Monday, March 18, 2013

Equipping The Disaster Clinic: The Space

Getting back to business for awhile, I've mentioned in post responses on other blogs, and here, that it would be possible to recreate an ER on a budget. Much like automobiles, many people have been in one, but not as many have built one. So, if you were going to do it, what would it take?

Let's imagine the bare minimum one-room clinic treatment room. Because you can work with more, but not less.

It's been successfully accomplished in barns, woodsheds, GP tents, WWI trenchline dugouts, heliborne pods, submarine messhalls, and hollowed out underground tunnels and caves, from dirt-floored to SAC Doomsday variety. Some of these work better than others.

Number one, a dedicated space. Doing it in your living room, for obvious reasons, won't cut it.
So what are the requirements?
The space should be large enough to do what needs doing. Bigger is better, but the smallest functional space would be 8' or so wide and 10' long. In other words, half of a 20' long conex box, or the equivalent. 16' x 20' would be ideal. Anything in between can work.
It needs light (overall, and one movable spot for detaile work)
 climate control (heat, cooling, humidity, and air filtration/purification - think more HEPA than CBRN) 
running water in and out (handwashing sink),
and the ability to clean/decon/sterilize the space at will, ceiling to floor.
A stable floor, impervious to fluids, and easy to clean.
Also the ability to make it dark, quiet, and private, as necessary.
And depending on the situation, possibly the ability to make it blend in or be invisible to the outside world.

Number two, you need something to place the patient on, to work on them, and or allow them to rest.
At the low end, two sawhorses and a pole litter.
At the top end, a height- and angle-adjustable gurney or surgical table, wheeled for easy patient movement.
Rails, straps, restraints, and/or whatever, to prevent patient movement/falls while being moved, unconscious, sedated, combative, or all three.
The ability, like the room, to clean/decon/sterilize it between patients, top to bottom, with a minimum of effort.

A sink connected to that running water supply, and drain away whatever goes in it. Probably a floor drain as well. Both drains should be regarded as blackwater/hazmat drainage. So this isn't going into grey water recycling, because you won't like what plagues that'll create.
Ability to do both eye and whole-body rinse for decon from chemicals, critters, or just from being dirty and funky either in room, or close-by.

A place to organize and store handily the necessary supplies, both for treatment, and for basic patient care like linens, potty breaks, and such.

A vital signs monitor. There is a rainbow of abilities, but the ability to monitor heart rate, respirations, oxygen saturation, and blood pressure are both current standard-of-care, and the least you should aim for. Note I said monitor, not measure. You can calculate spot vital signs with a stethoscope, a BP cuff, a drugstore fingertip pulse ox, and a watch. You might even manage to dedicate someone to repeating the process every minute or five. But that's a waste of them as a resource. It's also not very practical if things are changing fast, and your treatment area is loud. So you want an actual monitor to do this, just like you'll see in 50-90% of ER treatment rooms now, and in 100% of trauma rooms. It's the difference between using a radar gun, and using a speedometer. It's also the difference between having instruments to fly the plane, in this case a patient, rather than just looking at a snapshot of where the plane was 30 seconds ago taken every few minutes. Which would you like your pilot to use if you were on that plane?

A source of supplemental oxygen. Currently, small oxygen concentrators for home use peak out at a delivery of about 6L/minute. You'll need to be able to get to 15L, ergo you'd need either three concentrators dumping into the same supply, or a means of bringing in cylinders of 100% medical oxygen from purified and filtered compressors, and a regulator that'd deliver up to 15L/min. Nota bene oxygen is oxygen, but welding oxygen hasn't had those FDA-approved filters applied to make it jump through the hoop to being medical grade. If you can access oxygen cylinders at all, make the extra effort for a patient to get the right grade. The standard exists for a reason.

A means to suction blood, fluids, and whatever, is handy and frequently necessary.

A place to dispose of simple trash and garbage, and contaminated medical waste. The trash bags and red waste bags in patient rooms is only the front end of that. A means to incinerate those bags and bury the ashes is the necessary back-end. You can't skip either end of that process.

Patient care supplies: gowns, linens, urinals, bedpans, bedside commode. Nearby full bath (sink, toilet, shower/tub) if you can manage it. And a means to wash and decontaminate the linens, and bedpans and urinals, as disposables only work if you've got a warehouse full of them, and a way to keep getting them. If you're envisioning provision only for a small group, a dedicated set per person, plus spares for breakage and wear and tear is sufficient. If you're envisioning care for random victims in a disaster/third world/grid-down situation, rather more will be required.

Treatment supplies: from bandaids on up, which I'll cover in future posts.

That's every room I've ever worked in, in a nutshell. The more you provide, the easier the task of medical care gets. The reverse is also true.

1 comment:

Anonymous said...

seems like a refrigerated shipping container or van body would fit the bill for the shell. Stainless steel, easy to clean and insulated.