May 16, 2016
Following the March 2014 outbreak of Ebola Virus Disease(EVD) in West Africa, New York City (NYC) agencies began developing plans and protocols for handling potential EVD cases. As part of this effort, the New York City Fire Department (FDNY) collaborated with city hospitals and the Department of Health and Mental Hygiene (DOHMH) to develop Bio Isolation Transfer (BIT) cards—documents embodying standard operating procedures (SOPs) for safely transporting and handing off individuals suspected of having contracted EVD (known as “persons under investigation,” or PUIs). Created using $25,000 in Hospital Preparedness Program funds, the BIT cards can serve as models for other jurisdictions wishing to develop transport protocols specific to incidents involving highly contagious diseases.
In July 2014, DOHMH, FDNY, and Bellevue Hospital—the primary facility for EVD care in NYC—developed an interagency agreement
that FDNY’s Hazardous Materials Tactical (HazTac) units would all EVD already trained to work under similar conditions, e.g., in a bioterrorism reat situation. However, no protocol yet existed for transferring custody of a PUI from the HazTac units to the admitting hospital. To address this gap, DOHMH and FDNY worked with all 11 of the NYC Health and Hospitals Corporation’s acute care hospitals (ACHs) to conduct joint tabletop exercises and walk-throughs focused on scenarios that involved transferring a PUI from the HazTac units to the hospital staff. The partners also conducted a full-scale inter-facility transfer exercise transporting a PUI from Kings County Hospital to Bellevue Hospital. This exercise helped refine NYC’s PUI hand-off procedure.
These exercises culminated in the standardization of the safe transport and hand-off process through the BIT cards. Each ACH received a unique BIT card that identified exact instructions for the transport and hand-off process at their specific facility. FDNY distributed copies of the cards to every HazTac unit. The BIT cards include:
- A list of each step in the transport and hand-off process;
- Building maps showing hospital entrance points;
- Diagrams showing how to move a patient safely within a facility; and Names and cell phone numbers of FDNY points of contact.
Hospital staff and the HazTac units follow the SOPs on the BIT cards when transporting PUIs, which makes the process smoother and safer for all involved. The development of the BIT cards as institutionalized scripts for the safe transport and hand-off process has made NYC’s ACHs more comfortable with the notion of admitting a patient who may have EVD.