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5 CHAPTER 2 Phases of Quarantine Quarantine can be broken down into a series of sequen- Any traveler(s) who meets the criteria would be assessed by tial actions or phases: (1) the decision process to quarantine, a public health official, as well as by airline medical consult- (2) the establishment of a quarantine area with registration and ants or by airport emergency medical personnel who would assessment of the population going into quarantine, (3) the determine if the traveler required medical treatment. Nearly operational aspects of maintaining quarantine, (4) demobi- all airlines have in-house medical personnel or a contract lization, and (5) recovery. This section will discuss each of the with a service to provide medical advice on the ground to the phases and identify areas for further study. aircraft crew handling an in-flight medical incident. These medical professionals may also be able to coordinate with the CDC Quarantine Station personnel or other public health Phase 1. Decision to Quarantine officials by providing them with additional information prior What situation would require a quarantine action at an air- to landing that would expedite assessment of the traveler. port? There are several scenarios that could initiate a quaran- Generally, the arriving aircraft would proceed to its assigned tine action, but many of the procedures for carrying that out gate at the scheduled airport, where it would be met by pub- are undergoing revision or under development. The follow- lic health officials and the airport emergency medical response ing procedures provide a general idea of how a quarantine team. If a preliminary assessment identified the potential for might proceed. a quarantinable illness on board, the aircraft might be directed CDC could receive a report of a potentially quarantinable to a more remote area of the airport or to a gate closer to the disease on board an aircraft in flight. The airline, in particu- CDC Quarantine Station. The plane may even be diverted lar the captain or person in command of an international to another airport. The decision would be made by federal flight landing in the United States, is required under federal authorities, with CDC taking the lead. law (42 CFR 71.21) to report illness meeting certain criteria If the airline does not identify and report a potential com- to a CDC Quarantine Station. Notification can be done via municable disease in flight but requests medical assistance upon the air carrier's operations center or through air traffic con- landing, the airport medical emergency response team may de- trol. (A separate regulation found at 42 CFR 70.4 applies to termine that the situation involves a potential quarantinable ill- flights within the United States). The criteria for an "ill per- ness and the CDC Quarantine Station covering that airport son" as defined by the regulation are: would arrange for further assessment by CDC personnel or by local public health officials. In such circumstances, other pas- A fever, defined as a temperature of 38C or 100F or sengers and crew members may be requested to provide greater, accompanied by one or more of the following: rash, contact information for possible follow-up or to remain on the jaundice, glandular swelling, or temperature persisting for aircraft or in the gate area until their status is determined. two or more days. CDC may opt to have Quarantine Station personnel meet flights that have originated or stopped over in a country or re- and/or gion where an outbreak of a communicable disease is known to be occurring. CDC has the authority to observe and inter- Diarrhea severe enough to interfere with normal activity or view passengers as they leave the aircraft. work (defined as three or more loose stools within 24 hours Regardless of how the process is initiated, the decision to or a greater than normal number of loose stools). impose a quarantine order on international travelers arriving