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.

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.