Medical and Hospital

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Introduction

Mobile Hospital Solutions with NATO standard. Uniteam, together with the Norwegian Army Medical Service, found their initial goal to develop a mobile hospital, able to cope with the difficult conditions of disaster and war. This process was initiated in 2000 and has been modified following experience from in-field testing in 2001, NATO Strong Resolve exercise and NATO Field Surgeon Live Training Exercise in Norway 2002.

Several newly developed technical systems have been adopted to refine the concept after NATO standards. The guidelines for projecting has been: easy relocation, short set up time, rugged basic technology, easy maintenance and good working conditions for doctors and nurses equal to civilian hospitals of European standards.

The main idea is that situations with a large number of several wounded patients by itself offer a great challenge, and fighting with complex or non-functioning equipment will only contribute further to chaos and mental paralysis, the key elements of any disaster. Subsequent to this, good functioning equipment, present and ready, is necessary to manage a medical disaster.

The following has then, through the process of development come to be the characteristics of the concept based on the Uniteam “3in1” Operating Theatre.

Flexibility and wide applications

The Mobile Hospital Units is very well fitted for civilian disaster as well as military war medical services. Easy handling/operation and sturdy manufacture makes it possible to use this Mobile Hospital Solutions at locations of urgent needs.

The comprehensive technical and logical systems will permit final treatment of the majority of the patients if necessary.

By our decentralized technology, with small support machines placed in each of the units, you will obtain max flexibility; “STAND ALONE CAPABILITY”!

The units can then be operated separately or as a whole without much planning and installation. Light weight technology with extensive use of aluminium, makes the units easy to move and prepare for use at site. 

From the user’s point of view

The Mobile Hospital Solutions have the appearance of an international hospital and with equivalent equipment. Well-trained staff, as doctors and nurses, will immediately be able to operate the units without previous retraining for field medical service.

Using a central containerized treatment zone in one level, patients may be rolled in their bed to the site of examination or treatment, pushed by one person.

Consequently less staff is needed to prepare and run this hospital compared with tent hospitals or hospitals improvised in existing buildings.

Possibilities for treatment

In the Operation Theatre there are 1-2 working stations equipped for resuscitation and stabilization of trauma cases as done at a regimental aid post or battalion aid station. One of these working stations is equipped so further major surgical emergency operations can take place as usually in a field hospital.

By moving one Operation Table to the walls, the Operating Theatre is enlarged considerably, and in this way it will be possible to include several assistants during complex operations, and to teach as well.

There can also be placed 2 Intensive Care (ICU) working stations in one end of the operating theatre, for effective use of the anaesthesiologist. The most rational use of the anaesthesiologist in a single operating theatre unit is obtained with the following rotation system:

• Induction of anaesthesia on one station,
• Surgery in the operating theatre,
• Recovery at the third station

In this way the anaesthesiologist will be able to manage 3 patients in rotation.

Anaesthesia may be of inhalation type, intravenous, regional or local. Explosive inhalants should be, and is, avoided.

Treatment is only limited by instruments available and by the skills of the staff.

Hygiene

The criteria for a good level of hygiene in a mobile field hospital in addition to strong hygiene discipline by doctors and nurses are:

• Easy cleaning of the units
• Sufficient sanitary installations
• Sufficient room to carry out correct procedures
• The possibility to maintain order
• Stabile temperatures in the treatment and recovery zone.

All of this has been taken care of in the UNITEAM Mobile Hospital Solutions:

• The surface of walls, ceiling, floor and equipment is smooth and will stand soap and disinfectants.
• In each unit there is running water with a sink and local UV water purification.
• A convenient indoor climate reduces perspiration.
• Consistent use of cupboards with trays permits the use of one tray for one procedure, and facilitates maintaining of good order.
• Equipment which is easily contaminated during procedures, can be clicked off from the equipment rails to be cleaned and disinfected in a sink or sterilized.

In this way hygiene becomes a natural routine, which will not be compromised even during heavy stress situations.

 

Balanced technology

We have succeeded in selecting and developing technical equipment, which is rugged and easy to maintain, and it is our experience from field work that after one week of introduction, a UNITEAM Mobile Hospital, can be maintained by one person without special pre-qualification. Maintenance will require about one hour’s work daily.

After 3 month’s in service more extensive servicing is necessary, especially concerning change of filter components. Special procedures must be followed if the units are going to be stocked at temperatures below 0°C.

The decentralized technology, which may be found in relevant units includes:

• Oxygen system with oxygen generator, and oxygen cylinder back up.
• Laughing Gas system with pressure guard
• Vacuum system with pressure stat-controlled vacuum pump.
• Medical air compressor to support of medical air, and to run surgical tools and ventilators.
• Air-Conditioning incl. cooling/heating of fresh and recycled air.
• Thermostatic electrical heating panels or integrated floor heating.
• Humidifier is supplied to prevent corrosion during storage – will support inner climate as well when many people work together.
• Water is led to the unit through insulated frost-secured hose and stored in a local water tank in technical compartment of each unit.
• Local water purification is based on both filtering and UV-treatment. (Water must be taken from a non-toxic source and preferably chlorinated.
• Water is heated online in a thermostatic immersion heater.
• Grey water pumps are placed at each waste-pipe outlet. Waste water is pumped to external sewage tank, through an insulated frost-secured hose.

   

   

Equipment

Equipment list could be adapted to customers needs.

• The instrument kits, supplied in sterilization boxes, are equal to typical equipment at modern hospitals. Only equipment from recognized suppliers is used.
• For Operating Theatre Unit to be used separately, without sterilization unit available, an autoclave with small outer dimensions, but with (320*320*620mm) chamber dimensions, is recommended. This small autoclave has a double chamber, and re-circulation of vacuum pump water.
• The anaesthesia machine includes the following features: Oxygen, N²O and pressurized air flow metres, universal evaporator, a volume controlled ventilator with “bag-in-bottle” system. The anaesthesia machine has 3 back-up systems (“draw over” possibility e.g.) making anaesthesia safe even under critical conditions. It is delivered with a circle system to save gases and with a disposable coaxial system for simple use and for quick change of patients.
• The respirators for Post Operative ventilation are equal to the one used in the anaesthesia machine.
• The main Operation Table is hydraulic and adjustable for all types of surgery.
• The second Operation Table is mechanical and ready for X-Ray examination and operations.
• The operating lamp equipped with twin heads is rail mounted or swivel mounted in the ceiling.
• During transportation all equipment is strapped or fixed to the walls.

   

   

The field environment

It is assumed that the units will not have to resist bombshell fragments or other impact from artillery and heavy missiles.

If intended for a tactical environment the units will be delivered without windows or with plastic windows at your request.

The roof can be sandbagged with max load of 80 kg / square metre.

The Mobile Hospital Shelters is of course rainproof, and chemical agents will not penetrate the unit. The unit is sealed when fully employed, and application of a slight positive pressure will prevent ingress of hazardous vapour.

The air-conditioning module of the unit can have integrated EU7 and NBC filters. Combined with an air-sluice and decontamination tent, it can thus be used as a collective protection area, incl. all necessary precautions.

The unit is built from materials able to resist decontamination with aggressive matters such as DS2, and the smooth surfaces make decontamination easy.

Uniteam Mobile Field Hospital Modules

Other modules than the Operating Theatre in the Mobile Hospital System can with success be built into 3in1 units:

• Reception/Triage Unit with 2 treatment stations
• Emergency Unit with 4 treatment stations
• Intensive Care Unit with 4 ICU stations
• X-Ray unit with conventional or digital x-ray machine and C-Arm.
• Pre-OP/Laboratory Unit with range of modern laboratory machines, toilet and sluice room.
• Post-OP/Recovery with 6 recovery beds
• Pharmacy/Administration Unit
• Dental Unit with 2 treatment stations.
• Sterilization Unit with instrument washing machine, instrument dryer, Qty 2 large 2-door Sterilizers (Autoclave), sealing equipment. The unit is divided into a clean ”controlled access section” and a “general access section”.
• The different units can be selected according to the needs of client, and easily combined to different rational Level 1-3 Mobile Field Hospitals configurations.

All medical units are united together by tent connectors and/or containers, giving the total treatment area flat floor and easy access to different treatment stations.

Accessories

• Medical Gas Installations
• Local Compressor for Medical Air
• Laminar airflow
• Local water storage
• Integrated Power Generators, adapted to the expected power consumption.
• Levelling jacks
• NBC Filtration

Support and implementation

Uniteam technicians are used to travel under all conditions, and can assist in installation, user training programmes and maintenance programmes all over the world.

References:

Our hospitals are currently in service with

• The Norwegian Army Medical Corps (currently deployed in Afghanistan)
• The Swedish Army United Nations Mission in Kosovo
• The Norwegian Air Force Immediate Reaction Fighter Squadron (NBC Protected Medical Facility)
• The United Nations Mission in Sierra Leone (100 bed hospital)