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Many of you have seen or read about these make-ready hospitals. What are they and what do they look like?
Here are some new terms to be aware of:
1. FIO2: Functional Inspired Oxygen Percent, which is the concentration of oxygen in the gas used by the patient.
2. Arena to Health Care (A2HC), as defined by the U.S. Army Corps of Engineers (USACE):
3. Hotel to Health Care (H2HC), as defined by the USACE:
3. Closed Hospital to Health-Care Concept (CH2HC), as defined by the USAC; similar to the A2HC and H2HC requirements. Additional mandatory requirements:
4. Covid Positive:
You can read more about these make-ready hospitals created to help during the COVID-19 pandemic at https://bit.ly/2WaoAkS.
As the pandemic spreads, we have learned multiple do’s and don’ts of design processes and out-of-the-box thinking.
From a plumbing standpoint, there are minimal plumbing requirements and or modifications to provide.
Most, if not all, the selected sites above will have functioning plumbing and utilities already on site. Others will utilize bedside toilets, where staff will discard the waste.
Medical gas requirements depend on the level of the make-ready facility. A non-covid structure might consist of either E cylinders or H cylinders for oxygen and or medical air. A COVID-19 facility for the more serious make-ready structures may include a medical air skid and a mini-bulk oxygen system with a vaporizer. Piped medical gas could be installed using corrugated medical gas tubing and standard medical gas copper tubing.
Typically, the more serious the case of the COVID-19 coronavirus, the more likely that the patient will be transported to a local hospital that is better equipped to handle the more severe patients.
The existing hospitals housing the acute COVID-19 patients will see an increase in oxygen and medical air usage. Some facilities have been installing splitters on the oxygen and medical air outlets, going from a private room to a semi-private room. This may work for non-acute covid patients but not recommended for the acute (many agree this is not a good idea placing such a high flow rate on a 3/8-inch pigtail outlet).
For those more acute covid patients, select states have asked health-care facilities to increase their bed counts by 50 percent. Most of the existing hospitals cannot increase the demand on their medical air compressors and bulk oxygen tank farms by 50 percent, but they do have capabilities to handle more acute COVID-19 patients. How?
What this might look like for a Level 1 Trauma 450-bed facility:
Each facility is different with how they handle certain patients and crises. With that in mind, one of the first places you will start asking questions is to the respiratory therapy director. You need to understand how many ventilators they have operating at one time in areas of the facility.
For this facility, you will need to know the following factors:
The respiratory director has provided the following:
The facility has also provided additional information as follows:
Below are several respiratory therapies which may be implemented regularly:
Respiratory will tell you 40 lpm, so what does this mean to me? It lets you know that you could have 40 lpm of oxygen flowing at one time. This flow of 100 percent oxygen at 40 lpm does not last more than 10 to 15 minutes. This is the time frame for the ventilator to adjust to the patient’s needs.
When the unit has been calibrated to the patient, the ventilator could use 50 percent oxygen. The patient’s tidal volume will be your operating flow rate, so you know how many vents can be on a zone at one time. You will be able to bring more vents online as the zone is calibrated, which we will discuss in Part II of this article.
This facility’s oxygen usage in January was 3,007,500 scf (26,130 gallons) and March was 3,340,900 scf (29,026 gals). The daily usage in January was 105,000 scf per day and March was 107,771 scf per day. Keep in mind, over those three months, the census has gone down and elective surgeries have gone down.
This facility has two 100 scfm-capacity skids currently installed, with a fourth pump ready to be installed on one of the triplex skids, making it a quadraplex. A bypass valve interconnects the two skids.
If you are thinking about opening the bypass valve and let it all work together, you would be incorrect in this approach. To make this happen, you will need to adjust the settings at each skid to function as one big skid. You want to operate all seven pumps in rotation; you do not want to burn up any of the pumps. You will need to work with your source equipment manufacturer to make these adjustments.
If we could not bypass and open the system up to another set of skids, we would have had to evaluate each system and what it serves on its own. We still recommend doing this process to determine the capacity of each system and how many ventilators the system can handle.
The tricky part is, does the facility have a decent set of as-built plans of the medical gas system? This will assist you in determining what an area or a riser can handle. Many facilities do not have a very good set of as-builts. I recommend these facilities start locating and updating their as-built drawings for future events.
The second part of this series will cover the sizing and evaluating criteria for existing piped systems, including various bulk or manifolded systems.