Interview with Wang Tao of the National Emergency Medical Rescue Team of Dongfang Hospital: There will be a water version of the mobile cabin

The Surging News reporter He Liping Yang Yang Liu Hang

In the fight against COVID-19, the Fang Cabin Hospital has played a huge role. From February 2020, when the epidemic in Wuhan was at its worst, the government decided to quickly coordinate the opening of large-scale medical places for the centralized treatment of patients with confirmed mild diseases, and transformed convention centers, stadiums, etc. into square cabin hospitals. Looking back, this initiative is considered to be a key move in China's epidemic prevention and control.

In the construction of the cabin hospital, a medical team from Shanghai creatively built a "mobile cabin" - they are the National Emergency Medical Rescue Team of the Oriental Hospital Affiliated to Tongji University.

On February 3, 2020, the order was received, and the whole team assembly and 30 tons of material preparation were completed that night. The rescue team arrived in Wuhan in two ways on February 4, and on the afternoon of February 5, it took only more than 3 hours to set up 25 tents, equipped with relevant equipment and medical supplies, and the Wuhan Living Room Cabin Hospital Headquarters also quickly incorporated it into the Cabin Hospital System, as a command and administrative center, set up offices, conference rooms, remote centers, material departments and other departments, and also set up a monitoring room in case of emergency. The experts of the Oriental Hospital also participated in the construction of a number of subsequent cabin hospitals.

How does the Mobile Cabin Hospital work? After experiencing the test of the epidemic, what experience has the mobile cabin hospital accumulated? On March 26, on the sidelines of the 8th China (Shanghai) Underground Space Development Conference in 2021, Wang Tao, executive deputy director of the Institute of Disaster Medicine of Dongfang Hospital and executive director of the Shanghai Key Discipline of Public Health "Disaster Medicine and Health Emergency Management", was interviewed by the surging news (www.thepaper.cn) reporter.

During the anti-epidemic period in Wuhan, Wang Tao served as the deputy leader of the National Emergency Medical Rescue Team of Shanghai Oriental Hospital. He said that the mobile cabin hospital is a relatively new concept proposed by the team after the practice of working in the square cabin hospital. Professor Liu Zhongmin, the chief of the National Emergency Medical Rescue Team and president of Dongfang Hospital, is leading the joint research and development with Tongji University to develop the tent mobile hospital that previously mainly responded to natural disasters into a negative pressure tent mobile hospital with epidemic prevention functions. At the same time, Dongfang Hospital is also further developing full-featured mobile hospital systems, such as water mobile hospitals, with the goal of all-disaster species. At the end of 2020, with frequent floods in southern China, Dongfang Hospital conducted a comprehensive drill on the water mobile hospital in time, "The design scheme of our water mobile hospital has also applied for a national patent. ”

Wang Tao said that the new crown epidemic is a test for our medical emergency management, "and it has further promoted the development and progress of our country's disaster medicine and health emergency management." Wang Tao also looked forward to the topic of how the fang cabin hospital can be combined with the development of underground space, "The goal is to build a prevention and control system that can cope with the once-in-a-century public health emergency, which requires multidisciplinary scientists to work together." ”

Wang Tao, executive deputy director of the Institute of Disaster Medicine of Shanghai Dongfang Hospital and executive director of the key discipline of public health in Shanghai, "Disaster Medicine and Health Emergency Management".

The following is a transcript of the interview:

The Paper: In response to the covid-19 pandemic, China has adopted a square cabin hospital for the first time. Wang Chen, vice president of the Chinese Academy of Engineering, said that the word square cabin sounds reminiscent of "Noah's Ark" in the Chinese, which is somewhat similar to a field mobile hospital, but it refers to a novel concept: large, temporary hospitals, generally converted from public buildings (such as stadiums and exhibition centers). The Shanghai Aid-E medical team uses a mobile cabin hospital, composed of tents, and what are the similarities and differences between the mobile cabin hospital and the square cabin hospital converted from a public building?

Wang Tao: It should be said that the mobile cabin hospital is a relatively new concept that we put forward after the practice of working in the square cabin hospital, because the original cabin hospital we said was a square cabin shelter temporarily remodeled in a large public place.

In fact, when the epidemic occurred, we went to Wuhan Science and Technology Entrepreneurship Park, which is actually an exhibition center, where 3,000 beds can be completely put down, which requires a lot of cleaning, and we have also done some reconstruction, partition and humanized arrangement, so that it can be closer to the functional layout of the hospital, and it is also more conducive to the communication and exchange between medical staff and patients.

With the expansion of the epidemic in the international arena and the normalization of our epidemic prevention and control requirements, we are thinking that if there are concentrated and relatively large-scale outbreaks in the future, this may never happen, but we always have to make some positive preparations and respond to the so-called plan. On the one hand, it is necessary to select a site, it should be said that it is to cooperate with or suggest how to select a new cabin hospital; on the other hand, it is better to save these public resources and use some simple, buildable, reusable, and small-scale contiguous so-called "mobile cabin hospitals".

In fact, our Oriental Hospital has always been the national emergency medical rescue team that has been built as a whole system, the first batch of national emergency medical rescue teams, and the world's first international emergency medical team certified by the Shanghai Municipal Party Committee in 2016. The hardware of our medical team actually includes two aspects: one is called a mobile hospital on the car, and the other is called a tent mobile hospital.

This time, we took the tent mobile hospital to Wuhan together. When we were in Wuhan, we deployed the tent mobile hospital, a total of 25 medical tents, and also docked with the square cabin hospital. We think this way may be developed in the future, but in fact, now that we have done it, then this is the mobile cabin hospital we proposed.

The Paper: What is the progress of joint research and development you just mentioned?

Wang Tao: Now we have jointly developed with Tongji University to develop the tent that used to deal with natural disasters into a negative pressure tent with epidemic prevention function.

We must have a "three-zone, two-channel" suitable for infectious diseases, with functions such as isolation and disinfection. We embodied it in the new tent mobile hospital. If such a tent mobile hospital is expanded on a large scale, it should be said that it can also reach the capacity and function of what we originally called a large public place.

The Paper: How big can the scale of mobile be? Does it have a concept like a critical value?

Wang Tao: If we are well prepared, we propose the concept of growth, that is, basically there is no upper limit in theory. I said how many patients can we receive in 1 tent, and if 10 can receive how many patients, how many patients can you expand 100?

If we get through the technology beforehand, and then the production is in place and the transportation is portable, it may be able to be carried out quickly when needed. For example, in June last year, when there was a small-scale concentrated epidemic in Beijing, the so-called "Fire Eye Laboratory" was rapidly launched, which was very rapid, and the scale was not what we imagined as a single or a few small tents. At that time, the fireeye laboratory photos also appeared in the best scientific pictures of the month in Nature magazine, that is, if we built a growthable one, it should still be said that the scale can be expected.

The Paper: After the rescue team of Dongfang Hospital arrived in Wuhan, it took only more than 3 hours to set up all 25 tents, equipped with the required materials in the tents, and also built a remote consultation center that can be connected to the Shanghai Hospital by video. What was the biggest challenge in the build process?

Wang Tao: There are definitely difficulties. First of all, it is the uncertainty of this task, because we have also received a call from the National Health Commission, and 21 national emergency medical rescue teams across the country rushed to Wuhan. At that time, it was just to send us, and the task was not very clear, because at that time, the changes in the local epidemic situation may also be complicated.

We set off very fast. On the evening of February 3, we were informed that on the evening of February 3, we had assembled the whole team and prepared supplies for 30 people. But in fact, this is not to say that receiving orders can be done immediately, because before we have been as a national medical rescue team, we have this sense of mission and responsibility, we are already actively preparing for war, we are combined with peacetime and wartime, we have been in a state of readiness, so we are quickly transferring all the materials, and even we have brought our own supplies to eat, we pay attention to being able to survive independently in the wild for two weeks, without adding burden to the local area. Let's prepare according to this.

In fact, there were still a lot of protections at that time, but we were in the configuration of independent survival for two weeks, we were 53 team members at the time, plus our 8 emergency medical rescue vehicles and 25 medical tents, we only had the surgical part and did not open, because the epidemic really did not need our operating room, right? Except for the operating room, which didn't open, we all went.

After that, I think the first is the uncertainty of the task. However, because our team is still relatively well-trained, we have also carried out active preparation and repeated drills for the epidemic before, so I think this level is a psychological barrier is very sad. In such a public health emergency, the future is an unknown situation, I think psychological relations are very important.

The second one I think is protection, because I have heard that some medical staff in Wuhan have been infected, so we have also repeatedly trained all staff in public health skills. Because our national emergency medical rescue team was originally a more focused team on natural disaster response, this aspect of infectious diseases was not what we were best at. However, when the health of the party and the country and the people are in need, we as medical workers are indispensable, so we also carry out a lot of training in this aspect of protection, to be able to rescue patients, perfectly complete the anti-epidemic task, but also to ensure that their own team has zero infection, not one can be less, so a lot of protection training has been carried out in this regard. It's also an improvement in our skills.

Of course, there is also a way to achieve the docking of our tent mobile hospital and the square cabin hospital, because the square cabin hospital is actually a large venue, popularly speaking, there is no ventilation everywhere, strictly speaking, there is no cleaning area. So we launched the square cabin hospital in the whole system, and docked the mobile cabin hospital station with the square cabin hospital. Through the transition of the corridor and then to the tent base camp, such a good coordinated configuration from the polluted area, the semi-polluted area to the clean area is realized. That's why I say that the cabin hospital we moved in the operation of the actual cabin hospital, it finally played the role of a command center, a rest place, and a material reserve center.

In fact, other teams working at the Cabin Hospital at the time also used our Mobile Cabin Hospital as their command center, and finally many important meetings of our Shanghai Command Headquarters were placed here. Because we are also an information team, we can realize the connection between Wuhan and Shanghai, and a lot of uplink and necessary case discussions can also be completed in our command center, so it is basically such a situation.

The Paper: In the construction of the mobile cabin hospital and the whole process of patient treatment, are there any things or details that you are particularly impressed with?

Wang Tao: What impressed me personally is that china's creative use of the fang cabin hospital model has won a great victory in the fight against the epidemic. This model is not only a success of a medical model, but also a major achievement of social and humanistic relations.

I remember that there was an old gentleman who was hospitalized in the cabin hospital, and the couple lived in it, and this old gentleman said his birthday in it, and the medical staff gave him a birthday. He is also more knowledgeable and cultured, and he said that I said that everyone is very welcome today.

What is "Visit"? Visiting is a word with a strong sense of belonging and identity, and when you come to my house, it is called visiting. What does this mean? The health policy of the hospital, the medical staff and our country has been highly recognized by the people. In this case, when I attended the press conference of the joint prevention and control mechanism of the State Council on May 14, I said that I believe that this is a great success of our party and government in fighting the epidemic, and it is the success of the people's hearts.

The Paper: Did mobile cabin hospitals use control over the epidemic before last year's epidemic?

Wang Tao: In the past, our mobile hospital was for natural disasters, such as earthquakes and tsunamis, if all the medical facilities at that time were destroyed, then we temporarily formed a medical center there, with 100 beds, but its equipment and facilities were relatively not fully equipped with anti-epidemic functions.

But this time we have perfectly combined the cabin hospital and the tent hospital to form a mobile cabin operation model that can support the fight against the epidemic, but then we are researching and developing, so that the individual body of the tent itself is no longer combined with the direction of large public facilities, and we can form a facility with anti-epidemic function, which can be expanded, collected and reused. At that time, we just said that we did some exploration, and now I think we are doing in-depth research and development, some of which have been applied, and these things that we have jointly developed with Tongji University have also been issued in several countries, and they have also supported the fight against the epidemic in various countries.

The Paper: What is the biggest difference between running a mobile cabin hospital and running an ordinary hospital? What are the challenges for doctors and patients? How does it work with conventional hospitals?

Wang Tao: First of all, the structural and functional layout of the hospital is completely different. In the layout of information systems on hardware and software facilities, they are fundamentally different.

Second, it is also different from the patient's point of view. The degree of recognition of his own diseases, the degree of recognition of medical care and the recognition of the social environment of ordinary patients admitted to our general hospitals is completely different from the psychological state of patients under such large-scale public health events.

I think the important issue is not treatment, but the doctor-patient relationship, which raises a whole new subject. In fact, in the operation and management of the entire cabin hospital, I think that the component of medical humanistic emergency management is much higher than the conventional problems in the past. That's what we've always said is the difference between disaster medicine and clinical medicine. Clinical medicine is about the individual, and disaster medicine is about the group. I remember that on the first night of the square cabin hospital, more than 300 patients were admitted in one night, and it is impossible to receive 300 patients in a general hospital in one night, right? That's the difference between clinical medicine and disaster medicine.

On the other hand, clinical medicine places more emphasis on the individual skills of doctors or nurses. In such a large-scale public health event, it will feel that individual skills are weak and weak, and what is needed is overall management. So I guess that's complicated too, right? Of course, its follow-up logistics supply is completely different. So throughout the operation, the Square Cabin Hospital was a very remarkable and huge victory.

The Paper: How to combine the mobile cabin hospital with the underground space? What is its future trend?

Wang Tao: I think this is a very good interdisciplinary question. The combination of medical rescue and underground space has built underground emergency hospitals in many cities in the past, but these underground projects, as we said earlier, are mainly aimed at emergencies and natural disasters, and may be blank in the design and consideration of public health.

But in fact, since the founding of the People's Republic of China, the large-scale public health incident that has really been encountered is also a SARS. In fact, although it left a very heavy psychological shadow on our Chinese, the popularity at that time was not particularly extensive, that is, no more than 10,000 people in the world, 2/3 of which were probably in Chinese mainland, Hong Kong, and Taiwan. That is to say, although it is a very serious public health undertaking, its prevalence is far less than that of this new crown. In fact, this new crown is extremely rare in human history.

So how to use our underground space, to deal with a once-in-a-century public health event, I think this needs to be studied by multidisciplinary scientists.

If it is related to the square cabin hospital, then in general, if there are many large temporary large public places now, it may have underground space, right? If there is still such a possibility in the future, we will temporarily requisition a large public place to make a shelter hospital, then its underground space I think should be completely perfected.

Because compared with the ground space, the underground space is more complex than the ventilation and lighting or the treatment of contaminant medical waste. Therefore, it is not excluded that when using the above-ground space as a similar function of the bed-proof hospital, its underground space can be reasonably developed and applied, and I think this possibility exists. But it is true that some cooperative research by experts in the future is needed, because it is a scientific problem, and the direction may be right, but the specific operation must be scientifically detailed.

The Paper: Is there such a research direction in the world now?

Wang Tao: As far as I know, it seems that it has not been widely developed, and in the past it was still aimed at natural disasters. On a scale like this, it is once in a century, and after the pandemic 120 years ago, it may be the most affected area this time.

The Paper: Let's finally talk about your work, as the director of the Institute of Disaster Medicine, what is your daily work like?

Wang Tao: First of all, I have several identities in Dongfang Hospital, one is the executive deputy director of the Institute of Disaster Medicine, which is mainly to coordinate the work of the National Emergency Medical Rescue Team, the National Polar Scientific Expedition Medical Security Service Center, and the Emergency Management Office.

On the other hand, I am also the managing head of the Department of Acute And Critical Care. Then, I myself was the director of emergency trauma surgery, a surgeon. This is my whole job.

I don't think these jobs are in conflict. Because our national emergency medical rescue team is called peacetime and wartime combination, disasters are after all accidental, minority. In the vast majority of the time, we are in the process of seeing ordinary people to accumulate experience, improve skills, we also regularly carry out drills, training, training, etc., in order to better perform tasks when emergencies occur, to ensure the safety of people's lives and property. Therefore, I think that whether it is clinical work, management work, scientific research work, and rescue work, there is no conflict.

I am also thinking that maybe this outbreak will touch the level of our medical emergency management, and can further promote the further development of disaster medicine and health emergency management in our country.

The Paper: Is there a further deepening of scientific research directions or research and development directions that have been expanded after the outbreak of the epidemic? Further improving the mobile cabin hospital as you just said is also a direction. Is there a job like this?

Wang Tao: Yes. Let's say unmanned detectors. That is to say, we cannot ignore natural disasters because of a public health incident, we must fully manage it.

Let's say drone detection. We are also jointly developing with COMAC, called emergency rescue command aircraft and medical aircraft. So even if we are still developing a water mobile hospital, because after the epidemic, was there not another flood that affected the whole country at the end of last year? We are also working on a mobile hospital on the water, so that our mobile hospital can be built on the water.

If a hospital can be built on the water, then in the future, when we save people in the flood, we will not only search, but also save people at the first time, so that we may be able to save more people in the golden time.

Our own aerial medical treatment, the north and south hospitals of the Oriental Hospital, the north and south now have helicopter-type products, so is it necessary to do some research in air medical treatment in the future, these are what we are studying, there are some results.

Therefore, we have always said that we are a research team, not only for medical treatment, but also for research, because only if we have a certain level of research can we better carry out disaster relief tasks.

The Paper: When will the mobile hospital on the water have a stage result or practical application?

Wang Tao: In June and July last year, we conducted a drill on the floating mobile hospital, and the design scheme of our floating mobile hospital also applied for a national patent, and it is expected that it may be approved as soon as next month and can be authorized.

At the same time, in August and September last year, we also cooperated with the national Maritime Silk Road Center ocean spectrum, which is called the ocean spectrum number that is newer than the qubit. We jointly conducted a joint search and rescue on the waters of the East China Sea, simulating the casualties of large foreign ships on the high seas, at that time it was a land, sea and air integrated helicopter, our rescue team, a joint coast guard vessel, etc., we were searching and rescue in an all-round way. In the future, with the development of the water mobile hospital, the rescue capability may be radiated to the middle and cosmopolitan sea, which is also in line with our national strategy.

Editor-in-Charge: Li Yuequn

Proofreader: Luan Meng