Objectives of the service
ICUTrain is a safe, railway-based and space-asset-enhanced deployable hospital unit, increasing hospital bed capacity within all regions where healthcare facilities are contingently overwhelmed due to pandemic waves or other major public health emergencies.
The solution offers:
Timing advantages - ICUTrain provides timing advantages over tent-based or truck-container-based field hospitals in that it travels ready for operation, thus requiring no set-up time once the target destination has been reached. Time-to-availability of the additional treatment capacity can thus be reduced to a few hours since issuance of the deployment order.
Predisposition for biocontainment facilities - ICUTrain is designed for the installation of biocontainment facilities suitable for the treatment of highly infectious patients.
Reduced specialized medical staff - Being directly connected to hospital services through secure data sharing and VoIP teleconferencing services allowing live transmission of patient parameters and diagnostic images, the ICUTrain can contribute to reduce the number of specialized doctors to deploy on the operations theatres, thus freeing up resources to the benefit of other patients.
Deployment capability during all emergencies - ICUTrain treatment capability can be deployed during emergencies generated by natural disasters or critical situations affecting populations.
Users and their needs
The Covid-19 pandemic emergency stressed the Medical and Public Health Systems due to the need for a (sudden) large capacity of intensive care units as well as the need for moving patients from a hospital to another one. A fast, safe and ready-to-use mobile hospitalisation system, equipped with remote diagnosis instruments, and connected through secure, state-of-art satellite communication technologies is a solution able to contribute to such needs.
ICUTrain increases the number of readily available intensive care units, targeting the patients affected by severe respiratory infections.
Service/ system concept
The ICUTrain is based on the modification of the “Treno Sanitario”, a rolling stock specifically designed for health emergencies, conceived during the first COVID-19 pandemic wave. It was developed and equipped in collaboration with the Italian Civil Protection Department and AREU Lombardia (Health Emergency Agency for Lombardia Region) and made available by Trenitalia (Manager of the Italian Railway Transport). This complete train is composed of 3 coaches devoted to medical treatments, equipped with up to 21 intensive care units. The other coaches have been modified for the installation of the various technical equipment and utilities needed to afford a pandemic situation as COVID-19 or different MEDEVAC situations. The “Treno Sanitario” is already equipped with some medical devices (i.e. patient monitoring systems), but lacks terrestrial and satellite connectivity, which is provided by the ICUTrain. Medical devices in contact with patients (i.e. portable patient monitors, portable ultrasound scanners) are not always on the train and are brought by the healthcare staff when necessary.
The purpose of the ICUTrain is to create ready-to-use ICUs, easily transportable in Italy and abroad whenever railways network covers a given Country to promptly respond to the outbreaks.
ICUTrain key features can be synoptically summarized as follows:
Mobile intensive care unit with multiple beds, to be deployed at locations in need, provided with all necessary medical equipment
Ready to use, flexible and quickly reusable for future emergencies
Integrated Satellite/Terrestrial communication subsystem for uninterrupted connectivity (except for short periods during passage through tunnels where terrestrial cellular signal is not suitably distributed by infrastructure operators)
Remote digital monitoring of patients’ conditions during live calls, in order to reduce the number of medical staff required on-board
Attention to cybersecurity aspects of the onboard system and equipment, as well as measures needed to safeguard the privacy of patients and operators implemented by design.
The ICUTrain solution brings a complementary offer to other MEDEVAC concepts such as airborne transportation means used during the COVID-19 emergency. The ICUTrain solution allows for more patients to be transported than with helicopter ambulance or a typical C130 flight. Moreover, a train-based solution allows patients to depart from and arrive at the heart of a city. In addition, should conditions of any patient worsen during the transfer, the train can easily stop on its way.
Space Added Value
ICUTrain features a constantly and ubiquitously connected communication system serving both its healthcare and logistics needs through broadband communication and GNSS positioning. ICUTrain reaches the public internet through a terrestrial cellular interface implementing currently available packet radio access standards (i.e., up to LTE + and in the future open to 5G) as well as through satellite communication channel granted by government or commercial assets, Athena Fidus during pilot, providing lower bit-rate ( 3-5Mbs) ubiquitous access. All this is made available to the ICUTrain operators by an ad-hoc developed, integrated space/terrestrial communication system (IICS, ICUTrain Integrated Connectivity System).
Usage of the available external transmission resources is automatically managed by the network, depending on their availability, through load balancing functions implemented by the secure edge router on-board the train.
Started in October 2020, the project achieved the Baseline Design Review (BDR) in November 2022. The concept phase focusing on the user needs has been completed, identifying the Users’ requirements and the system architectural specifications.
Medical communication operational use-cases with ICUTrain medical users were defined, based upon actual operational needs; meetings have been arranged with end-users from Regione Puglia and Lombardy’s Regional Emergency Urgency Agency (AREU) to update and improve the system requirements.
A custom antenna for satellite connectivity, with the capability to lock and use Athena Fidus satellite (granting the full coverage of the Italian territory), has been designed and certified.
At the end of May, the Critical Design Review was held and the documents presented were considered adequate. The team is currently preparing the necessary documentation and evidence for the FAT scheduled for the end of July 2023.
The beginning for test activities are scheduled in the second half of 2023 and the project is expected to be concluded by the end of 2023.