MOBILE HEALTH FACILITIES
Mobile healthcare units arrive on the island.
not ideal for patients to have to travel long distances for treatment. In the immediate aftermath of the fire, a field hospital made up of military style tents was also deployed to provide some interim care. Although this was not a viable solution
for the entire anticipated period of renovation, the local response allowed the CHU time to thoroughly assess the damage and the extent of the repairs needed to return the hospital to functionality. Renovations to the structural aspects and the ventilation ducts were deemed necessary to ensure a safe and compliant environment for both staff and patients, but this would take several months to complete and possibly as long as a year. In the interim, the French government called in medical services specialist Idimed to provide a local answer to the sudden gap in patient care.
Challenges and solutions Idimed proposed bringing together technical advances from across Europe: mobile healthcare facilities from UK company Q-bital Healthcare Solutions; architectural planning and enabling works from Dutch specialist Young Medical; medical gas installation and commissioning from Meditechnik; and specialist ventilation systems from Modderkolk in the Netherlands. Representatives from these companies were able to be at the hospital within days of the fire and consulted with experts from the clinical team, the workers’ unions and the island’s health ministry. Together, the multinational team designed a temporary surgical complex that would provide greater operational capability than the field hospital deployed in the immediate aftermath of the fire. There were many diverse challenges
to overcome to deliver this innovative solution. The first of these was environmental. Guadeloupe is an archipelago in the Caribbean and has a tropical climate. Not only does it experience high humidity all year round, which is often at 90 per cent or above, it is also subject to a lengthy rainy season and is at risk of hurricanes in late summer and early autumn. In order to develop a temporary building complex robust enough to maintain service provision through these variable conditions, special air handling systems were installed to pre-
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cool the air before it entered the ventilation systems for the operating theatres. These systems chilled the air to about 14˚C, which dehumidified it, before passing it into the operating theatre facility. Once within the ventilation system in the theatre, the air was brought back up to 16˚C and humidified to provide the optimum conditions for surgery. This two- stage system ensured that the theatres’ air handling systems were not overloaded and performed to the optimal standard, and that staff and patients experienced a comfortable, compliant environment throughout the complex. Technical challenges also faced the
project team. The CHU is located almost at the top of a hill and the space chosen for the complex was on uneven ground. This site provided the most immediate access to the necessary support services within the undamaged parts of the hospital, meaning that it was the best position in which to ensure patient safety and easy workflow for staff. It was critical that the facility was as stable as a permanent building, so extensive preparation work was required to make the location suitable. The land was levelled off and hardstanding was laid, but the problem of weatherproofing remained. To ensure that the complex was as safe
and robust as possible, a local contractor with experience in healthcare construction was called in. Together, they designed a concrete structure with elevated plinths, interconnected by concrete beams to create one cohesive foundation. The mobile units were lowered and then secured onto the concrete plinths,
ensuring that the feet of the facility remained dry. In this way the total weight of the complex was judged sufficient to protect it from being lifted by hurricane force winds and the entire complex would move as a whole in the event of earth tremors, reducing the risk of damage.
Regulatory concerns Other technical challenges arose from regulatory concerns. As the facility was intended to provide emergency and trauma care, which includes orthopaedic cases, the operating rooms had to offer suitable clinical environments for this infection sensitive surgery. For this reason, mobile operating theatres with laminar flow ventilation were shipped to the islands from Southampton in the UK. In addition, a post-operative recovery ward with HEPA air filtration was deployed, as well as an additional unit to provide staff with a changing area, a welfare zone and an administrative area. The administrative area also served as the gateway to the new complex, ensuring that access could be suitably controlled by staff. Project management staff also liaised closely with the hospital teams to ensure that local safety standards, such as fire safety, electrical safety and water testing, were adhered to. From a clinical perspective, one of the
greatest challenges was introducing medical gas into the theatre complex. Mobile facilities are usually served by integral medical gas banks from cylinders, but in this case the projected duration of the project and logistics made it more appropriate to pipe medical gases in from
The complex is built on special wind and earthquake resistant foundations. IFHE DIGEST 2019
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