transport isolators, the risk of self-contamination during doffing, heat strain and communication limits imposed by personal protective equipment, decontamination of vehicles and isolators, the maintenance of team readiness during periods of low activity, and the psychological burden on patients and staff. These findings are integrated into a framework comprising a four-link containment chain, a seven-phase operational workflow, a three-tier complexity classification and a role-based responsibility matrix. Conclusions: Biocontainment transport is better understood as an integrated emergency system than as a device-centred intervention. The proposed framework is a structured, consensus-based reference for planning, training and quality assurance; its components require prospective evaluation.

Background/Objectives: Transport of patients with high-consequence infectious diseases (HCID) constitutes a critical interface between biosafety and emergency medicine. While biosafety frameworks originated in laboratory settings, their translation to mobile emergency systems introduces unique clinical, organisational, and human-factor chal-lenges. This paper describes and analyses an integrated operational model for biocon-tainment transport within emergency medical systems, addressing its theoretical foun-dations, procedural architecture, team governance structure, and determinants of safety and resilience. Methods: An integrated systemic model of biocontainment transport is presented, in-corporating biosafety classification principles, operational protocols, device performance monitoring, governance frameworks, and human-factor considerations. Results: The model rests on four interdependent pillars: personal protective equipment (PPE), physical containment envelope, negative pressure with HEPA filtration, and structured decontamination. Operational safety relies on structured pre-transport as-sessment, systematic device verification, complexity-based team composition, and a re-sponsibility allocation matrix. Continuous monitoring of environmental parameters and procedural compliance is expected to enhance system reliability. Psychological impact on both patients and operators emerged as a significant determinant of system sustainability. Model application across 1,585 transports yielded a zero operator contagion rate and no significant technical interruptions or containment chain failures. Conclusions: Biocontainment transport should be conceptualised as an integrated emergency system rather than a device-centred intervention. Governance clarity, scalability, continuous skill maintenance, and human-factor integration are critical components for resilient HCID transport within emergency care systems.