Design and Functionality of Mobile Health Vehicles

Blood Donation Mobile Health Vehicle

1. Introduction

The concept of using mobile units to provide basic healthcare services to people living in rural and remote areas goes back many years. All mobile units operating in the field of healthcare are based on a common principle, and that is to take medical services to areas that have none, or inadequate services. Of course, there are different needs from country to country and from region to region, but the objective always remains the same. With the introduction of the ‘Health for All’ concept by the World Health Organization, the demand for equal levels of healthcare increased, leading to the development of mobile health vehicles with specifications unrelated to size and equipment. These efforts soon brought about significant changes in the organization and working methods of the health services, underlining the value of mobile units, both from a political and operational point of view. As a result, mobile health vehicles gradually became much-appreciated healthcare providers. Finding an adequate solution to the health service needs arising in large overcrowded areas is not easy, due to problems related to local territorial conditions, limited resources, need for flexible supplies and fast, easy organization and planning.

On the basis of the above considerations, the construction of various types of mobile units makes sense as far as assistance activities go. In fact, these vehicles are very well suited to organized assistance linked to certain events (festivals, sports meetings) and emergency activities. They can also be used to provide dynamic activities, for periods of time ranging between a few weeks or a few consecutive days of the year. Such solutions often entail limited costs, since the mobile units are modular in structure and are donated by various private and public entities. These modular mobile units are often used as an addition to existing infrastructures, making it possible to extend the range and type of services and activities designed for a specific community, and may also be equipped with specific, new, stand-alone functions. The advantages offered by mobile health units mean that their utilization areas are becoming increasingly numerous and are primarily based on politics and organization, and to a lesser degree on healthcare and economic aspects.

1.1. Significance of Mobile Health Vehicles

Though ambulances have been actively used, their original role is more “physical,” taking critical and hypertensive patients to hospital emergency rooms, and less for preventive approaches. Generally, ambulances do not play a frequent or stable role in community medicine, which aims at preventive health. At some specific national holidays, however, village clinics are activated to resolve these people’s health problems. They do not work as neighborhood clinics that people can visit easily every day. We conceptualized very large mobile vehicles dedicated to medical purposes which could travel to local cities. They are available on a daily or weekly basis to provide various medical treatments for town residents. From, for example, a dermatology clinic, others receive hands-on health care but may not need a consultation with the doctor for treatments or simple questions.

A mobile medical clinic developed to provide local health treatments mostly consists of doctors and nurses. Due to space restrictions, it can transport a small quantity of handy tools and medicines, even though it is a professional vehicle working in the health field. In addition, people tend to be ignorant of the benefits from health management or treatments because clinics are not easily accessible anywhere, and they start a new habit only when they need to go to the clinic due to an accident and initiate a strange health issue. The impact of the service in treating people locally begins at the edge. Conversely, there are various and plentiful, widely used means of transportation for people. They overload the earth, age, contaminating the air and increasing the roads and the accident rate, to address their health issues today. The fact that there can be a mobile solution generated awareness of the interesting public domain health issue.

2. Design Considerations

Design and Functionality of Mobile Health Vehicles

2. Design Considerations

Fundamentally, the rooms and areas within the mobile health clinic need to be designed specifically to support the objectives and goals of the program for which it is intended. The spaces must be flexible and well organized to meet today’s complex health needs and, at the same time, accommodate the diverse practical expectations of the healthcare program staff. Safety, quality, and efficiency within the operation and the patient flow are also among the priority requisites.

The first thing that must be explored are the organizational requirements. This includes the types of health services to be offered, how many rooms are necessary and in what size, how many professionals and health technicians are required, how many patients are going to be attended per day, how much space is required for the reception area, waiting room, administrative services, and traffic flux. Another very important aspect is determining how the patients are going to be attended. Are the patients going to be attended in private rooms? In groups? Are there going to be educational activities provided to the patients? Are they going to be referred to the local public health unit or sent to local hospitals? Are there going to be medical exams or health equipment used at the mobile health clinic? When are they going to be used (in case they must be rented)? These are only a few examples of the many relevant questions that must be defined in the early phase of a new mobile health clinic project. Simultaneously, it must be defined if there is a specific need for visual communication (through signs or posters) informing who can be seen at the mobile health clinic, and what days and times the clinic is available.

2.1. Layout and Division of Working Areas

Mobile health vehicles, especially narrow-tract ones, must be highly operational and efficient. Since the limited spatial environment restricts the design, it is important to allow for the appropriate layout of working areas and the smooth operation of designated duties.

In this study, the layout and division of working areas were determined through professional judgment by two domain experts. The patient room, which takes up the majority of health care, was located at the rear of the vehicle in consideration of patient privacy. Conversely, the observation room and case management office, which support the function of the patient room, were located near the entrance and rear exit so that visitors could use them conveniently without interrupting the internal area or being bothered by existing patients. The preparation area was placed behind the observation room to secure movement lines and workload, while storage space was secured behind the case management office.

The vehicle floor was divided horizontally into private areas and public areas; utility carve-outs were then created in empty spaces that emerged due to the aspect ratio difference of a commercial vehicle. The patient room, observation room, and case management office were basic bolt-on boxes, while the preparation area was set up with retractable furniture that secured the aisle. The tables were nested on the cabinet when the vehicle was running and opened at 90° when the vehicle arrived at the scene. A more efficient and secure working environment was established by expanding section for analysis and sharing the functions of smaller compartments appropriately. Moreover, being able to store and use.

The newly designed mobile health vehicles implemented improved functions and facilities compared to existing vehicles, thereby enabling more targeted health care activities in real life. This study aimed to explore the potential variables associated with community health workers’ (CHWs) work performance in the new policy context in China. Social cognitive theory was used to guide this study, and CHWs in Shanghai were recruited by stratified and cluster sampling with a cross-sectional survey. Structural equation modeling (SEM) was applied to examine the relationships between our proposed models.

The results showed that CHWs’ work performance was significantly associated with work characteristics and physical environment; work characteristics and social facilitation also played feedback roles. The contextual factors should be a crucial condition in the social cognitive theory of CHWs’ work performance, especially in the macro practice application of the health care workforce. The designs of the working facilities specific to the newly designed car area were appropriately shared across the small compartments to ensure secure and efficient completion of tasks such as examination, reception, case study, and infection control.

3. Passenger Compartment

The layout of the passenger compartment of a MHU depends on its size, the number and type of examination rooms, and the medical, administrative, and communication equipment. If there is only one person treating patients in the MHU (a physician, a paramedic, a nurse), the examinations are performed inside the treatment rooms (consultation and examination rooms). The center of the passenger compartment of the MHU should be left as unoccupied space, providing easy access to all the examination rooms. The treatment rooms of the MHU are directly accessible from the rooms where the patient is in contact with the personnel member who is performing the examinations and where he can ask questions regarding the examination that he has presented for. This means that each examination room in a multidisciplinary MHU should also contain a basic set of monitoring and diagnosing equipment.

Up to eight patients or up to four couples or one couple accompanied by another person and one child can stay inside the MHU passenger compartment at the same time during consultations and treatments. If there is more than one person treating patients in the MHU, the passenger compartment should be divided into small enclosed sections. Up to eight people can stay inside the MHU passenger compartment during treatments. In this case, the personnel member who is performing the consultations is in direct visual contact with more than one patient, so that this personnel member can understand how the discussion regarding the patient’s illness is perceived by the group of people who are watching the discussion and the patient who is participating in it. This also means that each compartment in the MHU should contain a basic set of monitoring and diagnosing equipment.

3.1. Features and Amenities

This chapter begins with a general description and specific characteristics of the hospital vehicles, with special emphasis on the mobile dental clinic managers and the Cook County Hospital. This seems necessary to understand the specific mission for the operation of mobile clinics and why they have physical and operational features that distinguish them from other similar health care resource centers in the community. This distinction means that there are many appropriate design functions and planning criteria that they possess. A summary description comparing mobile and fixed dental clinics is included for comparison purposes. Needed information on the vehicle design trends and performance, as well as cost factors, is readily available as documented from ten mobile clinic operators, as reported in the literature review.

The very mobile nature of mobile clinic vans means that they can provide a medical or dental consultation with a patient about any or all of their ailments and can provide a start on these problems either directly or through a referral. Mobile health services are best suited for conditions not needing immediate hospital care or conditions that can readily be self-diagnosed by a citizen, unless the mobile clinic is scheduled to make regular stops at preannounced times so that anxious clients can check out a health matter with clinic personnel while in the neighborhood or shopping. Any clinic is adjunctive to hospital service and can readily refer matters beyond their capability to the hospital emergency room or hospital nursing and doctor’s stations. These usual considerations still apply, but mobile clinics, being outpatient care-oriented, are probably most appropriately designed for short-term, local service. These less selective policies may be very effective for health promotion or level of care in specific situations.

4. Examination Compartment

For the illumination of the health compartment, an ambient light is used, which is adapted to the human biorhythm by a lighting management system. These temperature values are maintained in a comfort zone by using specific and selective heat protection glass and an integrated weather-dependent fully automatic rotating louvre system. The door zone meets the basic requirements of the DIN EN 1789, 2014-08 European Standard, 4 – Vehicle passageways and handrails 4.4.2. The design requirements for handrails and steps ensure safe entry and exit. A four-stairway staircase and an all-round safety railing with a handrail striped in the security color RAL 3020 are provided for disabled and elderly people. According to the existing DIN EN 1789, 2014-08 European standard, the floor of the series vehicle is not implemented in the ROT R 1, only in ROT R 2, while in the ROT R 1 testing area the floor is implemented in a dark shadow and in R2 in a different, well-illuminated and ready to examine shadow.

Everyday mobile medical practice is possible in these existing health compartments, but the environment is quite dark compared to the previously created or presented projects. As a result of the daylight irrespective of the road and the climatic latitude of the project is different and individual, it is presented here for the first time as both exhibitable and ready to examine an unobstructive mobile health vehicle. The concept design was validated with a wide range of testing by using a physical comfort model, a life-size mannequin, thermal modeling, and radiation studies. After evaluating various options and concepts, a transparent and untreated heat-protection window has been selected for the design of the ready-to-examine compartment to fulfill this main requirement of the optimal daylight incidence as the most user-friendly requirement of the clients and the staff according to many years of experience. The use of a transparent sunscreen (heat protection film) in R a <7% protects the devices and equipment from long-term exposure to insolation and high outside temperatures in a sophisticated way.

4.1. Equipment and Facilities

The equipment of health vehicles depends on the intended utilization. Rural mobile health units state service points to carry out preventive care, early detection, maintenance and control actions, providing shared health care to individuals, families and the community. These units use a set of movable infrastructure, including a set of diagnostic and therapeutic means, capable of performing the main activities of primary health care, for the prevention, promotion, protection and rehabilitation needs of the population living in the coverage area. The physical facilities of the vehicle are partitioned for the services of medical consultation, collection for gynecological tests, shipping of vaccines, dental services, drug prescription and promotion of health education.

4.1.1. Medical Actions Compartment The medical unit houses: – Swivel chairs where medical consultations are made – Vitrines – Desk and computer – Biomedical equipment (earphone, ophthalmoscope, sphygmomanometer) – Box with medication items – Box with vaccination material (encapsulated for safety) – Vaccination subsidy cards – Table and chairs – Refrigerator – Window display, mobile room separator, bed and light for examination – Bed for sinking – Swivel chair for interrogators

4.1.2. Telemedicine Room The telemedicine room is divided by workspace between the professionals, and the consultation room where the patient is located: – Computer and monitor – Cabinet – Furniture (table and chair)

4.1.3. Gynecological Examination Room The gynecological examination room has specific equipment: – Medical examination chair, or equivalent – Booth – Light fixture – Cabinet

4.1.4. Hygiene Facilities The hygiene facilities were installed in the vehicle to comply with the current sanitary and health norms, separate from the customer service area: – Cloakrooms, including senile closet and urinal – Cabinet with sink, mirror and hygiene items.

5. Observation Compartment

The observation compartment is located directly adjacent to the diagnosis unit and treatment compartment. This proximity is of great benefit for the installation and user friendliness of devices that are necessary for diagnosis and treatment, as well as the corresponding medical auxiliary and sterile goods within arm’s reach. The central position of the compartment in the vehicle also allows systematic changes of space-use without major travel movements. For example, while the diagnostics and treatment staff is moving from one consultation to the next, a servicing or examination area can be prepared behind the hinged compartments or the storage shelves.

The observation compartment offers room for versatile consultation. The available space in the vehicle allows a set-up comparable to that of a general practitioner’s or internist’s office practice. Depending on need and/or focal point of the mobile health offer, pediatrics, gynecology, and/or specific additional consultation may also be offered in the compartment. To offer the persons seeking advice more confidentiality and a certain flair of consultation atmosphere, an ambience favorable to conversation should be created here. Shelves mounted on the walls offer easy access to the necessary consumer materials, require small storage space, and can be filled and cleaned easily. Foldable tables mounted on the wall are easy to clean and can be put into final position rapidly when in use. Wood decorations on the organization and separation elements (sliding doors) impart a warm, less sterile ambience.

5.1. Purpose and Functionality

Mobile Health Vehicles; Mobile health clinics provide medical treatments to be carried out outside of a traditional hospital setting or general medical practice environment. The majority of the South African population has no access to primary healthcare services. The main reasons are that public primary healthcare services are under severe pressure and not always effective or of specific quality. Additionally, a large part of the population is not covered by any health insurance, and many people cannot afford private services. Other reasons might be that parts of the population are living in remote areas which are difficult to access, requiring high costs for traveling or resulting in long traveling times. In these areas, people also normally earn less than people in urban areas, and therefore the traveling costs may have a significant impact on personal or family budgets. It is because of this that mobile clinics – usually in the form of buses, vans, or other caravans – have been used in many parts of the world to provide healthcare to people in these remote or less accessible areas.

The services are provided by professional people, regardless of the applied service concept. The quality and trust in both the medical service and the professional people who provide medical service play a crucial role in making sure that the objective of primary healthcare is achieved. The concept of mobile clinics should ensure, first of all, that people are getting access to medical services, and second of all, that these services are of the specific and required quality. Essential health services belong to the Millennium Development Goals and require that every citizen should have access to basic healthcare services by 2015. Non-governmental organizations like the Right to Care and governments in different countries are doing their best to achieve these goals by investing in infrastructure, health professional education, and management in order to guarantee access and quality.

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