EMERGENCY PLANNING
A logistical challenge to get engineers on site
However, organising engineers to attend is a logistical challenge, and it can often take a number of weeks from the placing a first call to a manufacturer, to its staff arriving – even for emergencies. With the Falklands lagging behind the UK in terms of the effects of COVID-19, there is an additional 14-day quarantine period in force for anyone coming off the South Atlantic Air Bridge (the UK MOD flight from the UK). Given that any technical support staff we do get are likely to be stuck on the Islands – increasing the likelihood of no on-site support, we soon realised that any engineering issues would need to be addressed by our ‘in-house’ team. If the oxygen manufacturing plant remained operational, there would only be a constant supply of oxygen for 54% of expected patients, even taking into account the extra capacity provided by the newly supplied portable oxygen concentrators. The stockpiled J-sized bottles are expected to last 12 hours each, supplying 10 litres per minute, and with both plants running close to capacity, the ability to re-charge medical oxygen bottles would be lost.
Risk of contamination
There is a sizable cache of empty industrial oxygen bottles on the Islands waiting for return to the UK, but while it was confirmed that the KEMH does have the capacity to fill these bottles via its ‘bullnose’ connections, any contamination in the bottle cannot be verified. As medical oxygen is a pharmaceutical product, it is a drug administered by a doctor, and the risk of potential contamination was deemed unacceptable. BOC in the UK is, in fact, currently converting W-size bottles and supplying the NHS to make up the shortfall of J-size bottles, but the turnaround for getting emptied bottles to the UK, filled, and returned to us in the Falklands, would be too long. At the time of writing, the MOD has negotiated for a substantial number of converted W-size medical oxygen bottles for immediate issue, and is currently investigating flying the bottles to the South Atlantic. The UK MOD has secured an air separation unit
(ASU) – a cryogenic plant which will take liquid oxygen (LOx) and fill gaseous medical oxygen into either J- or W-size bottles (or any other-sized bottles). This is a significant piece of machinery, and will require three civilian engineers to install and commission, and a further five military personnel to operate on a shift basis. The capability uplift the ASU represents is considerable, as it can fill eight bottles simultaneously (both pin- indexed and bullnose), and it has enough LOx for 600 charges. The ASU itself will be installed at RAF Mount Pleasant, enabling the installation and operational crew to remain in quarantine on the base – eating, sleeping, and working separate from all other personnel, thus negating the need for the 14-day quarantine. The UK MOD, in conjunction with the Falkland Islands Government, will then look to ferry lorry loads of bottles to Stanley and the KEMH, where emergency bottle caches have been set up, as required.
Lucky thus far
In reality the Falkland Islands have been lucky thus far, as the number of COVID-19 patients has been relatively light. This has allowed clinical and engineering staff to draft new procedures for this unprecedented situation, and to see if they work, thereafter altering them as required. The ‘Plan, Do, Check, Act’ approach has allowed us to review and improve systems we have put in place – a luxury many countries have simply not enjoyed. The Achilles heel for the KEMH will always be logistical supply; however, we have enjoyed strong support from the UK MOD in this area. The Engineering team has been forced to consider actions they would not have to think about normally, raising issues in areas that were previously unknown, as well as successes in other areas. Our next focus will be to how to support the hospital if the current pandemic requires us to maintain this higher level of day-to-day activity for a sustained period. Our strategy here is to put arrangements in place so we can wind down to effectively carry on as normally as possible, and then simply revert to the higher operational tempo in short order.
Martyn Barlow
Martyn Barlow is the Estates and Engineering manager at the King Edward VII Memorial Hospital (KEMH) in Stanley on the Falkland Islands. He has been in post as the head of Hospital Engineering for 15 months, having, as he puts it, ‘been succession planned in’ from his previous role as deputy Engineering manager. In addition to his engineering management role, he also runs all the Health Department Capital Projects.
Initially a Royal Navy weapons engineer – a role with a heavy electrical control engineering bias – he left the Senior Service after 17 years while serving in the Falkland Islands in 2007, working as an electrical technician in the private sector, before being recruited to a facilities management role with the Falkland Islands Government (FIG) Civil Service.
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The air separation plant – cryogenic plant which will take liquid oxygen and fill gaseous medical oxygen into either J- or W-size bottles – had to be flown 8,000 miles to the King Edward VII Memorial Hospital in two specially laid-on aircraft.
26 Health Estate Journal June 2020
While with the FIG, he worked in the tertiary education sector for three years, heading the Falkland Islands Apprenticeship Scheme. This role included promoting engineering careers to young Falkland Islanders, such as in hospital engineering, and guiding workplaces on how to balance vocational and academic requirements to meet the expectations of local industry. He was invited to join the KEMH Engineering team in 2018. Alongside his hospital engineering responsibilities, he continues to teach, and assesses for the local college. He is studying for a BSc (Hons) in Management of Healthcare Engineering, Technologies and Facilities at Eastwood Park, although this course is currently in stasis due to the pandemic.
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