Design It, Build It, Ship It: Solutions For Global Health Care Needs
The M2CU, a mobile medical care unit designed from a shipping container, is standalone, fast to build and easy to deploy throughout the existing global shipping container infrastructure.
The collaboration between NJIT, The Tuchman Foundation, and University Hospital in Newark produced what may be the next piece of a solution to meeting global health care needs. The partnership represents a multidimensional approach to solving a complex issue requiring several types of expertise, as well the ability to problem solve together.
The “problem” is that with few exceptions, health care systems are not designed to meet scenarios that are still outside the norm, like a pandemic, natural disasters or medical care delivery in conflict zones. Pop-up medical facilities that meet specific needs for varied levels of care are urgently needed and must include medical support systems that comply with the safety and building codes for health care facilities, such as HVAC systems to create negative airflow. In the context of the COVID-19 pandemic, the M2CU prototype architect Julio Garcia Figueroa points out that these pop-ups “need to support the rapid scaling of capacity in order to maintain routine and trauma care, while also accommodating the surge in demand for intensive care for patients with infectious disease and protecting healthcare workers.”
Several solutions have been tested recently, including ship-based and field hospitals, yet aligning mobile medical capabilities with the specific needs of hospitals remains a challenge as healthcare workers struggle to manage the pandemic. Not having adequate facilities is one part of the problem, supply chains for personal protective equipment (PPE) is another, and having enough testing capacity, healthcare workers and specialized equipment also needs to be resolved.
In response to the COVID-19 pandemic and other crises, a vast global network of architects and design professionals is “designing for good” to meet these challenges. It is a movement that is growing, as the need to respond to multiple crises grows: housing insecurity for the poor and refugees migrating to overcrowded urban areas, resilience by design for communities dealing with the devastation of extreme weather events, and health care systems on the brink of collapse. Nowhere has this movement been demonstrated more visibly than the initiatives by professionals and students around the world to design and produce open source PPE for health care workers.
“Many designers want to create solutions. I knew that if this project was going to be successful we needed a partner in the medical field for guidance on the feasibility and functionality within the needs of an established medical institution,” said Garcia Figueroa. “Architecture alone cannot solve the problem, we needed guidance from the people who are beneficiaries of our effort.”
One of those people is Dr. Adam Fox, associate professor of Surgery at Rutgers New Jersey Medical School, Division of Trauma and Critical Care and the medical director of New Jersey Emergency Medical Services Air Medical Program. “To get this right there clearly has to be a multidisciplinary approach, you have to bring all the right expertise together, not just design, or medicine or infrastructure, and you have to clarify what others in the group don't know,” said Fox. “I was skeptical at first. Is there enough room in the shipping container for critically ill patients? How will you take care of large numbers of patients with the space limitations? And how will you get the containers to the places you need them?”
Mena Grace ’06 (Civil Engineering), a senior project manager at University Hospital, said, “Early on in the project planning we thought we were going to build a mobile intensive care unit (ICU). When we sat down with our clinical staff we realized that an ICU has rooms dedicated to several specializations, like a burn unit, a cardiac unit or trauma unit, that need to be central to the emergency room (ER) and every other part of the hospital. Our planning shifted to building a mobile urgent care unit that could triage patients and take some pressure off the ER.”
“In an ICU there is a certain ratio of nurses to patients and they have to be within a certain distance of the patient so the design issues I was concerned with had to do with where the equipment is staged, where the nurses stations are placed for monitoring patients and where the clinicians sit down at a computer to record their notes,” said Fox.
“We had to understand what had already been done. We looked at the Connected Unit for Respiratory Ailments (C.U.R.A) design by Carlo Ratti at MIT but realized that it did not meet the criteria we had specified, which was to offer a solution that is self-contained and more adaptable, responsive and compact,” said Garcia Figueroa. “We also learned what is required for different levels of care: routine care, for infectious disease, testing or other medical issues, and for critical care patients who require a high degree of support or intervention, oxygen and monitoring. The vision has been to provide a modular capacity that could accommodate all of these levels of care, so it evolved to include vertical stacking as well as lateral expansion.” (See schematics and rendering gallery here.)
Hillier College interior design student James Chao ’20 was brought on to assist with the rendering of the prototype. “We looked at many projects for inspiration. Many were excellent and we learned from them, but many were not practical. The point of this project was to help people who are suffering and the guiding idea was always to design so it could be shipped and deployed quickly.”
“I wanted to keep focused on the value of the container as a solution, paired up laterally as well as vertically, I wanted to let the capabilities of the container itself guide us to develop the connectability of the parts. I decided to scale up to the standard 40-foot container that is 8 feet wide, 9 feet 6 inches tall and pierce the corridor right through it, so that as you start to pair them together you have a corridor that is flanked by two rooms, a double-loaded linear design. I also thought we could run all the mechanical and electric systems through the corridor to achieve negative pressure through the hallway pushing air into the rooms where it can be filtered out through vents in the exterior closets. This way we could protect the people who are providing the care,” said Garcia Figueroa.
“We began by modeling the container itself, professor Figueroa went out into the field and did a super accurate measurement of all the details of the container,” said Chao. “I used Revit to draw it, first making the floor plan, elevation and section drawings, then extruding the 3D rendering. Architecture and interior design are two sides of the same coin. Having deep knowledge as to how the shell of the building is constructed can be vital to making good choices when designing its interiors. We had to figure out how to install the HVAC system to be code compliant, to orient the ICU, registration, waiting and testing rooms, as well as where to stage the equipment, the electrical rooms and storage spaces.” (Prototype gallery.)
In response to the immediate nationwide need, the team set a fast-track fabrication schedule for the prototype. “James and I worked together on Zoom to model the container in 3D. We worked closely in a design-build mode on the fabrication of the prototype with Integrated Industries Corporation where construction started before design details were completed and we had to modify the systems and components that could be secured in a short time,” said Garcia Figueroa. (Fabrication gallery.)
“As we were first putting it into Revit - we realized the closets were key, the idea was to gang two closets side by side — so you are constantly reversing the containers to use the end with the door for access. We pierced a hole in the container to have a closet that is two containers wide for medical supplies and the mechanical systems. That way you can have support staff or an engineer enter the closet to change oxygen tanks, remove filters, adjust climate control systems, or set up electrical connections without ever disrupting the environment of the patients,” added Garcia.
Grace was skeptical about how well it would actually work in real-world conditions. “Honestly, I was worried about how the container would work for us in the limited space we have outside the hospital, but I have to say during the recent storm our tents blew down. (Delivering the prototype to University Hospital) I really appreciate the structural stability of the containers. They provide a safe, climate-controlled environment for the patients. Each trailer had an actual hospital bed, a medical chair, stretchers, ‘crash carts’, basic equipment and a computer stand.”
“We are in one of the most populated areas in the country, if there is another influx of patients I think this solution would be absolutely phenomenal. We are getting better at creating more ICU rooms within the hospital, and the trailers can be used to take the pressure off the ER. A sprained ankle and a COVID-19 patient could be separated. We did mock clinical trials to see with those two trailers how fast you can push patients through from the moment they step in the front door, to being screened, to being treated by the doctor or nurse practitioners, and what kind of patient influx can be handled,” said Grace. (Mock clinical trials gallery)
Steve Rubin, M2CU project leader and Martin Tuchman School of Management advisory board member is looking forward to the next phases of the product’s development with various New Jersey community stakeholders. “We are engaging in further research to discover how these units can best serve the health care needs of communities. Soon we will be placing units on NJIT’s campus for conducting further research with University Hospital and potential use as a testing site. We have partnered with Robert Woods Johnson Barnabas in Hamilton, working with them to build a significant M2CU facility on their campus of four units, with potential for more. In addition, we are excited to continue working with our original partner, University Hospital, to deliver a M2CU facility on the University Hospital campus. Our vision there is to provide space for ER overflow in the case of a second wave and to develop units that provide higher acuity care.”
Fox shared some photos from recent disaster response deployments with the team, showing equipment plugged into the wall and shelving systems to hang equipment on.
“The fact that people are thinking outside of the box for scenarios like disaster or large numbers of casualties is what we need to move forward in the world of care and response to things we don't see everyday. When people from one practice are thinking outside of the norm and can do things that could apply to medicine where you could improve the overall care someone gets is wonderful,” said Fox.
“Hillier College wants its students to understand the real world implications of whatever architectural conditions we specify. I want to design for good and improve people’s lives. This was a mission oriented project for us,” said Chao.
