EBME
on a pallet and they had to commission it quickly. “The time this process took depended largely on the equipment – a highly complex intensive care ventilator, for example, would take an hour to commission, while a simple oxygen flow meter would take five minutes. For a bed space with 15 pieces of equipment, the average commissioning time at these emergency field hospitals was reduced 20-30 minutes per device. When you have a complex, such as the Excel or NEC Nightingale Hospital, where there are thousands of beds, this is a huge undertaking – but, to achieve this in a matter of weeks, rather than many months, was even more of an undertaking,” he commented.
Strategy to reduce commissioning time for field hospitals
Commissioning equipment in an emergency (COVID-19) ITU field hospital requires medical equipment engineers and technicians on site, plus support staff to: 1) Unpack the equipment and give a quick physical inspection for transit damage;
2) Add it to the computerised asset management database;
3) Take it to the designated bed space; 4) Install it onto the bed, wall, drip stand, etc;
5) Connect the devices to electrical and/or compressed air and/or O2
supplies;
6) Electrical safety testing (Class 1 patent connected equipment only);
7) Functional testing (basic checks); 8) Signing off on a database for use.
The first four of these tasks can be performed by the armed forces or semi-skilled volunteers, while tasks 5-8 require specialist EBME expertise. Dr. Sandham explained: “The armed forces supported the logistics, helping with unpackaging, putting together of the trollies and stands, and generally getting everything ready for the clinical engineers to commission the equipment. However, often there was an element of assembly and attaching the accessories that required a full understanding of the way that
The Bart’s team at the NHS Nightingale London.
to the emergency situation? Dr. Sandham explained that it is vital to use a ‘stripped down’ procedure, to minimise administration and pre-use testing when setting up these types of field hospitals. On projects, such the Nightingale sites, key questions for the commissioning manager include:
Do we need to keep a computerised asset management system?
A computerised asset management system is essential – in the event of a safety alert being issued, it is important to know where devices are located, for example. Any devices that are rented or on loan also need to be identified, located and returned. Furthermore, if a fault is reported, the device will need to be found, repaired or replaced and a record made of the work completed. A computerised maintenance management system (CMMS) will help keep track of the work and to automate some processes.
Which devices should be electrically safety tested? Class 1 (earthed) equipment should also receive an automated safety test. (IEC 62353 – see
https://www.ebme.co.uk/ articles/electrical-safety/electrical-safety- testing-in-accordance-with-iec-62353). Where equipment is double insulated (class 2) equipment, the risk is very low, and there is no need to electrically safety test.
Before the Nightingale Hospital, at London Excel, became operational
equipment worked operationally. It should be acknowledged that being a clinical engineer requires a good understanding of physiology and the clinical application techniques used within the clinical environment.” The quick turnaround of these engineering installations was a major achievement, so how did engineers adapt
In my 35 years of working in this sector, I have never seen the clinical engineering community come together in the way that it did. It was amazing to see how quickly they turned around the equipment to
ensure it was available for patients. Dr. John Sandham
OCTOBER 2020
Is a physical inspection necessary before use? A physical inspection to check for any obvious signs of damage must be done by the person unpacking the device. This doesn’t need to be an engineer.
Is a functional test required? All equipment requires a functional test, but in many instances, this can be done without test equipment by the user, especially for small battery powered items such as thermometers, oxygen flowmeters, air flowmeters, suction regulators, etc. The equipment must be risk-assessed and separated into ‘device groups’, then commissioned in line with the rapid commissioning process. Patient warming devices, in particular, present challenges in non-standard field hospital environments, as they draw a lot of current, Dr. Sandham explained.
“In large spaces, such as the exhibition halls, where the ambient temperature can drop significantly, patient warmers are required to keep patients comfortable and normothermic. However, large field hospitals are not designed for the high current loads required by large volumes of intensive care equipment, so there needs to be
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