AMC News: Negatively Pressurized Conex: A Fast-Track Development for Transporting COVID-19 Patients


In late March of this year, the spread of the highly contagious COVID-19 virus challenged the entire world to mitigate what had become a deadly global pandemic. Governments and public health experts ramped up measures to protect populations by instructing people on the value of frequent handwashing, wearing protective masks, and physical distancing. With the rapid surge in confirmed cases of infection and the ensuing loss of life, health care professionals faced overwhelming influxes of patients with limited supplies of hospital beds, oxygen, and personal protective equipment.

In response to the crisis, the United States Transportation Command’s (USTRANSCOM) Joint Urgent Operational Need (JUON) issued a requirement on March 28 for high-capacity transport of personnel infected with COVID-19. The urgency of the pandemic prompted an unprecedented fast-track response.

The answer was the Negatively Pressurized Conex (NPC), which was made possible by a team comprised of the Air Force Chemical, Biological, Radiological, and Nuclear (CBRN) Defense Systems Branch working with the Joint Program Executive Office (JPEO) for CBRN Defense under the direction of the Program Executive Office (PEO) for Agile Combat Support (ACS) as the JUON lead for the AF. Other collaborators included experts from academia, contract partners, and the Department of Defense (DoD).

The NPC rapidly evolved from this directive to a proven concept in less than 30 days. The first NPC prototype was delivered for testing to Joint Base Charleston in South Carolina on April 21.

The NPC is an isolated containment chamber that offers a much higher capacity for moving patients than the existing Transportation Isolation System, the only comparable resource available to the Air Force at the start of the pandemic. Air Mobility Command (AMC) teamed with the Air Force Life Cycle Management Center (AFLCMC) to design and develop the NPC to fit inside a C-17 Globemaster III and a C-5 Super Galaxy to transport up to 23 ambulatory patients and as many as eight litters to medical facilities around the world, with room for medical personnel onboard.

The NPC container is negatively pressurized, with fans pulling air from the unit through high-efficiency particulate filters. According to Capt Alexis Todaro, NPC program manager, “The goal of the NPC is to help us keep infectious organisms contained in order to prevent the aircrew and medical professionals onboard the aircraft from being exposed.” The NPC also includes an anteroom where medical teams can change into or out of their protective equipment and safely exit the aircraft without the risk of contamination.

The design and construction of the NPC prototype was a collaborative effort by private sector companies UTS Systems, Highland Engineering, Inc., and Delta Flight Products under an Other Transactional Authority (OTA) contract. The contract award process, which under normal circumstances could last up to four months, was pinned down in only seven days, and the first prototype was delivered only 13 days after the contract was awarded at the cost of approximately $2 million.

When the prototype arrived at Joint Base Charleston, rigorous testing of the NPC began. The PEO ACS led teams from across the country to verify that the NPC met four prerequisites. The unit must be able to contain the virus away from the aircrew and the rest of the aircraft, be usable for aeromedical teams, have the potential to be certified airworthy, and have the potential to fly safely. According to Lt Col Paul Hendrickson, materiel leader within the AFLCMC PEO ACS and NPC Lead, “All of these assessments were pivotal to prove the capability and inform the production units’ design, so [that] they will be operational quickly. Procuring and demonstrating the NPC is a textbook example of rapid acquisition and development. In just nine days, we have proved the NPC concept’s capabilities, 21 days after contract award.”

After testing was completed and a successful demonstration flight of the NPC was accomplished on April 30, Gen Maryanne Miller, former Commander of AMC, with the recommendation of PEO ACS, decided to proceed with procurement and full production of the NPC for Inter-Theater Airlift on the C-17 and C-5 aircraft. A smaller variant, the NPC-Lite (NPCL), was delivered on June 1 and ready for operations by June 25.

Keeping in mind that this rapid development occurred during a global pandemic, some of the game plan involved unconventional approaches. “Helping a non-standard defense contractor understand the stringent requirements for airworthiness required an all-hands on deck and an outside-of­the-box teaming strategy,” said Robert David, Chief Engineer for the C-17 System Program Office (SPO).

Additionally, according to Dr. Casey Pirnstill, a biomedical engineer at the Air Force Research Laboratory, “We even had a local church donate personal protective equipment and hand sanitizer so the guys could work in proximity to build the test fixtures.”

With a team involving military and civilian personnel spread across the nation, modern communication tech­nologies helped keep the collaborative efforts in sync. “All of the coordination and cooperation happened remotely through all tools for telework—text, call, email, telecon—because we involved agencies from all across DoD. Collaboration was essential to the rapid success of NPC,” said Lt Col Tim Mach, AMC Chief of Requirements.

“This was not how I expected to spend the month of May,” said Matt Kilmer from the C-130 Program Office. “But the overwhelming commitment from both the government and contractor teams has been amazing to watch. Because these teams came together and worked diligently, we will be able to field this critical capability to the warfighter in an amazing short period of time.”

Ten days of ground tests for the NPC were scheduled for early June after an Operational Utility Evaluation (OUE) C-17 flight. Additional ground tests of the smaller NPCLs were planned for mid-June involving three different C-130s. The NPC was certified and delivered to Ramstein Air Base, Germany, on June 24. It was accompanied by 16 experts from Joint Base Charleston, South Carolina and three members of the program office team to stand on alert status and train additional Airmen on the NPC. Providing an unrivaled mobility capability for the nation and our allies is the reason we come to work every day.”

Less than a week later, the system was activated to move COVID-19 patients. The NPC completed its first operational mission on July 1, moving 12 patients from the U.S. Central Command area of responsibility to Ramstein AB, to receive a higher level of care at the Landstuhl Regional Medical Center.

This mission was demanding because it required the use of the brand new isolation system, multiple stops, and critical care procedures.

“This was definitely not your typical patient movement mission,” said Maj Benjamin Weaver, Bioenvironmental Engineer and 10th Expeditionary Aeromedical Evacuation Flight NPC Support Team Lead. “It was a long 22 hours for everyone involved, but the NPC and team performed exceptionally well to make it happen.”

“Providing an unrivaled mobility capability for the nation and our allies is the reason we come to work every day.”

– Col Scott Ekstrom

While on the ground, the 521st Air Mobility Operations Wing at Ramstein AB was essential to the success due to their role in training the NPC personnel, loading the system onto the C-17, and sanitizing the aircraft and NPC for the next mission.

“Watching the team come together to train on this system in theater and then fly its first mission shows what can be accomplished when whole-of-government and industry partners work selflessly, sacrificing long hours and personal time in order to produce a solution that saves lives,” said Capt Alexis Todaro, NPC program manager who delivered the NPC to Ramstein for training and site activation. “It took a team of teams to get NPC from a concept to operational in under 100 days.”

“Providing an unrivaled mobility capability for the nation and our allies is the reason we come to work every day,” said Col Scott Ekstrom, Senior Materiel Leader for the C-17 Program Office. “The demand for urgent solutions to current problems is constant. Supporting an effort like the NPC/ NPCL development showcased our teams working together to rapidly affect the safety and security of our Airmen. I could not be prouder of the team.”