With the escalation of Covid-19 patients during the fourth wave, the number of critically ill patients who require specialised care also surged. There emerged a felt need for a well-equipped facility to cater for this situation. In this light, we spoke to Peradeniya Teaching Hospital Director Dr. Arjuna Thilakaratne.
What is a mobile ICU facility?
A mobile intensive care unit (ICU) is a very new concept, and even though we have seen mobile clinics, mobile laboratories, and other common health-related mobile facilities, the concept of a mobile ICU is very unique. We have mostly seen military or relief organisations setting up emergency ICUs, emergency operating theatres, etc. in makeshift tents and buildings as a temporary measure, but these are not expected to function after the emergency is addressed. Therefore, such facilities are temporary and may not meet some of the strict healthcare standards.
In this background, the subject of the mobile ICU, which was commissioned at the Peradeniya Teaching Hospital, is not a temporary structure. It is a fully fledged modern ICU with all the high-tech features that you expect from an ICU of international standard.
The significance of it is that the entire ICU is built in a manner facilitating transport from one location to another. For instance, this unit was fabricated and equipped in Colombo, and thereafter was installed and commissioned in Kandy. Generally, prior to the introduction of technology of this nature, we assume that whenever it is “mobile”, it is for temporary use and sometimes could be lower in configuration to a standard stationary facility. However, contrary to this assumption, this mobile ICU is amazing, as its exterior appearance and its interior cutting-edge technology are unbelievable, some of which cannot even be found in an ICU in a hospital. As such, a mobile ICU is a unique facility that facilitates relocation if necessary and is also able to provide instant care to the critically ill.
What is its capacity in terms of occupancy?
The current mobile ICU has a capacity of three beds. Meaning for a year, there are 1,095 ICU day beds. This is also very useful not only during the pandemic but also during any other situation in a hospital. It needs to be emphasised that an ICU bed, especially in a government hospital, is a luxury. There isn’t a single hospital in the country that has an adequate number of ICU beds, in terms of hospital bed strength or the number of patients they serve.
Can high-dependency patients be treated in such a facility?
Most certainly. High-dependency patients can be treated in a mobile ICU with ease, since it is built with all essential infrastructure such as the medical piped gas system, laminar flow type air disinfection system, uninterrupted emergency power system, and a host of other cutting-edge technologies. We can treat not only patients who require high-dependency care, but also patients who are critically ill requiring ventilation support. Therefore, this is a lifesaver by all means, and it is a blessing to have such a unit in any hospital due to its practicality and dependability.
How has it helped during the Covid surge?
This concept is an innovation from Premium International, and it’s the first unit currently installed in the country. But going by the numerous demands and requests for such units from many other hospitals, undoubtedly other hospitals have also seen the benefits of this new facility in the fight against Covid-19. As mentioned earlier, the introduction of this type of unit has to be considered against the current context. We do not even have adequate ICU bed capacity in hospitals to manage our routine medical and post-surgical patients who require critical care patient management. With the pandemic, most hospitals ran out of the required ICU beds almost immediately and they were faced with huge challenges.
Given this scenario, how do you manage the Covid-19 patients whose conditions are deteriorating rapidly?
Frankly, we had no alternative nor did we have any remedy. Although there were many donations of equipment, one has to comprehend that the hospitals do not have basic infrastructure, such as space in the ICU or the required medical piped gas system, to benefit from such vital medical equipment. Hence, acquiring an abundance of equipment is not going to solve the problem, as there is a saturation point that is reached and from beyond that point, practically, ICU patient care delivery cannot be expanded.
Therefore, this unit is a game changer in the treatment of critically ill Covid-19 patients. First, it gives you the most important and valuable fully equipped standalone independent ICU. All you need is just space in the hospital. There are no cumbersome civil constructions and challenges to your daily hospital operation due to construction-related activities. Second, this is a “plug-and-play” system, meaning it is quick to deploy to the desired hospital. Third, it is instantaneously usable after commissioning. Hence, lives of critically ill Covid-19 patients can be saved from day one. Especially since the mobile ICU comes with a state-of-the-art Laminar flow-type air disinfection system that also destroys the viruses such as Covid-19, the frontline healthcare staff who are engaged in this ICU are assured of a safe environment to operate in. The facility also has remote patient monitoring through CCTV on each bed, facilitating not only monitoring, but also need-based interaction with ICU patients. Also, since this is an independent unit serving only the Covid-19 critically ill patients, the other ICUs in the hospital, which admit routine patients, are prevented from any exposure to Covid-19, which is an immense advantage to other patients.
How much staff (nurses, doctors, and attendants) is required to run a mobile ICU?
The three-bed ICU can be run with one fulltime doctor and two to three nurses depending on the circumstances. There might be a need for an attendant depending on the requirement. Furthermore, a specialist consultant will be on call for any ICU to attend to any emergency, depending on the need.
What are the costs, benefits, and limitations?
There is a huge benefit with regards to the quick deployment capability of the mobile ICU. The costs and benefits of this facility cannot be valued in monetary terms, as any delay in providing advanced patient care for seriously ill patients can unfortunately result in a fatality. One of the most significant benefits of this mobile ICU is that it does not depend on the existing facility. All you need is a space to keep it and connection to electrical power and water. One of the challenges sometimes faced with hospitals is the lack of staff for the ICU. However, as we had seen during the last year and more, frontline healthcare staff had done their best and at times worked for 48 hours continuously to provide their services to the nation.
Another challenge could be the space and maneuverability within the hospital. It is 40 feet long and a crane is required to lift it and place it in the right location. But these are all manageable when you weigh the significant benefit this innovative and unique solution can provide to the critically ill patients in Sri Lanka. As a healthcare professional, I cannot emphasise enough that this is a timely and unique approach to build up the stressed critical care infrastructure in Sri Lanka that has already been tested to its limit with the onset of the pandemic.
