Mobile hospital

A mobile hospital is a medical center or a small hospital with full medical equipment that can be moved and settled in a new place and situation swiftly in order to provide medical services to patients or wounded persons in critical conditions such as war or natural disasters.

The Biggest Trailer Mobile Hospital in the world. Saba Palaye 64 Bed Trailer Mobile Hospital  was established In Karbala / Iraq at 9 October to 22 October 2019

In fact, a mobile hospital is a modular in that unit that every part of it is on the wheel, so it can be moved to another place easily, although all the required space and necessary equipment are considered so it can be utilized in the minimum time.

With mobile hospital, one can provide medical services to wounded soldiers or patients near the war zone or any other place before moving them to the permanent hospital. In the mobile hospital, depending on the patient's situation and definitive treatment, admitted to the hospital and after evaluating the condition sent to another health center.

During hundreds of years, the armies need to save soldiers’ lives and rescue wounded has led to the development of military medicine

In fact, war always directly or indirectly has caused development in medical Science. In this case, mobile hospitals and field hospitals are developed to help them to present fast and desirable services in the battlefields.

Nowadays mobile hospital serves as a more comprehensive and wider type of the Mash, and more modern and up-to-date than the field Hospital to save human being's life and improve medical processes in natural disasters and war.

Since mobile hospital provides most of the medical equipment and required medical areas on the wheels through the roads, it needs a special platform.

Base platform of a mobile hospital can be a rear box of a truck or the box of a semi-trailer.

Since mobile hospitals have similar therapeutic protocols with permanent hospitals, the rules and Criteria are the same too. Therefore, mobile hospital platform must be so flexible and efficient to design a health center similar to a permanent one.

Regarding Variety of medical services or capacity of hospitalization part, mobile hospital and field hospitals are similar to each other

In particular, a mobile hospital is bigger than first aid units and smaller than a permanent hospital. Also, the mobile hospital can be connected to another field hospital, for increasing ward sections capacity every time everywhere.[1]

According to the international laws of human rights, including Geneva Convention based on the ban on strike to doctors, ambulance, and hospitals which Marked with Red Cross or Red Crescent sign, Mobile hospitals will have Immunity on any strike too.

Mobile hospitals or field hospitals

The primary platform of the mobile hospitals is on semi-trailers, trucks, buses or ambulances which all of them can move on the roads. However, the main structure of a field hospital is tent and container. Tents and all necessary medical equipment will be placed in containers and finally transport via airplane, train, ship, truck or trailer.

Therefore, the mobile hospital is a movable unit itself, but a field hospital is a transportable unit.

The body materials of the mobile hospital are thermal insulation layer with a sheet of steel or fiberglass, but the tent of the field hospital is a fabric and tarpaulin.

Hygienic Decontamination and compliance with health protocols in mobile hospitals better than field hospitals can be observed and also heat and cooling systems will be more efficient than field hospital.

Platform and structure of mobile hospital

In advanced mobile hospitals, special trailers with more efficient medical space are used, so some of these special trailers are expendable.

Expandable trailers are similar to other standard semi-trailers while they are moving on the roads but as they stop or during the use, the semi-trailer (or truck) boxes will expand. For example, the total area of a semi-trailer with four expandable boxes can reach over 80 square meters if a standard size of a trailer is only 35 in usual.

Structure of various parts of the mobile hospital

Structure of different parts of the mobile hospital can be different According to its purpose.

Generally, several types of platforms are used in the construction of mobile hospitals; therefore different parts of mobile hospital, from the viewpoint of platform framework, can be placed in three following categories:

  • Corridor trailers
Several kinds of trailer widely used in mobile hospitals
  • Utility trailers
  • Medical trailers

Corridor trailers structure

In the mobile hospital, connectable halls or corridors can be standard size trailers or a normal container. These trailers have several doors to connect to other units or corridors via a special connector.

The special connector can be a tent, inflatable structure, or open gangway connection.

For efficient use of space; technical rooms, receptionist desk, cabinets, and closets can be installed.

Utility trailers (service units, offices, welfare sections and accessories and necessary utilities)

Each hospital, apart from the medical departments, needs electrical and mechanical facilities, repair and maintenance units, safety and health section, administrative offices, communication servicing, equipment management, toilets, bathrooms, laundries, kitchens, food supply and distribution, staff and doctors dormitories, production, and distribution. Electrical energy, water purification and storage units, warehouses, merge command rooms, and other services

This equipment or spaces mostly takes place in a standard truck rear boxes or semi-trailers regular size boxes.

Medical trailers

Most Medical sections of mobile hospital are placed on special trailers Medical special trailers are semi-trailer boxes with expanding ability.

Division of space and various departments of the mobile hospital

The mobile hospital includes different sections of a permanent hospital. So all or some of the following departments can be a part of a mobile hospital.

The parts mentioned below may not be an essential part in mobile hospital, but due to the event, time and place some of these sections can be added to mobile hospital:

Requirements and arrangements
  1. The mobile hospital should be settled in a familiar, easily accessible place. It is recommended that the hospital is placed next to a relatively tall or well-known landmark (such as a school or shopping mall, etc.) So patients and locals may locate it without much trouble.
  2. The mobile hospital should be deployed locally to reach the appropriate road
  3. The mobile hospital's ambit should be large sufficient to provide the necessary space for the movement and rotation of the trucks and trailers.
  4. The mobile hospital's ambit should be enclosed with walls, fences or any other suitable coverings.
  5. The mobile hospital's scope should have a sufficient number of magnified flags of RED CRESCENT and the RED CROSS sign so that they can be discovered from the surrounding hills, ground or the air with relative ease.
  6. The mobile hospital's ambit should contain at least two standard Helipads.
  7. The mobile Hospital's area must have accessibility to the drinkable water, food, medicine & medical equipment and fuel supplies as well as drinking water tanks in its ambit must be considered; along with food and medicine storage, medical equipment storage and fuel tank and waste water tank (or dry well)
  8. After settling the mobile hospital, medical tents might be considered in blank spaces between structures, (and tents heating and cooling systems) in these free areas. In emergencies, these tents can be used for increasing ward section capacity.
  9. Inside the mobile hospital area; trailer trucks, cars, and ambulances should be identified, so these areas will always be available and clear.
  10. Before settling the mobile hospital, final location of trailers must be marked and linearized with a Surveying camera and a specified map
  11. Necessary arrangements should be made for lighting inside and outside of the mobile hospital on day or night.
  12. Parking areas should be considered for an enough number of ambulances.
  13. Security system, doorman, guards and road blocks should be considered for hospital discipline.

History of Mobile hospital

To discuss the history of the mobile hospital, we must first take a look at the history of Mash and field hospital; since the mobile hospital is the advanced and generalized form of Mash and more efficient and operational form of the field hospital.

Field hospital
Main article: Field hospital

The surgical, evacuation or field hospitals would remain many miles in the rear, and the divisional clearing stations were never intended to provide emergency life-saving surgery. With the Army's larger medical units unable to assume their traditional role in support of the front line combat units, the chain of evacuation was interrupted at a critical point. Some interim solution had to be found quickly to provide the necessary surgical services and care to the severely wounded directly behind the front lines. Otherwise, many wounded soldiers would die from either the lack of life-saving surgery at the front or from the long and arduous evacuation trek along jungle trails from the frontal clearing stations to the nearest surgical unit, Manned with skilled surgeons and located close to the fighting to render quick, life-saving surgical intervention, the portable hospital could be moved by its own personnel to remain with the infantrymen during fluid operations.

MASH units

The concept of Mobile Army Surgical Hospital or MASH was invented by United States army. It is by definition a fully functional hospital used on the battlefield. It first came into being in August 1945; later it was used in the Korean War and many following conflicts.

The idea of a mobile medical unit originated from the dental field by Major Vincent P. Marran, a medic during WWII. His achievements were highly appreciated, but it was never formally labeled. Also, Harry A. Ferguson, the executive officer of the Tokyo Army Hospital, had a big part in the development of MASH.

Korean War had a big part in defining of MASH since the rising number of battle-injured demanded a more efficient medical care than traditional army doctors or transportation to a permanent hospital. MASH was that solution. It was established near front not only to supply more flexible military medical care and offer better care but also to serve as other purposes such as blood storage and distribution.

A MASH unit was supposed to provide mostly surgical services for injured on the battlefield, but this definition was abandoned under the pressure of war-time needs. Early plans were a truck-based, portable, 60-bed facility deployed deep into the battlefield just out of enemy artillery range; to provide primary care for injured until they can be transported to back line to a permanent hospital.

In Korean War, without a proper means of transportation, as a result of the expansion of required services of MASHs without a possibility of more personnel, rapid evacuation of patients were essentialized. There are some reports of Korean War that in some cases, a MASH hospital took care of a number of patients two times its capacity, each day. In late 1951, MASHs were being deployed much closer to battles, usually in 30 kilometers of front line. Still, in relative safety, MASHs were able to operate more efficiently with wounded receiving medical care sooner than ever.

According to military standards, acceptable time for assembly of a MASH unit from arrival to becoming operational is 4 hours. For disassembly, getting loaded into vehicles and ready to depart, this time is 6 hours.

Early MASHs could perform five surgeries a shift and had an efficient system to prioritize wounded. Each MASH unit was accompanied by a platoon of ambulances to ease the quick evacuation of treated patients and a group of helicopters to resupply the unit and speed up patient delivery to it as air ambulances.

This system turned out to be super effective. The fatality rate for US army wounded dropped from 4.5 percent in WWII to only 2.5 percent in Korea.

MASH proved its worth in Korea and became a key part of armies afterward. Technological and medical progress have helped MASH to save many lives not only in battlefields but also during unpredicted incidents and less developed regions.[4]

Summary
  • MASH provides only basic surgical and lifesaving treatments to sustain the patient until transportation to a permanent hospital. Field hospital lacks the needed efficiency in harsh conditions such as abnormal rain, heat, cold, and bio-hazard environment as a result of structure and material used, and disability in proper air-conditioning and decontamination; And it takes a considerable amount of time to deploy and tents tend to be very difficult to set up in mentioned conditions.

To solve the mentioned issues and by combining the idea of the field hospital and platforms and structures of MASH, the mobile hospital was born.

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See also

References
  1. Nosratkhah, Keivan, Vice President of SabaPalaye Co.(Designer and producer of mobile hospitals)
  2. "lab tests in mobile hospital of KUOMS". 17 January 2018.
  3. "Hospital Departments: Definitions & Lists". Definitions and Descriptions of the Most Common Hospital Departments and Services.
  4. Jatoi, Ismail (May 2005). "The Mobile Army Surgical Hospital (MASH): A Military and Surgical Legacy". Journal of the National Medical Association. 97 (5): 650–651. PMC 2569328. PMID 15926641.

Further reading
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