What would happen if casualties from a bio-terror attack overwhelmed the capacity of hospitals in the surrounding area?
Conventional disaster plans authorize hospitals to convert hallways, offices, cafeterias and other space for patient care. Plans also point hospital administrators to community facilities such as public schools and convention centers.
Recently, however, emergency planners pondering the potentially large number of casualties from bio-terror attacks have begun to doubt the efficacy of conventional plans, which do not consider the long term care needs that may arise with bio-terror victims or the square footage that might become necessary to care for hundreds of patients.
“We found that most hospitals can only surge to 20 percent of licensed capacity,” says Christopher Lake, Ph.D., the director of hospital preparedness for the Nevada Hospital Association (NHA). “What if that weren’t enough space? What if you had patients who would be sick for a long time? At some point, you would need the hallways and cafeterias back.”
The NHA also found that it would be difficult to provide the long-term care necessary for bio-terror victims in community buildings such as schools and convention centers. Communities did not like the idea of turning over a school for an extended period. Moreover, many schools and convention centers have already been written into emergency response plans used by relief organizations.
So what happens to patients requiring critical and long-term recovery care? The NHA has been investigating this question for the state of Nevada under a $4.2 million grant from the Health Resources and Services Administration (HRSA) designed to help hospitals prepare for a bio-terror attack.
Finding space for terror victims proved so problematic that the NHA began seeking alternatives. “That’s how we got to portable hospitals,” Lake says.
Portable hospitals aren’t new. The Federal Emergency Management Agency (FEMA) and the U.S. military use them. NHA reviewed those options, with an eye toward Nevada’s needs. In the northern portion of Nevada, a portable hospital would have to provide heat to fend off the bitter cold of winter. It would have to support a snow load of several feet. It would have to fend off ice sheets and ice dams that often form at the base of building walls. In the southern reaches of Nevada, a portable hospital would need air conditioning and protection against sand storms and high winds.
The NHA determined that the FEMA model could not withstand high winds and snow. A U.S. Army model proved too clumsy to transport and assemble. Finally, an Air Force portable hospital, called the Expeditionary Medical Support System (EMED), appeared to fit the bill.
An EMED is made of three vinyl fabric tunnels shaped like half cylinders. The half cylinders lie parallel to each other on the ground. Another fabric structure bisects the three half-cylinders at their midpoint and forms a corridor that ties each wing to the other. From the air, the structure resembles a giant “H” with an extra vertical bar running down the center. The crossbar on the modified “H” is the corridor. Structural aluminum tubing provides support for the multi-layered vinyl fabric that insulates the facility from hot and cold temperatures and keeps rain, snow and sand out.
After discussing Nevada’s needs with BLU-MED Response Systems, the company that supplies EMED to the Air Force, the NHA used the grant money to purchase a system, with modifications. BLU-MED developed a blue and white color scheme accented by large orange stripes that could be seen from aircraft.
Nevada has outfitted the facility like a well-equipped emergency room. Medications are stored in quickly accessible kits at hospitals around the state. Areas within two of the three wings of the facility are designated as an emergency room, triage, intensive care, and a flexible space for surgery or patient beds. The third wing serves as a multi-purpose space.
An electrical harness connected to generators allows for the flexible distribution of power throughout the facility.
In a test, the NHA shipped the portable hospital from 600 miles away and assembled it with an untrained crew in eight hours — during a bad rainstorm, which happened along on the day of the test. It took another four hours to stage the medical equipment. Physicians asked to evaluate the facility said the working conditions were comfortable and required no special training.