1. Introduction to Mobile Health Vehicles
Mobile Health Vehicle; A mobile health unit or mobile health vehicle provides nearly the same healthcare services as in any conventional setup, but it has portability. In disaster or emergency situations, many healthcare personnel like doctors, nurses, paramedics, and other supporting staff suddenly rush to the affected area. The provision of medical care by these personnel is as important as the restoration of gas, communication, and other services. The mobile clinic is a transformative tool for the health sector.
Many people living in urban or rural areas in developing countries do not receive proper diagnosis and treatment in a timely manner. In some cases, many people do not even have access to healthcare facilities due to excessive distance from the city and income disparities. With the rapid progress of medical science and technology and the requirement for specialized healthcare for certain occupational groups, urban and rural areas are scattered and diversified due to the four seasons and unequal geographical distribution of climatic zones. Therefore, it is highly necessary to establish a mobile clinic in each district headquarters after setting up a specialized fixed center as well.
In emergency or routine activities, the proposed mobile health vehicle becomes a beacon for services. The results are widely felt, especially with the onset of “health for all” and “primary health centers” throughout the world, which are facing the following challenges. In developing countries, many people do not have the resources to reach the nearest or specialized health centers and doctors. In addition, more and more doctors in need of treatment are not able to provide advanced diagnostic and therapeutic facilities. Access to many villages, slums, or remote areas is cut off during the rainy months. Many people there are stuck in floods, and large numbers develop oral and fecal diseases like vomiting and diarrhea, as well as other systemic infections. Massive flooding can also occur after natural disasters such as tsunamis, earthquakes, and even wars, resulting in death from various causes, including waterborne and airborne diseases. Providing efficient health services for them becomes a major issue. It is also very helpful in handling mass communicable diseases at crowded locations like labor sites, large construction sites, and tourist areas.
1.1. Definition and Purpose
In order to deliver healthcare services to the populations, mobile healthcare vehicles, which vary from traditional hospitals and polyclinics, are being custom-designed. These mobile health vehicles can be custom-designed and manufactured as a bus, truck, or a trailer in various sizes by considering the targeted healthcare activity and the geography in which they will operate. These mobile healthcare solutions can serve in rural areas where healthcare facilities do not exist, urban areas where the healthcare facilities are insufficient, and other areas where disaster relief plans and overcrowding are needed. Defining the operational objectives, that is, if the vehicle is to be used for emergency medical care, primary care, preventive care, or for all of them, is of great importance for the efficient operation of these healthcare vehicles. Mobile health vehicles contribute to the solution of the insufficient and crowded healthcare facility problem in developing countries and are also a part of emergency management in the case of pandemics or large-scale natural disasters. In these cases, vaccines can be distributed to vulnerable populations, people with symptoms can be tested, and when necessary, early interventions can be made. In order to be able to transfer, treat, and discharge the patients who can be billeted due to natural disasters and infectious diseases such as pandemics, these vehicles can also be used when the hospitals are insufficient. Given that inpatient bed capacity is already inadequate and can sometimes be inoperable temporarily in major urban earthquake scenarios, these trailers prove to be indispensable. With the advancement of technology and increasing patient adherence, the demand for this service has increased in healthcare services.
1.2. Benefits and Applications
Mobile health vehicles can be used to deliver health services even in remote and underserved areas. They are the best solution for countries facing problems in providing standard services unconditionally due to limited resources. Millions can access unmet health care with them, which characterizes “door-to-door services.” They are versatile and can serve for preventive health check-ups, first aid, emergency medicine, blood donations, chronic diseases, tooth decay, and eye illness management for both children and older adults.
In developed countries, they have been widely accepted as a vulnerable area of the spectrum where access to healthcare is a problem and requires help. The same can be successfully executed in developing countries as well. Any country’s actual progress depends on how it addresses the secondary and tertiary levels of healthcare along with primary health. When the time comes, a hospital can be created in a few minutes and can be used for floods, earthquakes, pollution, or in case of a major illness outbreak; it can go door-to-door for basic check-ups. Patients with any illness receive fast consultation directly and can be transported instantly. Many items can be brought along with the medicines on demand in special cases or complications not required by other patients. To increase awareness, various steps such as health education, information, communication, drug delivery vans, emergency services, and blood banks can be added to the hospital emergency trailers. In the same way, various steps can be implemented according to the country’s requirements. Due to unique features, many investigations are done on this as well. Results show that they are cost-effective and the best way of disaster management.
2. Design Considerations
The initial design considerations are mainly based on the practical experience of some participating groups. As one of the main purposes of these vehicles is to move up and down between different hospitals and communities for the purpose of medical treatment, the patient transfer function of the hospital trailer should be considered. On the operating surface of the medical cabin, it is sufficient for an attending physician and an assisting nurse to complete a first-aid examination of patients in various hospitals. In addition, the operating table should be scalable. When the operating surface is increased by about 50%, some simple surgical treatments can be performed. We proposed the design method integrating the vehicle and cabin, and the design process is shown. Considering the different functions of the vehicle and hospital cabin, the unified design of the vehicle and cabin is generated. The unified design on the chassis reduces the weight of the cabin as much as possible, allowing the cabin and chassis to have the best overall dynamic performance. In our design, the hospital trailer can also provide a comfortable diagnosis and treatment environment.
The height of the cabin and the height of the chassis are relatively low, which leads to the diagnosis and treatment activities of the treatment room being higher above the ground. Considering the patient’s situation, the diagnostic area should be close to the ground. As a result, we reduce the vehicle chassis below the patient’s operating bed space while ensuring the basic gravity of the vehicle. The mechanical sliding structure can be better used outdoors and increases the robustness of the treatment structure when used. This specific design is used in the design of the first model. We also proposed two independent cabins integrated with the vehicle, and part of the medical instrument space is located above the wheel. A high floor platform requires patients to use elevators or a staircase from the entrance to the cabin, improving emergency treatment. The hydraulic platform is designed to facilitate personnel transfer and air lifting of tests. Mobile health vehicles have a length of about 12–15 m. The longer the length of vehicles, the more complete the diagnosis. The trailer can be used as a medical vehicle for emergency and visual inspection. It can carry a small amount of medical examination instruments and gather as much status information as possible. The minimum radius of curvature of the vehicle should not be too large to reduce the mileage of the vehicle. When the vehicle is running, the longitudinal and lateral acceleration of the vehicle will affect the diagnosis. The power, size, type, cost, and operating efficiency of the vehicle are important to design the vehicle. In severe weather, we must reduce the negative influence of the environment on the creation of vehicles. Due to the limitation of the highway, the more complex the vehicle, the greater the stall length, and the more difficult it is to steer. Ergonomics focuses on the scale of people and maps to ensure the efficiency of operations. Some important indices are given: 1. The size of the vehicle should comply with the more complex requirements of the driving distance. Because it needs to run on arteries, the width of the vehicle is basically fixed at 2.5 m. Drivers should take care that their head and body are not hurt when they get off the vehicle. 2. The adjustment of the car cabin: The height of the original car meets the requirements and the seat-back angle is adjusted between 0° and 10°. The driving room must have a windshield. 3. Usually, the driver’s field of vision and operation satisfy the requirements. 4. The balance of vehicles and compartments guarantees safety for passengers and cargo. 5. The operating capacity of the machine is integrated. The type of gasoline engine is mostly used for customization. The laser engine can be installed. The engine meets the requirements of fuel conduction and electric conduction. We hope to move the truck typology.
2.1. Size and Layout
A successful mobile health vehicle design is underpinned by the design of the size and layout. After examining the functions and characteristics of the mobile health vehicle, the issues centered around the size and layout design of the vehicle can be deduced, and experiments designed to verify the theoretical analysis. The mobility and complexity of medical services are the critical factors that shall decide the functions of mobile health vehicles and have a significant impact on the design of size and layout. Also, the design of the entrance is subject to patient flow and medical equipment. Thus, the size and layout design of the health vehicle shall consider the convenience of vehicles entering and leaving the area, the flow of vehicles and people, as well as the medical staff and the patients, the arrangement of medical equipment, the effectiveness, the reception space, and so on. In order to improve the sincerity and activity of user interaction, the arrangement of the inner and outer space shall consider the usage and maintenance convenience of the driver.
The layout design must take into account the following issues: various functional spaces: accommodation, diagnosis and treatment, test and examination, emptying service areas, waiting space, etc.; medical equipment: reasonable distribution to guarantee full functionality; through the medium of the nurses: the front part includes the driver’s area and the central operation area; both are separated and connected; and user behavior habits: including the carrying of personnel, domesticated animals, the wheelchair, etc., and user interaction. Also, the design of the layout of the mobile device hospital shall leave room for front and back double-layer quarters, housekeeping, and other facilities in the emergency room, preparation room, or counseling room, patient source extension consultation, treatment, or surgery, and so on. We understand that in large we are more likely to use a doctor and a professional to make decisions and even change according to the number of patient clinics. In general, the construction of the vehicle shall meet the following criteria: Industry Standards for disease control and prevention and the US Professional Occupations Health Act Association, as well as the American Society of the National Fire Protection Association for the prevention of research in relation to the national fire prevention system.
2.2. Accessibility Features
• Design a trailer for easy access for people of all ages and abilities to deliver healthcare. • All health issues will be addressed, so at least the following populations can be expected, if not more: o Very sick patients in wheelchairs. o Patients who can walk but cannot stand for long because of age or disability and might drop. o Patients who want to get to a medical provider with minimal standing but do not need to wait and will, therefore, not want to sit much. • Include regulations for buildings. o Reference should be made in the design to the standards for accessibility. Disparities may exist between state and local codes. We should use the most stringent code of each to match whenever possible. Patient care and patient satisfaction are significantly influenced by how pleasant the environment is. • An accessible and attractive hospital or healthcare building enhanced the practice’s image and contributed to patient satisfaction. • Healthcare workers also benefit from buildings or trailers that are designed and operated efficiently because it fuels work-life balance, morale, and dedication to the patients. o Therefore, we will include in this section that features benefiting providers may add value if patient satisfaction is an area of emphasis. There are far more subtle reasons to make the neighborhood more accessible. 2.2.3 Benefits of Accessible Principles to Operational Needs.
A bit more about accessibility. It should be accessible for all phases of life. As we start to think more globally, it is also a possibility we could encounter people who speak another language. Have bilingual labels and instructions to serve the client. Have easily comprehensible instructions. They should be no higher than 48” – 50”. Is the counter too high for wheelchair patients, or is the staff able to bend down in order to talk to the patient? What have you done to widen the aisle? Are these changes minor in the view of the county and city commissioners? Calmly present the fact that you do not want to discriminate against any customer that is in need of the service.
3. Key Components and Equipment
A mobile health vehicle is comprised of the following components: a staff office, examination and treatment rooms, an isolation room, a reception and waiting room, biological waste storage and disposal area, water storage and waste tanks and pump or other disposal methods, a laboratory, and storage closets for medications, supplies, and materials. The relevant medical equipment for delivering mobile services includes examination tables and diagnostic equipment. Sanitation stations include a hand washing sink, alcohol-based spray or wipes, gauze for bandaging, and paper towels with foot-operated units for controlling water. Sanitary waste is also stored in the vehicle. Finally, telemedicine is important for remote medicine and may allow some services to be provided on the mobile unit, eliminating the need to arrange transportation or walk-in services. Mobile units can be built to specification with vital records storage inside and work areas for staff representing a broad spectrum of medical disciplines. Logistically, it can also have electric outlets, water sources, and areas to install oxygen units, suction systems, and internet access. When populations are isolated, these core services might be the only available primary care. The equipment also needs to be collapsible or foldable for storage and use, as well as to minimize impact on patients, caregivers, and/or staff when regaining position. The operation of most devices in mobile units is even more complicated due to vibration and sustained movement problems. For highly populated disaster sites or for long-term use, units can have external power supplied as well. If mobile units are used for more than one patient in the area at a time, the inside equipment needs to have sanitation capabilities. The personnel chosen to staff the mobile medical unit need to be cross-trained on the mobile unit equipment and other medical equipment used routinely; all the functions of the vehicle, including electrical connections or generators, need to have similar training.
3.1. Medical Equipment
3.1.1. Medical Equipment in General First of all, the hospital trailer as a mobile health vehicle must be suitable for diagnostics and examination, so the appropriate medical standards conforming multifunctional devices are essential. They shall be suitable for measuring the majority of body signals in order to make a broader analysis of the patient possible on site. These instruments are built to take into account that room is scanty and portability is a demanding need. Required devices are: vital signs monitor (oximeter, ECG, non-invasive pressure measurement of systolic and diastolic blood pressure, pulse rate measurement) and a handheld neurodevelopmental electro-physiological visual computer hardware device and a stand-alone portable OAE analyzer; 3.1.2. General Thoughts on Essential Features The selection of devices is based on recommendations from respective specialist doctors. The adaptation of equipment to a certain environment must strike a balance between size and function and must permit simple and minimal storage while standing up to the transnational “on-road” conditions. The devices must have versatility, allowing for a broader application also in the diagnostics for the other body societies even during the downtime of the clinical research protocols. They also must be fully adherent to the European standards and norms for these medical tools. All instruments used in the mobile health vehicles will be regularly cleaned and their batteries’ rundown brought to a minimum after each usage. On a monthly basis, the team responsible for the neurophysiological measurements will carry out electrical safety checks on these instruments as part of the standard operating procedure. Furthermore, the majority of tools are used on a day-to-day basis in hospitals and therefore regularly calibrated in the respective units. The availability of emergency medical supplies in our hospital trailer is different from standard ambulances due to the different aim and planned use of these trailers in research. However, there is a first aid kit comprising the obvious ambulance gear and, inter alia, a defibrillator.
3.2. Technology and Communication Systems
3.2. Technology and Communication Systems The fastest path to offer advanced healthcare services is through leveraging technology tools. Most hospital systems have transitioned to electronic health records for operational reasons. When the vehicle infrastructure supports robust IT, healthcare providers can easily access patient records. Mechanisms that can streamline the patient flow, such as self-triage kiosks and easy check-in processes, are recommended for seamless operations and effective transportation in an emergency situation. Long-range communication tools are essential for vehicle operations. Deploying a vehicle such as a mobile stroke ambulance requires that the ambulance carry wireless telemedicine hardware to the emergency scene, which allows hospital-based stroke experts to communicate with the medics at the scene in order to diagnose potential stroke cases.
Communication tools that connect the hospital to the medical vehicle ambulance include networks. At the receiving hospital, telemedicine hardware and software are necessary to communicate with the medics. A variety of HIPAA-compliant telehealth platforms can be used to communicate between providers and patients and/or EMS. In addition to the electronic tools and devices mentioned above, creating a secure telehealth operation that meets health and privacy laws and protects patient data is important. Using mobile telehealth in Cajun country, the University of Mississippi Medical Center follows internal policies and guidelines as mandated by the country, as well as state, local, and international HIPAA laws. This is achievable with monthly in-person, online, and self-guided training sessions that have successfully trained more than 200 healthcare providers in the operation of telemedicine equipment. These monthly training sessions include cybersecurity updates and any changes to the system. Robust cybersecurity practices, including changing passwords frequently and zeroing out equipment before it is taken out of the vehicle to eliminate sensitive information entirely, are conducted.
Data should be collected as a function of EMR integration. By the third and ending the first year, data collected for continuous quality improvement and assurance includes time, patient demographics, pertinent stroke exam data, and pre- and post-availability of an mESI/rESI score, and stroke-ready hospital and stroke treatment information. An EMR can avail patient data seamlessly and long-term. Currently, in the event that a vehicle is staffed with rotating/intermittent providers, paper charting backups are the primary mode of record-keeping. Additionally, image backup is possible with the complete removal of patient data. The entire vehicle measures 53 feet counting truck and trailer. Consequently, for utilization in some locations, there is a space concern. Due to the measures adopted for launch, the 40-ft configuration suffices, but further adjustments to size may be required. Assuredly, it is expected that the addition or subtraction of the truck will impact the forward weight bias by foregoing a portion of the current weight split. The payload is anticipated to include EHR servers, though transitioning to a cloud service is possible.
4. Regulations and Compliance
There are various national and international standards in health that are required for a mobile health vehicle to meet during operation. Approval from the concerned authority or from the appropriate licensing body is required for using the hospital trailer in national and international states. The trailer also has to meet the international health codes set by the concerned licensing boards. Licensing is required for a hospital trailer to operate. The health department decides the protocols for operating the licensing, and officials inspect the trailer and assess its conditional status.
The ministry of health or other authorized concerned departments must keep the certificates of registration filed. Such a mobile health vehicle will have no value or existence until it is registered by the appropriate authority. A manifest contains a passenger list. It is imperative to maintain a proper manifest that includes the list of all patients, along with their personal identities. As part of infection control, various mandatory and ethical obligations must be fulfilled by the personnel. This includes not exposing the patients to unsterilized or unsuitable instruments, appliances, or other materials while administering medical care, as well as not being protected against such applications. Non-compliance with such regulations leads to a temporary stop of work, commencement of legal action, and the removal of unwarranted products that are available in the hospital trailers that do not meet the necessary requirements and concerns. To reduce or avoid non-compliance or risk, educational strategies and staff training can be implemented, and continuous education of health professionals is of paramount importance to provide guidelines and enhance strategies for cleaner health care and general hygiene to prevent hospital infections.
5. Case Studies and Best Practices
The following are a collection of case studies and best practices for the deployment of mobile health vehicles (MHVs) for delivering healthcare services to various populations. The best practices were derived from successful MHV deployments that target populations including undocumented immigrants in Boston and surrounding areas; vulnerable women and their families, who are being identified around a downtown hospital; and urban and remote rural inhabitants of New York State where insurance penetration for children is higher than the national average. Our multi-year experiences will inform community stakeholders’ planning and possible operations as they seek to design and deploy a mobile health vehicle program for their unique setting, organization, and clientele.
An overall finding from the best practices highlighted and the case studies presented is that it is possible to deploy mobile health vehicles with low barriers to care, but with realistic limitations. Deploying MHVs to deliver specialized care, services, testing, and treatment to specifically defined populations, to service subjects that are primarily healthy, and have periodic, relatively narrow needs, is not universally a good fit. Further, the vehicle is a visible sign of “charity,” and acceptance and use of the responsive resources are sometimes, and in some areas, driven more by political constructs and human emotion than by a rational assessment of need or impact on health outcomes. Thus, some programs became primarily an expected community service that also, at some level, validates the work and mission of the larger institution, as well as fulfills social mission responsibilities of the developmental initiatives that they represented. For some, the MHV projects and the more comprehensive projects of which they were a part became, at least in part, a way to be present in and to evoke an expansive concern for the enrolled subjects of both the clinical and research endeavors of the sponsoring organizations.
