1. Introduction to Mobile Surgery Trailers
Mobile Surgery Trailer (Regent 1500 P) has been designed as part of a project under the name “Application Field Prototypes of Extreme State Services”. Regulation prototypes can be deployed under extreme conditions to provide public services according to the project task, to ensure that the projects are safe, convenient, and functional.
The Mobile Surgery Trailer, as the name implies, is a multipurpose surgery module where surgical interventions can be carried out. The Mobile Surgery Trailer, which can work as a hospital and meet the urgent health needs of the citizens, is a service delivery model that can be deployed in disaster, social facilities such as sports halls, and temporary settlements – such as a prefabricated state, cargo container, office, patient room, and even surgical room. It has been designed and produced so that it can work as a transferable and fully equipped surgical intervention vehicle and has all necessary additional systems such as electricity, heating-cooling, and necessary waste containment.
This study prepared by TÜBİTAK UZAY (Hacettepe University Team Leader) includes the mobile surgery module specifications and a list of medical devices and consumables necessary to establish the module inside the trailer. In a disaster or similar emergency situation, the possibility of having the surgical module from the Ministry of Health to provide services has a high possibility of danger to the health of citizens. Therefore, the mobile surgical module in a short period of time prepared for the status of the trailer can ensure that, with the necessary team, disaster, sports – social halls and other facilities make social facilities a hospital and health services of the Ministry of Health in a short period of time.
1.1. Definition and Purpose
Mobile surgery trailers are incisively designed trailers to serve all necessary conditions for uninterrupted surgical operations. Mobile surgery trailers are easy to transport. These mobile surgery trailers are mostly preferred due to basic health requirements, especially in natural disaster zones and rural areas. These mobile surgery trailers are incisive solutions in providing both pre-surgery and post-surgery care. The mobile surgery trailers serve all kinds of medical emergency conditions for affected regions. These mobile surgery trailers come with 2 or 3 axles, which help in comfortable transport. The trailers are easy to shift, but once parked, the trailers get transformed into well-equipped operation theaters.
The unique features of the mobile surgery trailers are self-provided unit for electricity, central supply of medical gas cylinders, and air conditioning systems. The mobile surgery trailers possess an incisive design with different windows and wide doorways. These surgery trailers have a storage room, and the air conditioning and heating system are incisive features. The mobile surgery trailer is insulated in a way that it stands still even during extreme weather conditions. It contains a kitchen as well as restrooms along with the required medical equipment. The mobile medical surgery trailers serve the patients to their expectations. The medical equipment is fixed onto the walls in the mobile surgery trailer. These medical equipments might include surgical tables, integrated with X-Ray C-Arm TV System. These trailers ensure operational space with incisive design.
1.2. Advantages and Applications
For a number of emergency medical treatments and simple surgical operations, the concept of a fully equipped, high-quality professional medical care cubicle constructed within a specialized transportation vehicle is presented. For carrying the sick and wounded from the scene of the accident to medical facilities, as well as for performing simple surgical operations under conditions that are far from clinics and hospitals, a mobile medical-cubicle vehicle is developed. A significant reduction in the costs of construction and maintenance of medical institutions are the economical advantages of the proposed mobile medical cubicle.
Key Features, Advantages, and Applications: As a result, it is possible to use a simplified design of the car chassis as a cubicle-type load-carrying platform, a low-specialized standard vehicle for the car. Specially selected vehicle dimensions provide a small turn radius, which simplifies the maneuvering process and movement in enclosed premises of medical car station and medical professionals. With the developed concept of the medical cubicle, a significant reduction in the cost of construction and maintenance of mobile medical laboratories are the simplest mechanism and simple drive cylinder systems. With the developed concept of the medical cubicle, it is possible to significantly reduce the cost of equipping and transferring funds for its maintenance and maintenance in the prescribed state.
2. Key Components of a Mobile Surgery Trailer
1. The operating room The operating room (OR) should contain all necessary equipment and supplies for performing surgeries. This includes a table with a mattress pad, headrest, armrests, and interchangeable tables and accessories for various procedures. The room should have LED theatre lights and wall-mounted pendant lights within the sterile area. If digital imaging equipment is to be used, a diagnostic x-ray viewer is needed. An LED monitor or LED flat TV screen with wall mount and extension arm can be added to show various camera displays of the surgical procedure. The room requires an uninterruptible power supply (UPS), along with wall mount power outlets, entirely made of stainless steel or steel coated with white antistatic color. The UPS includes a SIC up-to-date electric stabilizing system in the control equipment to guarantee clean and stable current during surgery. In addition to all surgical instruments, dressing trolleys, and surgical sets, the OR needs wall-mounted or wall-pendant posts with the essential medical gases. The room must have an antibacterial vinyl wall covering, ceiling with LED lights, and easy-to-clean pass-boxes for material input (non-sterile) and unloading (sterile). The OR typically has a hydraulic table, one back surgery table, a laparoscopic surgical set, an autoclave trolley, and a patient warming device.
2.1 Key Components of Surgery Trailers The structure of a mobile surgery trailer is a steel frame carcass for the base body and artifacts. The base body and artifacts are made of sandwich panels consisting of steel skins and PIR foam core, to ensure the necessary thermal insulation. The floor is designed with a 3 mm pattern steel sheet over 100 mm fireproof PIR isolated foam core. The internal partitions are made from 50 mm fireproof sound and heat isolated panels. The surgical unit typically has a foot-operated aluminum door with an emergency break glass. The mobile surgery trailer is equipped with sufficient lighting conditions, HVAC system, recovery ward, staff room, pre-post surgery ward, X-ray system or C-arm equipment, medical gas supply galleries, and all necessary connections and tubing required to complete the concept. The mobile surgery trailer is delivered with all warranties.
2.1. Surgical Equipment
2.1. Surgical Equipment
When patients suffer from injuries, the first group of doctors needed for the treatments are orthopedists. Fractures and dislocations are the most common types of surgical diseases. In this sense, a comprehensive surgery kit for first-aid treatments is also a must for the MSI.
The Orthopedic and Surgical Equipment on the MSI includes: 1. Horizontal tension frame 2. Several traction units attached to the main frame 3. An operating rest
The hemostats consist of an upper and a lower hemostat. In the front ends of the upper and lower hemostats, positioning bars are fixed. The lower end of the upper hemostat is supported by a first support spaced from the positioning bar. The first support is fixed into a first fixture connected to an upper surface of the lower hemostat.
A horizontal extending bar is arranged to connect to the position rods and is retained on the positioning rods along the slip direction. The installation bars are positioned in the setting bar to keep separating distances. Upper ends of the threaded rods are connected to the extending bar and rotatably engaged with the lower hemostat.
The MSI table is retractable and may be placed under a skin flap to divide the surgical area into two parts and facilitate a doctor and a scrub nurse working at the same time. The interior of the MSI table further includes a plastic layer and a soft layer formed on the top side for contact with the skin flap, and an aluminum protection layer formed on the bottom side for protection from electric cautery burn.
2.2. Sterilization Systems
Sterilization and waste management systems have been designed in the light of these statistics. The systems are capable of achieving total destruction of all forms of microbial life, regardless of whether they are spore-forming organisms. There are two types of sterilization systems: a small-scale package that converts normal EPS to sterile EPS, and an Express Sterilization System, which has been developed for use on a larger scale. The Express sterilization system is process-based on microwave technology and is very compatible with high organic content in medical waste destructors. It consists of a microwave sterilization chamber, a condensation tank, and an OPS storage tank in Area 3 of the MST. The microwave sterilization chamber, which is manufactured from AISI 316L type stainless steel, operates at a 5 mV microwave frequency.
The condensation tank, which is used for cooling the pressurized and hot OPS vapor, is placed at the chamber exit of the microwave sterilization. The OPS storage tank is used for storing the sterilized OPS at the end of the sterilization process. The dimensions and capacities of these sterilization components are given in Table 2.6. The construction materials of the sterilization and waste management system are determined in accordance with the production standards of the bio-nanopolymer sheets of the Medical Surgery Trailer (MST), which has been developed as a successful surgery and telemedicine system for use in disasters. The sterilization and waste management system is very appropriate for the MST in terms of structure, area, equipment, and transportability features, as it enables the waste to be sterilized and prepared for bio-nanopolymer sheet production within the sterile area, which is isolated from human beings. The items used in the MST outside the sterile area can be recycled by directly being buried in the land.
2.3. Emergency Supplies
In addition to the regular supplies, there are some unique items related to the mobile surgery trailer. This refers to all supplies related to mobile surgery. The majority of the items are classified under section ‘T’ of CND codes, and some items are classified under other sections. Some items are classified under specific surgical procedures in order to classify them by operation, not the code. The specialty of surgery, body part, and diagnosis are also defined by the related procedure.
When there is a surgery on a patient, there is always blood. So we take care of a patient’s blood in order to perform a successful operation. Therefore, we require an anesthesiology machine and infusion and transfusion devices to resuscitate a patient in extreme condition.
However, as we mentioned earlier, the mobile surgery trailer is just a vehicle. So, it is impossible to know what happens inside a patient. Then, we require various medical devices such as an electrosurgical machine to treat various conditions related to breathing. In order to support an operation of appendectomy and colostomy, we also require those medical devices. Finally, we require surgical devices such as surgical and dressing materials to perform not only all operations defined in surgical data scope but also any surgery.
3. Specifications and Technical Details
The optimization of workflows in health units, especially in small and medium-sized hospitals, has led to new architectural solutions and working equipment to respond to these challenges. These mobilizations include coronarography, radiology control, surgical control, as well as being equipped to carry out intelligent operations. Our project represents a mobile surgical trailer where surgery can be performed using the best available equipment and all surgical tools, and it requires relatively low cost.
The surface value of the closed trailer is 36 m², as determined by a preliminary study. The height value is 2.20 m. The dimensions of the surgical area within the trailer are 6 × 3 m when open and 2.35 m when closed. Thanks to the electronically controlled telescopic and foldable rails designed on both sides, the surgical canopy creates a large surgical field. It opens 2.20 m outside the external stand of the trailer, increasing the surgical area width to 3.30 m. The electrical control system of the rails is an important feature to prevent any possible failure during surgery. The external stand is designed for in-space use, such as sterilization and preparation of the patient and anesthesia machine during surgical operation. Supply water, electricity, and compressed air are always available in the open condition inside the trailer. Inside the parked surgical trailer, doctors can retrieve any necessary surgical instrument, drug, device, and foreign body storage material from the front and sides. All the necessary infrastructure is available in the middle of the area.
3.1. Dimensions and Weight
The design of a successful mobile surgery trailer requires cooperation among a variety of professions in order to satisfy each of these conflicting constraints. For example, the primary goal of a surgeon is to provide optimal treatment to a patient; however, financial constraints as well as medical ethics force a surgeon to balance the potential perfect treatment against what is possible within a bottom line that often grows smaller. In this context, the collaboration of research engineers is most useful. Optimally, a research engineer can provide solutions for managing constraints using advanced technology. This paper presents additional medical tools for a previously best-practice-oriented design for a mobile surgery trailer. Adding additional tools, the 40-foot North American standard-based new mobile surgery vehicle contains operating/theatre rooms, scrub rooms, nurse stations, x-ray rooms, medical gas supply systems, physical examination rooms, and other necessary requirements.
The quality management of the clinical treatment of humans and animals is becoming more complicated due to the improvement of medical technologies, computer-aided medical diagnoses, more precise medical instruments, maximum probability medicines, and other modern treatments. The requirements for competition and the struggles between regulated payment systems and free capitalist financial bases are bringing increasingly difficult challenges. The result is that secondary and tertiary healthcare providers are attempting to add outpatient department treatment capabilities. The affordable internal use of modern surgical devices requires that neither large hospitals nor small treatment rooms are able to provide optimal treatment, and even less a field surgery during catastrophe conditions. This is the reason why a group of researchers connected with the Catholic University, Pécs, Hungary, and its Institute of Applied Science, felt the necessity to design a mobile surgery trailer.
3.2. Power Source and Backup Systems
3.2.2. Diesel Generator Set A 63 kVA/ 50 kW standby power, 60 kVA/ 48 kW prime power rated, space ventilation cooling type digital electronics system designed for continuous hard work. Vertical airflow with a cooling unit and with a wave-form distortion above the peak value, single-phase from zero to the peak value, 10% or less.
Model: Diesel Engine, In-line, 4 Cycle, 6 Cylinders Electronic Control: Diesel Engine Electronic Control Starting Method: 24V Electric Starter Motor Cooling System: Radiator Type Cooling by Air-Driven Horse Power Fan Power Generators Generator: Brushless, 4 Pole Dynamo, with Self-Excitation and Self-Regulation AVR
Frequency: 60 Hz Rated Voltage: 3 Phase, 220/127V (3Ø, 220/127V) Continuous Output (kVA)/(kW): Prime 60/48, Standby 63/50 Minimum Quantity: 1
Protection Device: AC circuit breaker; type THMC225
Enclosure: consisting of a silencer, radiator, filling oil opening, a shock-absorbing unit, and an aluminum alloy body encased in a steel body coated with glaze. Control Box: Standard with control indicator lamps (FAIL RUN) with an emergency stop switch, remote control switch, low oil pressure switch, and high coolant temperature switch.
3.2.3. UPS Unit The UPS system supplies emergency power to the trailer and its equipment when the generator is out of operation during its scheduled maintenance, spare replacement, generator failure, inclement weather, and other various planning or unplanned downtimes including long duration of operations and travels as well. The UPS capacity and related electrical designs are based on a comprehensive electrical load analysis that encompasses both the nominal and turn-key maximum electrical loads drawn by all types of typical equipment hosted by the trailer, such as AC load, DC load, and HVAC.
Input: H-Bridge, Double Conversion Battery: Lead Acid Battery with 15 Min Working Time at Full Load, 8 Batteries (4 Strings * 2 Batteries in Series); Storage Battery Outlet, Attached by Breaker Battery Charger: Static Control Type Battery Charger
Capacity: 30 kVA/30 kW (Optional: 40 Water-cooled) Output Voltage: 80~86/133~138 Frequency: 60 Hz Current Harmonic: TSHV = 8%
Output Waveform: Wave-form distortion above the pure Inverter Dc-Link. Zero peak value, single-phase from zero to the peak value, 2% or less, 100% linear squared wave with 0.25 micro-second greater, 1.0% superimposed up to 10% linear load, 1% non-linear load with 80% leading power factor: 2% Harmonic Overload Capacity: Overload 125% 10 Min, 150% 1 minute, 160% 30 seconds, 200% 1 second, 450% 1 cycle Transfer Time: 0 ms Overlap Battery Capacity: 15/30/45 minutes; 8 batteries.
4. Case Studies and Examples
Mobile Surgery Trailer; The medical area of disaster rescue is divided into several major subjects during the first three periods of disaster rescue, with Medical Disaster Rescue without Teams being the main part. Level I disaster rescue hospitals usually treat the on-site assistance casualties who have moved out of the disaster scene, and the refurbishment of the hospital does not limit medical operations and treatment projects. The hospital takes over the injured after the disaster rescue team from the official hospital leaves, shown by a dotted line in the figure. Thus, the medical disaster rescue on site is the main link of classes I and II hospitals in dealing with trauma injury in a short period of time. Improving the treatment conditions of hospitals and adding medical equipment can significantly help in dealing with disaster injuries. Medical disaster displays its characteristics. The design and selection of medical equipment for emergency medical facilities, taking into account the specific characteristics, are mainly evaluated from the aspects of function, structure, and cooperation that the required equipment needs to achieve.
The characteristics of telecommunications are limited in the command and resource dispatching of disaster rescue. Providing information services for rescue sites is a weak link. Although both satellite, mobile signal tower equipment, and remote communication systems such as wireless network control systems can solve local communication problems, considerable investment is needed when large communication facilities are not yet available. With the help of limited information at the disaster site during disaster rescue, the strong operational function of the mobile surgery vehicle can provide support for medical rescue. This article mainly introduces the medical equipment of the mobile surgery vehicle in terms of communication, medical check-up, radiology, auxiliary examination, and surgery and auxiliary surgery. The composition of mobile surgical vehicles is also introduced. The utilization of mobile surgical vehicles is analyzed in emergency medical rescue. Preliminary opinions on the standards and specifications of the current mobile surgical vehicle medical equipment are presented. It is expected to reach a unified standard that can be adopted by the majority of relevant hospitals and construction units in conjunction with relevant hospitals, management, scientific research units, and the standard and specification of mobile surgical vehicle medical equipment.
5. Future Trends and Innovations
In the future, the Mobile Surgery Trailer (MuST) can be utilized as a fully automated remote station. It will be used by specialized robotic tele-health systems to provide consultations on demand. Non-differentiated procedures may be done on-site, with the local team assisting in the training before or after the intervention is performed by specialized systems via the internet.
Although in the first implementation, you want to toggle between two different levels of video resolution, eventually the service may be able to increase or decrease the bandwidth it is using while maintaining the same degree of quality. Other rich tele-presence scenarios may apply, such as having real-time high-quality 360º audio-video and real-time 3D streaming of physical objects associated with high data exchange, for example, in a maxillofacial surgery operation while communicating via phone with other specialists who are joining or studying the same case.
Other system architectures using a hybrid control scheme could be used on simpler stations than the one depicted in Figure 5. The surgery robot could have its own controllers communicating directly with other local or remote systems. For example, a surgical aid can have its own purpose-built subsystems. Quality tele-consultation can be of utmost importance, especially when doctors go to manage the consequences of war or a natural catastrophic event. The first thing they always ask for is real-time interaction with other specialist surgeons.