Biocontainment Transport of Patients with High-Consequence Infectious Diseases: A Narrative Review and Integrated Operational Framework for Emergency Medical Systems

Background/Objectives: The transport of patients with high-consequence infectious diseases (HCIDs) links biosafety science and emergency medicine. The 2026 Bundibugyo virus disease epidemic and the multinational Andes virus outbreak associated with an expedition cruise ship have renewed attention on how such patients are moved safely between the community, hospitals and high-level isolation units. This narrative review synthesises the international literature on biocontainment transport and integrates it into an operational framework for emergency medical systems. Methods: A structured search of PubMed/MEDLINE and Scopus (to 10 October 2026), complemented by guidance from the World Health Organization, the European Centre for Disease Prevention and Control, the US Centers for Disease Control and Prevention and national authorities, was conducted, and the review was planned and written using the SANRA quality criteria. Evidence was organised across seven operational domains and combined with the operational experience of the Public Health Unit of the Italian Red Cross (CRI). Results: Of 2432 records identified, 1485 unique records were screened. The literature is dominated by aeromedical case reports, technical evaluations and expert consensus, with few comparative studies. Recurrent findings concern device integrity and air quality within transport isolators, the risk of self-contamination during doffing, heat strain and communication limits imposed by personal protective equipment, decontamination of vehicles and isolators, the maintenance of team readiness during periods of low activity, and the psychological burden on patients and staff. These findings are integrated into a framework comprising a four-link containment chain, a seven-phase operational workflow, a three-tier complexity classification and a role-based responsibility matrix. Conclusions: Biocontainment transport is better understood as an integrated emergency system than as a device-centred intervention. The proposed framework is a structured, consensus-based reference for planning, training and quality assurance; its components require prospective evaluation.