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Introduzione: il trasporto su strada in biocontenimento è essenziale per la gestione di pazienti affetti da patologie altamente trasmissibili, tuttavia nella letteratura civile mancano strumenti decisionali standardizzati a supporto dei trasferimenti su strada. Questo studio si propone di sviluppare un modello operativo per supportare le decisioni cliniche e logistiche in tali trasporti. Materiali e Metodi: è stato elaborato uno schema decisionale attraverso un'analisi retrospettiva di 1.994 trasferimenti effettuati in regime di biocontenimento in Sicilia tra dicembre 2020 e marzo 2022. Le variabili principali includevano le condizioni del paziente, l’impiego di dispositivi di supporto vitale e le caratteristiche logistiche del trasferimento. Il modello è stato perfezionato attraverso briefing strutturati post-missione, arrivando a classificare i trasferimenti in tre livelli di complessità (C1-C3) in base a criteri clinici e logistici. Risultati: i pazienti sono stati classificati in funzione della capacità di camminare, della necessità di monitoraggio o supporto vitale e del rischio infettivo. Sono stati identificati 590 trasferimenti ad alta complessità eseguiti mediante l’utilizzo di isolatori, mentre 1.403 casi a bassa complessità sono stati gestiti con un minibus di biocontenimento. Non sono stati registrati guasti alle apparecchiature critiche. Lo schema decisionale ha supportato una pianificazione coerente e ha migliorato la sicurezza operativa. Discussione: Il confronto con le principali raccomandazioni presenti in letteratura ha confermato la validità del modello e ha messo in evidenza criticità operative come la comunicazione inefficace e l’integrazione delle apparecchiature. Si propone l'integrazione dell’indice NEWS2 per migliorare la classificazione del rischio clinico. Conclusioni: lo schema decisionale proposto fornisce uno strumento riproducibile per classificare la complessità del trasporto sanitario in biocontenimento. È necessaria una validazione prospettica del modello al fine di garantirne l’applicabilità in contesti sanitari più ampi.   Introduction: ground biocontainment transport is essential for managing highly transmissible diseases, yet standardized decision-making tools for road-based transfers are lacking in civilian literature. This study aimed to develop an operational model to support clinical and logistical decisions during such transports. Materials and Methods: a decision tree was developed through retrospective analysis of 1.994 biocontainment transfers performed in Sicily between December 2020 and March 2022. Key variables included patient condition, use of life-support equipment, and transfer characteristics. The model was refined through structured post-mission briefings and categorized transfers into three complexity levels (C1–C3) based on clinical and logistical criteria. Results: patients were stratified by walking ability, need for monitoring or life support, and infectious risk. A total of 590 high-complexity transfers used isolators, while 1.403 lower-complexity cases were managed with a biocontainment minibus. No critical equipment failures were recorded. The decision tree supported consistent planning and improved safety. Discussion: Comparison with literature-based recommendations confirmed the model’s validity and highlighted operational issues such as miscommunication and equipment integration. Integration with NEWS2 is proposed to enhance risk stratification. Conclusions: the proposed decision tree provides a reproducible framework for classifying biocontainment transport complexity. Prospective validation is needed to support its application in broader healthcare contexts.

Introduction: ground biocontainment transport is essential for managing highly transmissible diseases, yet standardized decision- making tools for road-based transfers are lacking in civilian literature. This study aimed to develop an operational model to support clinical and logistical decisions during such transports. Materials and Methods: a decision tree was developed through retrospective analysis of 1.994 biocontainment transfers performed in Sicily between December 2020 and March 2022. Key variables included patient condition, use of life-support equipment, and transfer characteristics. The model was refined through structured post-mission briefings and categorized transfers into three complexity levels (C1-C3) based on clinical and logistical criteria. Results: patients were stratified by walking ability, need for monitoring or life support, and infectious risk. A total of 590 highcomplexity transfers used isolators, while 1.403 lower-complexity cases were managed with a biocontainment minibus. No critical equipment failures were recorded. The decision tree supported consistent planning and improved safety. Discussion: comparison with literature-based recommendations confirmed the model's validity and highlighted operational issues such as miscommunication and equipment integration. Integration with NEWS2 is proposed to enhance risk stratification. Conclusions: the proposed decision tree provides a reproducible framework for classifying biocontainment transport complexity. Prospective validation is needed to support its application in broader healthcare contexts.