EBME
contingencies in place – especially during winter months. “In the Gulf War, for example, electrical generators and consumer units were added to the electrical systems for field hospitals, to enable a greater draw of power. Ensuring there is enough current per bed space is vital,” he commented.
Clinical engineers rise to the challenge
While getting the commissioning strategy right is vital, scaling up the huge number of skilled clinical engineers on site was also a major undertaking – the response to the emergency was overwhelming. “The Health Care Science (HCS) community was essential in providing a willing and skilled workforce to step up to the challenge of providing 24/7 support to the clinical teams on the COVID ward,” commented Malcolm Birch, director of clinical physics at Bart’s Health – the host NHS Trust for the Nightingale London hospital. “Scientists from numerous HCS professions responded to the call from the London network, who then managed their focussed training prior to joining Nightingale teams where they were led by experienced Bart’s clinical engineers,” he explained. Many of the institutes and the
www.EBME.co.uk website also got involved in gathering volunteers from the clinical engineering community. “As an educational resource, we shared information on the EBME forums. There was an openness and an exchange of knowledge across the sector. During these unprecedented times, the clinical engineering community came together to understand what the commissioning issues were – the response was phenomenal. Sharing information across these platforms helped to accelerate the process of getting the field hospitals up and running,” commented Dr. Sandham.
He added that clinical engineers inside UK hospitals worked extremely long hours to transform normal medical space spaces into intensive care bed spaces: “Engineers were working 14-16 hours per day to get all of the equipment commissioned. This included
Intensive care bed at NHS Nightingale London.
the postponement of normal elective surgery, so the operating theatres could be converted into intensive care bed spaces. 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.
“Many of the engineers volunteered and put themselves at risk, not in the same way as nurses and doctors, but they went into environments where there were lots of people – especially on the Nightingale projects in London, Manchester and Birmingham. While they were doing their best to ensure social distancing, the equipment they were working on had been handled by many other people. There were also shortages of PPE. Yet they still carried on working. In extraordinary times like these, engineers pulled out all the stops to ensure lives could be saved.”
Operational delivery
A large team of engineers – including teams from MTS Health, Avensys and Althea – worked tirelessly and collaboratively together on the London Nightingale site. Having initially set up the governance processes for commissioning equipment, MTS, led by Andrew Frost, director of technical services, managed an on-site team, working closely initially with the Capital Projects team from NHSE London and latterly with Bart’s Health
The crisis has demonstrated the paramount importance of clinical engineering to both the technical and clinical governance of medical equipment, particularly, in this case, within the ICU – but also across the delivery of safe and
effective healthcare in our Trusts. Malcolm Birch
28 l
WWW.CLINICALSERVICESJOURNAL.COM
(the host NHS Trust for London). Once the hospital became operational in early April, the MTS Health team was retained to work in partnership with the Bart’s Health Clinical Physics team – comprising the core Bart’s clinical engineering team, led by Malcolm Birch, and volunteer clinical scientists who undertook specialist training. Working collaboratively, these teams provided full clinical engineering and management support for all medical devices, as clinicians cared for patients during the global pandemic.
“It was an incredible achievement to turn around the Nightingale Hospital in London in under two weeks. Industry and the public sector collaborated effectively, crossing traditional divides. In normal circumstances, there is an element of reluctance in the NHS to engage with the private sector. During this pandemic, all of this was swept away, and everyone pulled together. It was ‘all hands to the pump’,” commented Caroline Finlay, managing director of MTS Health. She reported that the clinical engineering teams had to work closely with users to assist them in adapting to unfamiliar equipment: “There was a lot of equipment that had not been seen before, in this country – including a variety of Chinese technologies and ventilators from Sweden,” she explained. “As there was a lot of unfamiliar equipment, the clinical engineers on site had to be on top of their game – not just in terms of setting up the equipment, but also in ensuring users had the right training. The clinical engineering teams provided a vital role in helping users navigate their way through these changes.” The London Nightingale hospital segregated clinical areas and non-clinical areas, separated by what was known as the ‘Berlin Wall’, to enable work to carry on safely, to equip the additional beds on site. “As patients occupied the Nightingale- style wards, a system was set up where the Bart’s healthcare scientists and clinical engineers worked within the clinical environment in full PPE, while the MTS and Avensys clinical engineers worked on the other side, with a buffer zone in between. “The buffer zone was where we interacted on a day-to-day basis and conducted handover meetings. We had two handover meetings with the clinical teams per day and there were clinical engineers working 24 hours around the clock,” Finlay commented.
Challenges
Althea’s specialist biomedical engineers also played an important role in helping to set up the Nightingale hospital in London, during the first phase of the project. “The biomedical engineering team was really responsive to a fast-moving situation and worked well beyond their contracted
OCTOBER 2020
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