Dräger Review 119: the Struggle for Raw Materials

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119 Technology for Life 2019 First issue 2019 R Harmony How the traditional and

aw Materials and Resources Resources and Materials aw modern are combining in a Chinese hospital p. 20

Freezing Cold Firefighters also respond in Greenland when things get too hot p. 30

Farmyard Smell Swiss scientists want to cut ammonia concentrations p. 46 The Struggle for Raw Materials The future of humanity depends on resources Contents 119

6 RUNNING ON RAW MATERIALS Rare earth elements get e-mobility up and running. The resources in the materials we use to build the future are generally rare. The struggle for them is fascinating and even creative. PHOTOS: PICTUREPHOTOS: ALLIANCE/REUTERS, MATTHIAS JUNG, PATRICK OHLIGSCHLÄGER; PHOTO: COVER JON BOWER/APEXPHOTOS/GETTY IMAGES

Around 3,700 kilometers was the distance traveled by the ash cloud after the Kilauea volcano erupted in May 2018, south-westerly from Hawaii to the Marshall Islands – turn to page 68. 40 LOOK UP Most people associate organ donation with hearts, kidneys, or livers. Yet corneas are transplanted in Germany much more frequently. The procedure can save a person’s sight. 62 One of the biggest centers specializing in this A GOOD NOSE treatment is the eye clinic at University Medical Center Mainz. Several hundred corneas are In some respects, military working transplanted here every year. dogs make better comrades. No technology in the world can beat them when it comes to highlighting dangers. What device can sniff out explosives, bark loudly, and bite on command? Germany’s armed forces breed their own, allowing them to train them when they are young.

2 DRÄGER REVIEW 119 | 1 / 2019 4 46 IMPRINT People going places Breathing in the calf shed PUBLISHER: Drägerwerk AG & Co. KGaA, Zhou Xujian works as a senior Ammonia smells unpleasant, even Corporate Communications nurse in China. Yassine Tajouaout to the cattle. It is formed when dung EDITORIAL ADDRESS: is a trainee in Hesse. and urine decompose. Gas detectors Moislinger Allee 53–55, 23558 Lübeck, Germany are helping to reduce the impact. 6 E-mail: [email protected] Coveted resources 52 EDITING: The demand for raw materials High and dry Björn Wölke (editor-in-chief), Simone Binder Tel. +49-451-882-2009, Fax +49-451-882-2080 is growing, but the supply is limited. Working at sea calls for maximum EDITING CONSULTANT: The global economy is in a quandary. concentration and readiness for Nils Schiffhauer What solutions are there? From action. There is no room for alcohol ART DIRECTION, DESIGN, IMAGE EDITING, AND COORDINATION: recycling to asteroid mining! and drugs here. Redaktion 4 GmbH FINAL EDITING: 20 56 Lektornet GmbH PRINTING: Tradition meets modernity Doctor Reddy’s hunt for the record Lehmann Offsetdruck GmbH People around the world are The world’s biggest hospital specializing ISSN: 1869-7275 physically similar. Yet in China things in gastroenterology is being built in the CODE NUMBER: 90 70 452 are somewhat different. Indian city of Hyderabad. The articles in Dräger Review provide information on products and 26 62 their possible applications in gen- Summoning spirits More or less best friends eral. They do not constitute any Germans also distill whisky. And Germany’s armed forces train their guarantee that a product has spe- ciﬁ c properties or is suitable for the stuff made in Baden-Württemberg working dogs in their own school, where any speciﬁ c purpose. Specialist per- is well worth tasting. they learn to act independently and sonnel are required to make use exclusively of the skills they have courageously – to protect the soldiers. acquired through their education 30 and training and through practical experience. The views, opinions, and statements expressed by the persons Storm over Greenland 68 named in the texts as well as by external authors of ar- Where there is ice, there is also fire. Built on fire ticles do not necessarily represent those of Drägerwerk And where there is fire, the fire Bubbling volcanoes are part of everyday life AG & Co. KGaA. Such views, opinions, and statements are solely the opinions of the people concerned. department is generally never far away – on Hawaii. Since the latest eruptions, the © Drägerwerk AG & Co. KGaA, 2019. All rights reserved. this also goes for the community of local fire department has been using portable This publication may not be reproduced, stored in a data 2,000 people in the east of the island. gas detection equipment from Dräger. system, or transmitted in any form or using any method, whether electronic or mechanical, by means of photocopy- ing, recording, or any other technique, in whole or in part, 36 71 without the prior permission of Drägerwerk AG & Co. KGaA. Surgery on Deck Two Our contribution Not all of the products named in this magazine are avail- Dream job on a dream boat? Maybe, Products from Dräger found in able worldwide. Equipment packages can vary from country to country. We reserve the right to make changes to or at least a little! Everyday life on board articles in this issue. products. Up-to-date information is available from your for the ship’s doctor is one thing above Dräger representative. all else: challenging and demanding. 72 Information on how personal data is processed in line with the provisions of the EU General Data Protection Regulation Pac 8500 can be found here: 40 This device measures two gases https://www.draeger.com/en_corp/Home/Data-Protection Ultrathin layers simultaneously, providing an acoustic and Dräger Safety AG & Co. KGaA, Lübeck, manufactures the If the eye’s cornea goes cloudy, visual warning signal as well as vibrating. X-plore 3500, the MRC 5000, the X-am 8000 (all p. 12), the chemical protective suits (pp. 28, 32 f.), the breathing appara- it must be replaced. The transplant tus (p. 28), the ammonia sensor (p. 46 ff.), the Polytron C300 technique is fascinating. (p. 51), the Alcotest 5820 (p. 55), the X-am 5000 (p. 70), and the Pac 8500 (p. 72). Drägerwerk AG & Co. KGaA, Lübeck, manufactures the Fabius Tiro (p. 24), the Oxylog 3000 plus (p. 38 f.), the gas management system (p. 58 f.), the Movita ceiling supply unit, and the Polaris 600 OR light (p. 58). www.draeger.com

DRÄGER REVIEW 119 | 1 / 2019 3 EXPERIENCE FROM AROUND THE WORLD

People Going Places PHOTOS: PATRICK OHLIGSCHLÄGER, PETER THOMAS; OHLIGSCHLÄGER, PETER THOMAS; PATRICK PHOTOS: TEXTS: PETER NILS SCHIFFHAUER, THOMAS

Zhou Xujian, 30, senior earned me a scholarship – even during tions always makes me happy. Since intensive care nurse at the the one-year internship that accompanied we also involve relatives in our work, Central Hospital in Lishui, the course of study. After getting I sense the success of our team all the Zhejiang province/China started, I joined the intensive care unit more. Although I have already achieved some years later, although I had to quite a lot professionally, I would like to go “I have been working at this hospital complete a special three-month training even further. That is why I am taking for more than nine years; our unit has course beforehand. It was especially continuing professional development 29 beds. I wanted to be a nurse for two unsettling at the beginning. We had a courses here at the hospital and in reasons: Firstly, it is easy to find a job 90-year-old patient who had been my free time. I would love to enroll on anywhere in the world in this profession. with us for a year, and I cried when he the ISPN* program, work internation- Secondly, thanks to my training I am also passed away. The fate of my patients ally as a nurse, and get involved in research in a position to offer expert assistance continues to affect me to this day, even projects. I like to embroider in my to other people when I am not at work, though I now keep a more professional spare time. It helps me to switch off – especially my family and friends. The distance. It wouldn’t be possible to do and the works I produce can also three-year bachelor’s course was tough. the job on a long-term basis other- be given to people as gifts.” I was pleased that my achievements wise. Helping people in difficult situa- * International Standards for Professional Nurses

4 DRÄGER REVIEW 119 | 1 / 2019 Yassine Tajouaout, 21, trainee pipe, sewer, and industrial works specialist at Raunheim/ Rüsselsheim City Services, Hesse/Germany

“Safety is our number one priority. We maintain a network of sewage pipes around 350 kilometers in length, together with the pump stations. This often involves the sewage workers inspecting underground systems. In such cases, they carry a mobile gas detector and a self-rescuer. A colleague secures them with a cord. I know how important such safety precautions are – to protect us from sewer gases and other hazardous substances that we may encounter in the sewer network. At the vocational college we also learn about the physical and chemical background to our work. The job is extremely diverse and technically demanding. This is also evident in our “helicopter” – an orange and red four-axle truck designed specifically for sewer work. It is named after a helicopter because its jib can spin on its own axis with the flushing hose. We don’t just carry out inspections, maintenance, and cleaning work underground, but also take care of natural sites, where surface water collects and drains off. The thing I find interesting about the sewer network in both of our cities is the fact that you can see how they have developed over the years. Some areas are older than others and the technical design is completely different – and the development continues. The sewer system is growing along with the new residential and commercial areas – like a city beneath the city.”

DRÄGER REVIEW 119 | 1 / 2019 5 FOCUS RAW MATERIALS THE BIG The global economy’s insatiable demand for RAW MATERIALS is compelling mankind to remain resourceful – from intelligent recycling and underground robots to planning for asteroid mining. Text: Steffan Heuer TRE

lars in the automation of its railroad network in Australia’s Pil- bara, a sparsely populated region and uncultivated wilderness I covering an area thousands of square kilometers in size. This is In mid-July 2018, the world’s longest and biggest robot set off where 200 locomotives transport ore from 16 mines to four dif- on a journey in North Western Australia. The locomotive was pull- ferent ports. As part of the “AutoHaul” program, trains and rail- ing 28,000 metric tons of iron ore from the mine in Tom Price road crossings have been fitted with cameras, and monitoring to the port in Cape Lambert. The fully autonomous goods train software has been developed. As a result, the employees in the belonging to the mining corporation Rio Tinto was monitored by control center only occasionally have to check the situation on a control center located around 1,500 kilometers away in the city the ground. The robots in the outback are just one chip in the of Perth. It was the first time that such a ghost train had made global game of resource roulette. The growing global population a journey with nobody on board, marking an important test run is striving for material prosperity, for which a constant and grow- for establishing how resources can be mined and transported ing supply of resources is needed. This is also the reason why more safely, quickly, and cost-effectively in the future. According there is a danger of a gap soon opening up between supply and to its own figures, Rio Tinto is investing almost one billion dol- demand for many minerals, which is pushing up prices and stok-

PHOTO: RIO TINTO, 2018 RIO TINTO, PHOTO:

6 DRÄGER REVIEW 119 | 1 / 2019 ASURE HUNT

Ghost train: These days, people merely look on from the control center as thousands of metric tons of iron ore are transported by fully automated goods trains – like here in Australia – to terminals on the Pacific coast

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79 This metal has the greatest attractive force – on explorers, moneymakers, Au GOLD and jewelers. It provides the best connections in the field of electronics. Aurum 196,967 QUANTITY MINED IN 2017: Globally 3,150 t; China 440 t; Australia 300 t; USA 245 t ABUNDANCE: 0.004 ppm (ranked 72 by parts per million in the earth’s crust) – worldwide reserves: 54,000 t USE: Gold is one of the first metals that mankind worked on. It has been a coveted material for ritual objects or jewelry for thousands of years and was used as a payment method as early as 600 BC. The precious metal is soft and easily malleable. It remains highly desirable to this day. PRICE TREND: Its function as a manufacturing material and stable financial investment is constantly driving up the price of gold to 1,355 dollars per troy ounce (2018).

ing fears of shortages. It is by no means a question of raw materi- ly packed lithium-ion cells have contributed to soaring demand. als running out in the foreseeable future, but rather a question of At present, 42 percent of global production is used to manufac- how and where the right quality of such materials can be found, ture batteries, primarily in the automotive industry. The new efficiently mined, processed, and ultimately recycled. When it Tesla Model 3, for example, contains around 4.5 kilograms of comes to the life cycle – from the mine to the garbage heap – cobalt, while the first version of the Model S contains 11 kilos. there is a high level of economic, geopolitical, and ecological Even though engineers are getting more economical and chem- interest. Germany alone imported raw materials worth 61.8 bil- ists are working on developing new kinds of batteries without lion euros in 2016, with the country almost completely reliant the “bewitched element,” experts have been warning of short- on the import of metals. Meanwhile, in the US minerals worth ages for quite some time. The International Energy Agency (IEA) 75 billion dollars were produced in 2017 (this figure does not expects the number of electric vehicles to rise from today’s fig- include energy sources such as oil, gas, and coal). ure of three million to at least 125 million by 2030. A striking example of the unpredictable nature of the relationship is the element cobalt, which experts from the United The hunger for raw materials States Geological Survey (USGS) rate as “critically important” to is becoming a problem the global economy. The gray and malleable heavy metal enjoyed “The future of electric vehicles depends on the demand for a stellar career very early on: Long before chemistry became an scarce resources,” say the IEA experts in their report on electric exact science, cobalt ore and other compounds were already well- mobility published in May 2018. “The shift to electric vehicles known and used as heatproof blue pigments for dyeing glass, will increase demand, especially for cobalt and lithium. Ongo- ceramics, and porcelain. Archaeologists have discovered it in ing developments in battery chemistry aim to reduce the cobalt Egyptian statues, Persian jewelry, and Chinese vases. Cobalt’s content.” Yet even then, warn the experts, demand in the auto- name dates back to the superstitious Middle Ages when people motive industry is expected to be 25 times higher by 2030. There thought it was silver or copper ore, only then to discover that is already little leeway between demand and production. Accord- it was difficult to work with and gave off noxious vapors when ing to a study, the global demand for cobalt in 2017 was around heated. So what could be more obvious than suspecting the 136,000 metric tons and is set to double to 272,000 metric tons kobolds of having eaten the would-be valuable silver and cast an by 2025. Production of new cobalt plus recycling amounted to evil spell on it? Only in 1735 did a Swedish chemist examine the between 127,000 and 140,000 metric tons and is expected to rise metal more closely and give it its name. to between 250,000 and 265,000 metric tons by 2025. Demand It is no longer possible to imagine many key industries cop- for electric vehicles is the big unknown quantity here. “There ing without cobalt, because it is ferromagnetic and heat-resistant, will probably be sufficient material available on the market until doesn’t corrode, and is a good conductor of both electricity and 2025. However, if an aggressive growth scenario occurs, cobalt heat. Its widespread use began in the early 1990s when the first could become scarce by as early as 2022,” warn the consultants. lithium-ion batteries came onto the market. Thanks to a com- The German Mineral Resources Agency is similarly concerned. paratively high energy density, these cells are especially suitable Even though the precise figures fluctuate depending on which for mobile applications – from the laptop to the electric vehicle. expert is asked, the general forecast tends to be much the same In particular, the many new cars with their thousands of tight- and explosive for two reasons. With such a thin buffer between

8 DRÄGER REVIEW 119 | 1 / 2019 When progress moves entire mountains

The Super Pit in Australia’s outback is 3.5 kilometers long, 1.5 kilometers wide, and more than 600 meters deep. Around 28 metric tons of gold are mined here annually

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PHOTOS: CARLA GOTTGENS/BLOOMBERG/GETTYPHOTOS: ISTOCK IMAGES, Treasures four kilometers underground

On a long leash: Initial tests in the Pacific by companies like Nautilus Minerals have shown that valuable resources such as copper and silver can be mined on the sea bed using robots

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PHOTOS: NAUTILUS MINERALS (2), HEINRICH PNIOK (WWW.PSE-MENDELEJEW.DE), LICENSE: FAL HTTP://ARTLIBRE.ORG/LICENCE/LAL/DE MINERALS NAUTILUS (2), HEINRICH PNIOK (WWW.PSE-MENDELEJEW.DE), LICENSE: FAL PHOTOS: RAW MATERIALS FOCUS

27 The material that provides the blue color used in ceramics, glass, and paint. Co COBALT It is now indispensable for the production of high-powered batteries. Cobalt 58,933 QUANTITY MINED IN 2017: Globally 110,000 t; Congo 64,000 t; Russia 5,600 t; Australia 5,000 t ABUNDANCE: 25 ppm (ranked 32 by parts per million in the earth’s crust) – worldwide reserves: 7.1M t USE: Cobalt is an important by-product of copper and nickel mining. The gray and malleable heavy metal is ferromagnetic, heat-resistant, and doesn’t corrode. Accordingly, it is hugely important to key industries such as aircraft manufacturing and the automotive industry. Around 40 percent of global production is used for batteries, including in electric vehicles and smartphones. PRICE TREND: Following fluctuations in the 1970s and 1980s, the price of the heavy metal is once again rising sharply; since 2013 it has risen from 24,424 dollars per metric ton to 80,491 in 2018.

supply and demand, the price is subject to wild fluctuations. they want to examine the question of short-ages. “The prospect of The price of cobalt rose from around 24,000 dollars per metric running out of resources is a popular subject for public debate, ton in 2013 to around 80,000 dollars in 2018 – also due to spec- although there is no urgent need to make any hasty decisions,” ulators who, in anticipation of a sustained boom, are stashing says Eggert in a reassuring manner. “I am more worried about away the material in the same way as conservative savers hoard the fact that we are mining a growing number of resources of their gold. This doesn’t mean that we will soon run out of cobalt. inferior quality. We are moving more rocks and using more water Known global reserves total 7.1 million metric tons. and energy to do so.” This involves considerable economic and ecological costs – unless technological innovations can improve When will there be a shortage efficiency in the field of mining and mineral extraction. This of certain resources? especially applies to the minor metals such are rare earth ele- Geologists suspect that there is considerably more cobalt in the ments – a group of 17 metals found in the earth’s crust that first earth’s crust on the seabed of the Atlantic, Pacific, and Indian have to undergo complex procedures to isolate them before they Oceans. Aside from the speculative bubble surrounding cobalt can be further processed. Their reserves are concentrated in and lithium, both of which are essential elements in the pro- China. The economist also mentions unusual elements such as duction of batteries, geologists are also concerned about oth- neodymium, a base material for permanent magnets found in er resources, but equally warn against scaremongering. Around smartphones and motors. 80 percent of the cobalt produced in the world currently comes “It is often the case that no more than a few hundred or from the Congo. Chinese mining companies recently secured a thousand metric tons of these metals are produced each year,” majority shareholding in one of the biggest mines there, along explains Eggert. “A new application area can quickly lead to with exploration rights to another site. These are strategic invest- a surge in demand and drive up prices. This uncertainty can ments. China is the world’s biggest vehicle market and there are cause manufacturers not to use this resource.” In other words, already 500 manufacturers of electric vehicles here. Companies the innovative strength of an economy can be impaired by such as Tesla and Daimler are building their own battery facto- ries. That is why experts at Germany’s Federal Institute for Geo- Valuable nodules: sciences and Natural Resources in Hannover look toward the Robotic arms harvest future with as much concern as their US colleagues. “From a polymetallic nodules off the coast of purely geological perspective, we consider the supply of mineral Papua New Guinea. The resources to be largely secure,” they write. In the short to medi- deposits, which have um term, however, there may be shortages in terms of the techni- built up over thousands cal supply. So when will there be a shortage of certain resources? of years, are rich in copper and cobalt This question concerns economists like Roderick Eggert. He is a professor at the School of Mines in Colorado and the deputy director of the Critical Materials Institute. The CMI is an association of raw material companies, universities, and public research labora- tories under the aegis of the US Department of Energy. Together

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29 In the history of human evolution, this metal lent its name to Cu COPPER the Copper Age, the period between the Stone Age and Bronze Age. Cuprum 63,55 QUANTITY MINED IN 2017: Globally 19.7M t; Chile 5.33M t; Peru 2.39M t; China 1.86M t ABUNDANCE: 60 ppm (ranked 26 by parts per million in the earth’s crust) – worldwide reserves: 790M t USE: Alongside gold, silver, and tin, copper was one of the first metals that humans learned to make use of. The soft metal is used in pure or alloyed form for electrical and electronic installations. Due to its high conductivity, it is particularly suitable for heat exchangers, cables, jump wires, electrical machines, and motors. PRICE TREND: Copper has experienced price peaks since the 1970s. In the fall of 2018 the price was around 5,700 dollars per metric ton; in 2016 it was 4,800 dollars.

actual or perceived shortages, because people do without certain products or switch to other resources. Experts like Eggert Safety underground: keep a constant eye on the balance between supply and demand to ensure that it doesn’t come to this. They try to sort raw mate- Breathing protection: rials by their geographical concentration, growth forecast, and Dust, aerosols, and toxic price trend. In March 2016, for instance, a US committee of gases can be released when experts produced a hit parade of “critical minerals.” Ultimate- mining and processing ores. Dräger supplies both filter- ly, 17 elements exhibited sufficient risk factors to be included on ing breathing protection and the red list – from yttrium and mercury to wolfram and cobalt. compressed airline equipment The latest state of knowledge must firstly be cataloged in order for use in hazardous areas to draw the right conclusions from this and start searching for (including the Dräger X-plore 3500 half-mask). substitutes. That is why Germany’s Federal Ministry of Educa- tion and Research has developed a research and development program involving “economically strategic resources for Germa- ny as a high-tech location.” The aim is to link German research- Escape: The bigger and deeper the mine, ers to colleagues all over the world, improve the acceptance of the more complex the escape raw material extraction, and enhance training and profession- and emergency concept. Dräger al development. The focus is on “metals and minerals that play supplies a wide range of solu- a pivotal role in the economy and have to be available to us in tions – from the personal escape apparatus to the refuge chamber. sufficient quantities for future technologies.” It is already clear The MRC 5000 (right) provides that the continuing growth of the global population and the protection for between eight and associated rise in industrial manufacturing necessitate a secure 20 people (for up to 96 hours). and reliable supply, particularly when it comes to the important resources. According to the World Economic Forum, China Ventilation: alone consumes 57 percent of all the nickel and 50 percent of all Clean breathing air provides the basis for working the steel and copper. Since copper is in demand for all kinds of safely underground, yet it soon becomes a significant products (from wires to semiconductors), experts expect glob- cost factor. The more sprawling and complex the al demand to outstrip supply within ten years. mine, the more carefully the supply of breathing air must be planned and monitored. Both stationary This brings us back to the role of mining companies. and mobile gas detectors are used here, including From Rio Tinto and Codelco to BHP, Glencore, and Freeport- the X-am 8000, which simultaneously measures McMoRan, they are all facing the same challenges: deeper, fur- up to seven toxic and combustible gases and vapors ther, pricier. “Mines are getting older and going even deeper as well as oxygen. underground, while the production and concentration of ores is sinking,” says Rüdiger Leutz, CEO of Porsche Consulting in Brazil. The consultancy works with, among others, Codelco , the

12 DRÄGER REVIEW 119 | 1 / 2019 Robots help in the hunt for copper

Deeper, further, pricier: Codelco in Chile is the world’s biggest copper producer. Mines like this one in the Atacama Desert are being excavated ever deeper and further and operated with robotic vehicles in order to satisfy the global demand

PHOTOS: CODELCO, DRÄGERWERK AG & CO. KGAA & CO. (3), ISTOCK AG DRÄGERWERK CODELCO, PHOTOS:

world’s biggest producer of copper from Chile, which operates concerned. In some Australian mines, for instance, intelligent seven mines in the country and produced almost two metric helmets are already being used, which record the brain- megatons of copper in 2017. Even though Codelco operates what waves of drivers and warn them of fatigue. Leutz explains that a is now the world’s biggest copper mine in El Teniente, which great deal more can be done with the acquired data to increase boasts over 3,000 kilometers of underground tunnels, the qual- productivity. Mine planners can identify the critical points on ity of copper ore is diminishing. The quality has almost halved roads and ramps and thus take measures to moderate danger- since 1990. On top of this, there is the lack of trained personnel ous inclines, bends, or intersections. capable of handling the latest technology. Thirdly, says Leutz, mining companies are not only under commercial pressure, Gold on the garbage heap but must also meet stricter requirements in matters relating to There is another key factor involved in the relationship between environmental protection and safety regulations. “The answer supply and demand: How to take a sustainable approach to de- to these challenges lies in digitalization, automation, the inte- vices that have already reached the end of their useful life. Those gration of data streams, and process optimization.” According- who collect old cell phones, computers, and batteries and prop- ly, Codelco and its competitors have ordered a modernization erly separate and recycle their components can prevent met- program. Priority has also been given to artificial intelligence als, precious metals, and rare earth elements from ending up and drones studded with sensors. This not only helps to locate on a landfill site forever. More than 7,500 metric tons of sil- new deposits, but also mine existing minerals using less ener- ver and 320 metric tons of gold are used annually around the gy and water. Artificial intelligence monitors and maintains world for manufacturing electronic devices. Their value adds huge drilling machines underground before they break down. up to around 21 billion dollars. If electronic waste is exported Such developments are inexorable even where we humans are to a developing country, only half of the valuable components

DRÄGER REVIEW 119 | 1 / 2019 13 Treasures also The ongoing recycling problem: The more electronics humans use and lie dormant in dispose of, the higher the mountains of electronic waste grow – like here in Wuhan, China, it can be recycled in- old electronics stead of ending up on the garbage heap

PHOTOS: PICTURE ALLIANCE/REUTERSPHOTOS: (2), DNN87/WIKIMEDIA

are generally recovered. However, if the devices are recycled in it possible to not only recover metals, but also split composite a modern economy, the recovery rate for gold, for example, is materials in a contactless process at the interface of the differ- 95 percent. When looked at in this way, there is a little mine in ent materials, including compounds of lithium, nickel, cobalt, every modern cell phone. and manganese, high-quality carbons, and alloys made of earth The US Environmental Protection Agency (EPA) has done elements. Since the number of electric vehicles will continue some calculations: Almost 16 metric tons of copper, 359 kilo- to rise, countries such as Japan and China are currently devel- grams of silver, 34 kilograms of gold, and 15 kilograms of palla- oping concepts for their own infrastructure in order to create dium can be recovered from one million recycled smartphones. the widest possible network of recycling points for old batteries. According to the Institute of Scrap Recycling Industries (ISRI), The People’s Republic presented a corresponding standard for there is as much gold in one metric ton of old computers as municipalities and vehicle manufacturers and in Japan the first there is in 17 metric tons of ore. These quantities soon add up, recycling factory for car batteries opened in March, not far from because in the US alone around 4.5 million metric tons of elec- the site of the nuclear reactor disaster in Fukushima. There are tronic waste is disposed of each year. Global research is being even hidden treasures in plastic. Another project set up by the conducted to find ways to return valuable resources to the cycle. Fraunhofer Institute for Process Engineering and Packaging is The Fraunhofer Institute, for example, is working on a new pro- examining the question of how the critical metals antimony and cess called NEW-BAT with several companies from the recycling, titanium can be rescued from old devices before they end up on battery, and plant manufacturing sectors in order to improve the garbage heap. Both are contained in the additives for plas- the recycling of battery components. This involves shredding tic housing, among other things; the former as a flame retar- lithium- ion batteries in a water bath using shock waves, making dant, the latter as a white pigment. The Add Resources project

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3 Initially only used as a lubricant, it has become ever more important Li LITHIUM and is now accelerating e-mobility with lightweight batteries. Lithium 6,94 QUANTITY MINED IN 2017: Globally 43,000 t; Australia 18,700 t, Chile 14,100 t; Argentina 5,600 t ABUNDANCE: 20 ppm (ranked 33 by parts per million in the earth’s crust) – worldwide reserves: 16M t USE: The rise of e-mobility and smartphones and other connected devices would be inconceivable without this soft, silvery white light metal, because (almost) nothing works without the standard lithium-ion battery these days. Lithium is mixed with many different materials to make it harder and more elastic and durable. PRICE TREND: Lithium continues to get more expensive; the price rose from 1,550 dollars per metric ton in 2003 to 16,500 dollars in 2018.

investigated the recyclability of metals and reached the conclu- images of hydrothermal vents that bubble from the fissures in sion that the stumbling block is essentially neither the tech- the earth’s surface beneath the ocean. Towering smokestacks nology nor the economic viability. Project manager Dr. Mar- form as soon as the black mineral clouds cool down. But who is tin Schlummer considers the biggest hurdle to be insufficient allowed to go prospecting underwater? According to the Unit- action – a lack of the requisite recycling infrastructure in Ger- ed Nations Convention on the Law of the Sea, nations can lay many to separate plastic containing flame-retardant material claim to a so-called exclusive economic zone for all resources from other types of plastic, for example. The more the garbage within 200 nautical miles (around 316 kilometers) of their coast, heaps grow, the more pressing the problem becomes. While Chi- including the raw materials that are lying dormant several kilo- na and India accept the most electronic waste from around the meters below the surface. world, one million metric tons of old electronic devices pile up each year in West Africa alone, according to the calculations of Deep-sea mining: treasures on the seabed the United Nations – with little prospect of sustainably recover- Responsibility for the management of the huge deposits of man- ing the valuable components. Since humans will produce about ganese, cobalt, nickel, and copper in international waters has three billion metric tons of waste by 2030, experts are thinking been assigned to the International Seabed Authority (ISA) based about urban mining – the process of obtaining valuable metals in Jamaica, even though it continues to work on the fine detail from urban garbage heaps. of the guidelines for mining: “Commercial deep-sea mining will The search for mineral resources doesn’t stop on terra firma. begin within the next five years,” says the Californian geologist Geologists at the USGS have been devoting their time to miner- Dr. James R. Hein, who heads the USGS’s Global Ocean Miner- als in the deep sea since the 1970s. Marine researchers brought al Resources project. The ISA experts have defined three main strange nodules to the surface as early as the nineteenth centu- categories for undersea resources: polymetallic nodules, poly- ry and deep-sea cameras are constantly delivering impressive metallic sulfides, and ferromanganese crusts. The last resources on this list are the result of volcanic activity and are therefore rich in cobalt and nickel. They can be found in shallower waters from a depth of 400 meters and are thus often located in the Consumer society: There exclusive economic zone of individual countries. “There are is a little mine in still plenty of unanswered questions, but it is highly likely that every smartphone – the resources on the seabed exceed the deposits on land,” says if manufacturers Amy Gartmann, marine researcher and USGS project manager recover the gold and silver integrated Hein’s second in command. Experts estimate that around 21 bil- within them lion metric tons of polymetallic nodules lie in the Clarion-Clip- perton Zone in the Pacific alone. They can be between two and twenty centimeters in size and – in addition to manganese and iron – contain traces of coveted elements such as nickel, copper, cobalt, and rare earth elements. Some countries have already begun the initial experiments for mining underwater. Japan, a

DRÄGER REVIEW 119 | 1 / 2019 15 FOCUS RAW MATERIALS

60 This material is used for extremely strong permanent magnets, Nd Neodymium like those used for high-powered wind turbines or hard drives. Neodymium 144,242 QUANTITY MINED IN 2017: Rare earth elements approx. 130,000 t (of which just neodymium: around 7,000 t); China 105,000 t; Australia 15,000 t; Russia 2,800 t ABUNDANCE: 42 ppm (ranked 28 by parts per million in the earth’s crust) USE: Neodymium belongs to the group of rare earth elements, which only occur in conjunction with other metals. Their extraction is associated with considerable environmental problems. The metal is used as a neodymium-iron-boron alloy for powerful permanent magnets, which are essential components in the electronics of smartphones and autonomous vehicles, among other things. That is why Western industrial nations are concerned that more than 80 percent of rare earth elements are mined in China. PRICE TREND: The price of neodymium has continued to rise sharply over the past two decades – it cost around 15,000 dollars per metric ton in 2009, by 2011 it had risen to 250,000 dollars, and in 2017 the price was hovering around 95,000 dollars.

country dependent on imports, hit the headlines in September the science is in the early stages. Another side effect of the min- 2017 when it sunk a yellow caterpillar vehicle off the coast of ing is well known on land: slag heaps and sewage ponds where Okinawa, which brought several metric tons of ore to the surface metals and acids accumulate before eventually ending up in from a depth of 1,600 meters. According to the government, the the environment. The same can occur when releasing sulfides haul included gold, copper, lead, and zinc. Commercial mining underwater, warns Gartman. Nobody knows how much addi- is set to begin in the Pacific in 2020, because Japanese research- tional acidity the sea can buffer. “It depends on the scale of the ers have discovered a total of six ore deposits in the area around work being carried out underwater.” Whether we humans can Okinawa and believe that there is as much zinc in one of the really satisfy our continuing need for metals in the depths of the fields as Japan’s industry uses in a year. A second project off the world’s oceans also depends on the economic viability. And it is coast of Papua New Guinea is not going quite as smoothly. Test by no means certain, as Richard Roth, professor of material sci- excavations at a depth of 1,600 meters beneath the Bismarck ences at Massachusetts Institute of Technology (MIT), has cal- Sea have uncovered copper, gold, and silver. The Canadian firm culated. He presented the findings at a meeting of the Seabed Nautilus Minerals, which has the backing of investors from Rus- Authority in March 2018 in Jamaica. His report states that the sia and Oman, wants to mine the metals. The government in initial investment for a hypothetical deep-sea mine would cost Port Moresby has issued the licenses needed to begin mining in between three and four billion dollars, plus between 600 million the Solwara One field at the end of 2019. However, the project and 1.1 billion dollars annually for ongoing operations. has been met by protests organized by local resident initiatives. The lion’s share of the costs is not attributable to a floating They are concerned that the underwater mining could stir up metallurgical factory, but a plant on the mainland where nickel, huge amounts of sediment. copper, cobalt, and manganese have to be painstakingly extract- ed, predicts Roth. The mineral quartet makes up 30 percent of “Humanity’s shared legacy” the nodules taken ashore. From an annual haul of three million The largely unknown environmental consequences are one of the many unanswered questions surrounding the hunt for raw materials on the sea bed. “Deep-sea biologists have begun to take Well-drilled: A NASA an interest in the subject. They want to know what lives down mission is set to start there and how it would be affected by the mining,” says USGS in 2020 to reach the marine researcher Gartman. Anyone who brings metalliferous Psyche asteroid, which crusts or nodules to the surface on a large scale will inevitably revolves around the sun between Mars and stir up huge amounts of silt. Researchers have only just begun Jupiter. The aim is to to catalog the worms, fish, and snails that have made places examine potential nickel like hydrothermal vents their homes. On one of her latest expe- and iron deposits ditions, Gartman and other marine researchers released artificial sediment clouds in the Pacific Ocean off the coast of San Diego and used a 3D sonar system to record how the particles dif- fuse underwater and where they settle on the seabed. Here, too,

16 DRÄGER REVIEW 119 | 1 / 2019 Universally present: Scientists have identified around 1,000 asteroids on which space mining may be worthwhile. NASA is already practicing how to mani pulate rocks weighing several metric tons with robotic grippers here on earth

Robots that catch asteroids

PHOTOS: NASA, MAURITIUS IMAGES/NASA/ALAMY, DORLING KINDERSLEY/RUTH NASA, MAURITIUS IMAGES/NASA/ALAMY, PHOTOS: JENKINSON/RGB LIMITED RESEARCH

metric tons of deep-sea nodules, an estimated 6,375 metric tons orbiting in the solar system. At least 1,000 of them are of inter- of cobalt and 32,400 metric tons of copper would remain. Such est to companies such as Deep Space Industries and Planetary a mine would generate an annual turnover of almost 2.4 billion Resources, because they are big and close enough to the earth dollars, which is no guarantee of being in the black given the and contain valuable minerals. Luxembourg has already passed fluctuating price of many metals. The biggest question for Roth, a law that gives operators of future mines in space the go-ahead however, is how to fairly distribute the expected profits among to reap their extraterrestrial profits. Planetary Resources keeps the operating companies and their investors, nations to whose the Asterank database, in which more than 600,000 asteroids jurisdiction they are subject, and “humanity’s shared legacy.” are listed in detail, together with their natural resources and After all, unlike mines, the oceans belong to everybody. That is economic value. NASA is planning to send a probe to the Psyche why not all experts are convinced that the future lies on the sea- asteroid in 2022, which revolves around the sun between Mars bed. “The technical hurdles are dauntingly high and it is hard and Jupiter. According to astronomers, it is the core of a former to imagine that we will ever extract raw materials from here planet that is made up of nickel and iron. So it is little wonder on a large scale – apart from maybe high-quality resources,” that Chris Lewicki from Planetary Resources recently stated that says the economist Roderick Eggert, voicing his concern. “The “the next Iron Age will occur in space.” subject is as exciting as a science fiction story, but we should always bear in mind that only some science fiction ultimately Recycling at Dräger: becomes reality.” When viewed in this way, it seems somehow Whether gold, aluminum, or soda lime, many devices remain valuable even at the reassuring that mankind already has the next goal in its sights: end of their life cycle. asteroids, the moon, and other planets. Millions of asteroids are www.draeger.com/119-17

DRÄGER REVIEW 119 | 1 / 2019 17 FOCUS RAW MATERIALS

3,305,000 Scarce Resources They make it possible to manufacture a wide range of goods: METALS can be found in a variety of different products, including smartphones, cars, and packaging.

Metals have fascinating properties, future, such as cobalt. The graphs answer during processing as well as when in questions relating to the origin of the met- use. They are indispensable in today’s als, the quantities mined, and how they world. They provide buildings with sta- are used. The limited supply is a remind- s ear bility, make aircraft lightweight, and er to use metals carefully and consider 7 y 22 they drive electronics and electric cars. recycling, which is making progress every- Metal ore deposits are distributed across where. Even though today’s recoverable different parts of the globe. Some (often reserves and existing resources are limit- politically fragile) countries have a virtual ed, mankind has proven to be quite flexi- monopoly on certain metals with a big ble in this regard!

Mining Annual extraction of the most important Origin The five metal ores (in 1,000 metric tons; 2017). As chemical elements, most important mining regions some belong to the groups of metalloids and transition metals. for each metal and the percen tage of the total global

production mined. 3

a 3

8 s

r s 60,000 31,000 19,700

1 ,2

13,200 0 0 4,700 y ea rs 2,100 290 290 150 110 64 43 25 3.15

Iron ore Aluminum Chromium Copper Zinc Lead Nickel Tin Molybdenum Antimony Cobalt Niobium Lithium Silver Gold 39% CHN 54% CHN 48% RSA 28% CHI 39% CHN 51% CHN 19% INA 35% CHN 45% CHN 73% CHN 58% COD 89% BRA 43% AUS 22% MEX 14% CHN 26% AUS 6% RUS 17% KAZ 12% PER 11% PER 10% AUS 11% PHI 18% INA 20% CHI 9% TJK 5% RUS 9% CAN 33% CHI 18% PER 10% AUS 13% BRA 5% CAN 10% IND 9% CHN 10% IND 7% USA 10% CAN 18% MMR 15% USA 5% RUS 5% AUS 1% RUS 13% ARG 10% CHN 8% RUS 6% IND 5% IND 9% TUR 6% USA 8% AUS 6% PER 10% NCL 9% BRA 9% PER 3% AUS 4% CAN 1% COD 7% CHN 6% RUS 8% USA 3% RUS 4% UAE 3% FIN 5% AUS 6% USA 5% RUS 9% AUS 6% BOL 4% MEX 2% TUR 4% PHI 2% ZWE 5% BOL 6% CAN

18 DRÄGER REVIEW 119 | 1 / 2019 Purpose Recycling The most important The percentage of

Tins Paint Steel Glass Cable applications for the recycled material used Jewelry Vehicles Batteries selected metals. in metal production. Machinery Solar cells Packaging Electronics

Fire retardantChrome steel

Building material Other metal alloys

Aluminum 51%

Chromium 31%

174 years Lithium <1% 14 4 ye ars

Cobalt 33%

9 Lead 60% 0 y e a Resources The length of time r s left until all currently known deposits are exhausted. These estimates are based Zinc 40% on unchanging conditions in terms of mining, consumption, and recycling. Iron ore 52%

ROM 2017, ALL FIGURES ROUNDED AND PARTIALLY ESTIMATED AND PARTIALLY ROUNDED 2017, ALL FIGURES ROM

a 7

2 Niobium 30%

e y

1 s 5 rs r Nickel 39% ea a 8 y e Tin y

rs 0 ea 4 11 y rs a rs Antimony ye a 17 ye 1 Gold 2 Molybdenum 30%

Silver

Copper F PRIMARILY DATA BGS, BGR, UNEP. USGS, SOURCES: IFFHAUER; Copper 42% Molybdenum

Nickel

Niobium Silver 20%

Iron ore

Zinc Gold 30% Lead

Cobalt Antimony 25% Lithium

Chromium

Aluminium Tin 25%

DRÄGER REVIEW 119 | 1 / 2019 19 INFOGRAPHIC: KLAIBER BEOBACHTER/ANDREA AND ANNE SEEGER; TEXT: NILS SCH Tradition

Training: Listening to the heart and lungs, taking the temperature – the trainees soon forget that it is only a virtual patient lying in front of them

20 DRÄGER REVIEW 119 | 1 / 2019 ASIA HOSPITALS Meets Modernity Insights into Chinese hospitals are rare, especially outside the big cities on the east coast. Yet Professor Wei Tiemin proudly shows people around the LISHUI MUNICIPAL CENTRAL HOSPITAL – and provides insight into the management and daily work that goes on here.

Text: Nils Schiffhauer Photos: Patrick Ohligschläger

T The rhythmic screech of the cicadas can be heard outside the open window, through which the fresh morning air wafts, providing an indication that it will be tropical in just a few hours’ time – with a temperature of 36 degrees Celsius and more than 60 percent humidity. The view stretches beyond high-rise buildings as far as lush green mountains that will soon disappear in the haze. On the floor is a selection of wall tiles. A slim gentleman enters the meeting room. For the past twenty years, Professor Wei Tie- min has been president of the biggest hospital in Lishui, a city with a population of around 2.5 million people in Zhejiang province, roughly a three-hour express train journey southwest of Shanghai. “We are a central municipal hospital as well as a school of medicine attached to Zhejiang University,” he explains. Lishui Municipal Central Hospital is one of around 30,000 hospitals in the People’s Republic of China and also one of the most modern.

Responsible for 3,000 employees They have a great deal here: from the emergency department by the entrance to state-of-the-art imaging techniques such as mag- netic resonance imaging (MRI) and positron emission tomog- raphy (PET). There is also a dental clinic, along with a number of different rooms for teaching, training, and conferences. The 60-year-old is proud of what has been achieved. “Our hospital was founded in 1971, initially as a small clinic that entered

DRÄGERHEFTDRÄGER REVIEW 404 119 | 2/| 20181 / 2019 21 At eye level: Concentrated expressions that say more than words – they are like a drill before the impending operation to which these doctors are heading

People and their relationship with one another are crucial

22 DRÄGER REVIEW 119 | 1 / 2019 ASIA HOSPITALS

service two years later. Today we have 1,650 beds; around 18,000 people pass through our doors every day,” says the man responsible for 3,000 employees, who has actually already reached the retirement age for doctors in the country, but has extended his contract at his own request as well as that of the city and university. Professor Wei says that there are two reasons why the hospital has grown to encompass around 45 departments, including ophthalmology, a tumor center, cardiac surgery, neurology, and nephrology: “On the one hand, the population of our city has mushroomed; on the other, the introduction of health insurance in China has led to a greater influx of people to the specialist hospitals.” Professor Wei not only has his eye on the hospital’s growth in terms of patient numbers. He has also guided it to a leading position with the right equipment – primarily, of course, with Real composure: Professor Wei Tiemin has made Lishui Municipal diagnostic technology (including, for example, “one of the most Central Hospital one of the most modern of its kind in the modern automated laboratory systems in the whole of Asia”) and region. The secret of its success lies in the professional expertise of the cardiologists, good employee management, and networking therapeutic equipment, as well as a sophisticated training program for its employees, which includes analyzing medical findings with the aid of virtual reality. Also striking is the interior architecture, which has been carefully coordinated both in terms function is downright impressive – including the compartment of its practicality as well as its design and color scheme. “Yes,” tailored to accommodate the large thermos flasks of hot water says Professor Wei, pointing to the tiles on the floor, “I initial- that are indispensable in the country. “I had a pullout drawer ly studied architecture before switching to medicine for health fitted underneath to catch the dripping water.” It may be just reasons and becoming a cardiologist.” Later, during a tour of one small detail, but it also serves as an example of how he effi- the VIP ward on the 25th floor, he points out a bedside cabinet ciently manages the hospital on a day-to-day basis. that he developed, which is patented in China, whose form and More than 4,000 medical devices Professor Wei has summarized his experiences and recommen- dations in a book: Detail-Oriented Management of Hospitals. While China’s typical five-year plans set the strategic and financial framework, the hospital president is able to concentrate primarily on managing his employees on a daily basis. “We get most Order and discipline are part of the Chinese desire for of them from the reservoir of 2.5 million people in our city and harmony. This is no different by the beds on the intensive care unit (below) to nature’s seemingly randomly arranged train them here,” he says, before going on to say that the peo- greeting (left). After all, mankind is just another part of nature ple and their relationship with one another are a crucial aspect of managing a hospital. Among these people are also heart specialists. Professor Wei opens the door to a room in which human organs stand tightly packed next to one another, preserved in a fluid produced in a special department. He points to the cross section of a large, calcified heart. “The man from whom we removed this heart before implanting another continues to enjoy the best of health to this day!” In a figurative sense, the technical equipment must also be in the best of health. “Together with a team of ten engineers,” he explains, “I am responsible for ensuring that more than 4,000 medical devices work correctly.” These devices are becoming ever more efficient, but also more complex. As such, the smooth service provided by the manufacturer plays a key role. So it is little wonder that he warmly welcomes

DRÄGER REVIEW 119 | 1 / 2019 23 Ever ready: Dr. Xin Tian manages the intensive care unit with 29 beds – equipped with the latest medical technology

the arrival of Ni Jianwei. Until recently the engineer was responsible for servicing the Dräger equipment in this hospital and clearly carried out his work to the satisfaction of everybody. “Like many people, we Chinese also don’t like waiting,” says Ni. “If they need us, they contact a call center, which in turn informs the relevant Dräger Service employee.” This person then immediately gets in touch to get to the bottom of the problem and solve it, even in the middle of the night or at the weekend if need be, because “most of the equipment remains where it is, such as in the operating room or on the intensive care unit.”

The washing machines had to go The intensive care unit is managed by Dr. Xin Tian. “We have 29 beds here and a further eight beds on another unit,” explains the 45-year-old. His unit is also equipped with state-of-the-art medical technology, although even at first glance it differs from ria, of course, it is the spirit: a general openness as well as a other intensive care units. It is much brighter and more open. certain sense of calm in spite of the workload. And the laundry Visiting and supporting relatives also tend to paint a portrait room, where the patients or relatives can wash their clothes in of a completely normal unit. “Technology helps to save lives a large basin. “We initially equipped it with washing machines, here,” says the doctor, pointing out the many different Dräger but for reasons of tradition they weren’t used or accepted,” venti-lators, “but technology alone isn’t everything in China.” recalls Professor Wei. Tradition in China is also due to the Traditional Chinese medicine (TCM) also plays a major role. commitment of the doctors in the area of prevention, even though “We achieve good results with it – among those who present with legend has it that doctors were once paid only for as long as their stomach complaints, for example,” says Dr. Xin, and even sees a patients remained healthy. Nowadays, lifestyle diseases such as growing trend in the use of TCM, a form of treatment that is obesity and diabetes are rampant. “We inform the population constantly regenerating itself. Yet it is not just the demand for of the risks, primarily in schools. We have to identify diseases TCM that is growing. “Overall, our patient numbers are set to as early as possible to maintain an efficient health care system. grow further over the coming years,” says Professor Wei. The In addition, I advise the government with regard to taking hospital is prepared for this. Two large buildings on the vast the right measures,” says Professor Wei, who incidentally is a hospital site are currently under construction at a pace typical of member of the Jiusan Society rather than the Communist the country (“three floors per month”). Party. When you leave the hospital after spending the day there, After the tour, one wonders what is actually typically Chi- the heat hits you like a wet towel. And the cicadas invisibly nese about this hospital. Apart from the menu in the cafete- continue to make their noise.

24 DRÄGERDRÄGERHEFT REVIEW 404 119 || 21 / 20192018 ASIA HOSPITALS

Shoulder to shoulder: The health of a patient is in their hands. They are on the way to the operating room to help him

A watchful eye: “Chinese customers This anesthetist uses the technology to monitor want the best” the patient’s condition during Dräger has been present in China since 1994. the operation Dietmar Roethlinger has been head of the subsidiary in Shanghai since 2015. “China is currently the third-biggest market for Dräger, after Germany and the USA. We serve this market from Shanghai and Beijing with a total of seven organizations. According to Medical Equipment Magazine (2018), we are even the market leaders in Patient the areas of anesthesia and ventilation. We also occupy this position Delighted by China and Dräger: in the field of mining, particularly in the mines rescue business. Dietmar Roethlinger, CEO China has one of the strongest-growing populations in the world numbers and we have by no means fully exploited this potential yet. Chinese customers always want the best so that they in turn can offer their customers the best. Dräger benefits from are set to this with its products, but also with its service. Two trends will determine the future: One of them is a level of growth which will be further accelerated by the privatization tendencies. grow further The other is the demand for local content – products that are developed and manufactured in the country for its own market. We are also well prepared for this with our own manufacturing over the operation in Shanghai. We have exploited just 40 percent of the premium hospital segment in coming China. There is still also ample potential among smaller hospitals in the middle price segment.”

The world is reflected in people: years How traditional Chinese medicine is modernizing and becoming integral to the thinking of both doctors and patients. www.draeger.com/119-25

DRÄGER REVIEW 119 | 1 / 2019 25 Summoning Spirits From beer to SINGLE MALT WHISKY – Rothaus Baden State Brewery has taken the step from one to the other. Particularly coveted are the special releases, like the Highland Cask Finish Edition.

Text: Peter Thomas

in the Baden Highlands

R brewers. So it is little wonder that whisky is in demand in Ger- Rothaus Baden State Brewery’s seven natural springs bubble many, traditionally a nation of beer lovers. Around three dozen far, far away from Scotland. Yet even here, 1,000 meters above distilleries alone currently belong to the VDW, an association sea level, in the heart of the Black Forest, the art of the single formed in 2012 to represent the interests of German whisky dis- malt whisky is flourishing. If it sounds like a humorous schnapps tillers. The distillery locations extend from the deep south (such idea, the transformation from beer to whisky is an obvious one as Slyrs in Schliersee) to the far north (Hinricus Noyte’s in Wis- for the experts. After all, single malt is made from almost exact- mar). VDW members have been presenting their wares at “Ger- ly the same ingredients as beer. The Scots are as uncompromis- man Whisky Day” since 2017. ing as the Germans and their Beer Purity Law (Reinheitsgebot) in this regard. Pure spring water and barley malt form the mash, Double distilled in copper pot stills while yeast ferments the mixture, transforming the malt sugar The beer brewer Rothaus (whose products include “Tannen- into alcohol. The distillers only leave out the hops used by the zäpfle”) began summoning fine bottled spirits in early 2000,

26 DRÄGER REVIEW 119 | 1 / 2019 FOOD AND DRINK INDUSTRY

Good things come to those who wait: The single malt whisky from Rothaus matures in these cellars at the Kammer-Kirsch distillery (left). The exclusive Highland Cask Finish Edition ages in the old vaulted cellar of the brewery itself, where master brewer Ralf Krieger (above) demonstrates the difference between young, almost colorless spirit and amber-colored whisky

ago alongside the brewery, which is still owned by the state of Baden-Württemberg to this day. Rothaus bottled the first whisky and launched it onto the market back in 2009. Since then, the single malt made with summer malting barley from Baden-Württemberg and soft water

PHOTOS: BRITTPHOTOS: SCHILLING, PETER THOMAS from the Black Forest has acquired a good reputation. Partic- ularly coveted are the special releases, like the Highland Cask Finish Edition – named after the highland region of the Black Forest rather than the Scottish Highlands – which goes from initiated by the then master brewer Max Sachs. “Turning this being an almost colorless, freshly distilled spirit to an amber- vision into reality wasn’t easy,” says his successor Ralf Krieger. colored whisky as it matures in the brewery’s vaulted cellar. The That’s because the Baden State Brewery no longer possessed maturation process is a journey through time and aromas. It private distilling rights, so simply taking the pot stills that now starts with the whisky ageing at Rothaus in American bourbon stand in the museum and heating them up again wasn’t an casks. The Highland Cask Edition is then aged to perfection option. And finding a distillery in Germany that was willing in new oak casks during the so-called “finish.” and able to carry out the double distillation process in copper Ralf Krieger dips the glass whisky thief into the bunghole of pot stills proved difficult. The company ultimately found what one of the casks, which are made by cooper Christof Schlegel it was looking for in Karlsruhe – and it turned out to be part of for Baden State Brewery. The light oak comes from the forests its own history. This is due to the fact that Rothaus Black For- by banks of the nearby lake known as Schluchsee. The engineer, est Single Malt Whisky is made by the Kammer-Kirsch distill- who specializes in brewing and beverage technology, draws up ery, which also belonged to the Grand Duchy of Baden 100 years an amber-colored fluid and drops it into a small stemmed glass

DRÄGER REVIEW 119 | 1 / 2019 27 Traditional beer and modern brewing: The Rothaus State Brewery based in Grafenhausen in the highland region of the Black Forest is wholly owned by the state of Baden-Württemberg and is one of the biggest breweries in southwest Germany

There are around 1,500 breweries in Germany – many do good business in their niches. Highly moderntechnology is also used at Rothaus for beer and whisky production

Angels are began – the concentrations in the atmosphere have always been silent partners in perfectly safe.” The firefighters at the brewery have a history that dates the cask cellar back more than one hundred years. The company fire service was founded in 1904 after a serious fire that was started by a lightning strike. It was evident at the time that the with a bulbous body. The bouquet is sweet, soft, and warm. It state fire department took too long to reach the factory located tastes spicy, like herbs and a little caramel. There are other 1,000 meters above sea level in the middle of the forest in the special releases besides the Highland Cask Finish Edition. The event of an emergency. The risks have changed since then. For whisky then ages in red wine casks from the renowned Franz instance, the barley is no longer malted on the premises, which Keller winery in Baden, for example. means that less dust is created, thereby significantly reducing Whisky production is a business based on reciprocity: Just the corresponding risk of explosion. This is also the reason why as the spirit absorbs flavors from the wooden casks and reacts a wet mill is used nowadays to grind the delivered barley malt with the carbon layer on the inner wall, the whisky also releases without creating dust. However, the company fire service (cur- alcohol into the atmosphere at the same time. Since the rently a 24-man team, 13 of whom wear breathing apparatus) process cannot be precisely controlled, the alcohol concen- remains important to the brewery and its 246 employees. Large tration of the cask strength editions always varies slightly. The quantities of ammonia are stored for the extensive refrigera- “angel’s share” is the name given to the alcohol that evapo- tion systems used to manage the temperature of the fermenta- rates in the cellar. It may sound poetic, but it is also an ethanol tion and storage tanks. emission that is subject to an occupational exposure limit (OEL) of 380 milligrams per cubic meter of air (based on TRGS 900 – Ice-cold business Germany’s Technical Rules for Hazardous Substances – dat- The company fire department is prepared to deal with any ed June 7, 2018). Thomas Strecker, who is responsible for spillage: Blue Dräger chemical protective suits are hang up occupational health and safety at Baden State Brewery, seeks between the fire trucks, ready to be worn at a moment’s notice. to reassure: “The company fire service has taken a whole The breathing apparatus, also from Dräger, is maintained in a

range of measurements in the cellar since the ageing process special workshop. Drills are carried out with the professional PETER THOMAS PHOTOS:

28 DRÄGER REVIEW 119 | 1 / 2019 FOOD AND DRINK INDUSTRY

The company fire service is well equipped, says Thomas Strecker, who is responsible for occupational health and safety

Hundreds of millions of bottles are filled in the brewery every year. Turnover of around 74.8 million euros was generated last year with a workforce of 246 employees

fire department from Freiburg, among others. tion. Two special strains are used. Bottom-fermented yeast – for “The high-powered refrigeration technology is critical to pilsner, Märzen (or “March beer”), and the naturally cloudy the products,” explains Ralf Krieger. That’s because Rothaus Maidle – accounts for the majority of production. Rothaus also relies on low temperatures and long processes for brewing its uses this yeast for making whisky. Top-fermented yeast is used beer. With the bottom-fermented beers this means a fermenta- for wheat beer. The finished product is pumped into the stor- tion process at atmospheric pressure and ten degrees Celsius age tanks once the fermentation process is complete. It mellows for a good week, followed by a four- to five-week storage period, here for at least a month until it can be sold. The brewery has during which the temperature is kept between ten degrees Cel- 67 storage tanks, each with a capacity of 180,000 liters. “This sius and just below freezing point. allows us to adhere to our meticulous process in times of high Anyone who stands in the brewing plant will first and fore- demand without sacrificing quality,” says the master brewer. most feel the heat, despite the thick insulation beneath the copper lids of the mash tun, lauter tun, and brew kettle. In oper- A bottle roller coaster ation since 2005, the modern technology in the brewing plant Once the storage period is over, however, there is no longer any immediately cut the brewery’s energy consumption by a fifth. peace and quiet for the beer. The bottles now whizz along fully But why is there a need for the high temperature that is sup- automatic lines from the sorting and cleaning stage to the fill- plied to the various vessels via water and process steam? Sug- ing and picking section. The state-owned company has invested ar and other materials are released from the grist by hot water around 30 million euros in the latest building measures, includ- during the mashing process. Lautering then serves to separate ing the filling and sorting plant. Hundreds of millions of 0.33- the solids from the liquid. The raw beer is heated with steam in and 0.5-liter bottles leave the brewery every year. In contrast, the brew kettle until it is almost boiling. The aroma hops from with around ten thousand 0.7-liter bottles, whisky production Tettnang are then added, which help to give the Rothaus beers only accounts for a fraction of the overall figure. In no other their characteristic flavor. Once everything has cooled down, product, however, can the spirit of the Black Forest be found in the finished wort comes into contact with the yeast for the first such concentrated form as in Rothaus Black Forest Single Malt time. The brewery uses its own pure yeast, which is continu- Whisky. Its classic cask strength variety is diluted to 43 percent ously cultured in-house. To this end, the brewers take active ABV – with the very same water from the seven Rothaus springs yeast cultures from each batch for the next round of produc- used to steep the mash.

DRÄGER REVIEW 119 | 1 / 2019 29 FIREFIGHTING ABROAD

Brightly colored world: In Tasiilaqs new quarter (left) colorful houses line the fjord, which is frozen for eight months of the year. As such, the Greenlanders frequently use dog sleds or snowmobiles to reach the hunting village of Tiniteqilaaq

ALASKA/USA

CANADA

USA

MEMEXIXIKKOO

“When the

P30 iteraqDRÄGER REVIEW 119 | 1 / 2019 Comes, Everyone Stays Indoors”

In East Greenland, the fire service functions well. However, GREENLAND things get difficult when the storm from the inland ice rages through the region. In 1970, it hit the town of Tasiilaq (pop. 2,000) with hurricane force winds reaching 200 miles per hour. Ilulissat

Tiniteqilaaq ICELAND Text and photos: Barbara Schaefer Nuuk Tasiilaq Qaqortoq

O hears it every day. The Greenlander with boss, a Dane, retired, he said to himself, On the dark red building is a sign bristly, short black hair and a blue uniform “The next fire chief must be a Greenlander. that says Arsaanneq Inerteqqutaavo- has been with the fire service for 28 years. As things turned out, in 2001, it was me.” qmit, together with the Danish transla- Why? He rummages through a stack of tion: Boldspil Forbudt (no ball games). framed photos and picks out one that shows Water in the fuel tank Yet as is often the case with such warn- a burned-out house. “The man had can- Tasiilaq and a handful of villages are dot- ing signs, Tasiilaq’s youngsters love to cer. He murdered his wife, set fire to the ted over a wide area. There are no roads play football right in front of it – because house, and burned to death with his young between them, and the local people trav- it makes such a wonderful clatter when son.” Back then, Andreassen rushed to the el with dog sleds or snowmobiles. Helicop- the ball hits the big metal doors of the fire fire, as did half of the town. “Everyone ters fly in essential provisions to the vil- station. Plus here in Tasiilaq – the largest helped with buckets of water. This made lages. Nowadays, not only Greenlanders (and only) town in the east of the country me think that there must be a better solu- travel around the region; tourists have also with a population of 2,000 – there are not tion – more organized and professional.” In begun to visit the white wilderness. Expe- many places where they can play. the following year, the electrician by trade ditions planning to cross the ice cap usu- Fire chief Hendrik Andreassen sits in began working with the fire service along- ally start out from the east coast. Officially, his office next to the garage. The 49-year- side his normal job and took advantage of the police are responsible for responding old hardly registers the clatter anymore; he every training course it offered. When his to the incidents that happen every now and

DRÄGER REVIEW 119 | 1 / 2019 31 FIREFIGHTING ABROAD

have the right equipment, so he sent them Polar bears, mercury, all home and swept up the mercury with a brush and shovel. “After that, I sat down and Mother Nature and ordered two Dräger chemical protection suits from the colleagues at headquar- ters in the capital, Nuuk, right away.” again in the wilds of nature, but Andreas- there as expected. His wife alerted Andre- sen wanted to train his crew for this, too. assen. It turned out that water had gotten On thin ice Training is a matter especially close to his into the fuel tank and the man continued The fire station, the low building up on the heart. He opens a trekking rucksack and his journey on foot. “As he was crossing an hill, was built in 1961. It was the first on the takes out climbing gear, ropes, a sleeping icebound fjord, he turned and saw a polar remote east coast, known in Greenlandic bag, a camping stove, and snow probes. bear. He ran as fast as he could to the safety as Tunu (which means “backside”). “The An outdoor specialist, born in Greenland of a hut on the shore.” The man wouldn’t Danes first came here in the late 1890s, and trained in Alaska, passed his skills on have stood a chance, but the bear wan- which makes us one of the youngest towns to the firefighters. “Amongst other things, dered off. He found three tourists in the in Europe.” The inaccessible coastline is he taught us how to find people buried by hut. They gave him some tea and a chance icebound for eight months of the year. So avalanches.” The rucksack also contains to get warm by the stove. “That’s where we if there’s a fire, where do you get the water trekking food, sealed bags with freeze-dried found him.” Think ahead and be prepared: to fight it? “That is not a problem,” says the rations – even labskaus (a kind of corned It sounds like a mantra when Andreassen fire chief. “There are enormous water tanks beef hash). Andreassen doesn’t think talks about his callouts – like the incident and hand pumps in all the villages, and here much of it. “My people prefer to take food involving chemicals at the local school. At in the city we have hydrants every couple from home with them: dried fish and Mat- first, the teachers hadn’t even noticed that of hundred yards. We also have a total of tak, whale skin with blubber. It’s much the children were playing with little balls around 2,000 feet of fire hoses.” They had to more nutritious.” Then this: A man from of mercury. Andreassen and Bianco Kallia, come up with a clever idea to dry them after Tasiilaq was on his way to the village of the second full-time firefighter, alerted the use. The buildings in Tasiilaq are all low, Tiniteqilaaq on a scooter, but didn’t arrive other members of the crew. They didn’t and nobody would think of building a tower

News exchange: People meet on the brow of the hill near the fire station. Youngsters play football or do a few laps on their mountain bikes. The adults tell each other the latest news

32 DRÄGER REVIEW 119 | 1 / 2019 because of the harsh weather conditions. So the hoses are dried with the aid of a hot-air blower in a long and narrow room. From there, there’s a door into the garage where the firefighting vehicles are kept. One of the vehicles is a rugged 1972 Unimog. “It only has 2,500 kilometers (1,550 miles) on the Command center clock so far. That’s because there are only 16 Tasiilaq is on the coast – where else? The hinterland is covered with an kilometers (10 miles) of streets in the whole ice cap that can be up to two kilometers thick. Around 2,000 people live in town.” In contrast, the Magirus Deutz is a the largest settlement on the east coast. The region just below the Arctic newer model from 1989. Hendrik Andreas- Circle was first populated by Inuit tribes from Alaska around 4,000 years sen stands next to it and asks what is strik- ago. The region was unpopulated for a long time due to worsening climatic ing about it. He answers his own question conditions. The first permanent settlements here were established in the straight away. “It’s too big for us Greenland- 14th century. Neither the Vikings, nor later European whalers, ever set foot ers.” They had to cut steps into the side pan- on the east coast. The first non-Greenlanders arrived unbelievably late – in el before the men – and two women – could 1884, when the Dane Gustav Holm spent the winter close to the present even get into the cab. At five foot seven, he’s location of Tasiilaq. Holm was fascinated by the culture and traditions of the pretty tall for a Greenlander. “But it’s even indigenous tribes, and was followed by trading companies and missionaries. too high for me,” he says. On top of this, the Life began to change. Although disease and alcohol decimated the Inuit, fire hoses weigh in at around 60 pounds better and more food helped the population to recover and rise again. apiece. “We have to roll them out at head height. In the long run, that’s not exactly good for your health.” They really need a new vehicle – one built specifically to meet the needs of Greenland and its people. The firefighting regulations from Denmark –

Lifeline: A helicopter links Tasiilaq to the rest of the world, bringing guests, locals, and fresh fruit – or urgent online orders. If it can wait, however, it only reaches Greenland’s east coast in the summer

Totally analog: The mobile network is considered unreliable, so Tasiilaq’s firefighters rely on fire alarms – 500 of them are installed in the town Provident: When fire chief Hendrik Andreassen had to deal with mercury using a brush and shovel following a chemical accident at a school, he DRÄGER REVIEW 119 | 1 / 2019 immediately ordered this chemical protective suit 33 FIREFIGHTING ABROAD

when there’s a fire, only one part of the Thunderstorm? Greenland building burns, and not the entire building. The fitting of smoke detectors is mandato- has other causes of fire! ry in all public buildings, in the two hotels, in the pizzeria, the bar, and the supermar- kets. There is also a small firefighting unit to which Greenland still belongs, despite Sermiligaaq – there are 112 firefighters on at the heliport, the lifeline of the region its autonomy – are also no great help. As in call. What are the most frequent causes of for the greater part of the year. Fire alarms Denmark, training was stepped up in the fires? “There’s not much chance of it being can be seen on the walls of buildings and aftermath of 9/11. “Only the problems we old electrical wiring,” explains Andreassen. on lampposts throughout the town – 500 of face here have nothing to do with skyscrap- And definitely not fish smoking ovens – we them in all. “We don’t have an emergen- ers and commercial airliners. We have to don’t have them here. Fish are simply hung cy number here because the mobile net- know how to rescue people who get stuck out to dry on racks in the dry Arctic air. The work is too unreliable – alerts are forward- after breaking through thin ice.” That’s remaining causes are just like anywhere ed to us via satellite from Nuuk. Classic fire why the equipment includes cold protec- else: forgotten pans of food on the stove or alarms work much better. If there’s a fire, tion suits, a floatable rescue sled, and two a combination of alcohol and cigarettes. we can get to any place in town within 15 snowmobiles. There’s a rope as thick as a Smoking appears to be a national sport in minutes – except when the Piteraq comes.” man’s arm hanging on the wall. A piece Greenland. On the streets, almost everyone The Piteraq (“that which attacks you”) is a of rescue equipment? Andreassen laughs: smokes – men and women, young and old. cold fall wind that originates on the Green- ‘No, that’s for the tug-of-war competitions There has never been anything even close landic ice cap and sweeps down the east we sometimes have with the crews of visit- to a real inferno here. The spaces between coast. It brings gales of up to 180 mph, but ing ships in the summer.” the houses are large, and their wooden can also gust at up to 185 mph or more. walls are painted with a fire-retardant lime “When that happens, everyone stays 112 firefighters wash that protects them for around an hour indoors.” There was a fire at the music hall In Tasiilaq and the seven neighboring vil- when a fire breaks out. The modern terrace once, but nobody went out. Andreassen has lages – from Tiniteqilaaq and Kuummiit to houses are made up of individual cells, so four children and his eldest son is a police

It’s only a drill: When it snows lightly, the car pulls the fire truck out of the garage. Now the children have to play football elsewhere

34 DRÄGER REVIEW 119 | 1 / 2019 officer. There’s no problem at all recruit- ing new firefighters. “Thankfully, there’s a long waiting list.” He takes care of this in his own professional way. “From those ISTOCK PHOTO: that I train here, hardly any leave – none to Nuuk, none to Denmark.” He convinces So many words for snow? anyone who proves to have the right talents Many people have heard that the Inuit have more than one hundred different words for to learn more. “More training and further snow. But, as is often the case with certain “facts” thought to be common knowledge, education are essential.” For instance, he they are not always right. The author Kathrin Passig explains why in a story for which helped ten young people to secure a place she was awarded the Ingeborg Bachmann Prize in 2006: “As our uninformed compatri- on vocational training courses. “I’m very ots often profess in conversation, the Eskimos have countless words for snow. This is proud of that.” probably to point out the long-since lost perceptions of nature amongst city dwellers.” Not so long ago, there was a big moor- As Passig says, she has no patience with people who permanently relate this banal land fire on the west coast. Has there ever misconception. “The Eskimo languages are polysynthetic, which means that even rarely been anything like that here? Andreassen used descriptions such as ‘snow that falls on a red T-shirt’ are contracted into a recalls a firefighting mission near Kuum- single word.” Greenlandic, the language known locally as Kalaallisut, is an Inuit lan- miiut in the 1990s. “We were taken in guage that is totally unrelated to other linguistic families. Anyone who learns Inuktitut, by helicopter.” Someone hadn’t properly the Inuit language of Canada, will understand about as much in Nuuk, the capital put out their campfire. “It burned a cou- city of Greenland, as someone from Portugal in Romania. In East Greenland, however, ple of feet into the ground.” It was nev- the people speak a quite different dialect. A couple of useful words: Maybe – uppa. er established whether it was tourists or Yes – Iiiji. No – eeqqi (with a very gutturally pronounced “q”). locals. Couldn’t the fire have been caused by lightning? Andreassen laughs out loud. He’s absolutely certain that it wasn’t: “It is simply far too dry. I’ve never seen a thunderstorm here in my life.”

Tied up: Hunter Salo often takes tourists to Tiniteqilaaq, beyond the bay. On the return journey he generally packs fresh seal meat on the sled – food for the dogs as well as for him

Head north – and then keep going. Right outside the tourism office with ice cream shop, these signs in Tasiilaq point the way

35 Consultation Hour

New ship, seasoned seafarer: Dr. Christian Ellendorff is the ship’s doctor on board the Mein Schiff 1 owned by TUI Cruises – for a few weeks each year. Back on land, he works as a registered internist

36 DRÄGER REVIEW 119 | 1 / 2019 CRUISES FORUM

There are no more continents to discover, yet more passengers than ever are traveling on cruise ships. The SHIPS’ DOCTORS take care of their medical well-being – like on the new ship Mein Schiff 1 owned by TUI Cruises.

Text: Olaf Krohn Photos: Patrick Ohligschläger on Deck Two H He hardly slept last night: At sea, between the Danish islands of Bornholm and Møn, a helicopter had to winch an acutely ill passenger from on board and fly them to an onshore hospital. And early in the morning, in Kiel, three ambulances were already waiting for the passengers who Dr. Christian Ellendorff, the ship’s doctor, had referred to hospital for further treatment at the end of a ten-day cruise around the Baltic Sea. “An absolute exception,” says the 69-year-old, who takes a seat in his waiting room just after midday. “I am just about to train new crew members on how not to infect themselves with bloody plasters or used insu- lin needles that some passengers leave behind in their cabins.” And then he is on his way. Ellendorff uses his English and Span- ish skills for the training, because the crew members of Mein Schiff 1 come from all four corners of the earth – most of them from the Philippines. He is back within half an hour.

A room with a view “On average, between 30 and 40 patients visit our medical facil- ities on board the ship every day.” The heavy fire door on Deck Two is open six hours a day, 365 days a year – from 8 till 11 a.m. and from 5 till 8 p.m. The first hour is reserved for crew members, while the rest are for the passengers. This much time is needed. After all, up to 4,000 people (approx. 2,900 passengers and 1,100 crew members) inhabit the new TUI Cruises flagship on its tours around the Baltic Sea and Canary Islands. “There are always two doctors on board,” explains Dr. Ellendorff. “We alternate on a daily basis; the other is then on call.” You have to enjoy it. There are hardly any days off and the cabin is rather small on a deck further down, where the crew lives – although a porthole does provide a view of the outside world. A dream job on a dream ship? The question is not really apt, because being a ship’s doctor is more of a role than a job. Back on land, Ellen- dorff works as a registered internist in Hamburg, but he has to get out. Since 2010, he has been regularly providing medical

DRÄGER REVIEW 119 | 1 / 2019 37 FORUM CRUISES

Only on board can the doctor also be a pharmacist

Emergency ventilation: An Oxylog 3000 plus from Dräger is available on board when treating critically ill patients and transporting them – by helicopter, for example

care as self-employed locum doctor for several weeks at a time on board ships owned by TUI Cruises. Even when he was still a student, Ellendorff was always fascinated by the huge vessels on the Elbe and wondered whether it might also be for him. At the age of 60, he has finally given an affirmative answer to this question. Ellendorff, who could also retire if he wanted to, appreci- ates the diversity and multicultural life on board. Furthermore, as someone joining the maritime world from a different career Emergency room: The stretcher team is on hand with background, he holds the rank of an officer and occupies a posi- the necessary equipment to quickly transport patients to the tion immediately behind the captain and his deputies within onboard hospital in the event of an accident the ship’s hierarchy. From a medical perspective, he is subordinate to nobody in his onboard hospital. language. “In accordance with international guidelines, we only really have to have one doctor on board, but we have two,” General practice meets emergency room says Angelina Koehler. The head of the Medical Department at Anyone who wishes to be a ship’s doctor must essen- TUI Cruises has built up the onboard hospital since it was estab- tially be a general practitioner, internist, or surgeon lished ten years ago. She previously managed onshore hospitals. and also possess a qualification as an emergency doc- “The spheres of influence are completely different to those on tor – the job requirements on board a cruise ship land. In addition, we have to observe numerous international sway between these poles. On the one hand, the on- regulations at sea.” Even though a growing number of young board hospital functions as a general practice that people are coming aboard, cruise ship passengers traditionally treats several thousand people a year with their tend to be somewhat older, because this form of travel primarily minor ailments and injuries. On the other hand, allows aged people, who aren’t always so steady on their feet, the doctors and care staff must be able to react pro- to visit exotic places. These guests, who often also have chronic fessionally around the clock – to heart attacks and and preexisting illnesses, pay particular attention to the level of strokes as well as occupational accidents among the medical care provided on board. crew. Anyone who books a cruise with TUI Cruises The ship’s doctor also holds the key to the well-stocked on- ultimately does so with the certainty that if the worst board pharmacy. “This is another aspect of my role, because should happen – either on the high seas or in the at sea I have a pharmacist’s license in addition to my doctor’s port of Montego Bay – they will receive medical care license,” says Ellendorff. “This wouldn’t be allowed onshore.” in line with German standards and in the German It is immediately evident just how much this experienced

38 DRÄGER REVIEW 119 | 1 / 2019 On prescription: The pharmacy in physician enjoys this work with its complex processes. He has the onboard hospital is well stocked. Since to decide quickly whether a patient who has suffered a heart space is limited and the next port is often attack, for example, can be treated on board or can wait to be far away, the ship’s doctor and his team must think ahead when reordering admitted to hospital at the next port, or even whether a rescue helicopter immediately has to be scrambled at sea. In emergency situations, he consults with his captain about whether the course and speed of the ship should be altered to give the patient the best possible treatment. A transfer to an onshore hospital is therefore sometimes the preferred option, because an onboard hospital is generally not suitable for inpatients staying a number of days. Among other things, the small intensive care unit is equipped with an emergency ventilator (Type: Oxylog 3000) and has room for a maximum of two patients – there are normally three beds available in the patient room. “We nonetheless aim to make sure that the ill guests can continue their vacation on board,” explains TUI Cruises Head of Medical Department Angelina Koehler. With some broken bones, for instance, a cabin with a balcony is ultimately also suitable as a patient ward. The team has recently gained support. “We have launched a cooperation partnership with the University Medical Center Hamburg-Eppendorf (UKE),” says Angelina Koehler. X-rays taken on board the Mein Schiff fleet are sent to the UKE’s radiol- ogy department online. “Our ship’s doctors then get a second opinion within 30 minutes, allowing us to improve the quali- The call of the sea: Nurse Julia Bauer has swapped her job at a hospital in Cologne ty of diagnostics.” This is why TUI Cruises wants to extend tele- for one on board Mein Schiff 1 medicine to other areas in the future.

Many people work here – in a tight space The Doc, as he is known to everybody, is on the move once again. There is a great deal to organize before the ship weighs anchor again this evening in Kiel. Two hours before it is due to set sail, Facts and figures Julia Bauer mans the reception in the onboard hospital. The nurse had been working in a large hospital in Cologne since com- pleting her training, but her career has now changed course. 315.7 meters made Mein Schiff 1 “Many people work in a tight space on board a cruise ship. The the longest cruise ship on the German market whole world is received here,” says the 28-year-old. Unlike Dr. in the summer of 2018. It was built in Finland Ellendorff, she is employed full-time on a four-month contract. and sails under the Maltese flag. At least she is able to satisfy her wanderlust a little while on board. “What you learn above all else here is the art of impro- visation.” In the beginning she often got lost on board the huge 1,100 people from more than 40 different vessel. She now knows her way around, even in an emergency. countries work on board, with Filipinos, Indonesians, “When the ‘Starcode’ is sounded, we immediately head to the and Germans most strongly represented. scene with the first-response bag. And if she needs support, the stretcher team is never far away. These specially trained crew members bring sick or injured people to the onboard hospital 30–40 passengers and crew as quickly as possible. members attend the six-hour consultation hour at the “Sometimes,” says Julia Bauer, “I forget which day of the onboard hospital every day, 365 days a year. week it is.” After all, there is no weekend to give the crew a sense of time and order. In the onboard hospital, Christian Ellendorff and his team can also forget whether it is light or dark outside. 2,200,000 German citizens went on But the Doc has a remedy for this: “I switch on one of our mon- a cruise in 2017; the figure in 1997 was 283,000. itors that relay images from the bow or stern camera.”

DRÄGER REVIEW 119 | 1 / 2019 39 HEALTH CARE EYE OPERATIONS

A miracle of nature: Crystal-clear, tear-resistant, and durable. A cornea contains no blood vessels – it is sustained by the lacrimal fluid and aqueous humor

Ultrathin Most of our sensory information is acquired via the eyes. The cornea functions as a kind of windshield here. If it becomes cloudy or overly bulges outward, often only a TRANSPLANT can prevent blindness. Nowadays, individual layers are preferably transplanted rather than the entire cornea.

Text: Dr. Hildegard Kaulen Photos: Patrick Ohligschläger

40 DRÄGER REVIEW 119 | 1 / 2019 Layers

sional sense of direction, it would have been a simple task for him to guide a catheter safely around the vascular system. Yet things turned out differently. The tissue that Dr. Gericke regularly holds in his hands these days has not one single blood vessel, because the cornea is sustained by the lacrimal fluid and aqueous humor. However, his skill and E sense of direction are no less in demand Everything is prepared. The diseased in the field of ophthalmology. That’s eye of Bernhard P. has been marked above because transplanting a cornea requires the eyebrow – only his eyes and nose are an especially sensitive touch, particularly still visible on his face. Today, the associ- since just the inner two of the five cor- ate professor Dr. Adrian Gericke will give neal layers are generally used rather than the 49-year-old a new lens and replace the entire donated cornea. Bernhard P. the diseased cornea with a donor graft. will also only have the innermost cor- Dr. Gericke is senior physician in the neal endothelium layer replaced along eye clinic at University Medical Center with Descemet’s membrane above it. Mainz and is head of the section of corneal This complex of endothelium and mem- diseases. In Bernhard P’s case, the cells brane is about 20 micrometers thick, in the innermost corneal layer are grad- which is roughly equivalent to a third of ually dying. The surgeon will operate on the thickness of a woman’s hair. “It is the other eye in a few weeks’ time, which often only this layer that is responsible is routine in Mainz as one of Germa- for the cloudy cornea, which is why we ny’s most important cornea transplant only replace the endothelium and Des- centers: 245 donated corneas were trans- cemet’s membrane above it and leave the planted here in 2017, many of them by rest of the cornea intact,” says Dr. Ger- Dr. Gericke. icke. The procedure is known as a DMEK. He actually wanted to be a cardiolo- The abbreviation stands for Descemet gist. With his dexterity and three-dimen- membrane endothelial keratoplasty.

DRÄGER REVIEW 119 | 1/ 2019 41 HEALTH CARE EYE OPERATIONS

The employees at the cornea bank in Mainz inspect the quality of the donations. They are given to the recipient a minimum of ten days later, once all the investigations are complete Sight is our most important sense. It is also the one that humans acquire last of all. We can hear, feel, taste, and smell in the womb, but we only learn to see after we are born. This sense cannot function without the cornea. It is the outer- most layer of the eye, protecting it from infection and injury. Its curved shape “The surgery is less invasive than replac- is responsible for most of the necessary ing the entire cornea, because only small light refraction and its material proper- incisions are made in the corneal periph- ties are unrivalled. The cornea is crystal- ery, via which the inner corneal layers clear, tear-resistant, and durable. Super- are replaced within the enclosed sys- caught on in other hospitals in the years ficial scratches are repaired within a tem. This is less prone to complications, that followed. It became possible because matter of days through the regeneration because the intraocular pressure is nev- the individual layers are not firmly joined of the uppermost epithelium layer. How- er lost during the operation. The opera- together, but can be separated from one ever, the innermost layer does not have tion is also shorter and can be performed another without leaving behind any dam- the same ability to repair itself. Once the under local anesthesia. The cornea age. “Up until a few years ago, we were corneal endothelium layer has degener- and visual acuity recover more quickly essentially still operating in the same way ated, it is lost forever – as in the case of than after the replacement of the entire as the Viennese ophthalmologist Eduard Bernhard P. The inner layer dehydrates cornea.” Zirm had done at the start of the twen- the middle layer (the so-called corneal tieth century. Zirm performed the first stroma); the middle layer swells up with- Late innovation penetrating corneal transplantation out the intact endothelium and the cor- The process of transplanting individu- in 1905,” says Dr. Gericke. “Not until nea becomes cloudy. Even though experts al cornea layers was pioneered by the almost one hundred years later did the have been working on artificial corneas Dutchman Dr. Gerrit Melles between procedure evolve significantly by trans- for a number of years and different prod- 1998 and 2006 and the procedure really planting individual layers.” ucts are in various stages of development,

42 DRÄGER REVIEW 119 | 1/ 2019 Precision work: During a cornea transplant, often only the diseased innermost endothelium layer is replaced alongside Descemet’s membrane above it. This complex of endothelium and membrane is not even as thick as a single hair of a woman

to allow the outer epithelium layer, which constantly regenerates itself, to grow over the material. We simply haven’t got there yet!”

Tiny roll of wallpaper When is a cornea transplant necessary? Accidents, chronic inflammation, con- genital illnesses, or a bulging and thin- ning cornea are often reasons for surgery. Dr. Gericke is operating on Bernhard P. under general anesthesia. He starts by replacing the lens behind the cornea. To do this, he makes a small incision into the there is still no widely acknowledged edge of the cornea, opens the lens capsule, “The material approach that would make donors reduces the contents to small pieces, and unnecessary. Dr. Gericke is also work- vacuums it all out. He then inserts an arti- properties ing on a product in conjunction with ficial lens into the empty capsular bag. Professor Werner E. G. Müller, a material Only then does he begin to transplant the of the cornea scientist from the Institute of Physio- endothelium and Descemet’s membrane, logical Chemistry at Mainz University. which he separated from the donor’s cor- are unique” “The shape of an artificial cornea is quite nea with a high-precision instrument Dr. Adrian Gericke, senior physician from the eye simply an outwardly curved disc,” says before the operation. Dr. Gericke has clinic at University Medical Center Mainz Dr. Gericke. “The properties are the prob- also made tiny marks so that he can dis- lem. The tear resistance, for example, tinguish the front from the back during is proving difficult for us. A full trans- the operation. The corneal layers are then plant must be sutured. If the material placed in sterile liquid on the instrument is made more tear-resistant by adding table and resemble a tiny roll of wallpa- extra fibers, it becomes less transparent. per. Dr. Gericke removes the diseased lay- That is a dilemma,” says the ophthalmol- ers from the recipient before he rolls out ogist. “It is also important that the mate- the new ones on the inside of the cornea rial is durable and doesn’t disintegrate via the small incision. An air bubble will or alter over time. The artificial cornea press the transplanted layers against the must reliably seal the eye and be designed rest of the cornea for a few days until they

DRÄGER REVIEW 119 | 1/ 2019 43 fragment is then positioned in the eye and sutured. Dr. Gericke uses a nylon thread that is also thinner than a woman’s hair. The sutures are not removed for at least a year in order to ensure that the transplant has taken correctly.

Removal is Good long-term results possible up to How high is the risk of rejection? Since the cornea has no blood supply and thus doesn’t really come into contact with 72 hours large quantities of defense cells, the risk is rather low. Most patients must use eye Organ Transplant Act (Transplantations- after death drops with an immunosuppressive agent gesetz), according to which it is only per- for a year. Only at-risk patients receive a missible to procure a cornea if the donor general suppression of the body’s defense has given their consent while still alive system, but in most cases this isn’t for or if the relatives opt for such a donation adhere on their own. They are not sewn the rest of their lives, as is the case after based on the donor’s presumed consent. into place. A gas mixture ensures the air transplanting an organ with a blood sup- Unlike an organ with a blood supply, how- bubble is not reabsorbed too quickly. ply. “We also don’t normally need to ever, the corneas can still be procured Dr. Gericke will later transplant a ensure that the tissue characteristics up to 72 hours after the donor’s death. complete cornea for his patient Christina match in the same way as we do for an In such cases, the deceased is also quite N. The 69-year-old suffers from scarring organ transplant,” explains Dr. Gericke. obviously dead in the eyes of the rela- involving all corneal layers. This proce- “This is only necessary for the cornea in tives. Brain death alone makes it diffi- dure will also be performed under gen- exceptional cases.” cult for many relatives to opt for organ eral anesthesia. During a full-thickness Dr. Gericke and his team get the cor- donation, because even though they can transplantation, the central part of the nea donations from the eye bank linked see that the brain has ceased to function, cornea is exchanged with all its layers. To to the eye clinic, which has been man- the body is still alive thanks to modern do this, Dr. Gericke starts with punching aged by Dr. Melissa Apel for the past six intensive care medicine. This problem a circular disc out of the donor’s cornea years. In the same way as organ trans- doesn’t arise with corneas. As such, the under the microscope and does the same plants, the cornea transplant is also donor situation is less dramatic than in

with the diseased cornea. The donated subject to the provisions of the German the case of organs. The cornea is also not SHUTTERSTOCK ILLUSTRATION:

44 DRÄGER REVIEW 119 | 1 / 2019 EYE OPERATIONS HEALTH CARE

A sensitive touch is vital: 11 The innermost corneal layers must be separated 5 from the rest of the cornea before they can be transplanted. To do this, the doctors take the tissue from the 10 transport container and place it in a special device with 2 the inner side facing upwards. They then mark it for later orientation purposes and remove the layers 3 1 6

9 4 7 8

Get the picture! Seeing is a complex process: In principle, the eye generates an image whose brightness values are then transformed into electrical impulses – like in digital photography – and then an organ, but a tissue, so it is a tissue processed into a sensory perception by the brain. Even though donation rather than an organ donation. the brain can compensate for many deficiencies of the eye By nature, not all donated corneas based on experience, only a healthy eye can guarantee the optimal possess the necessary quality. The tissue input. It does so as follows: The filtered and mostly reflected must not be scarred and the endothelium ambient light enters the eye via the protective cornea (1) and layer must have at least 2,000 cells per the anterior eye chamber (2) (with its nutrients and anti- square millimeter for most transplanta- bodies) and falls on the lens (3). Beforehand, the light passes tions, otherwise the number of cells is through the iris (4). This regulates the eye’s exposure to insufficient for good visual acuity. Of the light so that it isn’t dazzled. The shape of the lens is changed 715 corneas received by the eye bank in by the ciliary muscle and zonular fibers (5) to allow a sharp Rhineland-Palatinate in 2017, 397 were image to be projected onto the retina (6) with its many nerves. transplantable. The operations were per- The nerves converge on the blind spot (7). The optic formed either in Mainz or in one of the nerve (8) passes the image information, which has been cooperating hospitals across Germany. transformed into electrical impulses by the rods and cones The need for transplants, however, is in the retina, onto the brain for processing (visual cortex). greater. It remains to be seen whether The vitreous body (9) has a supporting function and fills artificial corneas will be a solution in the the greatest part of the eyeball. The choroid (10) supplies near future. the eye with blood, among other things. It is protected by the outer sclera (11). The dynamic range of the eye is about How does a cornea bank work? 20 stops – high-end cameras can only manage around twelve. And how are the donors Between ten and 15 blinks per minute, each lasting around even recruited, corneas removed, and the quality checked? 350 milliseconds, regularly moisten the cornea with lacrimal www.draeger.com/119-45 fluid to prevent it from drying out.

DRÄGER REVIEW 119 | 1 / 2019 45 AGRICULTURE LIVESTOCK HUSBANDRY Breathing

46 DRÄGER REVIEW 119 | 1 / 2019 in the Calf Shed

AMMONIA is an aggressive gas that develops in cattle sheds and affects the animals’ health. For the first time, Swiss scientists now want to use a Dräger sensor to measure the concentrations right by the animal and over longer periods of time.

Text: Tobias Hürter Photos: Patrick Ohligschläger

C Country air is healthy, so the saying goes. Cattle shed air could be healthier: It contains gases that can damage the body. This is no big problem for us humans. We can simply go outside at any time and breathe freely. The animals, however, live there. A good climate in the shed is therefore critical to their health and well-being. A sensor developed by Dräger is now helping Swiss scientists to better understand how ammonia, the main harmful gas in the shed, forms and spreads and how it affects the animals. It is the gas that prickles the noses of visitors to cattle For cleaner air in the shed: Professor sheds and public toilets and brings tears to Samuel Kohler, head of the their eyes. Ammonia is the simplest com- Swiss research project, pound of nitrogen and hydrogen (NH ) checks one of the portable 3 gas detectors together and plays an important role in the chem- with the ammonia sensor ical industry – in the production of artificial fertilizer, for example, which provides plants with the nutrient nitrogen. In the

DRÄGER REVIEW 119 | 1 / 2019 47 Fresh air: The calves in the test shed (seen here aged about one month) in the Swiss canton of Aargau can also go outside

shed the gas primarily forms when dung number of bacteria becoming resistant to calf sheds for a long time. What drives up and urine mix on the floor and are subse- them. This creates a risk of patients being the concentration? How can it be reduced? quently decomposed by microorganisms. at the mercy of an infection. The World Such questions couldn’t be answered The problem is less serious with mature Health Organization (WHO) estimates with the resources available five years dairy cows, because they are ruminants that several hundred thousand people ago. “Then this sensor emerged,” recalls with a fully developed digestive system, die every year as a consequence of antibi- Sax, and with it the chance to finally find which reduces the formation of ammo- otic resistance. That is why the Swiss gov- answers to these questions. The first aim nia. Calves, however, are not yet rumi- ernment launched its National Strategy of the ammonia project, which is being led nants. The rumen that allows cows to on Antibiotic Resistance (StAR) back in by Professor Samuel Kohler, is to under- digest grass and hay has not yet developed. 2015. The aim is for various authorities stand the level of pollution to which the In addition, they lie on the ground more and institutions to work together to fight calf is exposed in a shed – over the course frequently and their organs and immune the development and spread of new forms of a day and throughout its life. It is also systems have not yet matured. As a result, of resistance. about understanding the effects of ammo- they especially suffer from the ammonia Two years ago, Dräger entered the nia and reducing its presence by optimiz- that they produce themselves, because field of agriculture with a new electro- ing shed management. “The calves should it affects their respiratory passages and chemical sensor capable of withstand- grow up in an environment where they mucous membranes. Several calves of a ing long-term exposure to harmful gas remain healthy,” says Professor Kohler. similar age along with germs and stress and presented a new portable device for make the young animals more susceptible measuring the ammonia content in cat- How much is enough? to infectious diseases. “We deal with lung tle sheds. Gas detection tubes had gener- The researchers record their measure- problems very often in the area of calf ally been used up until that point. They ments in a test shed near Lenzburg, a rearing,” says Professor Samuel Kohler, a are tried and trusted, but only provide a small town in the canton of Aargau. It veterinarian who teaches animal health snapshot; a value at a certain moment belongs to the feed producer Ufa. Two and husbandry at the School of Agricul- in time. In order to gain a better under- groups of calves live in the shed, each tural, Forest and Food Sciences (HAFL) standing of how ammonia forms and the group containing 36 animals. They are in Bern. “And we therefore also deal with effect it has, however, it must be possible put in the stalls and taken to slaughter a high level of antibiotic use.” So it would to measure the fluctuating concentra- at the same time as each other. The toxic be an important step in the right direc- tions throughout the day or, better still, effect of ammonia on man and beast has tion to get a better grip on the formation the entire two- to three-month fattening essentially been known for a long time. of ammonia in calf sheds. period. There was previously no reliable In the chemical industry there is a lim- measuring method that was both practi- it of 20 ppm (parts per million). That is Excessive antibiotic use cal and affordable. Ammonia was the big the highest permissible concentration In addition, ammonia in the shed air pre- unknown quantity in the shed. Markus Sax to which humans can be exposed – eight sents a risk that also affects humans – even from Agroscope, a Swiss agricultural cen- hours a day, five days a week. The same vegetarians and vegans. That’s because ter of expertise, was one of the first peo- limit has been set for animals in Germa- the preventive administering of antibiot- ple to approach Dräger two years ago. He ny. Switzerland is even stricter – the reg- ics in the shed is resulting in a growing has been examining ammonia levels in ulatory authorities have recommended a

48 DRÄGER REVIEW 119 | 1 / 2019 LIVESTOCK HUSBANDRY AGRICULTURE

Cooperation: Dräger provides the measuring technology in the shed

Ammonia was previously the biggest unknown quantity in the shed

DRÄGER REVIEW 119 | 1 / 2019 49 The ammonia levels fluctuate much more than previously thought

limit of 10 ppm in the sheds here. How- take the first systematic measurements, it so that the animals have the best possi- ever, the Swiss researchers are critical. which involve the animals wearing a sec- ble conditions for growth in combination They say that this level has been arbitrari- ond sensor that constantly displays their with the lowest possible risk of infection. ly set and only applies to the air in the location. Is the animal currently stand- Highly technical, computer-controlled shed in general. In other words, there is no ing by the drinking trough, sleeping in the ventilation systems that consider param- definition of how much ammonia a calf can corner, or walking around outside in the eters such as temperature, humidity, and inhale, although it hasn’t been possible fresh air? All of these aspects influence carbon dioxide content in their manage- to verify this until now. Farmers and the ammonia exposure levels. ment routines have been standard for inspectors generally rely on their noses. a number of years. “We now also want A measuring device is only used if the Regular fresh air supply to include the ammonia concentration smell is noticeably strong and unpleasant. People might think that the ammonia here,” says Sax. However, it generally stays in the hand problem is easy to solve: Simply let the If the Swiss project could help farm- of the person taking the measurements air blow through the window! But it isn’t ers to stay within the existing ammonia and can reveal so little about the dose that that simple. Calves are generally fattened limits in the sheds, it would already be enters a calf’s lungs when it is lying in in an enclosed shed, shielded from germs classed as a success. Yet it can go even fur- the other corner of the shed with its nose and other environmental influences to ther by providing a better understanding above the dung-covered floor. the greatest possible extent. Furthermore, of how the ammonia affects the animals. In the spring of 2018, the Swiss the temperature in the shed would be too “It is clear that ammonia is an essential researchers teamed up with Dräger to low if the windows were left open in win- factor in the health of the calves, but as yet test whether the sensor can be used to ter – the calves need heat to grow quick- there are no clear results on the precise measure how much ammonia a calf ly. At the same time, they are constantly effects and interactions (connected with actually inhales. They slipped foal hal- standing on a layer of dung that is getting the shed environment),” says Marion ters onto the animals, to which a detec- ever bigger. Extra straw is continuously Zumbrunnen, an agricultural scientist tor was attached – fitted with a minia- being added and the shed is only mucked involved in the project. Some researchers ture version of the ammonia sensor as a out approximately every two months. This suspect that even concentrations signifi- prototype. Even though the data initially is known as the deep litter system. Oth- cantly below the limits may carry consid- only serves as preparation for a scientific er sheds are fitted with perforated floors, erable health risks. As such, the measure- study, it has already revealed that the lev- but this doesn’t change the level of ammo- ments could ultimately bring about more els to which the calves were exposed sig- nia in the air, because the dung is mere- meaningful limits. Everybody should have nificantly fluctuated, while the ammonia ly one level further down. “This means an interest in achieving a better climate levels recorded on the probes installed that high emissions end up in the shed within the calf sheds, including those who in fixed positions remained below the air as a result of the dung fermentation,” never even enter one. permissible values. The devices them- says Markus Sax. Accordingly, the animals selves must also be capable of withstand- need a constant supply of fresh air. When Stubborn germs: ing quite a lot. The calves rub themselves viewed in this way, the subject of venti- What do cattle sheds have to do with hospitals? More than against them or chew and suck on them. lation in calf sheds is a highly sensitive you might think. At the end of 2018, the scientists want to matter. The farm manager wants to set www.draeger.com/119-50

50 DRÄGER REVIEW 119 | 1 / 2019 LIVESTOCK HUSBANDRY AGRICULTURE

Good for man and beast: Less ammonia in the shed means fewer antibiotics are used – and thus fewer resistant germs

Fine tuning: The researchers are testing how well the mobile devices and ammonia sensors (above and below) can be attached to the calves, but also investigating where the fixed probes (Type: Dräger Polytron C300) can be best positioned within the shed

DRÄGER REVIEW 119 | 1 / 2019 51 High and The eternally inebriated sailor character created by Joachim Ringelnatz is but a legend. Shipping has become a sober industry that generally not only bans the CONSUMPTION OF ALCOHOL AND DRUGS on board, but also onshore. The shipping company is responsible for enforcing the ban.

Text: Constanze Sanders

W When the British cargo vessel Lysblink Seaways ran aground in the early hours of February 18, 2015, on the west coast of Scotland on its way to Norway, the first officer on duty had fallen asleep. After con- suming half a liter of rum, he had forgotten to activate the navigation safety systems at the start of his shift. The breath test required by the shipping company and carried out by the captain three hours lat- Maritime accident on the er revealed a value of 2.71 mg/l. The cap- west coast of Scotland: tain and second officer were sober. The Half a liter of rum was imbibed before officer on duty was fired; the vessel was starting a shift on the bridge – according scrapped after being recovered. It was to the investigation report, a drunken sailor was responsible for this cargo vessel human error – the cause of between 80 and

running aground in February 2015 90 percent of all accidents at sea. Alcohol PICTUREPHOTO: ALLIANCE/EMPICS

52 DRÄGER REVIEW 119 | 1 / 2019 SHIPPING PANORAMA

Dry consumption may play a role, but only in “Alcohol quickly numbs the anguish associ- monitored as life on board these vessels. a handful of cases. And yet: If someone ated with the job and softens the transition The International Safety Management in charge was drunk on the bridge, this from work to private life,” says the Har- (ISM) Code requires every shipowner, seemingly confirms excessive drinking rit- vard sociologist Cassandra Okechukwu. manager, or charterer to adopt a Safety uals on the world’s oceans. But it is often However, there is little room for maneu- Management System (SMS) that in- no different to the situation on land, even ver in the global merchant fleet. Many cludes an employment agreement on the though people like to consume alcohol on an onboard smoking lounge has decayed use of drugs and alcohol. The shipowner board merchant vessels in their free time. into a dusty old cabin, because a growing is responsible for ensuring that every- The notorious equator-crossing ceremo- number of shipping companies are adopt- body complies with it. Anyone who wants nies and all-night parties in the mess, how- ing a dry ship policy and completely ban- to work on board a ship needs a seafarer’s ever, are a thing of the past. ning alcohol, which means that the sea- medical fitness certificate. Examining Seafarers have a stressful job that farers remain dry even when they are on the individual’s addictive behavior is remains hazardous, although safety stan- shore leave. an integral part of the medical checks, dards have improved considerably in Tens of thousands of ships navigate which must be carried out at least every recent decades. Due to the high stress lev- their way around the seven seas, more two years. Around 20,000 seafarers were els, shipping crews are among the occupa- or less unnoticed by the rest of the world. examined annually between 2009 and tions with an increased risk of addiction. Yet few areas are as strictly regulated and 2015. On average, around three percent

DRÄGER REVIEW 119 | 1 / 2019 53 Important visitor: Every seagoing vessel that arrives in Hamburg is inspected by the river police – a visual examination for alcohol and drug con sumption is part of every clearance procedure

Waltershof. The visual examination for alcohol and drug consumption is part of every clearance procedure. If necessary, the officers also offer a breath test on a voluntary basis: “Almost everyone accepts it,” says Peterait. At sea, social control ensures that everyone remains fit to work. All hands are needed here when 20 sailors need to keep a 300-meter container PHOTOS: MAURITIUS IMAGES/ALAMY, DRÄGERWERK AG & CO. KGAA & CO. AG DRÄGERWERK MAURITIUS IMAGES/ALAMY, PHOTOS: ship with a draft of 14 meters on course – a pounding powerhouse with thousands of horsepower that works on the basis of failed. “However, addictive disorders 0.50 mg/ml in the bloodstream. On clear laws. “We all want to return home only played a subordinate role,” says Dr. tankers and vessels carrying hazardous safely,” says one sailor. “If somebody Philipp Langebuch, head of the marine cargo, alcohol has long since been taboo. overdoes it with drink or marijuana, a medical service at the German employ- “The international regulations require colleague will speak to them.” The aware- ers’ liability association responsible for effective prevention with clear limits ness of a community at risk informs life transport (known as BG Verkehr). “We and tolerances and mandatory testing among the wind and waves. Many seafar- found 40 addicts last year, 24 of whom devices,” explains Dr. Stefan Steinmeyer, ers often spend six months at a time or were alcohol-dependent.” The latter product expert for impairment checks at longer at sea. “In three months I was may- group thus accounts for 0.12 percent of Dräger and responsible for alcohol and be onshore three times for a few hours,” those examined. Every day, almost two drug testing. “Random checks must be reports the captain of another container million seafarers worldwide ensure that scheduled while safeguarding the priva- ship traveling between Northern Europe the crew, ship, and cargo safely reach cy of those being tested.” Checks are also and South America. There is hardly any their destination. Tankers, bulk carri- carried out in ports. Every oceangoing time for shore leave leisure activities. It ers, freighters, and container ships are vessel that arrives in Hamburg, for exam- takes just 36 hours to clear a mega-carri- constantly transporting goods around ple, receives a visit from the river police. er through customs, during which time the globe. Without them there would be “We go on board as quickly as possible so it has handled around 6,500 standard no cheap consumer goods, food, or raw that we find those on board in the same containers. materials. “There are working time reg- state as they were when the ship berthed,” Such a ship is an intense working envi- ulations, but at certain times I am sim- says Ulf Petereit, chief investigator at the ronment and it is difficult to get away even ply unable to take a break,” says the cap- river police department in Hamburg- during time off. It offers few home com- tain of a container ship with more than forts and every crew is different: Constant- 40 years of professional experience. The ly changing nations, mentalities, and cul- same goes for the crew. tures converge here. This all causes stress. The ocean is Having to get along with one another for Checks at sea and in ports months at a time – in cramped, sway- Since January 1, 2017, there has been a dangerous ing conditions, 24 hours a day – can lead a breath alcohol limit of 0.25 mg/l on to conflict, with stress symptoms such all of the world’s oceans, equivalent to workplace as insomnia, frustration, and general

54 DRÄGER REVIEW 119 | 1 / 2019 SHIPPING PANORAMA

0.0 BAC: Many ships now carry measuring devices like this (Type: Dräger Alcotest 5820). There is generally a zero tolerance approach to “alcohol at the wheel” exhaustion.“The problem is the isolation,” cated rescue services, help now arrives on says Langenbuch from the BG Verkehr. board comparatively quickly. “The sailors have no contact with their families, wives, and children.” Once the A new generation of sailors coast disappears from the horizon, there Human error nonetheless remains the big- is generally no cell phone network. The gest risk. Crewing agencies that hire the ocean is one huge dead spot for those who personnel for the global merchant fleet are cannot afford a satellite telephone. considered the first line of defense against When cargo ships still sailed, hard alcohol abuse at sea. In Manila alone there liquor flowed freely – due to boredom, are hundreds of such recruitment agen- but also for health reasons. For centuries, cies. Almost half a million Filipinos are Above all else, an Internet connection on rum was the better alternative to drinking employed on the oceans, approximately board the ship for contacting the family. water, which went stagnant in the basins one quarter of all sailors worldwide. Most The maritime industry has recognized this before the Madagascan rum. It was also of them are far away from home, trans- problem and is increasingly providing lei- considered a remedy for scurvy. The defi- ferring billions of US dollars back to their sure and sports activities. Relaxing enter- ciency disease and spoiled food and drink families every year. Even though the con- tainment and the ability to switch off are decimated entire crews until Captain sumption of alcohol plays a similar role in no longer a luxury, but a necessity, while James Cook served his men sauerkraut in their homeland as it does in other coun- also attracting well-qualified personnel. the 18th century. The vitamin C contained tries, Filipinos often drink less. A study A well-equipped lounge helps the crew to therein ended the sailors’ anguish and has revealed that this restraint is due to bond. Films are watched together or cards also ruined the excuse for the rum intoxi- their socially recognized status as family played during the coffee break or after the cation. Yet it wasn’t just Kuttel Daddeldu, ambassadors and breadwinners. There is evening meal. A ship that has a good chef the fictional character created by the sea- almost always a karaoke machine in their and celebrates birthdays, Christmas, and faring poet Joachim Ringelnatz, who con- mess, a national sport for which they cul- New Year is a good ship. If the company pol- tinued to get tipsy. Until the second half tivate real ambition. Everything that has icy allows it, there is sometimes also beer, of the 20th century, “the sailors were out ever conquered the pop charts is sung – wine, or spirits. Four hours before a shift to alleviate their various pains,” recalls sometimes with, but also without alcohol. begins, however, only soft drinks are gener- another captain. “Wine, women, and song “There is a new generation of sailors.” ally served. Most ships carry testing devices were an effective way of doing this. As long This observation was made by Ulf Petereit such as the Dräger Alcotest 5820 so that a as the duty officer on the bridge had his and his river police colleagues at the bor- crew member can be tested at any time. A wits about him to some extent, there was der checkpoint, which every ship has to growing number of ships have an absolute no real danger on the high seas.” Rapid- pass through before it can leave the port zero alcohol limit. “Captains are required ly changing weather conditions and pira- of Hamburg. “This generation thinks dif- to carry out random testing,” says shipping cy, however, made the ocean one of the ferently and drinks less.” His trained eye investigator Petereit. “The results are docu- world’s most dangerous places to work. can quickly tell if somebody is under the mented and presented to the shipping com- Around 2,000 sailors lose their lives every influence of alcohol. “But problems are pany in order to show the measures tak- year. In 2016, there were 2,611 accidents; exceedingly rare,” says Petereit, who has en on board.” However, the captain always 85 ships sank. Most of the accidents hap- 20 years of professional experience behind has the final say. He himself can ban alco- pen in bad weather. Thanks to modern him. The job of a sailor is a lonely one these holic drinks even if the shipping company communication technology and sophisti- days. So what could make a sailor happy? allows them.

DRÄGER REVIEW 119 | 1 / 2019 55 Doctor Reddy’s Hunt for the Record The world’s biggest HOSPITAL SPECIALIZING IN GASTROENTEROLOGY is being built in the Indian city of Hyderabad – and is designed to alleviate the lack of medical specialists on the subcontinent.

Text: Mathias Peer Photos: Harsha Vadlamani M Mehabub Halder* has traveled a long way for his appointment. The man from Calcutta sat on a train for 26 hours before reaching the southern Indian city of Hyder- abad. This is the workplace of Nageshwar XXL dimensions: It’s easy Reddy, currently one of India’s most in- to look lost in the lobby, in demand specialists in stomach, bowel, and which a medium-sized railroad liver problems. Halder has had an unusu- station would also fit al swelling in his stomach for a number of years and he wants to have it examined. He is certain that he will find help here. It is Tuesday morning in HITEC City, ing’s golden logo shines resplendently at a district of Hyderabad where internation- the other end: AIG. The three letters stand al companies such as Amazon, IBM, and for the Asian Institute of Gastroenterology, Deloitte have also opened offices. Hal- a hospital specializing in treating patients der is heading for the dark gray, nine-sto- with digestive tract problems. Dr. Nagesh- ry building next to the city’s expressway. war Reddy, the founder of the hospital, is At first glance, it could easily be mistak- pursuing ambitious plans with his insti- en for one of the modern shopping malls tute: The 62-year-old not only hopes that that are increasingly vying for the business it will become one of India’s leading pri- of the middle-class people with purchas- vate hospitals, but also the world’s biggest ing power in India’s cities. An automatic hospital specializing in gastroenterology. In demand: Dr. Nageshwar Reddy is glass door slides open at the entrance; a one of India’s most popular gastroenter- guard x-rays the bags at the security check- Around 70,000 endoscopies ologists. The waiting time for an appointment with him is several months point. A vast hall with marble floors and Dr. Reddy has experience in caring for escalators opens up behind it. The build- a large number of people – he has been

* Name changed

56 DRÄGER REVIEW 119 | 1 / 2019 ASIA MEDICAL CARE

practicing in Hyderabad for more than with the new building in HITEC City. It the past few weeks. With this so-called soft three decades. His good reputation has is set to take his life’s work to a new lev- launch he wants to test the procedures been earned by treating patients from all el: Around half a million patients could and make sure that his hospital can cope over India as well as neighboring states. In be treated here each year. However, as with the anticipated demand. Reddy walks his first hospital, which is located in the of August 2018 the large hospital is not along the corridor in a white gown with city center near the heart-shaped Hussain quite ready: Boxes are still waiting to be a group of visitors. There is a little bit of Sagar Lake, he and his team have recently unpacked by one of the entrances. Wires rustling, because the shoes are wrapped been treating more than 100,000 patients are poking through the wall where ceil- in blue plastic film for reasons of hygiene. per year and performing around 70,000 ing supply units will eventually hang, and Reddy stops by one of the window façades endoscopies. According to the hospital’s the drone of the drills constantly inter- and points to the construction work in own figures, it holds the world record for rupts the calmness that otherwise reigns. the inner courtyard: “Hanging gardens the number of these ERCP examinations The operating rooms and intensive care are being built here.” He says it is impor- performed annually. And since there is no units are not yet open, either, although tant to give patients a view of green spac- longer sufficient room for every patient, Reddy doesn’t want to lose any time: He es from their rooms. Daylight can be seen Dr. Reddy is aiming to go one bigger has been welcoming the first patients over from almost every hospital bed. “I have

DRÄGER REVIEW 119 | 1 / 2019 57 Operation “Blue”: The lighting in the treatment rooms makes it easier for the doctors to concentrate on the monitors. The temperature can be controlled by voice recognition. Besides the gas management system, much of the equipment (below) is supplied by Dräger

58 DRÄGER REVIEW 119 | 1 / 2019 ASIA MEDICAL CARE

visited more than 500 hospitals all over Thorough the world and am very pleased with what checkup: Dr. Nagaraja Rao we have achieved here,” he says. “We have Padaki examines created an infrastructure that is among a patient with a the best in the world.” There are 800 stomach complaint. beds, 20 endoscopy suites, and 16 operat- He prescribes a protein-rich diet ing rooms: No other specialist hospital in this field has as much capacity, according to Dr. Reddy. “In second place is a hospital in China with 400 beds.”

Doctor and entrepreneur The equipment in the rooms is like something from a science fiction film: The doctors hold their hands up to a sensor in order to enter. Without touching anything, the large steel door opens. The endoscopy suite is bathed in blue light – this is designed to make it easier for the doctors to see the monitors during the examination. Medical staff can change the light and temperature levels using voice command. Music can Procedure also be played via a speaker system during trointestinal diseases – equivalent to 400 operations thanks to a terminal embed- million people. “We would need at least ded in the wall with touchscreen and USB testing 100 hospitals like this one to treat them port. The gas management system, which, all,” he says. The lack of specialists makes like most of the equipment, comes from during the it difficult for patients like Mehabub Halder Dräger, supplies medical gases. The image to get the right treatment. Halder enters relayed by the endoscopy camera can be soft launch the hospital wearing gray cloth trousers, seen on a flat-screen monitor in 4K quality. a short-sleeved shirt, and sandals with no At the same time, another camera with an shut. He was impressed by the precision of socks. He is strikingly slim. His medical integrated microphone is directed toward the doctors and the efficient medical care. records are tucked underneath his arm. the doctor, allowing the examinations and Back in India he found a different situa- In the still largely empty lobby, in which a procedures to be broadcast live to confer- tion: There were just 100 gastroenterolo- medium-sized railroad station would also ences or students in an adjoining room, gists in his country at the time. Reddy rec- fit, men like him easily look lost. Employ- complete with commentary. For Dr. Reddy, ognized a huge problem in the shortage, ees responsible for admitting patients try to the project marks the highlight of his which remains unresolved to this day: He put the newcomers at ease: They walk up career, which has not only made him an says that even though the number of spe- to the patients from behind their desk and in-demand doctor, but also an entrepre- cialists in this field has grown to 3,000, explain to them what happens next. After neur. The man, who is easily recognizable Japan alone has ten times the amount, an initial examination, the taking of a blood from a distance thanks to his dark, bushy even though its population is just a tenth sample, and laboratory tests, Halder enters moustache, grew up in a family of doc- of that of India. the room of his doctor, liver specialist Dr. tors. His grandfather and his father were Diseases of the digestive tract are wide- Nagaraja Rao Padaki. Halder removes his both professors of pathology. Reddy says spread in India. There are many differ- sandals and shirt. The head physician uses he already knew as a child that he want- ent reasons for this: contaminated drink- his hand to examine the swelling that has ed to be a doctor. He opted to specialize in ing water, unhygienically prepared food, bothered Halder for quite some time. “No therapeutic endoscopy and traveled to Ham- genetic predisposition – but also the coun- pain?” he asks. Halder quietly says no. The burg in the 1980s to further his knowledge. try’s rise in economic prosperity. Problems doctor reads about blocked blood vessels He liked the fact that the streets were so such as obesity are also increasing along- in the medical records – clearly the rea- much quieter in Germany compared to side the growing middle class, which can son for the enlarged spleen and the slight India, although he wasn’t so keen on the cause fatty liver disease. Reddy estimates physical stature of his patient. Dr. Padaki weekends, because all of the shops were that 30 percent of Indians suffer from gas- says the condition can be managed. In his

DRÄGER REVIEW 119 | 1 / 2019 59 MEDICAL CARE ASIA

Modern building: president of India, Venkaiah Naidu, was The Asian Institute of one of the first VIPs seen by him in the Gastroenterology (AIG) is in a good neigh- new AIG building. Afterwards, he pub- borhood. The nine-story lished a picture on his Twitter account of building is situated him standing next to Reddy. “I have been amid the office sky- in many hospitals in this world,” he wrote, scrapers of international companies in “but this one here is truly outstanding Hyderabad’s HITEC City with its state-of-the-art infrastructure.” The vice president came to the appointment with several dozen police officers. Prominent patients will get their own separate entrance in the future to make it easier to meet their security requirements. Attracting affluent patients to the hospital is critical to its success: Even though they get the same medical treatment as any other patient, they pay more for the comfort. This allows the hospital to treat people in need free of charge – at the hospital itself and in mobile treatment centers that the AIG sends to villages with poor health care. More than ten view, an operation is not necessary at this million patients have received free treat- time. He prescribes a protein-rich diet to Advertising ment from Reddy and his team in this way. build up the patient with another follow- The hospital founder describes himself as up appointment in 12 months. “Elsewhere offensive a left-leaning, somewhat socialist person. they might review him in six months,” he He doesn’t want to judge the success of his says. But he has to remain pragmatic. company on the profit it makes, but rath- “People here cannot travel across half the with the er on its ability to reach as many people as country every few months.” possible. “I prefer to treat the poor rather Halder works in Calcutta at an out- costs than the rich,” he says, adding that poor sourcing company that undertakes busi- patients are especially grateful. ness processes such as human resources Reddy currently works with them less and logistics for other companies. It is a er. The hospital has gone on the offensive often than he would like to. Just before he good job that allows him to spend mon- by launching an advertising campaign to reaches the door to the endoscopy suite, ey on his health care. He saved 20,000 promote the costs. A poster hangs by the an assistant stops him with a pile of doc- rupees, about 250 euros, for the doctor’s entrance, advertising the price of a liv- uments. They have to be signed. A little appointment in Hyderabad 1,500 kilome- er examination: “Now just 2,500 rupees later, between two appointments, he is ters away – including travel costs and over- instead of 5,740!” The hospital charges just approached by a young woman who wish- night stays in hotels. That’s not an incon- 300 rupees, about 2.50 euros, for a sim- es to apply for a job. The hospital direc- siderable amount of money to him. In ple consultation – regardless of whether tor holds a spontaneous job interview Calcutta it is the equivalent of an average a young colleague or the hospital director there and then. Everybody wants some- monthly salary in his sector. Many of the sees the patient. thing from him, but there is seldom time patients at the AIG hospital have no health for them all. Reddy has already been work- insurance that covers their treatment, Free treatment for those in need ing 18-hour days for a number of years. He which is why hospital director Reddy is not Accordingly, appointments with the head says that he has paid a high price for this: only committed to providing high-quality physician are popular: Patients refer to There is hardly any time left to spend with care. The treatment must also be afford- Internet forums to find out how to get an his family, although his wife – a derma- able. Making efficient use of the large hos- appointment with Dr. Reddy. There is a tologist – and his now grown-up daughter pital’s capacity should make this possible. three-month waiting list, according to have always supported him. They are well Since a very high number of patients can the hospital. Celebrities and politicians aware: “You have to make sacrifices if you

be treated here, the average price is low- also want him to look after them. The vice want to achieve something.” SHUTTERSTOCKPHOTO: (1)

60 DRÄGER REVIEW 119 | 1 / 2019 ASIA MEDICAL CARE

Light moments: There is daylight in most of the rooms, designed to make the stay more pleasant for patients

Hyderabad is at the heart of India in every respect. With almost seven million residents, it is the country’s fourth-biggest city. It is one of the centers of biotechnology and the pharma industry. The northwest is also known as Cyberabad

DRÄGER REVIEW 119 | 1 / 2019 61 PANORAMA MILITARY WORKING DOGS More or Less Best Friends

Dogs sometimes make better comrades for soldiers. They sniff out explosives, apprehend suspects, and keep guard. Germany’s armed forces train their DOGS AND HANDLERS at a special school – and from then on they stick together through thick and thin for many years.

Text: Björn Wölke Photos: Matthias Jung

Then something happens. As the wind changes direction, Sergeant First Class Egon K.* opens the window of his special vehicle and leaves it ajar. Clóe may still be unable to see the suspect, but at least she can smell him now. Clóe is a I Malinois, the short-haired variety of the It is two o’clock in the afternoon near Belgian sheepdog. “They always want Kabul. The summer heat is brutal: nearly to work,” says the Sergeant First Class. tafa G. in a swift operation. To do this, 40 degrees with a light breeze. It is almost “That’s why they are first choice for using they have come heavily armed and taken unbearable in the observation vehicle – as special military working dogs.” Musta- up a position on this busy road a few kilo- 58.4 degrees Celsius. The four German fa G.*, the suspect, has been known to the meters outside Kabul. Clóe has trained soldiers remain calm, although the ten- Afghan authorities for some time. He is her entire life for moments like this. The sion is etched on their faces. For the past a suspected jihadist. He traveled to Pak- five-year-old dog recently underwent a ten minutes they have been observing a istan, spending three months at a Tali- special ten-month course to train as a battered pickup truck 100 meters away. ban school and subsequently staying at a scout dog at the school for military work- training camp in Afghanistan, where he ing dogs (Schule für Diensthundewesen learned to manufacture explosives and der Bundeswehr, known by its abbrevia- handle weapons. tion SDstHundeBw). The SDstHundeBw is in the town of Ulmen in the state of Four-legged specialists Rhineland-Palatinate, around 60 kilo- “We have to assume that he is armed meters south of Koblenz – in the mid- and carrying explosives, which is why dle of a forest. Between 50 and 70 mili- Clóe is our preferred resource ahead of tary working dogs and as many handlers the firearm,” says Sergeant First Class are trained here every year on an area K. Everyone in this team has a precise occupying almost 70,000 square meters. role, even Clóe. As a military working dog, A former ammunition depot and its she is accompanying the troop of soldiers 51 bunkers have been converted for charged with the task of capturing Mus- this purpose and special courses that

* Name changed 62 DRÄGER REVIEW 119 | 1 / 2019 Inseparable: Sergeant First Class Egon K.* and his military working dog Clóe during a training exercise on the grounds of the school for military working dogs in Ulmen. Once he finishes work, he takes the Belgian sheepdog home with him – she is part of the family

DRÄGER REVIEW 119 | 1 / 2019 63 PANORAMA MILITARY WORKING DOGS

Firmly under control: The dogs must even learn how to bite! There is a strict selection procedure. The animals must be stable, exhibit excellent social behavior, and appear very self-confident

instead rebels or lone operators that plant improvised booby traps in ambush- es of all kinds. “The dogs help us to give our comrades effective protection at any replicate potential deployment loca- time of the day or night,” says Lieutenant tions have been created: railroad tracks, Colonel Dr. Stefan Hampel, veterinary a derelict house, and a sewer tunnel surgeon and commander of the military system. There is even a railroad station working dog school in Ulmen. “No tech- but now the focus is on special working concourse with a baggage handling nology in the world can beat a dog when dog teams. Why aren’t they used much area here. It is not just the basics that it comes to highlighting dangers. What more often? “Even though the reality on are taught in the bunkers. Further rea- device can sniff out explosives, bark loud- the ground has shown that such teams listic training, the key element of any ly, and bite on command?” Germany’s are effective, the emphasis remains on special course, must be given in as many armed forces use hundreds of these ani- the technology, even though it can’t different places as possible (towns, railroad mals. Hampel prefers not to reveal the always solve everything,” says Hampel. stations, factory sites, shopping malls, precise number currently deployed in cri- Accordingly, he would like to see a coun- etc.) in order to familiarize the dogs sis zones, but he will say this much: “All tervailing trend in the future. with the various scenes they will face – seven types of military working dog that including combat sound effects. we train here are deployed.” Ever since Incredibly effective animals Dogs such as Clóe are now more Germany has been involved in overseas Lieutenant Colonel Hampel knows the important than ever to military person- assignments, however, the dogs have to kind of incredibly effective tool he will nel. In the world’s trouble spots, the do much more than just guard their own get at the end of such a training period: adversaries are often no longer regu- barracks. It used to be the case that sen- highly concentrated animals that can act lar troops that appear in the open, but try dogs were almost exclusively trained, at lightning speed and carry out missions exactly as required. A mine dog has to be able to indicate the presence of small amounts (a few grams) to large quantities (100 kilograms or more) of the usu- al types of material without delay. New Military dogs are canine recruits are either bought from outside or bred by the armed forces. now more important Here, in the Eifel region, there is a strict selection procedure, because particular- than ever to armies ly high demands are made on a special

64 DRÄGER REVIEW 119 | 1 / 2019 working dog. “The animals must be stable, exhibit excellent social behavior, and appear very self-confident,” says Ham- pel. Some animal welfare campaigners view this instilled obedience with sus- picion. They know how difficult it is to teach dogs something. So how exactly A military exercise with a scout dog: At do you get young dogs to seek and find the end of the training the dogs can act at explosives? They are primarily motivat- lightning speed and carry out orders exactly ed by a playful approach. “That is abso- as required – but this takes a long time lutely essential,” says Hampel. In addition, every aspect of the training must be designed to ensure that the animals suc- ceed, more or less leave the field a win- ner, and always receive a reward. Lieutenant Colonel The aim at the end of the training is Dr. Stefan Hampel to turn the dog and handler into a reli- has been head of the able team that can safely carry out each military working dog school in Ulmen since 2016. task required of it. At the same time, the Between 50 and 70 animals dogs themselves must work under con- are trained here under siderable stress and find mines, weap- his command every year ons, and ammunition within a matter of seconds. They must be able to enter a building or vehicle and overpower ene- mies. The animals shouldn’t always bite; sometimes barking is enough. Achiev- ing such results requires a significant amount of trust – both from the animal as well as the handler. They go through thick and thin – day in, day out – to build up this trust. “I spend more time with

DRÄGER REVIEW 119 | 1 / 2019 65 PANORAMA MILITARY WORKING DOGS

Six of the best: By breeding the dogs, the armed forces can begin optimally training them when they are young

thing from nutrition and dental care (even crowns!) to tricky operations. Var- ious Dräger products are used in the operating room, including OR lights. The gas management system also comes from Lübeck. When the time comes for a working dog to retire, it often moves in with its handler as a private pet. The bond between the two is so close that the “We are among the handler adopts their companion as soon as it is taken out of service for health or world’s best with our seven age reasons. Others return to the training school where they are cared for and types of working dogs.” also found homes with civilian families. Lieutenant Colonel Stefan Hampel, Head of the SDstHundeBw Outstanding sniffer dogs At five years old, Clóe is still a long way away from reaching this point. Her good nose is responsible for the fact that she is my working dog than with my family,” able to smell a suspect at a distance of 100 says one of the trainers at the SDstHun- meters. Her nose has around 200 million deBw. “The several hours of daily train- olfactory cells; a human nose only has a ing help to create a bond.” The animals fraction of this number. When Sergeant generally live at home with their han- First Class K. opens the side door of his dlers and are part of the family. A young “In recent years, we have developed var- vehicle and gives the order, everything dog’s basic training alone takes several ious working models and are now among happens very quickly – Clóe heads toward months, during which it is acquainted the best in the world – not in terms of the pickup truck at around 40 kilometers with its future tasks. The animals then the quantity of working dogs, but rath- per hour. A few meters before reaching take special courses, also lasting several er their skills.” There is no standing still it, she leaps in a single bound through months, to train as military police dogs, for Hampel. Everything is a dynamic pro- the open window and bites Mustafa G’s explosive detection dogs, or narcotics cess. “We are in regular contact with mil- lower arm. The approaching soldiers now detection dogs. They are also used by the itary working dog training schools in oth- have an easy task. Is there actually a med- air force and special forces as security er countries and continue to develop the al for military working dogs? “No, not at dogs or train to become weapons dogs relevant models on this basis.” Hampel the moment,” says Lieutenant Colonel and mine dogs. The dogs undergo regu- says that no German dog has ever died Dr. Stefan Hampel, “but we’re working lar annual tests once they have complet- while on duty. Should something happen on it.” Clóe has probably earned it. ed the basic training and so-called “spe- – if a dog picked up an injury while train- cialist training.” A dog is generally on ing, for example – the school has its own War in the mind: Many soldiers who suffer from active service for five years. hospital in Ulmen. It is the main cen- post-traumatic stress disorders The complex and intensive train- ter responsible for the veterinary care often struggle on a daily basis. ing pays off. Lieutenant Colonel Ham- of all military working dogs. Veterinary Yet there is effective therapy: it barks and has four legs. pel is confident that his working dog surgeons and nurses look after the ani- www.draeger.com/119-66 school compares well internationally. mals’ well-being, taking care of every-

66 DRÄGER REVIEW 119 | 1 / 2019 In good hands: Veterinary surgeons and nurses look after the animals’ well-being at the hospital, taking care of everything from nutrition and dental care to tricky operations

DRÄGER REVIEW 119 | 1/ 2019 67 In full flow: Only a few volcanoes on earth are as active as Kilauea on Hawaii. Its lava flows and ash deposits have forced thousands to flee this year

HOT SPOT Bubbling volcanoes are part of everyday life on Hawaii. Since the latest eruptions, the local fire department has been using PORTABLE GAS DETECTION EQUIPMENT from Dräger.

Text: Steffan Heuer

68 DRÄGER REVIEW 119 | 1 / 2019 VOLCANOES OCCUPATIONAL SAFETY

in the Pacific

D Darwin Okinaka was born and raised on Hawaii’s Big Island. As a native, he has known from an early age that the paradise beneath the palm trees is built on fire. “By the time I reached elementary school, it was clear to me that there was at least one active volcano on our island,” says Okinaka, who now deals with fires of all kinds in his job as a full-time firefighter. “It can erupt at any time, but we weren’t prepared for this scale of volcanic activity.” The chief of the local fire department is referring to the eruption of Kilauea, which has destroyed more than 700 homes with lava flows and ash deposits along its eastern flank and forced thousands of people to flee since the beginning of May 2018. Inci- dentally, the Hawaiian word kilauea means “spewing” or “much spreading.” Despite having modern seismographs and computer models, geologists and volcanologists are unable to say how long the eruptions will last or when they will increase in intensi- ty once again (after a relatively calm phase). Yet they know that they have to continue monitoring Kilauea using a dense network of measuring stations and sensors – because there are a growing number of settlements in the immediate vicinity of the volcano and gases escape from both the old and new fissures, prin-

cipally the invisible sulfur dioxide (SO2). The gases also pose a

PHOTOS: PICTURE ALLIANCE/ABACA, AP PHOTO PHOTOS: threat to communities further afield. However, Hawaii wouldn’t

DRÄGER REVIEW 119 | 1 / 2019 69 OCCUPATIONAL SAFETY VOLCANOES

Stand back! More than 700 homes have fallen victim to the Kilauea volcano since May 2018. Hawaii’s firefighters have been carrying portable gas detectors ever since

oxygen, moisture, and sunlight. Fine dust particles form, which Eruptions are part can also reach other islands, depending on the wind direction. This is how the volcanic smog from the latest eruption on Hawaii of everyday life here reached the Marshall Islands, 3,700 kilometers away, within the space of a month. As part of the studies on the Kilauea eruptions in 1983 and even exist if it weren’t for these formidable volcanic eruptions. 2008, scientists at the University of Hawaii in Manoa have set up The eight main islands (and many smaller isles) owe their exis- the Vog Measurement and Prediction Project (VMAP) in order to tence to the magma in the earth’s liquid interior, which makes be able to forecast the toxic mixture as accurately as possible. its way to the surface from a permanent hot spot beneath the The EPA and Hawaii State Department of Health also provide slowly shifting Pacific Plate.. constantly updated information about the general air quality and

SO2 concentration on their own websites. Although the measur- The ash cloud traveled 3,700 km southwest ing stations run by the authorities and scientists are important, The result is so-called shield volcanoes: huge mountains of solid- first responders like Okinaka need accurate and reliable infor- ified lava that rise high into the sky from the depths of the ocean mation about hazardous gases when they are called out to a spe- floor several kilometers down. Strictly speaking, Hawaii’s sum- cific location. That is why the fire department on the main island mits are therefore the highest in the world. Even though the vol- has owned a total of ten Dräger gas detectors (type: X-am 5000) since cano known as Mauna Kea, north of Kilauea, only rises 4,205 May 2018. The device, the size of a cell phone, is both water- and meters above sea level, it is actually around 10,200 meters tall dust-resistant, and can measure up to five gases simultaneously. when measured from its base in the ocean, putting even Mount “During the last eruption ten years ago, when parts of the

Everest (8,848 meters) in the shade. Of all the volcanoes on the central crater collapsed and there were high levels of SO2 in the Hawaiian Islands, however, none has caused more devastation air, we were lent devices by the Civil Defense Agency, which have than Kilauea. Its last big eruption at the end of the 18th centu- long since been returned,” recalls Okinaka. “Now we finally have ry claimed several thousand human lives. “Kilauea is showing our own portable devices that can be attached to our firefighting no sign of calming down in the foreseeable future – and the sur- jackets, which means that we have them with us at all times. In rounding area can no longer be described as remote,” says Oki- the event of impending danger, they warn us visually, acoustical- naka, voicing his concern. It is therefore all the more vital that ly, and haptically (by vibrating). It is both reassuring and conve- the volcanologists, the Environmental Protection Agency (EPA), nient.” The most important feature on the device for the firefight-

and the Hawaii State Department of Health have set up sensors er is the SO2 sensor. Okinaka has distributed the ten detectors to around the volcano, which measure the concentrations of sever- the ten fire stations on the Big Island that are either in the imme- al different gases and inform the population of the findings. On diate vicinity of Kilauea or are most affected by the gases and vog the official Hawaii Interagency Vog Information Dashboard, for due to the wind direction. As such, around 60 firefighters share example, it is possible to track the “vog” in real time – the toxic the devices in three shifts. “Nobody knows how long Kilauea will volcanic smog made up of water vapor, carbon dioxide, and sul- remain active,” says Okinaka. “But in the long term we must gear

fur dioxide. If SO2 is released into the atmosphere, it reacts with ourselves up to be prepared for anything.” OKINAKA/FIRE TIMES/REDUX/LAIF, DARWIN HAWAII THE NEW YORK DEPARTMENT PHOTOS:

70 DRÄGER REVIEW 119 | 1 / 2019 INFORMATION SERVICE

X-plore 3500 This half mask is the Our Con- first choice for long-term and demanding use. tribution Page 12

An overview of some of the Dräger PRODUCTS featured in this issue can be found Alcotest 5820 here in the order they appear. Breath tests can be performed Each product has a QR easily with the help of this device – it can also measure passively code which can be scanned (without a mouthpiece). with a smartphone or Page 55 tablet. The relevant product information will then be displayed. If you have any MRC 5000 This refuge chamber features questions about a product or redundant breathing air systems, the magazine, write to us: guaranteeing a supply of pure breathing air underground. [email protected] Page 12

X-am 8000 This gas detector simultaneously Movita measures the presence of up to This ceiling supply unit can seven toxic and flammable gases be maneuvered into as well as vapors and oxygen – in various positions for use in either pump or diffusion mode. OR and ICU environments. Page 12 Page 58

Fabius Tiro Polaris 600 This compact anesthesia This OP light features workstation is perfect intuitive operation, versatile for use in tight spaces (such adjustment options, as the induction room). and simply good light. Page 24 Page 58

71 INSIGHT MOBILE GAS DETECTION TECHNOLOGY Double the

3 Protection

1 8 5 2

13 12 10

Both seen 9 and heard: This gas detector warns its wearer visually and acoustically if there is too little oxygen or too concentration of O and CO (or – on 14 4 2 much carbon monox- a different version of the Pac 8500 – ide in the ambient air hydrogen sulfi de and CO). The version can be determined by the color of the 6 7 surfaces ( 6 and 7 ). The light 8 , indicates that the device is ready for use. 1 The triple alarm will warn the wearer if the gases reach one of the two (or four in the case of oxygen) individually adjustable limits. The wearer must then take appropriate action. The display 9 shows the gas 10 that has been detected, its concentration 11 , and the In certain workplaces, such as furnaces, a 360° light 1 , acoustically via an status of the special battery 12 , which the dangers can be visible as well as alarm 2 (at a piercing volume of 90 guarantees power for between one and invisible. Take carbon monoxide (CO), dB(A)), and mechanically by vibrating. two years, depending on the type of for example. Unnoticed by humans, As part of the wearer’s personal protec- device. A powerful battery that can be the gas prevents the blood from transport- tive equipment, the Dräger Pac 8500 replaced by the customer was one of ing oxygen, which can lead to a loss is attached to the work clothing at chest the features requested by users who saw of consciousness and even death. On height by means of a fi rmly closing it as the only way of satisfying explosion- the other hand, there may be an insuffi - crocodile clip ( 3 ; on the back). After protection requirements. The housing

cient concentration of oxygen (O2) in pressing the OK button 4 to switch it 13 is water- and dust-resistant (IP 68 rat- the air. This dual gas detector visually on, the sensor located behind the replace- ing). Certain functions and displays can

PHOTO: DRÄGERWERK AG & CO. KGAA/DRÄGER REVIEW 1/2019, PAGE 72 KGAA/DRÄGER & CO. REVIEW AG DRÄGERWERK 1/2019, PAGE PHOTO: warns the wearer of both dangers with able protective ﬁ lter 5 measures the be controlled via the menu button 14 .