Medical Corps International/Forum for Military Medicine & Pharmacy

MEDICAL CORPS International , Forum for Military Medicine & Pharmacy , Vol 3 N° 4/1988, pages 56, 58 to 60.

The Mobile Surgical Hospital of the Belgian Armed Forces

At the end of the 70's, it seemed necessary to develop a programme of medical units with high surgical level, and which should be used very close to the battle fields. These units ought to be extremely mobile, notwithstanding their complexity and the heaviness of the surgical infrastructure to be used.

At the same time, the Staff of the Belgian Armed Forces' medical Service had to face a multiple problem : the necessity of modernizing the most advanced elements of its third echelon, the wish for a surgicalization concept for its second echelon and the need for surgical medical support for air-transported missions.

For these reasons, it was then decided that a Technical Platform for primary Resuscitation/Surgery on the front should be developed with the collaboration of various private Belgian companies. This platform was to be complete and autonomous and able to be linked to any medical support unit of the front (second and third echelon). The logistic and commanding means, and the triage and hospitalization capability of the unit were to be deployed independently.

This technical platform was to be made of standardized modular elements, according to the civilian handling norms for international transport, and adapted to the severe military constraints of the battle field.

The elements were to be able to be combined to form functional units with variable-geometry, according to the imediate missions.

The main targets of the development were :

1. Medical performance : this system must perform

• pre-operatory conditioning (resuscitation procedures, radiological examination, laboratory)
• operative conditioning (surgical interventions, anaesthesia, sterilization)
• post-operative conditioning of the war-wounded, all this in the same conditions as in peace time

2. Versatility : easy and coherent adaption of the system to the various possible missions (surgical support to the second and third echelons or to the airtransported missions)

3. Mobility : the transport of the system must be possible and easy by any military operation means (sea, rail, C130, roads in operation zones up to the rear zone of the Brigade, …)

4. Flexibility of the system :

• ease of installation, which must be effective with the means at the disposal of any medical unit, after short training
• Autonomy (energy, water, medical supply)
• Ease of setting up and movement, within one hour time, even by night and on any foreseeable operation site

5. Reliability and sturdiness : the system must resist any operational constraint. According to this necessity, the homologation tests and the quality control of the modules were very severe and selective; they were the same as for all the military vehicles used by the Belgian Army for equivalent operation zones.

Functional description

The surgical technical platform, composed of 4 modules (see picture), is designed for treating at least 10 major surgical emergencies per day in full security.
The combination of the different modules allows coping with specific situations. Two of them (the operating suite and the laboratory - sterilization - technical module) can be sent as a support to an air-transported mission (AMF or overseas) or in case of temporary surgicalization of any medical support unit of the second echelon. The use of the operating suite on its own could even be considered under exceptional emergency circumstances. An 8 modules solution (two surgical technical platforms) is suitable to answer the medico-technical needs for a 120 beds mobile surgical hospital (third echelon).
The surgical technical platform can also be used as a temporary surgical reinforcement of a third echelon unit.

Complete Surgical technical platform. Four modules are able to treat more than ten major surgical emergencies per day.

For ground transportation, the modules are installed on trailers. On site, they are assembled and hydraulically operated platforms create a levelled area giving access to all the attached hospital modules. The pre-operating module is locked to the operating theatre. All the modules can be used with or without their (strictly interchangeable) trailers.

It must be stressed that the surgical technical platform is, far more than a gathering of complementary modules; the integrated system forms a coherent and efficient mobile surgical hospital.

Operating Suite

Intended for major surgery with diagnostic or per-operatory radiology, it consists of an operating area with a lockroom entry for the medical staff opposite to the entry of patients.
The lockroom and the induction and recovery module provide a good insulation to the operating theatre against the external environment.
The lockroom, housing the scrub-up, also serves as darkroom equipped with a manual film processor.

Pre-operative Module

Linked to the operating suite, this 2-beds module is in fact a transit area between the external environment and the operating theatre. It allows preparation of the patient for operation and for recovery with normal resuscitation procedures. In a sudden rush, minor surgery can also be carried out here.

Post-operative Module

With a 90° rotation of the two lateral panels, the floor triples its initial standard surface, allowing the hospitalization of 10 patients.
The beds are equipped to allow oxygen-therapy. The two central beds are equipped for intensive care (cardiac monitoring, tracheal and pleural suction).

Post-operative and recovery unit equipped with ten beds. The two central beds are used for intensive care.

Laboratory-sterilization-technical module

This module includes 3 different rooms :

• sterilization with steam autoclave
• laboratory for haematology and biochemistry
• technical installations for the four modules'utilities

Technical description

The mobility of the medical modules and the flexibility of the system are ascertained by the following specific assets :

Body

The panels are made of PVC foam and reinforced fiberglass laminate, in a metallic frame. This body has the same dimensions and the same handling devices as a standardized ISO 20 feet container.
Structural strength is essential and it is very important that all medical equipment is firmly attached to the structure. This can only be achieved by inserting within the panels (floors, sides or ceiling) metallic elements on which the various, and sometimes heavy, pieces of equipment can be firmly fastened in transportation position with simple and robust systems.
It is weatherproof for outdoor temperature ranges from -25°C to +40°C.

Trailer

The modules are transported on purpose-built trailers with pneumatic suspension, allowing all-track towing. Hydraulic jacks, permanently mounted on the trailer, ensure the level of the hospital.
The resistance tests performed on the NATO type military driving test track at Brasschaat (Belgium) have included the following full range of testing :

• vibration test
• structure torsion test
• braking test
• driving on ballast track
• fording and crossing slopes.

All these tests have been performed with trailers loaded with the four fully equipped modules.

Technical Equipment

The technical room contains the changeover from mains or generator external supply, water supply with a 1,300 liters tank, medical compressed air and pressurized water production. Electricity, compressed air and water are distributed from this technical room to all modules by various flexible cables and pipes. The oxygen distribution is also centralized for the whole surgical technical platform.
In case of electrical breakdown, batteries with a switch-over device for the operating lamps automatically enter into action for 3 hours time, which ensures the safe completion of the initiated operation.
Besides the normal supply of the refrigerator, two additional safety power supplies are possible : batteries with an autonomy of 24 hours of direct connection to the electrical circuit of the truck.
Each module is equipped with air conditioning.

Logistic Performance

This surgical technical platform composed of 4 highly mobile modules can be deployed or moved in about half an hour by logistic personnel. Another half an hour is required for the medical staff to be fully operational.
The modules are operated on their trailer, avoiding long and difficult unloading (always possible but with a deployment time twice longer), they are quickly and easily assembled or separated, and the permanent installation inside the modules of all medical and technical equipment requires no particularly long mounting or preparation.
Thanks to the hydraulic platform system, the inconveniences due to the deployment of the unit on trailer are definitively removed. The unit can thus be deployed even on unprepared ground such as a football field (minimal dimensions : 30 x 15 meters).

Thanks to the hydraulic platform system, the inconveniences due to the deployment of the unit on trailer are definitively removed. The unit can thus be deployed even on unprepared ground such as a football field (minimal dimensions : 30 x 15 meters).

Thanks to their standard dimensions, the modules can also easily be transported by air, sea and rail. They can be air-transported by most cargo aircraft, such as Hercules C130 (aircraft used for the in-flight homologation tests). The unloading with the help of embarked wheeled jacks makes the system completely autonomous on arrival.

Conclusions

All the technical characteristics described above were controlled during the homologation tests performed by the Belgian Army Technical and Medical Services.
These tests included :

• reliability of conception and design
• compliance with the standard
• trailer, module and equipment resistance and sturdiness
• logistical and medical performance

During the manœuvres of September 88 in Germany, the complete tactical capabilities of the system and its integration in the existing medical support will be studied.