When I was in Iraq/Afghanistan 2004-2010, one of my favorite things was working with the military hospitals (I sold satcom to a variety of clients, including medical use for radiology, and then worked on radiology PACS stuff).
The Army Combat Support Hospital (think MASH tv-show...) guys could set something up like this really fast, but it was expensive hardware, required their own personnel, etc. This makes sense for the US military (massive logistics, budget, etc.), but not for others. Also worked (volunteer/charity) with some local clinics who didn't have these kind of resources, but did have great personnel, who could use more locally-acquired or bespoke solutions -- problem was it was slow, not uniform standard, etc.
A cost-reduced, standardized, easily transportable hybrid is great. Ideally you'd use existing standardized readily available stuff with minimal medical/flown in stuff on top.
I went to Iraq despite being against the invasion (although very pro CIA/JSOC activities in Afghanistan in 2001, but anti Big Army stuff in Afghanistan -- I met some of the "first in" guys a few years later and double down on that belief now) to 1) get as far away from a girl I'd broken up with in 2003 in the US and 2) to do a startup IX business with some Iraqi expats (who'd moved to London in the 70s-80s) and 3) be close to the biggest news event happening in the world and see what it was like up close.
The helping-out-with-medical happened 5-6 years later and was entirely due to the company I was contracting for having some connections at the founder level with Christian and medical charities who were also helping out there -- I can't really take any credit for "volunteering" for that, it was much closer to "voluntold", but I'm glad I did it.
I love these IKEA hospitals and the quote at the end of the article assembled it all together,
"The hospital is a small contribution by India to humanitarian work around the world,” she said. “We are now ready to share it with any country that needs it.”
It reflects a new way of thinking and a fresh world view. A vastly different view from the one I grew up in (80s)... Which was huge headlines in NYT about how poor countries need aid and western aid organizations are helping them. When in reality it was "relief theater".
That is maybe an 80s world view at best. The United States government is extremely proactive and effective in providing international aid whenever a disaster strikes.
Lets take the 2010 Haiti earthquake as an example, which happened at about 4 PM. The US ambassador declared an emergency, the joint chiefs issued an order for support, SOUTHCOM initiated its crisis response operations center, and the newly formed Joint Task Force Haiti was setting up calls with local ministers before the Haitian president even formally requested assistance that evening.
At first daylight 3 surveillance aircraft were overhead surveying damage and identifying rescue targets, a US coast guard cutter that was in the area arrived in port to begin infrastructure damage assessments, and SJFHQ established a command post in country. By sunset US special operations has teams on the ground to assist with security, FEMA has an Urban Search and Rescue team rescuing trapped victims, and Air National Guard combat air controllers have taken control of the airport and turned it into the busiest single runway airport in the world for arriving aid workers and supplies.
By the second day hundreds of troops from the 82nd Airborne have arrived, the State Department diplomatic security service is in the process of evacuating thousands of American nationals, and multiple Global Hawk drones are providing real time video feeds to rescuers on the ground.
The third day the USS Carl Vinson aircraft carrier arrives where its deck is turned into a 50 bed hospital, and it would remain on station until the USNS Comfort hospital ship and USS Bataan causality receiving ship arrived the following week.
An IKEA hospital is an amazing thing, but it isn't worth shitting on the massive international aid operations most major countries conduct as "relief theater." India itself is among these, their light helicopters and skilled pilots were vital during the initial response to the Nepal earthquake.
Totally. During the early months of the pandemic when NYC was hit super hard, Samaritan's Purse set up a tent hospital in Central Park directly opposite the main campus of Mt. Sinai which was a marvel to see, I would run and cycle past it nearly every day. Another of my common running routes took me past the USNS Comfort, docked at Pier 90, and the Javits Center, which hosted yet another modular hospital. Then a little later, a modular morgue on Randall's Island, which is now the site of a modular migrant encampment.
I later read that because of strict policies relating to a notion that only the "simple" cases, of which there were few, could be transferred, the temporary hospital facilities ended up underutilized. But the ability to surge capacity in a specific area is hardly constrained to parts of the world with fewer hospital beds. Public health crises and natural disasters in the USA are perfect candidates for this technology.
I hope we can test this quickly, and if it works, buy a bulk pack.
I've always thought it strange that countries like the UK with the NHS haven't standardised a modular hospital design where you can slot prefab modules into some framework. Need a CT suite on floor C? Labs on floor F? Need a new floor on top?
And then (assuming the British government isn't feeling charitable, which is a good bet) you can export them at a profit or licence the design to other countries.
Instead, every single hospital seems to be a money-pit full-custom design and changing one after the fact is almost entirely impossible without huge effort, which is why my latest medical appointment was done in an old laboratory, complete with lab benches round the walls with a high-school-style desk and two chairs awkwardly plonked in the middle.
Obviously it's not a simple thing to design such a thing (not least the plumbing!), but the immense resources that go into full custom hospitals, the pain it causes when they become not what is needed, and the expense of modifying them really makes me think.
Everyone wants their city to have.unique hospitals. Plus it is rare to build a new hospital, what they do typically is remodel an existing one so there is less gain.
Elementary schools could also use a standard modular design, but every town would prefer to spend just a little extra for a custom design. The cost of a custom design isn't much more anyway, as all the parts are standard off the shelf. What a standard really gives is they don't make the gym too small for a.regulation basketball court and other details that are easy forget when specifying a custom building.
Admittedly not much gain up front, if anything it might be more expensive than a really efficient custom design (though I think most recent UK hospitals are not cheap, one near me cost something like £200 million and has 500 beds and took quite a while to design and build, would be interesting to what went to the design consultants).
You can still put a custom fascia on it. Most recent large buildings fundamentally work that way anyway. Concrete inside, panels or bricks outside.
The real gain comes in 20 years when you need to change things (medical technology changes, demographics change, multi-hospital organisations-trusts in the UK, networks in the US-change), and you find that you need to gut the whole place to do anything at all. So you either do that at huge expense, or you make do and do your consultations in a disused lab area with a waiting room in a corridor (because labs don't have waiting rooms, but now the lab work is done elsewhere, so it's what you got).
Of course when it's all about "profit this quarter" (US) and "being tough on spending" (UK), having a major problem in 20 years is not your problem.
It is a similar story for schools, and other building-types. They could be modular, and benefit from overhauls/extensions/fixups every decade or two. Instead we have historically "quirky" buildings that evolve a little in-place at great cost.
This recently came to a head, again, in the UK where it was discovered that some schools were on the verge of failing due to the limited lifespan of the concrete and building technique in use:
"Crumbling and potentially dangerous concrete has been found in 174 English schools, 27 more than previously known..."
I'm not sure if limited lifespan is really a negative. 50 years ago i'd expect to see asbestos, lead paint, aluminum wiring, single pane windows, and minimal insulation. All are things expensive to replace so so tearing down and starting over makes sense. That is in addition to they didn't plan for modern needs in other ways, computer networks are retrofitable, but it will show. Did they build a lunch room with the right equipment in place, modern cooking has changed some (not always for the better). Did they put in the right size gym for modern needs. Should there be a separate cafeteria. Is the school way too big or small for the local population (family sizes are down, but schools have consolidated). Is there space for the different break out classes, my impression is gifted talented programs have more importance today.
Well... That assumes willingness to build new things rather than miserably put up with the decaying things left to us by previous generations.
They're re/building about 50 a year, and there are 32000 schools, so about 0.15% of the stock per year. So a school has to last over 600 years on average before it'll get rebuilt at this rate.
> The hospital construction industry is huge and wouldn't want that.
Sounds very much like a them problem (assuming a government since 1948 could show such intestinal fortitude).
> hospitals have become luxury
Only if you allow the private sector to completely capture the entire industry from top to bottom including government and regulatory function (in the same way the US automotive industry made light trucks basically illegal where they could).
That process of top-to-bottom capture having not yet been fully completed in the UK, I don't think you'll find an NHS hospital, even a new one, especially luxurious. A BUPA one, probably yes (but they also don't have expensive money sinks like grubby un-insured and un-moneyed patients, A&E departments to run or junior staff to train).
And there's no reason you can't have luxury modules as an upsell, or even third party compatible models. It's how aircraft are configured. You get an empty fuselage and you choose the modules. But the difference is you could fit the same modules to the medical versions of Airbuses and Boeings.
I don’t know. Are CT or MRI machines ever found on anything but the ground floor because of the weight of them / installation complexity?
I agree that you want standardized designs, but modular stuff gets tricky because it’s physical infrastructure not code (eg things can fairly physically in unintended ways if the supports aren’t designed for it and designing supports for arbitrary undefined loads to be added later is tricky).
Well I mean, you still have to engage your brain and do some design at some point. PortaKabins are modular yet no one specifies to stack them 100 high, even though in theory you could just keep on stacking (infinite floor area hack, real estate agents hate this one simple trick!).
As for CT, the last one I had was actually on a floor C, but it was at the back I think, so now I think about it could have been the ground floor as the building was on a hill. But even then the module catalog can just say "you can only put Type H (heavy) modules at the bottom, and Type R (radiological) ones go at the bottom unless shielded".
Maybe it's just an insane and impractical idea, but I can't help thinking billions upon billions in one-off design and refitting work is being reinvented every new project (not that I hear architects and consultancies crying about it).
Couldn't find anything online except for a reddit thread with random guesses. Alternative explanations are colocating with ER (the places I go to tend to not have an ER so not sure that's the reason), or for CT & Xrays the floors might have to additionally be lead-lined if not on the first floor which adds to the cost (when there's a basement imaging can often be located there apparently). Could also be a convention that's just been established but there's no real reason.
Some of this is already occurring. The company I work for makes mobile imaging solutions (CT, MRI, PET) that fit in the size of a shipping container and are often transported by semi-truck. There are hospital designs that leave bays for these trucks to pull into with a door on the side to get patients in and out on detachable tables. So a small hospital system that only has the money for a single CT or MRI scanner can move it from site to site in rotation to see patients instead of siting it at a single hospital and having to send patients further from home.
Doing that on a larger scale would be the next step.
> NHS haven't standardised a modular hospital design where you can slot prefab modules into some framework
I think the nearest we got was the so-called Nightingale hospitals hastily erected for the first anticipated Covid-19 influx. They were put up very quickly but never saw much use.
Im not convinced that some of the most advanced buildings we build is the ones most fitting for standarization. Ideally every hospital is constructed to fit the needs of the local community (and budget and building permits).
Lots of things are this way. School busses and fire engines are mostly all custom built to order. Fire apparatus at least make some sense, as the needs of every district vary, but school busses? I would think a few common models would suffice.
I have been to many (majority?) of the states in the US, and took the school bus in 6 very different and far apart states, and I feel like they are all the same. Maybe there are 2 designs, flat front or truck style front.
> A tablet computer included in the cube pack is programmed to minimise assembly errors, and an alarm sounds if the wrong equipment is put in any given cube.
This is incredibly smart! Guessing Ultra Wideband beacons in some of the equipment, so you know what cube it's in!
In terms of “airdroppability to disaster zones”, hardly anything beats cardboard beds[0].
It is true that the field hospital in TFA is a much comprehensive solution. I just wonder what an equivalent would be if designed with similar minimalistic principles to the cardboard bed.
I don't really get the point of this bed, how is it better than sleeping on the ground? The only reasons I can think of are insulation (which just a couple sheets of cardboard would do well, a 50% savings on material), and keeping away from pests like mice and cockroaches. Granted, those are decent reasons, but I wonder if spending the money elsewhere for disaster relief would be better. Am I missing something?
In addition to your reasons, and sibling's 'easier to get up', I'd add:
- does actually look much more comfortable than the ground to me. The middle would give a bit into the cavity of the base, it's not just a sheet on the ground as I imagined reading your comment.
- being raised makes it easier for medical personnel to attend to any injuries etc.
- looks like a more clearly delimited arrangement, I imagine it would more easily become difficult to walk around people sleeping on the floor, as they'd sprawl out, lose the organised grid arrangement, etc.
But I don't have any relevant experience to comment on how important any of that is, or if it's the best way to spend whatever cardboard beds cost in such a scenario.
Tbh those look like they might collapse if you don't sleep still on your back, without tossing and turning. It doesn't really seem like a great fit for disaster relief for people who are under severe stress. If I were assigned one of those beds I think I'd lay it flat on the floor just so I don't have to worry about falling in the middle of the night.
> A hexayurt is a simplified disaster relief shelter design.[2] It is based on a hexagonal geodesic geometry adapted to construction from standard 4x8 foot sheets of factory made construction material, built as a yurt. [3] It was invented by Vinay Gupta. [4] Hexayurts are common at Burning Man. [5]
Is there a passive thermal roofline container modification for latrines and dispensaries? TODO link
- [ ] Heat pumps for disaster relief shipping containers
In searching for the shipping container by the ResponsePod folks, I just found an awning specifically for the area between multiple shipping containers in a corral configuration; prefabricated container shelter.
I couldn't find the link. It's a standard sized shipping container emergency response disaster relief dispensary with HVAC but not yet heat pumps FWIU.
- [ ] An open set of plans and modular interface specs for disaster relief shipping containers
I wonder if one could fold up an operating room tent and put the entire thing in an autoclave. Or, maybe more efficiently, have a tent frame that stays up and an inner all-fabric room that goes in the autoclave.
Yes, it is. A mobile field hospital is usually built around the premise of a tent. Germany, USA, UK, Russia - all have tent-based forward deployable field hospitals.
OK but the American field hospitals often only need to stabilize people because the expectation is that anyone needing serious treatment will be airlifted to expensive military hospitals in Germany or the US. In contrast, the victims of humanitarian emergencies in poor/developing countries usually need to be fully treated on site because they aren't getting airlifted anywhere :(
This is a side effect of recent US conflicts being low-intensity COIN operations involving brigade sized or smaller assets that spend most of their time in garrison.
In a conventional conflict mobilizing entire divisions, as the US is now preparing for again, you will see far more capable field hospitals again, because the US won't have the necessary capacity (either in terms of airlift volume nor existing hospital beds) to afford this luxury.
That is correct. The forward deployable field hospitals are really nurse stations to stabilize any active medical emergency for transport or otherwise stop the emergency (not necessarily treat it, they’ll do what they can).
Pretty sure this is just a PR exercise for the very gullible. Anyone who has seen a real operating theater and had experience of being outside will know this is nonsense. That tent is simply not big enough for one thing.
This is what innovation in healthcare and med tech looks like. Versatile, affordable inventions that serve those in desperate need. Western med tech could learn a thing or two here.
My impression is that when a disaster strikes a Western country, they have the capacity to airlift the people in need of medical attention to real hospitals in areas that weren't struck, instead of putting up tents and barracks in the disaster zone.
Minor nit, but countries like the US or Canada are huge and rescues can take a lot of time. However you don't need a portable hospital more than a rescue helicopter for a few injured/lost hikers.
Because it’s cheaper, not everyone has pentagon budgets to set up a modern hospital in a disaster zone.
Plus even if you did have all the fancy equipment, it takes forever to set up relief centers. After Hurricane Maria in Puerto Rico or after fired in Maui, it took days to setup basic relief centers. Imagine if you have these cheap “tent” hospitals available at every small nearby town, you could setup relief in a matter of hours.
I'm not seeing any innovation here as distinct from what is already done for inexpensive field hospitals, except that it's in a retail tent.
> Sharma says the hospital is the first of its kind in India, but is reluctant to make any grander claim as she is not certain of similar developments in other countries.
The Army Combat Support Hospital (think MASH tv-show...) guys could set something up like this really fast, but it was expensive hardware, required their own personnel, etc. This makes sense for the US military (massive logistics, budget, etc.), but not for others. Also worked (volunteer/charity) with some local clinics who didn't have these kind of resources, but did have great personnel, who could use more locally-acquired or bespoke solutions -- problem was it was slow, not uniform standard, etc.
A cost-reduced, standardized, easily transportable hybrid is great. Ideally you'd use existing standardized readily available stuff with minimal medical/flown in stuff on top.