After earthquakes or other types of disasters, infrastructures are often damaged and local hospitals destroyed. A modular hospital, developed under the direction of the European Commission’s Humanitarian Aid and Civil Protection Department is designed to be ready for these types of disaster situations and support the emergency response.
We are talking to Professor Thomas Neumuth about the structure and application of a modular hospital and discuss the role the Innovation Center Computer Assisted Surgery (ICCAS) plays in this setting.
Professor Neumuth, what challenges does medical (emergency) response face during a disaster situation?
Prof. Thomas Neumuth: The biggest challenge is to still be able to help all patients despite having significantly fewer resources at your disposal than you would have in a "normal" situation.
How can we imagine a modular hospital?
Neumuth: It is a fully functioning hospital with at least two operating rooms, an intensive care unit with critical care beds and – depending on the nature of the disaster and services needed – various units and departments. The entire hospital is made up of tents that are connected to each other to where everything is completely covered. The tents are arranged according to a floor plan, allowing for the set-up of the different response units. In other words, you can move within the tents the same way you would move within a normal hospital. This creates a hospital that can be transported to any place in the world.
There are different requirements placed on special units depending on the reason for the hospital activation. Experiences of the WHO from the past few decades indicate the different patterns of injuries that occur during various natural disaster settings. Injuries acquired in an earthquake scenario differ from injuries obtained during a flood or the medical care that's needed in a refugee camp. There are more cases of contusions and bone fractures during earthquakes. Meanwhile, refugee camps feature any types of disease patterns you might also encounter in a European city hospital, ranging from appendicitis to C-sections. This requires a different structure of hospital capacities. Depending on the situation, you need to set up those departments and units that can optimally treat the disease patterns associated with the type of disaster.
What makes this type of hospital different from a "conventional" hospital?
Neumuth: The biggest difference between the two is that this type of hospital can be transported to any place in the world and set up within three days. You can imagine it this way: if there was an earthquake in South America tomorrow and the local infrastructure along with the local hospitals were destroyed, this type of hospital would be activated and transported to this location. It is set up within a very short amount of time and staffed with the respective trained medical experts. The goal is for the hospital to commence operations no later than three to five days after the initial event.
Why is there a need for this type of hospital?
Neumuth: You need this type of hospital once the local public health infrastructure has either been completely destroyed, after an earthquake, for example, or the function of the local infrastructure has become significantly restricted. Depending on the needs and requirements, the hospital then remains in the disaster-stricken area between two weeks and three months. It provides a type of interim assistance until the respective country ensures that its own health care infrastructure is up and running again.
What are the responsibilities and duties of the ICCAS in this project?
Neumuth: We take care of the hospital technology, that is to say, we look after both medical informatics and medical technology. Medical informatics pertains to patient registration for example. The moment patients enter the hospital, they are admitted to the triage unit and evaluated by a physician to answer questions such as what types of injuries patients have and the level of severity. What units are patients assigned to? Might outpatient care be sufficient in some cases? The patient's demographic data and name is being recorded. This is done via an electronic patient record. During the course of patient treatment, all actions are documented in this patient record. Once patients are discharged, they obtain a copy of their treatment records. At the same time, the respective country also receives the data about the injuries that were being treated.
We ensure that ideally there is not a lot of usage of paper because you can only use paper once and it doesn't provide real-time information. That is to say, at any given time, hospital management needs to know how many patients are at the special units, how many beds are available, how many patients have been discharged or are still to be released. This type of information is needed instantly. Data on the consumption of bandaging materials or medications must also be available at all times to reorder items at the right time. Management needs to know the status quo or patient conditions in the hospital to manage, collect data and to pass on information.
What are the challenges? What do you have to pay special attention to in this case?
Neumuth: You really need to make sure that every patient is recorded in the system and that there are no mistakes and mix-ups. What's more, patients might speak a different language from the physicians since the hospital staff is recruited from European countries. This is a challenge all by itself because a nurse from Bulgaria works with a French doctor for example. They must be able to work together, share a common language and document the treatment in this common language. They have to be able to treat and educate patients according to the recommended guidelines and abide by the local, cultural conventions.
What is the current stage of the project and what are the next steps?
Neumuth: We are presently in the specification phase. For two years, the processes are being specified: what are the modules? Which specialty units are needed? How should the information systems work? What are the transport routes? What is the activation process? What does the withdrawal process look like at the end of the mission? Implementation starts around 2019. This is when the equipment is being obtained for the operation and the procedures for the training of the multinational hospital staff are being implemented. Starting in 2020, the hospital will be ready for its first operation.