Risk analysis by Failure Modes, Effects and Criticality Analysis (FMECA) and biosafety management during collective medical air medical evacuation of critically ill COVID-19 patients

Abstract In March 2020, COVID-19 caused an overwhelming pandemic. To relieve overloaded Intensive Care Units in the most affected regions, French Ministry of Defence triggered collective Air Medical Evacuations (MEDEVAC) on-board of an Airbus A330 Multi Role Tanker Transport of the French Air Force. Such collective air MEDEVAC is a big challenge regarding biosafety, as until now, only evacuations of a single symptomatic patient with an emergent communicable disease, like Ebola virus disease, have been conducted. However, the COVID-19 pandemic required collective MEDEVAC for critically ill patients and involved a virus still little known. Thus, we performed a complete risk analysis using a process map and an FMECA (Failure Modes, Effects and Criticality Analysis) to assess the risk and implement mitigation measures for health workers, flight crew as well as for the environment. We reported the biosafety management experienced during six flights with a total of 36 critically ill COVID-19 positive patients transferred with no casualties whilst preserving both staffs and aircraft.