RAMTIAF EXPEDITIONARY MEDICAL TEAM

GROUP CAPTAIN GS BHATIACOMMANDING OFFICER

AIR FORCE HOSPITALHINDAN, INDIA

• INTRODUCTION

• CAPABILITIES

• SCENARIOS

• DEPLOYMENT

• ROAD AHEAD

• CONCLUSION

NEPAL EARTHQUAKE 2015

RAMT DEPLOYMENT AT NEPAL

HISTORY

BACKGROUND

Army• Mobile – inherent role• Field Hospital

Air Force• PMT (1951)

Paratrooper Medical Team

• CAEU (1957)Casualty Air Evac Unit

• RAMT (1999)

Armed Forces called to assist

INTRODUCTION

RAMT

• Three

• Est : 1999

• Co-located with AF Hospital

• 1RAMT- South : Bangalore

• 2RAMT- East : Jorhat

• 3RAMT- North : Hindan

• Large transport base

• 3RAMT “unique” J&K FLOODS 2014

TASK DIRECTIVE

Description Task

Maintain State of readiness

Mobilize By Air/Road

Operate 25 bed hospital with surgical facilities

OBJECTIVES

ASSUMPTION

Low threat environment

Proximity of airfield

Supply chain maintained

Adequate manpower

Airlift /road tpt available

Air evac of post op cases

CAPABILITIES

Self sufficient : 07 days

Life/limb saving surgeries : 08/day

In patients : 25

OPD patients :100/day

ACTIVATION OF 3 RAMT

MAINTENANCE PHASE

Inventory management Serviceability of eqpts Consumables

Training

Exercise

Revision of plans/

procedures

OPERATIONAL PHASE

Preparation

Emplaning

Deplaning & Deployment

De-induction

2 PHASES

RESPONSIBILITIES

CAMP COMMANDER Liaise with local authorities

Enormity, type and extent of disaster

Water, food and fuel Assess feasibility of obtaining from civil authorities

Security of the camp Communicate

Controlling command – casevac, replenishment of eqpt & stores, turn around of manpower

Record keeping All aspects of deployment incl patients treated, transferred etc

SCENARIO I 03 tents

OPD/resuscitation

Lab/radio services

Dispensary

No ward/ICU/OT

SCENARIO Ia 04 tents

25 bedded ward

No ICU/OT

SCENARIO II 07 tents

25 bedded ward

4 bedded ICU

Fully functional OT

SCENARIO III 13 tents

Scenario II plus

Living quarters for staff

Kitchen

DEPLOYMENT

3RAMT CONTAINERS PLACEDOUTSIDE THE STORES

CONTAINERS BEING SHIFTED ON TRAILERS

PALLETISATION OF CONTAINERS

LOADING OF VEHICLES IN C-17 A/C

LOADING OF PALLETS IN C-17 A/C

C-17 A/C WITH RAMT LOAD

LOGISTICS

Load : 58 tons

Containers : 38

Vehicles* : 05

Genset : 03

Forklift : 01

Trailers trips required = 38/4 = 10

Calculation of• Electricity Load• Ration• Water• POL• Oxygen consumption

150 KVA GENSET

SELLICK FORKLIFT

ELECTRICAL LOAD- MED EQPTS

Name of Consumer RatingQuantity

HeldTotal

Consumption

Suction Apparatus 1.2 kw 8 9.6 Kw

Refrigerator 1.5 kw 3 4.5 Kw

X-Ray Machine 6 Kw 1 6 Kw

OT machine &Oxygen Concentrator 1 Kw 2 2 Kw

Sterilizer 4.5 Kw 1 4.5 Kw

Autoclave Machine 2 Kw 2 4 Kw

Miscellaneous -- -- 0.317 Kw

Total 30.917 Kw

15

ELECT LOAD- NON MED EQPTS

Name of Consumer RatingQtyHeld Total Consumption

Tube light 50W 130 6.5 KW

Air Conditioning 13

Heating Mode 12 KW 13*12=156 KW

Cooling Mode 16.35 KW 13*16.35=212.55KW

Oxygen Plant

Booster (6A) 380 V 1 2.5 KW

Oxygen Conc(20A) 380 V 1 8 KW

TOTAL NON MEDICAL LOAD 173 KW IN HEATING MODE AND 229.55 KW IN COOLING MODE

16

TOTAL ELECTRICAL LOAD

Non-Medical load : 173 Kw (Heating mode) :229.55Kw(Cooling mode)

Medical load : 30.917 Kw Maximum

Total load : 203.917KW(Heating) : 260.467KW(Cooling)

DG set Capacity : 120X3 = 360 KW

(150KVA each)

17

CALCULATION - RATION

DetailsNo of

personnelDays

Auth Rationper day per individual

Total ration In kg

RAMT Personnel

58 10* 2.7 Kg 1566

Air crew/MTD 20 02** 2.7 Kg 108

In patients 25 10* 2.7 Kg 675

Transiting patients

75 10* 1.0 Kg 750

Total 3099

* Three days reserve ration included

** For induction & de-induction

CALCULATION - WATER

Details Total Qty(In Ltr)

Remarks

DRINKING WATER

78 personnel (78X2.5) 195 On Induction day (First day)@2.5L per head

58 Personnel (58X2.5X3) 435 Next 3 days

OPD patients (100X1X4) 400 100 OPD/day@1 L/patient for 04 days

In Patient (25X2.5X4) 250 25 In patient2.5L/patient for 04 days

Cooking/washing of utensils (300X4) 1200 @300 L/Day

Total 2480

Water bowser capacity 3000 L

19

WATER - OT

Details Total Qty(In Ltr)

Remarks

OPERATION THEATRE

One person for one OT 04 02 L each for Pre OT and post OT

06 Personnel (6X4) 24 For hand washing for 01 OT

08 OT/Day (8X24) 192

Washing of instruments 05 For one set

Washing of instruments (8X5) 40 08 OT/Day

Mopping of OT 05 For 01 OT

Mopping of OT (8X5) 40 08 OT/Day

For one day Total 272

For four days Total (4X272) 1088

For Seven days Total (7X272) 1904

CALCULATION - POL

SL No

Details Tank Capacity

Fuel Consumption

RequirementPer Day

RequirementPer veh

Remarks

DIESEL

01 DG Set (Qty-2)

1018 20 L/hr 20X24=480480X2=960

480X7=3360 480L/2 DG set /7 Days(480X02X07=6720)

02 Fork lift 83 04 L/hr 96 192(For 02 Days)

96 L/Forklift/2 Days (96X01X02=192)

03 Amb 90 08 Km/L 08 56(For 07 Days)

Average 64 Km/Day

04 Tractor 60 04 L/hr -- 120* 60 L/15 hrs

05 Water Bowser

90 07 Km/L 06 42(For 07 Days)

Average 42 Km/Day

TOTAL REQUIREMENT PER DAY 1070WEEKLY REQUIREMENT 7130

21

POL Cont.

22

SL No

Details Tank Capacity

Fuel Consumption

RequirementPer Day

Requirementeach

Remarks

PETROL

01 LMV Gypsy

40 10 Km/L 06L 42L(6 LX7 Days)

60 Km/day

TOTAL 42

LUBRICANTS

01 Engine Oil 10W30

-- -- -- 15 For maintenance of equipments

02 Engine Oil 20W40

-- -- -- 15

CALCULATION - OXYGEN

Description Capacity Qty

Oxygen cylinder 200L 02

Oxygen cylinder 3Kg 05

Oxygen cylinder 623L 20

Oxygen cylinder 1246L 24

Oxygen cylinder 6000L 13

23

Details Requirement per day

Requirement per week

Remarks

Operation Theatre 8640 L 60,480 L (6 L X 60 Min X 24)

Wards/ICU/Emergency 14400 LPer bed

100,800 L (10 L X 60 Min X 24)

LAYOUT - TYPICAL

Tent 1

Reception

Tent 2

Resuscit-ation

Tent 4

OT

Tent 6

Lab /Radio

Tent 7

Med stores

Tent 3

ICU

Tent 5

Ward

Vestibule

Entrance

TENT 1 - RECEPTION

• Manpower– Med Officer : 01+ 01*

(*Surgeon - triage)– Med Asst : 04 + 01– Stretcher bearers: 04

• Stretchers• Triage• Documentation• Communication

– Motorola sets– Satellite Phone– Loud hailers

LAYOUT OF RECEPTION

COMMUNICATION

• Manpower– Med Officer : 01+ 01*

(*Anaesthetist to assist)

– Med Asst : 03(GD)+01ORA

• Stretchers beds on stand• Medical Equipment• Medical stores

• Salient points– Colour coded & numbered– Kept separately– Ownership

TENT 2 - RESUSCITATION

• Manpower– Med Officer : 01– Med Asst : 03+ 01

• ICU beds on stand

• Medical Equipment

• Medical stores– Medical brick universal– Disaster Specific brick

TENT 3 - ICU

• Manpower– Surgeon : 01– Anaesthesiologist : 01– ORAs : 03

(02 assist + 01 CSSD)

• OT Equipment

• Linoleum sheet for floor• Water adsorbent gel

• Medical stores– Instruments set– OT bricks

TENT 4 - OT

• Manpower

– Med Officer : 01

– Med Asst : 03 + 01

• 25 Beds

• Medical Equipment

• Medical stores

– Medical brick universal

– Lifestyle diseases brick

– Disaster specific brick

TENT 5 - WARD

• Manpower– Lab tech : 02– Radiographer : 01

• Equipment– Portable X-ray machine– CR system– Compact portable mobile lab– I-stat

• Medical stores– Lab brick– X-ray brick incl films

TENT 6 – LAB & RADIOLOGY

• Manpower– Med Asst : 01– Health Asst : 01

• Medical Stores– Medical brick universal– Disaster specific brick– OT brick– Lifestyle disease bricks– Hygiene chemical stores

• Waste disposal co-ordination— BMW, Solid waste— Kitchen waste - sullage

TENT 7 – STORES

MANPOWER

INHERENT AUGUMENTED

OFFICER 01 04+01

MED ASST 15 10

NON – MED ASST 08 08

NC(E) 04 07

TOTAL 28 30

CHANGE IN ATTITUDE

MANPOWER– Core team– Highly motivated– Physically fit– Well trained– Team spirit– Multi tasking– Ownership– Job cards

“Sense of pride”

“We make a difference”

26.04.2015

EQUIPMENT

• Light weight

• Compact

• Portable

• Sturdy

• Easy to use

• Low maintenance

• Compact portable mobile lab

• CR System

• Portable X-ray machine

• Fumigator

• Manifold alarm system

• Portable anesthesia machine

• Water absorbent gel

• Aluminium stretchers

• Spinal boards & Scoop stretchers

• Microwave – BMW disposal

MEDICAL BRICKS

CONTAINERS – Light weight with handle– Wheeled– Colour coded– Section wise– Disaster specific

• Universal• Earthquake• Floods• Burns

ANAESTHESIA MACHINE

COMPACT PORTABLE MOBILE LAB

CR SYSTEM

Linoleum sheet for OT floor

DEPLOYMENT

Exercises– Cope India 2009– Aero India 2011– Milan 2014

Real action– Op Rahat

• Uttarakhand Floods(2013)

– Op Megh Rahat• floods in J&K(2014)

– Op Maitri• Nepal earthquake(2015)• 25 Apr 2015 to 08 May 2015

HIGHLIGHTS – OP MAITRI

• Rapid deployment – excellent coordination: ops, admin, logistics and medical

• Jointmanship– Pooling resources of 3RAMT with other medical units– 932 patients seen, 73 patients admitted & 60 surgeries conducted

• Maintenance of good supply chain– adequate stock of all medicines, rations and other stores

• Liaison with local authorities and Nepalese Army– avoided confusion– the capabilities and limitations explained clearly during interactions– optimal and efficient use of all capabilities of 3RAMT

• Paediatrician, Gynaecologist and trauma trained nurse

CONCLUSION

Tremendous capability

Need to utilise full potential

Equipment up gradation

Procedures & drills

Regular trg & practice

“The more you sweat in peacethe less you bleed in war”

Thank You