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SIMPOSIO "EL SECTOR SALUD FRENTE A GRANDES DESASTRES" 22-23 de Nov de 2010

SIMPOSIO "EL SECTOR SALUD FRENTE A GRANDES DESASTRES" 22-23 de Nov de 2010

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  • 1. Disaster Response from A-Z! Preparation Response Reconstitution
  • 2. “Change is Hard”
  • 3. Begin with the end in mind FINISH
  • 4. It is time for innovation! Change Is Hard
  • 5. 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.
  • 6. Disaste r Preparation Local Response Reconstitution Basic Equation to Solve Disasters Time 2 8 16 24 32 40 48 56 64 72 Regional Response
  • 7. Natural History of Disasters That Produces Casualties Or Destroy Medical Facilities
  • 8. CapacityofMedicalCare Time 2 8 16 24 32 40 48 56 64 72 Steady State Capability Medical Capacity Demand “When Disaster Strikes” Demand Driven Demand Disaste r Demand exceeds supply Unmet demand = excess deaths
  • 9. CapacityofMedicalCare Time 2 8 16 24 32 40 48 56 64 72 Steady State Capability Medical Capacity Demand “When Disaster Strikes” Demand Driven Demand Disaste r Demand exceeds supply Unmet demand = excess deaths
  • 10. CapacityofMedicalCare Time 2 8 16 24 32 40 48 56 64 72 Steady State Capability Medical Capacity 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! Disaste r Unmet demand = excess deaths
  • 11. CapacityofMedicalCare Time 2 8 16 24 32 40 48 56 64 72 Steady State Capability Medical Capacity Demand “When Disaster Strikes” IF local facilities and people are intact THEN they can respond Demand Driven Demand Local Surge Disaste r Unmet demand = excess deaths
  • 12. CapacityofMedicalCare Time 2 8 16 24 32 40 48 56 64 72 Steady State Capability Medical Capacity Demand “When Disaster Strikes” IF local facilities and people are intact THEN they can respond Demand Driven Demand Local Surge Disaste r Excess deaths down to steady state from trauma. Unmet demand = excess deaths
  • 13. But
  • 14. CapacityofMedicalCare Time 2 8 16 24 32 40 48 56 64 72 Steady State Capability Medical Capacity Demand “When Disaster Strikes” IF local facilities and people are intact THEN they can respond Demand Driven Demand Local Surge Disaste r Unmet Demands = Excess Deaths Increase due to lack of food, clean water and sanitation.
  • 15. Disaste r Preparation Local Response Reconstitution Basic Equation to Solve Disasters Time 2 8 16 24 32 40 48 56 64 72 Regional Response
  • 16. For Example- Chile Preparation Disaste r 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!
  • 17. CapacityofMedicalCare Time 2 8 16 24 32 40 48 56 64 72 NGO, PVOs, WHO, etc Steady State Capability Medical Capacity is gone! Needs Surge Needs Demand 20- 25% “When Disaster Strikes” Demand Driven Demand Regional Response International Response Preparation
  • 18. How to meet the demand Disaster Equation
  • 19. If local facilities function “When Disaster Strikes” IF local facilities and people are intact THEN they can respond
  • 20. CapacityofMedicalCare Time 2 8 16 24 32 40 48 56 64 72 Steady State Capability Medical Capacity 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! Disaste r Unmet demand = excess deaths
  • 21. CapacityofMedicalCare Time 2 8 16 24 32 40 48 56 64 72 Steady State Capability Medical Capacity Demand “When Disaster Strikes” IF local facilities and people are intact THEN they can respond Demand Driven Demand Local Surge Disaste r Unmet demand = excess deaths Local Surge can fill to a certain degree, but there are limits!
  • 22. Local Surge 1.Cancel elective surgery 2.Close all elective admissions 3.Call everyone in from home 4.Surge in place If surge is only 20-25% of normal demand, local response can handle it
  • 23. If local facilities destroyed or damaged. “When Disaster Strikes” IF local facilities and people are not intact THEN they cannot respond
  • 24. CapacityofMedicalCare Time 2 8 16 24 32 40 48 56 64 72 Steady State Capability Medical Capacity Demand Demand Driven Demand Local Surge Disaste r Excess deaths down to steady state from trauma. Unmet demand = excess deaths “When Disaster Strikes” IF local facilities and people are not intact THEN they cannot respond
  • 25. 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
  • 26. 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
  • 27. Time 2 8 16 24 32 40 48 56 64 72 in hours Disaste r Local Response For Example- Chile The Chilean military deployed immediately to the disaster area to save lives. Regional response came to help quickly.
  • 28. CapacityofMedicalCare Time 2 8 16 24 32 40 48 56 64 72 NGO, PVOs, WHO, etc Steady State Capability Medical Capacity is gone! Needs Surge Needs Demand 20- 25% “When Disaster Strikes” Demand Driven Demand Regional Response International Response Local Response
  • 29. 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 “When Disaster Strikes”
  • 30. Disaste r Basic Equation to Solve Disasters 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.
  • 31. CapacityofMedicalCare Time 2 8 16 24 32 40 48 56 64 72 NGO, PVOs, WHO, etc Steady State Capability Medical Capacity is gone! Needs Surge Needs Demand 20- 25% “When Disaster Strikes” Demand Driven Demand Regional Response International Response Regional Response I cannot imagine a better planned and executed response phase anywhere in the world!
  • 32. Disaste r Preparation Local Response Reconstitution Basic Equation to Solve Disasters Time 2 8 16 24 32 40 48 56 64 72 Regional Response
  • 33. Reconstitution Disaste r For Example- Chile This 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
  • 34. 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! “When Disaster Strikes”
  • 35. It is time for innovation! Change Is Hard
  • 36. Component Construction and its Potential for Disaster Reconstitution
  • 37. Value equation 1.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
  • 38. • 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! Component Construction
  • 39. • 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! Component Construction
  • 40. Medical and Construction Innovations Three broad areas will be discussed: 1.Component construction techniques- medical. 2.Mobile Medical Units. 3.Growing a Hospital concept.
  • 41. • 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 Construction
  • 42. 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.
  • 43. 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.
  • 44. Standard steel framework, concrete floors, ceiling, HVAC, lights, insulation, are all built in a factory! Factory Site Construction
  • 45. 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! Factory Site Construction
  • 46. Components are then split apart, open areas covered, and then loaded on transporters for movement to permanent location. Factory Site Construction
  • 47. 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
  • 48. This is pier and beam construction with piers designed to support the component weight. On Site Building
  • 49. This pier is designed to support its corresponding component, per contract specifications. On Site Building
  • 50. Factory construction component then arrives when site prepared for them. This allows parallel construction time lines. On Site Building
  • 51. This picture shows the components being placed on site. This 24 bed patient ward was placed in 4 hours. On Site Building
  • 52. This photo shows the 24 bed ward being placed. All the observers are amazed at how quickly this has gone! On Site Building
  • 53. These integration pictures are from 27 July 2006. Each functional unit would be lettered and numbered for ease of construction. On Site Building
  • 54. Component Construction Bensalem, Pa., Women’s Hospital The finished product from the inside!
  • 55. Component Construction The finished product from the inside! Bensalem, Pa., Women’s Hospital
  • 56. Component Construction Bensalem, Pa., Women’s Hospital The finished product from the inside!
  • 57. Component Construction The finished product from the inside! Bensalem, Pa., Women’s Hospital
  • 58. Component Construction The finished product from the inside! Bensalem, Pa., Women’s Hospital
  • 59. Component Construction The finished product from the inside! Bensalem, Pa., Women’s Hospital
  • 60. 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.
  • 61. You say, “Give me a break! That looks exactly like any other hospital construction!” EXACTLY! Component Built Woman’s Health Facility in Buck’s County, Pa.
  • 62. Component 50 Bed Hospital Aspen Street Architects 21Jan10
  • 63. Component 50 Bed Hospital Aspen Street Architects 21Jan10 These component architectural plans are already completed! This could be at a port in the USA in three months!
  • 64. Aspen Street Architects 21Jan10 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
  • 65. Aspen Street Architects 21Jan10 Second floor patient wings. Second Floor Component: 250 Bed Hospital
  • 66. Value equation 1.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! Component Construction
  • 67. 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.
  • 68. 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.
  • 69. The rooms are spacious, well appointed, and meet all standards of care! Portable Buildings-Licensed Medical Facility in USA
  • 70. Patient closet to place valuables and clothes. Portable Buildings-Licensed Medical Facility in USA
  • 71. The window from the corridor looking into the patient room is 3x4 ft in size. Portable Buildings-Licensed Medical Facility in USA
  • 72. Portable Buildings-Licensed Medical Facility in USA Note board on wall for patient reminders.
  • 73. Bathrooms are American Disabilities Act compliant and easy to use. Portable Buildings-Licensed Medical Facility in USA
  • 74. Fold down seat for the shower makes bathing easy for patients. Portable Buildings-Licensed Medical Facility in USA
  • 75. Hand washing station outside the patient room. Portable Buildings-Licensed Medical Facility in USA
  • 76. Every room is independently controlled for temperature. Portable Buildings-Licensed Medical Facility in USA
  • 77. Corridor view into patient room. Portable Buildings-Licensed Medical Facility in USA
  • 78. 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
  • 79. 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.
  • 80. 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.
  • 81. 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.
  • 82. 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!
  • 83. 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
  • 84. 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 flexibility and save money
  • 85. Johnson Portable Buildings This building was assembled in 6 hours by an inexperienced crew during the hurricane aftermath of Katrina.
  • 86. 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
  • 87. Mobile Women’s Diagnostic/ Treatment Unit Mobile Cardiology Unit Mobile CT Scan Mobile Dental Unit Mobile Dialysis Unit Mobile Ophthalmology Unit Mobile Medical Staff Unit Mobile Personal Recovery Unit Mobile Medical Units
  • 88. 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
  • 89. 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
  • 90. Modular Hospital Minimizes bricks and mortar to maximize flexibility and save money
  • 91. 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 Minimizes bricks and mortar to maximize flexibility and save money
  • 92. Modular Hospital – Large Clinic Minimizes bricks and mortar to maximize flexibility and save money
  • 93. Health Orbit 11Dec07 Mobile Surgical Suite Heading into Iraq!
  • 94. Let us get specific for Chile! “When Disaster Strikes”
  • 95. 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
  • 96. Earthquake In Chile
  • 97. 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
  • 98. 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!
  • 99. For Example- Chile Preparation Time 2 8 16 24 32 40 48 56 64 72 in hours Disaste r 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!
  • 100. CapacityofMedicalCare Time 2 8 16 24 32 40 48 56 64 72 NGO, PVOs, WHO, etc Steady State Capability Medical Capacity is gone! Needs Surge Needs Demand 20- 25% “When Disaster Strikes” Demand Driven Demand Regional Response International Response Local Response Regional Response I cannot imagine a better planned and executed response phase anywhere in the world!
  • 101. Reconstitution Disaste r Time 2 8 16 24 32 40 48 56 64 72 in hours For Example- Chile This 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!
  • 102. 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
  • 103. Reconstitution Disaste r Time 2 8 16 24 32 40 48 56 64 72 in hours For Example- Chile This 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!
  • 104. 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
  • 105. Aspen Street Architects 21Jan10 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 Component: 250 Bed Hospital
  • 106. Aspen Street Architects 21Jan10 Second floor patient wings. Second Floor Component: 250 Bed Hospital
  • 107. 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
  • 108. 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.
  • 109. 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
  • 110. Earthquake Proof Hospitals! The Time is Right! Rees Brochure USC University Hospital Teaching Hospital Los Angeles, California 1. Building Type Healthcare 2. Size 350,000 square feet 3. Client University of Southern California University Hospital
  • 111. Earthquake Proof Hospitals! The Time is Right! Rees Brochure Description Failures 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.
  • 112. Earthquake Proof Hospitals! The Time is Right! 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.
  • 113. Earthquake Proof Hospitals! The Time is Right! 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.
  • 114. Earthquake Proof Hospitals! The Time is Right! 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.
  • 115. Computational biology — Modeling of primary blast effects on the central nervous system NeuroImage 24Feb2009 An architecturally very appealing building! Beauty runs clear through!
  • 116. Earthquake Proof Hospitals! The Time is Right! 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.
  • 117. 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.
  • 118. Earthquake Proof Hospitals! The Time is Right! 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.
  • 119. Earthquake Proof Hospitals! The Time is Right! 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.
  • 120. Earthquake Proof Hospitals! The Time is Right! 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.
  • 121. 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
  • 122. 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
  • 123. 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
  • 124. CapacityofMedicalCare Time 2 8 16 24 32 40 48 56 64 72 NGO, PVOs, WHO, etc Steady State Capability Medical Capacity is gone! Needs Surge Needs Demand 20- 25% Demand Driven Demand Regional Response International Response “When Disaster Strikes” Only then do you begin to execute the issues of reconstitution! You should already have a long term game plan in place!
  • 125. 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 Hospital Built in 2 months after learning curve Hospital Production (learning curve) (single production facility)
  • 126. 5 Component Hospital Built in 3 months Full Production each component hospital built in 6 weeks after learning curve 5 Component Hospitals Built in 2 months after learning 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.
  • 127. Component Hospitals for Disaster Areas Hospitals Completed 15 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
  • 128. 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
  • 129. “Change is Hard”
  • 130. Begin with the end in mind FINISH
  • 131. It is time for innovation! Change Is Hard
  • 132. 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.
  • 133. 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