Crisis Response Unit_Malawi (Part 1)

C.R.U. Malawi crisis response unit

Addressing the Road Traffic Fatality Rate in Malawi

by Hardi Shah

project Title: crisis response unit - c.r.u. malawi

by hardi shah

Project presented to the Faculty of the Department of Architecture College of Architecture and the Built Environment, Thomas Jefferson University

In partial fulfillment of the requirements for the degree of BACHELOR OF ARCHITECTURE

Arch-508 / Design 10: Research and Design Faculty

Associate Professor Chris Harnish

Philadelphia, Pennsylvania

May 2019

table of contents

abstract & research question

Could a deployable, pre-fabricated mobile emergency response unit help reduce the on-site road traffic accident mortality rate?

“Every second counts in a road traffic emergency. Reducing the time it takes for medical services, firefighters and rescuers to arrive on the scene can save lives and limit the severity of the consequences of road accidents for survivors .”

-“New UN Regulation on Automatic Emergency Call System for Road Traffic Accidents Will Reduce Response Times, Save Lives.” Targeted News Service, Nov 23, 2017.

Road traffic injuries are a common cause of hospital visits in Malawi, and they are also the leading cause of adult injuryrelated deaths at 30%. In Malawi, death at the scene of crash may be related with either critical and maximum injury severity or poor post-collision care. Factors such as delay in emergency services, lack of ambulance services, and shortage of prehospital teams contribute greatly to the victims survival till they can access medical attention at a healthcare facility. The

emergency response system and trauma services in Malawi are quite disorganized and at many times non existent. If the goal is to reduce the number of road fatalities on scene, providing adequate post-collision care is imperative.

Even a 10 minutes reduction of the medical response time can be statistically associated with an average decrease of the probability of death by one third, both on motorways and conventional roads. By enabling the first responders at the crash site to conduct efficient triage, the medical staff can quickly recognize which victims need to be taken to a healthcare facility and which can be treated on-site. If the critical victims are identified as early as possible, they can be transported in the emergency vehicle to the nearest healthcare facility while the other victims can be attended to on-site by the paramedics.

thesis statement

“Emergency and trauma services within the country are at best disorganized and often non-existent.” 14

“Adequate post-collision care is key to reducing road fatalities on scene.” 14

“Primary intervention is widely believed to be the most appropriate strategy to prevent traffic collisions” 14

“even a 10 minutes reduction of the medical response time can be statistically associated with an average decrease of the probability of death by one third” 14

Providing a quickly deployable emergency tent structure to conduct on-site triage will improve efficiency of healthcare given at the crash-site.

literature review topics

Urgency of the issue of road traffic accident mortality

Global statistics on RTI mortality rates

National (Malawi) statistics on RTI mortality rates

Types of RTIs & respective fatality rates

Current sequence & encountered issues

The usual RTI timeline: <4 victims

The mass casualty RTI timeline: 20+ victims

Presence (or lack) of post-collision care

Current transportation and ambulance system

Current challenges with medical supplies

Various Mass Casualty Systems currently in place

ASAP Rapid Shelter Systems

Ambubus & FirstLine Technology

Structural Typology

Benefits vs challenges of deformable and mechanical structure in a Malawi context

Deployment criteria for mechanical structure

Types of mechanical deployable structure systems

Telescoping Structure

Tensile Structure

Programmatic Criteria

Contents and functions of an ambulance

START triage system & protocol

Triage category adjacencies & on-site program flow

On-site medical services and utilities respective to program

Case Study Analysis

Various deployable structures

HTS Clearspan Structures

Shelterpod Advanced Shelter

HDT Global 12 bed EMMTS

HDT Global 25 bed EMMTS

Various ambulance, trailer, tent organization strategies

Various program adjacency organizations

Manufacturing Criteria

Shipping container size & proportion availabilities

Shipping container structural details

Trailer form and types

Two axle - hitch symmetrical

Two axle - hitch asymmetrical

One axle - hitch asymmetrical

post collision care: triage

By enabling the first responders at the crash site to conduct efficient triage, the medical staff can quickly recognize which victims need to be taken to a healthcare facility and which can be treated on-site. 5

This can reduce the amount of time that it takes for a critical victim to be recognized and be taken to a healthcare facility.3

This effectively reduces burden on the emergency vehicle and reduces overcrowding at the healthcare facility.3

the roadways are difficult to navigate with a large vehicle

there is a shortage of staff available to handle the accident

staff is not trained to handle victims of such a large crash; improper handling can lead to more injury

benefits of on-site triage

a significant period of time is lost due to the magnitude of the crash & the lack of efficiency and size of the responding EMTs

a significant period of time is lost due to the volume of victims, lack of efficient on-site triage, and few first respondants

prelim care is given on site

The objective is to be able to train medical professionals to be able to identify on-site, the proportion of patients who do not need immediate emergency medical care.A large issue even in developed countries is the wastage of resources on patients who did not need to be taken to the hospital and could have just been treated minimally on site.

a significant time is lost due magnitude of & the small size emergency

the victim in critical condition worsens enroute

This does however require that there be a staff of well trained human resources who can accurately decide how to triage victims on site and decipher whether they need emergency medical attention or not.

on-site triaging. Robert B. Dunne, Scott Compton, Robert D. Welch, Robert J. Zalenski, Brooks F. Bock, Prehosp Emerg Care. 2003 Jan-Mar; 7(1): 85–88.

methods methods of research

A.LITERATUREREVIEW

USINGTHE PAULGGUTMANLIBRARY’S DATABASES

BACKGROUNDRESEARCH

-URGENCYOFISSUE

This research on mass casualties and road traffic accidents in Malawi was majorly based on literature review conducted on the Jefferson Library databases and various internet sources. Reliable information was found on PubMed, the United Nations, and the World Health Organization databases as well.

Various medical professionals as well as architectural faculty and alumni provided valuable feedback throughout the process.

-ROADTRAFFICACCIDENTS

-MASSCASUALTYACCIDENTS

LITERATUREREVIEW

USINGTHERESOURCESAVAILABLEONTHE WORLDHEALTHORGANIZATION’SWEBSITES

LITERATUREREVIEW

USINGTHERESOURCESAVAILABLEONTHE UNITEDNATION’SWEBSITES

LITERATUREREVIEW

USINGTHE PUBMEDDATABASEONTHEPAUL GGUTMANLIBRARY’SWEBSITE

B.LITERATUREREVIEW

USINGTHE PAULGGUTMANLIBRARY’S DATABASES

CASESTUDIES

-tenttypologies

-ambulancecontents&types

-masscasualtyresponsesystems

-structuralsystems

LITERATUREREVIEW

USINGTHERESOURCESAVAILABLEONTHE WORLDHEALTHORGANIZATION’SWEBSITES

LITERATUREREVIEW

USINGTHERESOURCESAVAILABLEONTHE UNITEDNATION’SWEBSITES

INTERVIEWS

ON&OFFCAMPUSGROUNDS

ELIZABETHKREBS,MDMSC

ASSISTANTPROFESSOR

DEPARTMENTOFEMERGENCYMEDICINE

SIDNEYKIMMELMEDICALCOLLEGE

THOMASJEFFERSONUNIVERSITY

TYCZYNSKA,NICOLEE.

ONLINEINTERVIEWBYHARDISHAH. FEBRUARY06,2019.

PERSONALINTERVIEWBYHARDISHAH APRIL01,2019

global statistics on rti fatalities

“Every second counts in a road traffic emergency. Reducing the time it takes for medical services, firefighters and rescuers to arrive on the scene can save lives and limit the severity of the consequences of road accidents for survivors.”10

(“New UN Regulation on Automatic Emergency Call System for Road Traffic Accidents Will Reduce Response Times, Save Lives.” Targeted News Service, Nov 23, 2017.)

Every year, about 1.2 million people die through road traffic crashes worldwide. Majority of these deaths occur in Africa where most of their emergency medical services are underdeveloped.12

MALAWI RANKS 1ST IN AFRICAIN RTI MORTALITY AT 35

FATALITIES PER 100,000 POPULATION.6

THE UNITED NATIONS RECOGNIZES THIS AS A GLOBAL CRISIS AND HAS DEVELOPED A SUSTAINABLE DEVELOPMENT GOAL TO COMBAT THIS.2

BY 2020, HALVE THE NUMBER OF GLOBAL DEATHS AND INJURIES FROM ROAD TRAFFIC ACCIDENTS.2

AT

LEAST

MALAWI, 1/3RD

national statistics on rti fatalities

About 20 road traffic collisions occur every day in Malawi, two of which are fatal and two serious injuries. About 1,000 people are killed in road traffic crashes in Malawi every year. In 2015, 5,700 individuals died in Malawi from a road traffic accident despite there being only one motor vehicle on the road per 40 residents. 6,14

road traffic accident types

A road accident refers to any accident involving at least one road vehicle, occurring on a road open to public circulation, and in which at least one person is injured or killed.

A mass casualty incident (MCI), is any number of casualties that exceed the resources normally available from local resources. This is based upon available resources, number of injuries, and severity of injuries.

(“What Is a Mass Casualty Incident?” Classification of Social Media Platforms. Accessed February 27, 2019. https://delvalle.bphc.org/mod/wiki/view. php?pageid=89.)

{MOST COMMON} MOTOR VEHICLE VERSUS PEDESTRIAN COLLISIONS14

FATAL CASES: 44% 14

MOTOR VEHICLE VERSUS BICYCLE COLLISIONS14

FATAL CASES: 41% 14

MOTOR VEHICLE VERSUS MOTORCYCLE COLLISIONS14

FATAL CASES: 41% 14

MASSCASUALTYACCIDENTS,20+VICTIMS

MOTOR VEHICLE VERSUS MOTORVEHICLE COLLISIONS14

TYPICALLY MINIBUS OR TRUCK COLLISIONS14

FATAL CASES: 19% 14

Steps in the sequence from crash site to the healthcare facility

Issues encountered during the process

the mass casualty timeline: 20+

victims

A mass casualty incident (MCI), is any number of casualties that exceed the resources normally available from local resources. This is based upon available resources, number of injuries, and severity of injuries.

(“What Is a Mass Casualty Incident?” Classification of Social Media Platforms. Accessed February 27, 2019. https://delvalle.bphc.org/mod/wiki/view. php?pageid=89.)

a mass casualty road traffic accident

on -site triage must be performed but is not

there may only be one ambulance available

a call to emergency services is placed

this call may or may not be placed

the roadways are difficult to navigate with a large vehicle

there is a shortage of staff available to handle the accident

a significant period of time is lost due to the magnitude of the crash & the lack of efficiency and size of the responding EMTs

if that is the case, victims will be taken to a healthcare facility via

staff is not trained to handle victims of such a large crash; improper handling can lead to more injury

collision occurs (20-24 people injured) ambulance arrives on scene

more victims than needed are transported to the hospital significant spatial challenges exist at facility causing overflow of patients

RESOURCES

prelim care is given on site

a significant period of time is lost due to the magnitude of the crash & the small size of the emergency vehicles

VICTIMS

casualties >>resources

the ED at the facility might not have the services needed to save a victim

To provide post-collision care with efficiency and reduce the road traffic accident mortality rate, the response time for emergency healthcare must be reduced drastically. By improving upon the efficiency of emergency vehicles with respect to mass casualties, victims of road traffic accidents could obtain medical attention sooner.

When road traffic accidents begin to increase in size, it completely overwhelms the postcollision care system in Malawi which currently struggles to cater to 3-5 person road traffic accidents.3 This particularly challenging category of road traffic accidents is mass casualty road traffic accidents where the number of affected victims is significantly higher.

victim(s) are treated in the 2-4 person surgery theater

victim(s) transported to nearest healthcare facility

the long wait for medical attention could result in worsened injuries or fatalities

the victims do not all fit into the ambulance

the victim in critical condition worsens enroute

the trip is too long and the critical victim dies

the nearest healthcare facility is 20 minutes away

the district hospital is 20 minutes away while a central hospital could be 2 hours away

staff is unable to detect critical patient due to lack effective triage system and equipment

Lynn, Mauricio. “Hospital Planning and Response to Sudden Mass Casualty Incidents.” Mass Casualty Incidents, 2016, 25-55. doi:10.1007/978-1-4939-3496-6_3. Harrison, Hooi-Ling, Nigel Raghunath, and Michele Twomey. 2012. Emergency triage, assessment and treatment at a district hospital in malawi. Emergency Medicine Journal : EMJ 29 (11): 924-5. Schlottmann, Francisco et al. “Road traffic collisions in Malawi: Trends and patterns of mortality on scene” Malawi medical journal : the journal of Medical Association of Malawi vol. 29,4 (2017): 301-305.

analyzing the system: current challenges

There are a number of considerations to be able to apply this theory of a deployable tent for on-site triage which is identified here. For example, developing a transportation and ambulance system will need better integration and coordination between the Ministries of Transportation and Health. 14

In terms of triage, developing an efficient triage system specifically for mass casualties will be a challenge as will training and building up the human resources for this position. 14

collision

TRIAGE

developing an efficient triage system specifically for mass casualties

ambulance arrives

developing a transportation and ambulance system will need better integration and coordination between the Ministries of Transportation and Health

training first responders and building up the skilled human resources

providing enough medical supplies in the emergency vehicle

othervictims

on-site treatment

providing enough staff to address all the people in the accident

healthcare facility

healthcare facility

criticalvictims

quickerhealthcare forcriticalvictims

lesscrowdingin vehicle&hospital

medicalsuppliesarenow reservedforcriticalvictims

providing enough space for emergency treatment of the critical patients

othervictims

analyzing the system: positive impacts

By enabling the first responders at the crash site to conduct efficient triage, the medical staff can quickly recognize which victims need to be taken to a healthcare facility and which can be treated on-site. 5

This can reduce the amount of time that it takes for a critical victim to be recognized and be taken to a healthcare facility.3

This effectively reduces burden on the emergency vehicle and reduces overcrowding at the healthcare facility.3

c.r.u.- crisis response unit

ASSISTING THE HEALTHCARE PROVIDERS ON THE CRASH SITE OF A MASS CASUALTY ROAD TRAFFIC ACCIDENT

Providing a quickly deployable emergency tent structure to conduct on-site triage will improve efficiency of healthcare given at the crash-site.

project goals

Could a deployable, pre-fabricated mobile emergency response unit help reduce the on-site road traffic accident mortality rate?

A deployable, pre-fabricated mobile emergency unit would be able to assist healthcare providers at a crash site and effectively address critical patients as quickly as possible.

This emergency unit strives to be able to provide an effective area for treatment and create some organization on an incredibly chaotic site. By establishing this organization, it is easier for medical staff to be able to triage critical victims quickly and administer emergency stabilization.

The response time which could otherwise be wasted attempting to transport each victim to a healthcare facility to then await triage in an overwhelmed facility, is now cut to a fraction by providing an organized space to conduct that triage initially on site. As stated in multiple sources, the quicker the critical victims are addressed on site and taken to a facility of definitive care, the higher the chances of their survival.

two types of deployable structures

Deployable structures can expand and/ or contract due to their geometrical, material and mechanical properties. Such structures may pass from a ‘folded’ to an ‘erect’ state; and in many cases the component parts are connected throughout topologically, but alter their geometry through the process of deployment. In the process of deployment the initial mobility is transformed into a final rigidity. 13

By the application of a force at one or more points, it transforms in a fluid and controlled manner. Despite such ease of transformation, these structures are stable, strong and durable. 13

DEFORMABLE STRUCTURAL

BENEFITS

BENEFITS >> << CHALLENGES CHALLENGES

do not require physical manpower to deploy & assemble

depend upon the elasticity of their members to allow mobility from the deployed to compacted shape

performance dependent on the strain level in the structure and the type of material

limits their applicability to shelter structures, as the stressed structures are not suitable for repeated deployments.13

deployment does not induce any strain in structural elements

robust performance and repeatability of deployment characterise structural mechanisms. They can also compact to a small fraction of their deployed volume.

The deployment process can be controlled or terminated whenever required with the structure assuming any of the intermediate stable configurations.

very difficult to manufacture and more expensive than other conventional structures13

Spaces must accomodate 3-4 paramedics and provide ‘beds’ for individuals, cabinets for supplies

the ideal deployable tent structure

Volume of the structure must be able to fit into a carry bag and placed in or under a

As the tent is developed, it is critical to set up criteria which can be used to assess the success or failure of the proposed solution.

However, we must also accept that not all of the criteria might be able to be incorporated into a solution. The challenge of this proposal lies in the question of compromise.

internal program layout and adjacency

Approximate sq ft of ambulance = 14x7 for one patient

On-site services which need to be provided are:8 sutures

burns fractures

Equipment for these can be provided in go-bags otherwise, beds and water & energy connections are necessary

Harrison, Hooi-Ling, Nigel Raghunath, and Michele Twomey. 2012. Emergency triage, assessment and treatment at a district hospital in malawi. Emergency

Mohammed-Najeeb Mahama, Ernest Kenu, Delia Akosua Bandoh, and Nuhu Zakariah Ahmed. “Emergency Response Time and Pre-Hospital Trauma

Rate

(January

EQUIPMENTINABASICLIFESUPPORTAMBULANCE7

equip. in

EQUIPMENTINAPARAMEDICGO-BAG1

Criteria for the Ambulance:7 size & weight ability to navigate difficult, muddy roads staff accomodation

Criteria for the Paramedic Bags:1 should be battery or solar powered quantity should be sufficient for mass casualty should be able to detach & work independently from ambulance

Branas, C. C., E. J. MacKenzie, and C. S. ReVelle. 2000. A trauma resource allocation model for ambulances and hospitals. Health Services Research 35 (2): 489-507. “Model Comparison Chart.” Demers Ambulances. Accessed February 27, 2019. https://www.demers-ambulances.com/model-comparison-chart/.

case studies

Conducting precedent studies has helped establish criteria for the tent and understand how the criteria are balanced, achieved, and compromised in existing situations.

It also serves as an exercise to analyze the existing models and rate their effectiveness in a situation such as a mass casualty road traffic accident. When proposals are created for on-site triage later in the semester, this type of analysis will be utilized to determine the possible failures or successes.

Studying existing emergency tent structures available for commercial, military, & medical use and their successes & drawbacks.

case studies

precedent: HTS

Clearspan

Structures

Rapid Deployment Shelters - Emergency Shelters

Tents for humanitarian response and emergency relief

Eave height: 1.70m

Span width: 5.65m

Peak height: 2.70m

Longest component: 2.44m

Maximum length: 6.00m

PRECEDENTANALYSIS

TOTAL COVERED AREA: Tallest height: Height at corner: set-up time: less than 30 minutes

Max allowed wind speed: 60 km/h

Aluminium type: Anodized aluminium profiles

Connecting components: Aluminium couplings

Roof covering type: Robust industrial grade

PVC, Flame retardant

PRECEDENTANALYSIS

135 sqft

Total covered area: set-up time: less than 22 seconds

With practice one person can set up these shelters very quickly. Setting stakes, lines and zipping in the floor will take another couple of minutes.

precedent: shelterpod advanced shelter

Width: 11.5’

Height: 6’ 4”at center 5’10” at Shoulder

Stowed Size: 12” x 12” x 74”

Weight: 65LBS

6-layer super-composite reflective fabric with a fiberglass frame and metal hubs. Reflective, Insulated, and Wind resistant

precedent: HDT Global 12 Bed EMMTS

A trailer based system complete with power generation, heating and cooling, and water distribution including showers and sinks.

This system provides treatment space for 6 beds with surge capability to 12 beds.

Also has capability to provide negative pressure isolation for 2 to 4 beds. Multiple systems complex together to provide larger multi-bed systems in increments of 25, 50, 100 or more.

Medical equipment included can be tailored to meet your specific requirements, Beds included

PRECEDENTANALYSIS

set-up time: almost one hour

To be operational, system needs: power source water source oxygen connection

12 BED EMERGENCY MEDICAL TREATMENT AND TRIAGE SYSTEM (EMTTS)

This 6 – 12 bed rapid deployable infrastructure system provides an on site Emergency Treatment & Triage System (E-MTTS). A trailer based system complete with power generation, heating and cooling, and water distribution. Free standing and designed to be setup in 1 hour. System only needs fuel, water source and oxygen to be operational. This system provides treatment space for 6 beds with surge capability to 12 beds. Also has capability to provide negative pressure isolation for 2 to 4 beds. Multiple systems complex together to provide larger multi-bed systems in increments of 25, 50, 100 or more.

precedent:

Rapid deployable infrastructure system provides support for 25 patients complete with power generation, heating and cooling, and water distribution. The system is free-standing and designed to be set up in 2 hours. It only needs fuel, a water source and oxygen to be operational. System can be augmented with medical equipment and supply sets to provide for a total turnkey solution to surge hospital capacity. Design promotes efficient traffic flow and improved utilization of staffing resources.

PRECEDENTANALYSIS

The hub and spoke version of the 25 bed system features a center core that acts as a control point when joined with open end boot connectors.

Key Features

• Rapid deploying shelters for Mass Casualty Event Response

• 25 bed, isolation capacity

• Boot connectors

• Lighting

• Complete with heating, 3.5 ton ECU, and water distribution system including showers and sinks

• System only needs power source, water source, and oxygen to be operational

• Chairs, tables, desks

• Waste containers

Medical 25 Bed systeMs Square and Hub and Spoke Configurations

• Fire extinguishers

• Cargo trailer

• Center core that acts as a control point when joined with open end boots

• Free standing and designed to be set up in two (2) hours

• Medical equipment included can be tailored to meet your specific requirements

• Beds included with this system

HDT Global 25 Bed EMMTS

A trailer based system complete with power generation, heating and cooling, and water distribution including showers and sinks.

This system provides treatment space for 25 beds with isolation capacity.

Also has capability to provide negative pressure isolation for 2 to 4 beds.

Medical equipment included can be tailored to meet your specific requirements, Beds included

Rapid deployable infrastructure system provides support for 25 patients complete with power generation, heating and cooling, and water distribution. The system is free-standing and designed to be set up in 2 hours. It only needs fuel, a water source and oxygen to be operational. System can be augmented with medical equipment and supply sets to provide for a total turnkey solution to surge hospital capacity. Design promotes efficient traffic flow and improved utilization of staffing resources.

The hub and spoke version of the 25 bed system features a center core that acts as a control point when joined with open end boot connectors.

Key Features

To be operational, system needs: power source water source oxygen connection Stand off triage and remote treatment capability from your Emergency Department

set-up time: almost two hours

the three component typologies

On-site services which need to be provided are:8

sutures burns fractures

Equipment for these can be provided in go-bags otherwise, beds and water & energy connections are necessary

severe/critical patients

emergency transport access to water, oxygen, and energy

allow for larger sqft easily deployed multiple patients, two EMTs light equipment

AMBULANCE TRAILER CARETENT

typical size= 7’x14’ one patient, two EMTs, driver

ONSITE TRIAGE

allotheron-site facilities

allotheron-site services contains equipment and square footage not available in ambulance

successes & drawbacks study 1

TENTPLACEDONROOFOF

INDEPENDENTTRAILERCONTAININGMEDICAL EQUIPMENT(150SQFT)

PROS

FLEXIBILITYOFVEHICLES

VOLUMEOFSTOREDSTRUCTURE

WEIGHTOFOVERALLSTRUCTURE

CONS

RATEOFASSEMBLY

SQUAREFOOTAGE

STORAGE&ENERGY

TYPEOFINTERNALSPACE

ACCORDIANSTYLEMECHANICALLY DEPLOYEDTENT(302SQFT)

*THISSCHEMEALLOWSTHEAMBULANCETOLEAVEWITHACRITICAL PATIENTWHILETHEEMTSHANDLEOTHERVICTIMSWITHMINORINJURIES

PROS

case studies

successes & drawbacks study 3

PROS

SQUAREFOOTAGE STORAGE&ENERGY

VOLUMEOFSTOREDSTRUCTURE

RATEOFASSEMBLY

WEIGHTOFOVERALLSTRUCTURE

CONS

FLEXIBILITYOFVEHICLES

TYPEOFINTERNALSPACE

TRAILERISCONNECTEDTOTENT

TRAILERISASSEMBLEDAND POSITIONEDADJACENTTO AMBULANCE

TENTSTRUCTUREISPULLEDDOWN& AROUNDTOCREATEACANOPY

RELEASEFABRICROLLSFROMTOPOF CANOPYTOCREATEA‘CLOSED’TENT

AMBULANCEISASSEMBLED ANDPOSITIONEDADJACENTTO TRAILER

PROS

SQUAREFOOTAGE

STORAGE&ENERGY

VOLUMEOFSTOREDSTRUCTURE

RATEOFASSEMBLY

WEIGHTOFOVERALLSTRUCTURE

FLEXIBILITYOFVEHICLES

CONS

TYPEOFINTERNALSPACE

RELEASEFABRICROLLSFROMTOPOF CANOPYTOCREATEA‘CLOSED’TENT

*THISSCHEMEALLOWSTHEAMBULANCETOLEAVEWITHACRITICAL PATIENTWHILETHEEMTSHANDLEOTHERVICTIMSWITHMINORINJURIES

works cited

Branas, C. C., E. J. MacKenzie, and C. S. ReVelle. 2000. A trauma resource allocation model for ambulances and hospitals. Health Services Research 35 (2): 489-507.

“Goal 3: Good Health and Well-being.” UNDP. Accessed February 10, 2019. http://www.undp.org/content/undp/en/home/sustainabledevelopment-goals/goal-3-good-health-and-well-being.html#targets.

Harrison, Hooi-Ling, Nigel Raghunath, and Michele Twomey. 2012. Emergency triage, assessment and treatment at a district hospital in malawi. Emergency Medicine Journal : EMJ 29 (11): 924-5.

HDT Global. Accessed February 27, 2019. http://www.hdtglobal. com/series/medical-mergency-operations/.

Lynn, Mauricio. “Hospital Planning and Response to Sudden Mass Casualty Incidents.” Mass Casualty Incidents, 2016, 25-55. doi:10.1007/978-1-4939-3496-6_3.

“Malawi.” World Health Organization. February 01, 2015. Accessed February 11, 2019. https://www.who.int/gho/countries/mwi/en/.

“Model Comparison Chart.” Demers Ambulances. Accessed February 27, 2019. https://www.demers-ambulances.com/model-comparisonchart/.

Mohammed-Najeeb Mahama, Ernest Kenu, Delia Akosua Bandoh, and Nuhu Zakariah Ahmed. “Emergency Response Time and Pre-Hospital Trauma Survival Rate of the National Ambulance Service, Greater Accra (January – December 2014).” BMC

Emergency Medicine 18, (2018). doi:http://dx.doi.org/10.1186/ s12873-018-0184-3.

“New UN Regulation on Automatic Emergency Call System for Road Traffic Accidents Will Reduce Response Times, Save Lives.” Targeted News Service, Nov 23, 2017.

“Rapid Deployment Shelters For Sale | HTS.” Roder HTS USA. Accessed February 11, 2019. https://www.hts-usa.com/products/rapiddeployment-shelters/.

Rivas-Adrover, Esther. (2015). Deployable Structures.

“Road Traffic Deaths.” World Health Organization. March 11, 2016. Accessed February 12, 2019. https://www.who.int/gho/road_safety/ mortality/en/.

Schlottmann, Francisco et al. “Road traffic collisions in Malawi: Trends and patterns of mortality on scene” Malawi medical journal : the journal of Medical Association of Malawi vol. 29,4 (2017): 301-305.

“SHELTERPOD (RED) Limited Edition.” SHIFTPOD | Advanced Shelter Systems Inc. Accessed February 11, 2019. https://store. advancedsheltersystemsinc.com/responsepod/shelter/shelterpod-r.

Sion, Melanie, MD, and Anthony Charles, MD, MPH, FACS. Central Malawi District Hospital Surgical Capacity Assessment. Report. Department of Surgery, Thomas Jefferson University Hospital.

Tyczynska, Nicole E. Online interview by Hardi Shah. February 06, 2019.

“What Is a Mass Casualty Incident?” Classification of Social Media Platforms. Accessed February 27, 2019. https://delvalle.bphc.org/ mod/wiki/view.php?pageid=89.

https://www.who.int/bulletin/archives/80(11)900.pdf

final presentation script

The goal of this project was to analyze and combat the high road traffic accident mortality rate in Malawi with a special focus on mass casualty incidents.

To express the weight of this issue, malawi ranks 1st in Africa in road traffic accident mortality rate at 35 fatalities per 100,00 people. The United Nations recognized this as a global issue and set a sustainable development goal which has not been met.

1/3rd of all injury related deaths are caused due to road traffic accidents and 30% of all accidents result in at least 1 fatality. The cause for this has been identified to be the delay in emergency medical attention, lack of ambulance services, and a shortage of pre-hospital teams. This identifies the main issue to lie in the response system for road traffic accidents.

I first looked at the timeline for a typical road traffic accidents and identified the issues in the process in red.

I then looked at the timeline for a mass casualty road traffic accident. A mass casualty is defined as an accident which results in more patients than the local resources are able to handle. In red, I have identified issues that are faced in addition to the ones identified for a typical accident.

As stated before, the main issue lies in the response system for road traffic accidents. This includes the initial triage and urgent care, which is the area of intervention.

This brings me to my thesis question:

Could a deployable prefabricated mobile emergency response unit help reduce the on-site road traffic accident fatality rate?

By enabling the first responders to conduct efficient triage, the medical staff is able to quickly recognize victims in critical condition. These victims could then be transported to a healthcare facility where they will have access to definitive care, while other victims may be treated on site. This will reduce the amount of time that it takes for a critical patient to be recognized and taken to a hospital.

To assist healthcare providers on a chaotic crash site, the crisis response unit, or CRU, will be a deployable emergency unit which will provide a space for the responders to recognize and treat patients.

I studied the three main components of the system: the ambulance, trailer, and tent and established their uses and relationships on the site.

I also established a set of deployment, structural, and programmatic criteria to assess the success or failure of the proposed solution within the context of Malawi.

A goal for this project especially within the context of Malawi, was to be able to design the CRU to be a prefab and efficiently shippable design. A 2-unit set would aim to be fit into a 45 long shipping container.

The timeline of the crash was then reanalyzed as the response system was recreated. After a crash occurs, the police is contacted. As the police race to arrive at the crash-site and deploy the Crisis Response Unit, the ambulance makes it’s way to the crash site. This way, the medical staff is not wasting precious time deploying the tent when they could be triaging

the victims. Once the critical victims are identified, they are stabilized and taken to the healthcare facility while the rest of the patients are addressed on site.

The unit is divided into two sections: the primary treatment zone and the secondary storage zone. The primary zone is home to the emergency supplies, and the connection to oxygen, electricity, and water. The secondary zone contains the larger units needed on site such as the foldable stretchers, go bags, portable batteries, portable oxygen, and extra supplies.

When dealing with a mobile unit, there had to be a flexibility in the features to be able to exist in different conditions. Things such as a PVC fabric for durability, the choice to make a mechanically deployable tent to ensure multiple deployments without causing strain on the physical material, and a structural frame which is modeled from the structure of a durable shipping container were all considered. There also had to be features included to increase the ease in use such as a lever to crank the fabric back into the roll, the walking space within the unit between the supplies, and the footing to assist with the circulation within the site.

The floor plan further clarifies the organization of the components within the unit.

The elevation expresses the location of the utilities with respect to the hitch. To ensure more stability during transport for the utilities, it is located directly above the hitch. The flag is placed to signify the triage category which is being addressed at that time.

The sections express the relationship between the treatment areas and the supplies. Creating the walkway within the unit allows the treatment areas to connect and bleed into each other.

The loads affecting the unit were addressed when the structure was being created. The tension cables at the ends of the telescopic structures are

incorporated to offset the wind uplift.

The overall system can be created using multiple units.

CRU is designed to be able to be walked through and create a continuous circulation within the site for the staff. The circulation flows through the supply corridor of one unit into a covered treatment area in front of the storage space with portable utilities.

The CRU system could also be utilized in case of a larger mass casualty situation such as a flood or fire. A makeshift clinic can be created using these units.

The layout of the supply and storage zones determines the types of treatment areas. Critical treatment areas can be created where the supply and utility zone is located adjacent to the storage zone as that area has access to resources available in both zones of the unit. Other treatment areas are adjacent to only the supply & utility zone.

This creates a grid like organization on an otherwise chaotic site. While patients travel along this grid.

The staff can travel along a different grid utilizing the corridors within the unit.

CRU strives to be able to provide an effective area for treatment and create some organization on an incredibly chaotic site.

By establishing this organization, it is easier for medical staff to be able to triage critical victims quickly and administer emergency stabilization.

The response time which could otherwise be wasted attempting to transport each victim to a healthcare facility to then await triage in an overwhelmed facility, is now cut to a fraction by providing an organized space to conduct that triage initially on site.

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