J R Army Med Corps 2001; 147: 161-167 Organisation and design of regular field hospitals MCM Bricknell ABSTRACT who will probably survive further The organisation and design of field evacuation (with appropriate sustaining hospitals within the British Army has treatment) to rear hospitals so that they been under review since the Gulf War. may concentrate their efforts on This paper discusses principles for the providing primary surgery to ensure that organisation and design of field all seriously injured casualties who would hospitals and makes suggestions for otherwise die are operated upon in the further development. The paper forward hospital within 4 hours: describes the deployment of field c. capable of sustaining themselves in the hospitals from a 25 bed hospital troop up field. to a 200 bed field hospital. The proposals contained in this paper Key words: military, hospitals, design. must be seen as separate from the grouping of Field Surgical Teams within Medical Introduction Regiments at Role 2. This capability is The organisation and design of field designed to meet the 2 hour clinical timeline hospitals within the British Army has been for resuscitative surgery, and is only viable under review since the Strategic Defence when supported by a Role 3 facility located Review. A comprehensive study of the elsewhere in the CASEVAC chain to meet requirements for land based medical units the 4 hour rule. behind the divisional rear boundary in a The function of field hospitals in the theatre of operations has been conducted by Nuclear Biological and Chemical (NBC) HQ LAND command. This has led to a environment has also been under review. careful examination of the function and This led to the procurement of equipment organisation of field hospitals.The aim of this specifically designed to meet such a threat. paper is to describe principles for the Although much of the developmental work structure and design of deployable military has also informed the requirement for the hospitals in order to inform the readership of field hospital operating in a non-NBC this Journal of current developments within environment, this paper will not specifically the regular field hospitals.The content of this consider NBC issues. paper has been endorsed by the chain of Ideally, field hospitals should be sited in command.The concepts described may have buildings with existing infrastructure utility for field hospitals within the Territorial services. However it has been stated that Army but these units are not yet resourced to regular field hospitals must be able to deliver the capabilities described. activate at full capability on a ‘green field’ site. This is the greatest challenge for field Scope hospitals. Detailed pre-planning is required The proposals contained in this paper are to ensure effective use of external logistic based on the current establishment of regular support (eg. engineers, pioneers, mobile bath field hospitals(1). This paper does not and laundry units). It has been agreed that examine field hospital structures beyond 200 templates for field hospital shelter systems bed capability. Theatre or Role 4 level should be created in order to ensure that the capabilities will not be considered. The Unit Equipment Table (UET) supports such capabilities listed in the HQ LAND Study deployment and to practice the logistic planning process. The field experience of all Lt Col MCM Bricknell are considered to be the requirement for DM MMed SciMFOM regular field hospitals. A regular field hospital 3 regular field hospitals during 2000 has MFPHM MRCGP is to be: been reviewed in order to produce this paper. DMCC DRCOG a. capable of deploying, and redeploying, in DFFP RAMC order to conform to the supported Basic Principles Commanding Officer division during manoeuvre warfare and General Design. The overall design of the 22 Field Hospital able to function in a relatively adverse field hospital site should include the Thornhill Barracks military environment. They must be following 4 functional components: clinical Gallwey Road capable of operating on a ‘green field’ site, services, command, administrative support Aldershot GU11 2DF and be modular to facilitate Task and accommodation. The size of these Organisation into smaller or larger components clearly depends on the overall Email: hospitals. capability of the complex. A schematic for [email protected] b. capable of identifying those casualties the site design of a field hospital is shown at 162 Organisation & design of regular field hospitals Fig 1. Schematic Field Hospital site. Figure 1. If buildings or hard standing are command group to function as a guard tent. available, this should be adapted to Regimental Headquarters (RHQ). accommodate the field hospital. The designs The RHQ has to be capable of managing a contained in this paper assume the worst ‘medical group’ and/or a full 200 bed field case scenario of a flat green field site. hospital. Thus the RHQ is a large Scales of Deployment. Field hospitals organisation which includes the Regimental are equipped with 2 communications Administrative Office and Medical Records vehicles for operational deployment. This Office functions. It is scaled for DRASH in communications equipment allows field order to provide a robust environment hospitals to be sub-divided into a maximum suitable for 24 hour working with sensitive of 2 components: a main body (max 150 IT equipment.The RHQ is separate from the beds) and a single sub-unit (max 50 beds). clinical complex in order to avoid micro- The ‘common user departments’ (A+E management by the command team. The complex, Evacuation and Support Sqn) all design for RHQ is shown at Figure 2. have a critical mass below which there is Squadron Headquarters (SHQ). The either a disproportional decrease in SHQ is a small command and capability or the equipment reduction is communications (C2) node that commands illogical (e.g. removing a bay in resuscitation the Hospital Squadron. It should work to a when there is space available in the allocated medical RHQ. This can be based on a single shelter). The basic division of these areas communications vehicle attached to a should be divided on a 75%/25% template. DRASH No 2. Where the Medical Equipment Table (MET) Administrative Support. Administrative provides for 3 modules (e.g. X-ray and support to the field hospital consists of the laboratory) then these should be divided in following functions: Quartermasters 66%/33% split. It is axiomatic that UET department, Medical Stores Section, Motor scales and the MET must be designed to Transport Section (including Light Aid support the same modular capabilities. Detachment), Catering Section, Medical and Command. There are 2 scales of Dental Support Section and Artisan Section command: Regimental Headquarters (Royal Engineer carpenter, electricians and (RHQ) and a single Squadron Headquarters plumber). These are scaled on a 150/50 (SHQ). These are based on DRASH as the basis. The designs for administrative support increasing use of computers for HQ require further development and are not functions requires robust protection from the included in this article. weather. A 12x12 tent is included in each Accommodation. The detailed MCM Bricknell 163 have two-way traffic in all but the smallest design and these shelters are too narrow to allow stretchers to pass each other. Therefore the spine should be composed of corridor pairs at above 50 beds of deployment. Unfortunately this creates a 'double apex' which drains water between the corridor pairs which may degrade the floor in the corridors in heavy rain. It might be necessary to add an additional 'vertical' spine at the end of each ward if the patient load generates congestion in the central spine. The ground occupancy of shelter systems is greater than the internal dimensions because of the necessity for guy lines. Thus it has been found necessary to have double corridors between '4 ways' to ensure sufficient space between lateral shelters. There must be sufficient external Fig 2. Regimental Headquarters. exits to enable convenient access to the complex and rapid exit in the event of fire. accommodation plot can only be planned in Neither the '4 way' nor corridor is provided detail once the organisation and nominal roll with a groundsheet. This risks damage to has been confirmed and the breakdown by the critical thoroughfare in the clinical gender and rank is known. It is probable that complex. The ideal future design for the accommodation will be mixed by rank and spine should be a single, two-way gender at Hospital Troop and Hospital thoroughfare with a robust system for Squadron levels of deployment. protection of the ground and specifically Deployments above this scale may enable designed lateral connections to segregation of accommodation and even departments. separate mess tents. The accommodation Shelter systems. The shelter system has shelters may also be used as overflows for the the greatest influence over the clinical Reception or Ward departments. environment within which medical care is delivered. The main considerations are Clinical Complex temperature control and cleanliness. The The clinical complex comprises 4 functional appearance of the clinical environment is groupings, Accident and Emergency (A+E), also important to reinforce that they, the clinical support, surgical complex, and casualties have been removed from the wards. The following paragraphs discuss key chaos of the battlefield and are now considerations in the design of the clinical safe(3).The current basic shelter system is complex. GS tentage. GS tentage is provided in a Orientation: The majority of field variety of sizes.The most utilised size for the hospital designs are based around a central clinical complex is 18x24ft that can be spine with branches for individual joined to construct 18x48ft, 18x72ft or departments. The design of US Army 18x96ft sized shelters. GS tentage is robust, Combat Support Hospital is based on simple and provides sufficient space for two several patient entry points with the spine as rows of stretchers or beds.