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Urgent Acquisition Effort Provides Safe COVID-19 Patient Transport in 95 Days

By C. Todd Lopez

WASHINGTON (July 07, 2020) -- The Air Force, Air Mobility Command and U.S. Transportation Command have a new capability to bring large numbers of COVID-19 patients home via airlift without putting associated flight crews at risk -- and the solution arrived quicker than expected.

The "Negatively Pressurized CONEX," or NPC, flew its first operational mission June 30 out of Ramstein Air Base, Germany, just 95 days after Transcom published a joint urgent operational need statement that spelled out the requirement for the high-capacity transport for large numbers of individuals each month who might be infected with COVID-19.

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The NPC is a 40-foot metal shipping container outfitted with air-handling and other equipment that can be carried aboard a C-17 transport jet. The NPC can be used to move up to 23 COVID-19 patents who need the attention of medical personnel. The system's onboard equipment ensures negative air pressure on the inside so that the aircrew responsible for transporting it and its patients won't be put at risk for infection.

The system also can be configured to hold as many as 30 ambulatory passengers who might potentially be infected with COVID-19 and need to be kept quarantined during an airlift operation, but who don't need the attention of medical personnel.

Navy Capt. Jeff Stebbins, deputy director of the Joint Rapid Acquisition Cell, commended the Joint Staff, the Air Force, AMC and Transcom for taking a requirement spelled out March 28 and turning it into a product that meets warfighter needs in just 95 days, when the process might normally take more than a year to complete.

"Our work with the Joint Staff and Transcom was done in parallel, not sequentially," Stebbins explained. "That allowed us to move faster."

Stebbins said Transcom sent the joint urgent operational need statement to the Joint Staff for validation on the same day that the Joint Rapid Acquisition Cell assigned it for execution to the Air Force. The Air Force assigned the Program Executive Office for Agile Combat Support as its lead for the effort.

"Everybody was working together, and there was a lot of crosstalk," he said. "Because we all worked effectively together and in parallel across departments, across agencies, we were able to move all of the authorities necessary to execute this mission quickly."

Within the Air Force PEO Agile Combat Support, it was Air Force Lt. Col. Paul Hendrickson, the materiel leader for Air Force chemical, biological, radiological and nuclear defense -- CBRN for short -- and Air Force Capt. Alexis Todaro, Joint CBRN Collective Protection Program manager, who first conceived of the NPC.

"When the COVID crisis kicked off, Transcom and Air Mobility Command began to see a need for the transport of COVID patients," Hendrickson said. "They took a look at their inventory. And the only system that they had readily available was the 'transport isolation system,' or TIS. It was developed through a JUON for the Ebola outbreak in 2014."

The TIS, Hendrickson said, is basically a metal frame with plastic sheeting surrounding it. While functional, it has operational limitations, and it can accommodate only about six people.

Another option was the Portable Bio-Containment Care Module, a system owned by the State Department, Hendrickson said. At the time, a cross functional Air Force team was working to get the PBCM its flight-worthiness certification for transport on the C-17 aircraft. The PBCM effectively carries only three people for aeromedical missions, only four of the systems exist, and it would take a long time to get more of them purchased, he said.

Neither solution was ideal to meet the needs to move so many COVID-19 patients.

Hendrickson said his team was working on a solution for agile and adaptive "collective protection" to provide CBRN protection to groups of people. For example, he said, airmen who perform aircraft maintenance when required to wear the full array of individual CBRN protection equipment will eventually suffer exhaustion due to the thermal burden. They ideally need a need a place to go that is near their work area between tasks where they could be safe from a chemical attack, but at the same time be able to remove their individual protection suits so they could recover.

"We had been working with Osan Air Base and the 51st Aircraft Maintenance Squadron [in South Korea] to figure out how to get them more agile collective protection," he said. "We were working on a rapid technology demo of what we call the 'Collective Protection CONEX,' which is taking a 40-foot ISO container and retrofitting it to be a collective protection facility."

The "Collective Protection CONEX" or ColPro CONEX, was conceived to keep people inside it safe from dangers that might be outside.

The concept of the ColPro CONEX might be flipped on its head, Hendrickson thought, to keep people on the outside safe from people on the inside who might be contagious. He asked Todaro, who was leading the ColPro CONEX effort, if such a thing could be done -- and within just a few hours, he said, she had a design of what would eventually be the NPC.

Air Mobility Command liked the idea, he said, and with the help of the Joint Program Executive Office for CBRN Defense and numerous experts across the CBRN, aeromedical and air worthiness communities, by April 7 a contract was awarded using the "other transaction authority" process. The first proof of concept NPC was constructed in only 13 days and delivered to Joint Base Charleston, South Carolina on April 20 for validation testing. That testing concluded April 30, at which point Air Mobility Command green-lit the NPC as the system to meet its requirements under the JUON.

Hendrickson credited the contractors involved in building the NPC and NPCL -- UTS Systems, Highland Engineering Inc. and Delta Flight Products -- along with the C-17 and C-130 program offices; the Air Force Lifecycle Management Center's engineering directorate and human systems division; Air Force Research Lab; personnel at Joint Base Charleston; members of Detachment 2, Air Force Operational Test and Evaluation Center; the 28th Test and Evaluation Squadron and the 417th Flight Test Squadron out of Eglin Air Force Base, Florida; Air Mobility Command's surgeon general, A5Q requirements division and aeromedical standards evaluation shop; three bio-containment and pathogen experts from the Center for Sustainment of Trauma Readiness Skills Omaha; the Army's Combat Capabilities and Development Command and Public Health Center; and others as being instrumental in getting the NPC developed, and then proven airworthy and safe to fly.

The first production NPC was delivered to Joint Base Charleston on June 7, where it was subjected to a rigorous series of tests, Hendrickson said. It had its test flight June 15, and flew its first operational mission June 30.

In addition to the NPC, the team simultaneously developed a "NPC-Lite" model, which is a custom-built aluminum structure about 12 feet shorter than the NPC. It carries fewer passengers, and it will fit on the smaller C-130 aircraft. The NPCL, he said, is designed to move patients inside a theater of operations, while the NPC will be used to move patients out of theater. The first production NPCL was delivered to Joint Base Charleston on June 1, where it was subjected to similar tests as the NPC but on three variations of C-130 aircraft, and it had its final test on June 24. It arrived at Ramstein Air Base on July 3 and is expected to enter operations imminently.

Currently only one NPC and one NPCL exist, but officials expect that the Air Force will get 30 of each system and that the first NPC will roll off the assembly line in mid-July and the NPCL end of July. Hendrickson said he expects the manufacturers could produce systems as quickly as three or four per month once their production lines are established.

"The Air Force and what Lieutenant Colonel Hendrickson's team has done is a phenomenal job at developing an initial capability," Stebbins said. "We believe this serves as an excellent case study for urgent capability acquisition -- that when a combatant command has an urgent need, we use every tool available to rapidly develop and field a capability."

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