MH 34:02 V3

21 December 2015

CEOs and CMBs, Public Sector Hospitals

GMs and CEOs, Private Hospitals

MOH DIRECTIVE 02/2015

MEDICAL EVACUATION OF CASES OF EMERGING INFECTIOUS DISEASES

(EIDs) INTO SINGAPORE

In accordance with MOH Directive 5/2006, the assessment of infectious

diseases (ID) cases for medical evacuation (ME) is currently devolved to the
receiving healthcare institution’s Medical Board. In situations where significant public
health risk exists, the Medical Board is required to inform MOH and ensure that
proper infection control protocols are in place. We have reviewed this workflow for
ME in light of the greater public health risks associated with emerging infectious
diseases (EIDs) of pandemic potential1.

2 With effect from 4 January 2016, MOH’s approval will be required for all
ME involving suspect or confirmed EID infection. Hospitals should alert MOH of
all ME requests involving patients with a confirmed or suspect EID of pandemic
potential, via MOH's Communicable Diseases Division Surveillance Duty Officer at
9817-1463 (available 24 hours). Hospitals should follow up with an email to MOH
(MOH_MCT@moh.gov.sg) to furnish information in the “Request Form for
Medical Evacuation for EIDs” (Annex A), to facilitate the review of the request.
This will include patients who meet the case definition for a suspect EID but tested
negative twice for the EID in the source country.

3 Hospitals should also note the following:

a) Need for accurate risk assessment: Hospitals should obtain an accurate

risk assessment of the patient for all ME requests, even if the diagnosis is not

1
EIDs of concern may change from time to time. At present, MOH remains on heightened alert for
Middle East Respiratory Syndrome (MERS), Ebola Virus Disease (EVD) and avian influenza
(including influenza A/H7N9 infection). Please refer to the Fifth Schedule of the Infectious Diseases
Act.
 EID-related. This includes travel history to EID-affected areas and any other
EID exposure risks, as per the case definitions for the specific EIDs2.

b) ME involving suspect or confirmed EIDs: Hospitals will require MOH’s

approval for any evacuation requests which could potentially involve EIDs
(whether suspected or confirmed), if the hospital intends to receive the
patient. This will apply to both Singaporean and foreign patients.

c) Management of confirmed EID cases: Depending on the nature and

transmission risks of the EIDs and the isolation capability required, MOH may
designate a specific hospital to receive the ME patient in view of infection
control concerns.

d) Management of suspect EID cases

i. For patients meeting the suspect case definition for EIDs, MOH
requires prior testing in the source country.
ii. Patients meeting the suspect case definition for droplet-transmissible
EIDs such as MERS, but who have been tested negative twice at the
source country (and hence technically are no longer suspect EID
cases) may be received at hospitals which have the capabilities to
manage droplet-transmissible EIDs3. As an additional precautionary
measure, such patients should be isolated in the local receiving
hospital until two further tests are done to confirm the negative results.
iii. In the event that ME patients are not initially suspected to be EID cases
and are only found to meet the suspect case definition (e.g. previously
undetected positive travel history) after admission to the local hospital,
they should be immediately isolated and tested. MOH should be
informed immediately. To prevent such cases from happening,
hospitals are required to take an accurate history for all ME requests
(refer to 3(a)).

e) Infection prevention and control: In general, for MEs involving EIDs and
other infectious diseases, receiving hospitals should ensure that adequate
infection prevention and control infrastructure, equipment and processes are
in place to manage the patient from arrival to isolation, including coordination
with the evacuation company. Hospitals should also comply with MOH’s policy
on designated hospital and guidance on infection control and PPE
requirements with regard to the management of EIDs.

2
Please refer to the case definitions for the specific diseases which have been sent out to all medical
practitioners.
3
Hospitals must have negative-pressure isolation room, as well as proper IPC protocol and practices.
4 We seek your compliance with the new workflow for ME involving EIDs in
paragraphs 2 and 3. Please disseminate the information in this directive to relevant
staff in your institutions.

5 For clarification of this directive, please email MOH_Info@moh.gov.sg.

A/PROF BENJAMIN ONG

DIRECTOR OF MEDICAL SERVICES
MINISTRY OF HEALTH