Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.
Disaster Response from A-Z!
Preparation
Response
Reconstitution
“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...
Disaste
r
Preparation
Local
Response
Reconstitution
Basic Equation to Solve Disasters
Time 2 8 16 24 32 40 48 56 64 72
Reg...
Natural History of
Disasters That Produces
Casualties
Or
Destroy Medical Facilities
CapacityofMedicalCare
Time 2 8 16 24 32 40 48 56 64 72
Steady State
Capability
Medical Capacity
Demand
“When Disaster Stri...
CapacityofMedicalCare
Time 2 8 16 24 32 40 48 56 64 72
Steady State
Capability
Medical Capacity
Demand
“When Disaster Stri...
CapacityofMedicalCare
Time 2 8 16 24 32 40 48 56 64 72
Steady State
Capability
Medical Capacity
Demand
“When Disaster Stri...
CapacityofMedicalCare
Time 2 8 16 24 32 40 48 56 64 72
Steady State
Capability
Medical Capacity
Demand
“When Disaster Stri...
CapacityofMedicalCare
Time 2 8 16 24 32 40 48 56 64 72
Steady State
Capability
Medical Capacity
Demand
“When Disaster Stri...
But
CapacityofMedicalCare
Time 2 8 16 24 32 40 48 56 64 72
Steady State
Capability
Medical Capacity
Demand
“When Disaster Stri...
Disaste
r
Preparation
Local
Response
Reconstitution
Basic Equation to Solve Disasters
Time 2 8 16 24 32 40 48 56 64 72
Reg...
For Example- Chile
Preparation
Disaste
r
Chile as a country has been preparing for
such disasters since the last big
earth...
CapacityofMedicalCare
Time 2 8 16 24 32 40 48 56 64 72
NGO,
PVOs,
WHO, etc
Steady State
Capability
Medical Capacity
is gon...
How to meet the demand
Disaster Equation
If local facilities function
“When Disaster Strikes”
IF local facilities and people are
intact THEN they can respond
CapacityofMedicalCare
Time 2 8 16 24 32 40 48 56 64 72
Steady State
Capability
Medical Capacity
Demand
“When Disaster Stri...
CapacityofMedicalCare
Time 2 8 16 24 32 40 48 56 64 72
Steady State
Capability
Medical Capacity
Demand
“When Disaster Stri...
Local Surge
1.Cancel elective surgery
2.Close all elective admissions
3.Call everyone in from home
4.Surge in place
If sur...
If local facilities destroyed
or damaged.
“When Disaster Strikes”
IF local facilities and people are not intact
THEN they ...
CapacityofMedicalCare
Time 2 8 16 24 32 40 48 56 64 72
Steady State
Capability
Medical Capacity
Demand
Demand Driven
Deman...
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
eq...
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
eq...
Time 2 8 16 24 32 40 48 56 64 72
in hours
Disaste
r
Local
Response
For Example- Chile
The Chilean
military
deployed
immedi...
CapacityofMedicalCare
Time 2 8 16 24 32 40 48 56 64 72
NGO,
PVOs,
WHO, etc
Steady State
Capability
Medical Capacity
is gon...
COUNTRY FACILITY LOCATION
Chilean Army 25-bed medical facility with specialized services and hospitalization capacity. Tal...
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 wit...
CapacityofMedicalCare
Time 2 8 16 24 32 40 48 56 64 72
NGO,
PVOs,
WHO, etc
Steady State
Capability
Medical Capacity
is gon...
Disaste
r
Preparation
Local
Response
Reconstitution
Basic Equation to Solve Disasters
Time 2 8 16 24 32 40 48 56 64 72
Reg...
Reconstitution
Disaste
r
For Example- Chile
This phase of the
response is to:
1.get out of
temporary, do not
meet standard...
Only then do you begin to address the
issues of reconstitution!
Modern construction methods can replace
damaged or destroy...
It is time for
innovation!
Change Is Hard
Component Construction
and its Potential for Disaster
Reconstitution
Value equation
1.Cost- the same or less.
2.Quality- the same or better.
3.Time- is always shorter
because you are doing wo...
• We have multiple
examples of
factory built
medical facilities
to share with you.
• We are talking
any type of
medical
co...
• We have multiple
examples of
factory built
medical facilities
to share with you.
• We are talking
any type of
medical
co...
Medical and Construction
Innovations
Three broad areas will be discussed:
1.Component construction
techniques- medical.
2....
• We have multiple
examples of factory
built medical
facilities to share
with you.
• Buck’s County, Pa.
was the first
comp...
Component Built Woman’s Health
Facility in Buck’s County, Pa.
This medical
facility was
completed in less
than one year! I...
90% in Factory
• Fully functional standard units constructed
in factories in USA.
• Inspected to meet all codes in the USA...
Standard steel
framework,
concrete
floors, ceiling,
HVAC, lights,
insulation, are
all built in a
factory!
Factory Site Con...
This is a 24 bed
ward that is
nearing
completion in
the factory in
the USA. It was
licensed and
certified as
meeting all
s...
Components are
then split apart,
open areas covered,
and then loaded on
transporters for
movement to
permanent location.
F...
10% On Site
• Site preparations, foundation of pier
and beam, and utilities.
• Erector set putting together the
functional...
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 ...
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
construc...
Component Construction
Bensalem, Pa., Women’s Hospital
The
finished
product
from the
inside!
Component Construction
The
finished
product
from the
inside!
Bensalem, Pa., Women’s Hospital
Component Construction
Bensalem, Pa., Women’s Hospital
The
finished
product
from the
inside!
Component Construction
The
finished
product
from the
inside!
Bensalem, Pa., Women’s Hospital
Component Construction
The
finished
product
from the
inside!
Bensalem, Pa., Women’s Hospital
Component Construction
The
finished
product
from the
inside!
Bensalem, Pa., Women’s Hospital
Component Built Woman’s Health
Facility in Buck’s County, Pa.
This medical
facility was
completed in less
than one year! I...
You say, “Give me a break! That
looks exactly like any other
hospital construction!”
EXACTLY!
Component Built Woman’s Heal...
Component 50 Bed Hospital
Aspen Street Architects 21Jan10
Component 50 Bed Hospital
Aspen Street Architects 21Jan10
These component architectural
plans are already completed!
This ...
Aspen Street Architects 21Jan10
Wings-16 rooms per wing,
two stories high= 126 single
rooms, 256 bed double
occupancy.
Cor...
Aspen Street Architects 21Jan10
Second
floor
patient
wings.
Second Floor
Component: 250 Bed Hospital
Value equation
1.Cost- the same or less.
2.Quality- the same or better.
3.Time- is always shorter
because you are doing wo...
Medical and Construction
Innovations
Three broad areas will be discussed:
1.Component construction
techniques.
2.Mobile Me...
Yahoo.com 10Dec07
Portable Buildings-Licensed
Medical Facility in USA
This portable
building is due
to be put in
use in
Mi...
The rooms
are
spacious,
well
appointed,
and meet
all
standards
of care!
Portable Buildings-Licensed
Medical Facility in USA
Patient closet to
place valuables and
clothes.
Portable Buildings-Licensed
Medical Facility in USA
The
window
from the
corridor
looking
into the
patient
room is
3x4 ft in
size.
Portable Buildings-Licensed
Medical Facility...
Portable Buildings-Licensed
Medical Facility in USA
Note board
on wall for
patient
reminders.
Bathrooms are
American Disabilities
Act compliant and
easy to use.
Portable Buildings-Licensed
Medical Facility in USA
Fold down seat
for the shower
makes bathing
easy for patients.
Portable Buildings-Licensed
Medical Facility in USA
Hand washing
station outside the
patient room.
Portable Buildings-Licensed
Medical Facility in USA
Every room is
independently
controlled for
temperature.
Portable Buildings-Licensed
Medical Facility in USA
Corridor
view
into
patient
room.
Portable Buildings-Licensed
Medical Facility in USA
Built platform from ED
to trucks and portable
building
Surgery unit Surgery unit ICU unit
Portable building
for Pharmacy
G...
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...
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...
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...
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...
Facility would cost from $110 to
$180 per square foot depending on
the amount of bathrooms, private,
semi-private, or ward...
Hardsided Facility
Attach medical trailer so
that every facility
becomes the hospital that
is needed at the time-
configur...
Johnson Portable Buildings
This building
was assembled
in 6 hours by
an
inexperienced
crew during
the hurricane
aftermath ...
Mobile Surgical Unit Mobile Intensive Care Unit Mobile Diagnostic/Treatment Unit
Mobile Laboratory/Pharmacy Unit Mobile La...
Mobile Women’s Diagnostic/
Treatment Unit
Mobile Cardiology Unit
Mobile CT Scan
Mobile Dental Unit
Mobile Dialysis Unit
Mo...
Mobile Surgery Unit
•Operating room designed to U.S.
healthcare standards
•Pre-op / post-op recovery area
with capacity fo...
Mobile Intensive Care Unit
•Standard configuration 6
beds
•Equipped with state of the
art medical equipment for
either tri...
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 t...
Modular Hospital –
Large Clinic
Minimizes
bricks
and
mortar to
maximize
flexibility
and save
money
Health Orbit 11Dec07
Mobile Surgical Suite
Heading into Iraq!
Let us get
specific for
Chile!
“When Disaster Strikes”
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 populati...
Earthquake In Chile
Angol’s 190-bed regional surgical/referral
hospital damaged beyond repair
Provided medical care over 63,000
80 inpatients,...
Earthquake In Chile
Your earthquake
affected large areas of
your country!
Unfortunately, it was in
the most populated area...
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 f...
CapacityofMedicalCare
Time 2 8 16 24 32 40 48 56 64 72
NGO,
PVOs,
WHO, etc
Steady State
Capability
Medical Capacity
is gon...
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....
How do you get back to meets all standards healthcare and
not break the bank?
1.Go component now to replace what you have ...
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....
How do you get back to meets all standards healthcare and
not break the bank?
1.Go component now to replace what you have
...
Aspen Street Architects 21Jan10
Wings-16 rooms per wing,
two stories high= 126 single
rooms, 256 bed double
occupancy.
Cor...
Aspen Street Architects 21Jan10
Second
floor
patient
wings.
Second Floor
Component: 250 Bed Hospital
How do you get back to meets all standards healthcare and
not break the bank?
1.Go component now to replace what you have ...
Earthquake In Chile
The soft sided
shelter
system has
served well
for a short
period of time.
Then it is
time to fold it
u...
How do you get back to meets all standards healthcare and
not break the bank?
1.Go component now to replace what you have ...
Earthquake Proof Hospitals!
The Time is Right!
Rees Brochure
USC University Hospital
Teaching Hospital
Los Angeles, Califo...
Earthquake Proof Hospitals!
The Time is Right!
Rees Brochure
Description
Failures are often more widely publicized than
su...
Earthquake Proof Hospitals!
The Time is Right!
Rees Brochure
REES’ unique success story has been widely
publicized. It is ...
Earthquake Proof Hospitals!
The Time is Right!
Rees Brochure
Not only did the USC Medical Center hospital
suffer:
1.no str...
Earthquake Proof Hospitals!
The Time is Right!
Rees Brochure
The Los Angeles Hospital had been designed
and built accordin...
Computational biology — Modeling of primary
blast effects on the central nervous system
NeuroImage 24Feb2009
An architectu...
Earthquake Proof Hospitals!
The Time is Right!
Rees Brochure
The idea of seismic base-isolation is to
separate the structu...
Earthquake Building Protection
Base isolators in laboratory tests—(left) undeformed isolator, (right) deformed isolator wi...
Earthquake Proof Hospitals!
The Time is Right!
Rees Brochure
The USC Medical Center Hospital was instrumented by
the Calif...
Earthquake Proof Hospitals!
The Time is Right!
Rees Brochure
With this technology, USC Medical Center
Hospital is expected...
Earthquake Proof Hospitals!
The Time is Right!
Rees Brochure
With seven above-grade
and one below-grade
floor, USC Medical...
How do you get back to meets all standards healthcare and
not break the bank?
1.Go component now to replace what you have ...
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!
...
How do you get back to meets all standards healthcare and
not break the bank?
1.Go component now to replace what you have ...
CapacityofMedicalCare
Time 2 8 16 24 32 40 48 56 64 72
NGO,
PVOs,
WHO, etc
Steady State
Capability
Medical Capacity
is gon...
Production – total of 3 hospitals in 6 ½ months
1 Component
Hospital
Built in 3
months
Full Production
each
component
hosp...
5 Component
Hospital
Built in 3
months
Full Production
each
component
hospital built in
6 weeks after
learning curve
5 Com...
Component Hospitals for Disaster Areas
Hospitals Completed
15 20 25 30 35 40 45 50 55 60
2 yrs
6.5
months/ 26
weeks
Hospit...
How do you get back to meets all standards healthcare and
not break the bank?
1.Go component now to replace what you have ...
“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...
Questions?
Dr Paul K. Carlton, Jr.
Lt Gen, USAF, Ret
Director, Office of Innovations and Preparedness
The Texas A&M Univer...
Upcoming SlideShare
Loading in …5
×

Hospitales modulares

886 views

Published on

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

Published in: Education
  • Be the first to comment

  • Be the first to like this

Hospitales modulares

  1. 1. Disaster Response from A-Z! Preparation Response Reconstitution
  2. 2. “Change is Hard”
  3. 3. Begin with the end in mind FINISH
  4. 4. It is time for innovation! Change Is Hard
  5. 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. 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. 7. Natural History of Disasters That Produces Casualties Or Destroy Medical Facilities
  8. 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. 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. 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. 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. 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. 13. But
  14. 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. 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. 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. 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. 18. How to meet the demand Disaster Equation
  19. 19. If local facilities function “When Disaster Strikes” IF local facilities and people are intact THEN they can respond
  20. 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. 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. 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. 23. If local facilities destroyed or damaged. “When Disaster Strikes” IF local facilities and people are not intact THEN they cannot respond
  24. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 35. It is time for innovation! Change Is Hard
  36. 36. Component Construction and its Potential for Disaster Reconstitution
  37. 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. 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. 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. 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. 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. 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. 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. 44. Standard steel framework, concrete floors, ceiling, HVAC, lights, insulation, are all built in a factory! Factory Site Construction
  45. 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. 46. Components are then split apart, open areas covered, and then loaded on transporters for movement to permanent location. Factory Site Construction
  47. 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. 48. This is pier and beam construction with piers designed to support the component weight. On Site Building
  49. 49. This pier is designed to support its corresponding component, per contract specifications. On Site Building
  50. 50. Factory construction component then arrives when site prepared for them. This allows parallel construction time lines. On Site Building
  51. 51. This picture shows the components being placed on site. This 24 bed patient ward was placed in 4 hours. On Site Building
  52. 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. 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. 54. Component Construction Bensalem, Pa., Women’s Hospital The finished product from the inside!
  55. 55. Component Construction The finished product from the inside! Bensalem, Pa., Women’s Hospital
  56. 56. Component Construction Bensalem, Pa., Women’s Hospital The finished product from the inside!
  57. 57. Component Construction The finished product from the inside! Bensalem, Pa., Women’s Hospital
  58. 58. Component Construction The finished product from the inside! Bensalem, Pa., Women’s Hospital
  59. 59. Component Construction The finished product from the inside! Bensalem, Pa., Women’s Hospital
  60. 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. 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. 62. Component 50 Bed Hospital Aspen Street Architects 21Jan10
  63. 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. 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. 65. Aspen Street Architects 21Jan10 Second floor patient wings. Second Floor Component: 250 Bed Hospital
  66. 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. 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. 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. 69. The rooms are spacious, well appointed, and meet all standards of care! Portable Buildings-Licensed Medical Facility in USA
  70. 70. Patient closet to place valuables and clothes. Portable Buildings-Licensed Medical Facility in USA
  71. 71. The window from the corridor looking into the patient room is 3x4 ft in size. Portable Buildings-Licensed Medical Facility in USA
  72. 72. Portable Buildings-Licensed Medical Facility in USA Note board on wall for patient reminders.
  73. 73. Bathrooms are American Disabilities Act compliant and easy to use. Portable Buildings-Licensed Medical Facility in USA
  74. 74. Fold down seat for the shower makes bathing easy for patients. Portable Buildings-Licensed Medical Facility in USA
  75. 75. Hand washing station outside the patient room. Portable Buildings-Licensed Medical Facility in USA
  76. 76. Every room is independently controlled for temperature. Portable Buildings-Licensed Medical Facility in USA
  77. 77. Corridor view into patient room. Portable Buildings-Licensed Medical Facility in USA
  78. 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. 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. 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. 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. 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. 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. 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. 85. Johnson Portable Buildings This building was assembled in 6 hours by an inexperienced crew during the hurricane aftermath of Katrina.
  86. 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. 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. 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. 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. 90. Modular Hospital Minimizes bricks and mortar to maximize flexibility and save money
  91. 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. 92. Modular Hospital – Large Clinic Minimizes bricks and mortar to maximize flexibility and save money
  93. 93. Health Orbit 11Dec07 Mobile Surgical Suite Heading into Iraq!
  94. 94. Let us get specific for Chile! “When Disaster Strikes”
  95. 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. 96. Earthquake In Chile
  97. 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. 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. 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. 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. 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. 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. 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. 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. 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. 106. Aspen Street Architects 21Jan10 Second floor patient wings. Second Floor Component: 250 Bed Hospital
  107. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 129. “Change is Hard”
  130. 130. Begin with the end in mind FINISH
  131. 131. It is time for innovation! Change Is Hard
  132. 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. 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

×