EMERGENCY PLANNING
such projects remain suspended at the moment. It was clear early on that in order to meet the threat of COVID-19, the KEMH needed to secure extra medical equipment such as bottle regulators, Continuous Positive Airway Pressure (CPAP devices), ventilators, portable concentrators, and all their associated consumables to name a few. It was also anticipated that some of these items would either be difficult to source, or that there would be significant lead times due to demand. One of the issues for the Falklands is logistical supply given the vast distance from the UK, so things are usually transported by sea, but this is a 6-8 week process, and that is also dependent on the items being shipped being available right away. The MOD greatly assisted the Falklands Health Service, with a priority stores route established to allow us to fast-track critical items relative to COVID-19 straight to the islands. The UK Military need to maintain an operational capability wherever they are deployed, and this includes the Falkland Islands. If any of the tri-service personnel based in the local military base become ill, they could would require hospital support, and to that end, elements of the British Army 16th Medical Regiment were deployed to the Islands and stationed in the KEMH, augmenting the civilian staff; with them came extra medical equipment, increasing KEMH’s capability further. This opened up another potential logistical supply route, and with access to previously unavailable military equipment, the British Army staff and their equipment would be used to treat any patients irrespective of whether they were civilians or members of the armed forces.
Zoning in to ‘Hot and ‘Cold’ As contingency planning continued, it became evident that without the ability to confirm that patients were free from the virus, it grew increasingly unlikely that the critical Aeromed evacuation could be relied on. That opened up the possibility the hospital would need to treat more seriously injured patients, as well as for caring for those showing signs of
A bottle filler at the hospital – one of the prime concerns of the Engineering team was the resilience of the medical oxygen system.
coronavirus. The hospital was immediately zoned into ‘Hot’ (C19 patients) and ‘Cold’ (non-C19) areas. The normally resident, elderly care patients were moved to another location, where they remain shielded, to protect them, and free up space within the KEMH. The area they had occupied now became the Cold Ward, while the existing area dedicated to secondary care became the Hot Ward. Further planning for escalation of the Hot Ward was also considered and put in place. Part of these plans required taking over a detached house normally used for sheltered housing and converting it to act as the Cold Ward, should the Cold Ward need to be moved.
Supply and extract system adjustments As the hospital was zoned, the ventilation requirements were considered, and supply and extract systems reconfigured or isolated as required. A main consideration was reducing the potential
for contamination, while another was to maintain air supply for the Hot Zone care workers, as there was a potential for staff wearing PPE to overheat. Most of the dedicated ventilation systems remained in the ‘Cold ‘areas of the hospital. However, the ‘general vent’ supplies both the Hot and Cold wards, as well as other areas, and so careful consideration was required. One of the prime concerns of the Engineering team was the resilience of the medical oxygen system. Due to logistical challenges, the KEMH manufactures medical oxygen via two identical O2 concentrator plants. This is directly piped to the various areas that need it, which totals 39 points. The system is designed for one concentrator to run with the other in standby, with extra resilience afforded by two banks of three J-size bottles, which are independently switched. There remains an extensive supply of J-sized bottles held in reserve for the emergency bottle bank, and by chance an extra supply of medical oxygen bottles was already ordered when the pandemic started. The plant also has a small compressor, which can be used to charge medical O2bottles, but as a small such unit, charging one J-size bottle takes over two hours.
PHE patient modelling When the KEMH received the Public Health England (PHE) COVID-19 patient modelling, it painted a very bleak picture of needing to cater for 300 per cent more patients than the hospital was designed to hold, with the Falkland Islands Chief Medical Officer confirming that the only patients being admitted would be those requiring oxygen. This created a huge problem, since as things stood, there was no way of delivering a sustained oxygen supply to that many patients, and it was not lost on the staff that they would probably know most, if not all, of the patients being admitted, which potentially included colleagues and family members. With no possibility of an Aeromed, and no chance of sending patients to another hospital, any breakdowns of critical systems would need to be repaired by the Engineering team, since site support
A ‘Cold’ ambulance with drive-in swabbing space. IFHE DIGEST 2021
A ‘Hot’ ambulance with COVID assessment path and signs. 31
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