Single-patient isolation units: Soft- or hardtop?

In medical transportation, many elements need to work together to ensure safe conduct – the procedure, medical personnel, equipment, and communication. Most of these are already in place and the biggest challenge can be the equipment available. During a medical transport, the equipment should ease the medical personnel’s challenges and ensure their safety at work. As more equipment becomes available on the market, the focus must be on ensuring that it is aiding the medical personnel and not a hindrance in their work. So, it must be easy to use and applicable in different situations.

Single-patient isolation units have been instrumental during the Covid-19 pandemic and aided medical personnel all over the world in transporting patients with highly infectious diseases. There are various alternatives commercially available, but the question is always which one is the best? We have taken a closer look at one important aspect of the different isolation units on the market – the top. What advantages do you get with an isolation unit with a hardtop, such as the EpiShuttle?  


What is the difference between a hardtop and a soft-top?

The medical isolation units come either with a hardtop or a soft-top, and their main function is to isolate the patient from the environment, either to protect the environment or the patient. The units should also ensure that the patient can be transported safely and comfortably. Whether a hardtop or soft-top solution is best, depends on the user and their needs.

Historically, most single-patient isolation units have had a soft-top, and this solution does have some advantages. These units can be shipped collapsed and assembled on arrival, saving shipping costs and making them easy to store when not in use. With the soft-top units, you get a more flexible structure that can be easier to maneuver in tight spaces and fit into a wide variety of vehicles. However, as they don’t have a firm structure, many are not suitable for transportation by plane or helicopter, as rapid decompression, vibrations, and hard impacts can cause tears and leakage. This can cause issues if a patient needs to be transported from one place to another, over a great distance in a short time. Additionally, most soft-top units offer limited access to the patient’s airways, since all the access ports are on the side of the patient and the head end is vertical and opaque.

There are a few units with hardtops available on the market, the most prominent being the EpiShuttle. They are naturally more robust than the soft-top and can be used in a variety of vehicles, including ambulances, planes, and helicopters. One limitation of the hardtop that’s important to consider, is that its lack of flexibility can mean that it can’t fit into all setups – particularly some smaller planes and helicopters. In most cases, however, this can be solved by preparation and good communications between the manufacturer and the user – as manufacturers often solutions for these issues. We at EpiGuard offer adapters for a range of stretchers, such as Stryker, Stollenwerk, and Ferno, and we collaborate with manufacturers of aircraft interiors to develop adapters and lifting systems for the EpiShuttle. Additionally, The EpiShuttle can provide better access to the patient’s airways due to the shape of the hardtop, its transparency, and the filters are fastened so they are not a hindrance in terms of access.

Protection and safety of healthcare professionals

The safety and health of the patient is the main focus in medical transportation, but it is equally important that the medical personnel are protected. Most single-patient isolation units are equipped with blowers that create a negative pressure inside the unit, helping to ensures that there is no transmission of dangerous pathogens in the case of a small rupture or tear. However, the negative pressure doesn’t solve the issue with droplets or bodily fluids. If the units are not completely sealed, there can be a transmission. With the EpiShuttle, the base is firm, has high edges, and keeps the patient elevated, so that the fluids stay inside the unit and away from the patient. Between the hardtop and the base, there is an airtight seal. While with soft-top units, there can be issues with leakage through the zippers used to close the unit after patient loading – particularly if the zippers are located at the lowest point, where fluids will gather.

What about the costs?

Considering the costs of the different units all depends on the needs of the user. There is a wide range of units available on the market – you can find reusable units, different sizes, and suitability. With the EpiShuttle, the patient is completely isolated, and dangerous pathogens are contained within the unit and its filters. This means that there is no need to decontaminate the vehicle and the medical staff only need to wear PPE during on- and offloading – ensuring that the vehicles stay in operation and that the medical team doesn’t suffer fatigue. In contrast, the use of soft-top isolators units will require decontamination of vehicles after transport and the medical staff has to wear PPE throughout. As a result, longer transports will require a bigger team of healthcare professionals to ensure safe conduct – as they can only wear PPE for 2-3 hours before requiring a new team to take over.

When comparing the soft-top units to the EpiShuttle, there is a difference in costs, especially in total operational cost of ownership. Soft-top isolators are typically cheaper to buy, but the total operational cost may be higher. Most of the soft-top units are single-use and the vehicles used for transport will usually require decontamination. The EpiShuttle, on the other hand, can be reused after a two-hour decontamination, while the vehicle used for transport can proceed immediately to the next patient. The initial cost of the EpiShuttle might be higher, but it can be used several times, longer shelf-life and you can replace parts on a need-to basis.

So soft- or hardtop?

The isolation units on the market have been highly useful and crucial during the ongoing Covid-19 pandemic. We have experienced that the EpiShuttle has been used for well over 150 patient transports in the last few months – some within the hospitals or from one hospital to another, and many across borders. The EpiShuttle has offered additional protection for the healthcare professionals, making their workday easier and safer, as well as providing comfort for the patient and enabled them to be transported to where they need to go.

The isolation units with soft or hardtop offer similar basic functionality but looking at the overall benefits and costs the hardtop units come out on top. With the hardtop, healthcare professionals can offer better care and treatment due to the structure, as well as get better access to the patient. Though it might not fit into every vehicle, there are different solutions available, making the unit adaptable. The main advantage is that the hardtop units are airtight, which ensures that nothing escapes, specifically fluids. The soft-top units often have zippers to attach the base and top, which has been known to leak, and there is a bigger chance of rupture. Nevertheless, the single-patient isolation units offer additional protection for the environment and make the transportation of patients easier and safer.

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