Aeromedical evacuation of biological warfare casualties: a treatise on infectious diseases on aircraft.

A basic understanding of the transmission and isolation of infections would be essential to the safe and effective aeromedical evacuation (AE) of biological warfare (BW) casualties. First, the airframe as microbial environment is considered, and relevant preventive and disinfecting measures are discussed. A survey of past infectious disease transmission on civilian aircraft (including tuberculosis, influenza, measles, smallpox, and viral hemorrhagic fevers) is presented, and the communicability and stability of likely BW agents is described. A brief history of U.S. military aeromedical evacuation (as it relates to contagious diseases and U.S. Air Force BW doctrine) is also outlined. Special containment procedures (especially as used by the U.S. Army Aeromedical Isolation Team) are described. Finally, international legal and regulatory aspects of the AE of BW casualties are considered, and some unanswered questions and suggestions for future research are offered. It is concluded that, given adequate foresight, expertise, and resources, the AE of even contagious BW casualties could be safely and effectively accomplished.