Trans RINA, Vol 157, Part C1, Intl J Marine Design, Jan –Dec 2015


with equipment and torrential rains, which slowed their initial response. Progress was further exacerbated by logistical errors. The American troops constructed 18 Ebola treatment centres, each with a capacity for 100 patients. They each took 3 weeks to build with the support of local contractors. [4]


1.1 FIELD HOSPITALS


A field hospital (FH) is a mobile, self-contained and self- sufficient


health care facility capable of rapid


deployment and expansion or contraction to meet immediate emergency requirements for a specified period of time. The World Health Organization (WHO) and Pan American Health Organization (PAHO) have developed


guidelines for the use of


hospitals: 


  foreign Field


Hospitals in the aftermath of sudden-impact disasters outlines


preconditions for the deployment of field


Following an appropriate declaration of emergency and a request from the authorities of an affected country


When they are integrated into the local health services.


When the respective roles and responsibilities have been clearly defined


They have formulated guidelines for the use of foreign field hospitals after sudden-impact disasters and divided the response into three phases:


 





First 48 Hours: Early advanced trauma and emergency medical care


Day 3-15: Follow-up care for trauma cases, emergencies, routine health care and routine emergencies


2nd Month up to 2 Years: Rehabilitation, temporary facility to substitute damaged installations pending final repair or reconstruction


FHs and foreign medical teams (FMTs) have been deployed for decades by a host of agencies and groups to provide medical and surgical services to populations affected by disasters and war. Usually operating in austere and insecure environments, the units provide temporary substitutions


for collapsed and non-


functioning local facilities. Field Hospitals continue to evolve over time in the breadth of services offered, technologies


mobility and modularization. We have also observed increased ‘non-traditional’ deployments over the past five years to non-sudden onset disasters, mainly epidemics (Cholera and Ebola). The current Ebola outbreak in West


Africa is and various


overwhelming local authorities, humanitarians


responders


challenging and governments, to


sufficient beds and expertise to cope with this epidemic. Amongst other factors, logistics and availability of


C-164 provide deployed, infrastructure, rapid set up, 


skilled personnel locally and internationally continue to hinder the expansion of clinical care.[5]


Managing deployment of logistics with timely arrival of teams to achieve a rapid response is a challenge in sudden onset disasters. Again, coordination here proves to be paramount, and swiftness would be increased if agreements with host countries were in place and FMT pre-registration existed. Those benefits are augmented by the presence of guidelines, central command, solidarity and political alliances. Logistics can be one of the most expensive parts of a disaster response. Several studies estimate that they account for approximately 80% of the funds spent on a disaster response. With human lives at stake, efficient delivery, transportation and distribution of logistics are vital parts of


relief operations. The


uncertainties about the location, magnitude and nature of the next disaster are constant challenges for humanitarian response and underline the importance of preparedness and flexibility in terms of supply chain set-ups and management. As a well set up supply chain can reduce the emergency element. Field hospital providers are encouraged to identify their strengths and weaknesses with


regards to logistics and to predetermine their


abilities and capacities to either supply or outsource them. After the earthquake that struck Bam and surrounding areas in south eastern Iran in 2003, a global consultation concluded the following timing lessons:





FH equipped to provide emergency medical care for trauma are useful only if they are available and on-site within the first 24 hours. No hospital arrived in Bam before the third day. Despite sending 25 surgeons, three field hospitals carried out only 15 operations, demonstrating that sending surgeons three to five days after impact is not cost effective.


Once a FH is operational, it should remain on- site for a minimum of 15 days, allowing for follow up (secondary) care of trauma and routine medical attention. In Bam, the main purpose of one of the FHs was delivery of primary health care services, and because it remained in Bam for just one week, not many patients benefited. [5]


The World Health Organization recommends a FH layout [6] that tries to keep people who are suspected of having the virus separate from patients with confirmed cases. The international community built 27 of these facilities in Liberia. The operational detail of the FH layout is delineated in Figure 2, including basic resources and staffing levels. The MSF FH for Ebola treatment [7] is shown in Figure 3. Setting up a field hospital requires substantial logistical effort within a challenging deadline. Disaster areas usually lack the resources and infrastructure to support such a project. The innovative MSF inflatable field hospital (Figure 4) does not only provide a rapid ready-made plug-and-play solution to


© 2015: The Royal Institution of Naval Architects


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