RAMT
IAF EXPEDITIONARY MEDICAL TEAM
GROUP CAPTAIN GS BHATIA
COMMANDING OFFICER
AIR FORCE HOSPITAL
HINDAN, INDIA
• INTRODUCTION
• CAPABILITIES
• SCENARIOS
NEPAL EARTHQUAKE 2015
• DEPLOYMENT
• ROAD AHEAD
• CONCLUSION
RAMT DEPLOYMENT AT NEPAL
HISTORY
BACKGROUND
Army
• Mobile – inherent role
• Field Hospital
Air Force
• PMT (1951)
Paratrooper Medical Team
• CAEU (1957)
Casualty Air Evac Unit
• RAMT (1999)
Armed Forces called to assist
INTRODUCTION
RAMT
• Three
• Est : 1999
• Co-located with AF Hospital
• 1RAMT- South : Bangalore
• 2RAMT- East : Jorhat
• 3RAMT- North : Hindan
• Large transport base
• 3RAMT “unique”
J&K FLOODS 2014
TASK DIRECTIVE
OBJECTIVES
Description
Task
Maintain
State of readiness
Mobilize
By Air/Road
Operate
25 bed hospital with
surgical facilities
ASSUMPTION
 Low threat environment
 Proximity of airfield
 Supply chain maintained
 Adequate manpower
 Airlift /road tpt available
 Air evac of post op cases
CAPABILITIES
 Self sufficient : 07 days
 Life/limb saving
surgeries
: 08/day
 In patients
: 25
 OPD patients :100/day
ACTIVATION OF 3 RAMT
2 PHASES
MAINTENANCE PHASE
 Inventory management
 Serviceability of eqpts
 Consumables
OPERATIONAL PHASE
 Preparation
 Emplaning
 Training
 Deplaning & Deployment
 Exercise
 De-induction
 Revision of plans/
procedures
RESPONSIBILITIES
CAMP COMMANDER
 Liaise with local authorities
 Enormity, type and extent of disaster
 Water, food and fuel
 Assess feasibility of obtaining from civil authorities
 Security of the camp
 Communicate
 Controlling command – casevac, replenishment of eqpt & stores,
turn around of manpower
 Record keeping
 All aspects of deployment incl patients treated, transferred etc
DEPLOYMENT
SCENARIO I
03 tents
OPD/resuscitation
Lab/radio services
Dispensary
No ward/ICU/OT
SCENARIO Ia
04 tents
25 bedded ward
No ICU/OT
SCENARIO II
07 tents
25 bedded ward
4 bedded ICU
Fully functional OT
SCENARIO III
Scenario II plus
Living quarters for staff
Kitchen
13 tents
3RAMT CONTAINERS PLACED
OUTSIDE THE STORES
CONTAINERS BEING SHIFTED
ON TRAILERS
PALLETISATION OF CONTAINERS
LOADING OF VEHICLES IN C-17 A/C
LOADING OF PALLETS IN C-17 A/C
C-17 A/C WITH RAMT LOAD
LOGISTICS
Load
: 58 tons
Containers
: 38
Vehicles*
: 05
Genset
: 03
Forklift
: 01
Trailers trips required = 38/4 = 10
Calculation of
• Electricity Load
• Ration
• Water
• POL
• Oxygen consumption
150 KVA GENSET
SELLICK FORKLIFT
ELECTRICAL LOAD- MED EQPTS
Name of Consumer
Rating
Quantity
Total
Held
Consumption
Suction Apparatus
1.2 kw
8
9.6 Kw
Refrigerator
1.5 kw
3
4.5 Kw
X-Ray Machine
6 Kw
1
6 Kw
OT machine &
Oxygen Concentrator
1 Kw
2
2 Kw
4.5 Kw
1
4.5 Kw
2 Kw
2
4 Kw
--
--
0.317 Kw
Sterilizer
Autoclave Machine
Miscellaneous
Total
30.917 Kw
15
ELECT LOAD- NON MED EQPTS
Name of Consumer
Tube light
Rating
Qty
Held
Total Consumption
50W
130
6.5 KW
Air Conditioning
13
Heating Mode
12 KW
13*12=156 KW
Cooling Mode
16.35 KW
13*16.35=212.55K
W
Oxygen Plant
Booster (6A)
380 V
1
2.5 KW
Oxygen Conc(20A)
380 V
1
8 KW
TOTAL NON MEDICAL LOAD 173 KW IN HEATING MODE AND
229.55 KW IN COOLING MODE
16
TOTAL ELECTRICAL LOAD
Non-Medical load
:
:
:
173 Kw (Heating mode)
229.55Kw(Cooling mode)
30.917 Kw Maximum
Total load
:
:
203.917KW(Heating)
260.467KW(Cooling)
DG set Capacity
(150KVA each)
:
120X3 = 360 KW
Medical load
17
CALCULATION - RATION
Days
Auth Ration
per day per
individual
Total ration
In kg
58
10*
2.7 Kg
1566
Air crew/MTD
20
02**
2.7 Kg
108
In patients
25
10*
2.7 Kg
675
Transiting
patients
75
10*
1.0 Kg
750
No of
personnel
RAMT
Personnel
Details
Total
* Three days reserve ration included
** For induction & de-induction
3099
CALCULATION - WATER
Details
Total Qty
(In Ltr)
Remarks
DRINKING WATER
78 personnel (78X2.5)
195
On Induction day
(First day)@2.5L per head
58 Personnel (58X2.5X3)
435
Next 3 days
OPD patients (100X1X4)
400
100 OPD/day
@1 L/patient for 04 days
In Patient (25X2.5X4)
250
25 In patient
2.5L/patient for 04 days
Cooking/washing of utensils (300X4)
1200
@300 L/Day
Total
2480
Water bowser capacity 3000 L
19
WATER - OT
Details
Total Qty
Remarks
(In Ltr)
OPERATION THEATRE
One person for one OT
04
02 L each for Pre OT
and post OT
06 Personnel (6X4)
24
For hand washing for 01 OT
08 OT/Day (8X24)
192
Washing of instruments
05
For one set
Washing of instruments (8X5)
40
08 OT/Day
Mopping of OT
05
For 01 OT
Mopping of OT (8X5)
40
08 OT/Day
For one day Total
272
For four days Total (4X272)
1088
For Seven days Total (7X272)
1904
CALCULATION - POL
SL
No
Details
Tank
Capacity
Fuel
Consumption
Requirement
Per Day
Requirement
Per veh
Remarks
480X7=3360
480L/2 DG set /7 Days
(480X02X07=6720)
DIESEL
01
DG Set
(Qty-2)
1018
20 L/hr
20X24=480
480X2=960
02
Fork lift
83
04 L/hr
96
192
96 L/Forklift/2 Days
(For 02 Days) (96X01X02=192)
03
Amb
90
08 Km/L
08
56
Average 64 Km/Day
(For 07 Days)
04
Tractor
60
04 L/hr
--
05
Water
Bowser
90
07 Km/L
06
TOTAL REQUIREMENT PER DAY
WEEKLY REQUIREMENT
120*
60 L/15 hrs
42
Average 42 Km/Day
(For 07 Days)
1070
7130
21
POL Cont.
SL
No
Details
Tank
Fuel
Capacity Consumption
Requirement
Per Day
Requirement
each
Remarks
PETROL
01
LMV
Gypsy
40
10 Km/L
06L
TOTAL
42L
60 Km/day
(6 LX7 Days)
42
LUBRICANTS
01
Engine Oil
10W30
--
--
--
15
02
Engine Oil
20W40
--
--
--
15
For maintenance
of equipments
22
CALCULATION - OXYGEN
Details
Requirement
per day
Requirement
per week
Operation Theatre
8640 L
60,480 L
(6 L X 60 Min X 24)
Wards/ICU/Emergency
14400 L
Per bed
100,800 L
(10 L X 60 Min X 24)
Description
Remarks
Capacity
Qty
Oxygen cylinder
200L
02
Oxygen cylinder
3Kg
05
Oxygen cylinder
623L
20
Oxygen cylinder
1246L
24
Oxygen cylinder
6000L
13
23
LAYOUT - TYPICAL
Tent 2
Resuscitation
Tent 4
Tent 6
OT
Lab /Radio
Tent 7
Vestibule
Med stores
Tent 1
Tent 3
Tent 5
Reception
ICU
Ward
Entrance
TENT 1 - RECEPTION
• Manpower
– Med Officer : 01+ 01*
(*Surgeon - triage)
– Med Asst : 04 + 01
– Stretcher bearers: 04
•
•
•
•
Stretchers
Triage
Documentation
Communication
– Motorola sets
– Satellite Phone
– Loud hailers
LAYOUT OF RECEPTION
COMMUNICATION
TENT 2 - RESUSCITATION
• Manpower
– Med Officer : 01+ 01*
(*Anaesthetist to assist)
– Med Asst : 03(GD)+01ORA
• Stretchers beds on stand
• Medical Equipment
• Medical stores
• Salient points
– Colour coded & numbered
– Kept separately
– Ownership
TENT 3 - ICU
• Manpower
– Med Officer
– Med Asst
: 01
: 03+ 01
• ICU beds on stand
• Medical Equipment
• Medical stores
– Medical brick universal
– Disaster Specific brick
TENT 4 - OT
• Manpower
– Surgeon
: 01
– Anaesthesiologist: 01
– ORAs
: 03
(02 assist + 01 CSSD)
• OT Equipment
• Linoleum sheet for floor
• Water adsorbent gel
• Medical stores
– Instruments set
– OT bricks
TENT 5 - WARD
• Manpower
– Med Officer : 01
– Med Asst : 03 + 01
• 25 Beds
• Medical Equipment
• Medical stores
– Medical brick universal
– Lifestyle diseases brick
– Disaster specific brick
TENT 6 – LAB & RADIOLOGY
• Manpower
– Lab tech
– Radiographer
: 02
: 01
• Equipment
– Portable X-ray machine
– CR system
– Compact portable mobile lab
– I-stat
• Medical stores
– Lab brick
– X-ray brick incl films
TENT 7 – STORES
• Manpower
– Med Asst
– Health Asst
: 01
: 01
• Medical Stores
– Medical brick universal
– Disaster specific brick
– OT brick
– Lifestyle disease bricks
– Hygiene chemical stores
• Waste disposal co-ordination
— BMW, Solid waste
— Kitchen waste - sullage
MANPOWER
INHERENT
AUGUMENTED
OFFICER
01
04+01
MED ASST
15
10
NON – MED ASST
08
08
NC(E)
04
07
28
30
TOTAL
CHANGE IN ATTITUDE
MANPOWER
– Core team
– Highly motivated
– Physically fit
– Well trained
– Team spirit
– Multi tasking
– Ownership
– Job cards
26.04.2015
“Sense of pride”
“We make a difference”
EQUIPMENT
• Light weight
• Compact portable mobile lab
• CR System
• Compact
• Portable X-ray machine
• Portable
• Fumigator
• Sturdy
• Portable anesthesia machine
• Easy to use
• Low maintenance
• Manifold alarm system
• Water absorbent gel
• Aluminium stretchers
• Spinal boards & Scoop stretchers
• Microwave – BMW disposal
MEDICAL BRICKS
CONTAINERS
– Light weight with handle
– Wheeled
– Colour coded
– Section wise
– Disaster specific
• Universal
• Earthquake
• Floods
• Burns
ANAESTHESIA MACHINE
COMPACT PORTABLE MOBILE LAB
CR SYSTEM
Linoleum sheet for OT floor
DEPLOYMENT
Exercises
– Cope India 2009
– Aero India 2011
– Milan 2014
Real action
– Op Rahat
• Uttarakhand Floods(2013)
– Op Megh Rahat
• floods in J&K(2014)
– Op Maitri
• Nepal earthquake(2015)
• 25 Apr 2015 to 08 May
2015
HIGHLIGHTS – OP MAITRI
• Rapid deployment
– excellent coordination: ops, admin, logistics and medical
• Jointmanship
– Pooling resources of 3RAMT with other medical units
– 932 patients seen, 73 patients admitted & 60 surgeries
conducted
• Maintenance of good supply chain
– adequate stock of all medicines, rations and other stores
• Liaison with local authorities and Nepalese Army
– avoided confusion
– the capabilities and limitations explained clearly during
interactions
– optimal and efficient use of all capabilities of 3RAMT
• Paediatrician, Gynaecologist and trauma trained nurse
CONCLUSION
 Tremendous capability
 Need to utilise full potential
 Equipment up gradation
 Procedures & drills
 Regular trg & practice
“The more you sweat in peace
the less you bleed in war”
Thank You