Species Conservation Customs officers find Dräger Review 105 parrot eggs in cookie boxes Energy Dräger Review Dräger Where hospitals can save costs

2 02 Tunnel Safety 2/ 2012 105 Technology for Life 2/ 2 0 1 2 Food Chemistry against hunger

Breakthrough What makes tunnels safe

EN_01_Titel105.indd 1 08.06.12 07:59 ORIGINS Alcotest A kgA o. c & g PhotogrAPhy: Drägerwerk A PhotogrAPhy: Do you know… … how the Dräger Alcotest was invented?

After an office party in 1953, Dräger employees came up with the idea of measuring the alcohol content in the air a person exhales. they did some research – and developed the Alcotest tubes. An advanced form of the Alcotest is still used today, all over the world. in this issue we take a look behind the scenes of today’s Alcotest production process: page 46.

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EN_02-03_Anzeige_Inhalt.indd 2 07.06.12 08:11 Contents

Up to is the price of a Jamaica Amazon parrot. But trade in these protected 15,00parrots0 species euro is illegal. Customss authorities are trying to stop animal smuggling. Read more on page 18. mb h g teritz S CK o e Pie ST K er er TT W toff anc o: SH u KS zuP UnIQUe UnIFoRM URGent over over P HoT SaScha Pflaeging PhotograPhy inc. SKW Stic Daniel Daniel

C 18 22 38

4 e XPeRIenCe 22 InFo RMAtIon teCHnoLoGY 42 neon AtoLoGY two People Who Perform: networking: At the Kaweah Delta Volume-oriented Ventilation: it is Dr. gernot rückert, a senior physician, Medical Center in California, doctors visit a milestone in the treatment of premature communicates the fascination of their patients via an iPad. infants. A clinic in Madrid has gathered his work with Playmobil figures; Patrick many years of experience in this area. 28 GRAPHIC Krott, a safety engineer, explains his Anesthesia: How does anesthesia work? 46 I nsIGHt ‘safety alphabet’. An overview of the art of switching off pain. Alcotest: Stringent testing procedures 6 Ke YWoRDs account for a large part of the 30 PoRtABLe GAs DeteCtoRs And What’s More…: Additional information production time, for devices that measure Wastewater: The inhabitants of a city are about the themes of this issue. the alcohol content in exhaled air. connected by sewers, among other things. 8 Fo CUs it’s a network that harbors some dangers. 52 oUtLoo K tunnels: They save time, eliminate stress, energy Costs: Hospitals have 34 H osPItAL and make journeys shorter. Cutting gigantic considerable potential for energy savings. neonatology: Prematurely born babies tunnels through the earth is a difficult Those who use it, can profit. need special attention, because their challenge – not only for engineers. organs are still developing. Family-centered 56 CLose-UP 18 sPe CIes ConseRVAtIon care takes this into consideration. Perseus A500: where modular Animal trafficking: The “chocolate eggs” anesthesia is becoming possible. 38 AGRICUL tURAL MARKet confiscated by vienna customs officers Artificial Fertilizer: Plants cannot grow were actually fertilized parrot eggs – which without nitrogen. A facility in wittenberg, were then incubated and hatched. southwest of Berlin, produces more nitrogen- based fertilizer than any other facility in germany.

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EN_02-03_Anzeige_Inhalt.indd 3 07.06.12 08:11 ExPERiEnCE ArOUND THe wOrlD

People Who Perform

Dr. Gernot Rücker, Senior Physician & Simulation Center Director, Rostock, Germany “i’ve never had a day as busy as yesterday – and i’ve been an emer- taught in schools from the seventh grade on. The school children gency physician for 30 years. A suspected heart attack in a doc- can already practice on our resuscitation dummies. tor’s office, then another emergency call, then another. Three acute But we want to convey the fascination of medicine to younger emergencies in a single office! we had three ambulances standing children too. That’s how the idea for our Playmobil Hospital was in front of our door. That’s not very likely, but it’s always possible. born. we created a model hospital, as an addition to our train- An emergency physician has to be prepared for surprises. ing simulation. it may be the biggest model of its kind ever, a real when you’re treating a patient, ‘learning by doing’ is too risky. e very teaching tool. Over 200 figures in 50 individual scenes show what move has to be absolutely right. That’s the kind of training we do happens in a real hospital. All of the professions are represented here at our Simulation Center. Just three weeks ago i received here – not just the medical ones, but also electricians and gardeners. seven respirators. Now every physician taking the course has his i thought that this was just for children, but i was wrong. we own respirator. Hands-on training is more effective than abstract soon realized how useful the Playmobil hospital was, as a teaching explanations. Thousands of doctors come to the training courses tool, for every age group. even experienced professors use it in at our clinic. And thanks to our research, Mecklenburg-vorpom- their courses. And it keeps on growing. right now we’re creating mern is the first german state in which, resuscitation measures are rescue scenarios on land, in the water, and from the air.” : : Silke U MBACH T weBer; Tex ; ; A NJA CHACHT : : Ulrike S HOTOS P

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EN_04-05_Menschen.indd 4 07.06.12 08:13 Patrick Krott, Self-Employed Safety Engineer, Bremen, Germany “It all began when I joined the volunteer firefighters in Aachen. 50°C, you also learn to include cultural considerations into As a teenager, I learned to look danger in the eye. Later on your assessment of occupational safety. my uncle, a Fire Department trainer and team leader, sug- In our industry, we have extremely high standards. My gested I become a safety engineer. I was all for it! After re- ‘safety alphabet’ is HSSQE. The H stands for the most im- ceiving my engineering degree, I found fascinating work in portant criterion, the ‘Health’ of the people you’re working the oil and gas industry. When I started my own business in with and for. ‘Security’ and ‘Safety’ are just as important: they 2008, I knew I had a valuable service to offer: managing risks. stand for workplace safety at all times, and security from polit- Fires and explosions are only the most obvious ones; my ical risks and attacks. ‘Quality’ stands for compliance with the job is much more complex. Whether I’m working on the North highest standards for equipment and processes, and ‘Envi- Stream pipeline or in oilfields in North Africa, I have to have ronment’ reflects our concern for environmental conservation. an overview of the whole situation, including the technical Before I became self-employed I worked for a major company and political risks, as well as the weak spots. And I have to in the oil industry in various places, including Libya, where I focus on the human factor as well. Hard work in the desert, helped to set up basic emergency plans for my coworkers. for example, is a big challenge. When Ramadan starts and I felt tremendous relief when everyone was flown out, exactly your coworkers stop drinking anything in temperatures above as planned, at the start of the armed struggle!”

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EN_04-05_Menschen.indd 5 07.06.12 08:13 Keywords

wHAT IT’s ALL ABoUT N e T worKs Key words Communication Maps each keyword you’ll find on these two whether it’s the silk road or the railroad: these pages reveals a new aspect of an article roads not only go from A to B - but are apart of and shows it from a new perspective. networks that deliver a much greater benefit. This is because every topic has multiple Today the internet, with its unlimited number of facets. The explanations and defini- connections, produces something completely tions of the keywords come from lexicons, new every day. its clients, servers, and fiber optics dictionaries, and specialized encyclope- are the maps we use for our modern journeys dias – and they include some detours into of exploration. Just like every network in history, other subject areas. As a result, the internet is accelerating the development readers may see some things in a different light. of society and helping us to further increase our productivity. when a hospital is networked, the resulting benefits are similar. Page 22. G rowING Fer ti li zer The synthesis of ammonia developed by d IVersITy Fritz Haber and Carl Bosch has helped humanity to avoid catastrophic food short- e n dan gered ages. This development has made it “variatio delectat” is a Latin expression that can be translated as “variety is pos sible to produce artificial fertilizer, there- delightful.” However, variety is also necessary – for plants and animals alike. by eliminating the need to spread human Monocultures cause atrophy, and inbreeding leads to stagnation - at risk are and animal waste on fields to increase crop also languages. By the year 2100, half of the roughly 6,500 languages that yields. But there is a dark side to this are still living today will be in danger of disappearing, says the British linguist achievement, which is still honored by the David Crystal. Language is a way of interpreting the world – a sort of philoso- Nobel Prize. Ammonia is also used in phical building that collapses when its last native speaker dies. But you can’t sell the manufacturing of explosives, where a language. That’s not the case for endangered animals, which is why it replaces saltpeter, which germany animal smuggling is booming. Page 18. had previously been required to import. Haber’s later development of poisonous gases is a story for another day, because this is about agriculture. Page 38.

M o UNTAIN CLIMBers Making Underground s hortcuts it was something no one could imagine in 218 B.C. with tens of thousands of soldiers and 37 war elephants, Hannibal crossed the snow-covered Alps in less ANesTHesIA than 16 days. According to history only one elephant, named Suru, survived work place the journey. But this is the stuff of which The functional features of workshops were made practical thanks to Frederick legends are made. Today, tunnel Taylor, who in 1881 examinded workflow with scientific methods. The culmination tech nology conquers mountains, of his work was the assembly line, which Margarete Schütte-Lihotzky even time, and space every day. applied to the kitchen in 1926. The Perseus A 500 anesthesia workstation Page 8. also follows scientific methods. Page 56.

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EN_06-07_Stichwörter.indd 6 07.06.12 08:15 Showing i l lus tra tion when william Playfair published his commercial and Political atlas in london in 1786, it contained history’s first clearly laid out illustration of information – the bar chart, which can be understood at a glance. he also invented the pie chart to illustrate proportional distribution, and thereby became the founder of info- graphics. today infographics help to clarify complex procedures, such as anesthesia. Page 28.

hYgiEnE waste wa ter in the middle ages people simply emptied their chamber pots into the street, making it much easier for diseases to spread. the art of construct- ing waste water removal systems had been lost. it wasn’t rediscovered until E nERgY modern times: a boon for the nose E f fi cien cy as well as for public health! But today’s sewer systems must be maintained. is it only convenience that motivates a person to leave a route that has already Page 30. been mapped out and search for a shortcut? another way of looking at it would be to realize that people simply want to be efficient. Prof. Dirk helbing, who works at the eth in Zürich, has discovered that people will always choose to take a new path if it shortens their trip by 20 to 30 percent. or at least they will do this if they are able to calculate the costs involved. that’s not so easy when the

hoto (2) hoto issue is fossil fuels. and it isn’t just the cost in euros and cents that must be P taken into account – there are environment costs as well. one of these costs is reckoned in terms of greenhouse gases and their crucial effects on climate ien; ien; istock

w change and its global consequences. more efficient approaches, such as the use en F of renewable energy, can help to alleviate this problem – even in hospitals. Page 52.

ALCohoL D i s in hi bi to ry C onTACT the first swallow of beer already reduces inhibitions. continuing to drink leads homas Bethge; Zollamt Flugha t K a n ga roo ing to slowed reaction time and blurred vision. after 30 to 40 days kangaroos give birth especially when driving, people become eystone; eystone; k to a thumb-sized embryo that further a danger to themselves – and to others. develops in the mother’s pouch for up to limits on allowable blood alcohol levels 235 days. Premature babies or “neo- for drivers are meant to protect everyone. nates” experience something similar. The These levels are measured using hy: hy: Jochen Zick/ kangaroo method is the best way breathalyzers, which register to help preemies through their breath alcohol content with sober

P Photogra difficult first days of life. Page 34. precision. Page 46.

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EN_06-07_Stichwörter.indd 7 07.06.12 08:15 Hong Kong, China: Rush hour traffic flows quickly through the Cross- Harbour Tunnel. It’s one of the world’s most traveled highways and connects Kowloon with Hong Kong Island (in the background)

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EN_08-17_Tunnel.indd 8 07.06.12 08:20 Tunnel Focus

Arteries underground Tunnel construction sites are extreme places that require complex solutions to make them safe. even the later operation, of the underground facilities for transport and infrastructure, makes high demands.

eep beneath the city center in transportaion tunnels.” But the new long- London, UK, gigantic machines distance roads and rail tunnels need larger Dare working their way through and greater dimensions. clay and chalk. In spring 2012 the first of As a result, not only the number of tun- eight tunnel boring machines, from the nels, but also their lengths are growing. German manufacturer Herrenknecht, One example of this is the 55-kilometer- began to drill more than 40 kilometers long Brenner Base Tunnel, whose con- of rail tunnels under the British capital. struction is soon to begin. The Brenner These tunnels are at the heart of the Cross- Pass currently the most important and rail Project, which will channel long-dis- busiest north-south connection in the Alps. tance rail transport under London in the Around two million trucks and 12 million future. The massive project is currently cars drive through this bottleneck every the biggest construction site in Europe. year. The planned base tunnel, which will be solely for rail use, will run underground Rapid Growth between Innsbruck and Franzensfeste, and Many new tunnels are being built in should greatly reduce traffic congestion. similar mammoth projects all over the Building on exploratory galleries began in world, because the future of transporta- 2007, and construction of the main tun- tion infrastructure lies underground. Af- nel will begin in 2013. The project, which ter all, high-speed rail lines and highways will cost about eight billion euros, and is need tunnels; and high-performance tran- expected to be completed in 2022. sit systems in congested cities need un- derground tubes, so that they can go on Rescue concepts Required growing. Besides tunnels for passenger Also the diameters are larger: Opened in transport, networks must also be built 2009, the Changjiang Under River Tun- for data and energy transmission, water nel in Shanghai is divided into two tubes, pipes, and sewer systems. each with more than 15 meters in diam- Tunnels are the arteries of cities, eter. This provides enough space for a creating increasingly dense networks of three-lane highway plus a subway line un- structures beneath the earth’s surface. derneath. As tunnel projects become more Hundreds of kilometers of tunnels are cur- ambitious, safety requirements increase rently being built or planned worldwide. as well – not only during construction, but “The priorities are especially in Europe also during later operation. The fact that and Asia, “ says the construction engineer safety at tunnel construction sites has to Roland Leucker, Managing Director of the be further improved was emphasized by nonprofit Research Association for Under- In-Mo Lee, President of the International ground Transportation Facilities (STUVA) Tunneling and Underground Space Asso- hy: hy: Corbis in Cologne, Germany. “For everyone in the ciation (ITA), at the World Tunnel Con- ogra P

T megacities, with their several Million in- gress 2011 in Helsinki. “It’s essential for

P h o habitants, there is a huge need for public us to develop technologies that will en- >

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EN_08-17_Tunnel.indd 9 07.06.12 08:20 Focus Tunnel

Mining and tunnel construction largely use the same technologies and tools

structure. Perhaps that’s why the mining M

eu industry has often been a major source of inspiration for tunnel construction tech- nology. The similarities, between these /Science /Science Mu S

l two types of excavation, have been a con- sistent feature ever since the first tunnels o / SSP T were built for irrigation purposes over 3,000 years ago. “For a long time, the ung Pho T methods and equipment used in excava- tions were largely the same as those asso- che che Zei

TS ciated with tunnel construction and min- ing,” says Dirk Bühler, Ph.D. Engineer and

hy: hy: SüDDeu Tunnel Expert at the Deutsches Museum in Munich.“However, in terms of transpor- ogra P T tation, tunnel construction differed from P h o mining with regard to slopes, cross-sec- commissioned in 1908: The 1481-meter-long Rother hithe Tunnel runs under the Thames River tions, and surface features.” Werner Ochse, a tunnel expert at Dräger, adds, “There are also technical > able us to protect and rescue people even similarities between mining and tunnel- more effectively after accidents, especially ing when it comes to safety technology.” in the case of fire,” he said in an interview The Lübeck-based company’s long experi- with the trade magazine tunnels et espace ence with mine rescue operations is the souterrain. This applies especially to very foundation on which the firm’s current long tunnels, whose numbers are steadily range of safety equipment, for tunnel con- increasing. struction, is based. An impression of how tunnel workers conditions like those in a mine were protected in past centuries is pre- The safety concept for the construction sented by a replica of the Simplon Tunnel and operation of tunnels is complex, as is construction site, which can be viewed in demonstrated by the large number of rele- the Deutsches Museum’s permanent exhi- vant ordinances and regulations. Because bition. The first tube of this almost 20-kilo- of the unusual conditions at the construc- meter-long tunnel connecting Switzerland tion sites and in completed tunnels, many and Italy was built between 1898 and 1912. issues need to be addressed. They include The solid wood support structure leaves occupational safety, accident prevention, enough room for a mine railway in the fire protection, and safe escape routes. lower half of the tunnel profile. Above it, The similarities to mining operations numerous roughly cut tree trunks create are especially apparent during a tunnel’s a claustrophobic tangle of closely spaced excavation and the building of its support pillars. If you add poor lighting and heat,

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EN_08-17_Tunnel.indd 10 07.06.12 08:21 Rescue cham- bers offer hours, or even days, of self-contained underground protection – from toxic gases

you can get an impression of the conditions under which the workers built the world’s first major traffic tunnel. Ongoing Construction Site Risks Conditions have changed considerably since then, thanks to electrical lighting, high-performance ventilation systems, and, above all, ultramodern tunnel exca- vation equipment. Tunnel construction was significantly transformed by large tunnel boring machines, which resemble underground factories consisting of ev- erything from the tunneling shield to the tubing installation system. “In Germany, shield tunneling is used primarily to con- struct railway tunnels,” says Leucker. Road tunnels, on the other hand, are still often made using mining processes, due to the need to have flexible profiles. Open- pit construction also continues to play a major role; this technique is used for around 20 percent of the tunnel stretches built in Germany today. The basic risks of tunnel construction

(2) have remained unchanged. The tunnel-

gaa ing route has to be protected primarily o. K c against geological factors such as water &

ag penetration and rock pressure. In addi- tion, workers have to be protected against the effects of blasting, tunnel boring, traf- Breakthrough: fic, and the building of the support struc- On March 23, 2011, the tunnel boring machine tures, as well as possible fires and their “Heidi” created the consequences. There are also specific chweiz/laif; DrägerwerK

final section of the s risks associated with a hard-to-reach un- west tube of the Got- thard Base Tunnel, derground sites that depend on external which is scheduled to energy supplies and ventilation.

be inaugurated in 2016 hy: Keystone In the early days of modern tunnel construction, working under high pres-

P Photogra sure was especially dangerous, because >

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EN_08-17_Tunnel.indd 11 07.06.12 10:47 The German automobile club classifies the safety concept of the Richard Strauss Tunnel in Munich as “very good”

> insufficient decompression could cause world. The eight Herrenknecht tunnel ers to work in typical scenarios involving the workers to suffer from Caisson Dis- boring machines being used in the Cross- long assignment times. ease, which is similar to the bends. A rail project in London are equipped with milestone in the prevention of this dis- rescue chambers from Dräger. “This tech- Multistage Safety Concepts ease was achieved by a physician couple nology has great potential, considering Preventive fire protection is necessary during construction of the St. Pauli Elbe how many tunnels are being constructed during a tunnel’s construction as well as Tunnel in Hamburg, Germany. “For the worldwide using shield tunneling,” says its operation. However, the measures used first time ever, from 1909 to 1910 Arthur Werner Ochse from Dräger. for ensuring tunnel safety are different and Olga Adele Bornstein monitored the According to Dräger Sales Engineer during operation than during the tunnel’s workers on a caisson or compressed air Peter Medek, the organizers of a new tun- excavation and the building of its support construction site. The couple systemati- nel construction project, or the upgrade structure. That’s because a tunnel is uti- cally combated the disease, using meth- of an existing system, should develop a lized by a great amount of people once it ods that they enhanced themselves,” ex- consistent safety concept from the very has been opened. These users have to be plains Dr. Jürgen Bönig from the Museum beginning, on the basis of a specific haz- directed to safe areas if there is an acci- of Work in Hamburg. ard assessment. Medek understands these dent or a fire. The differences between processes in detail, because Dräger has the various modes of transportation are Working Under Pressure developed into a supplier of holistic safety much more apparent during a tunnel’s Nowadays, slurry-supported shield tun- systems for tunnel construction built on operation than when it is being built. The neling technology has reduced the im- the foundation of its extensive portfolio of conditions in a pedestrian tunnel, for ex- portance of manual tunnel construction around 60 products and many services. ample, are very different from those found under high pressure, and the cutters in “We are already engaged in the early in a road tunnel or a railway tunnel. the cutting wheels of today’s tunnel bor- stages of new construction and or ren- The world’s longest tunnels are used ing machines can even be replaced at nor- ovation projects so that we can provide for railway, and a variety of safety con-

mal atmospheric pressure. This technol- all of the necessary services,” explains cepts have been established for them. aas h ogy had its debut in the cutting wheel of Medek. The tasks involved include pro- Deutsche Bahn AG, for example, has de- obert

Herrenknecht’s tunnel boring machine viding consultation during the develop- veloped a multistage safety concept for its r

“Trude,” which was used to create the ment of the safety concept, training work- tunnels. “The first stage consists of pre- ase, h fourth tube of Hamburg’s new Elbe tun- ers and rescue crews, supplying rescue ventative measures, followed by event-al- obias nel. However, tunneling work is still done chambers and personal protective equip- leviating actions,” explains Klaus-Jürgen t using pressurized air in many places ment, in addition to offering a flexible Bieger, Head of Safety and Chief Fire Pro- lliance/ around the world. rental management system for a broad tection Officer of Deutsche Bahn AG. In a Especially in recent years, one of the range of safety technologies. The services the next stage, the victims either man- technical solutions used to improve safety include making sure that the respiratory age to flee from the accident site or are

at tunnel construction sites worldwide is protection systems are always in working externally rescued. In order to prevent P; Picture- DPa the rescue chamber. These containers order for the fire departments that are re- accidents and fires, trains with passen- are pressure-sealed and gastight. They sponsible for the various tunnels. To en- gers and freight are not allowed to pass

are equipped with an oxygen and energy sure respiratory protection, Dräger sup- in long tunnels with high-speed rail lines. a DDP images/ supply system that is independent of the plies closed-circuit breathing apparatuses In addition, passenger rail cars have to hy: surrounding environment, and allow oc- (e.g. Dräger PSS BG 4 plus) that can op- comply with the Federal Railway Authori-

cupants to communicate with the outside erate for up to four hours, enabling wear- ty’s fire protection regulations in order to > P Photogra

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EN_08-17_Tunnel.indd 12 07.06.12 08:21 Tunnel Focus

Rescue chambers increase the level of safety

Following an acci- dent in March 2012, rescue helicopters landed in front of the portal of the sierre Tunnel in switzerland

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EN_08-17_Tunnel.indd 13 07.06.12 08:21 Focus Tunnel

Mulitlevel: Preventive measures are followed by measures to save oneself and others

> be approved for registration in Germany. These regulations are based on the DIN 5510 standard, supplemented by the cur- rent version, of the as yet unpublished, DIN CEN/ TS 45545-1 standard. If a fire should nonetheless break out on a train, measures such as an emergency braking override system will ensure that the train doesn’t stop until it has left the tunnel. If all of these precautionary mea- sures fail to prevent a critical incident from occurring in a tunnel, the passen- gers will either flee to safety or be res- cued by firefighters. The rescue concept is supplemented by structural measures such as specially protected escape routes and lighting systems, escape route signs, emergency exits, and emergency tele- phones. In new tunnels such measures are augmented by additional features, such as built-in fire extinguishing pipe- lines including the reservoir, power sup- ply systems, and wireless infrastructure. Fast Rescue Trains While the approaches to tunnel portals and rescue missions are designed to ac- commodate road vehicles, road-rail vehi- cles, and rescue trains, representing spe- cial types of rescue technologies. Germany has six rescue trains, which are stationed along the high-speed rail lines between Hanover and Würzburg and between Mannheim and Stuttgart. Schweizerische Bundesbahnen (SBB) in Switzerland op- erates a total of 15 firefighting and res- cue trains. In 2006 SBB ordered eight new trains that were built by a consor- tium in which Dräger was responsible for the safety technology. These trains, which

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EN_08-17_Tunnel.indd 14 07.06.12 08:21 Safety in the Eurotunnel: Testing a high-pressure fire-extinguishing system (left). On the right: the connecting door to one of the cross-cuts that connect the two main tun- nels with the technologies that lies between them

can travel up to 100 km/h, consist of a res- ing truck releases a huge amount of toxic cue car and and a self-propelled fire en- substances.” gine carrying a tank pumber in between. In a research project commissioned The emergency room can evacuate up to by the Federal Highway Research Insti- 60 individuals. tute, occupational safety experts tested “Evacuating people from road tun- various measures for quickly and reliably nels during a fire is a major challenge, be- guiding people from their vehicles to cause most people instinctively think that the emergency exits. They tested psycho- their car is the safest place in the tunnel,” acoustic means as well as innovative sig- says the psychologist Professor Berthold naling technology. As an acting sublimi- Färber, who heads the Human Factors In- nal alarm signal, according to Prof. Fär- stitute at the Universität der Bundeswehr ber, a low frequency sound proved to be in Munich. “In subjective terms, a vehi- effective, while birdsong unterlaid with cle is a protective space. However, if fire “white noise”, pointed people to the breaks out in a tunnel people only have a emergency exit. The way to the exits were few minutes to escape,” he says. “A burn- marked by the researchers with running >

Combating tunnel fires with water mist From 2009 to 2012, the “safety of life in tunnels 2” (solit2) project investigated technical systems for fire protection in tunnels. as part of the project, which was financially supported by the german Federal Ministry of economics and technology, e Masson l more than 30 simulations of major fires were carried out in summer 2011 in order to test the effectiveness of water mist fire fighting systems in connection with fire ventila- tion in highway tunnels. these simulations were carried out in the “tunnel safety testing” test tunnel in san Pedro de anes, spain. in the process, liquid fires and solid

areth Fuller, Pierre material fires with fire loads of up to 100 megawatts were simulated. e/ g

C at the stuva conference in Berlin in 2011, Dr. roland leucker (Managing Director of stuva) and stefan Kratzmeir (Managing Director of iFaB – i nstitute for applied llian a Fire safety research) concluded that the project had been successful. they said that ture- C the use of water mist systems can favorably affect the development of liquid fires Simulation: FogTec a Pi and solid material fires in a tunnel, as the finely distributed drops of water cool off the tests extinguish- ing methods using C; DP burning material and, its surroundings , and also alleviates the level of smoke. water mist under ogte additionally, the use of water mist reduces the danger of fire flashing over onto other realistic conditions hy: F vehicles. “in general, it’s important to activate the system as early as possible so that the positive effect of the cooling occurs sooner,” wrote the two experts in a joint

P Photogra article in the trade magazine tunnel (issue 8/2011).

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EN_08-17_Tunnel.indd 15 07.06.12 08:21 A low-frequency sound has proved to be effective as a subliminally alarm signal

> lights, the escape door had a pulsating la- employed at the Stachus underground Tunnel system ser marking the exit across the tunnel. complex. The seal was granted after a ren- Bodio ovation of the complex, which is one of Eu- portal 12,000 New Sprinkler Heads rope’s largest underground structures and Combined station Emergency Technical aspects of fire protection play includes about eight kilometers of under- station Sedrun Shaft I an important role in tunnel safety, begin- ground escape routes. As part of the reno- Shaft II ning with pedestrian tunnels and large vation, the fire protection system was up- Combined station underground constructions that are used graded and 12,000 new sprinkler heads Erstfeld Emergency by many passers-by. For example, in Feb- were installed. portal station Cable tunnel ruary 2012 Munich’s municipal utility Another type of fire protection tech-

Access company was awarded the distinguished nology was chosen by the operators of the tunnel “Sprinkler Protected” seal of quality, from Dartford Tunnel and the Tyne Tunnels in Exhaust air Emergency the Federal Association for Fire Protection the UK, which are part of the M25 and M9 station Technology, for the fire protection system highways. The Tyne Tunnels have been in

3,000

Geology as a challenge: When the Gotthard Base Tunnel was being excavated, a whole 2,000 range of rock had to be drilled through. This posed big challenges for the tunnel constructors. Among other things, Final breakthrough they had to combine Sedrun on March 23, 2011 mechanical excavation and blasting technology

1,000

Combined station Sedrun East tube 13.7 km North portal Erstfeld Amsteg access 8.7 km tunnel West tube 0 11.3 km

7.7 km

16 DRÄGER REVIEW 105 | 2 / 2012

EN_08-17_Tunnel.indd 16 07.06.12 08:22 TUNNEL FOCUS PHOTOGRAPHY: CROSSRAILPHOTOGRAPHY: LTD A view of the Crossrail tunnel construction site in London. It is part of a 21-kilometer-long network that will connect 37 stations

operation since November 2010, and the An overview of tunnel construction Dartford Tunnel tubes will be equipped Shield Tunneling: A tunnel boring machine mills off the surface soil with high-pressure fire extinguishing tech- with a rotating cutting wheel. The tip of the machine is surrounded by a nology from Fogtec, a German firm. “The cylindrical shield. Depending on the site’s geology, the tunnel face is extinguishing water is atomized by means supported by a slurry under pressure or by the excavated material itself. of special nozzles, so that a comparatively In solid rock, the excavated material can be simply crushed and taken low amount of water with extremely high away. As soon as the tunnel has been excavated, the tube is firmly secured surface area combats the fire,” says Dirk and its inner surface is lined. Laibach, Technical Manager at Fogtec. Mine Tunneling: In this traditional mining procedure, holes are drilled into the existing rock so that it can be blasted apart in a targeted manner. Sophisticated Fighting Technology Subsequently the miners drill tunnels through the rock with hydraulic The company has installed the same tech- excavators. The modern version of this traditional mining technique is called nology in the Eurotunnel, which lies un- the “New Austrian Tunneling Method.” der the English Channel between England Cut-and-Cover: This type of construction is often used to build tunnels and France. Here there are four “safe sta- that lie close to the surface and for large underground constructions tions,” into which the truck-carrying shut- such as subway stations. An open excavation pit is dug, the tunnel is tle trains are automatically guided to if a constructed, and finally the site is covered with a ceiling. In a variant fire is detected on board. Once the site of process, only the walls and ceiling are built and the excavation of the the fire has been identified by the redun- tunnel is carried out underground. dantly installed measuring technology, the Caisson Construction: Tunnels under rivers or estuaries can be fire extinguishing technology, around the constructed by connecting a series of caissons underwater. This was the site, is released with a valve pressure of up procedure used for the first three tubes of the new Elbe Tunnel in Hamburg. to 100 bar. The water mist that is released cools the surface of the burning object im- mediately and simultaneously reduces the influx of oxygen. Roland Leucker, the Managing Direc- tor of STUVA, also mentions building fire protection measures based on, for exam- ple, the construction of the inner shells

Faido access of tunnels with a type of concrete that has tunnel South portal been mixed with polypropylene fibers. In Bodio case of fire, this prevents the concrete 15.6 km overlay from extensively spalling off from the steel reinforcements. This type of con- crete has already been used in the Cross- rail Tunnels in London. Peter Thomas

For information on Dräger products:

ILLUSTRATION: DIETERILLUSTRATION: DUNEKA; SOURCE: ALPTRANSIT GOTTHARD AG, ETH ZÜRICH, WIKIPEDIA www.draeger.com/105/tunnel

DRÄGER REVIEW 105 | 2 / 2012 17

EN_08-17_Tunnel.indd 17 07.06.12 08:22 Of Parrots and Fake Easter Eggs When it comes to animal smugglers, some countries have a very keen sense of smell. Vienna Airport, for example, uses sniffer dogs to thwart the trade in endangered species. Last year, customs officers there seized a haul of 74 PARROT EGGS. Improvisation helped to hatch and ensure the survival of most of the chicks – with lots of assistance from Vienna’s Schönbrunn Zoo and an incubator from Dräger.

t was a cunning plan, but it was no it’s the third most lucrative line of busi- knowingly or unknowingly, traffickers in match for the Austrian customs offi- ness worldwide, and it jeopardizes the rare plants and animals. Such behavior Icers. In April of last year, two EU cit- survival of many endangered species in can have unpleasant consequences when izens attempted to import 74 fertilized their natural habitat,” explains WWF ex- tourists return home from their vaca- parrot eggs from Jamaica by stashing pert Birgit Braun. tion. The 54 Jamaican parrots hatched them inside empty cookie boxes and a from the 74 eggs seized at Vienna Airport coconut. Yet there was something about Big Profits, Small Sanctions would have had a black-market value of the packaging, the contents, and, above This illegal trade in endangered species up to 15,000 euros per bird. The alleged all, the passengers that made the cus- is organized crime, involving huge sums ringleader, a major dealer in exotic par- toms officers smell a rat. “If you want to of money. Interpol estimates a volume rots, now faces a fine. A search of the be successful in this business,” explains of 10 to 20 billion dollars a year. And the premises, in a neighboring country, un- Robert Geschina, a team leader with profit margins are high: Certain kinds earthed forged papers for the birds, that the Customs Authority at Vienna Inter- of turtles can fetch 30,000 euros and would have been hatched in Vienna from national Airport, “you’ve got to have a chimpanzees up to 60,000 euros. As a the smuggled eggs. Austria’s maximum good nose and lots of experience.” The X- rule, the rarer the species – the higher penalty for animal trafficking is 35,000 ray scan revealed a large number of what the demand – the higher the price. Aside euros – a trifling amount compared to looked like chocolate eggs. “We thought, from the professional smugglers, tour- the potential profits. ‘That can’t be right!’ After all, you buy ists can also jeopardize protected species Easter eggs here in Europe, not in the by bringing back seeds and buying cer- Caribbean!” tain types of souvenirs or medicine, par- ticularly in Asia, and thereby becoming, Live Contraband Geschina is no stranger to the tricks of this illegal trade. To satisfy a grow- ing demand for exotic species, animal smugglers have become infinitely cre- Endangered Beauty: ative in thinking up new places of con- The International Union cealment: snakes in DVD cases, baby for Conser vation of Nature (IUCN) lists the turtles in toiletries bags, black bears in Yellow-Billed Amazon shipping containers. Today the smug- Parrot as one of 682 bird gling of live contraband is almost as species under threat common as the illegal trade in narcot- ics. “Sadly, the operators are also be- coming more and more sophisticated,” warns Geschina. The World Wide Fund for Nature (WWF) estimates that inter- national trafficking in protected species of plants and animals is now one of the largest illegal branches of trade in terms

PHOTOGRAPHY: DANIEL ZUPANC DANIEL ZUPANC PHOTOGRAPHY: of revenue. “After weapons and drugs,

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EN_18-21_Papageien.indd 18 07.06.12 08:26 ANIMAL TRAFFICKING SPECIES CONSERVATION

Polly or Pete? Neither the parrot’s sex nor its species can be deter- mined until it has grown feathers

For the Austrian authorities, the discov- were from a parrot of some kind, but you ing a modified Dräger incubator – an ery and seizure of the parrot eggs was can never be 100 percent certain,” she item of medical equipment that is more only the beginning. After the customs of- explains. As to the immediate plan of ac- frequently found in hospital maternity ficers had done their job, they handed tion, however, there was never any doubt: units. Its normal job is to provide a con- over the precious finds to Vienna’s Tier- hatch the eggs, raise the chicks, conserve trolled temperature, constant humid- garten Schönbrunn, the world’s oldest nature. She put together a team of ex- ity, a precisely measured flow of oxygen, zoo. Then it was time to move fast. “In perienced zoo personnel, adapted prem- and to protect newborns against infec- a situation like this, you have to impro- ises, found brooders to hatch the chicks, tions. “But parrots are very sensitive vise,” explains, the 33-year-old biologist, and procured feed. But before that, the creatures too,” explains Petra Stefan, a Simone Haderthauer, a department head eggs – which ranged in age from several zookeeper at Tiergarten Schönbrunn. at the zoo. Starting in January 2011, she days to three weeks – had to be unpacked, She has been working in the zoo’s aviary has managed some of the zoo’s stock weighed, measured, photographed, and for the past 18 years. The Dräger incuba- of animals, coordinated exchange pro- then placed in a brooder to hatch. tor was initially set at 35 °Celsius with grams, and been in regular contact with 60 to 65 percent humidity. “The more other zoologists and veterinarians. “The “Parrots are very sensitive!” feathers the young parrots put on, the eggs were between 3.2 and 3.5 centime- Once hatched, the chicks were immedi- more we had to adjust the temperature ters in size, so we were fairly sure they ately transferred to incubators, includ- and humidity,” she explains. And to pro- tect the birds against disease, the incu- bators were cleaned and disinfected on a daily basis. By the end of two weeks, however, it had become too hot for the >

19

EN_18-21_Papageien.indd 19 07.06.12 08:26 SpecieS conServation AnimAl TrAfficking

By the time the last parrot had been fed, the first one was hungry again

> young birds, which were then ready to leave the warmth and security of the nest. A total of ten zookeepers were kept busy. At first the birds were fed around the clock, every two hours. “By the time the last parrot had been fed, the first one was getting hungry again,” Stefan recalls. Working in six-hour shifts, the team kept a precise log of the weight, feed intake, and general condition of each bird. All in all, these records now add up to over 1,500 pages. Forty-Five Birds Survive The first parrot – Toni – hatched after two days, followed by an additional 53 over the next three weeks. All in all, 45 birds survived – a quota that not even Stefan had considered. “I thought that because of the adverse conditions dur- in the nest: parrot chicks weighing 10 grams growing in a Dräger incubator ing transport only between 10 and 20 percent would hatch,” she says. Nei- ther the species nor the sex can be de- termined while the chicks are newly hatched and still naked. But after few weeks, when the birds had put on plum- age, it was confirmed that they were members of two different species of Amazon parrots native to Jamaica. At the same time, the zoo sent feather sam- ples to two institutes to determine the sex of the fledglings. As it turned out, there were 22 black-billed and 23 yellow- billed Amazon parrots. Genetic variety is important for the purposes of further breeding, so the zoo also had the lineage checked out. “We wanted to know how many of the birds, if at all, were from the same nest,” Haderthauer explains. Foster parents: the biologist Simone Haderthauer (left) and the zookeeper So how many animals are required to petra Stefan had to improvise when the parrot eggs arrived

20 Dräger review 105 | 2 / 2012

EN_18-21_Papageien.indd 20 07.06.12 08:26 A keen nose for contraband: Lord, a German shorthaired pointer, and modern technology help to catch smugglers. Robert Geschina (left) and his fellow customs officers at Vienna Airport seized 74 parrot eggs. On X-ray images, they appeared to the world like the filling of Easter eggs

ensure species survival? “The larger home. In fact, he even joins her on va- will snuffle more than 100 times be- the basic stock, the better the chances. cation. “I applied specifically to become fore breathing out. What’s more amaz- Over a period of 100 years, you should be a dog handler,” she says. ing, they are able to detect minuscule aiming for a genetic variation of 90 per- In principle, any breed can become amounts of smuggled goods and can cent,” she answers. The Amazon parrots a detection dog for work in the field of check several hundred pieces of lug- in Vienna, together with members of the species conservation. During training, gage a day. Like narcotics, explosives, and same species living in other zoos, may the dogs are given a reward – a tidbit or large amounts of cash, all animals and suffice for this purpose, she believes. a favorite toy – whenever they detect con- animal products have a distinctive odor Rearing the chicks was a delicate traband. As a team, both the dog and the that special sniffer dogs are trained to de- business, demanding a mixture of handler have precise roles. The handler tect. The Tiergarten Schönbrunn helps knowledge, experience, and intuition. is responsible for leading the dog and out with the dog training by providing, When the black-billed Amazon parrot has to know, by its behavior, whether it for example, reptiles and samples of their Toni was fed for the first time with liq- has finished searching the bags or has feces. It costs tens of thousands of euros uid feed from a syringe, he weighed a picked up a scent. While at work, Lord to train a dog for work in species conser- mere 9.3 grams. Added to the feed was relies totally upon his nose. “A good vation. Is this kind of outlay worth it? “If A (3)

kgA specific intestinal bacteria to replace sniffer dog is both fast and reliable,” you make a find like the parrot eggs, it the microflora that are normally passed Eitel confirms. certainly is,” says Eitel. Björn Wölke & Co. Co. & g on via the saliva of the parent birds in Behind such speed and accuracy order to protect the chicks against infec- are some amazing facts. When sniffing For information on Dräger incubators: tious diseases. One and a half months for contraband, for example, the dogs www.draeger.com/105/neonates later, Toni had increased his weight by (1); Drägerwerk A T a factor of 13 and was downing 13 mil- or P liliters of liquid feed each mealtime. To- l Air A day his diet consists mainly of sprouts, ion

AT fruit, and vegetables. Black-billed and

ern yellow-billed Amazon parrots almost al- The Washington Convention (CITES) ways leave the nest after 55 days – just as The Convention on international Trade in endangered Species of wild Fauna and

iennA inT though they had an internal calendar. Flora (CiTeS), which was signed in 1973 and entered into force in 1975, is one of the v AT

y The birds then live in flocks until they world’s oldest conservation and environmental treaties. it regulates the trade in T find mates, to whom they generally re- endangered wild animal and plant species, and currently has 175 member countries hori T

Au main faithful. as signatories. Their representatives meet every two years or so. The issues up

om S for discussion include determining which species have become so endangered as to Sniffing Out Endangered Species warrant their inclusion on the list covered by the Convention. At present, the list

(1), Cu ST For over a year, the 29-year-old customs includes over 5,000 species of animals and around 28,000 species of plants. nC officer, Regina Eitel, and her dog, Lord, CiTeS consists of the text of the Convention and three appendices. Appendix i lists have also been pretty inseparable. Her species that are threatened with extinction; commercial trade in these species, e.g. niel Zu PA A four-legged friend is currently being sea turtles and certain parrot species, is prohibited. Appendix ii lists the threatened plant hy: D trained to help detect animal traffick- and animal species for which an export permit is required, such as ape, bear, and

ogrAP orchid species that are not already protected by Appendix i. Appendix iii lists species T ers at Vienna Airport. After work, Eitel

P h o takes the German shorthaired pointer that are protected by trade restrictions only in certain countries. www.cites.org

Dräger review 105 | 2 / 2012 21

EN_18-21_Papageien.indd 21 07.06.12 08:26 InformatIon technology NetworkiNg

emergency Physician hipskind has all the patient data in hand via the wireless network 22and his tablet Pc Dräger review 105 | 2 / 2012

EN_22-27_IT im Krankenhaus.indd 22 07.06.12 08:38 NetworkiNg InformatIon technology

for more than 40 years the Kaweah Delta medical center in california has serviced the region with excellence: today, there are about 450 open-heart surgeries performed yearly m aking the rounds with an iPad Kaweah Delta meDIcal center in california, USa, is considered to be one of the most advanced hospitals when it comes to connecting portable computers to modern medical technology through wireless networks. this example demonstrates how tablet computers can accelerate and improve medical treatment.

t first glance, the Emergency igian built the cart himself and chris- ably one of the most modern hospitals Department at the Kaweah Delta tened it “Khushcow II.” The “cow” part in the U.S. Whether it’s X-rays, ultra- AMedical Center in the U.S. state of this made-up word stands for “com- sound scans, images from the four car- of California seems quite unspectacular: puter on wheels.” A monitor and its diovascular labs, telemetry data, dos- a well-choreographed ballet of doctors, keyboard are linked to the hospital net- ages for intravenous pumps, patient nurses, paramedics, and patients who work, and for urgent discussions with files, notes, or any other memos – all are being laid in their beds for treatment. his colleagues Khushigian wears a Blue- data passes through the Wireless Lo- There is only one thing that you won’t see: tooth headset connected to the Inter- cal Area Network (WLAN). A portal wires, through which a stream of vital in- net Phone or VOIP system of the hospi- provides access to the entire staff ev- formation would typically be flowing. tal. “You can hardly get more mobile erywhere on the hospital campus. Doc- John Hipskind is one of the emer- than this,” says the physician. “I can tors can even use their own cell phones gency doctors in the 581-bed hospital in move freely all over the Emergency De- or tablet PCs when they’re at home or Visalia, CA, a city of 100,000 residents partment just as it suits me, and I have traveling to check the condition of pa- between San Francisco and Los Ange- all the important data in front of me. tients, monitor their recovery, and in- les. A gaunt man with a shaved head, The batteries last up to 20 hours and, tervene in treatment matters. Hipskind swears by his white iPad. With if necessary, I can call experts some- just a few finger strokes, he can use it to where else in the country while keep- obvious Benefits call up the live ECG readings of a newly ing both of my hands free.” “We’re way out in front with our vi - admitted patient and enter the appro- On the ceiling above his head, as sion of making hospital data accessi- priate pharmacological treatment, be- though in confirmation of his words, ble everywhere and all the time,” says c. fore he dictates the results of a test to flashing green diodes indicate the near- Dave Gravender, who is the hospital’s hy iN P a voice-recognition application. A few est hotspot. A Cisco Cleanair access Chief Information Officer (CIO). He minutes later, the data will then be avail- point that minimizes interference from has just returned from a conference able to the personnel in the intensive wireless networks of all kinds, from Wi- organized by the trade association for g g Photogra N care unit, to which the patient is about Fi to 3G to Bluetooth, as well as any members of his profession. Of the 15 to be transferred. other interference emitting from elec- CIOs who were present, only two others

cha Pflaegi tronic devices. have followed a similar course and al- S “It could hardly be more mobile” When it comes to the intensive lowed every physician to access the hos- hy: Sa A few meters away, his colleague Jacob and creative use of a wireless network pital’s network with whatever device Khushigian is pushing a mobile treat- as a lifeline of hospital activities, the he or she chooses. “It was amazing,”

P Photogra ment console down the hall. Dr. Khush- Kaweah Delta Medical Center is prob- says Gravender with a diplomatic smile. >

Dräger review 105 | 2 / 2012 23

EN_22-27_IT im Krankenhaus.indd 23 07.06.12 08:38 The fast and straightforward access to data saves time for doctors and nurses

Always mobile, always informed: Using a computer on wheels the physician Jacob Khushigian has access to all the important information

24 Dräger review 105 | 2 / 2012

EN_22-27_IT im Krankenhaus.indd 24 07.06.12 08:38 NetworkiNg InformatIon technology

the Data center: here more than 120 terabytes are stored – including all the telemetry data, patient files, and medical imaging records

> To him, it’s obvious that a unified, wire- fits the whole system and its services and ing campus, in one control room. Here, less architecture for medical devices and applications. A new building can be con- the vital data of 172 patients are displayed IT infrastructure brings benefits as far nected just by pushing a button.” on a wall equipped with twelve monitors, as hospital treatment and care, techni- One important component in this which are carefully monitored by three cal administration, and cost-effective- pioneering architecture is the Infin- telemetry specialists. If there are any de- ness are concerned. “For us, it supports ity OneNet from Dräger, which trans- viations from the norm, the technicians what I call the ‘Six Rights of Information mits vital patient data from the wire- immediately consult the appropriate de- Managment’. It provides the right infor- less Dräger M300 monitors via Wi-Fi partment or contact a physician. They do mation, to the right people, in the right signals. When the hospital in California so even if the physician happens to be at place, at the right time, in the right for- officially opened a new 23,000-square- some distance from the hospital, when mat – and of course for the right value.” meter wing, devoted primarily to car- the deviation occurs. diology patients, it was not necessary to The patients don’t notice much of Saving and Simplifying set up a separate, closed telemetry net- this process, because the seamless net- The Kaweah Delta Medical Center be- work, let alone lay cables. “All we had work simply works. Patients and their gan experimenting with wireless access to do was to link up some new hotspots, family members can go online free of to important information back in 2003. and within a mere six hours our new te- charge anywhere in the hospital through Initially the scope of the trial was re- lemetry network was ready to use,” re- a guest account and even organize video stricted to a small field test in which the calls one of the Kaweah Delta Medical conferences with their friends and rela- hospital pharmacists used ten existing Center’s IT experts. tives scattered across the country. access points. This enabled them to log After the installation of the new te- Examinations and tests follow the into the pharmaceutical data base with lemetry network, a number of advan- patient, if possible. In other words, most four PDAs. Next, laptops and 400 “thin tages were self evident. The hospital X-rays and ultrasound images are made clients” were distributed to each patient saved two to three million dollars in in- with mobile devices from the relevant room. When a thin client is used, pro- stallation costs and simplified its mainte- departments, which are connected to cessing occurs on servers instead of in- nance work, because technicians can re- the wireless network. To achieve the idividual PCs, in turn reducing the cost motely access, service, and, if necessary, best possible Wi-Fi coverage every- of each device. repair any device connected to the net- where, including the older buildings, The great starting point for Graven- work. Since each monitor has its own IP the IT experts installed eight to nine ac- der was when the hospital administra- address, its location can be determined cess points per floor, on average. “There c. tion decided to modernize its telephone to within three meters – and the same are more than 400 access points in all,” hy iN P system and opted for a solution that was goes for IV pumps and other hardware says Gravender. “We also didn’t add any based entirely on VOIP technology. “If connected to the network. The fast and staff to support the increase, because you’ve invested in a system like that,” straightforward access to data saves time it was an expansion of our existing g g Photogra N the CIO says, “it’s almost inevitable that for doctors and nurses. Obviously, the pa- environment.” you’ll set up a network with a uniform tients benefit as a result, because more Data is Secure

cha Pflaegi 802.11 standard for all your informa- time is available for talking with the peo- S tion needs” – in other words, everything ple who are treating them. Through its wireless access points, hy: Sa from telephone, e-mail, and messaging In addition, the Kaweah Delta Medi- Kaweah Delta operates a total of eight to clinical data and telemetry. “Every cal Center has centralized the monitoring different virtual networks, each of

P Photogra cent that you put into the network bene- of patient data, for its entire four-build- which has its own SSID. They include, >

Dräger review 105 | 2 / 2012 25

EN_22-27_IT im Krankenhaus.indd 25 07.06.12 08:38 InformatIon technology NetworkiNg

nutrition host, David lopez-orellana, receives meal preferences on his iPad: “It’s better and faster – mis- takes are impossible.”

> for example, the Family Birth Center, including technicians and personnel in CIO Gravender now routinely receives the Imaging Center, telemetry from the Emergency Department. inquiries from other hospitals through- Dräger, a telephone network, and a pub- “The first iPad was launched on a Sat- out the U.S. and abroad that want to lic patient network. This guarantees the urday,” says Gravender. “Twenty minutes see what an open network looks like in security of the data and the best possible after one of our doctors had unpacked an everyday clinical setting. “We delib- transmission speed in each case, up to it, it was connected to our network, and erately took some risks, because we al- a maximum of 54 megabits per second, he was making his rounds with it.” Now lowed our doctors to access our network because each network carries data pay- even the hospital’s nutritionists use one with the device of their choice. But the loads of different sizes with very differ- of these tablets to send food preferences results showed that we were right,” says ent priorities. to the kitchen via the wireless network Gravender. And he adds, “I don’t under- half an hour before meals. “It’s better and stand the objections of people who say award-Winning Desktop faster – mistakes are impossible,” says Nu- that you supposedly lose control with an The hospital’s computer center is a low- trition Host, David Lopez-Orellana, at the open architecture. Control over what? rise structure, located near the main intensive care unit, as he clicks through We gave up control of the hardware a building. In total, it has 120 terabytes of lunch menus. long time ago.” storage capacity, which is mainly used This seamless interconnection is In a hospital that has only station- for archiving patient files and medi- made possible by a virtual desktop named ary PCs, confidential data is often cop- cal imaging records. Telemetry data, “MyKD” (My Kaweah Delta), which ied or taken home. “The important on the other hand, is kept for only 72 is based on the technology of the U.S.- thing,” Gravender says, “is that the hours before being overwritten. Thanks based Citrix company. For this innova- hospital retains control over that sort to a triply redundant system and multi- tion, Kaweah received an award from the of data. In that respect, we’re better off ple backup power supplies, Gravender technical journal Computerworld in 2011. than we ever were before. At the same is not concerned about any heightened The client software allows all staff mem- time, we’re making life easier for every- susceptibility to failure. “A smoothly bers to log in from any device and display one – the medical staff, the patients, and functioning Wi-Fi network is possible if data from any connected system. Signifi- our IT experts.” you first create a well thought-out wired cantly, no data is stored locally. Instead, network on which the wireless infra- it is streamed from the “cloud” to the ter- assessment via iPad structure is based,” he says. minal device. The data involved could be Patients can now file reports that re- The fact that the network can be anything from real-time ECG readings or veal whether or not they were satisfied c. accessed from anywhere has met with archived X-rays to updated treatment his- with their treatment and their stay at hy iN a great response, as far as the hospi- tories or prescriptions. the Kaweah Delta Medical Center just P tal staff is concerned, says the IT man- Every doctor finds his personal desk- before they are discharged. Instead of ager. Today, for example, approximately top just the way he left it when he logged receiving a questionnaire weeks later g g Photogra half of the 300 doctors in Visalia own a off last, regardless of whether it was ac- in the mail, they can provide their feed- N smartphone and a laptop, and a third cessed from a client computer in a pa- back to the hospital in a specially devel-

of them also have tablet PCs, mostly tient’s room or from an iPad. Users are oped app that a nurse brings to their cha Pflaegi S iPads. The hospital has also purchased currently still providing authentication bed – on an iPad. Steffan heuer 100 iPads itself and distributed them to with a user name and password when hy: Sa its staff. As a result, the devices can be they log on, but soon the chip in their for information on Dräger products:

used by a wide variety of staff members, staff IDs will suffice. www.draeger.com/105/it P Photogra

26 Dräger review 105 | 2 / 2012

EN_22-27_IT im Krankenhaus.indd 26 07.06.12 08:39 Colleagues around the world want to know how an open network works in a daily clinical setting

Dave Gravender is responsible for the information tech­ nology: “We’re way out in front with our vision of making clinical data available every where.”

Dräger review 105 | 2 / 2012 27

EN_22-27_IT im Krankenhaus.indd 27 07.06.12 08:39 InformatIon GraphIc AnesthesiA

p ainless Intervention illness can be painful – and so can the treatment. Anesthesiology is about making the body insensitive to pain during an intervention while enabling it to maintain its vital functions. this overview presents several possible approaches, functional processes, and challenges.

Inhalation anesthesia a multIfacEtEd General anesthesia Balanced anesthesia SpEcIalty Anesthesia affects Intravenous anesthesia multiple regions of the human body. An example anesthesia Spinal anesthesia of “balanced anesthesia” near Spinal cord Epidural anesthesia is the combination of inhaled narcotic gases regional anesthesia with another anesthetic, e.g. one in an aqueous plexus anesthesia peripheral solution administered Individual nerve Block anesthesia intravenously.

how narcoSIS workS More than 165 years since the first anesthesia, the precise effect of narcotics still has not been completely deciphered. the current state of knowledge is reflected in two theories:

Biochemical theory Biophysical theory Effect on protein functions: direct Effect on protein functions: indirect mode of action: specific mode of action: nonspecific primary point of action: receptors primary point of action: cell membrane

Membrane in its normal state Sodium enveloped by during the water molecules progress of an nerve cell action potential Ion channel

neurotrans- opioid mitters cell membrane Membrane expansion receptors due to the effect of Impulse no impulse narcotics (ion channels blocked; no possibility nerve cell of action potentials)

the biochemical theory (protein and receptor the biophysical theory (lipid theory) describes how substances that theory) focuses on how narcotics affect protein are soluble in fats (lipophilics) cause a physical narrowing of the ion channels receptors and thus selectively influence the function in membranes. the sodium ions are enveloped by water molecules and of neurotransmitters. For instance, opioids inhibit the diffused through the open ion channel (left). narcotics cause the ion channel transmission of nerve impulses by neurotransmitters to constrict, and they also cause the formation of a small gas bubble at its and thus suppress the transmission of the pain impulse. outlet (right) which prevents diffusion of the sodium ions.

28 Dräger review 105 | 2 / 2012

EN_28-29_Infografik_Anästhesie_NEU.indd 28 07.06.12 08:41 Spinal cord

Tough spinal membrane Area of injection injection of Area in thoracic EDA thoracic in Epidural anesthesia DOSAGE MAKES THE DIFFERENCE

Thoracic spine Thoracic One challenge in anesthesia is to precisely titrate the medications that are used to effect sedation/ hypnosis, analgesia, and muscular relaxation for each Hollow needle patient. The medications must produce the optimal with catheter effect for the desired duration – without any possible Lumbar vertebra side effects that could have a negative effect on the patient’s blood pressure.

Space containing cerebral and verte- Sedation bral fluid (liquor) Unconsciousness in lumbar EDA and and EDA lumbar in spinal anesthesia Area of injection injection of Area X Awareness

Lumbar spine Lumbar Epidural anesthesia

Inter- Spinal vertebral anesthesia Interaction disk PATIENT

Nerve fibers Analgesia Relaxation Painlessness Paralyzed X Hemodynamic effect muscles Sacrum

WAKING UP WITHOUT BEING ABLE TO TALK An insufficient narcotic effect occurs only in one or two out of 1,000 anesthesias. This remaining risk can be THIS IS HOW ANESTHESIA AND NARCOSIS WORK reduced, for instance by taking account of concomitant A principal tool of anesthesiology is the application of drugs to produce conditions. When intraoperative awareness occurs narcosis. Such drugs can be used during a surgical procedure to block the nevertheless, various perceptions are encountered that sensation of pain – either locally or generally. The first academic chair vary in incidence (see table). Innovative drug displays, in this field was established during the mid-1930s at Oxford University. such as SmartPilot View by Dräger, are designed to u Local anesthetics affect sensitive end organs and nerves but have further reduce this remaining risk. virtually no effect on the central nervous system. u General anesthesia, on the other hand, has a temporary and reversible Perceptions during depressing effect on the central nervous system. intra operative awareness Incidence Noises 85–100% +++ About 230 million anesthetic procedures are performed Visual perceptions 27–46% worldwide annually. +++ Many countries suffer from a severe Anxiety 78–92% shortage of qualified anesthesiologists. For example, Afghanistan’s Helplessness 46% current population of 32 million is served by only 9 anes- Surgical details 64% thesiologists. By comparison, the United Kingdom’s 64 million Paralysis 60–89% Pain 41%

ILLUSTRATIONS: PICFOUR. ALL INFORMATION IS MERELY SCHEMATIC OR BY SCHEMATIC ORDER PICFOUR. IS OF ALL ILLUSTRATIONS: MERELY MAGNITUDE. INFORMATION people are served by about 12,000 anesthesiologists. +++

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EN_28-29_Infografik_Anästhesie_NEU.indd 29 08.06.12 07:52 Where things get tight and dirty: A secure descent into the underworld

Most of the canal has already been cleaned; now it’s time to finish the job

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EN_30-33_Stadtentwaesserung.indd 30 07.06.12 08:44 wastewater Portable gas detectors

t he third Man beneath almost every city in the world lies a sewers network that disposes wastewater in a hygienic and almost always odor-free manner. to ensure that this remains the case, the systems need to be regularly inspected, cleaned, and serviced – as is done in stuttgart, germany.

n 1948 the actor Orson Welles had the Middle Ages generally dumped their the walls of the sewers in Vienna per- waste into rivers or open canals in front I fumed so that he could shoot his clas- of their doors, while farmers simply piled sic film The Third Man there. In the film it up on dung heaps. he played the role of the penicillin traf- It’s hard to imagine today how things erger

ficker Harry Lime. But those who descend were back then. For example, at the b to the underworld of the Austrian capital “Black Assize” in Oxford, England, in today will notice only a moldy scent – t he 1577 there was “a stench so malignant ebastian s olfactory signature of every sewer. “It’s that nearly everyone caught typhus from hy: somewhat stronger in the summer, less it and 300 people died.” The author Al- so in the winter,” says Dennis Helsch exandre Tournon wrote the following from the Stuttgart wastewater manage- description of Paris in 1789: “The capi- P Photogra In a good mood: robert Hertler in the testing ment agency, which ensures that every- tal is nothing less than a giant cesspool, room, at stadtentwässerung stuttgart thing flows properly in the 1,750-kilometer the air is foul, and some districts are so sewer network that serves the city with ap- contaminated that their residents can proximately 580,000 residents. Most of the hardly breathe.” general ‘dole’ plan for the city,” says Rob- waste comes from toilets – where the av- When fecal matter and urine decom- ert Hertler, the head of the canals depart- erage citizen flushes between 60 and 250 pose, they release gases like methane ment, at the Stuttgart wastewater man- grams of fecal matter, half a liter to two li- and hydrogen sulfide, which generate agement agency. “Dole” is an old German ters of urine, and a huge amount of water a foul smell even in small amounts that word for a covered sewer ditch. into the sewer system every day. are also highly toxic. Nothing much has changed with regard to this biochemi- necklaces and car tires deadly Mist cal process – but thanks to well-function- The engineers performed some great Such underground drainage systems, ing sewer systems, most cities in the de- feats right from the start. “The brick ca- and the facilities for treating other types veloped countries are largely free of the nals here are extremely durable,” says of wastewater, for example, from wash- associated smells, although there are Hertler, Graduate Engineer. “They’re ac- ing machines and industrial plants, are still about 2.5 billion people around the tually more stable than some of the con- among the greatest inventions in human globe who don’t have flush toilets whose crete canals from the 1960s.” The Canals history. Sewers allow people to coexist water can be properly treated. Department has around 100 employees. in densely populated areas without fall- Wastewater treatment is also relatively They are responsible for ensuring that ing prey to disease. Thus they also make new in the industrialized world, where wastewater reaches the treatment facil- civilization as we know it possible. The modern sewer systems only developed ities without any problems: “Every year first simple sewer systems consisted of slowly, originating in England in the 19th we use mobile cameras and make inspec- subterranean clay pipes that were laid century. Six years after a fire in Hamburg tions to check more than 150 kilometers in the early cities of Mesopotamia a little destroyed much of the city in 1842, offi- of the network. We go through the whole over 6,000 years ago. The Cloaca Maxima cials installed the first sewer system with system about once every ten years.” in Rome hygienically disposed of waste underground pipes in Germany. Other cit- The inspection teams use ten vacu- 2,500 years ago – but the knowledge be- ies soon followed. “In 1874 the munici- uming and rinsing vehicles to clean al- hind the system was lost after the Roman pal council of Stuttgart commissioned the most 650 kilometers of sewers each year, Empire fell. That’s why city residents in English engineer J. Gordon to draw up a collecting more than 230 tons of solid >

Dräger review 105 | 2 / 2012 31

EN_30-33_Stadtentwaesserung.indd 31 07.06.12 08:44 Portable gas detectors wastewater

one worker always stays at the tripod for safety reasons; he’s “the third Man” > material in the process. “Most of it is mud and sand that gets in with the rain,” Den- nis Helsch explains. Sometimes car tires and tree trunks end up at treatment facil- ity grates, however. “We have no idea how they get here,” says Helsch. Indeed, the strangest things end up in sewers. Helsch has found many items, including a neck- lace that he was able to return to its grate- ful owner. He has also experienced some horrible things – like the time in the late 1970s when some of his coworkers decided not to take the protection against the toxic gases in the sewers too seriously and ended up suffocating. gas Protection Means safety “The most dangerous gas in the system is hydrogen sulfide,” Helsch says. The gas the gases used to test the detectors ropes and visual and auditory rises up and quickly destroys the olfac- stand ready in the cabinet contact enhance safety tory receptors in the nose, which means a person exposed to it is no longer able to tell when dangerous concentrations have accumulated. “You lose consciousness, fall down, and drown.” A healthy person can go 30 days without eating, three days without drinking, but only three min- utes without air. That’s why the agency in Stuttgart has stringent regulations for protecting workers who enter the sewers. Everyone who goes down below must carry a gas detector. The canals depart- ment has more than 50 Dräger X-am erger 5600 multigas detectors and several b Dräger X-am 7000 models. “Our peo- ebastian ple pick them up from the testing cen- s ter when they start work at 6:30 a.m.,” hy: says Helsch, who goes on to explain the

complex procedure for ensuring that P Photogra each worker is equipped with a properly In the dark: a sphere measures gas content in the air before descent

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EN_30-33_Stadtentwaesserung.indd 32 07.06.12 08:44 “The wastewater is always a centimeter higher than your boot”

functioning device. Before the detectors the main alarm cannot be shut down un- are issued, a coworker puts five devices der any circumstances. The device also into an automated test and calibration emits a brief signal every minute to re- system (Dräger E-Cal) simultaneously. mind workers of its protective function. A gaseous mixture of predefined concen- Gas detectors are only one element of the trations of hydrogen sulfide, methane, safety system – but a very important one. oxygen, nitrogen, carbon monoxide, and The detectors and other equipment make carbon dioxide is then injected into the descending into the depths of the sewers station. The functionality and reaction a little like an expedition. time of the sensors are tested and docu- mented for each of the five units. “Until A Journey to the Underworld recently, we used a different cylinder for Today the sewer workers are going to clean Dennis Helsch checks the cabinet that holds each gas,” Helsch explains as he opens a canal that leads to a rainwater reten- the cylinders containing the test gases the highly secure cabinet that holds the tion basin. “The basin ensures that the gases, which is located outside the test- water doesn’t overflow out of the gullies ing center. “The new gas mix saves us in heavy rain,” Helsch explains. In dry and hygiene articles that have collected time – but without any sacrifice of safety.” conditions, 500 liters of water per second on the floor of the canal, whose ceilings Each steel gas cylinder holds 1,500 li- flow through the sewers, but that amount are adorned with ice-like stalactites. This ters of gas compressed to 150 bar – enough increases to 100,000 liters per second is what it’s like to work in the dim light of for a month of testing. “You have to be when it rains. It rained here last night, an open gully in the sump pit of the rain- very careful with the hydrogen sulfide so murky water is all you see when you water retention basin: a temperature of 12 even when you’re just testing it, because look down the manhole, making it impos- degrees Celsius, humid air, relative dark- it begins to settle at temperatures below sible to see where the conduit ends and ness, and a constantly lurking danger of ten degrees Celsius,” Helsch explains. the “bank” (gangway) begins. A tripod has toxic gases and sudden floods. It’s rough That’s why during the cold month of been placed above the shaft; the workers down here – very rough. Still, one 52-year- February 2012 the gas mix, for the tests, step into a harness hooked to a rope to se- old worker says, “I think I’d get sick if I was placed in a small cartridge that was cure them as they enter the sewer and de- couldn’t come down here any more!” stored together with the devices, inside a scend down the climbing iron. It smells For safety reasons, every team always lab fume cupboard, at the gas testing cen- moldy, but there’s no foul smell. It’s also consists of at least three coworkers. Each ter. It’s not just the alarm function that’s slippery – but the workers’ boots keep them worker in the sewer is always within sight tested before the devices are handed out; from falling. “The wastewater is always a and hearing distance of the one standing the rechargeable batteries, which last centimeter higher than your boot,” jokes in the shaft, who can then convey messages longer than just an eight-hour working one member of the team – but he’s wrong. to the worker standing next to the tripod day, are also checked. Once the tests are “Hydrogen sulfide bubbles can rise if you up above. He’s “The Third Man” – the man over, each worker takes a detector and kick up mud when you walk,” Helsch says, who really exists, both above and below the confirms its receipt in writing. describing the type of danger the gas de- streets of Stuttgart. Nils Schiffhauer “The gas detector has both optical and tectors are designed to respond to. acoustic pre-alarms and main alarms,” The workers have climbed down into For information on portable gas says Helsch. The acoustic pre-alarm can the feed duct. They need to go all the way detectors from Dräger: be turned off, but in the interests of safety, to the back to clean up mud, toilet paper, www.draeger.com/105/gas

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EN_30-33_Stadtentwaesserung.indd 33 07.06.12 08:44 Hospital NeoNatology

When parents learn Humility Children and parents must not be separated. that’s a basic human right established by the United Nations. the best interest of the child must be the primary concern, especially for premature babies. this is why FaMilY-oRiENtED tREatMENt CoNCEpts are practiced in Sweden.

He knows his child is in good hands: Björn Friman looks attentively after his son Elion. the premature baby is in the Neonatal intensive Care Unit of the University

Hospital in linköping hy: BliND P Photogra

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EN_34-37_Neonatologie_Schweden.indd 34 07.06.12 08:46 Touching: Four-year-old Sana, still a little shy, touches her brother Yousif

ith sharp eyes and a gen- immature, organs can lead to a num- cares for about 450 patients a year, many tle touch, Björn Friman ber of complications. A particular worry of whom must be artificially ventilated. W watches over his son. Last is apnea, respiratory arrest that can last The medical team tries to eliminate any night Elion came into the world 11 for several seconds. Another ever-present unnecessary separation of critically ill weeks too early. At birth the tiny infant threat is lung infection. The parents of children from their parents. “As soon as weighed just over 1,200 grams. He will premature babies must learn humility. the patients are physiologically stable, we have the first meal of his life in the Neo- Depending on the baby’s age at birth (in encourage the mothers to carry their ba- natal Intensive Care Unit (NICU) of the gestation weeks), as well as the condition bies against their chest,” says Hassel. University Hospital in Linköping, Swe- and the development of the little patient; “Kangaroo care,” as it is sometimes den. Friman feeds his son carefully. A the struggle for life can last days, weeks, called, is also offered to the fathers, sib- half milliliter of mother’s milk, pumped or even months. lings, and other close relatives. While by his mother Cornelia that morning, “You feel a lot of emotions at a time his wife remains in the hospital recover- trickles through the feeding tube. like this,” whispers Nuur Abdulmajed. ing from the complicated delivery, Björn The young mother tells of the unexpected Friman will be the one giving his son Many Emotions birth of her son Yousif in the 23rd week warmth and a feeling of security through Premature babies lose body heat very rap- of her pregnancy. She clearly remembers physical contact. But they also have a idly. Most of the time, Elion will be sleep- the paralyzing terror that overwhelmed three-year-old son at home – around 200 ing in a Dräger incubator (Type: Caleo) her then, her feelings of suddenly being kilometers away in Gnosjö – who needs to with its protective microclimate. His del- constantly surrounded by medical per- be cared for. There is also another con- icate organs have to work very hard to sonnel, and being at the mercy of com- cern for Friman, who is a very busy small maintain his basic bodily functions. A plex technology. She spent long days and business owner. “In the future, my wife ventilator supports his underdeveloped even longer nights at the side of her ex- will be ‘on duty’ here at the hospital 110 lungs. Adhesive sensors, around his frag- tremely premature son. “I was aware percent of the time – and I’ll be helping ile wrists, continuously mearsure his of Yousif’s every movement – every little out only part time,” he says. blood’s oxygen saturatuion. Medical per- sound,” she says. The regulations concerning parental sonnel can keep track of the parameters Abdulmajed sits down in a comfort- leave in Sweden are extremely generous, for humidity, temperature, and oxygen on able chair in her room next to the inten- and they make it possible to give sick chil- a glowing display. All around, monitors sive care unit. Then a “neo-nurse” hur- dren the intensive care they need. A simi- show curves with vital signs. ries in. She lifts little Yousif out of the lar level of acceptance in professional life “To be honest, I haven’t really taken incubator, together with his tubes and also allows for flexible sharing of respon- it all in,” says Friman almost casually. wires, and lays him on his mother’s sibilities between parents. He reaches through the open door of the chest. The child is only wearing a diaper incubator and softly caresses the red- and a cap and is wrapped in a blanket. “Parents Learn Fast” dish skin of his baby. “Feeding, wash- His head leans to the side and he listens Cradled against the chest of their mother ing, changing diapers: I have to be here to his mother’s heartbeat. or father, a premature infant is better able ricson

e around the clock. There just hasn’t been “We want to see the infants in the to endure even painful procedures like any time to reflect.” arms of their parents as often as possi- the introduction of a nasal tube, taking hy: hy: Åke The care of premature babies is a ble,” stresses Marie Hassel, the trained blood from veins or capillaries, and intra- challenge, even for experienced health- midwife who heads nursing care services venous injections. As soon as the parents

P Photogra care professionals. The development of at Linköping University Hospital. Her unit feel they are ready, they are integrated >

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EN_34-37_Neonatologie_Schweden.indd 35 07.06.12 08:46 Hospital NeoNatology

External stress factors influence the development of newborns – so great care must be taken to minimize them

> into the daily routine of care. “Parents with all the tubes and wires attached in says Marie Hassel. Venetian blinds on are resilient, and highly motivated, and flexible way. The staff’s work station is in the windows keep out direct sunlight. they learn fast,” praises Hassel. the middle of the NICU and is kept ready Small blankets are draped over the incu- Even when the “kangaroo care” for any necessary interventions. The chil- bators to shield against harsh lighting. method is being used, the highly special- dren are monitored individually, but every And loud noises are not allowed. There is ized hospital staff members continue to child’s monitor is connected to all the oth- one wall mounted with a volume indica- be responsible for patient monitoring and ers through a central monitor. In a room tor that everyone can see – a stylized red medical intervention. But the integration glassed off from the rest of the unit, doc- ear that lights up, when the noise level of parents was not without consequences. tors and nurses can call up data and dis- exceeds the permissible level of 55 dB. “We regard ourselves as the parents’ part- cuss specific cases while still keeping an It is hoped that a planned renovation ners,” says Hassel to explain the overall eye on things through the glass walls. of the NICU will double the number of pa- philosophy. “We teach the parents each of In the third trimester of pregnancy, tient beds available. In the future, single the controls in turn and what to do when the baby’s brain develops more rapidly rooms should make it easier for family life an alarm goes off. We support them in than at any other time in a person’s to develop normally and help to protect their roles as the most important people life. Most of the synapses and nerve fi- against the increasing threat of multi-re- in the lives of their children.” bers develop during this early period. sistant bacteria. Environmental conditions have a ma- stressful sensations jor impact on the development of the Hygiene: Covert sampling The physical layout of the NICU is also de- nervous system. In the womb a fetus is Hygiene is the prime directive. “We have signed with the needs of premature babies protected from external stress factors. very strict regulations,” stresses Hassel, and their relatives in mind. NICU rooms But in the NICU, just the alarms, elec- pointing to one of the many signs for- are divided into two sections, each with trodes, tubes, and masks cause numer- bidding jewelry and other unwanted incubator and a single bed or chair for ous stressful sensations for a prema- foreign objects. Sinks are strategically the parents. Chest-high room dividers al- ture baby. “We are very serious about placed and supplied with disinfecting low for a modicum of privacy. The mobile having quiet periods in order to pro- soap for hand-washing. patient care stations are clearly laid out, tect newborns from sensory overload,” But it’s not only visitors who might be carrying pathogens. Many hospital infections, which are transmitted by staff or contaminated equipment, can be avoided through education and in- p remature babies: too soon for this world spection. Covert sampling by specially a child is considered to be premature if it is born before the 37th week of pregnancy. trained personnel has long been the rou- every year, approximately 12 million infants all over the world are born weighing tine at Linköping. less than 2,500 grams. in europe, that accounts for about 6 percent of all live births For a long time, many people believed on average. in Sweden, according to statistics, around 6,000 children a year are that the most important precondition for born prematurely. Most of them are cared for in one of the country’s seven perinatal successful treatment was the virtually centers. Neonatology is a relatively new field of children’s medicine, but its techno­ complete isolation of the newborns in logical advances have been rapid. these days even extremely premature babies born incubators. The nursing staff determined in the 22nd week of pregnancy are surviving, thanks to the care provided by how long someone could visit. “In the specially trained personnel. past, parents of premature babies were

36 Dräger review 105 | 2 / 2012

EN_34-37_Neonatologie_Schweden.indd 36 07.06.12 08:46 ricson e hy: hy: Åke P Photogra Exhausted but happy: A young mother delivered her child in the 24rd week of pregnancy. For cases like this, nursing care director Marie Hassel (middle) and neo-nurse Therese Sjöström have the right concept

only allowed to hold their children for a reflection about role models and hierar- less affected by stress, they develop faster short time,” says the neonatologist Profes- chies that had never before been brought both physically and mentally, and on av- sor Uwe Ewald, remembering the begin- into question. “Children and parents erage they can go home sooner than pre- ning of his career as a resident physician must not be separated,” states Ewald, mature infants who don’t have such in- in the 1970s. Ewald shows visitors photos quoting one of the basic human rights es- tense contact with their parents.” from that time which show pre-term in- tablished by the United Nations Conven- The early release of patients is also an fants lying still and overshadowed by med- tion on the Rights of the Child. established practice in Linköping. During ical equipment. Today, his little patients Ewald can also point to interviews her stay in the NICU, Nuur Abdulmajed can interact with the people and objects that the nursing care team has conducted has learned to keep a cool head, even in in their environment through their sense with the parents of their little patients. difficult situations. In their family room of hearing, smell, and touch. Participating in the care of their children right next to the intensive care unit, she Ewald heads the Neonatal Intensive and having an influence on the way they shares the bed with her son Yousif. Four- Care Unit at the Uppsala University Chil- are treated in the hospital are a couple of year-old Sana also cradles her brother in dren’s Clinic. In 2004 he took advantage the strongest desires expressed by moth- a baby sling. Their grandmother stirs pots of a planned renovation of the unit to in- ers and fathers. in the communal kitchen. Occasionally, troduce the family-oriented nursing care friends of the family visit to play cards or concept, something he had spent years Going Home Sooner watch TV. The social network for the baby passionately campaigning for. Since then, Numerous studies have shown that close- has been created. Uppsala’s Perinatal Center, the second- ness and physical contact have a posi- The doctors from the hospital will con- largest in Sweden, has been employing tive effect on the emotional connection tinue to assist the parents even after they “kangaroo care” around the clock. between premature babies and their go home by means of telephone support Ewald had to spend time convincing parents. Ewald mentions other advan- and house calls. “I think, I’m ready to take some of his own staff to accept his pio- tages of the method: “They put on weight this step,” says Abdulmajed, with a weary neering ideas. This was preceded by deep more quickly, they sleep better, they’re smile. Alexander Budde

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EN_34-37_Neonatologie_Schweden.indd 37 08.06.12 07:52 Chemistry Against Hunger The world needs food – and so do plants. Today almost half of all crop yields are due to CHemiCAl fertilizers, which are produced using natural gas, water, and air. That can be seen at germany’s largest manufacturer of ammonia and urea.

or Thomas Robert Malthus, the end When Malthus published his Essay on the omist published his essay, which is still in- of population growth was a mat- Principle of Population in 1798, just un- fluential today. F ter of simple arithmetic. Since hu- der one billion people were living on the Dieter Busse’s office is located at one manity is growing geometrically and food earth. By 1930 that number had risen to of the centers of this scientific progress. production is increasing only arithmeti- two billion, and at the end of 2011 it was Around 120 km southwest of Berlin on cally, the world is heading for mass star- over seven billion. The fact that there is the outskirts of Wittenberg, the city of vation, he wrote. Agricultural productiv- still enough food to go around – at least in Martin Luther, his office overlooks the ity climbs along a linear path (1-2-3-4-5-6), principle – is thanks largely to a rate of sci- facilities of SKW Stickstoffwerke Piester- whereas population grows exponentially entific progress, that was unforeseen two itz GmbH. “We’re Germany’s largest pro- (1-2-4-8-16-32). hundred years ago when the British econ- ducer of ammonia and urea,” he says.

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EN_38-41_Stickstoffwerke.indd 38 07.06.12 08:49 ArtificiAl fertilizer AgriculturAl MArket

AdBlue – How urea protects the environment the reduction of commercial vehicle emissions is an important goal of environmental protection. the additive Adblue contributes to these reductions. “Adblue” is a registered trademark of the Association of the Automobile industry of germany. Adblue basically consists of a 32.5 percent solution of urea in highly purified water. together with a special catalytic system, Adblue reduces the emission of Nox and particulates from heavy-duty diesel engines. commercial vehicles thus outfitted can meet the european environmental standards required by euro iv and euro v, for example. At over 200 degrees celsius, nitrogen-rich urea is converted into ammonia, which reacts in the catalytic system to create nitrogen and water, both of which are also contained in the air we breathe. because the engine can continue to operate at the thermodynamically optimal level, fuel consumption goes down by as much as eight percent and particulate emissions are reduced. the Scr system converts dangerous nitrogen oxides into nitrogen and water.

Scr catalytic reduction system in trucks

exhaust gases Oxidation Hydrolysis Scr cat­ Oxidation catalyzation catalyzation alyzation catalyzation PM PM H O NO2 OX HY Scr OX 2 cO c O 2 N 2 H c injection of AdBlue

NO =nitrogen dioxide, PM=particulate matter, cO=carbon monoxide,

icfour 2 P Hc=hydrocarbons, H2O=water, N2=nitrogen, cO2=carbon dioxide APhic: gr ; ; mb h g teritz S vent Malthus’ prediction from coming panies in Europe with a total of about e Pie K true. As a young graduate of the compa- 27,000 employees, around 800 of whom ny’s training program, Busse helped to work in Piesteritz. toffwer

KS build this facility in the 1970s. He worked The core process here is the highly First the seeds are Stic alongside fellow students and specialists efficient production of ammonia, an ex- sown, then plant w growth is fostered from global corporations based in Japan, tremely pungent gas that is colorless, by fertilizer Czechoslovakia, and Poland. “In those water-soluble, and poisonous. It causes days, if you were 28, you were one of the tears and can lead to asphyxiation. One

PhotogrAPhy: SK PhotogrAPhy: oldest ones,” he says. of the world’s most extensively produced chemicals, ammonia is the basis for the urea in the tank production of all other nitrogen com- Incorporating technology that was cut- pounds, including urea and nitrogen fer- Ammonia is the basis of chemical fer- ting-edge at that time, the factory was tilizers. Specific forms of nitrogen foster tilizers that are helping to increase ag- built on a 220-hectare site with in four the growth of plants (see the box on p. 41: ricultural yields, in previously unimag- years by the Japanese firm Toyo Engi- “Blossoming and Thriving”). And urea, ined ways. In 2008, exactly 100 years neering Corporation. “Fortunately, the as a basic component of AdBlue, reduces after the invention of synthetic ammo- same company refurbished our facility the emission of particulates and nitro- nia, half of the almost 6.5 billion people between 1988 and 1990,” says Busse. Em- gen oxides from heavy-duty diesel engines in the world would have gone hungry if ployees of the nitrogen plant were very (see the box above: “AdBlue – How urea it weren’t for artificial fertilizers. Dieter involved in the “revamp.” Today the firm protects the environment”). Busse, now Director of Ammonia Produc- is a wholly owned subsidiary of the Czech The work of two German research- tion, has been working for 40 years to pre- Agrofert group, which includes 230 com- ers came together to ensure that, thanks >

Dräger review 105 | 2 / 2012 39

EN_38-41_Stickstoffwerke.indd 39 07.06.12 08:49 The SKW nitrogen facility in Piesteritz: An area of the plant that Color everywhere: In Wittenberg, various fertilizers are produces artificial fertilizer, around 120 km southwest of Berlin developed and continuously optimized

Back then, the name “Dräger” had to be blacked out

> to additional fertilization, crop yields Busse. He opens the cover of the primary to the organization, testing, and train- can keep pace with human population reformer with its separation pipes, be- ing of respiratory protection measures.” growth. The chemist Justus Liebig is rec- hind which ceiling-mounted gas burners The combination of poisonous and ognized as the founder of modern agro- create a glowing red inferno. The plant cold gases is the key theme of drill sce- chemistry. He formulated optimized uses three million cubic meters of nat- narios. “Escaping ammonia can spray methods of fertilization that were based ural gas from the North Sea and Russia out at temperatures as low as minus 70 on natural fertilizers in which guano every day. degrees Celsius,” Kracke says. The speed (the droppings of birds and bats) played Due to the heat, fire, and dangerous with which the cold penetrates mittens a prominent role. Guano is made up gases, the fire department, which is op- often limits the firefighters’ working of ammonia, phosphorus, and calcium erated by Securitas Fire Control + Ser- time more than does the capacity of the compounds. It wasn’t until 1908, when vice GmbH & Co. KG, isn’t far away. “At compressed air breathing apparatus. a process for synthesizing ammonia was the plant we have six full-time and three For stationary and portable gas measur- perfected by the chemist and eventual part-time firefighters on every shift,” ing instruments as well as personal pro- Nobel Laureate Fritz Haber, that the says fire chief Olaf Kracke, who came to tection equipment, both the plant’s fire path was opened for the large-scale man- this job by way of the almost customary department and SKW rely almost exclu- ufacture of fertilizers. Operations at the path of participating in youth and volun- sively on products from Dräger. “And facilities of the SKW nitrogen works in teer fire departments. He is a fireman, that’s not a recent development,” as Di- Piesteritz are based on exactly this Haber- heart and soul, and he strongly favors eter Busse will tell you, the chemical Bosch method (Carl Bosch was also in- fire prevention over firefighting: “That’s protective suits were obtained from Lü- strumental in its development). why we provide assistance and guidance beck even when this area was still part for proactive fire prevention, in addition of East Germany. “Safety is pretty much Heat, Fire, Dangerous Gases the most important thing, even though In the central control room, Dieter Busse the name ‘Dräger’ on the suits had to be explains the complex synthesizing pro- blacked out back then,” he says. cess. Natural gas, feed water, and air are These days the facility’s fire de- subjected to pressures of up to 240 bar partment, outfitted with six vehicles and heated to over 1,000 degrees Celsius. and assorted towable equipment, is al- Iron is introduced as a catalyst, causing ways on call for the extensive industrial ammonia to be formed. “Our facility site. It also does some work for neigh- is designed to operate according to the boring companies in the Agrochemi- steam reforming method, generating an cal Park – for example, the Wittenberg- output of up to 1,650 tons per day,” says Regular drills for greater safety Piesteritz Biomass-Fired Power Plant.

40 DRÄGER REVIEW 105 | 2 / 2012

EN_38-41_Stickstoffwerke.indd 40 07.06.12 08:49 ARTIFICIAL FERTILIZER AGRICULTURAL MARKET

Formation of organic NO3- Atmospheric N compounds nitrogen N2

Nitrate formation Nitrogen PHOTOGRAPHY: SKWPHOTOGRAPHY: STICKSTOFFWERKE PIESTERITZ GMBH N2 Research in Cunnersdorf, Saxony: Which combination gives the highest yield? Animal conversion of nitrogen Nitrous compounds oxide N2O

The specially equipped “hazardous sub- stances” vehicle has an ammonia pump Microbial with a burner for excess gas and connec- N fixing Microbial tion fittings for tanker cars. It also has a breakdown Microbial of organic Hydrocare set, among other things. denitrification material NH4+ NO3- Research for the Future Microbial nitrification However, it isn’t only the plant’s fire de- partment that’s prepared for a safe and secure future. The company is planning to invest 31 million euros in 2012 alone. Infiltration Infiltration The biggest of these projects is the new round storage hall that is 35 meters tall PICFOUR ILLUSTRATION: Fertilizer accelerates the processes of the natural nitrogen cycle and 68 meters in diameter. Research has always played an important role in Piesteritz as well. The company holds more than 100 patents, and there are Blossoming and Thriving over 60 employees working in research Nitrogen could be called the “engine of plant growth.” But this mostly inert gas, which alone. “That includes the research tak- makes up 78 percent of the air, can’t be used by plants directly. Therefore, most ing place at our Cunnersdorf test farm plants must rely on getting nitrogen that is bound to either hydrogen (ammonia) or near Leipzig,” says production head Di- oxygen (nitrate). However, these compounds, which are usually the products of eter Busse. “That facility encompasses natural bacterial processes, are only available in limited quantities. Adding nitrogen 170 hectares divided into 4,200 individ- in the form of fertilizer increases crop yields. ual plots. We are also carrying out test- The predominant fertilizer today is urea. According to statistics for 2009, the ing in greenhouses there.” most recent numbers available, worldwide use of urea fertilizer was about 70,000 The company’s success is therefore kilotons. There was much less use of ammonium nitrate, urea solution, calcium no accident. During the night shift on ammonium nitrate, ammonium sulfate, and fertilizer containing nitrogen, phosphorus, March 11, 2012, the plant produced its and potassium. 35 millionth ton of ammonia since it was Adding just the right amount at just the right time ensures the most economical commissioned. And in the future, a grow- and ecological fertilization for the different phases of a plant’s development. ing world population will still need to be In this way, nitrogen’s harmful effects on the environment, such as emissions and provided for. Nils Schiffhauer contami nation of groundwater, can be minimized.

DRÄGER REVIEW 105 | 2 / 2012 41

EN_38-41_Stickstoffwerke.indd 41 08.06.12 07:53 NeoNatology volume-orienteD ventilation

Hope in e very Breath artificial ventilation with volume guaraNtee is a milestone in the treatment of premature infants. the Hospital general universitario gregorio marañón in madrid has been using this procedure since the end of the 1990s – and was one of the world’s first.

ne thimbleful of air, no more ents around the clock. They sit by the in- than that, flows through the cubators and warming beds, caring for Otransparent tube with every their children. This close contact be- breath. And yet, this tiny amount of air tween the premature babies and their is keeping a preemie alive – a little pa- families is part of the hospital’s concept tient lying in a small bed surrounded by for the Level III Neonatal Intensive Care state-of-the-art intensive care technol- Unit, or NICU (see p. 34). ogy. “This patient,” says Professor Man- uel Sánchez Luna, “is a pre-term baby a Stable Breath volume who came into the world weighing less When it is necessary to artificially venti- than 1,000 grams.” late newborns, Sánchez Luna always em- Sánchez Luna directs the Depart- ploys Volume Guarantee. “In our Inten- ment of Neonatology at Hospital General sive Care Unit and Intermediate Care, Universitario Gregorio Marañón in Ma- premature and newborn babies are only drid. In the past year, almost 6,300 little ventilated using Volume Guarantee,” says “Madrileños” were born at this hospital. the 53-year-old physician. This mode, The premature babies that are treated which was developed by Dräger, com- here (in 2011 it was more than 850 chil- bines the benefits of pressure-controlled dren) come from all over the country. and volume-controlled ventilation. This During transportation to this highly spe- combination ensures that the little pa- cialized hospital, they are attended by a tients receive the most stable volume pos- team of intensive care experts. sible from breath-to-breath. The rooms are darkened and quiet, The artificial ventilation of prema- and the atmosphere is friendly. “We cre- turely born babies presents enormous ate the most peaceful environment pos- challenges for medicine. For example, sible for our newborns,” says Sánchez babies need to be supplied with only a Luna. That’s why the unit is open to par- very small volume of air for each breath.

42 Dräger review 105 | 2 / 2012

EN_42-45_Neonatologie_Spanien.indd 42 08.06.12 07:54 A handful of humanity: One breath is often under five milliliters of volume – and sometimes this includes artificial ventilation that must be under high pressure PHOTOGRAPHY: ULRIKE PHOTOGRAPHY: SCHACHT

DRÄGER REVIEW 105 | 2 / 2012 43

EN_42-45_Neonatologie_Spanien.indd 43 08.06.12 07:54 NeoNatology volume-orienteD ventilation

> Often, the smallest patients require a ventilation setting in the single digits of milliliters per breath, at a high respi- ratory rate. There are also other special physiological circumstances that have to be taken into account. The organs of prematurely born infants are not fully developed. The lungs are still relatively stiff, and the surface of the alveoli has not yet fully adjusted chemically for the gas exchange during breathing. Artifi- cial ventilation, therefore, must be at a relatively high pressure to ensure that the body is supplied with enough oxy- gen and that carbon dioxide is removed from the blood. “Medically speaking, controlling the breath volume of air is not so easy,” says Thomas Krüger, a Product Manager at Dräger. When compared to older pa- tients where cuffed intubation is used for ventilation, the endotracheal breath- ing tube in neonatal patients simply ends freely in the windpipe. So as it comes Continuous monitoring of artificial ventilation on a clearly laid out display out of the breathing tube, it’s normal for a certain amount of air to escape, back out through the mouth and nose with- out ever reaching the lungs. Studies Document the advantages This endotracheal leakage has to be measured and compensated for by ad- justing the ventilation equipment. This is one of the benefits of artificial venti- lation with a Volume Guarantee. “We measure the expiratory tidal volume, be- cause this value is much closer to the actual breathing volume of the lungs than the inspiratory tidal volume is,” explains Krüger. longings, wishes, and thank-you cards: “Fan mail” from parents

44 * Babylog vn500 is not commercially available in all countries. Dräger review 105 | 2 / 2012

EN_42-45_Neonatologie_Spanien.indd 44 08.06.12 11:39 A friendly atmosphere in the heart of Madrid the roots of hospital general Universitario gregorio Marañón in Madrid reach back to the year 1581. Structurally, the pediatric unit with a level iii neonatal intensive care unit (NicU), which was built in 2003, has little in common with the historic facility. in the neonatology, there are 16 beds and 40 places in intermediate care. all of the rooms have windows, with wooden shutters for shade, and views of sunny courtyards. it makes for a friendly atmosphere, even though a few meters away, raging at the front of the building, is Madrid’s downtown traffic.

Ventilation with a Volume Guarantee Whereas the Babylog 8000, which was is pressure-controlled ventilation with first introduced by Dräger in 1989, was a continuous flow at a set tidal volume. further developed to offer volume-con- It works in harmony with the little pa- trolled ventilation, its successor, the Bab- tients’ own efforts. The Baby log 8000 ylog VN500*, was designed to include this plus, which Dräger introduced world- mode from the beginning. The innova- wide 15 years ago, was the first ventila- tions in the new model include a greatly tor offering Volume Guarantee which, improved capacity for high-frequency os- among other things, avoids the risk of cillation with Volume Guarantee, intui- volutrauma, the overexpansion of the tive operation via a touchscreen, and the lungs. This is a complication that may permanently installed backup battery. arise when the functional ability of the At the same time, the Babylog VN500* lungs improves rapidly, for example af- can also be used for other types of ven- ter surfactant therapy. tilation, including non-invasive oxygen Since then, studies have docu - therapy. “Neonatologists can use this mented the advantages of this mode. machine for different treatments, rang- For example, C. Klingenberg, K. I. ing from non-invasive ventilation all the Wheeler, P. G. Davis, and C. J. Morley way to invasive high-frequency ventila- published a meta-analysis demonstrated tion – that’s a wide spectrum of treat- that volume-controlled ventilation of ments,” says Thomas Krüger. neonates compared to pressure-lim- “When I was first presented with ited reduced the risk of various dis- the volume guarantee mode in 1996 in eases and consequential damages sig- a pre-production prototype, I immedi- nificantly (“Journal of Perinatology”; ately saw the ‘diamond in the rough’ 2011, 31(9):575585; Nature Publishing that it represented,” remembers Profes- Group). sor Manuel Sánchez Luna. The neona- tologist has been involved in the devel- A Wide Spectrum of Therapy opment of volume control from the very During ventilation using Volume Guar- beginning. Ever since Dräger launched antee, tidal volume (VT) is measured the Babylog 8000 plus on the market, regularly and the PIP (Peak Inspiratory Sánchez Luna has used this mode of Pressure) is continuously adjusted. Be- therapy for neonatal patients and new- fore the therapy begins, the physician borns with diverse pathological condi- determines the VT and the maximum tions, ranging from dysfunction or fail- allowable ventilation pressure. Then ure of the heart and lungs, all the way to the ventilation equipment continuously septic shock. The therapy is vital to the hy: hy: Ulrike Schacht measures the actual tidal volume at the tiny patients’ recovery because, espe- end of every breath and makes adjust- cially in the most difficult cases, their

P Photogra ments to the PIP to compensate for any hope for a healthy life often lies in ev- Growing Up: A Very Long Road deviations from the set VT. ery breath. Peter Thomas

Dräger review 105 | 2 / 2012 * Babylog vN500 is not commercially available in all countries. 45

EN_42-45_Neonatologie_Spanien.indd 45 08.06.12 07:54 InsIght Alcotest

team Coordinator Björn Andresen knows how to find the alcohol

Lots of Alcohol Alcohol detection devices are not only developed and manufactured in lübeck, germany, but also meticulously tested in accordance with numerous regulations. All of this helps ensure greater sAfety on the roAd.

With a steady hand and platinum wire, the sensor is soldered into place

46 Dräger review 105 | 2 / 2012

EN_46-51_Schulterblick_Alcotest.indd 46 07.06.12 08:54 Blood alcohol content limits around the world those who like to tie one on have to be careful in some countries. in Poland, Norway, and Sweden, a BaC of 0.2 per mille will get you arrested – and estonia, romania, Slovakia, and the Czech republic have a zero tolerance alcohol policy.

0.0 ‰ estonia, romania, Slovakia, Czech republic, hungary 0.2 ‰ Poland, Norway, Sweden 0.3 ‰ Serbia* 0.4 ‰ Lithuania** laus Nemitz is assembling two housing shells and an electronic 0.5 ‰ Belgium, Bosnia-herzegovina, Bulgaria, Denmark, K circuit board to create a long-last- germany*, Finland, France, greece**, ireland**, iceland, ing device. With a steady hand, he picks italy*, Croatia*, Latvia**, Luxembourg**, Macedonia**, up a component that’s barely larger than Montenegro, Netherlands**, austria**, Portugal, Switzer- a penny, clips it on to the board, and uses land, Slovenia**, Spain**, turkey***, Cyprus an extremely thin soldering gun to weld 0.8 ‰ Uk, Liechtenstein, Malta two platinum wires into place. The device still isn’t finished, but it will work – at least in principle. * 0.0 ‰ during the probationary period for new drivers in germany, as well as for everyone else under 21. 0.0 ‰ Nemitz and his colleagues assemble for drivers up to the age of 24 in Croatia. 0.0 ‰ for new drivers and drivers of mopeds, trikes, quads, and motorcycles devices that have been developed at the (including passengers) in Serbia. 0.0 ‰ for drivers who have had their license for less than three years in italy. same location where they work. The por- ** 0.0 ‰ for drivers who have had their license for less than two years in Macedonia and Slovenia; 0.1 ‰ for such drivers in austria, 0.2 ‰ in greece, ireland, Latvia, Lithuania, and Luxembourg, 0.3 ‰ in Spain. generally 0.2 ‰ table and stationary breathalyzers they for motorcycle drivers as well in greece. 0.2 ‰ in the Netherlands for drivers who have had their license for less than build are sold around the world. “Here five years and for moped drivers under 24. in Lübeck, we do the final assembly and *** applies only to drivers of private vehicles without trailers. 0.0 ‰ for drivers of all other vehicles and trailers. conduct the stringent tests that each de- the per mille value shows the blood alcohol level, but measurements are usually taken of the amount of alcohol per liter of exhaled air (in milligrams). this overview is only for individuals traveling for private purposes. this information may vary. vice has to pass – before it’s released from the plant,” the team coordinator, Björn Andresen, explains. Of course, if everyone obeyed the rules, no breathalyzers would be needed. But the sad fact is that today such devices tent in a person’s breath in mg/L, and ple, which he or she could also theoreti- are more necessary than ever before. The where stipulated by law, convert that cally manipulate, of course. That leaves World Health Organization (WHO) de- value into “per mille” (Blood Alcohol us with alcohol detection via exhaled scribes alcohol abuse as “one of the main Content – BAC), whereby 1.0 per mille air –which is what the electrochemical health risk factors around the globe” (see corresponds to about 0.48 mg/L. Obtain- sensors in breathalyzers do. box on p. 49: “2.5 million alcohol-related ing this value with a blood sample is very Converting the alcohol content in deaths every year”). In 2010 the WHO expensive and time-consuming –not to breath into a BAC is a difficult job, how- published its “Global Strategy to Reduce mention the fact that this method is also ever. The initial attempts were under- the Harmful Use of Alcohol,” in which it invasive and should only be done by a taken in 1927, in response to the in- aa

kg called for the adoption of “measures to physician. However, because only around creasing number of traffic fatalities prevent drunk driving,” including “mon- five percent of the alcohol absorbed by caused by drivers under the influence. & Co. Co. &

ag itoring and surveillance” – in other words, the body is exhaled, sweated, or urinated The techniques then became more re- increased use of devices like those Andre- out of the body in an unaltered state, al- liable in the late 1940s. By 1953 Dräger sen and his colleagues produce. cohol levels can also be measured by ana- had developed a device with a tube for lyzing exhaled air and urine. Urine again exhaling and a bag for holding air that hy: hy: Drägerwerk A Difficult Job poses the same problem of an invasion could replace the wet-chemical proce- All alcohol testing devices have one thing of privacy, especially when a person is dure (known as the “drunk-o-meter”)

P Photogra in common: They register ethanol con- observed while providing a urine sam- introduced in 1938. The “Alcotest” >

Dräger review 105 | 2 / 2012 47

EN_46-51_Schulterblick_Alcotest.indd 47 07.06.12 08:54 Chemical and optical sensors measure the alcohol content in exhaled air

> trademark, that Dräger applied for and received for this development, eventu- ally became a common expression all over the world. From the Depths of the Lungs Such tubes are no longer used today. “The devices we build have two dif- ferent sensors. One is electrochemi- cal, the other is optical,” Andresen ex- plains. Each reacts in a different way to the presence of ethanol in exhaled air. The electrochemical sensor is mainly used in handheld devices developed for screening purposes, as a type of pretest, that can objectively confirm initial po- lice suspicions. The optical sensor is used in stationary units, frequently in combination with an electrochemical Precise assembly, exact results Ensures safety on the road as well sensor. Depending on the laws of a given nation, such stationary devices thus de- e: e: who

C liver results that stand up in court, so they are as reliable as a blood test. “Both types of sensors operate with CFour; CFour; sour similar precision,” says Dr. Jürgen So- hège, a product manager at Dräger. Still, the level of complexity is much higher

illustrations: P i illustrations: with evidential devices, which take D two measurements for comparison. All

harts an breathalyzers work in basically similar C ; ; ways, however: One simply blows into kgaa the unit through a mouthpiece. The ex-

& Co. Co. & haled air is channeled into the sensor ei- ag ther through a very short feed (handheld device) or via a heated duct in order to prevent condensation from the exhaled

hy: hy: Drägerwerk air, which has a temperature of 34°C. The breathalyzer’s software ensures

P Photogra that an initial analysis isn’t made un- Glass casing for the wet air tests – the balls inside prevent heat loss til a certain amount of air has been ex-

48 Dräger review 105 | 2 / 2012

EN_46-51_Schulterblick_Alcotest.indd 48 07.06.12 08:54 Alcotest InsIght

Alcohol consumption per capita (in liters of pure alcohol – 2005) < 2.50 2.50–4.99 5.00–7.49 7.50–9.99 10.00–12.49 ≥ 12.50 no data available Inapplicable 2.5 million alcohol-related deaths every year in the well-known magazine “Nature” (No. 482, February 2012), the British scientist Devi sridhar from the University of oxford called for a more aggressive campaign against alcohol abuse, which she claims is responsible for around 2.5 million deaths each year. “that’s nearly four percent of all deaths – and more than the number of haled. The evidential device also exam- deaths caused by Hiv/AiDs, tuberculosis or malaria,” she wrote. sridhar called on the ines the breath profile and only allows world Health organization (wHo) to move away from its non-binding recommenda- an analysis after the concentration of ex- tions regarding alcohol abuse and replace them with binding obligations on the part of haled air has reached a stable level. This governments that would allow this disease to be combated more effectively. means that the air comes from deep in- side the lungs and the results therefore can’t be confused by, for instance, by a brandy bean the person has chewed just measuring parameter (see the box on Different legislation from country to before taking the test. p. 51: “Two complementary measuring country or state to state, as well as spe- Nemitz points to two tubes that techniques”). cial requests from customers like police he is currently assembling. “The ex- departments and doctors, mean that al- haled air is released back into the at- testing: Piece by Piece most every production batch is made mosphere through the wider one; the The assembly process also includes load- to order. “That’s a big challenge for thinner black one has a small pump ing the software, which controls all the us – but at least it means things never above it that extracts a predefined processes in the breathalyzer, while also get boring!” says Andresen. The same amount of air, and the ethanol con- providing a suitable user interface that can be said about the huge effort that tent of this air is measured by the sen- is available in German and English in goes into testing every finished product. sor,” he says. Among other things, the addition to Japanese, Chinese, and Viet- Dräger conducts its tests in line with electrochemical sensor contains a fine namese. Do some customers have special the legal requirements in each coun- platinum powder that has been applied wishes? “Oh, definitely,” says Andresen. try. “We make a basic distinction here to a membrane which is filled with “Some states in the U.S. want the display between tests with dry and wet gas,” So- concentrated sulfuric acid. The opti- to show their state seal as soon as the de- hège explains. The “dry” gas test uses cal sensor uses the fact that ethanol is vice is switched on.” Probably so the drunk air held in gas cylinders to which pre- absorbed at a specific wavelength as a driver will at least know where he or she is. cisely dosed concentrations of ethanol >

Dräger review 105 | 2 / 2012 49

EN_46-51_Schulterblick_Alcotest.indd 49 07.06.12 08:54 InsIght Alcotest

the “wet” test precisely recreates exhaled air containing alcohol

> are added. Authorities in many coun- tries, such as the Netherlands, con- sider this completely sufficient in itself. However, other nations, like neighbor- ing Germany, require the more com- plicated “wet” testing method. “In this test, we recreate exhaled air that con- tains alcohol and has a temperature of exactly 34 degrees Celsius. We can even reproduce the humidity,” Andresen ex- plains as he points to a glass structure, the size of a giant aquarium holding nu- merous devices, that can generate the wet test gas in accordance with official standards. Glass vials containing pure alcohol also stand ready for the tests. Increasing Demand A display in Andresen’s building contains Will stand up in court: Meticulous testing ensures accurate measurements samples of alcohol detection devices used throughout the years; it’s clear that al- though breathalyzers have gotten smaller, they haven’t changed much in terms of their basic principle. This leads to the question of what they might look like in a few years. “The demand for them is ris- ing,” says Andresen, who also mentions the new need for such devices like the In- terlock XT*, which is a combination of an Alcotest device and a vehicle immobilizer. A

kgA This new demand will be met with devices o. c that operate according to the same prin- & g ciple as today’s breathalyzers. Customer requests for even more compact units (es- pecially for evidential devices) are contin- ually examined in order to assess their fea- sibility. nils schiffhauer

PhotogrAPhy: Drägerwerk A PhotogrAPhy: For information on Dräger products: the wet air for the test is created here tested and shipped around the world www.draeger.com/105/alcotest

50 * For law enforcement purposes only in the U.s.; including state administrative and judicial process. Dräger review 105 | 2 / 2012 Two Complementary Measuring Techniques Consumed alcohol is diffused air that originates deep sensor, it becomes electro- approximately 9,500 nano- into the blood through the inside the lungs. chemically oxidized at the cat- meters in the infrared range. colon. That’s how it reaches Alcotest devices from alyst layer of the measuring This light shines through a the lungs, where a small Dräger measure alcohol in the electrode. The produced elec- chamber filled with a specific portion of it is released into breath with two different tricity indicates the air amount of exhaled air that exhaled air. The British sensors: an electrochemical sample’s alcohol content. This is always at precisely the right chemist william Henry quanti- and an optical sensor. “coulometric measuring temperature. A photo sensor tatively defined this “passive The electrochemical sensor system” also gives the sensor measures how much of the diffusion” in the law that bears contains a membrane that high long-term stability. emitted light is “swallowed” his name. This law makes is soaked in an electrolyte and The optical sensor uses (absorbed), and this value it possible to derive BAC from holds two electrodes. when the specific absorption value of serves as the indicator of the the ethanol content in exhaled alcohol makes contact with the ethanol at a wavelength of air sample’s alcohol content.

eleCTroCheMICal sensor

electrochemical Measuring system electrochemical sensor Cross-section

piston electric pump Motor

ARJF-0033

06 95 06 68XXXXX

Measurement electrode with a catalyst sample Chamber layer on both sides electrochemical sensor Connection Wires

Infrared opTICal sensor

Infrared optical sensor with schematic measuring principle an electrochemical sensor of the infrared optical sensor

Both sensor types are used simultaneously lamp Window Window Interference detector Infrared to take measurements in stationary devices filter spectrum whose results are admissible in court spectral lines Gas

Dräger review 105 | 2 / 2012 51

EN_46-51_Schulterblick_Alcotest.indd 51 07.06.12 08:54 icfour P tration: tration: S illu D rchitect; chart rchitect; an a MiDt MiDt Sch D ter Pechtol S

Good for the climate: 2/Schu the new hospital w

planned for lichten- hy: M fels, Germany P Photogra Green Hospitals as energy costs continue to rise, energy efficiency is becoming a major priority for hospitals. investing in energy savings has a price tag – but those who find the right balance – will not only save money over tHe lonG term but also improve the quality of patient care and the work environment.

perating Room 1 at the Lubinus must be lit at 500 lux illuminance – even morning, do some work, and then spend Clinicum in Kiel, Germany, is though some of the areas can’t even be hours in operating rooms while the PCs O quiet and empty at the moment. accessed by patients. run all day long. It’s 2 a.m., the last procedure was per- So the savings potential is huge – up to formed hours ago, but the operating millions in energy savings 40 percent, according to the “Blue Hos- room’s ventilation system is still running There are so many examples, of how en- pital” position paper from the Associa- at full steam, as though it were already ergy conservation is underutilized in hos- tion for Electrical, Electronic & Informa- 11 a.m. That’s because the German gov- pitals. But it would be too easy to blame tion Technologies in Germany. The study ernment requires all operating rooms to most of the waste on legislation, since found that “hospitals could save 600 mil- remain ready-for-use around the clock, the hospitals themselves could do a lot to lion euros per year in energy costs and which means the ventilation system improve their energy efficiency, without reduce the emissions of harmful carbon

has to be ready too. By contrast, such circumventing the legal requirements. dioxide (CO2) by six million tons.” Rap- units can be shut down at night in Aus- Substantial savings could be achieved idly rising energy costs also continually tria and Switzerland. “If we could turn through the use of energy-efficient ma- increase the savings potential. Energy these things off, we’d save 150,000 euros chines, building insulation, and opti- accounts for 6 to 9 percent of all mate- a year in energy costs for our ten oper- mized hospital management systems, as rial costs, and the heating requirement ating rooms and also reduce the strain well as better utilization of capacity and of one hospital bed in Germany is still as on the environment,” says Horst Träger, the employees’ adoption of a different at- high as the annual requirement for three Technical Director of the Lubinus Clini- titude toward energy consumption. For single-family houses. cum. Similar waste is caused by another example, it’s still very common today for The main reason why public hospi- stipulation that all rooms and corridors staff to turn on their computers in the tals don’t fully exploit their energy-saving

52 Dräger review 105 | 2 / 2012

EN_52-55_Ausblick_GreenHospitals.indd 52 07.06.12 08:56 energy costs outlook

A Climate-Friendly Future

-23% -66%

Existing Buildings New Conventional Buildings Green Hospitals 2,760 tons of Co2/year 2,130 tons of Co2/year 710 tons of Co2/year

-75% potential is due to their tight budgets, ac- cording to Horst Träger. Whatever funds Electricity/lighting savings are available are usually spent on the -60% through optimized lighting control systems and lEDs. core business – medical care. “If a hos- pital faces the choice of either buying a Heat energy savings Building optimization measures can lower new X-ray machine or installing well-in- -56% heat-energy consumption. sulated windows, whose cost won’t be recouped until a few years later, it will Primary energy requirements most likely opt for the medical device,” -32% according to EnEV (2009) Building shell meets passive building standard; base load Träger says. Public hospitals also have to operation is fully covered by renewable energy sources. deal with the fact, that even a small in- vestment requires a public call for ten- ders, and this generally ends with the cheapest supplier being awarded the contract. This obviously means that en- There is hope, however, because a mar- 66 percent as compared to normal new ergy-efficient devices usually are not ket for energy efficient measures in hospi- constructions. bought, because they tend to be more ex- tals is taking shape and initial large-scale The reductions will be achieved pensive than conventional equipment. projects are now under way. New build- through an innovative building shell that A financing system as this doesn’t suffi- ings are very promising, because they are makes the hospital a “passive building,” ciently take into account, the fact that, not subject to the same restrictions as ex- at least on the upper floors, where the pa- the high procurement prices for energy- isting ones. tient rooms will be located. In other words, efficient equipment could easily be re- good building and window insulation, as couped through the lower energy costs lichtenfels lights-up with lEDs well as better utilization of heating tech- that result. A sustainable flagship project is the new nology in the building, will sharply lower Many hospitals also have no idea as “Green Hospital” with almost 300 beds, energy consumption. The remaining en- to how effectively they’re using their re- which is scheduled to be built in Lichten- ergy requirement will be covered in an sources. Instead they rely on rough fig- fels, Germany. Construction will start at environmentally sound way through so- ures, as a research project discovered, the beginning of 2013 and will be com- lar-thermal, geothermal, and photovoltaic conducted by the Fraunhofer Institute for pleted in mid-2016. The hospital will cost units (integrated into the roof and façade) Environmental, Safety and Energy Tech- 114 million euros; 75 percent of the funds and a woodchip heating system. nology. The institute found that hospitals will come from the state of Bavaria. “This This will allow the hospital to generate calculate the number of kilowatt-hours project marks the first time that a new 12 percent of its electricity requirement of power used per bed or per square me- construction in Bavaria will incorporate and 26 percent of its heating requirement ter – but such an approach completely medical, economic, and ecological con- by itself. The rest will be met by external ignores the way in which a hospital is siderations,” says Michael Jung, the new sources, ecologically generated electric- equipped. For example, if there are only hospital’s Managing Director. The proj- ity, and biogas. The hospital’s design also a few operating rooms, energy consump- ect, which is among the first of its kind ensures that as much daylight as possible tion can still be much too high, even if in Germany, will help to reduce carbon will be exploited to reduce lighting costs. To the figure calculated seems acceptable dioxide emissions by 75 percent as com- this end, light guilding prism in the upper in comparison to other facilities. pared to conventional hospitals, and by part of the windows of the patient rooms >

Dräger review 105 | 2 / 2012 53

EN_52-55_Ausblick_GreenHospitals.indd 53 07.06.12 08:56 The planned measures could reduce energy costs of up to 30 percent

> will guide daylight that hits the ceiling to ages previously dark areas in the back of the iM rooms, meaning that the lights won’t have rco to be turned on until later in the day. LED : : a iMago/

lighting systems will cover the remaining hy

lighting needs throughout the building; gra P this will lead to a 10 percent reduction of P h o t o electricity consumption, while also provid- Solar cells integrated into Mühlacker Hospital’s façade ing patients with a more comfortably lit at- mosphere. Possibilities are also being ex- amined for allowing patients to adjust the light and thus the mood in their rooms – an option that is at least technically feasible. Heat From Below It’s therefore clear that the new hospital will benefit patients as well. This is also true of the triple-glazed windows, which will not only save energy but also ensure draft-free rooms. Another patient comfort feature is the floor heating system in their rooms and the hospital lobby. This system is a direct result, from the desire to utilize

geothermal heat sources. The heat comes gMbh izinFotoKöln/MeDFacilities out of the ground at a temperature of 9 to hy: hy: Me D 12 degrees Celsius and generates a flow temperature of roughly 30 to 35 degrees.

That’s not enough for radiators, but it’s suf- P Photogra ficient for floor heating, which is why the Cogeneration Plant: One of the newest units is at Cologne University Hospital hospital won’t have any radiators. Heat storage is also part of the passive building concept. The ceilings also play a role here, as they will be fitted with paraf- efficient medical equipment, especially X- All in all, the measures in Lichtenfels will fin pellets that serve as Phase-Change Mate- ray machines that conserve electricity, as reduce annual energy costs by approxi- rial (PCM). These balls melt when they are well as CT and MRT devices, and left-heart mately 30 percent (400,000 to 500,000 exposed to heat, thereby cooling the room. catheters. “The X-ray machines conserve euros) as compared to conventional new If the room gets cold, they solidify again electricity because they emit less radiation buildings – and this figure doesn’t even in- and emit heat. Temperature differences while still producing clear images,” Jung clude the small contribution to be made are offset more effectively as a result. Sav- explains. Lower radiation levels are obvi- by photovoltaic units. Construction of new ings will also be generated by new energy- ously good news for patients as well. hospitals is actually very rare in Germany.

54 Dräger review 105 | 2 / 2012

EN_52-55_Ausblick_GreenHospitals.indd 54 07.06.12 08:56 EnErgy costs OutlOOk

Fewer than ten completely new clinics are had a cogeneration plant since 1996. The IMPRINt now being built and around 40 hospitals facility will be replaced with a new one this Publisher: Drägerwerk Ag & co. KgaA, corporate communications are getting new wings, although the to- year. The new plant will initially run on Editorial Address: Moislinger Allee 53–55, tal number of hospitals in the country is natural gas from the local grid and will 23558 Lübeck, germany / [email protected], www.draeger.com approximately 2,000 at the moment. The then switch over to biogas in early 2013. Hy- Editor in Chief: Björn wölke, hospital in Lichtenfels will be the first drogen is still too expensive, although it’s tel.: +49 451 882 20 09, Fax: +49 451 882 39 44 Publishing House: new clinic in Bavaria in ten years. The technically feasible and a lot more ecolog- tELLUs corporAtE MEDiA gmbH city got lucky because it was determined ical, as Träger points out. In any case, the Editorial Consultant: nils schiffhauer (responsible according to press law) that modernizing its old hospital would heat produced from electricity generation Art Direction, Design, and Picture Editing: be more expensive than building a new will be fed into the heating system, while redaktion 4 gmbH translation: transForm gmbH one. Energy-efficient hospitals can only at the same time generating enough cool- Printing: Lehmann offsetdruck gmbH have a broad environmental impact if ex- ing energy for the air conditioning. The ISSN 1869-7275 Code number: 90 70 316 isting clinics are modernized for energy new plant will generate around 600 kilo-

efficiency as well. As Träger points out, watts of electricity and will be virtually CO2- “energy savings of up to 30 percent are neutral. The current peak output is 50 kilo- the articles in Dräger review provide also possible in existing buildings.” watts; in the final stage of construction the information on products and their possible applications in general. they Träger’s own 200-bed hospital is a plant will produce around 340 kilowatts. do not constitute any guarantee that good example of a modernized clinic; the Also being considered is the possibility to a product has specific properties or is suitable for any specific purpose. hospital was upgraded to boost energy ef- install small wind turbines in the southern All specialist personnel are required to make use exclusively of the skills ficiency over the past few years. Among part of the hospital grounds, which will they have acquired through their edu- other things, the lighting system is now help achieve Träger’s goal of making the cation and training and through practical experience. the views, opinions, and statements expressed by the regulated in line with external light con- hospital energy-independent in five years. persons named in the texts as well as by the external ditions and pumps are speed-controlled. The new cogeneration plant will cost authors of the articles do not necessarily correspond to those of Drägerwerk Ag & co. KgaA. such views, The building management system was 3.5 million euros, but the investment will opinions, and statements are solely the opinions of the respective person. not all of the products named in also upgraded and highly efficient heat be recouped in 8.5 years, says Träger. this magazine are available worldwide. Equipment pack- exchangers were installed. In addition, Other energy-saving options aren’t worth ages can vary from country to country. we reserve the right to make changes to products. the current infor - cool air from the building’s own com- the cost and effort, though, so the hospital mation is available from your Dräger representative. bined heating and power station is now in Kiel decided not to reinforce the insula- © Drägerwerk Ag & co. KgaA, 2012. All rights reserved. this publication may not be reproduced, stored in used for the hospital’s cooling systems. tion on the outer building façade. It turns a data system, or transmitted in any form or using any method whether electronic or mechanical, by means out that the hospital already has good- of photocopying, re cor ding, or any other technique in Saving Energy Pays Off enough insulation, having been built in whole or in part without the prior permission of Drägerwerk Ag & co. KgaA. The cogeneration unit is the focal point of 1984. The savings of 3 to 5 percent would Dräger Safety AG & Co. KGaA, Lübeck, Germany, is the hospital’s energy efficient strategy in therefore be too small to justify the large the manufacturer of the following products: Rescue Kiel. More and more hospitals are in fact investment required. “That would have Chambers (p. 11), PSS BG 4 plus (p. 12), X-am 5600 + 7000 (p. 32), E-Cal (p. 33), Alcotest (pp. 46-51), now producing their own heating and elec- taken 40 years to recoup,” Träger explains. Interlock XT (p. 50). The manufacturer of Infinity- OneNet and Infinity M 300 (p. 25) is Draeger Medical tricity. The advantage of generating power Such measures make more sense for hos- Systems, Inc., USA. Dräger Medical GmbH, Lübeck, and heat close to consumers, especially in pitals built in the 1970s. It’s clear, then, Germany, is the manufacturer of Perseus A 500 (pp. 3, 6, 56), SmartPilot View (p. 29), Caleo (p. 35), Babylog large complexes, becomes clear when you that not every energy efficient concept for (8000plus) (p. 44) and Babylog VN500 (p. 45). consider the development of energy prices hospitals makes sense – but luckily there www.draeger.com in recent years. The hospital in Kiel has are enough that do. Dyrk Scherff

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EN_52-55_Ausblick_GreenHospitals.indd 55 07.06.12 08:57 Close-up PerSeUS A500

6

7

5

2 3

1

4

8

D-6835-2011

Anesthesia Following the Modular principle Perseus A500* is a complete anesthesia workstation, which can Once anesthesia has been started, Perseus supports the anesthe- be individually configured. Over three-quarters of the technol- siologist in carrying out all further functions for ventilation and main- ogy – including the power supply and the electronics – is built into the taining anesthesia. An integrated prediction system forecasts the basic unit 1 under the work surface – in addition to, the power sup- anesthetic gas concentration in the patient for the following 20 min- ply and electronics. Directly above: the LCD system control field 2 , utes. An additional touchscreen 7 provides hospital personnel with vapor 3000* (left) and the D-vapor 3000* 3 anesthetic vaporizers access to the in-house iT system. This screen can be used to doc- communicate with the workstation, report on camera and image ument the course of anesthesia and to call up patient information. processing, the respective levels as well as control dial settings and The Perseus A500 integrates various high-tech components, provide an early alarm, for example, if an anesthetic was expenden. such as quality turbine ventilation for iCU-like capabilities, that The anesthesiologist can check at a glance whether the anes- allows the patient to breath spontaneously at any time, within a thetic gas discharge 4 is connected to the hospital extraction sys- compact and ergonomically optimized space which also provides tem, and thus make sure that volatile anesthetics do not escape storage room with lockable drawers 8 . The turbine ventilation into the operating room. makes it possible for patients to breathe spontaneously at any time Patients entering the operating room are frequently already regardless of the set ventilation mode. “wired” – that is, their vital signs such as eCg and blood pressure The illustration and the text include optional components and are displayed on mobile patient monitors 5 , and their data can be describe one of many possible configurations. For more information: read from the touchscreen 6 as soon as they have been connected. http://campaigns.draeger.com/perseus_a500/en

56 * Not commercially available in all countries Dräger review 105 | 2 / 2012

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