Exclusive: Fear covid pods could explode

Fifteen of the EpiShuttle devices for England were bought through the ambulance service, but on the instruction of and paid for by NHS England. 

They are described by their manufacturer as a “single-patient isolation and transport system” and are intended for moving highly infectious patients in ambulances, while containing infection.

The English NHS bought six in February, apparently intended for other infectious diseases; then the purchase of a further nine was brought forward in response to the covid-19 outbreak in the UK, with these delivered in March and June, HSJ understands.

NHS England and the ambulance service have not stated the fee they paid, but the normal basic cost of each unit is around £35,000. The Scottish Ambulance Service has also spent more than £500,000 on eight Epishuttles for both land and air transfers, and has also not used them.

A number of sources detailed their safety concerns to HSJ and said ambulance chiefs had warned NHS England about the risk of an explosion when a patient requires oxygen support and gas levels are increased inside the pod. Oxygen in confined spaces is a common and well known fire risk, and often needs to be mitigated.  

HSJ understands the serious safety concerns began to be raised by staff during the training of some ambulance trusts’ hazardous area response teams in April – and the pods have subsequently not been used to transport patients, despite costing the NHS hundreds of thousands of pounds. 

Concerns were also raised about the ability of the pods to be safely mounted on stretchers inside ambulances.

The company which manufactures the “EpiShuttle” pods —  specialist isolation transport company EpiGuard — insisted they were safe and met regulatory standards. The company said it was in close contact with the NHS and was confident any safety concerns could be resolved. 

The EpiShuttles were ordered by the National Ambulance Resilience Unit, hosted by West Midlands Ambulance Service Foundation Trust, but paid for by NHS England. Sources familiar with the arrangements told HSJ the impetus to buy the EpiShuttles came from NHSE, rather than from ambulance services.

EpiGuard chief executive Ellen Cathrine Andersen told HSJ: “The EpiShuttle is tested and approved according to the European standard for ambulances, and CE-marked as a Class 1 medical device.

“The EpiShuttle is currently in daily and successful use in many countries worldwide, including Norway, Denmark, and Germany.

”In the last few weeks, the EpiShuttle has been used to transport numerous covid-19 patients, many of whom have been seriously ill and intubated during transport. EpiGuard’s medical team is in close dialogue with our customers worldwide. We have not registered any problems with either fixation or use of oxygen with the operators that use the EpiShuttle.

“We respect and appreciate that the NHS has high safety standards, and their thorough work on implementing the Epishuttle into their healthcare system and procedures. We are in close dialogue with the NHS and are confident that any concerns they may have will be resolved. The EpiShuttle represents a highly useful solution for the transport of contagious patients in the UK healthcare system.

”Fear of explosion during use of the EpiShuttle however is not justified and must be caused by poor knowledge of the equipment and lack of training.”

EpiGuard added in a statement that oxygen flow in the pod could be adjusted to reduce the concentration and oxygen could also be “captured” and removed through the ventilation port to ensure limits were not exceeded. It said it had been crash-tested as part of the certification process and there were methods to safely attach it within an ambulance, but a more generic adapter to fit stretchers was being developed.

NHS England did not directly answer most of HSJ’s questions about the concerns raised.

However, a spokesman said in a statement: “No adverse events have been recorded related to the use of this equipment internationally, but, as with any product, concerns should and will be taken seriously if they exist.

“While it’s good news that they have not been required during the covid-19 pandemic, EpiShuttles are an important addition to our ambulance resilience plans, have been welcomed by [the National Ambulance Resilience Unit], and will provide vital protection for both patients and staff in some of the most dangerous circumstances.”

NHSE had previously indicated the pods had not been used to transport covid patients because they were intended for highly infectious diseases. Covid-19 was downgraded from a high consequence infectious disease category on 19 March – before the UK went into lockdown. However, other health systems have used them with covid patients.

High consequence infectious diseases are extremely rare in the UK and are usually associated with travel abroad and transmission to close contacts on return to the UK. They include haemorrhagic fevers such as ebola, pneumonic plague, and other conditions such as Middle East Respiratory Syndrome.

The Scottish Ambulance Service said its eight EpiShuttles had been distributed around the country and were available for operational deployment, as necessary, although none had been used for covid patients. Regional airline Loganair had converted two aircraft to take one of the pods and the RAF also adjusted a helicopter to take them, it said.

”Oxygen build-up has not been any problem with our use of the EpiShuttle, and with the ventilation port it is easy to avoid excessive oxygen inside. We do not fear any hazards due to oxygen, and the risk is considered to be negligible, says Jens Klüver, Major and Medical Director of the Royal Norwegian Air Force, Squadron No. 330 RNoAF.”