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we cannot know if transporting patients would have resulted References
in an outbreak in the larger population group, we do know 1. Perper R, Woodward A. Business Insider. New York state has
that it would have brought a known source of pathogen into confirmed its first coronavirus case. https://www.businessinsider
an otherwise uncontaminated area. Within an austere envi- .com/new-york-state-confirms-first-coronavirus-case-2020-3. Ac-
cessed 12 October 2020.
ronment and expeditionary medical teams, there is a lack of 2. Joint Publication 4-02 Joint Health Services. Joint Chiefs of Staff.
sophisticated medical equipment, personnel, and facilities. 28 September 2018. https://www.jcs.mil/Portals/36/Documents
We believe the chances are high that there would have been /Doctrine/pubs/jp4_02ch1.pdf?ver=2018-10-10-113551-603.
unintended and unnecessary exposure to the main population Accessed 12 October 2020.
if medically low-risk patients were moved to the larger popu- 3. Garibaldi BT, Conger NG, Withers MR, et al. Aeromedical evac-
lation hubs based on previous practices. Additionally, this case uation of patients with contagious infections. Aeromed Evac.
2019;317–335.
series provides reassurance to public health planners and med- 4. Hall MA, Morrow ML, Monsaert MK, et al. Converting a small
ical decision-makers that otherwise healthy, low-risk patients surgical team into a pandemic response team for an isolated pop-
can be treated in austere locations with proper monitoring. ulation. J Am Coll Surg. 2020;230(6):e27–e30.
This allows the medical assets to prepare and focus on those 5. Gibbs SG, Herstein JJ, Le AB, et al. Review of literature for air
patients that demonstrated they needed higher levels of care. medical evacuation high-level containment transport. Air Med J.
2019;38(5):359–365.
This report describes the experience and solution of a single 6. Garg S, Kim L, Whitaker M, et al. Hospitalization rates and
isolated and austere military population. It may not be proper characteristics of patients hospitalized with laboratory-confirmed
coronavirus disease 2019—COVID-NET, 14 States, March 1–30,
for other austere or perhaps rural regions to mimic these ac- 2020. MMWR Morb Mortal Wkly Rep. 2020;69(15):458–464.
tions entirely based on medical assets or other factors. The 7. Weiss P, Murdoch DR. Clinical course and mortality risk of se-
idea of protecting the public good is an important one, though, vere COVID-19. Lancet. 2020;395(10229):1014–1015.
and the urge to transport all sick patients to a central location 8. Wu Z, McGoogan JM. Characteristics of and important lessons
should be resisted. from the coronavirus disease 2019 (COVID-19) outbreak in
China: summary of a report of 72 314 cases from the Chinese
Center for Disease Control and Prevention. JAMA. 2020;323(13):
Conclusions 1239–1242.
9. Hellewell J, Abbott S, Gimma A, et al. Feasibility of controlling
Isolation and treatment of infected patients in their small con- COVID-19 outbreaks by isolation of cases and contacts [pub-
stituent groups, rather than immediate evacuation to higher lished correction appears in Lancet Glob Health. 2020 Mar 5].
levels of care, resulted in additional time to develop medical Lancet Glob Health. 2020;8(4):e488–e496.
assets and plans to cope with any widespread infections. In 10. Pan A, Liu L, Wang C, et al. Association of public health inter-
ventions with the epidemiology of the COVID-19 outbreak in
future pandemics, a similar military strategy of population iso- Wuhan, China. JAMA. 2020;323(19):1915–1923.
lation should be considered rather than an aggressive evacua- 11. Parmet WE, Sinha MS. Covid-19: the law and limits of quaran-
tion policy, if the risks are similar. For rural or other isolated tine. N Engl J Med. 2020;382(15):e28.
populations with a centralized medical capability, a similar 12. Stelfox HT, Bates DW, Redelmeier DA. Safety of patients isolated
isolation strategy should also be followed depending on local for infection control. JAMA. 2003;290(14):1899–1905.
capabilities. 13. Schörnig N, Lembcke AC. The vision of war without casualties:
on the use of casualty aversion in armament advertisements.
J Conflict Resolution. 2006;50(2):204–227.
Disclosure 14. Army Techniques Publication. Medical Evacuation ATP-402.2.
The authors have no relevant financial relationships to disclose. July 2019. https://armypubs.army.mil/epubs/DR_pubs/DR_a/pdf
/web/ARN17834_ATP%204-02x2%20FINAL%20WEB.pdf.
Author Contributions Accessed 12 October 2020.
ABH participated in data collection, data analysis, study de- 15. Zhou F, Yu T, Du R, et al. Clinical course and risk factors for
sign, and manuscript writing. MDD participated in study mortality of adult inpatients with COVID-19 in Wuhan, China: a
retrospective cohort study [published correction appears in Lan-
design, data, analysis, and critical revision. AJD and RLW cet. 2020 Mar 28;395(10229):1038]. Lancet. 2020;395(10229):
participated in data analysis and critical revision. 1054–1062.
16. Matos R, Chung K. Clinical management of COVID-19. DoD
COVID-19 CPG. https://health.mil/Reference-Center/Technical
-Documents/2020/07/30/DoD-COVID-19-Practice-Management
-Guide-Version-2. Accessed 12 October 2020.

94 | JSOM Volume 20, Edition 4 / Winter 2020