E-book: draeger_review_100_1_en
Drägerheft Navy Dräger Review A hospital on the high seas 384.1 100.1 Gas Detection Laboratory in a tube Gestures Touch-free Das Magazin für for Technology in Medicine June 2010 The Magazine Technik in der Medizin Februar device operation Back to Life The fine art of trauma surgery It’s a Riddle Quality is a matter of details, and at Dräger you’ll find top quality in every product – including the roughly 250 gas detection tubes. But how many different gases can they identify? You’ll find some hints starting on page 16. 1. 250+ 2. About 500 3. Over 1,500 Send us the correct answer via e-mail to draegerreview@draeger.com or on a postcard to our editorial address (you’ll find it on page 22), and you may win two of a total of 50 ballpoint pens modeled on Dräger gas detection tubes. The deadline for entries is July 31, 2010. Winners will be notified in writing, so please indicate your name and address. Prizes cannot be paid in cash. Dräger employees are not entitled to participate. Participants hereby waive all legal rights to enforce any award. C on t en t s 26 special containers house the naval hospital on the task Force support ship Frankfurt am Main. read more starting on page 14. COver PhOTOgrAPh: Kevin CurTiS/SPL/AgenTur FOCuS unFALLKrAnKenhAuS BerLin K ARL STORZ MI-RepORT DPA/PiCTure-ALLiAnCe 20 14 8 ConCentration speeD poWer e xper ien Ce Fo Cu s ou t lo ok 4 people Who perform Training for air 8 routine surprises Trauma surgery 20 Headshaking in the operating room rescue operations in germany; screening often involves life-and-death gesture-based systems for controlling for drug users in Spain. struggles, critical injuries, and technical devices reach hospitals. extreme time pressure. ne W s serv i Ce 6 news from the World of Dräger 22 Where and Who? Dräger worldwide; r ep o r t 14 Hospital on the High seas A new emergency ambulance for preterm publishing information. infants. An italian hospital with a long From an ectopic pregnancy tradition chooses SmartPilot view. Dräger to third-degree burns – naval physicians Close -u p 24 High-frequency ejector The Babylog review in german, english, and Spanish. have to be ready for anything. vn500 makes it possible to utilize a broad range of therapies for premature insig H t 16 Where gases show their Colors babies. One important component is Dräger tubes analyze invisible dangers. the expiratory valve. 3 Dräger review 100.1 June 2010 E x PER i En C E PeO PL e w h O Pe rfO rM What Moves Us – Dräger Worldwide Marco Monnig, specialist nurse and paramedic at the ADAC Air Rescue division, Munich / Germany “it’s a good feeling when you see the child is alive – and watch it leave the ing tool made of wood, is in hangelar near bonn. it’s constructed as an hospital with its parents perfusors, monitors, an Oxylog for newborn babies a number of times, and it has affected me. a rapid 3000, and little space. The SimMan, our patient, is true-to-life. he can treatment, at the right moment, means the difference between life and actualize bodily functions, be auscultated and ventilated. death. if it works, the patient is rescued. That’s our objective it’s also vitally important to be able to plan ahead under stress. any- There’s little room for error. The right equipment and knowledge one here who is trained in air rescue knows: “i can’t just pull over and need to be deployed at the right place. Our tool is the helicopter. but a stop on the shoulder of the road if something hasn’t been correctly tool is only as good as the hands that guide it. and to insure that they’re thought through.” Once in the air, we already need to have an overview the best, we provide intensive training. My colleagues have come here of what we’re doing. Does ‘ChristophSim’ really work? Time and again we knock on his side door to say: ‘welcome to the hospital. you’ve from all over to be trained. and we train to act as a team – the seamless landed’ – that’s how gripping the simulation is.” coordination of all involved is crucial on board. ‘ChristophSim,’ our train- PhOTOgraPhy: hanS rOSariuS, azuL MarinO ; TexT: SiLke uMbaCh, MerTen wOrThMann 4 Dräger review 100.1 June 2010 Francisco Javier Rodríguez-Madridejos Jiménez, Police Chief of Seseña, Castilla-La Mancha / Spain “until two years ago we had no equipment for doing drug tests. we sim- The results have been amazing: Sometimes we catch eight drivers on drugs ply had to let suspects go, and it was really frustrating not to be able to for every one drunken driver. But drug users’ attitudes are slowly changing. when we confront them with the test results, they’re astonished take any action. it’s true that we always caught drunken drivers during and incredulous. They no longer have any excuses. Many of them then our traffic checks, but the issue of drivers on drugs was left completely open. That ate away at my professional pride: we were sending time tell us about their worries and problems, and we listen to them with a bombs on wheels back out onto the streets. Things just couldn’t go on psychologist’s sensitivity in order to find out what factors are influenc- that way. Our community, Seseña, is located in the north of Castilla-La ing their condition. Mostly these are people of a certain age, about 40, Mancha and has less than 20,000 inhabitants. Madrid is not far away, and the drug is mostly cocaine. A 20-year-old who smokes marijuana so we have a lot of through traffic. reacts differently. in 97 percent of the cases, these people pay the fine Two years ago i initiated the project ‘no drugs at the wheel’. we immediately. we also have the feeling that they realize how efficient the bought a reliable mobile drugs of abuse detection system from Dräger – and police force is and that they have a bad conscience because of their now we can finally conduct comprehensive and effective drug screening. consumption of illegal substances.” News BJörn STeiger STiFTung D-5195-2010 For challenging assignments: the HPs 3100. In Abraham’s bosom: Quiet and gentle transportation for babies. A New emergency Ambulance Dräger HPs 3100 for Preterm Infants Universal Helmet The Dräger HPS 3100 multifunctional universal About 700,000 babies are born in germany every year. Some 30,000 of them have helmet is ideal for challenging assignments in the to be transferred from children’s and maternity hospitals to special clinics, either because field, such as forest fires, traffic accidents or they are preterm infants or because a child with a normal birth develops life-threatening complications. Transporting these babies calls for specially equipped emergency ambulances, mountain rescue missions. it combines optimal and the Björn Steiger Foundation has been developing them since 1974. The latest protective functions, thanks to the integrated model is scheduled to be inaugurated in the second half of the year. “neonatologists are polystyrol inner shell, and is very comfortable as a already calling it a quantum leap,” says Melanie Storch, who works at the foundation. result of features such as the four-point harness and it cost about one million euros to develop the prototype, and the foundation intends to padding throughout the entire head area. An adjust- finance 100 of these ambulances by 2014 at a unit price of about 200,000 euros. ment wheel lets the helmet fit individual head The centerpiece of the emergency ambulance for babies is the crosswise transport sizes. The ventilation system ensures a comfortable incubator. “in newborn babies the fontanelles in the skull have not yet closed,” Storch ex- temperature and humidity level inside the helmet, even during long periods of forest firefighting. A metal plains. “That’s why the babies have to lie crosswise to the direction of movement so they lattice keeps out large debris particles, and the won’t be affected by the acceleration and deceleration during the drive.” However, this kind ventilation system can be closed with a simple slide of crosswise transport is not possible in conventional ambulances. in addition, the newly developed model is equipped with an innovative active damping system that significantly control to protect the wearer from smoke or extin- guishing water. The modern design and structure of the reduces shocks and vibrations. An electric motor and pneumatic springs are capable of HPS 3100 make it a combination of an industrial cushioning even the impact of ten-centimeter-deep potholes. Dräger will provide almost all of the vehicle’s medical technology equipment. This includes the transport incubator safety helmet according to en 397 and a mountain- system, which was developed in cooperation with neonatologists, nurses, and midwives, as eer helmet according to en 12492. The entire inner suspension ring and the neck curtain are padded. well as an international team of medical technicians. The central gas supply equipment, A comprehensive range of accessories, including respirators, and monitoring systems also come from Dräger. in addition, acoustics special- an electric visor, optimizes the helmet for a multitude ists at the Dräger test center are working on the sound insulation inside the emergency of special applications. The market launch is planned ambulance for babies. for the third quarter of 2010. 6 Dräger review 100.1 June 2010 Dräger Review in German, English, and Spanish Ever since its first issue in the summer of 1912, Dräger Review has informed its readers about the company’s technological products and their applications. The first issue in English, which was published in 1959, featured the use of compressed- air breathing equipment in the mining industry and firefighting. This issue of the magazine is the 385th published in German and the 100th published in English. “This is our demonstration that we speak our customers’ language, not just metaphorically but also literally,” says Burkard Dillig with a smile. Dillig, who is currently Dräger’s press spokesman, MT-5469-2008 was responsible for Dräger Review for over 20 years until the end of 2007. In this, its 99th year, the magazine is launching an SmartPilot View provides an overview. Customer-friendly: the Dräger website. additional edition in Spanish, which is soon to be followed by one in French. By taking Italy: First A Dräger Website these steps, the company is responding to the growing significance of the markets SmartPilot View for 48 Countries where these global languages are spoken. The history of the Ospedale Maggiore The slogan “One Dräger – One Voice” “We feel the same way about Dräger Review began in 1351. Today the 638-bed hospital, now also applies to the Internet. Thanks as we do about our products,” says Stefan Dräger, CEO of Drägerwerk Verwaltungs which is located about 50 kilometers to a recent innovation, the company’s AG. “Everything we produce should provide southeast of Milan, serves about 150,000 website now automatically registers the country from which it is being accessed our customers with maximum utility.” residents in the surrounding region. It and then redirects the user to the Since the end of 2008, the new recently acquired two new Zeus Infinity Em- corresponding local website. This feature design has been accompanied by technical powered anesthesia systems – including a SmartPilot View. “That makes this hospital information and local reports that now applies to 48 countries and 29 the first one worldwide that can monitor are appreciated by many readers. Today, languages. the anesthesia stage with the help of our three issues of Dräger Review in two All of the websites offer general infor- smart display,” says Emilio Car-mignotto versions – one for each corporate division – mation about the company as well as are published annually. It has a total of the Dräger sales team. Dr. Agostino information and fascinating 360° views circulation of over 80,000 copies. Dossena, Director of Anesthesia at the of Dräger products, videos, and pro- Ospedale Maggiore, chose the anesthesia duct demonstrations. Visitors can find out systems first, and was then impressed more about the company and its pro- Marine us auf Krankenhaer See D D Drägerheft ä er r e Navy fDräger ReviewrräggeRhviet hoh t Review1 by the sophisticated monitoring technology. duct range by clicking on links such as A hospital on the rägerhe essen Gase m im Rohr 384.10.1 ef w high seas or 100.1 0 Das Lab 384.1 Gas Detection D 385 Gesten Medició Laboratory in a tube n de ch Un labora gases uern dur 1.1 Geräte ste Bewegung Gestures 384.1 tor The SmartPilot View supports the “Products & Services,” “Careers,” io en pequeño tubo de un Touch-free vidrio Das Magazin für for Technology in Medicine June 2010 The Magazine Technik in der Medizin Februar ar 2010 La s Ma Da revista n Juni device operation La n Febru gazin la de fürtec der Medizi Hospital Marina k in Medizi Technik nología k in der für Techni inen me der Mediz für Techni en alta ma dicina Jun Magazin in Febru Magazin Ci Das Das r io de 20 Un innova clo respira ar 10 torio anesthesiologist in the operating room “Investor Relations,” “Press Center.” You dor métod o liza para r la ventila ción del visua- pulmón from the initial administration of the can find an overview of the contents anesthesia all the way to the wake-up phase. of Dräger Review in the “About Dräger” De Zurück eBack to Life vuelta section. www.draeger.com All of the important data – including a a la vida n Lb ins he eunst The finesurgery La precisión en el forecast of the course of the anesthesia – is art of ho K trauma de la ciru gía de tr ar te Die lchirurgie der Unfal auma graphically depicted on a large display. (see also Dräger Review 97.1, p. 18f.) 7 DRÄGER REVIEW 100.1 JUNE 2010 Fo cu s T r au m a s u rge ry Routine surprises every medical specialty has its own particular challenges. in tRauma suRgeRy several elements come together: the life-and-death struggle, critical and diverse injuries, and extreme time pressure. touching down: the crew of the “christoph Berlin” critical care transport helicopter from unfallkrankenhaus Berlin has landed. 8 Dräger review 100.1 June 2010 PhoTogrAPhy: unfAllkrAnkenhAus Berlin unfallkrankenhaus berlin D r. Gerrit Matthes has just gone off the skin. No cast is required following the IN bRIeF Doctors and nursing staff face duty following a grueling 20-hour procedure. After a few months he will re- extraordinary challenges at a trauma center – not shift. However, under the circum- move the nails, once again via a small in- just professional challenges but physical and stances he still appears wide awake and cision in the skin. After treating the boy, mental ones as well. The need for quick action surprisingly fresh. A trauma surgeon, he the doctor and his team operated on an according to algorithms should not become runs the emergency room at Unfallkran- 80-year-old woman who had fallen dur- an obstacle to new methods. it’s also important kenhaus Berlin (ukb) and has just per- ing the night and fractured her thigh near to institutionalize this flexibility and have a formed two emergency surgeries. First, a the hip joint. viable business concept. 14-year-old boy was brought to the hospi- a finger on the pulse of time tal, which is located in the eastern section of Berlin, by his father during the night. It’s all just another night, as far as Mat- The ambitious young soccer player had thes is concerned. And despite the length been tackled hard by an opponent and suf- of the shift he has just performed, the ded- surgeons. “The cooperation here is ex- fered a broken lower leg. “He was in se- icated trauma surgeon remains enthusi- tremely smooth. We have the latest equip- vere pain, and that alone is reason enough astic about his specialty area and his hos- ment and work more or less with a fin- to go ahead and operate during the night,” pital. “Sure, the workload is very heavy ger on the pulse of time.” State-of-the-art says Matthes. The senior physician had to here, but that gives us a great opportu- equipment and team spirit help ukb live choose the treatment method very care- nity to improve things. Medicine is an ex- up to its high expectations. The trauma fully. That’s because bone growth is not perience-driven science, and we see a very center is considered one of the most mod- yet completed at age 14 and can be dis- large number of cases in a very short pe- ern in Europe. rupted by a fracture. Dr. Matthes opted riod of time,” he says. From hangar to operating room for a method developed by Prevot. To Unfallkrankenhaus Berlin was de- spare the bone’s growth plates, Matthes signed and built to focus on accidents The ultramodern character of the place inserted elastic nails into the marrow and emergencies, and according to Mat- is immediately obvious on the roof, where cavity of the shin via a small incision in thes it offers ideal conditions for trauma a red-and-white wind sock waves atop the four-story building of light brown bricks. This is where the rescue and critical care transport helicopter “Christoph Berlin” a flying intensive care unit lands and is then immediately trans- ported on rails into a glass-enclosed, tem- PhoTogrAPhy: unfAllkrAnkenhAus Berlin The “Christoph Berlin” ensures that patients in rural regions are also perature-controlled hangar. In emergency able to take advantage of the city’s high-tech medicine. The Bell 412 critical medicine, even short distances can mean care transport helicopter stationed at the unfallkrankenhaus Berlin is the difference between life and death. on call 24 hours a day and is crewed by two pilots, an emergency physician, For this reason, an elevator leads di- and a paramedic. The helicopter can, for example, carry an infarction rectly from the hangar to the centerpiece patient together with an intra-aortic balloon pump, which it can supply of the trauma center: the trauma room for with electricity. it can now even transport heart-lung systems. As a the seriously injured. Directly adjacent result, the “Christoph Berlin” not only flies to accident sites in Berlin is the massive apparatus of a 64-line spi- and Brandenburg, but also transports patients from smaller hospitals ral CT, one of the hospital’s technologi- to specialized medical centers. cal highlights. The patient’s entire body > 9 Dräger review 100.1 June 2010 An MRI machine with a magnetic field strength of three teslas shows the beating heart > can be scanned within minutes here. Af- ering more than 80 percent of the body tient Care. Sometimes the accident that ter a serious accident, the whole-body surface have already been successfully brings them here has happened several scan helps the doctors recognize which treated at ukb. In case such as this, syn- days previously. In principle, the hospi- injury is truly life-threatening and must thetic skin is cultivated in a ukb labora- tal, which comprises a total of 17 clinics, be treated first. This morning, several doc- tory if the amount of the patient’s own centers, institutes, and departments and tors are standing in the radiology viewing remaining skin is insufficient. has more than 500 beds, accepts every pa- room next door looking at the monitors. The distances between the emer- tient. What is noteworthy, however, is the Displayed on one monitor is the detailed gency room and the operating rooms, hospital’s policy of never refusing to ac- image of a beating heart recorded at a the cardiac catheter laboratory, and the cept patients who require intensive care. magnetic field strength of three teslas. intensive care unit are also short. In con- So far the hospital has managed to live up The image has been made using the most trast, a largely glass-covered passageway to its commitment, although some ad- powerful MRI machine at the hospital. through the hospital encourages visitors justments have been necessary since it Another shows a high-contrast image of to stroll. Walking between the lush plants opened. “We originally expected 15,000 the spinal cord of a woman who suddenly and the brightly colored African art, one patients a year. Last year it was more than can no longer move her legs. could almost forget that right next door 51,000,” says Witt, who was involved in teams supported by high-tech medicine the planning of the hospital. A world without germs are deeply engaged in their work. Com- Other countries, other traumas A second elevator leads from the helipad pleted in 1997, the building is flooded on the roof to a second trauma room de- with light and radiates an air of seren- In the meantime, many other countries signed especially for burn victims. It is ity. It’s misleading to believe that every are interested in the ukb’s expertise. the gateway to a germ-free world main- patient who arrives at the trauma cen- Witt has just returned from a consulting tained at a constant temperature of 40 ter, which is a member of the Associa- trip to Brazil, where some facilities are degrees Celsius. In the event of severe tion of BG Clinics (VBGK), does so ac- also specializing in trauma medicine. burns, the patient is first placed into companied by flashing blue lights or by “There’s no air rescue service there, and a large tub where the burned skin is helicopter. “Approximately 60 percent of the streets are often in poor condition,” scrubbed away from the patient’s body our patients check themselves in,” says reports Witt. The types of trauma encoun- using steel brushes. Even deep burns cov- Matthias Witt, who is the Director of Pa- tered vary greatly from region to region. In rural areas, surgeons often treat cuts suffered by farm workers. In the city, on the other hand, they are confronted with PhoTogrAPhy: unfAllkrAnkenhAus Berlin The critical hour a large number of head injuries, in part because Brazilians often ride their mo- The narrow time interval between an accident and life-saving measures is referred to torcycles without helmets. “The technical as the “golden hour of shock.” “it is always underestimated, because the clock starts equipment there is completely different ticking immediately after the accident, long before emergency personnel arrive,” warns than it is here, but everyone has national trauma surgeon Dr. gerrit Matthes. Although deploying a helicopter at a cost of health insurance that pays in full for all 1,143 euros per trip is significantly more expensive in Berlin than deploying an emer- services,” adds Witt. gency physician’s vehicle (700 euros), it can prove to be more cost-effective in Up to now the situation in the U.S., the end. “under certain circumstances, a few minutes of acute care can save many where ukb also maintains partnerships, days in the intensive care unit,” says emergency physician Dr. Jörg Beneker. has been very different. A trauma cen- > 10 Dräger review 100.1 June 2010 Fo c u s T r aum a surge ry short distances, fast help: An elevator goes from the helicopter directly to the trauma room. 11 Dräger review 100.1 June 2010 Despite all the routine, procedures must be constantly questioned > ter like the one in Berlin would be com- pletely unprofitable because many people have no health insurance. However, in an emergency they must be provided with at least a minimum of care free of charge. It remains to be seen just how the U.S. healthcare reform will affect this sector. Emergency medicine is also structured differently in the U.S. than it is in Ger- many. “They don’t have a head physician system there; instead, specialists from the various departments work together on an equal footing,” explains Prof. Dr. Michael Wich, Deputy Director of the Casualty Sur- gery and Orthopedics Clinic. “The emer- gency room doctors do only the bare min- imum. The specialized departments are often decoupled from emergency treat- ment. It’s a situation that can lead to problems.” Fluctuation is wanted In Berlin, those responsible for the hos- PhotograPhy: unfallkrankenhaus Berlin, Picture-alliance pital are determined to continuously at- tract new, young people who have visions. “We don’t just want to be one of the most modern trauma centers in Europe, we want to stay that way too,” says the Di- rector of Patient Care. A certain fluctu- ation is therefore desirable. Nurses who have been with the hospital for longer than four or five years have to spend a few weeks each year working in another ward in order to maintain their versatil- ity. Existing procedures, such as those for choosing the best position for patients, Always ready: The acute medicine departments at Unfallkrankenhaus Berlin are fully networked. Dräger supplies them with equipment including such items as medical should be periodically questioned. ventilators and anesthesia workstations, monitoring and IT solutions, and ceiling supply The ukb also collaborates with in- units. The Dräger Infinity M540, for example, is used to continuously monitor the novative partners in industry, such as patient’s vital signs, while the Dräger Infinity C700 for IT workstation analyzes and integrates real-time information with additional clinical data. Dräger, so that it will be able to live up 12 Dräger review 100.1 June 2010 Fo c u s T r aum a surge ry PHOTOgraPHy: unFallkrankenHaus Berlin “The primacy of to its own high expectations in the near pelvis. He was deeply comatose, and his future as well. Matthes also tries to con- relatives wouldn’t have been able to rec- trauma surgery” tinuously optimize relevant procedures ognize him,” reports Dr. Metzner. The while providing care in the trauma room. pelvic fracture by itself was life-threaten- ProF. Dr. meD. michael Wich, Emergency physicians work according ing due to the vast blood loss.” The man Deputy Director of the Casualty surgery to algorithms: prescribed treatment in- survived thanks to the intensive efforts and Orthopedics Clinic at unfallkranken- structions outlining which measures of a large team. haus Berlin, on the advantages of special- must be performed under which crite- Patient exercise brings success ized emergency medicine ria in which sequence. “Algorithms are important, but they are also a very static However, it isn’t enough to simply repair What advantages does the ukb construct,” he says. all of the wounds following a serious in- possess when it comes to caring for At the moment, Matthes and his col- jury. A lot of patience and a lot of exer- the critically injured? leagues would like to critically question cise are required before a person regains The primacy of trauma surgery is crucial. when the whole-body scan is truly jus- control over his or her body and can re- everything is oriented toward the needs tified. Although the method is an out- turn to work. Many people with spinal of the injured patient. if an experienced standing diagnostic tool and has already cord injuries must learn to cope with life trauma surgeon feels that an operation is saved numerous lives, it also subjects in a wheelchair. This is why trauma cen- necessary at 3 a.m., his or her decision the patients to a high radiation dosage. ters in Germany, which are sponsored by is accepted with no questions asked. “You can’t administer radiation as if you the employers’ liability insurance associ- how do you finance the high level were using a watering can,” points out ations, also include many facilities for re- of care that is required? Matthes. habilitation activities, including a mod- roughly 25 percent of our cases are paid The doctors at ukb, who also pub- ern gymnasium and a swimming pool. for by a statutory accident insurance lish scientific articles, may occasionally “Everyone in Germany has a right to company rather than a health insurance com- question their procedures. However, pre- good medical care, but when I’m decid- pany because they involve work-related ing on what measures are appropriate I scribed decision-making paths are indis- accidents. Payment in these cases is not also always have the patient’s age, occu- pensable in an acute emergency. “When according to the german social insur- you’re working, you have your mind on pation, and individual expectations in ance Code (sgB) v, but rather sgB vii. your algorithms; you’re focusing on one the back of my mind,” says Matthes. As whereas the health insurance companies problem and you don’t think too much,” far as he is concerned, thorough after- pay for “necessary care,” occupational is how Dr. Michael Metzner, another at- care is a key element of statutory per- accidents are treated “with all suitable tending physician at ukb, describes the sonal accident insurance. After all, this means.” That’s an important difference. situation. It is only after his work is fin- is what makes it possible for patients to You also strive to always ished that he sometimes falls into a chair remain in outpatient care even after they accommodate the emergency and notices how exhausted he is. This have been discharged. And that, in turn, dispatch center’s needs. was the case with one of the most serious means he can support them for a longer how do you manage? Dr. Birgit herden accidents he can remember. A middle- period of time. The limiting factor is always the number of aged man fell under unknown circum- Further information online, including: ventilator beds in the intensive care unit. stances from the 11th floor. “The patient Product information we can increase this number by using our had serious injuries to the head, all ex- www.draeger.com/385/emergency fully equipped intermediate care unit. tremities, in all body cavities, and to the 13 Dräger review 100.1 June 2010 R e p oR t n av y Hospital on the High Seas Bumps, bruises, and third-degree burns – just like their colleagues on dry land, naval pHySicianS have to be ready for anything. T he patient – a crew member – was formed, and found he had his first sus- antined and all the crew members were suffering from a high fever, shiver- pected case of swine flu to report. treated with the influenza drug Tamiflu. ing, and an intense headache. His The case occurred last year, the symp- “Fortunately, we were at sea for so long that mouth was dry as dust, his muscles ach- toms of the disease first presenting them- by the time we entered Liverpool on the selves three days after the frigate Sach- ing. As if that weren’t enough, he also other side of the Atlantic, the patient was sen had cast off from the port of Halifax had diarrhea and nausea – both much already cured and the other crew members more pronounced than would have in Canada. Due to the danger of a global were beyond the incubation period. So, we been the case for a normal dose of influ- pandemic, Haber and his colleagues had to were sure that the none of the other sailors enza. Ship’s doctor Dr. Axel Haber was in- take strict precautions: The sailor was quar- would be infected,” Haber recalls. the task Force Support Ship Frankfurt am Main, a Berlin-class supply vessel, cruises the world’s oceans. D-11053-2010 D-11054-2010 D-11055-2010 it looks almost like a regular hospital below deck, if a little cramped. Dr. axel Haber (right) has access to a fully equipped operating room (left) and can also consult land-based specialists via satellite communications. His workplace, the Task Force Support ized – to severe burns, resuscitations, and from which we can send diagnoses, X- Ship Frankfurt am Main, is a double- even, on one occasion, an ectopic preg- rays, ultrasound images, and video se- hulled steel colossus with a length of al- nancy on the part of a female sailor. quences from anywhere in the world most 174 meters, a beam of 24 meters, “As a rule, medical emergencies on back to Germany for consultation with and a draft of 7.4 meters – making it the naval vessels generally involve trauma, specialists,” says Haber. largest craft in the German Navy. It is while those on other vessels such as And how would he deal with a case of powered by two diesel engines that de- cruise ships tend to involve internal psychosis? Haber explains that this has liver a combined output of 14,500 horse- complaints,” Haber explains. There are, been known to occur and that it is one power (5.28 megawatts each) and pro- however, some basic similarities. In both of the few reasons for removing a sailor pel the 20,000-ton vessel to a maximum cases, the ship’s doctor is responsible for from the ship, for example if a patient speed of 20 knots (approximately 37 kilo- all aspects of the patient’s wellbeing – as threatens to jump overboard. The cru- meters per hour). The job of these Berlin- used to be the case with all doctors, be- cial thing is to recognize any psycholo- class vessels is to provide logistical sup- fore specialization fragmented the medi- gical changes on the part of personnel port to German naval units on missions cal profession on land. For example, they as early as possible. For difficult cases, abroad – including provisions, fuel, spare treat even small wounds right up until there is also a military chaplain avail- parts, and also medical care. the healing process is completed. able. Things don’t usually get to that For the latter purpose, the vessel is The advantage of treating patients on- stage, though. “After we’ve been on equipped with a mobile naval hospital. board ship is that they can’t disappear. “I board for a few weeks, I often know the This consists of fixed onboard installa- can take a close look at my patients every sailors so well that I’m able to judge how tions as well as a two-story assembly of day,” says Haber. And should there be any- resilient they are,” says the ship’s doctor. 26 special shipping containers – 20 and thing out of the ordinary, he’s already on One factor that makes this possible is the 30 feet in length – mounted on the upper the spot to take direct action. At most, a relatively small crew on board – around deck. The containers, which are painted call to the bridge is required, and then 200 sailors compared to the 4,000 or so gray, contain a variety of treatment and the distance to the patient is no further stationed in a garrison. If need be, the diagnostic facilities, including two oper- than in a normal hospital ward. doctor can provide individual care for ating rooms, an intensive care unit, an X- every sailor on board. Support from specialists on land ray unit, various labs, and even a dental Haber has just gotten to know a new crew. In January, the Frankfurt am Main unit. They can accommodate up to three Every vessel in the German Navy has its medical teams working at the same time. own ship’s doctor. The sick bay team on left its home port of Kiel in northern Ger- “If we don’t have a dentist on board, I’ll a frigate, for example, can comprise up many for a five-month voyage to South Africa handle the drill myself,” says the Ham- to five people: a ship’s doctor, an assis- as part of a naval task force and training burg-born Haber, whose general medical tant ship’s doctor, two medical NCOs, unit. During the course of this voyage, more knowledge must encompass a number and an enlisted man. On a task force than 200 cadets will complete onboard PhotograPhy: DPa/Picture-alliance of disciplines. support ship, there are eight more crew training. It is the trainee officers’ second members, including two medical tech- voyage, following a sailing course last fall cruise liners are different on board the training ship Gorch Fock. nicians. Should this prove insufficient, The kinds of cases that Haber encoun- onboard medical teams can also request Haber himself has obviously been to ters can range from bumps and bruises support from doctors in Germany – via sea many more times than that. Five years to crush injuries caused by bulkhead the German navy’s own Medical Insti- from now, his 17 years of naval service will Björn Wölke doors – all the vessel’s cabins are pressur- tute. “We have a workstation on board come to an end. 15 Dräger review 100.1 june 2010 Who can identify the various gases by their colors? dräger tubes for D-11060-2010 approximately 500 gases contain indicators that change color if a specific gas is present. I nsI g h t P or ta ble g a s De t ect ioN Where gases show their Colors Dräger tubes are a classic instrument when it comes to analyzing gases and determining their concentrations. metICulous produCtIon is required to ensure the high reliability of these tools – which is why Dräger has been producing them in-house for over 70 years. W ith its first cry, a newborn baby manually operated “accuro” hand pump. crosses the threshold into life The hand pump pulls a precisely metered as a separate being and begins amount of ambient air through the tube. breathing. Oxygen is vital in this situa- If a particular gas is present in the air, it tion. Being without it for just a few min- reacts with the indicator in the tube. This utes can be critical. What’s more, it is chemical reaction results in an easily vis- essential that humans inhale this elixir ible change in color. The amount of this of life in an uncontaminated form, be- gas in the air in ppm – parts per million, cause they have no defense against toxic in other words, milliliters per cubic me- D-11061-2010 gases. If the gases have a strong odor at ter, for example – can then be read off of a graduated scale on the tube. This colo- low concentrations – as is the case with sulfur compounds (mercaptanes, for ex- rimetric method was patented in the U.S. In charge of tube production: Bernd Witt foth ample) – the people affected can at least in 1919. Since Dräger presented its first flee. But not every hazard announces it- tube for the detection of carbon monox- self. Carbon monoxide, for example, is ide using this technique in 1937, the com- amounts of indicator are sufficient to sig- odorless. Once leaked, gas is soon every- pany has helped to protect people by pro- nal the presence of certain gases, smaller where. The laws of thermodynamics en- viding millions and millions of Dräger grains of glass are used as the carrier ma- sure that it spreads. tubes. Today, in order to ensure the ap- terial. These grains are produced in the propriate quality, these tubes are pro- required grain size and purity from bro- Around 250 types of tubes duced in Lübeck, Germany, in a techno- ken pieces of quartz glass in an in-house A detection system must respond reli- logically advanced and fully automated glass mill. “We are a batch plant and pro- ably to a variety of gases, identify them, manufacturing operation. duce custom batches on an order-by-or- and measure their concentration in the But how do these nondescript glass der basis,” explains Wittfoth. This keeps ambient air. “Dräger tubes come in a di- tubes measuring some 125 millimeters in inventories low and the product reactive. verse spectrum of varieties,” says Bernd length and around seven millimeters in “The tubes have a chemical shelf life of Wittfoth, who heads this unit at Dräger. diameter actually work? At the center of 24 months from the date of delivery,” says “Some of the hottest sellers among our the tubes is roughly two grams of a gran- Wittfoth, adding that random samples are roughly 250 types of tubes for up to 500 ular substrate that contains the chemi- taken from the batch and tested periodi- gases are tubes for the offshore industry,” cal indicator. “The carrier substance,” ex- cally during the shelf life period. he adds. “These are important when it plains Wittfoth, “comprises grains with a Continuous tests comes to the detection of hydrogen sul- diameter of between 0.2 and 1.2 millime- fide.” Wittfoth is also quick to point out ters. Their exact size is a function of their In parallel, chemical technicians have the advantages offered by a fast-acting intended application.” A total of 12 differ- been mixing the indicator according to a analysis technology used on site that re- ent carrier materials are used. “We are all formula. Some 400 basic substances are quires no electricity and thus does not familiar with the silica gel from the little available for composing the reagent sys- pose a spark hazard. bags that are often included as a drying tem. “Each batch is custom mixed. Even Measurement itself is easy. In prin- agent with electronic equipment,” con- the humidity can trigger undesired re- ciple, the user opens the glass tube at tinues Wittfoth. This material is porous actions. A formula therefore can’t really both ends using a device that looks like and therefore holds larger amounts of an be repeated 100 percent,” says Wittfoth. This is why up to 70 complete tubes are > a pencil sharpener and places it in the indicator substance. However, if smaller 17 Dräger review 100.1 JUNe 2010 A crystal-clear process provides the basis for the reliable detection of gases D-11063-2010 D-11062-2010 Some of the roughly 250 types of tubes still require that some things be done by hand (left). The test on the right is fully automated. Only a machine can tap against the tubes 2,000 times with consistent precision and a force that is four times stronger than that of gravity. D-11064-2010 D-11065-2010 Finally, the heat of the gas burner first makes the open end of the glass tube soft before it is melted closed (left). The mini-vacuum this produces is part of the process, which is checked and documented every step of the way. 18 Dräger review 100.1 JUNe 2010 I nsI g h t P or ta ble g a s De t ect ioN tomatically sealed, of course. The open end of the tube is first passed by a num- ber of smaller gas flames, which not only make the glass soft, but also heat the air to the point that a mini-vacuum is estab- lished when the tube cools down after hav- ing been melted closed. The tubes, which are still hot, are col- lected in a wooden crate (plastic would melt, and the glass would shatter upon contact with metal). A custom calibra- tion scale is prepared for each batch > produced for preliminary testing. These chine that took three years to design. produced. This is done by taking sam- are used to check compliance with the The machine first places a small ceramic ples during production, testing the tubes specification immediately upon comple- disk into the tube. This disk is three mil- with a variety of defined gas concentra- tion of the preparation. Once the combi- limeters thick and contains up to eleven tions, and using these values to generate nation of carrier substance (silica gel or holes – each measuring 0.2 millimeters in a batch-specific calibration curve. Even grains of glass) and indicator have been diameter – through which the air can later the aging of the tubes is simulated to en- individually matched, the material must pass. “That serves as our zero point for sure that they achieve the targeted chem- be processed within the next six weeks. If filling,” explains Wittfoth. This ceramic ical shelf life. The scale is printed on the this condition isn’t fulfilled, the test pro- disk also ensures that the material does sticky side of an adhesive film, which is cedure begins all over again. not pour out if the tube is opened prop- wrapped around the tube. This arrange- The Dräger tube reagent prepara- erly. The materials can now be added in ment also provides mechanical protection. tion is stored in 20-liter conical-shoulder a defined sequence and defined quanti- “The scale must not only be accurate; the bottles that are hermetically sealed with ties. Each individual tube stars in a video concentration of the detected gas in the ground glass stoppers. Just as the chem- of the filling process, which a video cam- ambient air in ppm, for example, must ical properties of the materials involved era transmits to a control monitor. also be easily legible,” explains Wittfoth. can be very different, so too can the phy- The analysis system is initially sealed Under certain circumstances, pre- sical properties. “Some materials are al- using a layer of glass fabric that has been tubes are required to first break down most as sticky as honey,” says Wittfoth, cut out from a strip of the material and the gas to be measured so that it can be “while others are so dry that they can has the shape of a circle. Something re- analyzed. Dräger is particularly proud of become electrostatically charged while ferred to rather floridly yet nevertheless its equipment’s ability to detect relatively being filled into the tubes and adhere to appropriately as the “tulip” ensures that stable compounds such as sulfuryl fluo- the glass walls. At least that’s what would the grains are firmly secured. The tulip ride – a process that requires the air to be happen if we didn’t specifically dissipate is likewise a circular blank that has been heated to roughly 900 °C in a pretube. How this static electricity.” This is particularly stamped from stainless steel wire mesh. It is this done without electricity? The trick is important when various substances must has a mesh size of 0.2 millimeters that has to use a chemical compound that releases be layered one after another in a glass been formed into the shape of a tulip by energy when it reacts with the air. tube. Altogether, as many as eight layers means of a spine. The resulting folds gen- Isn’t chemistry smelly by nature? “You can be involved. erate the tension that results in the hold. don’t smell anything around here unless The tubes themselves are made of we are working with a lot of butyric acid,” tapped 2,000 times glass, whose type varies according to says Wittfoth, wrinkling his nose. Isn’t it the intended use. High-quality labora- Does it really hold? The answer is pro- dangerous to test tubes that detect toxic tory glass grades such as Duran or “Du- vided by a box that taps the tube 2,000 gases? “No, it isn’t. That’s because the robax” borosilicate glass are frequently times with a force that is four times stron- people who work in this field do so in ac- used if extraordinary chemical resis- ger than that of gravity. Nothing is per- cordance with the strictest of safety regu- tance is required. The tubes, which are mitted to shift unduly in the box. And lations and have the necessary qualifica- generally provided with one end already only homeopathic quantities of the “sub- tions.” The expert doubts that electronic systems will replace the Dräger tubes any melted closed, resemble a pipette that strate grains” at most are permitted to is closed at the bottom. After an inspec- fall through the holes in the ceramic disk. time soon. “After all, the tubes are reli- tion aimed at detecting possible defects, This quality-assurance measure can only able, inexpensive, fast, and require no nils schiffhauer the tubes are loaded into a filling ma- be performed after the tube has been au- electricity.” 19 Dräger review 100.1 JUNe 2010 Shaping the future: Gesture-based control of devices in the operating room is still a dream of the future, but it’s already being intensively researched. Headshaking in the Operating Room experts are researching how the CONTACTLESS CONTROL of technical devices can be utilized – in the kitchen, in train stations or in the operating room. what they found out will surprise you. I n the Western world, a brief nod gen- municate with one another. But how well rectly on the screen, have been around for erally signals agreement. Shaking do gestures and facial expressions trans- many years. Multitouch technology even the head signals the opposite. Wrin- late to the computer world? allows the use of multiple fingers at the kling the nose expresses disapproval; a Many cellular phones and laptop com- same time. This intuitive, gesture-based smile, on the other hand, great affin- puters today have long moved beyond just method of operation shortens the learn- ity. No touching and no listening are re- the mouse or keyboard for operation. ing curve and lets users get down to work quired – just looking is enough. There is Touchscreens, with which users issue right away. Man-machine interaction is no more efficient way for people to com- their commands via finger pressure di- still far from being contactless, however. 20 Dräger review 100.1 June 2010 O u t lOO k gest ure-ba se D Con t rol Hospital-caused Researchers at the Fraunhofer Heinrich systems to be operated even if the screens Hertz Institute (HHI) in Berlin hope to are behind glass or mounted three me- illness change that. They have developed a 3D ters above the ground,” says Wolf-D. More people die from hospital germs technology called “iPoint,” which works Konrad, who is responsible for develop- than from the immunodeficiency disease without a data glove or electronic mark- ing new business areas at the HHI. “This aiDs. it is estimated that as many as ers on the fingers and can also translate would also them against vandalism in one million germans a year contract an spatial gestures into digital commands. airports or train stations, for example.” illness while they are being treated in The system comprises two infrared cam- ... to the operating room a hospital. experts assume that between eras that track the movements of the 170,000 and 250,000 of these noso- hand and communicate them to a com- The advantages of this technology in the comial infections could be prevented if puter. The computer translates the im- operating room are likewise as plain as doctors and nursing staff would follow ages, interprets them, and immediately the hand in front of your face. After all, hygiene rules correctly and avoid typical executes them as commands. the boundaries between sterile and non- transmission paths. PhotograPhy: Karl storZ Mi-rePort sterile areas must not be violated through From the kitchen... infections due to the Mrsa bacterium tactile contact when staff members are are a source of great concern to medi- HHI researchers were in Hanover in adjusting medical devices or navigating cal personnel. the letters sa stand for the early March of this year for CeBIT, the through patient information system. Dis- pathogen “staphylococcus aureus” world’s largest computer trade show, infecting control elements such as com- and the prefix “Mr” means “methicillin and demonstrated a scenario in which puter mice or touchscreens is very time- resistant.” this means that the antibio- cooks were able to read a digital cook- consuming and in some cases impossible tic methicillin no longer helps against the book on a media wall, regardless of how because the chemicals used destroy the sa pathogen. in practice, the abbrevia- sticky their fingers happened to be. To electronics. Other approaches have their tion has long ago ceased to refer to just open the book, they used their extended own weaknesses. Placing touchscreens this one individual case. Many patho- index finger to move the mouse pointer inside transparent disposable covers re- gens are already immune to multiple an- onto an icon. They paged through the duces the image quality and adds to the tibiotics, and there is the risk that some- book by swiping contactlessly past the expense. And placing assistants in the day no antibiotic will be able to help. edges. They extended a fist to start the non-sterile area so that they can perform by avoiding contact with medical desired video and returned to the main these actions on call harbors a high risk devices that may be contaminated, iPoint menu by spreading all five fingers. And of errors, particularly in the case of com- technology can prevent the spread of why not use gestures to turn on the range plex commands. The same applies to the Mrsa and thus enhance patient safety. hood or the stove, play music and check direct voice control of the computers. your electricity consumption? A German The background noises in the operating celebrity chef has already equipped his room are often simply too loud. culinary studio in the town of Gulden- So what does a contactless, yet reli- tal in the Pfalz region with the iPoint able and accepted form of human-ma- technology. chine interaction in the operating room Beside the hygienic aspects, the con- look like? And how can proven technolo- tactless operation promises advantages gies be carried over to this environment? with respect to the safety of the device it- This essentially requires two steps: Navi- gate to the desired menu item and then > self. “This technology allows information 21 Dräger review 100.1 June 2010 O u t lOOk gest u re-ba s eD Co n t ro l the reliability of gesture- HEADQuARtERS: based control is being Dräger Medical AG & Co. kG Moislinger Allee 53–55 successfully researched 23558 lübeck , Germany www.draeger.com > execute the command with a mouse REGION EuROPE CENtRAl REGION ASIA / PACIFIC AND EuROPE NORtH Draeger Medical South East Asia Pte. Ltd. click. HHI researchers have provided Dräger Medical AG & AG Co. KG 25 International Business Park two different ways of clicking in the con- Moislinger Allee 53–55 # 04-27/29 German Centre 23558 Lübeck, Germany Singapore 609916 tactless space: first, by holding the fin- Tel +49 451 882 0 Tel +65 6572 4388 ger steady in space for a certain period Fax +49 451 882 2080 Fax +65 6572 4399 info@draeger.com asia.pacific@draeger.com of time, and second, by moving the fin- ger in the direction of the screen. “These REGION EuROPE SOutH REGION NORtH AMERICA two methods were compared in the test Dräger Médical S.A.S. Draeger Medical, Inc Parc de Haute Technologie d’Antony 2 3135 Quarry Road and studied more closely in order to de- 25, rue Georges Besse Telford, PA 18969-1042, USA termine their advantages and disadvan- 92182 Antony Cedex Tel +1 215 721 5400 Tel +33 1 46 11 56 00 Toll-free +1 800 437 2437 tages,” says test director Paul Chojecki as Fax +33 1 40 96 97 20 Fax +1 215 723 5935 he explains the results. “What we found dlmfr-contact@draeger.com info.usa@draeger.com was that, contrary to our initial hypoth- REGION MIDDlE EASt, AFRICA, esis, the time-based solution is easier to CENtRAl AND SOutH AMERICA learn and was preferred by the majority Dräger Medical AG & Co. KG Dubai Healthcare City of the test subjects.” P.O. Box 505108 Chojecki warns against overvaluing Dubai, United Arab Emirates Tel +971 436 24 762 these results, however, because the al- Fax +971 436 24 761 ternatives tested represented only a frac- tion of all the contactless control op- tions. But one can learn a lot from him and his colleagues. They distrusted their 90 66 601 own hypotheses and kept a sharp eye on the users’ fingers from early on. Real- world feedback is essential for translat- ing novel technologies into commercial Frank Grünberg success. PublISHING INFORMAtION Publisher: Drägerwerk ag & Co. Kgaa, Corporate Communications Editorial Address: Moislinger allee 53–55, 23542 lübeck, germany / draegerreview@draeger.com, www.draeger.com Editor in Chief: björn wölke, tel. +49 451 882 20 09, Fax +49 451 882 39 44 Publishing House: tellus Publishing gMbh Editorial Consultant: nils schiffhauer (responsible according to © FraunhoFer heinriCh-hertz inst tut press law) Art Direction, Design, and Picture Editing: redaktion 4 gmbh, hamburg translation: transForm gmbh, Cologne Printing: Dräger + wullenwever print+media ISSN 1869-7275 The articles in Dräger Review provide information on products and their possible applications in general. They do not constitute any guarantee that a product has specific properties or is suitable for any specific purpose. All specialist personnel are required to make use exclusively of the skills they have acquired through their education and training and through practical experience. The views, opinions, and statements expressed by the persons named in the texts as well as by the external authors of the articles do not necessarily correspond to those of Drägerwerk AG & Co. KGaA. Such views, opinions, and statements are solely the opinions of the respective person. Not all of the products named in this magazine are available worldwide. Equipment packages can vary from country to country. We reserve the right to make changes to products. The current information is available from your Dräger representative. © Drägerwerk AG & Co. KGaA, 2010. All rights reserved. This publication may not be reproduced, stored in a data system, or transmitted in any form or using any method whether A sensor registers the up-and-down electronic or mechanical, by means of photocopying, recording, or any other technique in movements of hands and fingers. whole or in part without the prior permission of Drägerwerk AG & Co. KGaA. 22 Dräger review 100.1 June 2010 Welcome to next level the Anesthesia workstation – Primus® IE The Dräger Primus Infinity Empowered is much more than just a high-performance anesthesia workstation. Built to work seamlessly with the Dräger Infinity Acute Care System™, the Primus IE lets you take advantage of Drägers latest monitoring and anesthesia information system solutions as well as hospital information system technology. With the Primus Infinity Empowered, comprehensive data integration directly at the point of care is a reality. FOR FURTHER INFORMATION: WWW.DRAEGER.COM PDF1674 CLOS E - UP V E N T IL AT ION 6 4 8 2 3 4 7 5 1 9 D-11058-2 010 A High-frequency Ejector Delivers Top Performance The Babylog VN500 ventilator was specially designed for premature sure, resulting from the ejection supports the “active expiration” of the babies and offers powerful high-frequency oscillation in addition to con- patient, which is controlled via the silicone membrane 6 . The silicone ventional ventilation. An important component of the ventilator is the membrane has a soft flat surface enabling a leak-free seal with mini- expiratory valve, through which the patient exhales. The Infinity ID an- mal back pressure. A monocrystalline nickel disc vulcanized onto the tenna module 1 transmits data from an Infinity ID hose system through back side ensures that it is perfectly flat. the angled connector 2 to the ventilator, where the data are processed. The check membrane 7 prevents pendular breathing in the event Up to 18 liters of compressed gas at a pressure of a maximum of 2 of a possible failure of the device. The muffler 8 uses turbulence to bars is propelled into the ejector 3 each minute through two channels reduce noise. The potential condensation is collected in the water trap 4 measuring only 0.65 millimeters in width. The ejector itself is made 9 . The entire assembly can be cleaned manually or processed in an of nickel silver, where the gas is fed into connector 5 . A lower pres- autoclave at 134 degrees Celsius. =
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