In The News – Shipping Container Modification Project

New Jersey R&D Consortium Unveils Mobile Medical Care Unit to Address Health Facility Shortfalls

Written by: Tracey Regan 
Published: Tuesday, July 14, 2020

Full Article Can be found here

A rendering of the mobile medical unit at University Hospital in Newark.

In response to the extreme challenges to clinical capacity posed by the COVID-19 pandemic, three New Jersey institutions – New Jersey Institute of Technology (NJIT), University Hospital in Newark and The Tuchman Foundation – are collaborating in a unique partnership on the development of modular, mobile medical care facilities to be deployed to areas of surging disease outbreaks and other disasters, as well as to regions that lack health care infrastructure at all times.

The modules, now under construction in Woodbridge, N.J., are fabricated from 40-foot-long repurposed shipping containers. They will be tested first in mid-July for their effectiveness as triage centers in staged patient-care simulations conducted by medical personnel at University Hospital. 

The units can be customized for various medical care needs, such as primary point-of-care applications and testing and treatment of communicable and non-communicable diseases. They can be staged horizontally to create larger clinical field operations sites with effective patient separation and management.

As shipping containers, they can be deployed rapidly and re-deployed regionally, nationally and internationally within the existing commercial intermodal networks across all health care systems.

“This pandemic has challenged emergency healthcare systems and patient management capacity globally. But it has also emphasized the critical importance of distributed health care facilities in resource-constrained environments in both urban and rural areas,” said Atam Dhawan, senior vice provost for research at NJIT. “The mobile medical care units we are designing can be reconfigured and adapted to deliver a variety of medical needs to augment facilities at hospitals and nursing homes. They can also function independently in communities lacking these facilities.”

The partners are contributing their respective expertise in these areas:

NJIT provides architectural design, management and technological know-how. Julio Garcia Figueroa, an architect and university lecturer in the NJIT Hillier College of Architecture and Design, is the principal designer. Officials at NJIT’s Martin Tuchman School of Management are overseeing project management.  

University Hospital, the state’s only public hospital and Northern New Jersey’s only Level-1 trauma center, is the consortium’s academic medical partner. The hospital is responsible, among other aspects, for input and feedback on the units’ internal configurations, clinical use and workflow and regulatory requirements.

The Kingston, N.J.-based Tuchman Foundation, established by Tuchman Group CEO Martin Tuchman, supplies his company’s deep experience in shipping and logistics. The foundation, a nonprofit corporation that supports research on health care, including diseases and cures, provided initial funding to develop the prototype. 

Important new features of the module’s design include its capacity for customizable internal environments within individual sections with specific needs, its expandability and its transportability, the team emphasized.

“The project is researching the design of a module that has the highest utility, not just for the current pandemic, but going forward for underserved communities, both urban and rural,” said Steven Rubin, an adviser to The Tuchman Foundation who has worked in the intermodal and container shipping logistics sectors for three decades and is also a member of the board of advisers of the Martin Tuchman School of Management at NJIT.

He added, “If we’re able to scale up our model – that is, quickly transforming the same containers for use from testing centers to mobile field units capable of housing critically ill patients who have contracted infectious diseases – we will need to develop something highly adaptable and flexible. Some areas may lack ICU beds, others testing and triage centers.”

The prototype is being constructed by Woodbridge, N.J.-based Integrated Industries Corp, a company that provides intermodal services including container and chassis modification, fabrication and storage services. As currently configured, two side-by-side units, with a corridor between them, will each include a registration/triage area, a patient waiting room and two testing and examination rooms.

The group’s phase-1 prototype will focus on simple health care provisioning, including initial COVID-19 point-of-care examination and testing. A potential phase-2 model would address increased healthcare complexity with an airborne infection isolation room required to treat and manage critical patients.

Garcia Figueroa designed the initial units to create a workflow around patients who had potentially been exposed, but displayed no symptoms, by creating enough space throughout them to safely admit, test and examine patients.

“We’ll test the value of the box’s modularity, with the idea of potentially scaling it up vertically or horizontally, to accommodate dozens of beds if needed,” he said.

The prototype’s designers have worked closely with Tomas Gregorio, chief innovation and technology officer at University Hospital, as well as with a team of emergency physicians and nurses. These experts contributed their experience in managing COVID-19 patients at the hospital and in additional tented structures set up on the facility’s grounds to manage patient overflow during the height of the pandemic surge in the New York-New Jersey region.

“Managing the COVID pandemic was challenging because of the clinical needs of these patients and the unique infection control requirements that posed. We had to isolate patients on a greater scale than ever before. At the peak of the surge, almost every patient in the emergency department needed to be distanced from other patients or placed in a negative pressure isolation room,” said Jonathan Green, executive director of University Hospital’s emergency department.

“By rapidly expanding our space with the tents, we were able to take patients who were not very sick out of the hospital, including lower-severity COVID patients, and keep them away from the flow inside the ED,” said Lewis Nelson, chief of service of University Hospital’s emergency department and chair of emergency medicine at Rutgers New Jersey Medical School. “By expanding our capacity to rapidly and safely manage the very ill patients in the main ED, we surely saved lives.”

In light of these experiences, both Green and Nelson said they viewed the mobile units as potentially useful screening rooms to fast-track care for patients needing moderate levels of medical attention. Their ability to withstand extreme weather, such as high winds, and to control the temperature inside them, would also be an advantage, they said.

The clinical team running the simulations – physicians, nurses, technicians and infrastructure support personnel – will assess the efficacy and efficiency of workflows in the module, and the group will consider refinements if needed.

“We will be watching for our ability to similarly expand our capacity and efficiency while improving the overall safety and quality of care we provide patients,” Nelson noted.