hospitales modulares

Disaster Response from A-Z!

PreparationResponseReconstitution

“Change is Hard”

Begin with the end in mind

FINISH

It is time for innovation!

Change Is Hard

Recommendations for Post Disaster Recovery

1. Preparation is critical to success.2. Response must be properly planned and practiced.3. Reconstitution must start very quickly:

a. Soft sided shelters right now are the only “hours” response.b. Component construction can provide a meets all standards healthcare facility in months, not years. This step gets you out of tents, back to “meets standards”. c. Long term earthquake resistant multi-story buildings can then be constructed, using existing models, in 18-24 months if needed for the long term.d. Once the multi-story is complete, you can dismantle the component construction, put it in other areas of the country that are under-served, use it daily, and then you have a strategic reserve if another disaster occurs.

Disaster

PreparationLocal

ResponseReconstitution

Basic Equation to Solve Disasters

Time 2 8 16 24 32 40 48 56 64 72

Regional Response

Natural History of Disasters That Produces

CasualtiesOr

Destroy Medical Facilities

Cap

acity

of

Med

ical

Car

e

Time 2 8 16 24 32 40 48 56 64 72

Steady State Capability Medical Capacity

Demand

“When Disaster Strikes”

Demand Driven

Demand

Disaster

Demand exceeds supply

Unmet demand = excess deaths

Cap

acity

of

Med

ical

Car

e

Time 2 8 16 24 32 40 48 56 64 72


Demand

“When Disaster Strikes” IF local facilities and people are

intact THEN they can respond

Demand Driven

Demand

Local Surge can fill to a certain degree!

Disaster


Cap

acity

of

Med

ical

Car

e

Time 2 8 16 24 32 40 48 56 64 72


Demand



Demand Driven

Demand

Local Surge

Disaster


Cap

acit

y o

f M

edic

al C

are

Time 2 8 16 24 32 40 48 56 64 72


Demand



Demand Driven

Demand

Local Surge

Disaster

Excess deaths down to steady state from trauma.


Cap

acit

y o

f M

edic

al C

are

Time 2 8 16 24 32 40 48 56 64 72


Demand



Demand Driven

Demand

Local Surge

Disaster

Unmet Demands = Excess Deaths

Increase due to lack of food, clean water and

sanitation.

Disaster

PreparationLocal



Time 2 8 16 24 32 40 48 56 64 72

Regional Response

For Example- Chile

Preparation

Disaster

Chile as a country has been preparing for such disasters since the last big earthquake in the early 1960s.I have been involved with them since 1995, bringing what the USA had learned about disaster training and response.The FACH ERSAM led the world in disaster response capability since 1998!They have deployed the ERSAM multiple times over the past 12 years and saved many lives!They have also taught disaster response courses to the region since 1996.

Time 2 8 16 24 32 40 48 56 64 72

I cannot imagine a better planned and executed preparation phase anywhere in the world!

Cap

acit

y o

f M

edic

al C

are

Time 2 8 16 24 32 40 48 56 64 72

NGO, PVOs, WHO, etc

Steady State Capability Medical Capacity is gone!

NeedsSurge Needs

Demand

20-25%


Demand Driven

Demand

Regional Response

International Response

Preparation

How to meet the demand

Disaster Equation

If local facilities function



Cap

acity

of

Med

ical

Car

e

Time 2 8 16 24 32 40 48 56 64 72


Demand



Demand Driven

Demand

Local Surge can fill to a certain degree!

Disaster


Cap

acity

of

Med

ical

Car

e

Time 2 8 16 24 32 40 48 56 64 72


Demand



Demand Driven

Demand

Local Surge

Disaster


Local Surge can fill to a certain degree, but there are limits!

Local Surge

1.Cancel elective surgery2.Close all elective admissions3.Call everyone in from home4.Surge in place

If surge is only 20-25% of normal demand, local response can handle it

If local facilities destroyed or damaged.

“When Disaster Strikes” IF local facilities and people are not intact

THEN they cannot respond

Cap

acit

y o

f M

edic

al C

are

Time 2 8 16 24 32 40 48 56 64 72


Demand

Demand Driven

Demand

Local Surge

Disaster

Excess deaths down to steady state from trauma.


“When Disaster Strikes” IF local facilities and people are not intact

THEN they cannot respond

Now you have a two-fold problem!1. Must fill in for basic services that have been lost.2. Must meet all of the demand equation OR have an excess loss of life!

Disaster Equation

Now you have a two-fold problem!1. Must fill in for basic services that have been lost.2. Must meet all of the demand equation OR have an excess loss of life!

These are two very different problems to solve!

Disaster Equation

Time 2 8 16 24 32 40 48 56 64 72 in hours

Disaster

Local Response

For Example- Chile

The Chilean military deployed immediately to the disaster area to save lives. Regional response came to help quickly.

Cap

acit

y o

f M

edic

al C

are

Time 2 8 16 24 32 40 48 56 64 72

NGO, PVOs, WHO, etc


NeedsSurge Needs

Demand

20-25%


Demand Driven

Demand

Regional Response


Local Response

COUNTRY FACILITY LOCATION

Chilean Army 25-bed medical facility with specialized services and hospitalization capacity. Talca

Chilean Army 25-bed medical facility with specialized services and hospitalization capacity. Curicó

Chilean Army 25-bed medical facility with specialized services and hospitalization capacity. Chillán

Chilean Army 25-bed military field hospital w/ med ward, laboratory, sterilization facilities. Talca

Chilean Army 25-bed military field hospital with hospitalization capacity. Constitución

Chilean Army Tent hospital with medical ward and hospitalization capacity. Curanilahue


Disaster


Time 2 8 16 24 32 40 48 56 64 72

Regional Response

1. Peru 40-bed facility with 2 medical wards, 4 ICU and 200 cots. Location: Penco Lirquén

2. Cuba Hospital facility with one surgical unit, ICU, ultrasound, lab, med ward. Location: Rancagua

3. Argentina Medical facility and two medical wards

Location: Parral, Cauquenes y Curicó

4. Spain Hospital facility with one surgical unit,

medical ward. Location: VIII Región

5. Brazil 400-bed hospital. Location: Santiago

6. USA 10-bed med/surgical (EMEDS) field hospital.

Location: Angol

Regional response was rapid and had an impact!It was enough to carry the load for both immediate trauma and re-establishing the basic healthcare system.

Cap

acit

y o

f M

edic

al C

are

Time 2 8 16 24 32 40 48 56 64 72

NGO, PVOs, WHO, etc


NeedsSurge Needs

Demand

20-25%


Demand Driven

Demand

Regional Response


Regional Response

I cannot imagine a better planned and executed response phase anywhere in the world!

Disaster

PreparationLocal



Time 2 8 16 24 32 40 48 56 64 72

Regional Response

Reconstitution

Disaster

For Example- ChileThis phase of the response is to:1.get out of temporary, do not meet standards for daily healthcare,2.and replace or repair what has been destroyed or damaged.3.This should occur as quickly as possible!

Time 2 8 16 24 32 40 48 56 64 72

Only then do you begin to address the issues of reconstitution!

Modern construction methods can replace damaged or destroyed medical facilities in a short period of time!



Change Is Hard

Component Construction and its Potential for Disaster

Reconstitution

Value equation1.Cost- the same or less.

2.Quality- the same or better.

3.Time- is always shorter because you are doing work in two places, one of which is unconstrained by weather!

Component Construction

• We have multiple examples of factory built medical facilities to share with you.

• We are talking any type of medical construction here- outpatient or inpatient!


Medical and Construction Innovations

Three broad areas will be discussed:

1.Component construction techniques- medical.2.Mobile Medical Units.3.Growing a Hospital concept.

• We have multiple examples of factory built medical facilities to share with you.

• Buck’s County, Pa. was the first component built hospital. It is a hybrid facility, part site built and part factory built.


Component Built Woman’s Health Facility in Buck’s County, Pa.

This medical facility was completed in less than one year! It combines the beauty of traditional architecture with the functionality of component construction!

It is in Bensalem, Buck’s County, Pa.

90% in Factory• Fully functional standard units constructed

in factories in USA.• Inspected to meet all codes in the USA, then

split apart to ship.• Quick connect fittings for electrical, medical

gases, computer connections and telephone connections

• Standard fittings for water and sewer• Erector set mentality to rejoin functional

units.

Standard steel framework, concrete floors, ceiling, HVAC, lights, insulation, are all built in a factory!

Factory Site Construction

This is a 24 bed ward that is nearing completion in the factory in the USA. It was licensed and certified as meeting all standards before leaving the factory!


Components are then split apart, open areas covered, and then loaded on transporters for movement to permanent location.


10% On Site

• Site preparations, foundation of pier and beam, and utilities.

• Erector set putting together the functional standard units previously split apart – numbered and sequence for easy final construction

• These would be delivered in logical sequence of construction to allow for optimization of all utility interface

This is pier and beam construction with piers designed to support the component weight.

On Site Building

This pier is designed to support its corresponding component, per contract specifications.

On Site Building

Factory construction component then arrives when site prepared for them. This allows parallel construction time lines.

On Site Building

This picture shows the components being placed on site. This 24 bed patient ward was placed in 4 hours.

On Site Building

This photo shows the 24 bed ward being placed. All the observers are amazed at how quickly this has gone!

On Site Building

These integration pictures are from 27 July 2006. Each functional unit would be lettered and numbered for ease of construction.

On Site Building


Bensalem, Pa., Women’s HospitalThe finished product from the inside!


The finished product from the inside!

Bensalem, Pa., Women’s Hospital


Bensalem, Pa., Women’s HospitalThe finished product from the inside!


The finished product from the inside!

Bensalem, Pa., Women’s Hospital


This medical facility was completed in less than one year! It combines the beauty of traditional architecture with the functionality of component construction!

It is in Bensalem, Buck’s County, Pa.

You say, “Give me a break! That looks exactly like any other

hospital construction!”

EXACTLY!


Component 50 Bed Hospital

Aspen Street Architects 21Jan10

Component 50 Bed Hospital


These component architectural plans are already completed! This could be at a port in the USA in three months!


Wings-16 rooms per wing, two stories high= 126 single rooms, 256 bed double occupancy.

Core-4 OR, 16 bed ICU, 10 room ED, one trauma of 2 beds, 4 radiology suites, two docking stations.

Component: 250 Bed Hospital

First Floor


Second floor patient wings.

Second Floor


Value equation1.Cost- the same or less.

2.Quality- the same or better.

3.Time- is always shorter because you are doing work in two places unconstrained by weather!


Medical and Construction Innovations

Three broad areas will be discussed:

1.Component construction techniques.2.Mobile Medical Units.3.Growing a Hospital concept with Portable Buildings.

Yahoo.com 10Dec07

Portable Buildings-Licensed Medical Facility in USA

This portable building is due to be put in use in Michigan in May 2008, assembled on top of a traditional hospital to solve an acute space problem. It has been fully certified by the State for hospital use.

The rooms are spacious, well appointed, and meet all standards of care!


Patient closet to place valuables and clothes.


The window from the corridor looking into the patient room is 3x4 ft in size.



Note board on wall for patient reminders.

Bathrooms are American Disabilities Act compliant and easy to use.


Fold down seat for the shower makes bathing easy for patients.


Hand washing station outside the patient room.


Every room is independently controlled for temperature.


Corridor view into patient room.


Built platform from ED to trucks and portable

building

Surgery unit Surgery unit ICU unit

Portable building for Pharmacy

Galveston in Hurricane Ike Sept 2008

Johnson Portables

This 24x32 ft building of 768 sq ft was set up in 1.5 days in the parking garage outside the ED entrance in UTMB Galveston to function as their pharmacy after a hurricane.

Johnson Portables

This 24x32 ft building of 768 sq ft was set up in 1.5 days in the parking garage outside the ED entrance in UTMB Galveston to function as their pharmacy. All components are steel or aluminum and click together.

Johnson Portables

This 24x32 ft building of 768 sq ft was set up in 1.5 days in the parking garage outside the ED entrance in UTMB Galveston to function as their pharmacy.The only thing temporary is the foundation!Note how easily it copes with an uneven surface!

Facility would cost from $110 to $180 per square foot depending on the amount of bathrooms, private, semi-private, or ward style patient care areas. Beaumont is all private rooms with full bathrooms. Theirs is closer to the $180/sf number.

Portable Buildings for Medical Facilities

Hardsided Facility

Attach medical trailer so that every facility becomes the hospital that is needed at the time- configured daily!

Administration

CLINIC

Only requirement is to lay pad and connection for unit

Minimizes bricks and mortar to maximize flexibilityand save money

Johnson Portable Buildings

This building was assembled in 6 hours by an inexperienced crew during the hurricane aftermath of Katrina.

Mobile Surgical Unit Mobile Intensive Care Unit Mobile Diagnostic/Treatment Unit

Mobile Laboratory/Pharmacy Unit Mobile Laboratory/Pharmacy/ Patient Diagnostic Unit

Mobile Breast Care Unit

Mobile Medical Units

Mobile Women’s Diagnostic/Treatment Unit

Mobile Cardiology UnitMobile CT Scan

Mobile Dental Unit

Mobile Dialysis UnitMobile Ophthalmology Unit

Mobile Medical Staff Unit

Mobile Personal Recovery Unit

Mobile Medical Units

Mobile Surgery Unit

•Operating room designed to U.S. healthcare standards •Pre-op / post-op recovery area with capacity for two or three patients (depending upon configuration)•Centralized nurses station designed for easy visual and electronic monitoring of all systems•Soiled utility room designed separate from the “clean” area•Clean utility room designed to maintain proper sterilization of instruments•Integrated medical gases zoned for activation with required shut-off valves

In use around USA

Mobile Intensive Care Unit

•Standard configuration 6 beds•Equipped with state of the art medical equipment for either triage and treatment or intensive patient care systems•Can be utilized for additional surge capacity in large scale disasters•Two utility rooms for project specific needs; can be readily equipped for a variety of uses

Modular Hospital

Minimizes bricks and mortar to maximize flexibility and save money

Modular Hospital – Small Clinic

Attach medical trailer so that every facility becomes the hospital that is needed at the time- configured daily!

Administration

CLINIC

Only requirement is to lay pad and connection for unit


Modular Hospital – Large Clinic


Health Orbit 11Dec07

Mobile Surgical Suite Heading into Iraq!

Let us get specific for

Chile!


8.8 magnitude earthquake on 27 Feb 10

Death toll was 799

6 of Chile’s 13 regions were affected

Home to 80% of the population

Chile had 27,336 hospital beds (71% filled)

Area affected had 77% of the total hospital beds (20,950 of 27,336)

Hospital status in affected area:4 severe, 6 minimal, 8 normal operation, 3 under evaluation

Chilean response: 6 field hospitals

Other assistance: Peru, Cuba, Argentina, Spain, Brazil, USA

Earthquake In Chile

Earthquake In Chile

http://www.cbsnews.com/2300-202_162-10002626-16.html




Angol’s 190-bed regional surgical/referral hospital damaged beyond repair

Provided medical care over 63,000

80 inpatients, no deaths or serious injuries

Earthquake In Chile

Earthquake In Chile

Your earthquake affected large areas of your country!

Unfortunately, it was in the most populated area of the country!

Still have 11 field hospitals running in Chile, so reconstitution is important!

For Example- Chile

Preparation

Time 2 8 16 24 32 40 48 56 64 72 in hours

Disaster

Chile as a country has been preparing for such disasters since the last big earthquake in the early 1960s.I was involved with them since 1995, bringing what the USA had learned about disaster training and response.Their ERSAM led the world in disaster response capability since 1998!They have deployed the ERSAM multiple times over the past 12 years and saved many lives!They have also taught disaster response courses to the region since 1996.

I cannot imagine a better planned and executed preparation phase anywhere in the world!

Cap

acit

y o

f M

edic

al C

are

Time 2 8 16 24 32 40 48 56 64 72

NGO, PVOs, WHO, etc


NeedsSurge Needs

Demand

20-25%


Demand Driven

Demand

Regional Response


Local Response

Regional Response

I cannot imagine a better planned and executed response phase anywhere in the world!

Reconstitution

Disaster

Time 2 8 16 24 32 40 48 56 64 72 in hours


How do you get back to meets all standards healthcare and not break the bank?1.Go component now to replace what you have lost. This could be up in 4-6 months.2.Take down tent hospitals as soon as component facilities are up and running.3.Put up a more earthquake resistant multi-story replacement facility over 18-24 months.4.Once the earthquake resistant facility is up and running, then take down the component facility.5.Move the component facility to other locations in Chile, use them daily, and you have a strategic reserve for future events!6.The components can be moved multiple times!

Earthquake In Chile

Reconstitution

Disaster

Time 2 8 16 24 32 40 48 56 64 72 in hours



Earthquake In Chile


Wings-16 rooms per wing, two stories high= 126 single rooms, 256 bed double occupancy.

Core-4 OR, 16 bed ICU, 10 room ED, one trauma of 2 beds, 4 radiology suites, two docking stations.

First Floor



Second floor patient wings.

Second Floor



Earthquake In Chile

Earthquake In Chile

The soft sided shelter system has served well for a short period of time. Then it is time to fold it up for future use.


Earthquake In Chile

Earthquake Proof Hospitals! The Time is Right!

Rees Brochure

USC University HospitalTeaching HospitalLos Angeles, California1. Building Type Healthcare2. Size 350,000 square feet3. Client University of Southern California University Hospital


Rees Brochure

DescriptionFailures are often more widely publicized than successes. One exception is the USC Medical Center Hospital designed by Rees Associates, Inc. As the world’s first hospital designed and constructed with base-isolation seismic technology and the world’s first “seismically isolated” hospital, the initial construction costs were reduced and, the repair costs typically caused by a 6.8 earthquake were virtually eliminated.


Rees Brochure

REES’ unique success story has been widely publicized. It is important to understand this success story by investigating the different behavior of two neighboring hospitals hit by the Northridge, California earthquake of January 17, 1994, which measured a Moment Magnitude (Mw) of 6.8 and damaged 31 Los Angles hospitals, forcing 9 to fully or partially evacuate. Content damage ran into billions of dollars.


Rees Brochure

Not only did the USC Medical Center hospital suffer:1.no structural damage, 2.but none of the equipment or key contents were damaged in the earthquake, 3.and the facility remained in operation throughout the crisis and beyond.


Rees Brochure

The Los Angeles Hospital had been designed and built according to:1.traditional standards. 2.Damage to it was so severe it could not continue to operate 3.and was eventually closed. 4.Another hospital, one kilometer away, suffered $389 million in damage and had to permanently close two wings.

Computational biology — Modeling of primary blast effects on the central nervous system

NeuroImage 24Feb2009

An architecturally very appealing building!Beauty runs clear through!


Rees Brochure

The idea of seismic base-isolation is to separate the structure from the shaking earth. The 350,000 square foot, 283 bed hospital rests on 68 lead-rubber isolators and 81 elastomeric isolators which isolate it from the full lateral force of an earthquake. The foundation is a spread footing and grade beams on rock.

Earthquake Building Protection

Base isolators in laboratory tests—(left) undeformed isolator, (right) deformed isolator with sizeable horizontal displacement (see red arrow on right side of photo on right). Such displacement of isolators prevents large displacements of floors of the building above.


Rees Brochure

The USC Medical Center Hospital was instrumented by the California Strong Motion Instrumentation Program (CSMIP) soon after its completion, and digitized acceleration, velocity, and displacement recordings from the Northridge earthquake have been made publically available.

The seismic performance of the REES designed USC Medical Center Hospital are very encouraging in that they represent the most severe test of an isolated building to date.


Rees Brochure

With this technology, USC Medical Center Hospital is expected to:1.withstand an earthquake of up to 8.2 on the Richter scale, 2.while decreasing the amount of steel needed to stabilize the structure. 3.By decreasing the amount of steel needed, construction costs were substantially reduced.


Rees Brochure

With seven above-grade and one below-grade floor, USC Medical Center Hospital is a full service acute care teaching hospital and includes nuclear medicine, research laboratories, a 30 bed psychiatric unit and many other research and treatment facilities.


Earthquake In Chile

They can be taken down as easily as they were set up!

Taking a component building down is as easy as it was to put it up!

December 20, 2008


Earthquake In Chile

Cap

acit

y o

f M

edic

al C

are

Time 2 8 16 24 32 40 48 56 64 72

NGO, PVOs, WHO, etc


NeedsSurge Needs

Demand

20-25%

Demand Driven

Demand

Regional Response



Only then do you begin to execute the issues of reconstitution! You should already have a long term game plan in place!

Production – total of 3 hospitals in 6 ½ months

1 Component Hospital Built in 3 months

Full Production each component hospital built in 6 weeks after learning curve

2nd Component HospitalBuilt in 2 months afterlearning curve

Hospital Production (learning curve)

(single production facility)

5 Component Hospital Built in 3 months

Full Production each component hospital built in 6 weeks after learning curve

5 Component HospitalsBuilt in 2 months afterlearning curve

Hospital Production(five production facilities)

Production – total of 15 hospitals in 6 ½ months

If 5 production facilities producing 1 hospital every 6 weeks then 25 additional hospitals could be ready for delivery in approximately 8 months.We could receive 50 hospitals ready for set up in approximately 15 months.

Component Hospitals for Disaster Areas

Hospitals Completed15 20 25 30 35 40 45 50 55 60

2 yrs

6.5 months/ 26 weeks

Hospital Production(five production facilities-

full production)

32 Weeks

38 Weeks

44 Weeks

50 Weeks

56 Weeks

62 Weeks

68 Weeks

74 Weeks

18 months/ 80 Weeks


Earthquake In Chile

“Change is Hard”

Begin with the end in mind

FINISH


Change Is Hard

Recommendations for Post Disaster Recovery

1. Preparation is critical to success.2. Response must be properly planned and practiced.3. Reconstitution must start very quickly:

a. Soft sided shelters right now are the only “hours” response.b. Component construction can provide a meets all standards healthcare facility in months, not years. This step gets you out of tents, back to “meets standards”. c. Long term earthquake resistant multi-story buildings can then be constructed, using existing models, in 18-24 months if needed for the long term.d. Once the multi-story is complete, you can dismantle the component construction, put it in other areas of the country that are under-served, use it daily, and then you have a strategic reserve if another disaster occurs.

Questions?

Dr Paul K. Carlton, Jr.Lt Gen, USAF, Ret

Director, Office of Innovations and Preparedness

The Texas A&M University System Health Science Center

hospitales modulares

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