1. Introduction
Expandable Mobile Hospitals are essential needs at a time of disasters and catastrophes. One of the most important reasons in this case is the increase in the number of people who may be physically hurt and need hospital care. States have reported that disasters and emergencies, which are risk factors, are faced among people throughout the world and result in deaths, injuries, and serious losses. When natural disasters and social challenges increase, health investments are more important for the protection and rehabilitation of human resources. Long-term and much more infrastructure investments have a higher effect on health. Against any unforeseen risk, the issue of healing in any place is of great importance. This requires the establishment of hospitals equipped with all kinds of technological equipment and physical infrastructure. Mobile hospitals could be described as a central health care offer that includes vital and non-vital operations and hospitalization.
Despite all these recommendations and the experience of ethnically motivated killings over recent years, mental health services do not include two divided basic networks of separate clinics for these two groups. In such incidents, members of the affected group must know the details of the events before treatment can be initiated, and adaptation and coping strategies must be identified. Mobile hospitals are flexible hospital facilities designed to temporarily increase a region’s medical resources. They are innovative hospitals, in that they are versatile, embedded deeply into the existing healthcare system and health community, and capable of peacetime and emergency operation. Therefore, countries are advised to plan for immediate investigation, including the collection of basic core data needed to address the immediate needs. Sufficient, high-quality epidemiological studies are required to clarify the extent of and scale of mental health. Mental health is an important factor in recovering from any traumatic event, such as a war or natural disaster. Mental health consequences of a catastrophic event also have connections with other health areas such as alcohol and drug abuse, suicidology, forensic materials, and interpersonal violence. Given the volatile security situation of today and the political threats, one cannot afford to ignore the mental health consequences. A country that does not care about mental health may expose itself to instability in managing its citizens. Therefore, it is recommended that the concept of mobile hospitals be used by giving directions and instructions in many different places. In other words, these hospitals are based on the supply and demand of personnel capacity in a region.
1.1. Background and Significance
In the early 1970s, with the continuous development of industry and in the fight against diseases, the worldwide progressive demand for expandable mobile hospitals has driven great development. In 1991, the American National Standards Board established a systematic standard for expandable mobile hospitals (the ANSI Board is a member of the International Standards Organization, and it has 163 active subcommittees that together develop and implement U.S. standards). The International Organization for Standardization (ISO) issued its own standard in 2012 and revised it in 2018. According to contemporary studies and literature, there are two main types of surgery that have been conducted in general hospitals. Every year, safe surgery will result in 143,000 to 284,000 deaths, whereas unsafe surgery will result in 5 million to 10 million deaths. In this way, it is conceivable to efficiently eradicate the disease, as well as to alleviate the suffering of the people.
In recent years, military conflicts have caused a wide range of suffering, and various pests have worsened the people’s condition, thus sparking widespread fear and anxiety among the general public. As soon as the initial development phase of the Awful Bug Breakout has passed, the Infectious Malady Epidemiology Contain Health-care Institution will be swiftly put into operation. Consequently, they offer a comprehensive remedy for the illness. Infectious-disease control hospitals are sources of alerted and/or obsessed people with a range of pesky, life-threatening diseases. Accountability for the perceived demand for infectious-disease-containing institutions lies with the Ministry of Health, which refuses to sanction free-standing treatment institutions for the purposes of mandatory confinement or health care. This helps people infected with unhealthy illnesses to move on if they are infected. These establishments will be erected near lengthy and established hospitals in line with potential risks. When your public health care facility and treatment center’s areas are restricted, the conditions for treatment cannot be fully relaxed.
1.2. Purpose of the Study
The first part is to develop an expandable mobile hospital prototype that can meet all these vital functions and ensure continuous medical treatment within severe conditions. A field-mobile hospital vehicle needs the structure of an indoor space capable of converting low cost and rapid inflatable components. The patient container area may be expanded by an electromechanical system. The second purpose is to implement this expandable mobile hospital as a prototype of a vehicle.
In addition to the prototyping research, long-term or present clinical studies will help validate the prototype. The deployable structure or system has to meet certain standard requirements comprised in the rules governing the construction, organization, individual business use, and operation of field mobile hospitals before the mobile hospital will be put into use. These prescriptions are proposed in accordance with the points provided for “field mobile hospitals” in the Turkish Healthcare Facilities Guide or other similar international documents with the same treatments that provide a direct basis or referred to by these. In addition, it offers a basic construction and structural design concept as a “design guide” for design enthusiasts who want to make new designs other than the technical requirements of the design. Field Mobile Hospitals can be used for the provision of health services in severely affected or crowded situations due to their seasonal, natural disasters, external or internal migration, unexpected emergencies, mass gatherings, etc. The field mobile hospital is constructed with demountable systems to be able to be relocated to another region if necessary.
2. Conceptual Framework
The ongoing power of nature is a challenge for societies and policymakers. In such a framework, the establishment of Medical Activities is bound to a joint force action among many players. The research focuses on the design and implementation of Expandable Structures (ESs) aimed to realize mobile hospitals. This work refers to the proposed system to treat the Educational Area of the Risk Map II of L’Aquila’s municipality.
Expandable Mobile Hospitals (EMHs) are environments that can exploit their facilities respecting modularity, easy transportability worldwide of prefabricated modules, speed of mounting and the communication among them. This point is the aim of the present work, driven by the continuous change of needs, medical cures and technological service updates and looking and trying to provide improved and modernized solutions. This paper, first, proposes a couple of state-of-the-art and innovative multi-disciplinary implemented references of expandable mobile hospitals. After these frames, the educational area object of the present Risk Map II of L’Aquila’s municipality is proposed. Finally, a Service Value methodological approach is applied to design ESs. The risk is identified as the possible source of funding, free service enhancement, augmented by hospital service providers. In the present paper, a real case study is presented, as a proposal for the improvement of a Physical Education Area (PEA) in L’Aquila with ESs and analysis of the potential sources of funding for project implementation.
2.1. Definition and Features of Expandable Mobile Hospitals
With the advancement of mobile technologies, mobile environments, and even smart homes to smart cities, are no longer science fiction. Since the 2003 Severe Acute Respiratory Syndrome and 2009 H1N1 pandemic, the implementation of isolation rooms and pandemic ward systems in hospitals, and the expansion of medical facilities, emerged to save time and cope with patient surges with a low occupancy rate. However, such temporary facilities require a short time for realization and are not helpful in building them immediately when a disaster happens.
One of the suitable forms of this strategy comes from reference 2, “30 Mobile Medical Services for All”. We expect that this design will be helpful in establishing medical facilities when disasters and humanitarian relief operations from pandemic influenza A and disasters in low- and middle-income countries far from Korea occur. In this reference, mobiles can be defined as either a vehicle or something constructed to be installed on-site from several transport cases. In particular, in Korea, in order to manage infectious diseases, safe hospitals (with patient isolation function) were constructed in armed forces only, and no other medical facilities have been. A concept paper of the reserving mobile hospital was described in Science. However, the expandable mobile hospital was summarized in orders through acute multiple disaster simulation of Korea, so that many features associated with hospital design are included in expandable mobile hospitals.
Under such a difficult situation, this study aims to meet the limited transportation environment and mobility of specialized equipment after analyzing the expandable mobile hospital supply system, the damage of disasters, and emergencies. Many researchers developed special vehicles or transportation units and proposals for the final configuration. In order to operate hospitals more quickly and overcome the disadvantages of mobile hospitals in conventional definitions with this strategy, the extendable mobile hospital was defined to be built under the following conditions: rejections of special reflectors or carriers in the hospital. In constructing a mobile hospital, attention should be paid to improving the accessibility to them and to the replacement of current isolation wards and specifications of mobile hospitals and spatial information in general hospitals. An implementation strategy for expandable mobile tents has been developed using seven weight criteria. Emergency department staff and hospital managers can use these criteria to establish informative management and organizational policies that decrease treatment time and improve patient care.
2.2. Previous Research and Innovations
In Italy, due to the yields on materials caused by a punctuated study of construction, there are many buildings not suitable for the vital function assigned to them. It is therefore appropriate to define technical solutions capable of making existing facilities usable and expandable according to new structural and organizational requirements. The solution proposed in some cases has been to design and implement expandable mobile hospitals which are functional, ready, independent, and autonomous for basic care based on the activation of specific “Emergency Units.”
The expansion of the structures occurs by opening two side curtains which only need to be unrolled. In total, this allows for an increase in the number of beds inside. We believe that, in the future, more research will be focused on management systems and environmental sustainability inside hospitals, making it possible to make the latter optimal in terms of physical as well as mental health, with a focus on patient well-being.
From what has emerged from the research, it has been found that several solutions for barracks, actually mobile hospitals, of recent design or developed based on previous configurations, were built starting from the yard and had their sets shipped subsequently. From this comparison, for the solutions that provided for the construction of parts in the factory but not a mobile hospital, the quantity of installed works was not detected since with this type of solutions the distinctions of what has already happened technically have no impact. In the event that further auxiliary works are necessary, they are anticipated only on the basis of the technical and commercial interview with the interested parties.
3. Design Considerations
Design considerations: A large number of patients pose a risk of overwhelming and exhausting the capacities of stationary hospitals and care structures. Using an expandable mobile hospital can alleviate and spread the patient burden in a large-scale epidemic or disaster. In times of high demand, rapidly reconfigurable structures are needed. This section covers the design considerations needed for creating a flexible and mobile solution to build a mobile hospital.
First, the structural design is crucial when space inside the mobile hospital is to be provided quickly and without many obstacles. In addition, flexible use of space, such as providing space for quarantine zones in the hospital, should be possible. The usability of the hospital should be equally considered. Important aspects here are the interior design, including lighting, washbasin construction, and toilets. Because different needs of patients have to be addressed, an appropriate equipment concept is necessary and a plan for disinfection and decontamination must be developed. Furthermore, the question arises of where to store all the equipment, so that the mobile hospital is also equipment-ready. Patients should then also be able to be transferred inside.
The mobility and transportability of the entire system, including the vehicle pulling the container system, also present a challenge. Because mobile hospitals are always location-dependent, additional aspects of location security and the necessary perimeters must also be taken into account. All of these aspects require technical, process, and material solutions. They must be well coordinated and, above all, practicable in operation and transport.
3.1. Structural Design
The mobile hospital of the future is expected to be fully equipped to perform all functions with modern equipment and will be able to be transported anywhere in the world for all kinds of disasters. In terms of the architectural aspect, the expandable structure of the mobile hospital becomes the basic concept from the beginning of the design of the hospital. The architectural aspect of the structural design of a mobile hospital for disaster and conflict areas to meet these requirements is important.
There are many challenges and considerations relating to the actual construction of an expandable facility in addition to the readymade or temporary facilities available on the market or local facilities in case of the need. When designing the structure of such a hospital, most importantly, awareness of local conditions that will be constructed in advance will facilitate the pre-determination of the construction system. The cost of transporting all open type conditions, operation and construction (assembling and dismantling) practices must be taken into account. Likewise, the expenses to be made for the same purpose when the hospital is loaded (towing) by the trucks required to be removed from the locality must be calculated (dismantled).
3.2. Functionality and Equipment
Today, virtually all military or rescue operations require comprehensive medical aid. Many injuries or multi-organ involvement determine the need for multidisciplinary medical assistance. Therefore, mobile hospital or routing supplies is an inseparable element of current soldiers’ equipment or undergo paramedics on routine and emergency missions. The design of the hospital must meet the basic requirements set for medical facilities: the proper separation of operational wards, treatment and reconnaissance departments, full performance, proper isolation wards (spread of infections such as NBC mode), the ability to treat several patients at the same time, the modularity of the design, the ability to attach to the facility fully equipped electro-hydraulic. This is necessary because emergency medical assistance can only be effectively carried out by health professionals using efficient and effective equipment. Careful design of the examination and additional equipment can lead to significant simplifications in hospital design and equipment transport conditions (specifications).
Another issue that has to be taken into account is the need to provide medical staff with equipment that is adapted to harsh conditions, including: lack of participation in various means of communication, dirtying of transport compartments, and storing extra equipment, and external dimensions of facilities are to fit the bed, ideally are plenum, or pleno with a trampling area for rescuers. Local fealties between pianists set according to the need preference. Mobile hospitals have not always used optimized construction solutions. One example of this is the orientation of medical tents developed by the Polish Armed Forces. It was observed that a more advantageous solution is the tight-panel design made of sandwich panels with a curtain facade. This solution makes it possible to maintain the air conditioning parameters regardless of the ambient physical-chemical parameters. Such a design is particularly advantageous in the climatic and environmental conditions of use, which are very different. Integration of technical and technological solutions for expandable (multi-task) hospitals with existing resources in terms of warehousing and reloading. In conclusion, the hospital must be provided not only with the necessary devices but also many engineering solutions that are necessary for the operation of this ISS.
3.3. Mobility and Transportation
Mobile hospitals, in general, and specifically expandable hospitals, must be mobile and readily moved from one location to another. It is necessary to physically move the modular and expandable mobile hospitals because they need to be reconfigured and set up again when reassembling the initial configuration. The initial configuration involves organizing the land to ensure a suitable fit. Since unfinished or partially finished land plots are not identical upon receipt, the foundation on which the initial configuration units are set up and deployed may vary across the available area.
The above outlined assumptions and characteristics drive the specific requirements of mobile hospitals and necessitate them to be container-based. Once the hospital is emptied and cleaned of waste, it should be easily transported to the next location. The specific characteristic of mobility and transportation partly explains the standardization systems contained inside a single expandable hospital unit (EHU+X). This ensures that each container satisfies the internal boundary conditions and physical configurations required for interfacing with a different transport vehicle. A very similar set of requirements also justifies the use of a modular control system, or at least modular control units. If each individual EHU is equipped with its own module controller, then the control systems of the EHUs within the expandable unit are “cloned” to ensure they have the same input/output list and exchange the same signals.
4. Implementation Strategies
The team leadership is responsible for overall public health and emergency response, while the site leadership, who are familiar with local needs, will determine the type and number of temporary care and expandable mobile hospitals required to meet the demands of mass patient care. Reconfiguration of existing buildings may be considered if necessary to meet local emergency requirements. Once these determinations are made, temporary care or expandable mobile hospitals of defined capacity will be deployed to the affected region. The logistical requirements to move the number and type of patient care facility to the affected area will be organized and can be done regionally, nationally, or through international assistance, depending on the affected area and resources.
The patient care facility can be brought to the location of a population in need of medical aid where all other infrastructure and services may have been disrupted or lost. Alternatively, expandable mobile hospitals can be deployed in or around a host nation’s existing health system where infrastructure might not have been affected more than to accept a large influx of patients. Implementing the expandable mobile hospital in these two contexts will have different strategies in terms of integration and overlap with existing services and should involve different parties in the deployment. Finally, the vendor, providers, or other commercially owned companies will retain a variable hospital size of one or more patient care units and deploy and manage many or all of the operational requirements as required and as agreed to with the implementers. Staffing of the expandable mobile hospital should be performed following the principles outlined for surge capacity, where and when staff have been trained according to the guidelines and protocols in place at the hospital when they are recruited into deployed as a functioning unit. If local staff need to be trained to operate the patient care facility, plans should be in place to receive expatriate staff to operate the hospital until sufficient local staff have been trained to either take over or provide surge capacity to the medical team that is on site.
4.1. Deployment and Setup
In order to set up an expandable mobile hospital, logistical and infrastructural preparations must be made, and the proposed site of implementation must be inspected, assessed, and secured in advance. The mobile hospital can be readied for use in a controlled environment and tested according to the indicators stipulated. In the event that a field hospital is needed, the planned setup time for a field hospital is around 3 hours for a complex instead of 6 hours.
Logistically, the mobile hospital should be installed in a location near a good connection road to make the passage of trucks and vehicles as smooth as possible. The area should be inspected in advance to prevent damage to the infield (e.g., public roots, trees, etc.). The implementer should inspect the site’s conditioning and condition to assess how much equipment and personnel are needed to prepare the field. Mobile hospital set-up begins with the arrival of the logistics conveyor. Staff and contractors are trained and reinforced by the medical chief to ensure the optimal amount to meet the planned field hospitals. The extension team enters the infield to clear the site and performs the handover according to the bandeirante of the medical chief or coordinator of the field hospital. Once they have prepared the infrastructure and installed the services at the field hospital, the site is made safe by placing the first band, the passing zone for all of them, and the perimeter fence. This zone is off-limits to all civilians except the coordinator. People who have been injured and slip off will be deprived of it. Then, Way in is existed where the equipment is then sent to the reception of the field hospital. The chair is prepared according to the front method of the intended house and is counted towards the house. In a flat house, stereos are supplied with elevators and people push themselves or vegetables. In this case, são monta-scenics by mover. In the field hospital, the paint or band of designation – “field hospital” is prepared and when necessary, autonomous central hang. At this piantão instaiagse ehag candid concentrentai there LAMP merchand and free workers to receive the beds “Fairtex Moines.” J way is defined the (“KG / 50m / prodia free admission route-limit-) co- o- performance engineering (>) dressing gear.
4.2. Training and Staffing
Physicians, nurses, and supporting personnel will be required to work in an expandable mobile hospital. It should be organized to meet the requirements for healthcare staff organization. Staffing ratios vary with service and need. The field hospital will consist of well-equipped staff niches where supervisory staff of appropriate levels are trained to provide healthcare disparities. Hospitals are expected to engage in disasters and infectious disease prevention for expanding patients. It is hoped that they will arrive with a degree of training and are checked for negative pathogens. A registered nurse with additional training in disaster response must take care of interface operation/nursing staff – Disaster Medical Officer (DMO). Next in command is generally Internal Medicine Boarded Physician with additional training in emergency management (may be MD or DO) and finally will be Infection Prevention before and after medical care – Infection Prevention Officer (IPO).
Training for healthcare service staff includes a review of employee safety nuances and personal protective equipment, radiation safety, ethical practice, and professionalism. Understanding patient needs are unique and attending to those needs will promote optimal patient care, and medical ethics/do no harm. The training of both doctors and nurses will be provided by the larger area medical facilities while interacting with the small groups. Training outpatient support personnel in decontamination and basic disinfection will supplement the basic learning of the large-area hospitals. Compliance with all documentation requirements is discussed in the personnel management section of the documentation section. All hospital personnel must meet the health and security document before entering the camp. Attention should be paid to professional and ethical issues. Such a small proportion of staff are needed. Every effort must be made to ensure that the staff is in good mental health when hired and receive ongoing care after the disaster is in place. All staff members should be trained in mental health.
5. Case Studies
The knowledge about expandable mobile hospitals presented in the preceding sections was derived from the literature and web-based search. On the other hand, expandable mobile hospitals are not common among professionals in asset management and healthcare providers. This section presents hospital case studies which are part of the on-the-ground solution catering to the expandable mobile hospitals based on the standards mentioned in Sections 3.4 and 3.5. This provides some in-service solutions for the expandable mobile hospitals, as well as their learnings and recommendations. The case studies help provide practical insights into creating expandable mobile hospitals.
These hospitals may not only cater to various projects, populations, geographical emergencies, and other requirements, but they also provide the technology of modal change and rapidly transform traditional brick-and-mortar hospitals into expandable mobile hospitals. Fundacion Centro Internacional de Entrenamiento e Investigaciones Médicas (CIDEIM) and Clínica Universidad del Norte (CUND) developed, designed, and implemented a mobile field hospital (HFM) in response to a regional health crisis, as happened in northern Colombia with the arrival of Venezuelan refugees. The experience, divided into three phases, took place between 2018 and 2019 and is presented in this article. Phase One describes the planning of the mobile field hospital. Phase Two presents the challenges and lessons learned in setting up the modules during an international event. Finally, Phase Three showcases the clinical attention and services deployed, which were the result of the planning and execution carried out during the previous phases and the series of strategic and operational decisions made in response to the standard, unexpected, and critical conditions experienced.
5.1. Successful Examples of Expandable Mobile Hospitals
Many examples have shown the effectiveness of expandable mobile hospitals in different scenarios. As a good strategy, expandable mobile hospitals can be incorporated in the global healthcare response plan as a royally predetermined risk strategy. The China National Medical Team in Sierra Leone used and modified a Chinese unit hospital, which is an ISO operative container and shelter-based field hospital and can be rapidly deployed, as well as easily relocated, expanded, and upgraded. The China National Medical Team operated in the T102 Ebola Treatment Center (ETC Hubei 1) in Port Loko, the T108 ETC Hubei 2 in Mile 91, and a Chinese army mobile biosafety laboratory one-hour distance from the SLE ETC in Jui (Western Urban District of Freetown) during two missions in Sierra Leone. The 100 Community Care Centers (CCC) and 20 ETCs constructed by China have contributed a lot to fight the Ebola. All these ETCs and CCCs have different dimensions, but the design is based on the deployable ISO Product. Two case studies of the ETUs Hubei 1 and Hubei 2 provide an especially good understanding of the conditions under which the Chinese ISO product was built. The 6-ISO-unit facility at Mile-91 was fully equipped and operational but only for 18 days, the time it took for the EVD patients to die or recover. To the best of our knowledge, the T102 Chinese ETC in Port Loko is one of the few EVD facilities that did not turn away suspect cases after reaching maximum occupancy. It catered to both EVD and CFR suspect cases, five of which ended in recovery and four in death.
The ETC at Congo Town continued to be host to a laboratory—possibly the most vital—and the large ETC at ELWA1 operated by Partner for Health Services (PfHS) accommodated the continuous flow of both suspect cases and admissions. ELWA was the second-largest ETC and the largest operated by an NGO, WinAfric. All of the final ISO tent-hospitals could be designated as ETC, ETC-U, ETU, Transit Centre or CFL. Regardless of different comrades from contrasting nations provisioned practically all the tent-hospitals, ample similarities existed for making generalized analysis. The tent-hospitals accommodated by NGOs and Ministries of Health included the 13-China ETCs, 1-Burkina, and 1-Saudi Arabia ETC. 60% of the large Chinese hospitals housing 3 ISHEs hospital units accommodated treatment beds. Of the 3-Saudi Arabia and each 1- Korean, Danish, Norwegian, UK, and Germany—with all but the UK and Germany supervised by the NGO Intermountain Foundation—tent-hospitals also offered treatment pads. Despite all the ISHEs in the 13-China ETCs, only one hospital worked solely as a holding center while the others were a mixture of treatment and/or holding centers. Three out of the four tent-hospitals in South Africa were done as holding plus EID wards and only one solely as a holding center.
5.2. Lessons Learned and Best Practices
In both the design and implementation of expandable mobile hospitals, some lessons were learned by designing them and by actually managing the hospitals and coming up with workarounds and improvements. In this section of the essay, we share our lessons learned from the four case studies and four assessment studies, as well as lessons learned during use and operations from the establishment of a mobile hospital immediately after natural disasters. Although rapid deployment right after a natural disaster and application while being deployed in a humanitarian setting are not the same, we still feel that there are valuable lessons to be derived from the experiences and best practices that were learned along the way. In the last part of this section, we sum up practices from the four case and four assessment studies and address the expansion capabilities.
The field experience taught us a variety of lessons inherently related to both establishing a hospital and maintaining a hospital from which lessons were derived that can be used for design and possible application in the four case studies as well. This allows us to learn from what actually happens in the field and relate these to both the possibilities and limitations of expandability, as well as designs or design criteria and specifications. In comparison to literature study, the involvement and actual engagement in deploying mobile tented hospitals that were then run allows us to come up with lessons that are based on best practices and field experience.
6. Conclusion and Future Directions
This study designed and implemented a combined expandable mobile hospital, where the mobile hospital is the major construction, and the expandable facilities are used as its extensions to be functioned as single integrated healthcare units. This study also implemented the replica of the designed mobile hospital for enabling the level of validation of the designed systems. Versatile applications in urgent and disaster-based responses or time-based medical interventions on remote sites may be shown to be beneficial and promising. However, final check and validation studies in close real-application conditions remain. Some future research directions in the design and implementation of expandable mobile hospitals could be considering other applications beyond the COVID-19 and treating only level one patients, having the mobile hospitals to be designed in such a way that the upper deck mainly functions as cargo loading and handling, and the mobile hospitals could be used for an emergency dispatch, among others.
A COVID-19 disease outbreak can cause disruptions to the healthcare of the population. The mobile expandable hospital designs are expected to respond to local healthcare conditions with carefully designed drawing sets and simulative models, which can adapt the international best practices of testing, evaluation, and ultimate commissioning. Careful balance between the cost of deployment and function of the facilities is one of the key parameters when utility of such hospital is being assessed, and this work shows these carefully iterated design solutions. In our present study, we took into account only the design aspects which are mainly engineering. In future research studies, such designed expandable mobile hospital can be evaluated using simulation models for their firmness against the medical services offered to the patients staging there.
6.1. Summary of Findings
In this paper, we have focused on the design and implementation of a set of expandable mobile hospitals, varying from a simple configuration of 5 tents to a fully equipped hospital unit of 20 tents. The strength of the present work lies mainly in the systematic evaluation of such interventions based not only on the maximum clinical needs but also using data reflecting the real-life implemented procedures during the earthquake in Italy. Testing reliability and validity using these real-life scenarios makes the suggested hospital types more accurate.
Based on preliminary computations, the number of bed-days in hospitals for the casualties due to an earthquake with the equivalent of a moment magnitude of 6 is expected to be 3,500 during the first thirty days after the earthquake. Assuming that 10% of these bed-days will be in tents corresponds to 11,700 bed-days. The number of emergency operations is calculated to be 900.
Assuming that the tents can be used at 1% of their capacity to screen patients before they join the existing queue, it would take 189 days to screen this large group of mildly injured patients. The implementation of our expanded hospital makes very efficient utilization of spare operating room capacity in the medical centers surrounding the earthquake areas. Once patients are screened through the tent hospital, the expectation is that about 3% of them will require emergency inpatient care and 7% of them will require non-emergency inpatient care. If the latter type of care is associated with surgery, and about 9% of those from the earthquake needing inpatient care will require surgery, then a tent hospital with 20 operating rooms could take care of most of both of these groups of casualties.
6.2. Recommendations for Future Research and Development
(Expandable) Mobile healthcare facilities are responsible for transporting equipment, software, and personnel to points closest to those who need care or provide up-to-date care on-site. There are a number of issues that arise from the design of these hospitals, which should be further investigated and developed, and these are summarized below. The main contribution of this research is theoretical contributions and gaps in the field of designing mobile hospitals and researching potential development areas in the field of integrated/expandable/transforming hospitals.
The areas of future research can be further divided into topics such as infrastructure, software development, digital transformation, business model development, market research, standards and regulations. We have summarized the research and further development areas by constructing a roadmap that describes the different loops that can guide further discussion through 3 levels, i.e. global, market state, development state. The hospital and design concept, presented in this publication, have a number of possible development areas in terms of designing the exterior, interior, and functionality of a mobile hospital, as well as potential research areas such as standard analysis, case investigation, or business model design.
