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Firemen’s Helmets Hard exterior, smart interior Design Pleasant hospital architecture supports recovery Tough Tugboat Rescue on the high seas Technology for Life May 2011 Dräger Review 102 Prevention is the best medicine Operation Fire Protection Dräger Review 102 May 2011 Fire Protection in Hospitals

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Page 1: Dräger Review Firemen’s Helmets...Firemen’s Helmets Hard exterior, smart interior Design Pleasant hospital architecture supports recovery Tough Tugboat Rescue on the high seas

Firemen’s Helmets Hard exterior, smart interior

Design Pleasant hospital architecture

supports recovery

Tough Tugboat Rescue on the high seas

Technology for Life May 2011

Dräger Review 102

Prevention is the best medicineOperation Fire Protection

Dräger R

eview 102

May 2011

Fire Protection in H

ospitals

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2 Dräger review 102 | May 2011

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Contents   

  4  experienCe She is a doctor who works “very close to the edge” every day. He was one of the first to break through the St. gotthard Massif in Switzerland.

  6   news including: safe driving with interlock, wireless networks in hospi tals with certified wi-Fi, and test results showing that the Dräger Drugtest 5000 is the only product with evaluated results.

  8  FoCus Fire protection in hospitals poses extremely tough requirements. However, a unique and pragmatic safety concept can minimize the risk.

20  personal proteCtion Firefighters’ helmets made in Chomutov, Czech republic, meet the highest safety requirements.

26 Gas proteCtion the Nordic is the world’s only rescue tugboat that offers protection in toxic or explo-sive atmospheres.

32 DruG testinG Just a small drop of saliva is enough for Dräger’s quick test for illegal drugs.

36 neurosurGery Special anesthesia workstations make it pos-sible to use imaging processes for monitoring anesthetized patients during an operation.

40 DesiGn Carefully planned design in workplaces and patient rooms can support recovery – and reduce costs.

44 researCh what brings new developments to our world? the Helmholtz-association creates networks for research, development, production, and recycling.

48 pharmaCeutiCals  Producing pharmaceuticals for the global market requires especially stringent safety measures.

about 60,000 times stronger than the earth’s magnetic field are the forces that offer insights into the brain of an anesthetized patient during an operation. read more starting on page 36. 

8 26proteCtion resCue

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52 InsIght ThelogisticsexpertsatDrägerensureasmoothflowofgoods.Theirmottois“There’snosuchthingas‘nocando’”!

56 AdvAnced trAInIng Internet-basedseminarsareingreatdemand.TheteachingmethodsusedinDrägerwebinarsconfirmtheconclu-sionsofeducationalresearchers.

58 ImAgIng Electricalimpedancetomographyshowsthedistribu-tionofairinthelungs–withnoradiationandinrealtime.

62 OutlOOk ResearchersattheUniversityofLübeck,Germany,areexaminingpossiblewaysofnet-workingsensors.Theresultscouldrevolutionizesafetyconcepts.

66 newbOrns AmotherpandainMadridgavebirthtotwins.ADrägerincubatorplayedakeyroleinthenewborns’firstfewweeksoflife.

70 servIce Drägeraroundtheworld.

72 clOse-up Atransportablefirecontainerhelpsfirefighterspracticetheirskills–realisticallyandunderstrictlycontrolledconditions.

6640 suppOrtdesIgn

publIshIng InFOrmAtIOnPublisher:DrägerwerkAG&Co.KGaA,CorporateCommunicationsEditorial Address:MoislingerAllee53–55,23558Lübeck,[email protected],www.draeger.comEditor in Chief:BjörnWölke,Tel.+494518822009,Fax+494518823944Publishing House:TELLUSCORPORATEMEDIAGmbHEditorial Consultant:NilsSchiffhauer(LegalPressConsultant)Art Direction, Design, and Picture Editing:Redaktion4GmbHTranslation:TransFormGmbHPrinting:Dräger+Wullenweverprint+mediaLübeckGmbH&Co.KGISSN 1869-7275

DRäGERREvIEW102|MAy2011

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4 Dräger review 102 | May 2011

ExpEriEncE    PeoPle who PerforM

What Moves Us – Dräger Worldwide 

Dr. petra Wegermann, Medical Director of the intensive care Unit, Klinikum Kassel / Germany“i actually wanted to be a latin and math teacher, but i finished high school with very good grades, so i decided to study medicine. i didn’t like the way we were taught back then. i hated multiple-choice tests. it was difficult for me, because i wanted to do things that make sense. when i passed my second certification exam, i was pregnant with my daughter, who is now 20. During my resi-dency and afterward i worked very hard. lots of anesthesia, many personal stories, many experiences. all of this became my routine. But we physicians shouldn’t let routine replace reflection. we have to ask ourselves every day: what am i actually doing? which of my activities are helping the patient? and – a crucial question in inten-sive care medicine – how can i help the relatives understand the sit-uation and cope with it? after all, every day we work very close to the edge. it can happen at any time. i remember a young pregnant

woman who had a prematurely detached placenta. She had lost a lot of blood. we were able to save the baby, a preemie, but we lost the struggle to save the mother’s life. and now it was up to me to not only give the young father support but also ask him if he would consider authorizing an organ donation that would help other peo-ple. That’s what it looks like, my area of responsibility. i accept it, and here in Kassel i’m responsible for coordinating organ donations, which i believe in completely. anesthesiologists and intensive care doctors have better technical support today than ever before. Sur-geons can also cope with more complicated cases than was possi-ble even 20 years ago. That saves lives, but it also makes it more urgent to clarify the ethical issues involved – with discipline and pro-fessionalism. This is my life. and i’m especially pleased by the fact that my daughter is training to become a teacher.”

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5Dräger review 102 | May 2011

Hubert Zistler, Civil Engineer / Project Coordination Manager, AlpTransit Gotthard AG / Switzerland“The breakthrough! On October 15, 2010, the tunnel-boring ma-chine drilled through the last meter of rock, and we were on the other side. We were greeted by our colleagues who had been drilling from the north. I climbed through the opening, which was just big enough for me to get through. I was carrying the blue-and-white flag of my home state of Bavaria, and I became part of a huge sea of flags. The men, who came from 20 different countries, had all brought their flags with them. Our express train tunnel under the Gotthard Massif is 57 kilome-ters long. In five years, these trains will connect German-speak-ing Switzerland with the canton of Ticino. It’s a monumental project. Gigantic ventilators and refrigerant compressor units create the climatic conditions that are needed for this difficult work. A temperature of 28°C is the maximum we can stand, but

the rocks at this depth can get as hot as 55°C. Our indivi dual equipment includes protective clothing and an oxygen self- rescuer. In case of danger, it protects you from smoke and gases and enables you to breathe clean air. Rescue chambers offer a safe haven. Switzerland is very diverse, but somehow the people stick together. The workers from the north speak Ger-man. I’m from the south, where most people speak Italian. My wife is from Ticino, so I feel at home with both languages. I’ve worked on major construction sites all over the world, most recently on a huge dam project in Lesotho , Africa. I often spend my leisure time underground too. With my friends, I like to ex-plore caves and go diving in grottos. One cave has a good chance of soon being officially registered as the longest one in the Ticino region.”

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6 DRÄGER REVIEW 102 | MAY 2011

NEWS

First Combined Edition, in Four LanguagesThis Dräger Review is the first – following the relaunch at the end of 2008 – in which the formerly separate editions of Safety Technology and Technology in Medi-cine appear combined in one publication. “Wherever our products are used they protect, support, and save lives. For five years, we’ve been working hard to bring together our two divisions under the guiding philosophy ‘Technology for Life’,” says Stefan Dräger, Chairman of the Executive Board of Drägerwerk Verwaltungs AG. This applies to Dräger’s brand strategy, as well as to its products and employees. “Life is the element that connects our company with our customers all over the world – in all sorts of different professional bran-ches,” says Dräger, adding that the new combined customer magazine itself is a kind of lifeline providing indepth reporting on complex topics from all areas where the company’s customers are protecting lives or fighting for the lives of others. “It was very exciting to develop a concept that would appeal to all our readers,” says Burkard Dillig, the company’s corporate spokes-man. Stefan Dräger would like readers to offer their personal feedback: “I’d love to hear what you think of our new concept,” he says. So share your opinions at: [email protected]

Drug Testing: The Only Product with Evaluated ResultsThe Dräger DrugTest 5000 uses saliva as the basis for drug testing, detecting substances including tetrahydrocannabinol, the active agent in cannabis. The device delivers reliable, easy testing with a high degree of acceptance, which was confirmed by the German Police University (DHPol) in Münster when they put the DrugTest 5000 through its paces. The DHPol arranged trials of the product in nine German states and evaluated the results, concluding that the device is “the most accurate saliva-based system for drug use pre-testing currently available on the market and can test for the presence of many different types of drugs.” The final report describes the product as an important improvement in testing for drug use, and one that has impressive practical features.

The feedback from personnel in the field was consistently very positive in terms of the DrugTest 5000’s ease of use, evaluating the device as simple, hygienic, and uncomplicated, while providing clearly readable results. And the results – for all the drugs tested – matched the blood analysis with 95 per-cent agreement. The Dräger DrugTest 5000 is thus the only drug testing product in Germany whose effectiveness for use by police is backed up by evaluated DHPol results.

Multi-faceted: The new Dräger Review. Reliable performer: The Dräger DrugTest 5000 in use.

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Casque de pompier Solide à l’extérieur,

intelligent à l’intérieur

Design

Un design bien conçu accélère

le processus de guérison

Remorqueur de secours

Sauvetage en pleine mer

La technologie pour la vie Juin 2011

Revue Dräger 2

La prévention est le meilleur remède

Opération de protection

contre les incendies

Revue D

räger 2 Juin 2011

Prévention incendie dans les hôpitaux

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La prévention est le meilleur remède

Opération de protection

contre les incendies

Casco de bomberos Inteligente por dentro, duro por fueraDiseño El interiorismo deliberado acelera la recuperación

Remolcador Rescate en alta mar

Tecnología para la vida Junio de 2011

Más vale prevenir que curar

Protección contra incendios

Revista Dräger 3Revista D

räger 3 Junio de 2011

Protección contra incendios en el hospital

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Más vale prevenir que curar

Protección contra incendios

La prévention est le meilleur remède

Feuerwehrhelm Harte Schale, kluger Kern

Krankenhaus-Design Überlegte Innenarchitektur

steigert Wohlbefinden

Notfallschlepper Rettung auf hoher See

Technik für das Leben Mai 2011

Drägerheft 387

Vorbeugung ist die beste MedizinOperation Brandschutz

Drägerheft 387

Mai 2011

Brandschutz im

Krankenhaus

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Más vale prevenir que curar

Vorbeugung ist die beste MedizinOperation Brandschutz

Firemen’s Helmets

Hard exterior, smart interior

Design

Pleasant hospital architecture

accelerates recovery

Tough Tugboat

Rescue on the high seas

Technology for Life May 2011

Dräger Review 102

Prevention is the best medicineOperation Fire Protection

Dräger R

eview 102

May 2011

Fire Protection in H

ospitals

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7Dräger review 102 | May 2011

Wi-Fi Certified Wireless Monitoringwhen it comes to the wireless trans mis sion of vital signs data, Dräger relies on the wi-Fi standard. a case in point: in the second half of 2010, the infinity M300 patient-worn monitor was certified as meet-ing the 802.11 standard by the wi-Fi alliance. wi-Fi devices yield cost savings because they run on existing wireless networks rather than requiring separate proprietary networks, and they conform to international norms. This also means that maximum peace of mind ensuring by secure data transmission and easy instal- lation. Com pared to other radio network systems, such as wMTS, wi-Fi offers a greater coverage area and thus a greater activity radius for mobile patients, whose vital signs are monitored in real time. The advantages of this technology are winning over a growing number of hospitals: Last year wi-Fi use in the healthcare sector increased by 60 percent compared to the 2009 level.

Interlock for Safe DrivingMore and more companies that transport valuable or hazardous cargoes are using the interlock XT immobilizer system from Dräger. The international full service logistics prodiver HOyer equipped about 30 of its hazardous cargo vehicles with the system in order to ensure zero tolerance for alcohol use – their drivers have to pass a breath-alcohol test before they can start the trucks. The company believes this is the most effective preven- tive mea sure for raising drivers’ aware- ness of alcohol, with lasting effects. it has already been using interlocks in over 60 of its group’s vehicles in Scandinavia with great results. and in Lübeck the logistics provider voigt, which provides internal plant transport for Dräger among other services, is installing inter- lock in all of its new vehicles. also in Lübeck, a taxi company taking part in a pilot program is using the system to boost safety and protect against residual blood alcohol content, an underestimated risk.

Wireless network monitoring. First blow, then go.

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Breathing Easy: The SavinaToday you can find the Dräger Savina intensive care ventilator in use all over the world – over 25,000 of them have been sold since the product was launched in 2000. all of them taken together have provided a total of more than 400 million hours of ventilation for patients. Due to the turbine-driven concept, which uses ambient air for ventilation, the unit can be operated without a central gas supply. The Savina’s independence from an external power supply and its mechanical robust-ness make it a ventilator for use wherever reliability in challenging settings is a must – for example, in aircraft for transport-ing patients, in remote hos pi tals, or in regions at risk of earthquakes. Last year, after a process of continual enhance-ment, the successor model was launched on the market. The features of the Savina 300 include a 12-inch touchscreen that simultaneously displays pressure, flow, and volume curves.

Savina 300 – with 12-inch touchscreen.

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Focus    Fire Protection

8 Dräger review 102 | MAY 2011

 Planning for an EmergencyAcrid smoke and a roaring blaze are a nightmare combination anywhere – especially in a hosPital full of patients. However, a unique and pragmatic safety concept can help minimize the risk. training is also a crucial aspect.

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B reathing apparatus, personal pro-tective equipment, radios, and flashlights are all ready and wait-

ing. Next to them are powerful ventila-tors and 100 fire escape hoods packed in red bags – after all, many lives are at stake. This equipment is stored in a container fitted with rollers which is on standby in the patient building of the University Hospital of Cologne, Germany. This is a special kind of “fire truck”. It has no red paint or flashing blue lights, but it is help-ing the onsite fire service to protect the patients and hospital personnel.

Such equipment can also be found aboard normal fire trucks. Yet there is nothing normal about a fire in a hospi-tal. Here, lots of people are concentrated in a small area. Many of them are unable to move or to properly assess the risks posed by a sudden fire. That’s why effec-tive fire protection measures, which ei-ther prevent the outbreak of fire or min-imize its impact, are vital in a hospital, not only to protect human lives but also to ensure continued operation and min-imal damage.

In a hospital, fire protection is needed not only for the buildings themselves but also for the expensive medical equip-ment within them and the risk of a fire

disabling entire departments. The total damage caused by a fire can quickly run into a lot of money.

Each hospital  functions differently

Fire safety in a hospital, as elsewhere, is divided into preventive and active mea-sures. Each individual hospital has its own detailed fire protection concept. There is no standard approach here, since each facility differs in terms of size, architecture, and areas of specialization. A fire protection concept must therefore be precisely tailored to the specific risks that arise from the nature of the build-ing and its use.

There are approximately 2,000 hos-pitals in Germany, with a combined to-tal of over 500,000 beds. Such facilities range from small local hospitals to com-plex clinics housed in new buildings lo-cated amid historic hospital architec-ture. A particular challenge is posed by large, complex hospitals housing differ-ent departments under one roof and pro-viding a comprehensive range of special-ized care. In the case of larger hospitals, it is also unusual for the fire protection concept to cover the facility in its entirety. More often than not, individual fire pro-

tection provisions will be drawn up for new and renovated buildings. These must also make allowances for differ-ent areas within the hospital. An operat-ing room, for example, will have differ-ent fire protection requirements than a patient ward. Similarly, kitchens, offices, and laboratories all have their own spe-cific fire protection profiles.

“The highest standards normally ap-ply to healthcare areas, particularly in-tensive care and neonatal intensive care units,” explains Hans-Georg Walz, a fire protection officer at the University Med-ical Center of the Johannes Gutenberg University Mainz, Germany. An engineer by training, he has chaired the confer-ence “Fire Protection in Hospitals” for the past three years. This event is staged by VdS, one of the most important inde-pendent testing institutions for fire pro-tection and safety in Germany. Once a year, experts in this field meet up to dis-cuss the special fire risks pertaining to hospitals and other care facilities.

Recent decades have brought substantial changes in hospitals. This applies not only to the layout of wards but also to the development of new types of outpatient treatment. There have also been major advances in medical

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9Dräger review 102 | MAY 2011

Key fixture: Stringent fire protection means that hospital staff members can concentrate on treating patients. P

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10 Dräger review 102 | MAY 2011

> equipment and building technology. At the same time, allowances must be made for the increased use of plastics in build-ings, equipment, and consumables, since they substantially increase the risk of smoke and noxious fumes in the event of a fire. In other words, fire protection must move with the times and take these new materials into account.

The same applies to the legal situ-ation, which in Germany requires par-ticular attention. Here, building legis-lation and fire protection are regulated state by state – i.e., there are no unified federal building regulations for hospi-tals. Instead, the Working Committee of the Ministers and Senators of the Fed-eral States responsible for Urban Develop-ment, Building, and Housing (ARGEBAU) drew up a model building code for hospi-tals (MKhBauVO) in 1976.

The building regulations for hospitals in the state of North Rhine-Westphalia (KhBauVO), written in 1978, are based on this building code, as are the regula-tions that apply in the German state of Hesse. In the wake of deregulation at the end of the 1990s, most of these regula-tions were withdrawn across Germany. Today, building regulations for hospi-tals are still in force at the state level in Brandenburg (BbgKPBauV), and build-ing and operating regulations for hospi-tals are in force in Saarland (KhauBauR). In fact, not all of the federal states ever issued such regulations. In Bavaria, for example, proof of compliance with fire protection standards in hospitals has al-ways been based on an individual inspec-tion and risk assessment of the facility in

As hospitals have changed, so too have the approaches to fire protection

Warning signal: A shrill electric horn alerts students in this lecture hall to a fire. The siren is automatically triggered by the alarm system.

Safety mechanism: In normal mode, fire doors are held open. As soon as smoke is detected, an electromagnetic system allows them to swing shut.

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Fire Protection     Focus

11Dräger review 102 | MAY 2011

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question, as Andreas Bell explains. Bell is the Planning Director at the Senior Planning Authority of the Bavarian State Ministry of the Interior and the leader of the “Fire Protection” project group at ARGEBAU. According to Walz, this model also applies to fire protection in the hos-pitals of Rhineland-Palatinate.

A system with  many elements

In Germany, it is now standard practice to draw up a fire protection concept for new and renovated hospital buildings. This concept must be not only tailored to the individual requirements of the hospi-tal but also systematically implemented and regularly updated in the course of general operation. This requirement has been formulated by Jörg Reintsema and Christoph Hartung in their standard work Brandschutz im Krankenhaus (Fire Protection in the Hospital). In everyday practice, this means that “safety levels must be maintained, and any vulnerabil-ities must be identified and eliminated,” explains Christoph Lammer, an engineer and Fire Protection Officer at the Univer-sity Hospital Aachen.

In order to describe how fire can be prevented or how the spread of a fire can be stopped rapidly, the fire protec-tion concept must take into account fac-tors such as the nature of the building, its infrastructure, and the type of care that is being provided. The aim is to come up with a system that combines preventive measures – which are based on the na-ture of the building, the equipment in-stalled in it, and various organizational

aspects – with active firefighting mea-sures on the part of fire crews.

All of these individual elements are linked. This means, for example, that the architectural requirements regard-ing fire protection may be less stringent for an area of the hospital that is fitted with fire detectors and sprinklers than for one that is equipped merely with smoke detectors.

The guidelines issued by the VdS also ease planning. In addition, there must be compliance with the occupational safety regulations issued by the Employ-ers Liability Insurance Association for Health and Welfare (BGW). “The ma-

jority of the current fire protection con-cepts for hospitals place the top prior-ity on patients remaining in the wards. This demands correspondingly high standards with regard to the building itself and the fire safety installations,” Lammer emphasizes.

What is the difference between the fire protection standards for industry and public buildings and the standards for hospitals? For a start, a hospital must have at least two fire compartments located on each level and be connected by fireproof escape routes. These com-partments are required in addition to vertical escape routes via stairwells. This

Training, instruction, and drillsthere’s a fire in the neonatal intensive care unit. with the fire service already on their way, the ward physician decides to evacuate the unit because there is so much smoke. within 20 minutes, six doctors and nurses have removed 30 premature babies and themselves out of harm’s way. this is an actual excercise that took place at the Uni- versity Hospital of Leipzig in november 2010. Similar exercises are held at many hospitals. “once a year we stage a command post exercise with the onsite emergency services, as well as joint training exercises with Lübeck’s municipal fire service,” says Sven Klempau, chief of the hospital fire service at the University Medical center Schleswig-Holstein. According to Britta naumann, head of Building infrastructure Administration at the University Hospital of Leipzig, complex training exercises have been part of the hospital’s fire protection concept for a number of years now: “these help us review and improve our emergency procedures and sensitize staff members to destruc-tive events.” one vital component was a workshop held to train the hospital’s opera-tional command in all of the necessary procedures for an evacuation. Such large-scale exercises serve to train staff members to carry out complex procedures, but it is also important to provide basic practical instruction for hospital employees. in parti- cular, this applies to firefighting equipment installed in the hospital, such as fire extin guishers and wall-mounted fire hydrants.

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12 Dräger review 102 | MAY 2011

> horizontal division into fire compart-ments is necessary because evacua tion of patients always commence horizontally.

Fire doors ensure that the fire com-partments remain free of smoke. In Germany it is also standard practice to equip all doors – except the doors lead-ing to stairwells – with a mechanism that holds them open. This mechanism often functions by means of electromagnetic fasteners fixed to the wall, which can be deactivated by a signal from a smoke detector. When heavy fire doors are au-tomatically closed by the fire-alarm system, although they are not in an area affected by smoke or fire, doors have to

be opened individually for each patient who is moved during an emergency evac-uation. However, if the fire doors are individually controlled by a smoke de-tector mounted on each door, it would make the evacuation of patients easier.

A sophisticated chain of alarm

Current fire protection standards re-quire the installation of fire detectors throughout the hospital. These are in-stalled in patient wards, corridors, and treatment rooms. The majority of fire detectors are of the optical type, though heat detectors are also used, as are flame

detectors that react to specific wave-lengths, and gas detectors that react to pyrolysis gas. “The important thing is to make sure that ventilation shafts and other out-of-sight areas are also equipped with smoke detectors,” says Hans-Gerorg Walz, referring to the new building for Conservative Medicine at the University Medical Center in Mainz. “Added to that, you need a fine-meshed system of main-tenance and monitoring procedures.”

In Cologne, the University Hospi-tal has a dense network of sensors that together form a sophisticated chain of alarm. As soon as one smoke detector is tripped, the hospital fire service is alarmed. If a second is also triggered, the city fire department is automatically no-tified. “That reduces the response time,” says Fire Chief Wilfried Breuer (see in-terview p. 19). At the same time, many of the departments of the University Hos-pital of Cologne are equipped through-out with sprinkler systems, which are ac-tivated by heat. “That means the safety standards are very high,” says Fire Chief Breuer. Not all German hospitals are fit-ted with sprinkler systems.

In the absence of fire prevention sys-tems and the related organizational mea-sures, the probability that an incipient fire will develop into a full blaze is about the same for a hospital as for an indus-trial building: Without sprinklers and similar systems, and without automatic alarming of the municipal fire depart-ment, the likelihood of a full-blown fire developing is approximately ten percent. Installation of a fire alarm system and a sprinkler system reduces this risk to one

How hospitals prepare for an emergency“Apart from fires, there are other critical situations that hospitals can train for by means of special exercises,” says Dr. Peter Schmiedtchen from Dräger. These include pandemics or incidents with a large number of casualties. in 2010, emergency medical services from the rhine-Main area conducted a joint training exercise together with local hospitals and fire crews to practice providing swift medical care to a substantial number of injured persons. evacuating a hospital because of fire poses a major challenge for fire services, rescue services, and other hospitals in the vicinity, as Professor Leo Latasch, Head of Frankfurt’s emergency Medical Services, explains. This is particularly the case when intensive-care patients have to be evacuated and transferred to other hospitals. The fire service is responsible for evacuating patients from the hospital building, after which they are handed over to emergency medical services for any further treatment and transfer to another hospital. During the major training exercise at Frankfurt Airport, a digital information system – developed as part of a research project on “rapid rescue for major incidents,” led by Professor Latasch – was tested for the first time. This is also designed to facilitate the evacuation of a hospital. each patient is assigned a digital record, which can be consulted and updated via a mobile device at any time. This makes it easier to organize the allocation of patients to other hospitals in the area and to keep up-to-date on the latest situation.

Fire detectors are virtually standard in hospitals, and sprinklers are starting to become common

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percent. If the facility in question has a fire alarm system plus its own onsite fire service, the level of risk falls even further, to between 0.1 and 0.01 percent. In addi-tion to a fire alarm system plus an onsite fire service, there is also a sprinkler sys-tem installed. With this scenario, the prob-ability that an incipient fire will develop into a full blaze is lower than 0.01 percent.

Organizational fire protection covers all the measures designed to ensure and facilitate correct behavior in the event of fire. This includes fire drills and train-ing for employees, proper installation and signage of fire extinguishers and fire hoses for use by trained personnel, and regular checks to ensure compliance with fire regulations.

The hospital’s fire protection officer has a very important role to play here. In-demnity insurers expressly recommend that hospitals should appoint someone to this post. Twice a year, VdS runs a special training program for fire protection of-ficers in hospitals. As the program orga-nizer Peter Gülden explains, the speakers are VdS experts and fire protection pro-fessionals from hospitals. Around 40 par-ticipants complete the training program each year, which demonstrates that there is a demand for people who are suitably qualified for this crucial job.

Drills are a critical part of  fire protection

“Ensuring fire protection in hospitals is first and foremost an organizational chal-lenge,” says Dr. Peter Schmiedtchen from Dräger. As he explains, when hospitals are drawing up emergency plans to take effect

Mapped out: A proper fire protection concept includes correct signage of   emergency exits and an evacuation plan indicating the shortest route to a safe area.

Firefighters only: In the event of a fire, the alarm system blocks all the elevators. Fire service elevators are specially marked and can only be operated via a master key.

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7:41 a.m.: Fire escape hoods inspection in a fire truck

8:19 a.m.: Sprinkler system inspection in the patient building

8:43 a.m.: Discussion of evacuation plans

9:52 a.m.: Fire protection instruction in a training area

1:14 p.m.: A callout in response to a signal from a fire detector

3:42 p.m.: Smoke ventilation system inspection

6:02 p.m.: Fire protection instruc-tion in the healthcare center

12:10 p.m.: Fire service control panel inspection

12:35 p.m.: Announcement of the arrival of a rescue helicopter

12:43 p.m.: CO2 fire extinguishing

system inspection

3:09 p.m.: Wall hydrant and hose inspection in the basement

3:16 p.m.: Fire protection instruction in the Ophthalmic Clinic

3:33 p.m.: A request via a dedicated telephone line

4:30 p.m.: A coffee break in the recreation room

4:55 p.m.: Monitoring in the patient building

5:13 p.m.: On the move with the equipment trolley

On duty around the clock: A visit to the hospital fire service At the University Hospital of Cologne, germany, the onsite fire service consisting of 25 full-time members takes care of fire safety 24 hours a day, 365 days a year. The pictures below document a typical day at work for the fire crew.

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in the event of a fire or another type of ma-jor incident, firefighters must be prepared to move over to a completely different mode of operation. In addition to implementing measures to fight the fire, it may also be necessary, in extreme cases, to evacuate patients, make arrangements for their transfer and alternative accommodation, take care of relatives and visitors, inform the media, coordinate the arrival of emer-gency services, and manage many other tasks. “That all goes far beyond the med-ical field,” emphasizes Schmiedtchen, who also teaches in the course “Safety and Hazard Defense” at the University of Magdeburg-Stendal and the Otto von Guericke University of Magdeburg.

“Fire drills and regular training for employees are all crucial elements of proper fire prevention,” he adds. And that applies in both theory and practice. At the University Hospital of Cologne, the hos-pital’s onsite fire service instructs hos-pital staff members, wherever possible at their own workplaces, on how to deal with specific risks. And at the University Medical Center in Mainz, employees are trained in how to use fire extinguishers and the hydrants with hose reels that are mounted on hospital walls. “This is oblig-atory for members of the nursing staff,” says Walz. It is optional for laboratory and administrative employees.

Details make all the difference

It is the little things that make all the dif-ference when it comes to fire protection. This can be explained in terms of a risk pyramid, which in the field of occupational

10:36 a.m.: Workshop inspection  of a dry-powder fire extinguisher

11:28 a.m.: under way  with the fire car

2:23 p.m.: servicing the foam  monitor at the helipad

2:25 p.m.: Drawing up a  new duty roster

4:17 p.m.: Breathing apparatus    inspection

4:23 p.m.: Refilling   breathing-air cylinder

7:07 p.m.: sport keeps firefighters fit and helps prevent back problems

8:19 p.m.: Making beds in  the fire crew’s ready room

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Instruction and fire drills: Training, both in theory and practice, is a crucial aspect of fire safety

safety, is known as Heinrich’s Law: Statis-tically speaking, 300 minor incidents of carelessness result in 29 accidents with no injuries or only minor ones, and in one accident involving a major injury. This cor-relation, which was first formulated by the U.S. occupational safety expert Herbert William Heinrich in 1931, is applied by Melanie Pippig in her 2005 paper Risiko-management im Krankenhaus (Risk Man-agement in the Hospital) in order to de-scribe the concept of patient safety, defined as the “absence of unwanted events.”

The basic principle at work here – that the probability of a major event happen-ing diminishes in line with the extent to which minor incidents of carelessness are avoided – can be applied to fire pro-tection. In this context, the systematic prevention of minor incidents of care-lessness translates into a significant re-duction of the risk of a serious fire. Typi-cal examples of such negligence include wedged-open fire doors, objects imped-ing escape routes, and prohibited smok-ing on the part of patients and visitors. Blocked fire doors, in particular, consti-tute a major risk. They enable not only the fire itself but also smoke and toxic fumes to spread to further parts of the building.

In many cases, it is merely a question of minutes whether or not a fire can be brought under control, or if flames and, above all, smoke are able to spread. The time that is gained by using an automatic fire alarm system as opposed to the tele-phone or a manual alarm button can sub-stantially reduce the impact of a fire. This short space of time can amount to the dif-ference between the initial breakout of

Medical gas lines and fire protectionThe fact that hospitals require a variety of gases poses a particular chal­lenge for fire protection. As with electrical power, the supply of such gases is crucial if essential units are to remain in operation.

“This means first and foremost the supply to intensive care units, oper­ating rooms, and any other areas requiring medical gases,” explains Michael Hass, a Fire Protection engineer for Pure gas Systems at Dräger. For this reason, it is not feasible to have the supply of such gases automatically cut off by the fire alarm system, as is generally the case with the gas supply to laboratories. in addition, there must also be a facility for the emergency feed of medical gases.

Medical gases are differentiated into oxidizing (e.g., oxygen and nitrous oxide) and inert (e.g., carbon dioxide); laboratory gases are categorized as oxidizing, flammable, and inert. The equipment rooms and gas stores in a hospital are designed as autonomous fire compartments with a fire re­sistance rating of 30 to 90 minutes (F30 to F90). The Dräger mounting sys­tem for the installation of gas pipelines provides a versatile basis for the correct transport and distribution of gases to their place of use according to fire protection regulations. This system is suitable for the installation of gas lines above either non­classified or classified suspended ceilings with an F30/60/90 fire resistance rating, for in­wall installation, and for a variety of other installation methods, including exposed installation.

Fireproof housings protect the area control units installed in the gas line against damage from fire. in the past, a fire barrier had to be specially constructed around the area control units, which resulted in extra costs. The fireproof coffer can be installed in lightweight or solid wall and ceiling components conforming to F30/60/90. The gas lines are fitted with integrated fireproof grommets. “it is vital to ensure that lines are properly fireproofed wherever they pass through walls,” says Michael Hass. in this case, such areas can be made safe with special fireproofing systems com­prising sleeves made of insulating materials. Openings in walls can also be made fireproof by the use of materials that foam in contact with fire and thus prevent the spread of flames and noxious fumes. Such materials are available in the form of fireproof matting or moldable fire­proof silicone.

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F ire Protection     Focus

flames after a match has made contact with bed sheets (approximately 2.5 min-utes) and the point at which the ceiling catches fire (approximately 8 minutes).

In order to reduce the time required to start fighting a fire, many hospitals now have their own fire services. This has the advantage of not only fast response but also extreme familiarity with the hospital environment. In the past, it was mainly psychiatric institutions located in the countryside that maintained their own fire services; in recent decades, how-ever, a number of large university hospi-tals in Germany– e.g., in Cologne, Mün-ster, Göttingen, and Lübeck – have set up their own fire crews.

In Cologne, for example, the fire ser-vice at the University Hospital has 25 full-time employees. They have designed two special containers to hold all the equip-ment they need to fight a fire. One is sta-tioned on the first floor and one on the top floor of the 22-story hospital building. “The containers are transported with the fire service elevator to the floor directly beneath the fire,” explains the Hospital Fire Chief. “That’s where we go to work putting out the fire.”

on the spot for fast help  in emergencies

Hospital fire services often develop un-conventional approaches to active fire safety. At the University Medical Center Schleswig-Holstein (UK S-H) in Lübeck, for example, the onsite fire crew has its operations room right at the heart of the central clinic building. This means that members of the fire service, many >

control panel: A console with a joystick is used to determine the length,  direction, and shape of a jet of foam mixed with water.

More than just froth: For the purposes of fire protection, the hospital helipad  is equipped with a number of remote-controlled foam monitors.

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No standard solution: Fire protection in hospitals is always tailored to individual requirements

of whom work in the same building, do not have far to go in the event of an emer-gency and can therefore go into action almost straightaway. “There would be lit-tle point in using a vehicle,” says Sven Kl-empau, an engineer at the Department of Health and Safety at Work at UK S-H. He is also the chief of the hospital fire ser-vice, which was set up in 1999. The mem-bers of the fire service come from areas such as fire prevention, patient transfer, and safety. The University Hospital of Mün-ster, meanwhile, has just completed a full reorganization of its fire service. In the past, the onsite fire crew was made up of a mix of full-time and part-time members. Now a team of 43 full-time employees is re-sponsible for ensuring fire protection at the hospital. As Josef Strotmeier, the chief of the fire crew, explains, the hospital fire service uses not only fire trucks but also equipment containers for fighting fires in patient buildings. In addition, there is video surveillance of the main network of escape routes.

In Germany, the University Hospital Aachen is known not only for being one of the largest hospital buildings in Eu-rope – with teaching, research, and pa-tient care all under one roof – but also for the unusual nature of its fire service. Completed in 1984, the building initially had an onsite fire service. “Since Sep-tember 2000, however, this service has been provided by Aachen’s municipal fire department,” explains Christoph Lammer, the hospital’s fire safety offi-cer. A rolling team of six firefighters is on duty around the clock, joined by a an additional six during the day shift. Until

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Emergency colors: The button for activating the smoke ventilation system is right next to the customary pushbutton fire alarm (red).

Rain on demand: The spray nozzle of a sprinkler, which is activated as soon as the room temperature reaches a critical level.

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 “In an emergency, the fire service  will be there in two minutes”WIlFrIed Breuer , born in 1952, is the chief of the fire service at the University Hospital of cologne. together with a crew of 25 full-time firefighters, he is responsible for ensuring fire protection at the hospital.

Mr. Breuer, when did you join the hospital fire service  here in cologne?i’ve been here since the service was founded in 1985, and i was one of the people who helped set it up. i’ve been a fireman since i was 17 – first of all in the voluntary fire service in erftstadt-Lechenich, which i joined in 1969. i then became a full-time fireman in 1970 and initially worked with the fire and rescue service. At the same time, i was doing one training course after another. Around 1980, the university hospitals in cologne, Aachen, and Münster were told that they had to set up their own fire services. i applied for the cologne service, was appointed as deputy chief in 1985, and became chief in 2002, after my predecessor went into retirement. What does it mean to be a part of this  highly exceptional fire service?Being part of a university hospital certainly leaves its mark on the job. that begins with the contact to hospital staff members, patients, and visitors. People from outside are often surprised that the hospital has its own fire service. And in the hospital, we lend a hand wherever we can. our motto is: You want it, we’ve got it! Is there any one incident that you often think about?Yes, the evacuations in the middle of the past decade, for example when bombs from world war ii were discovered during construction work for the new cardiac center. these were huge operations, with lots of organiza-tion involved. But everything worked out fine.What’s the biggest firefighting operation  that you have ever been involved in?there have been several exceptional operations, but all the fires remained small. that’s thanks to our own equipment and to our fast response times due to the service being on the hospital site.What do the other people in the hospital think of the fire service? the hospital staff members know for a fact that in an emergency the fire service will be there in two minutes. in the early days there may well have been a little skepticism about the idea of setting up an onsite fire crew at the hospital. But today people are proud of us.

recently, rolling containers were used to store the equipment required for fire-fighting operations inside the building, as these fit inside the fire-service eleva-tors. In the wards of the newly renovated patient building, however, there are spe-cial depots for storing equipment for fire-fighting and patient evacuation.

“Even very simple techniques for evacuating patients can be highly effec-tive,” says Rüdiger Weich, Customer Pro-cess Monitoring Manager at Dräger. As he explains, this applies to beds equipped with special rescue mattresses or rescue sheets, by means of which patients, while still lying in bed, can be evacuated by a single person and brought to safety on an-other level via the stairwell.

Construction work is a common cause of fires. For this reason, measures to en-sure fire protection during such work, par-ticularly when it involves the use of heat, are a major priority in any hospital fire protection concept. “For a hospital fire service, ensuring proper fire protection and coordinating both fire prevention and active firefighting measures is a major challenge, given the fact that there is al-ways some kind of construction work tak-ing place,” says Christoph Lammer from University Hospital Aachen. Yet it is a chal-lenge that has to be mastered, for the sim-ple reason that fire protection is at its most successful when it prevents the outbreak of fires altogether. Peter Thomas

42 years of experience: senior Fire officer Wilfried Breuer.

Further information online, including: Fire protection in UK and U.S.

hospitals. www.draeger.com/102/fireprotection

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Hard Exterior, Smart Interior a fire helmet is an essential part of the personal protective equipment worn by firefighters and other emergency workers. it protects the wearer against a variety of dangers, including mechanical impacts, extreme heat, and exposure to flames. REgulaR qualIty tEStS carried out at the Chomutov plant in the Czech republic help ensure that dräger helmets consistently meet the exacting standards required.

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HELMET PRODUCTION     PERSONAL PROTECTION

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Released from a height of 2.5 me-ters, the rounded metal weight of five kilograms lands with an im-

pressively solid thud on the outer shell of a firefighters’ helmet. As a photograph of the moment of impact will later reveal, the hard exterior of the helmet flexes un-der the blow and disperses the force of impact laterally, while a special damp-ing system inside the helmet further ab-sorbs the energy.

In the lab, Kristyna Pösingerova is satisfied with the force curve displayed on her monitor screen: the Dräger HPS 6200, fresh off the production line that very morning, has passed the impact absorption test with flying colors. Pös-ingerova, a 32-year-old Quality Control Officer at Dräger Busch Helmets Pro-duction s.r.o. in Chomutov, Czech Re-public, is responsible for conducting running tests on the firefighters’ hel-mets manufactured here. In addition to undergoing this impact absorption test, the protective headwear for fire crews and emergency workers has to endure a series of further trials. Hav-ing been placed under an electric ele-ment and exposed to a specific amount of thermal radiation, the helmet is then subjected to another impact test – once again from a height of 2.5 meters, but this time with a wedge-shaped steel ob-ject weighing one kilogram. The sharp edge leaves a visible indentation in the outer shell, which is made of a duro-plastic material reinforced by aramid fibers, but fails to perforate the hel-met – and that’s exactly what the test is intended to demonstrate. >

Before and after: The rim of the 

helmet is milled smooth.

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A complete test cycle takes almost two hours. The program encompasses a ther-mal radiation test, an impact absorption test, an impact penetration test, a projec-tile test, a lateral stability test, and a test to check that the chinstrap opens auto-matically when excessive tensile force is applied. After such an ordeal, the helmet bears a range of scars on its outer shell, not to mention blistered paint and a se-ries of concentric rings around the im-pact point from the five-kilogram steel weight. A look at such damage suffices to explain why helmets need to be replaced after being subjected to such stresses.

Made in the Czech Republic

Firefighters from around the world place their faith in helmets from Chomutov. The Dräger-Busch manufacturing oper-ation – a joint venture in which Dräger holds a majority interest – has been pro-ducing firefighters’ helmets here since 2009, with Dräger solely responsible for the development and marketing aspects of the business. Thousands of firefighters’ helmets leave the factory each year, most of them destined for the European market. “But we’ve also supplied customers as far away as Ghana, Canada, and Singapore,” says Makus Lamm, Portfolio Manager for Head Protection Systems at Dräger.

“Our tests document that we, as a manufacturer, always meet the strict criteria specified in the relevant stan-dard,” explains Werner Jumpertz, Man-aging Director of the Czech plant. A me-chanical engineer by training, Jumpertz is Head of Globalization and Projects at Dräger. Before a firefighters’ helmet can

even be marketed in Europe, the prod-uct must already have Personal Protec-tive Equipment (PPE) approval and the manufacturing process must be certified according to ISO 9001. Although they are rigorous in their own right, the tests rou-tinely carried out in the plant’s own lab should therefore, as Jumpertz explains, not be confused with those that a hel-met must undergo in order to gain PPE approval.

The latter are conducted by the certi-fication company Dekra Exam in Essen. New firefighters’ helmets seeking ap-proval according to the EN 443:2008 stan-dard must undergo a flame engulfment test, for example. This involves heating the helmet at a temperature of 90 °Cel-sius for 15 minutes and then fully engulf-ing it in flames at a temperature of 950 °C for a period of ten seconds. This rep-licates the conditions in a so-called flash-over. To pass this test, the plastics in the helmet must neither melt, burn, nor smolder for longer than five seconds.

German accident prevention regula-tions for fire services (GUV-V C53) stipu-late – in line with EN 443:2008 – the use of fire helmets with a neck curtain. EN 443:2008 is the current European stan-dard for “helmets for firefighting in build-ings and other structures.” It was intro-duced three years ago to replace the previous version, which dated from 1997. Before then, firefighters’ helmets in Ger-many had to conform to the DIN 14940 standard. The requirements implemented in the 2008 amendment of EN 443 were substantially more rigorous than those mandated in earlier regulations.

Smart headgear: ever greater functionality through the use of high-tech materials

Keeping cool: The outer shell is tested for its resistance to thermal radiation.

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Quality con-trol: Kristyna Pösingerova

heads testing.

Before a new helmet is approved, tests have to be carried out on all the mate-rials. This applies not only to all of the components of the shell but also to any attachments and paints. The approval can be subsequently amended to allow for different colors or new and modified attachments or accessories. In particu-lar, requests for different color schemes are regularly received. In fact, the range of approved paints is much more varied than might be expected. In Germany, for example, fire helmets are painted a lu-minous white color that has a yellowish-green hue by daylight, but the company also supplies helmets in pure white, yel-low, red, black, and blue, and has even had requests for silver and gold. One rea-son for such variety is that Dräger sup-plies not only state fire departments in Germany and abroad but also company fire services and emergency organiza-tions. Last year, for example, the Ger-man Federal Agency for Technical Re-lief placed an order for several thousand helmets.

A story of increasing safety

The imposition of stricter requirements with regard to helmets and other PPE items is also a reflection of the changed nature of firefighting. Helmets must now have a much higher resistance to heat, particularly for firefighting oper-ations inside buildings. This evolution can also be traced in the history of the materials used over the years. The ear-liest headgear for firefighters was made of felt, oilcloth, or leather, and the first proper helmets of brass or iron plate.

Point-blank: Test weight with a sharp wedge. The screen shows the resulting force curve.

Hard shell: The helmet is subjected to a penetration test with a metal wedge.

Drop test: Five kilograms fall from 2.5 meters onto the helmet. >

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PERSONAL PROTECTION HeLMeT PrODUCTiON

These were followed by fire helmets of steel sheet and, later, aluminum. It was not until the second half of the 20th cen-tury, however, that thermosetting plas-tics were used.

Such helmets were initially made of a phenolic resin mixed with cotton or wool fibers. Today, however, glass fiber reinforced plastic (GRP) is the mate-rial of choice. This is because the latter has a substantially higher resistance to thermal radiation and flames than is the case for fiber-phenolic resin plastics. In real fires inside buildings and also train-ing drills in fire containers, such mate-rials were badly damaged even by a rela-tively short exposure to flames and high temperatures.

Temperature plus high pressure

In the lab in Chomutov, the test helmet is now being examined for lateral sta-bility. With each turn of the hand-oper-ated wheel, the pressure increases on the outer shell of the HPS 6200. This proce-dure is designed to test the rigidity of the glass fiber-reinforced plastic, which at Dräger is made of sheet molding com-pound (SMC). SMC is a synthetic resin mixed with glass fibers which is deliv-ered as a compound, ready for use, be-tween two protective films. Workers in the plant first cut the sheets to size and then work a piece of aramid webbing into the area that will later form the crown of the helmet. This blank is formed into a conical shape and placed in the mold-ing press, where the resulting shell is left to harden for a time at a temperature of more than 100 °C and several hundred

Molded, milled, and assembled by hand: from GRP blank to professional Head Protection System

>

The outer shell of the helmet is molded from glass fiber reinforced plastic. A CNC machine then drills fixation points for attachments.

Employees fit the lining of the helmet by hand. A label applied to the back of the helmet documents its history.

tons of pressure. A light is then shined through the hardened shell to see if the aramid webbing is in the right place and to check for any defects in the composi-tion of the GRP. The next stop is the mill-ing machine, where the rim of the hel-met is made smooth and fixation points

are drilled for attachments and acces-sories. The helmet is then polished and cleaned before heading off to the paint shop via a dust lock. Robots paint the helmets with the desired colors inside and out. Once dry, the helmets are fitted with a lining and a visor made of polysul-

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fone before having lettering or images ap-plied by means of a pad printing process. It is particularly important at this stage to ensure that the impact absorption el-ements are properly fitted between the outer shell of the helmet and the place where the head will sit. These are respon-sible for dispersing kinetic energy when the helmet is struck by an object. The impact absorption elements for both the HPS 4300 and the HPS 6200 helmets are manufactured in the Chomutov plant – a process that involves coating a flexible framework of tubes and bands in poly-urethane foam. This forms the smart in-terior of a hard exterior and ensures a predefined compression whenever the helmet receives a blow.

Into the archive

Once a helmet has passed through all the production steps and quality checks, it is labeled, placed in a bag made of foam wrap, and packed in a box. But a prede-termined number of helmets do not get this far. These are the ones Kristyna Pös-ingerova removes from the end of the production line for testing in the lab lo-cated above the production floor.

After a helmet has successfully com-pleted all the tests, it ends up on the shelves of the laboratory archive, along-side all the other test helmets from the previous months. Each one of them has come though with flying colors and is therefore a testament to the care and ex-actitude with which the employees at the Chomutov plant work to ensure the safety of firefighters in many different coun-tries around the world. Peter Thomas

Right out of nowhereit was on October 23, 2010 that Belgian volunteer firefighter gert Nijs was hit on the head by a lump hammer falling from a height of 30 meters. The 1.5-kilogram projectile first struck the outer shell of his fire helmet before ricocheting off his right arm and falling to the ground.

yet what exactly had happened? The grobbendonk Fire Service, where Nijs had been serving as a volunteer since 1996, had been called out to deal with a fire in a grain silo. in order to tackle the blaze from within the tower, the fire crew decided to make an opening at the top of the 30-meter-high silo. with this in mind, they requested a hammer. The hammer was therefore attached to a noose tied at the end of a rope, so that it could be raised to the firefighters above. what they had failed to take into account, however, was the strength of the wind. as the hammer was nearing the top of the silo, a powerful gust made the rope swing so violently that the hammer fell out of its sling and plummeted headfirst back to earth.

at that precise moment, Nijs happened to be bending over to pick something up. The next thing he knew, he had been dealt a huge blow right out of nowhere. “at the time, what i could feel most of all was the pain in my arm,” he recalls. although he had certainly registered an impact to the side of his head, he initially thought nothing of it. By contrast, the pain of the blow to his right arm, which was not yet fully healed from a previous accident, was sharp and enduring. “My legs were shaking from the shock, although at that point i didn’t even realize just how heavily the hammer had hit my helmet, and just how lucky i had been!” he explains.

He withdrew from the operation, and colleagues drove him back to the fire station so that a doctor could take a look at his arm. it was only while Nijs was waiting for the medic to arrive that he took a closer look at his helmet and saw that the outer shell had been ripped open by the force of the blow. “it was then that i realized just how lucky i was to have been wearing a helmet,” he says. when the doctor examined him, the only thing he could find wrong was slight bruising. in fact, the helmet had absorbed so much of the impact that the only treatment required was an ice pack applied to the right arm. The doctor was astounded to discover that the fire helmet had protected Nijs from any head injuries whatsoever, despite the huge forces to which it had been subjected.

Nijs sent the helmet – which had more than likely saved his life – to Dräger Belgium. Since then, the HPS 6200 has been returned to the fire station, where it now occupies a place of honor – in memory of what could have been a very serious accident, and as a reminder of how important it is for firefighters to wear their helmets at all times when they are on duty.Do you have a similar story? If so, write to us: [email protected]

Gert Nijs with the hammer that hit him from a height of 30 meters. Luckily, he was wearing a sturdy helmet.

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One Tough TugThe NOrdic is helping vessels in distress since January 2011. with its 23,000 horsepower, the tug is the most powerful, most advanced emergency towing vessel (eTv) in the world. and it’s the only one that has been approved for deployment where toxic or explosive materials have been released.

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27DrägEr rEviEw 102 | MAy 2011

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on the ropes. But Tobias Pietsch, 30, is in his element. In the frigid temperatures, the captain of the ETV Nordic is inspect-ing the deck in his T-shirt at the end of last year. Not a big deal for him, he has to be right back in the engine room any-way. And there, between two gas-protected MTU engines rated at 11,500 horsepower each, the temperatures are tropical. From the outside at least, the only thing that dis-tinguishes the 78-meter-long Nordic from other tugboats is its size. Only when tour-ing the belly of the vessel does it become clear that it’s a world first. Dräger devel-oped technical equipment that makes it a unique tug. An airtight protective citadel allows the crew to work in a self-contained area under hazardous atmospheric con-ditions, such as when a damaged ship is burning and toxic gases are released.

Fortunately, though, the passageways still smell of nothing more than fresh paint and diesel. Suddenly an alarm sounds, and Pietsch hurries down the narrow stairs from the bridge, passes the crew’s mess room, and goes to the primary airlock onto the main deck. The practice alarm is keeping the crew on the move today; it’s all part of a simulated emergency in which the ship en-ters a cloud of toxic fumes. “One of the quar-antine areas, which holds protective suits we need for working outside the citadels, is located at the exit of the living quarters,” says Pietsch, a native of the eastern West-phalia region. In passing, the captain points to two huge drums in the winch room. Wrapped around the winches are steel ca-

bles 1.2 kilometers long and as thick as a man’s leg. By now it’s becoming clear why the ship is unlike any other vessel to Cap-tain Pietsch. This system has a bollard pull of approximately 200 tons. “That’s enough power to hold even a supertanker in a storm and prevent it from stranding on our coast,” says Pietsch. The Nordic was designed for just this sort of maritime disaster; its mis-sion, chartered by the German government, is to keep the waters of the North Sea safe.

New safety concept

The vessel was built by the Arbeitsgemein-schaft (ARGE) Coastal Protection, a group comprising the towing and salvage com-panies Bugsier, Fairplay Towage, URAG Unterweser Reederei, and Wiking Helikop-ter Service GmbH. With the safety package it offered, the consortium won the contract in a Europe-wide call for tenders. For the next ten years, the German Federal Min-istry of Transport, Building, and Urban Development has chartered the Nordic.

With 23,000 horsepower at his command: Captain Tobias Pietsch on the bridge of the Nordic.

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The vessel has ten years of planning, two years of construction, and two months of testing behind it. Since January 2011 the new special-purpose tug has been patrolling in gale-force winds (strength 8 and upward on the Beaufort scale) close to the shipping fairways off the East Frisian coast near the island of Norderney. It was a maritime ac-cident that first compelled the German gov-ernment to launch the “Maritime Emer-gency Preparedness” project. The case of the freighter Pallas, which ran aground in October 1998, was the basis for a report by an independent commission of experts in February 2000, and their findings in turn marked the conception of Nordic. Pallas ran aground off the island of Amrum, and the 90 tons of oil that spilled in the process polluted a nearby bird sanctuary. As a re-sult of this and other damage, the new safety system stipulates that ETVs must be ready for deployment at any time. The “seagoing fire brigade” that was created comprises 16 men who live and work on the Nordic. If a damaged ship is drifting toward the German coast, the emergency towing ves-sel can reach it within two hours to keep it from running aground. To guarantee this safety, all the men on board stay at sea for 28 days, waiting for emergency calls or ac-companying large tankers through the dan-gerous coastal waters. Afterward, they head to Cuxhaven, where a fresh crew takes over.

Versatility is the trump card

The great versatility of the Nordic is what makes it especially useful for emergency deployments. Commenting on the struc-tural profile, Chief Engineer Robert Nüss says: “We had to find a good compromise

because we needed to reconcile many re-quirements.” On the one hand, the tug-boat has to be prepared for storms on the open seas. But its draft can’t exceed six me-ters, in order to operate in the North Sea’s shallow tidal waters. And when it comes to speed, the brawny propulsion system can move the Nordic at 20 knots, about 37 ki-lometers per hour, a brisk pace for quickly reaching damaged ships. “The bow is de-signed to ensure that waves aren’t cut in a way that sends a deluge of water surging up to the bridge windows when the ship is moving at full speed in a storm,” says Nüss.

The most important thing, however, is that the Nordic is the first emergency tow-ing vessel in the world that can operate in a hazardous atmosphere independent of the outside environment, taking the air from a reservoir – a situation where other tugs would have to abort their missions right away. Given the increasing prevalence of hazardous materials in the cargo holds of ships, such as toxic or explosive substances, the demands being placed on tugboats are increasing all the time. “In close coopera-tion with Dräger, the engineers came up with a design which ensures that the tug is supplied with safe air in self-contained ar-eas that are shut off from the atmospheric conditions outside,” says Captain Pietsch. And when it’s time for the team on board to rotate ashore, a second crew with Captain Hildebrandt also stands ready in Cuxhaven.

In the event of a deployment, airlocks on the main deck and the “A” deck can be used to exit the citadel, which is in turn di-vided into two areas with different air pres-sures: area A, which is permanently used by the crew, and area B, where crew mem-

bers don’t generally stay. During a mission, an overpressure is maintained throughout the whole ship. The supply of clean air for the overpressure areas makes it possible for the ship to operate for at least eight hours in this mode, and this can be extended when necessary with the purge air reserves. It’s an unprecedented innovation – the 40-year-old predecessor salvage tug Oceanic had no protection against toxic gases. Jens Münzer, First Mate on board, explains the effect of Nordic’s high-tech equipment: “The crew can seal itself off completely from the out-side world and start to rescue and stabilize a damaged ship.” This is an advantage that can prevent disaster during an emergency.

Red alert

When designing the protected area, how-ever, the engineers faced formidable chal-lenges. The measures that are relied on to guarantee the protected space are unlike the NBC protection used in the military: With NBC, toxic substances can’t be kept out by means of appropriate filters. If a ship is damaged, there may be a mixture of toxic or combustible products against which the usual NBC filters with activated charcoal can’t provide full protection. There’s sim-ply too much that remains unknown about the conditions in which a crew will have to be deployed. That’s why there had to be an onboard supply of clean air independent from the external atmosphere.

Since crew members need to enter and leave the locked-down citadel during an emergency towing mission, and the gas locks required for this have to be purged with clean air, the new ETV is equipped with a large supply of safe air. It carries nine

Nordic is the world’s first rescue tug designed to operate in hazardous conditions

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AT SEA     GAS PROTECTION

29DrägEr rEviEw 102 | MAy 2011

Changing room 211 (photo at left) holds not just alkaline and acidic cleaning liquids but also supply units that provide men with  breathable air at the outlets inside and in front of the airlock (right).

The crew member is dwarfed by the equipment: The winch room holds coils of cable as thick as a man’s leg, 1,200 meters in length.  They are strong enough to hold even a tanker during a storm; the entire system has a maximum bollard pull of 200 tons.

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30 Dräger review 102 | May 2011

Air-curtain units are used to reduce the influx of contaminants

Preparation and egress: Above, men equipped with compressed- air respirators are getting into their chemical protective suits. Below, they step onto the deck, looking like creatures from another planet. They are entering dangerous realms.

Stationary gas detectors continually provide information concerning the composition and concentration of gases. By providing up-to- date and reliable data at all times, they ensure maximum safety on board the vessel.

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31DrägEr rEviEw 102 | MAy 2011

clear-air modules, each consisting of 12 50-liter bottles of compressed air. If a towing connection is needed while the tugboat is locked down for protection against hazard-ous gases, three crew members leave the citadel and enter a changing room where there is an overpressure. Two crew mem-bers stand by for them as a rescue team. Only after the first three crewmen have put on their Dräger Chemical Protective Suits (CPS) 7900 chemical protective suits do they leave the changing room and enter the winch-house on deck.

Air-curtain units are installed at the en-trances to the gas lock and winch-house to reduce any flow of contaminants into areas beyond them. Such air-curtain units are often found on land in department stores, where they act as barriers to cold air dur-ing the winter months. Dräger uses them in tunnel rescue trains to keep contami-nants away from firefighting and rescue teams, and to allow the teams to get to work without the protracted efforts of moving through airlocks. A fan on one side blows the ambient air past the door opening and into an intake vent on the opposite side, where it is guided back to the fan in a cy-cle. And the air is circulated back to the fan through a ventilation duct located above the entrance door. “Thanks to the experi-ence Dräger has gained with rescue trains, we know that air-curtain units minimize the influx of contaminants over a period of hours,” says Chief Engineer Nüss.

Cleverly devised system

A very clever strategy has also been devised for decontaminating the crew after a mis-sion. In the winch-house there are several

shower stations right next to the gas-lock en-trance. Contaminated personnel clean their CPS first and then enter the gas lock, where they undergo another cleaning process. To this end, multiple high-pressure nozzles have been installed in the ceiling and walls. These remove contaminants from the CPS and use the atomized spray to “scrub” gas-eous pollutants out of the gas-lock air. After this in-depth decontamination, the gas lock is finally purged with clean air in order to flush out any leftover contaminants. Only than does the crew reach the door to the changing room. If crew members haven’t been sufficiently decontaminated they re-main in quarantine with their CPS on in the changing room and disembark at the nearest port for decontamination.

Another gas lock on the A deck serves as an entrance to the treatment room, which is outside of the citadel and functions as an additional quarantine area. Captain Pietsch appreciates the very high safety standards. “If someone is injured, the rescue team can bring him through that airlock on a stretcher and into the treatment room,” he says. With the supply of air that’s carried in-side the CPS, crewmen can breathe in it for a maximum of 30 minutes. In order to stay longer, they can draw breathable air from several connections, e.g. in the changing room, in the treatment room, inside and in front of the gas locks, in the winch room, and behind and inside the deckhouse. These connections are linked to an onboard supply of clean air. The PAS ASV switch unit devel-oped by Dräger automatically switches be-tween external air supply and compressed-air respirator when necessary. This makes it possible to maximize the period in which

> breathable air is available when crewmen are putting on or taking off the CPS, enter-ing or exiting airlocks, or undergoing decon-tamination. This control unit has the major advantage of being almost completely me-chanical in design; it operates with prac-tically no electric or electronic compo-nents. “That means the supply of clean air is secure even if the ship’s electrical system fails,” says Pietsch. During a deployment, crew members in a CPS also wear a com-fort vest developed by Dräger. This vest low-ers the body temperature by between three to four degrees Celsius. When the surface temperature is 28 °C and higher, the chem-ical components integrated into the vest re-duce the wearer’s raised body temperature.

Safe job 

The supply of clean air aboard the tug is refilled by air compressors for breath-ing devices. This happens outside of the contaminated area of deployment, which the emergency towing vessel must leave. “When we’re closed down and breathing from our own air reservoir, we’re always kept informed about how much time we have left,” says Pietsch. A “countdown” clock on the bridge indicates the remain-ing time. This differs from a system that supplies safe air by pumping in filtered air from outside, in which case the air be-comes unsafe when the filter becomes sat-urated, with no prior warning. But Cap-tain Tobias Pietsch sees his new job as a challenge. As a man who once signed on to serve on a cruise ship, he loves variety. “It’s good to try out different things. And you would probably have a hard time find-ing a safer workplace.” Thomas Soltau

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Witness to Drug AbuseA small drop of saliva is all the Dräger DrugTesT 5000 needs to conduct a rapid check to detect whether a person is under the influence of specific illegal substances. the system exploits the fact that saliva reflects the concentration of drugs in the blood – except cannabis, for which an extra step is required.

A driver is behaving suspiciously. Is he or she under the influence of illegal drugs? This is a question

that is increasingly being confronted by traffic police. The latest data from traf-fic controls indicate that more and more people are driving under the influence of drugs. “It’s a major hazard to road us-ers and the public at large. Drugs seri-ously impair both physical and mental fitness to drive. It’s not a trivial matter by any means,” warns Dr. Stefan Tönnes, Head of Forensic Toxicology at the Uni-versity of Frankfurt’s Institute of Foren-sic Medicine.

High acceptance

In Germany, road users under the in-fluence of drugs are most likely to have consumed cannabis, whose active agent is tetrahydrocannabinol (THC), though other substances such as opiates (her-oin), cocaine, amphetamine, metham-phetamine, and related designer drugs have also been detected in drivers. It is important for police to be able to deter-mine rapidly and reliably whether a per-son is under the influence of an illegal substance. All they now require is a drop of saliva – or, to be precise, 0.28 millili-ters if the analysis is conducted with the rapid test kit developed by Dräger.

“Provided the sample is fresh, that’s all the saliva you need to be able to tell within a couple of minutes whether a person is under the influence of one or more of the illegal drugs in common use,” explains Dr. Stefan Steinmeyer, whose responsibilities include Business Development at Dräger’s Drug Detec- St-

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Saliva     DRUG TESTING

33Dräger review 102 | May 2011

tion unit. In addition to the substances listed above, the test strips also react to benzodiazepines. Dräger has also devel-oped a version that reacts to methadone instead of methamphetamine. This is for use with participants of methadone sub-stitution programs, where tests are con-ducted to check for the concomitant use of illegal drugs.

The Dräger test kit has a crucial ad-vantage compared to the urine-based test procedures commonly in use: In terms of taking and analyzing the sam-ple, saliva is much easier to handle for all concerned. This is true of both traf-fic controls and tests for the treatment of addiction. According to Dr. Andreas Ewald, Head of Toxicology at the Uni-versity of Saarland’s Institute of Forensic Medicine in Homburg, saliva-based tests therefore enjoy a much higher accep-tance among both the police and those being tested. “The saliva test, which is preliminary and voluntary, involves a

much smaller invasion of privacy than a urine sample,” says Ewald, drawing on the experience he has gained while ac-companying the Saarland police on traf-fic controls since October 2009. Further-more, as he explains, a saliva sample can be produced more quickly than a urine sample. And because it’s a noninvasive procedure, the test can be performed at the roadside, unlike a blood test.

Saliva is not the same as spittle

For a sample to be reliable, the saliva must be as freshly secreted as possible. “Saliva is not the same thing as the fluid in the mouth,” explains Ewald, the fo-rensic toxicologist and pharmaceutical analyst. “That also contains the remains of food and drink, as well as oral flora.” The best way to obtain a high-quality sample is therefore to swab the inside of the oral cavity. For this purpose, the Dräger DrugTest 5000 uses an oral fluid collector made of a rigid, porous mate-

rial that can absorb a precisely defined amount of saliva. The test subject places this inside his or her own mouth and wipes it back and forth on the mucous membrane of the oral cavity, thus ensur-ing that the sample is taken close to the glands where it is secreted. An indicator turns blue when a sufficient amount has been collected.

But how do drugs find their way into saliva in the first place? The mouth of a grown person produces as much as 1.5 liters of this watery fluid every day. Saliva is secreted by the submandibu-lar gland, the parotid gland, and the sublingual gland as well as a series of smaller salivary glands. The subman-dibular gland is responsible for around 65 percent of saliva production, the pa-rotid gland for around 23 percent, and the sublingual gland for around four per-cent. The remaining eight percent or so is secreted by some 750 small salivary glands located in the membranes lining

To test for drugs, the oral fluid collector is slotted into the Dräger DrugTest 5000. The analysis is conducted under   controlled conditions and evaluated using an optoelectronic system.

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the oral cavity and the pharynx. From a toxicological point of view, the crucial fact about saliva is that it is derived from the blood – 99 percent of it consists of wa-ter that has entered the salivary glands via the blood vessels. This water also con-tains a variety of dissolved substances, possibly including the active agents of drugs and their decomposition products, which therefore enter the saliva and, by this means, the oral cavity and pharynx.

Saliva, blood, urine

Compared to the urine test normally used in such situations, the saliva test is therefore substantially different not only because it is easier to use but also, and most importantly, because of what it ac-tually reveals.

A urine test can detect drugs for a relatively long period after consump-tion – primarily because of the high con-centration of decomposition products of the active agents in the sample. How-

ever, if there is a need to show recent consumption and the direct influence of illegal substances, a saliva test is more suitable. This is because it provides infor-mation about the concentration of the active agent in the blood.

Is it therefore possible to search di-rectly for the active agents of drugs in saliva? That’s not quite so simple. “The body processes different drugs in differ-ent ways,” explains Tönnes. “In the case of some illegal substances, the test there-fore has to be able to detect not only the active agent but also its decomposition products.” The test for cocaine reveals both traces of the drug itself and its de-composition products, whereas heroin is practically always detected only on the basis of its decomposition products. This is because the diacetylmorphine in her-oin is metabolized, first to 6-monoacetyl-morphine and then to morphine, within a few minutes of consumption.

By analyzing saliva, however, it is pos-sible to infer that such processes have oc-curred in the blood. This is because of the so-called concentration gradient that exists between blood and saliva when the one contains a greater concentration of a dissolved substance than the other. The result is that the solute migrates down the gradient toward the solvent with the lower concentration. In other words, if the active agent of an illegal substance or one of its decomposition products is present in the blood, this will result in a corresponding concentration in the sa-liva, even if there is no absolute correla-tion between the two values. “If a rapid test is what you want, saliva is indeed the

closest medium to blood,” says Ewald. Also important is the fact that a saliva test can provide evidence of drug con-sumption even if the drug has not been taken orally.

The challenge of THC

Intravenous injection, smoking, snort-ing, and swallowing are the most com-mon methods of taking illegal drugs. Drugs injected intravenously enter the bloodstream directly. In the case of smoking, tiny particles of the active substance are absorbed via the lungs, whereas with snorting or swallowing the drug passes into the body via the mu-cous membranes in the nasal cavity and via the stomach and small intestine, re-spectively. The method of consumption determines how much of the drug actu-ally enters the bloodstream and thereby acts upon the central nervous systems. When drugs are swallowed, for example, the liver already breaks down a portion of the active agent when is it absorbed via the digestive tract.

Yet there is one exception to the rule that saliva always provides an indication of the concentration of an illegal drug in the bloodstream. In the case of THC – i.e. the active agent of the illegal drug most frequently consumed by drivers – only ex-tremely small amounts are transported from the bloodstream to the saliva.

Here, however, development engi-neers at Dräger were able to exploit the fact that when cannabis is consumed, traces of the lipophilic THC molecules are detectable in the mucous mem-branes of the oral cavity and the pharynx

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SALIVA DRUG TESTING

35DRÄGER REVIEW 102 | MAY 2011

A unique match: The lock-and-key model describes the bond between an antibody and a specific antigen.

Using antibodies to detect drugsA rapid test for drugs needs to deliver quick and precise results on the basis of a small sample. A procedure known as immunoassay is used to detect the active substance of a drug and its decomposition products. This method identifies the presence of a substance on the basis of antibodies specific to that substance. These antibodies are proteins that are responsible in the immune system of vertebrates for defense reactions against pathogens, as a rule. What distinguishes them is that they are highly selective and only bind to the molecules of a certain substance, which is then termed the antigen of that antibody.

The reactions between antibodies and antigens have been used for diagnostic purposes and other tests for around 50 years now. The standard method here is known as solid-phase immunoassay, in which the antibo-dies are bound to a solid surface. This surface is then exposed to the sample in order to test for the presence of the specific antigen (also termed the analyte or target substance). The reaction between an antibody and its target substance is also the basis of the signal that is evaluated by the analysis.

The Dräger DrugTest 5000 uses immunoassays according to the principle of competition. Molecules of the substance to be identified by the test are fixed to the membrane of the test strip. In the analysis, the sample is brought into contact with antibodies and then run across the membrane. If the target substance is not present in the sample, the color-marked anti-bodies bind to the molecules attached to the membrane. This reaction can be detected and evaluated optoelectronically using light sensors.

If, on the other hand, the sample does contain the target substance, antibodies bind immediately to the latter, and the reaction in the test zone on the membrane either does not occur or is correspondingly weaker. In other words, a strong signal (powerful reaction) indicates that the test is negative. In the case of the Dräger DrugTest 5000, the detection sensitivity of this method is a few nanograms of analyte per milliliter of saliva.

for the same length of time as the drug remains active in the body. “The corre-lation is tenable, even though the cur-rent state of research indicates that it’s fortuitous,” says Tönnes. Studies have demonstrated a correspondence of 85 to 90 percent between the results of sa-liva tests with the Dräger DrugTest 5000 and blood tests for THC.

Rapid results

Both the test cassette containing the fluid collector and the analyzer have been designed by Dräger to permit the reliable detection of oral contamination with THC. It takes eight minutes for the test kit to deliver positive proof of can-nabis consumption; five minutes are re-quired for other drugs.

In all cases, the procedure is identical. Once the fluid collector has been filled with saliva, the test cassette is slotted into the analyzer. A buffer solution rinses the sample out of the porous tip of the col-lector, and the analyzer dips the special test strip into the solution. The ensuing immunochemical reactions are analyzed within a few minutes by means of an op-toelectronic method, and the results are shown on an illuminated display.

The testing device is internally cli-mate-controlled, which means that the tests can be carried out in the rain, dur-ing the hours of darkness, and outdoors. All of these are important considerations for a system that is designed for use by traffic police, among other applications. As a result, all it really takes to achieve a reliable result is a little patience – and a drop of saliva. Oskar Meyer

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NEUROSURGERY    AnesthesiA

36 Dräger review 102 | MAy 2011

A look through and a look  inside: The surgical area is set up in the MRT control room before the procedure itself is carried out.

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AnesthesiA     NEUROSURGERY

37Dräger review 102 | MAy 2011

Powerful attractionMri scanners are very attractive pieces of equipment to physicians and scientists alike. in general terms, the greater the magnetic field – generated by superconducting coils cooled by liquid helium – the higher the resolution of the images that are pro­duced. Magnetic field strength is measured in tesla. the earth’s magnetic field has a magnetic flux density of between 30 and 60 microtesla. By way of comparison, refrigerator magnets have a flux density of around 25 millitesla, and the range for Mri scanners for medical applications is between 0.25 and 3 tesla. in the field of neuro­science, Mri scanners of up to 10 tesla are now in use, while machines of 20 tesla and more are found in material sciences applications.

 Working Side by Side  in the field of NEUROSURGERY a scalpel must be used with absolute precision, which is why the preferred method today is to use imaging techniques for monitoring anesthetized patients during surgery. this, of course, requires the right kind of anesthesia system.

Before 1895 only pathologists were able to take a look inside the body. On November 8 of that year Wil-

helm Conrad Röntgen discovered “a new kind of ray” that cast a silhouette – espe-cially of the skeleton – onto a sheet of lu-minescent material. Röntgen’s discov-ery was awarded the very first Nobel Prize in Physics, in 1901. It revolution-ized medical diagnostics, enabling phy-sicians to see if and where bones were broken. Nonetheless, the method still de-manded great expertise on the part of doctors, who needed to interpret a two-dimensional silhouette of a three-dimen-sional structure.

Things improved in 1934, when the Berlin physician G. Grossmann filed a patent for his “tomograph,” a device that produced a sharp image of an individ-ual cross-section of the body. The term “tomograph” comes from the Greek “tomos” (“cut”) and “graphein” (“to draw”). This new technology also pro-duced a higher contrast in the image, making it possible for doctors to also dis-cern soft tissue. Further advances in X-ray technology were recognized with another major award in 1979, when God-frey H. Hounsfield received the Nobel Prize in Medicine for his first-ever com-puter tomograph, which he had devel-oped seven years before. This honor un-derscores the enormous significance of what are now known collectively as “im-aging techniques.”

In their latest development, the var-ious kinds of magnetic resonance imag-ing (MRI) provide a new, clearer picture of the body. They all exploit the mag-

netic properties of nuclei – particularly those of hydrogen (protons). As a rule, nuclei have a spin that is aligned with the earth’s magnetic field. An MRI scan-ner generates a powerful magnetic field. This artificial field forces the protons in the tissue under examination to realign according to its (magnetic) properties. The specific “resonance frequency” as-sociated with this process depends on the power of the MRI scanner. For wa-ter protons in a 3 tesla scanner such as those now used in some modern hospi-tals it is 127.7 megahertz. The polarity of the protons is then reversed at a specific frequency to produce the image.

Excited protons

If these pulses are brought to a halt af-ter only a few milliseconds, the protons realign with the earth’s magnetic field, within one second at most. In this pro-cess, they emit a weak radio frequency field, the type, strength, and duration of which depend on the water content of the tissue that is being scanned. Ul- >

Hand in hand – the Fabius MRI makes it possible to examine anesthetized patients in the MRI Scanner.

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38 Dräger review 102 | May 2011

tra-sensitive coils in the MR tomograph receive these signals in all three di-mensions and convert them into elec-tric signals, which are then processed into images by powerful computers. The greater the strength of the electromag-netic field that is applied during an MRI scan, the larger the “echo” it produces and the higher the spatial resolution of the structures that are imaged.

On the one hand, every MRI scanner contains a very powerful electromagnet. In a 3 tesla machine, for example, it is 60,000 times stronger than the earth’s magnetic field. On the other hand, the scanner also features an ultra-sensitive receiver capable of detecting the weak magnetic fields that are emitted by ex-cited hydrogen protons as they return to their original state.

In the presence of a such a power-ful magnetic field, certain precautions are necessary. Before entering the MRI room at the University Hospital in Er-langen, Germany, patients must hand over anything containing metal: keys, eyeglasses, wristwatches, belts. Georg Wendel, the duty nurse, often hands a forceps to patients so that they can feel the tremendous magnetic force exerted by the scanner, even at a distance. And that is only the “stray field.” When a pa-tient is being pushed into the bore of the scanner, which is just 70 centimeters in diameter, the magnetic field is so power-ful that it tugs at the patient’s waistband. “That’s just the small metal fastener,” Wendel reassures via the intercom. The scanner is noisy when operating but not excessively so, thanks to earplugs worn

to muffle the sound. Within a few min-utes, the computer starts recording im-ages of sections of the brain.

Intraoperative monitoring during MRI

MRI scans are also increasingly being used by surgeons, especially during com-plicated brain operations. Here confir-mation can be required of whether, for example, a tumor has been fully removed. In Erlangen, surgeons use an MRI scan-ner and an anesthesia system in close combination. “This involves placing the still-anesthetized patient in an MRI scan-ner,” explains Prof. Dr. med. Dr. h.c. Jür-gen Schüttler, Director of the Clinic of Anesthesiology at the Erlangen Univer-sity Hospital. This is a very safe procedure which puts minimal strain on the pa-tient. Nevertheless, as Schüttler empha-sizes, it requires an anesthesia system ca-pable of performing reliably in the stray field of a powerful MRI scanner. “Before the introduction of intraoperative scan-ning,” Schüttler adds, “the patient was first operated on, then transferred to intensive care and extubated there, be-fore being placed in the MRI scanner to check whether the tumor had been com-pletely removed.” If that wasn’t the case, a further operation – often a complicated and arduous one – had to be scheduled. “With the right kind of anesthesia sys-tem, though,” says Schüttler, “we can en-sure a much higher quality of neurosur-gical intervention than was previously the case with conventional surgery.”

However, as Günter Steppan explains, the development of a suitable anesthe-

sia system was by no means straightfor-ward. From the beginning, Steppan was involved in the development and subse-quent introduction of Dräger’s Fabius MRI. “On the basis of conventional anes-thesia equipment and a number of pilot studies,” he says, “we were able to supply the first machines by the end of 2007, fol-lowing three years of development.” Step-pan’s colleague Joachim Behrje points out two essential features: “For one thing, the anesthesia equipment has to remain un-affected by the powerful stray field, but it also mustn’t interfere with the MRI scan-ner’s sensitive receiver coils.”

Screened and shielded

The biggest challenge was to prevent the anesthesia system from emitting any elec-tromagnetic radiation. The microproces-sors in standard anesthesia equipment switch so fast that they function like tiny transmitters, with the interconnecting ca-bles acting as transmission antennas. The apparatus was granted approval only when this unintentional radiation had been at-tenuated by a factor of more than 16 com-pared to the already stringent norm for medical equipment. And prior to that, the developers had encountered a num-ber of other obstacles. While the funda-mentals of these problems could all be in-vestigated in Dräger’s own labs, some of the fine-tuning called for wheeling the Fa-bius MRI prototype into a typical operating room situation. “That was when we discov-ered that although it worked perfectly with a 3 tesla MRI scanner, it still caused inter-ference with a 1.5 tesla machine!” Behrje recalls. The key to this problem was not

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AnesthesiA     NEUROSURGERY

39Dräger review 102 | MAy 2011

Anesthesia – past, present, and futurePROf. DR. mED. DR. h.c. JüRGEN SchüttlER  is Director of the Clinic of Anesthesiology at the University hospital in erlangen, a place of historical significance. it was here in 1847 that Johann Ferdinand heyfelder administered one of the first ether anesthetics in germany. since 1986 patients – pri­ma rily children – are undergoing Mri scans in erlangen. intraop­erative Mri using a swiveling table was introduced in 2002. the Clinic of Anesthesiology treats around 200 such patients a year.

What are the advantages of being able to use mRI for patients  under anesthesia?it substantially increases the quality of the operation and therefore patient safety, particularly in the case of brain tumors. it means we can check during the operation and determine if the tumor has been completely removed.And is that part of a general trend?Absolutely. in germany, 11 million operations out of a total of 14 million are conducted under anesthesia. Back in the 1950s one in 2,680 patients died as the result of anesthesia; today, for healthy patients without any accompanying medical condition, this rate has fallen to a statistical residual risk of one in 250,000. Is there such a thing as the ideal anesthesia?People are always postulating an ideal anesthetic with no side effects that works re liably and quickly for every patient, but that’s misguided. when a patient needs an anesthetic, we have to ensure a 100 percent success rate. now that’s only possible with powerful drugs, which always have some side effects. that’s even true for xenon gas as an anesthetic, not least because other drugs are required to initiate the anesthesia.this touches on the tricky area of drug interactions…Qualified anesthetists are well aware of such problems, especially because they now have effective support from systems such as smartPilot view, which provide a kind of moving map to help them guide the patient safely through the anesthetic.What developments do you expect to see in your discipline?research is currently required in two areas: anesthesia for old and multimorbid patients, and in the area of monitoring. it’s only a matter of time before new it methods, such as pattern recognition, will be used to evaluate and interpret in real time the biosignals thus gained.Will that eliminate need for anesthetists?not at all. here in germany, we train almost 1,000 highly qualified anesthetists every year. their well­founded and wide­ranging expertise, not only in medical areas, will continue to be in big demand!

the mRI check of  the patient directly after the surgical  procedure offers many advantages.

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in the strength of the magnetic field, but rather in the specific resonance frequency of the MRI scanner, which increases linearly with magnetic field strength. It requires a frequency of around 63 mega-hertz at 1.5 tesla to make hydrogen pro-tons resonate, and therefore around 126 megahertz at 3 tesla. But a switching op-eration that interferes with the coils of the MRI scanner at 63 MHz does not necessar-ily do the same thing at 126 MHz.

However, with appropriate screening this problem has been solved. But it was also necessary to shield magnetic com-ponents in the anesthesia device and thus prevent any interference from an external magnetic field. Such parts in-clude loudspeakers, pumps, and solenoid valves. Wherever possible, non-magnetic material was used. Otherwise, compo-nents were shielded with a magnetically soft nickel-iron alloy that is largely im-penetrable to magnetic fields. And very sensitive parts such as the PEEP valve, which controls the positive end-expira-tory pressure and thus prevents individ-ual alveolar regions from collapsing, are installed as far away as possible from the influence of any stray field – in this case at the base of the anesthesia system.

Thanks to these modifications, phy-sicians have access to anesthesia equip-ment that can also be used in the im-mediate vicinity of an MRI scanner. The first person to try out the new system – for purely scientific and nonmedical rea-sons – was Joachim Behrje of the devel-opment team, who said, “My brain scan with the Fabius MRI in attendance was as smooth as could be!” Nils Schiffhauer

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40 Dräger review 102 | May 2011

Feel-good HospitalsPatients need much more than just medication and skilled treatment in order to get well. attentive care demonstrably accelerates people’s recovery. Hospital arcHitecture and the design of workplaces and patients’ rooms also play an important role.

A t the beginning of the year, the staff at the St. Josef Hospital and Pediatric Clinic in Neunkirchen,

Germany, faced the difficult task of mov-ing their patients and all of the medical equipment to a new hospital building. Despite all of the cost pressures, this new beginning gave planners the rare oppor-tunity to design and configure the hospi-tal building and wards from the ground up. Upon entering the red-and-white painted hospital facility, visitors arrive in a foyer with a waiting area contain-ing a piano. The corridors are painted in warm shades of yellow, and the patients’ rooms are much friendlier and more comfortable than those in the previous building. The impression of being in a living room is further enhanced by curtains and movable cupboards for the patients. Even such comparatively simple measures seem to have a big effect. “The patients say that they imme-diately feel as though they’re in a five-star hotel,” reports Dr. Ernst Konrad, Chief Physician of the Clinic for Anesthesio logy and Intensive Care Medicine. In the in-tensive care units, doctors and nurses find it easier to do their work, and here too the rooms are more comfortable and colorful than those in the previous hos-pital building. “Our conscious patients feel much better here,” says Konrad about his first few weeks of working in the new wards. “And even patients who are on life support notice their surround-ings to some extent.”

The hospital is responding to a gen-eral trend that began in the U.S. and is now becoming more pronounced in Eu- although a hospital room isn’t a vacation home, even simple measures can make it more restful.

colors can appear harmonious or contrasting – and create a good atmosphere. Welcome to the Marienhaus Hospital St. Josef Kohlhof!

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Workplace     DESIGN

41Dräger revieW 102 | May 2011

ropean clinics as well: The focus is not only on providing expert medical care but also on creating a feel-good atmo-sphere. This also applies to the techni-cal equipment, which is being designed to not only perform well but also appeal to the eyes. One of the reasons for this development is the changed relationship between hospitals and patients, who are no longer viewed only as people in need of help, but also regarded as discerning customers. Another reason is that an in-dividual’s psychological condition has an undisputed impact on the course of his or her illness. The fact that a patient’s surroundings can affect his or her well-being and recovery is not just an intui-tive assumption; it has been proven in a series of scientific studies.

Looking at nature helps the healing process

“Hospitals used to be places where pa-tients left their personalities and in-dividual needs at the reception desk,” says Matthias Witt, Care Director at the Unfallkrankenhaus Berlin (ukb/Berlin Trauma Center). Witt has many years of professional experience and was closely involved in the planning and design of the center when it was built in the 1990s. During this process, he considered the patients’ subjective well-being in many specific areas. His initial focus was on how patients appear to be when they are in a given room, and on how they view themselves. “If everything is painted white and a pale patient is lying there, the patient ends up feeling even sicker than he or she actually is,” says Witt.

The surroundings that people see and the materials around them can have a direct impact on how much stress they experi-ence. In some cases, this effect can even be measured in terms of the patients’ physical reactions. Whereas abstract art affects people in different ways and can even result in negative reactions, peo-ple generally like to see nature, wide ex-panses, and water – which can have posi-tive effects on heart rates, blood pressure, and the perception of pain. A study at the University of Delaware showed, for exam-ple, that patients who had had a cholecys-tectomy (surgical removal of the gallblad-der) needed fewer painkillers and could be discharged sooner if, after their opera-tions, they lay in a room from which they could see trees, as opposed to an iden-tically furnished room with a view of a brick wall. Another study demonstrated that even burn victims can feel less pain if they watch films of nature scenes such as waterfalls, forests, or oceans while their bandages are being changed.

In order to liven up cold surround-ings, some hospitals are again using natural materials. At the Berlin Trauma Center, for example, Witt is planning to obtain tables and chairs made of real wood. “The sense of touch is particu-larly important for patients who are old or suffer from dementia,” he says. He doesn’t think this will negatively impact hygiene, pointing out that “modern pro-cessing techniques mean that aesthetics and functional requirements are no lon-ger contradictory.” In fact, some hospi-tals now even have carpeting. The Ber-lin Trauma Center quickly gave up such >Although a hospital room isn’t a vacation home, even simple measures can make it more             restful.

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42 Dräger review 102 | May 2011

an attempt, however, because the car-pets made it too difficult to push hospi-tal beds around and to remove coffee and other stains. Besides, the vacuum clean-ers made too much noise.

Visitors can relax, too

In many older hospitals, the constant bar-rage of noise in particular should be re-duced for the benefit of the patients. To do this, the floors at the Berlin Trauma Center are covered with a thick layer of natural rubber in order to muffle steps, and all trolleys and beds have especially quiet wheels. Thick doors help to insu-late against noise, and the patient call system only generates light signals in the corridors. Not surprisingly, scien-tific studies have repeatedly shown that a hospital’s general noise level affects patients’ sleep and stress levels. Swed-ish researchers at the Karolinska Insti-tute demonstrated that patients in the cardiological intensive care unit slept more soundly, experienced less stress, and assessed their treatment as better after noise insulation was installed. In addition, the study showed that these patients had to be readmitted to the hos-pital somewhat less frequently than pa-tients in other wards.

Patients are negatively affected not only by noise and bare surroundings; they can also suffer greatly from being at other people’s mercy and having no control over their lives. People who be-come suddenly or seriously ill are often deeply distressed and feel that their self-image has been undermined. They liter-ally find themselves exposed to a foreign

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Having a modicum of privacy also has a big impact on well-being

Ergonomics: Separate “wet” and “dry” workstations flank the hospital bed.

Color: The Ponta supply system can generate red, green, and blue light.

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Workplace     DESIGN

43Dräger revieW 102 | May 2011

environment that they often do not un-derstand, where they cannot find their way around, and over which they have little control. A number of simple mea-sures can be used to mitigate these feel-ings a little. Examples include enabling patients to control the lighting and ven-tilation from their beds or to offer their visitors a cup of coffee, and providing patients with sufficient room to display some personal mementos.

Having a modicum of privacy and the support of familiar people also has a big impact on patients’ sense of well- being. Having a room to oneself has undis-puted advantages in this regard. Hospital planners are taking new approaches in other ways as well, as it’s not only the pa-tients’ well-being that is of crucial impor-tance – visitors’ needs are also increas-ingly being taken into account. “They also feel better in hospital rooms that are bright and cheerful,” says Dr. Kon-rad. The new hospital in Neunkirchen has waiting rooms with lockers for vis itors. “After all, visitors have to relax now and then, too,” he says. The Berlin Trauma Center is trying to create a more homelike atmosphere or environment in some of the waiting rooms by setting up sofas and partitions. Some hospitals in the U.S. have even gone a step fur-ther. For example, the new neurological intensive care unit at Emory University Hospital in Atlanta now has a separate family room next to each treatment room so that family members can pro-vide patients with intensive support.

Even though hospitals are becoming more and more comfortable and appeal-

ing, the patients’ main concern remains the expertise of the doctors and nursing staff so that they can obtain reliable di-agnoses and optimal treatment. Giving workplaces and hospital rooms a state-of-the-art design can be helpful in this regard. For example, it is becoming in-creasingly difficult to place all of the re-quired equipment next to the patient’s bed in an intensive care unit so that doc-tors and nursing staff can easily get an overview of the situation and quickly ac-cess the patient from all sides. “In the previous building, the devices were con-nected to a wall system at the head of the patient’s bed,” says Dr. Konrad. “As a result, you almost tripped over the big pile of cables when you did a bronchos-copy, for example.” Today, the supply unit in the form of a beam is mounted to the ceiling. This system from Dräger, which is called Ponta, integrates all of the gas lines, electricity cables, and data transmission lines. Various workstations can be attached to this beam and can be moved along a rail system and a swivel arm. All of the “wet” equipment for infu-sions and suctioning are located on one side of the patient, while the other side is reserved for “dry” equipment such as respirators and monitors. “In addition to providing a clearer overview, this sys-tem has a big advantage in that it allows us to walk around the patient,” says Dr. Konrad. “What’s more, the new system makes the rooms look bigger.”

This is also beneficial for patients and visitors, since the beds are no longer sur-rounded by a tangle of tubes and cables. Now patients can have an overview of the

various devices and recognize where a particular hose leads to, for example. The supply units also increasingly incorpo-rate sophisticated lighting systems. For example, in the future Dräger’s Ponta system will be equipped with a lighting system that can combine red, green, and blue light as desired in order to provide hospital rooms with a range of different atmospheres that can have a stimulating or relaxing effect, depending on the sit-uation. If the room lacks windows, the system can also imitate natural daylight, and indirect lighting can prevent bedrid-den patients from feeling blinded by ceil-ing lamps.

Inspiring technology

The design of hospital equipment has changed with the times as well. “Laypeo-ple often don’t even recognize the res-pirators any more,” says Witt. The rect-angular, metallic machines of the past have been replaced by smaller devices that have rounded shapes. In addition, options such as Dräger’s Color Line en-able hospitals to select supply units in a variety of colors that are coordinated with the room in which the equipment is installed. All of these measures can help patients react to the unfamiliar hospital situation in a more relaxed way.

“Medical technology can frighten pa-tients who are totally dependent on it, and who can no longer exert any control over their environment,” says Dr. Kon-rad. “Things don’t have to be that way, however. In many cases, we’ve discovered that technology can even have an inspir-ing effect.” Dr. Birgit Herden

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RESEARCH    HeLMHOLTZ assOciaT iOn

 Science Creates Benefits what brings us new developments? it’s hardly the results of a single spark of creativity any more. instead, change arises from nEtwoRking between the areas of research, development, production, and even recycling, as the Helmholtz-Zentrum geesthacht demonstrates.

Dietmar Letzig slowly takes off his silvery heat protection gloves. The physicist had just opened

a hatch, providing a glimpse of liquid magnesium. Physicist Wolfgang Diet-zel, a colleague of Letzig’s, shows what sorts of things can be made from this material. From a little case he takes a tiny tube made of this lightweight metal, no bigger than a matchstick. “This will become a bioresorbable stent that can be used to keep a coronary artery open, for example,” says Dietzel. The human body, he explains, can dissolve and re-sorb magnesium, and the stent can even be used to carry pharmacological sub-stances – for instance, it could release blood thinners that prevent blood plate-lets from adhering to the fine mesh structure of the ready-to-use stent, thus helping to prevent undesirable constric-tions. A manufacturer based in the Ger-man state of Mecklenburg-Vorpommern uses a laser to precisely cut the mesh structure in the tiny tube, which is then ready for surgical use. The device is de-livered together with a balloon catheter.

Magnesium,  a magical metal

This is only one example of how the ba-sic research being done at the Helm-holtz-Zentrum Geesthacht leads to new products. And the Magnesium Innova-tion Centre (MagIC) covers just one of several research fields that are being addressed at this Centre for Materials and Coastal Research, which is located about 30 kilometers southeast of Ham-burg. Over 800 employees conduct re-

search at this historic site, where Alfred Nobel built his first dynamite factory out-side of Sweden in 1865. Also at the site is the research reactor, which opened in 1958 and has been used during the last 30 years for research focusing on light-weight alloys and welded seams. “The re-actor was shut down in 2010 and is now in the post-operational phase,” says Heid-run Hillen, who is responsible for press and media relations at the research cen-ter’s Public Relations department. “Some areas of the materials research work have been moved to the off-site facilities at the FRMII research reactor in Garching and at the Deutsches Elektronen-Synchrotron (DESY) in Hamburg.”

This too shows how, in keeping with the motto “Science creates benefits,” the work encompasses the entire chain from basic research to production processes and the development of prototypes. The primary concentration here is on topics that the German government considers to be of strategic importance for its research and business-related policies – even though such topics are not addressed by

universities or companies for various rea-sons. Magnesium is an excellent exam-ple, says Dietzel. “The eighth most abun-dant element is available in practically unlimited quantities, and it’s about one third lighter than aluminum.” To illus-trate his point he produces three identi-cally large model vehicles. One is made of steel, one of aluminum, and the third of magnesium. After picking each one up, it becomes clear how remarkably light mag-nesium really is. But why hasn’t magne-sium replaced aluminum yet? “There are many reasons,” says Letzig.

Metals – stirred,  not welded

The head of the Wrought Magnesium Al-loys department is standing next to a deep-drawing press, which is used to deep-draw auto body elements from different sheet metals. Magnesium sheet can be formed well only at temperatures that are higher than 250 °C. “That means more energy consumption in production, so the pro-cesses must be adjusted and new alloys have to be developed,” he says. On the other hand, the vehicles made with mag-nesium would be lighter, which would re-sult in overall energy savings over their life cycles – due to lower fuel consumption. Susceptibility to corrosion was also a con-cern in the beginning. Letzig picks up two pencil sharpeners, one covered with the typical gray coating of oxidation, although white “blooms” of oxidation can also ap-pear. “We prevent that,” he says, point-ing to the second sharpener, “by means of a very thin ceramic layer, which we ap-ply using a plasma created in a solution.”

A car hood: today’s cars already contain about five kilograms of magnesium.

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Polymer research in Geesthacht: In laboratory autoclaves, the scientists take great care to precisely adjust the critical parameters for the synthesis – for example the arrangement of the repeating units, the monomers.

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RESEARCH    HELMHOLTZ AssOciAT iOn

46 DrägEr rEviEw 102 | MAy 2011

The ceramic layer protects the metal from corrosion. But doesn’t magnesium burn? In bygone days, didn’t photographers ig-nite blindingly bright magnesium flashes? “Well that definitely won’t ignite a work-piece!” Letzig, says, holding the flame from a cigarette lighter to the pencil sharpener.

Convinced that great benefits are of-fered by the lightweight metal, the re-searchers at the MagIC are working on approaches for increasing its use in in-dustrial production processes and also for recycling it as scrap. They are using electron microscopes to study the mi-

crostructures – for example, the durabil-ity of “friction stir welded” joints for the aerospace industry. Here, two pieces of metal are subjected to pressure in a ro-tating movement. This results in dura-bility equal to that achieved by riveting or welding. The researchers developed a twin roll caster that first melts the ingots of magnesium in two phases, in order to then form them into roll cast strips about five millimeters thick. These strips are processed into sheets only one mil-limeter thick by means of hot rolling in an additional machine. “We can draw these sheets into a roof element for a

convertible, for example,” says Letzig. The complex processes involved can be adjusted in an almost infinite number of ways. One of them is something of a se-cret: the special shape of the “tip,” the name given to the nozzle outlet for the liquid metal.

It’s essentially an ideal field for indus-trial espionage. That’s why, at the outset, the MagIC team was for the most part denied access even to production facili-ties and labs – for instance in Korea. “But when we invited our peers to visit us,” Letzig recalls, “and we informed them about our research activities and process developments, we were then allowed to visit their facilities.” This shows how pub-licly funded cutting-edge research – 90 percent of the Helmholtz budget is cov-ered by the taxpayers – can act as a kind of crystal nucleus for innovation.

Polymeric membranes separate  gas mixtures

Dr. Torsten Brinkmann – who has a doc-torate in engineering – sees things exactly the same way in his own field. Brinkmann is the head of the Polymer Technology de-partment in Geesthacht, and his work is currently focused primarily on mem-branes – films that are only permeable to some substances. That’s easy in the case of a tea sieve: Its holes are so small that the tea leaves are contained and only

 Helmholtz – the research associationThe Helmholtz Association is a community of 17 scientific-technical and biological-medical research centers in germany. The centers pursue long-term research goals on behalf of the state and society to help preserve and improve the foundations of human life. At the beginning of 2011 just under one third of the approximately 30,000 employees are scientists who are committed to cutting-edge research in the following research fields: Energy, Earth and Environment, Key Technologies, structure of Matter, and Aeronautics, space and Transport. Two thirds of its annual budget of about three billion euros is covered by public funding, and the individual Helmholtz centers are responsible for raising the remaining third themselves in the public and private sectors.

The association was named after Hermann von Helmholtz (1821–1894), one of the last universal scholars. A physician by profession, Helmholtz conducted pioneering research that linked the fields of medicine, physics, and chemistry – both theoretically and in a practical way.

Thinking big in a very small world. At left: On a beamline at the Deutsches Elektronen-Synchrotron (DESY),   scientists from Geesthacht research nanoscale structures. At right: Mechanical testing at the atomic level.

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HELMHOLTZ AssOciAT iOn     RESEARCH

47DrägEr rEviEw 102 | MAy 2011

high pressure and thus allows a high rate of gas throughput. For technical applica-tions, individual combinations of filters are mounted into modules at different separations which have been precisely cal-culated in terms of fluid dynamics. This in-creases the effective membrane area for the passage of gas and improves the sepa-ration of the gas mixture fed in. The mem-branes are also tested in house – a process that requires many different gases, which are made available via gas lines with Dräger reducing valves. Last but not least, the integrated and decentralized Gas Detection System – consisting of the Dräger Regard 3900 and different sensors and transmitters – takes care of the safety of the researchers and developers.

“Membrane technology has a very bright future,” says Brinkmann, who goes on to say that experts in the field expect demand to double with each passing de-cade. And the research being carried out in Geesthacht is helping to open up new, expanded areas of application. What’s more, the researchers there are also mak-ing magnesium more attractive to auto-makers – several of whom are already us-ing it. The applications involved include engines and even lighter alloy rims for lux-ury-class vehicles. These examples demon-strate that the publicly funded research conducted by the Helmholtz Association is really going places. Nils Schiffhauer

clear tea flows into the cup. “But here we are mainly working on the separation of gases,” says Brinkmann. And that doesn’t work with the sieve principle; instead, a solution-diffusion process is used.

The latter works because of the differ-ence between so-called partial pressures. A partial pressure is the pressure one component of a gas mixture would exert if it alone filled the space in question. Ac-cording to Dalton’s law, the total pressure of a gas mixture is the sum of the partial pressures of the mixture’s different con-stituent gases. In principle, this means a constituent of the gas dissolves on the side with the higher partial pressure in the polymer for as long as it takes to achieve a solution equilibrium there. The gas then migrates (“diffuses”) in its dissolved state from the side with the higher concentra-tion to the side with the lower concentra-tion. This migration does not take place via holes that have been previously made in the membrane, but through gaps in the membrane that arise due to the ther-mal movement of its molecule segments, and then disappear again. The gas is re-leased again on the side with the lower partial pressure. Unlike a tea sieve, such a membrane doesn’t become blocked, so it doesn’t have to be changed – like a con-ventional filter – and can instead be oper-ated in place, which reduces the main-tenance required for this kind of system.

And if the theory sounds complicated, put-ting it into practice is even more difficult.

Biogas requires  membranes

One of the first major applications of poly-meric membranes was in the petroche-micals industry. Here, they are used even at filling stations for recovering gasoline vapors from outgoing air. Thanks to re-search – including that carried out in Geest-hacht – more and more new applications are being found. “Today, for instance, our polymer filters are helping to clean CO2 from biogas,” says Brinkmann, citing a cur-rent example. “The biogas can then be fed directly, and therefore at lower cost, into the natural gas network because a separate in-frastructure isn’t needed.” The mechanical engineer then offers another example: “The polymer industry uses our membranes to recover monomers that are outgassed fol-lowing production of polymer granulate.”

The Institute of Polymer Research is basically doing what the Institute of Mate-rials Research has been doing with mag-nesium. Here too it is necessary to study many details in order to discover new ar-eas of application and optimize efficiency. The polymer membranes’ thin separation layers, for instance, are stabilized with a porous substrate, whose permeability be-comes lower the closer it is to the mem-brane. This combination is resistant to

This twin roll caster for magnesium, which is being used to   research magnesium sheet in Geesthacht, cost millions of euros.

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RepoRt    PharMaceutical ProDuction

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A World without Germsthe international pharmaceuticals sector has been changed by a series of acquisitions and mergers over the past few years. the LichtenheLdt Gmbh company is a good example of how this development has affected the sector’s many contract manufacturers.

T he small city of Wahlstedt, some 50 kilometers north of Hamburg, Germany, has a population of

just under 10,000, a theater, and a vol-unteer fire service. It’s not the sort of place where you would expect to find a world-class pharmaceutical company. Nonetheless, it certainly isn’t a blank spot on the map as far as the world’s drug manufacturers are concerned. That’s because of Lichtenheldt GmbH, one of several hundred companies in Germany that manufacture pharma-ceutical medications and healthcare products. The firm, which has been based in Wahlstedt in the German state of Schleswig-Holstein since 1948, has around 200 employees. The work it per-forms is based on reliability and discre-tion. According to company sources, five of the world’s ten largest pharma-ceutical firms have their “bulkware” produced here. These products include mouthrinses, medicinal disinfectant so-lutions, tinctures, emulsions, suspen-sions, creams, and ointments. Most of them are for direct sale to end con-sumers, although some are further pro-cessed and refined. “We used to manu-facture various medications on our own behalf, but nowadays we concentrate on low-germ fluids and semi-solids,” says Jens Paulig, Head of Bulkware Produc-tion at Lichtenheldt.

the human factor

The production locations here are care-fully screened – like all such areas in the pharmaceutical industry where even the smallest amount of contamination can

have enormous consequences. That’s why you won’t get in without a special permit. And if you actually managed to get hold of such a permit, you’d end up wearing a one-piece chemical protec-tion suit, complete with mask, hood, and overshoes. “The human factor is the main source of uncertainty in pharma-ceutical production,” says Paulig. People harbor a substantial risk of microbiolog-ical contamination.

Paulig, who is a qualified pharma-ceutical technician and foreman, knows what he’s talking about. In total, he has been working at Lichtenheldt for more than 15 years. The company was origi-nally established by J. N. Lichtenheldt in the Thuringian city of Meuselbach in the year 1745 – in the very early days of evidence-based medicine. It moved to Wahlstedt after World War II. Around ten percent of Lichtenheldt’s customers are based outside Germany. The company has been offering a one-stop service pack-age that includes manufacturing, filling, packaging, storage, and dispatch of the pharmaceutical goods – also in small or medium-sized batches – since 1984. “At present, we can manufacture batch sizes from 18 to 20,000 liters. The packaging sizes extend from six milliliters to 30 li-ters,” says Paulig. The products are ba-sically delivered in traditional packag-ing – in other words, in glass or plastic bottles – or in tubes of aluminum or plas-tic. In some cases, delivery is in the form of individual stickpacks. “Any liquid prep-aration that has to be filled into bottles can theoretically be transferred to stick-packs,” says Paulig. That is more hygienic

caution, glass:  Filling light-protected bottles

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PrODUCTiON     PHARMACEUTICALS

Spotlessly clean: 

Products are manufac-

tured in large steel tanks.

Large quan- tities are a big respon- si bility: Jens Paulig, Head of Bulkware Production. D

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PHARMACEUTICALS    PRODUCTION

50 DRägeR RevIew 102 |May 2011

than a bottle with a screw-on top, which can quickly get gummed up.

The “open product” is present at the beginning of every production chain – as is the employee at the balance scales, which are located in the immediate vi-cinity of the individual raw materials. As far as pharmaceutical manufacturing operations are concerned, even a cough or a sneeze represents a major problem. Germs could be transferred, thereby put-ting patients at risk. The situation is in some ways reminiscent of open-heart sur-gery. Depending on the recipe, the indi-vidual raw materials are brought together in a mixing tank on a floor scale. The amounts involved range from 0.02 grams to 1,200 kilograms, according to the active ingredient and the batch size. “The weigh-ing process is a delicate affair,” confirms

Paulig. And things are especially compli-cated if the number and the amount of raw materials are greater than normal. Altogether, the plant works with several hundred starting materials. They include exotic ingredients whose swell times and stand times stretch to several hours, and which can only be further processed after they have reached a specific viscosity. It’s like dealing with a wallpaper paste whose consistency can’t be too thick or too thin. But while a “rule of thumb” is fine for working at home, pharmaceutical produc-tion requires precision. The maximum tol-erance range for any raw material on the balance scales is just 0.5 percent.

Explosive atmosphere

Sometimes the mixing process can be dangerous – for example, during the pro-

A glimpse of the raw materials   store: Healing by the ton.

All-rounder for area monitoringThe Dräger X-zone 5000 utilizes the advantages of portable and stationary gas detection technology. The area monitor can be operated in locations or situations where a gas hazard could arise – in production areas, when servicing industrial plants, or in oil and gas extraction. In other words, it protects people and materials from harm in a wide range of situations. a portable gas detection instrument (Dräger X-am 5000/5600) is plugged into the area monitoring device in order to conduct the measurement. This enables the units to “understand” one another. The X-zone 5000, which can detect up to six explosive, flammable, and toxic gases simultaneously, issues a warning if one of these gases is present in the ambient air. The area monitor operates for up to 120 hours without an external power supply. with an optical warning of a full 360 degrees and an acoustic warning at a volume of >108 dB at a distance of one meter, its warning is unmistak-able. The unit monitors an area with a radius of upt o 20 meters. Connect-ing multiple units into a wireless fenceline can greatly extend this radius.

 A poisonous material can have a healing  effect when combined with other substances

duction of tinctures. This process re-quires the use of pure alcohol or ace-tone – a colorless, sweet-smelling liquid that is both easily miscible with water and highly flammable – and other or-ganic solvents. Because heavier-than-air vapors can form, there is a risk of explosion. “Nonetheless,” says Paulig, “we can work under explosion-proof con-ditions in all areas.” This is another hall-mark of the Lichtenheldt operation, he says, glancing at five portable gas de-tectors (Dräger X-am 5000) including area monitoring devices (Dräger X-zone 5000) with which the company ensures the safety of its employees.

In the event that a dangerous gas mixture arises – despite the central extraction system – the X-zone 5000 provides an acoustic and optical warn-

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Unmistakable warning: Area monitoring  

with the X-zone 5000.

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Further information online, including: Background: How area monitoring

can support safety concepts and lower operating costs. www.draeger.com/102/xzone5000

ing. “It’s a comforting margin of safety,” says Paulig.

Less comforting are the varying prices for the raw materials, which ar-rive at the plant “just in time” for use, ideally day by day. The price of indi-vidual raw materials can vary tremen-dously. The plant-based ingredient of a homeopathic medication prescribed for overweight patients might cost around 200 euros per kilo; a synthetic ingre-dient for the treatment of chronic ob-structive bronchitis could cost 40 times as much. And these prices are rising al-most continuously. Can they be passed on directly as part of the wholesale price? “Basically, there is room for nego-tiation,” says Paulig. “However, the cus-tomer will sometimes demand a price cut of a few percent in spite of all the various cost increases.”

Times are getting harder, and ne-gotiations are becoming tougher. Pric-ing – like many other areas – is increas-ingly being determined by public calls for tender. The government’s procure-ment of a vaccine against avian influ-enza, which was primarily aimed at ob-taining extremely large quantities for the lowest possible price, was an exam-ple of this tendering process.

Water has various forms

That brings us back to production, where raw materials are not always in the same form. “A starting material might be poisonous in its original form, yet have a healing effect in combination with other substances,” explains Paulig. Water and oxygen atoms are often in-

Automated processes from production to packaging and storage ensure both the efficiency and the quality of pharmaceutical products – decisive reasons for Lichtenheldt’s strong market position.

volved – many products have a high wa-ter content. But even water has various forms. “We use purified water to avoid the danger of bacteria and germs,” says Paulig. Unlike drinking water, it does not contain any mineral substances such as calcium, magnesium, or so-dium. The quality of the various dis-tilled and demineralized waters is mea-sured electrically – the purer the water, the lower its conductivity.

For some products, the water used has to be almost germ-free. Here, Lich-tenheldt uses reverse osmosis, a techni-cally difficult process in which the wa-ter is repeatedly forced through a thin membrane under high pressure, elec-trically deionized, and permanently ir-radiated with UV light. The result is an almost germ-free world.

Hygiene is also a top priority in the final stage of production. Here, medi-cations are filled, sealed, and labeled; droppers and spouts are mechanically added; and sealing components are ap-plied and screwed tight with specific preset torques. The product is then di-rectly packaged into the carton – usually a collapsible box – with the package in-serts, reference code, and dosing aids.

Retained and laboratory samples are taken regularly on all production lines and tested to see if they are fit for sale. For example, have all the manufactur-ing and testing specifications been ad-hered to? The goods are then forwarded to the warehouse and delivered to the respective customer’s distribution cen-ters. Should anything not be 100 percent in order or should problems arise in the

production process, the company must react rapidly and flexibly.

Flexibility is key

The really tricky cases – such as those in-volving certification issues at the Federal Institute for Drugs and Medical Devices (BfArM), new product ideas, product op-timization, or stability tests – are handled at Lichtenheldt’s Development & Sup-port department. Most of the 12 employ-ees there are chemical laboratory tech-nicians; the remainder are chemists and pharmacists. The stability tests in partic-ular require a lot of time. The continual control of the medication quality as an element of “good manufacturing prac-tice” is intended to show that the product is stable enough to achieve the declared shelf life and that the ingredients are present in the required concentration. The process can take weeks, depending on the product and the package size. “Meeting delivery dates is everything,” says Paulig. “We aren’t magicians. There are two main reasons for our success: We supply everything from a single source, and we are extremely flexible in the way we react to customers’ wishes.” That’s another reason why the detailed produc-tion planning in Wahlstedt seldom ex-tends over periods longer than one or two months – even though the company’s or-der books are full. Björn Wölke

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InsIght    Logist ics

52 Dräger review 102 | May 2011

A high-bay warehouse at Dräger in Lübeck  is one link in a complex supply chain.

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 “You want it, we’ve got it!”order delivery is one of the last stages in the manufacturer’s value chain – and one of the first in the customer’s. the use of supplY chaIn management helps Dräger ensure a smooth flow of goods – as is perfectly illustrated in the area of transport.

L ogistics specialists always get the toughest assignments. “Our com-pany pledges to deliver all equip-

ment by the date that is agreed to upon receipt of the order,” explains Jan F. Römer, Head of Transport & Warehouse Management at Dräger in Lübeck. “If there are any delays in the procurement of materials or in the production itself, then we may be able to make up for a couple of days’ lost time.”

Together with about 70 co-workers here in Lübeck, Römer is one of the links in the Dräger supply chain, which serves both of the company’s divisions and stretches all the way from the manu-facturer to the customer. The progress a product makes on this journey is indi-cated by milestones. At each stage, every-thing depends on the right items being in the right place at the right time. This is essentially what supply chain manage-ment is all about – ensuring that materi-als and goods arrive on time. “It’s some-thing that should take place without anyone noticing. That’s a sign that it is functioning properly,” says Römer.

His job begins with an incoming or-der and ends with delivery to the cus-tomer (outbound), which can some-times include assembly or installation. Logistics is a broad field, and the respon-sibilities involved also range over a wide spectrum. Römer’s duties start in the dispatch warehouse. Working in close coordination with the order processing department, the members of his team are notified as soon as an order is re-ceived – as early as the tendering phase with major contracts – and they can start

planning all the steps involved in trans-port and delivery. Last year, they handled well over 20,000 pieces of equipment, not including a host of small parts and replacement parts.

Dates the customer can trust

Almost all the equipment supplied by Dräger is manufactured to order and to the customer’s individual specifications. This can mean that various accessory items only get added to the shipment shortly before it leaves the warehouse. This is also where packaging takes place, at times on pallets that are customized in-house for specific types of instru-ments and devices and feature modi-fications such as shock absorbers. The shipments are then handed over to the carrier, together with all the necessary documentation.

Before studying at the German For-eign Trade and Logistics Academy, Römer trained and worked as a forward-ing agent, a job which took him to Hong Kong for a year and gave him a solid prac-

Jan F. Römer and about 70 co-workers    ensure fast, reliable delivery of goods.

tical grounding. “You want it, we’ve got it – that’s our motto,” he says. “But it all depends on the price and what the cus-tomer really needs!” That’s something Römer often needs to figure out first. “If the customer simply names a date, we can almost always do that. But if ship-ping costs are going to explode as a re-sult, we’ll suggest cheaper alternatives.” That gives the customer a choice, since slightly faster delivery can often make costs skyrocket without there being any corresponding value.

Once such issues are resolved and the shipments are packed and ready for transport, they are collected from the Dräger location by truck. If the ship-ment is by air, as is often the case, the carrier must be certified and the ve-hicles subjected to a security audit. By this point it already becomes clear that there is a special bond of trust between manufacturer and carrier. “In the logis-tics machine, each individual cog must intermesh perfectly,” Römer says. Kai Beckmann, Director of the School of Lo-gistics in Kiel, compares logistics to a 4 x 100-meter relay, which is run in a time that’s actually faster than the world re-cord for the 100-meter sprint multiplied by four. This is because the baton hand-off takes place in one flowing movement, just like in logistics, where the delivering company and the receiving company are both properly prepared and have the ex-perience and professionalism to take all eventualities into account.

Cost is therefore a big factor when ne-gotiating contracts with carriers, but not the only one. Even more important for >

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54 Dräger review 102 | May 2011

Dräger are reliability and performance. On the basis of order forecasts supplied by Dräger, the carrier will set up a frame-work agreement with air freight compa-nies. Being able to make optimal use of booked capacity is one of the secrets of a successful shipping operation.

Freight costs depend on supply and demand

This market is driven, to a greater de-gree than most others, by supply and de-mand – a fact strikingly evident in what are very asymmetric shipping costs. Last year, for instance, the cost of sending one kilogram of air freight from Germany to China fell to below 10 cents, whereas the reverse route was practically never cheaper than two euros. “The Chinese are tremendous exporters, but they im-port relatively little themselves,” ex-plains Römer. Such discrepancies are only remarkable at first sight, though, and there is a similar situation, if in re-verse, when it comes to shipping costs between Germany and Brazil. Natural disasters can also send prices through the roof without warning. “Last year the ash cloud from the Eyjafjallajökull volcano in Iceland grounded air traffic throughout most of Europe for about a week. After that, there was a big back-log to work through, which had an im-pact on delivery schedules and prices,” Römer recalls.

Once the device or piece of equip-ment has arrived in its country of des-tination, customs clearance poses the last big hurdle before delivery to the cus-tomer. “For example, we have to supply

customs with a very precise description of what the product does,” says Römer. “That’s because import tariffs are also based on the class of goods to which it belongs.” The shipment also must be ac-companied by the full set of documents required for customs clearance. And the regulations governing which documents have to be provided often change. “We have to be up-to-date for every country,” Römer says. And is there sometimes chi-canery by customs authorities? Römer answers diplomatically and merely ex-plains how exceptional circumstances can generate extra work. Since 9/11, for example, all shipments to the U.S. have to be registered with U.S. customs be-fore being sent. “And it took a little lon-ger to clear customs in China during the EXPO in Shanghai – more than likely be-cause of the higher volume of freight,” says Römer.

Customs authorities can also exercise their right to inspect the goods. This can mean scrutinizing a piece of equipment literally down to the very last screw – to determine, for example, whether its function actually corresponds to that specified in the freight documents. Af-ter clearing customs, the instrument or device can be delivered to the customer, who would be less than satisfied if the shipment were simply deposited on a pal-let at his doorstep, as Römer explains: “Customers like to have the equipment properly installed and ready for use.” His team therefore coordinates the timing with technicians from the local Dräger branch, who are on hand to take receipt of the product, unpack it, hook it up, and

commission it. The carrier, meanwhile, is responsible for taking the packaging away. Delivery of replacement parts, by contrast, is much faster – as it has to be, since downtimes for medical equipment need to be kept to an absolute minimum. To fulfill this service, Dräger has two dis-tribution centers – one in Memphis for North America, and one in Frankfurt for the rest of the world – from where spare parts are often delivered overnight.

Right into the trunk of the service technician’s vehicle

Overnight delivery is available in 17 Eu-ropean countries, for example, where orders received by no later than late afternoon are delivered early the next morning. This can be a complex oper-ation, although the last few miles are often much more tricky than air trans-port from Frankfurt, which is very rou-tine. As soon as the spare part arrives at the destination airport, it is collected by the designated night carrier and then deposited either directly into the trunk of the DrägerService technician’s vehi-cle or into a special drop box. “He has a key for the trunk, so he doesn’t have to wake the technician,” Römer explains. In some cases, more parts are sent than might at first seem necessary, to ensure that nothing is missing. Superfluous parts are collected later by the carrier.

The annual freight costs at Dräger amount to tens of millions of euros, with logistics costs accounting for, on average, between two and three percent of the price of each device or piece of equipment. It is possible to realize sav-

Up-to-date information, including customs requirements, is a must in the logistics business

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Logist ics     InsIght

55Dräger review 102 | May 2011

Logistics also depend on human skills such as logical thinking and attentiveness.

small parts such as accessory items and spare parts demand extra concentration.

ings that wouldn’t compromise service quality? In recent years Römer has re-peatedly shown that this can be done. “Negotiating new prices with carriers is certainly one way,” he says, “but even more important is to reduce inventory, avoid unnecessary transport, and, last but not least, enhance our processes.” If all that sounds a little abstract, an expla-nation of the spare parts business sheds light on the matter: “In the past, each foreign branch used to stock spare parts. That meant not only maintaining a large and costly inventory but also having to monitor the shelf life of a lot of parts, such as Dräger tubes” (cf. Dräger Re-view 100, p. 28 ff.). Having the two dis-tribution centers in Frankfurt and Mem-phis – “Every year we consider opening one in Asia as well,” Römer says – not only slashes costs but also boosts service qual-ity while still ensuring equally fast deliv-ery to customers.

But the work never ends for Römer and his team, partly because the condi-tions of the job are always changing. This calls for keeping a cool head and com-ing up with solutions that fulfill a vari-ety of needs. Römer believes the key as-pect of this highly rationalized business remains the human factor: “Lots of the know-how involved in logistics is stored in the heads of our staff and of our busi-ness partners.” To ensure fast, reliable, and cost-effective delivery, these people must be able to combine up-to-the-min-ute information from a variety of sources at any time. Imme  Ubben

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ADVANCED TRAINING WEBINARS

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“The Conference Comes to You”Sharing knowledge, forming professional networks, overcoming borders – INTERNET-bAsED sEmINARs are proving to be a valuable innovation. the new Dräger webinars confirm educational researchers’ experience.

One of our cardiac surgeons al-ways says: “Do it now!” Dr. Dirk Schädler, an anesthesiolo-

gist based in Kiel, Germany, agrees with his colleague’s motto. It was thus no sur-prise that when he was presented with the chance to try something new – to address an invisible audience – he jumped at the opportunity. Some of his listeners, how-ever, were at the other end of the world.

Given that the event consisted of a pre-sentation in an area in which Schädler feels at home – automatic weaning from mechanical ventilation – and a group of in-terested listeners well versed in the sub-ject, it wasn’t really much different from a conference presentation, was it? “Totally,” says the physician. “At a conference, I look around the room, see faces I know, and adapt my presentation to their reactions.” This time, however, Schädler was standing in front of a microphone in Lübeck, Ger-many, speaking to the world – live, without editing or repeated takes. Radio revolution-ized the world decades ago; the Internet with its boundless communication possi-bilities is doing the same thing today – espe-cially when it comes to learning and trans-ferring knowledge.

Dirk Schädler’s medical webinar – a seminar on the Internet – is an example of

how things are changing. He was follow-ing in the footsteps of the U.S. firefight-ers who described the dangers of toxic fire gases in a well-received webinar last year (see Dräger Review 101, p. 32 ff.). Similarly, Wolfram Windisch, a profes-sor from Freiburg, Germany, described the current state of non-invasive ventila-tion technology for patients with chronic obstructive pulmonary disease in his re-cent webinar (see: www.draeger.com/customer-webinar).

Overcoming borders

Digital presentations have developed in-ternationally into a valuable extension of conventional forms of teaching and infor-mation sharing. More than 250 leading universities, from Harvard and the Massa-chusetts Institute of Technology in Boston to the African Virtual University in Nairobi, offer courses and lectures via the Internet. And Apple’s iTunes Store, the world’s larg-est media shop, operates a very successful free area for education and training: the iTunes University. The difference between these events and the Dräger webinars is that participants cannot attend live. The download involves events that have already taken place. The webinar, in contrast, of-fers a “real presentation,” with time for

questions from the global auditorium. It’s only after this interactive live event that the knowledge shared becomes perma-nently available in the form of downloads from the Dräger website.

As Schädler stepped up to the micro-phone at the end of September 2010, his audience included colleagues in Thai-land, Vietnam, Africa, America, and Eu-rope. “Every continent was represented,” says Berna Weyer, Marketing Manager at Dräger. As far as the users were con-cerned, the conference was just like a pre-sentation with slides prepared by the ex-pert, who presented them and explained their content over the Internet. This form of presentation has now been established at companies for years. And studies show that it works. Educators have studied it, particularly at U.S. universities, which ad-opted webinars in the early stages. Studies show that new information produces the greatest learning impact when listeners take their own notes while following a pre-sentation live. The opportunity to ask ques-tions on the basis of these notes reinforces the knowledge they have just acquired.

This learning technique is just as possi-ble during a live webinar as it is in a lecture theater. “That’s why we also say: the con-ference comes to you,” says Dräger Product

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webinars     RepoRt

Manager Stefan Mixa, who organized Dr. Schädler’s webinar. The same is true of the content. “Dräger makes these events possi-ble – we are the facilitator,” says Mixa. “The content, however, is physician speaking to physician.” Mixa’s colleague Karin Deden, who helped organize Professor Windisch’s webinar, adds, “It was fascinating for our speakers to address a community of inter-ested participants in Spain, Saudi Arabia, Japan, and beyond.” The common profes-sional background overcame all borders.

The technical system that brings to-gether professional users from around

the world is designed so that the mem-bers of the audience do not need com-plex technology. Data-intensive video is not used; only the slides and sound are transferred. Nor do they need a micro-phone or a webcam to participate in the question and answer session at the end – which turned out to be a very pop-ular feature of both Schädler’s and Win-disch’s webinars. A keyboard is all that’s required. Research shows that people are more comfortable typing a question in their non-native language than asking a question.

According to a post-webinar survey, parti-cipants were very enthusiastic. More than 98 percent of the respondents would par-ticipate in another webinar, and almost as many intended to recommend webinars to their colleagues. The webinars are even available in locations where the techni-cal requirements are still relatively unsta-ble. “Some Asian countries have asked us to burn the webinars onto DVDs because local connectivity problems have arisen during the event,” says Weyer. “Of course we’re always delighted to accommodate such requests.”  Silke Umbach 

All together: Webinars connect their participants like a network of nerve cells. they all benefit together, not only from  the presentation itself, but also by evaluating individual practical cases from around the world.

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IMAGING    IntensIve Care

58 Dräger revIew 102 | May 2011

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A Gentle Look Into the Lungsto operate ventilators in a manner that is correct for each patient, doctors need reliable data on the DISTRIBUTION OF VENTILATION in the lungs. now, thanks to electrical impedance tomography, Dräger is delivering this information directly to the patient’s bedside – with no radiation and in real time.

What happens inside a person’s body? And how can these pro-cesses be quickly and gently

measured? These important insights are provided by various electro-medical techniques.

One example is pulse oximetry, which makes it possible to determine the level of arterial oxygen saturation. A clip fastened to a finger, toe, or earlobe determines the attenuation of certain wavelengths of light as it passes through these parts of the body. This technique was almost completely unknown 25 years ago. But today it is a standard pro-cedure used in emergency medicine, in-tensive care, and neonatal care. And it’s also used by amateur pilots and moun-tain climbers, for example, to prevent al-titude sickness.

Or take bioimpedance analysis, which competitive athletes use to moni-tor their fitness. The technique uses electrodes attached to the hands and feet to measure the resistance to the flow of electrical current through tissues (“im-pedance”). These measurements make it possible to draw conclusions concern-ing ratios of fatty tissue to muscle within seconds, allowing fine-tuning of train-

ing and nutrition concepts for the next competition.

Diederik Gommers, an anesthesiol-ogist, was among those who searched for years for guidance of fine-tuning re-spiratory care. Dr. Gommers is the Vice Chairman of the Adult Intensive Care Unit at Erasmus Clinical Center in Rot-terdam, the Netherlands. His work there has confronted him many times with the question of how to heal lung dam-age suffered by patients. The theory be-hind the Open Lung Concept provides important usage patterns for this effort. Relying on this concept, collapsed (“at-electatic”) regions of the lungs can be made accessible again for gas exchange, using targeted recruitment maneuvers with temporarily high inspiratory pres-sure. These lung regions can then be sta-bilized by applying a lower, end-expira-tory pressure level. The end-expiratory lung volume corresponds to the quan-tity of air that remains in the lungs af-ter exhaling.

New technique provides insights

Practical implementation of this theory had long proved difficult, however. “For the doctor to ventilate with the right

pressure at the right time,” explains Dr. Gommers, “he or she has to know pretty quickly how the lungs respond to the individual recruitment maneu-vers.” Established measurement meth-ods haven’t been up to that job. Com-puter tomography (CT) does provide a very detailed image of the lung morphol-ogy, but the patient must be transported from the ICU to the radiology depart-ment. In addition, continuous measure-ments can’t be taken because CT uses X-rays, which can be harmful.

Measuring the functional residual capacity (FRC) also does not provide sufficient information. It only indicates the extent to which the lung volume has changed as a result of the targeted re-cruitment maneuvers. With FRC the end-expiratory gas volume is measured at specified intervals. A key question remains: Is the increased FRC due to reopening of atelectatic lung regions or to a dangerous overdistension of alve-olar volumes that are already opened? FRC thus provides the doctor with clues, but no real guidance.

Dräger decided to take a new ap-proach, collaborating with Gommers and other leading intensive care

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59Dräger review 102 | May 2011

physicians to test electrical impedance tomography (EIT). Their work was a success: “EIT has been used in hospi-tals and has proven to be an efficient method for treating patients with seri-ous pulmonary conditions, in a way that prevents consequential damage from taking place,” says Gommers. “Espe-cially in difficult cases where a doctor has to act quickly, EIT provides up-to-date information that hadn’t been avail-able to us in the past.”

Measuring with 16 electrodes

EIT makes use of the fact that the air content of the pulmonary tissue influ-ences the tissue’s bioelectrical prop-erties. The more air contained in the pulmonary tissue, the greater the im-pedance. But the story doesn’t end there: Continual measurements make it possi-ble to ascertain the ventilation distribu-tion in the lungs both chronologically and spatially, enabling immediate con-clusions regarding the processes at work there.

To determine the impedance, an ar-ray of 16 electrodes is placed around the patient’s chest. Tiny electrical currents are then applied to the body through one

The PulmoVista 500: Sleek design, intuitive operation, and easy visualization – it took a lot of research to go from the measurement concept to the medical device.

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60 Dräger review 102 | May 2011

electrode pair at a time, and the result-ing voltages at the remaining electrode pairs are measured. Because the posi-tion at which the current is applied to the body during EIT rotates around the chest, the voltage measurement loca-tions also change. As a result, the mea-sured values obtained after one 360° rotation can be used to compute a to-mographic image that provides informa-tion about the distribution of air in the ventral and dorsal lung regions.

More effective in real time

To resolve the change in the distribu-tion of air with respect to time, EIT requires more than just one snapshot. Instead, up to 50 images are captured per second, and ventilation is continu-ously displayed in a manner similar to that of an old-fashioned cartoon film. In one respiratory cycle lasting approxi-mately three seconds, a sequence of up to 150 images is created, showing the ventilation distribution in the lungs. The EIT concept has been known for a long time, and since the 1980s there have been repeated attempts to use the method for everyday applications in hos-pitals. But it nevertheless took decades for this idea to lead to a product mature enough to be marketed.

Why has Dräger succeeded now? “Because we made ease of use a very high priority during the development of the new PulmoVista 500,” says Product Manager Eckhard Teschner. “That in-cludes everything from the easy-to-use electrode belt to the clear display of the measurement results, which we were

able to optimize again and again – also thanks to the close cooperation with us-ers around the world.”

Exact placement of the electrodes is crucial for getting good data from an EIT measurement. Early prototypes called for affixing 16 individual electrodes to the patient’s chest, which resulted in a confusing tangle of wires and height-ened the risk that individual electrodes could become detached from the skin. And it often took longer than a half hour to attach them all. That’s why Dräger in-tegrated the electrodes into a silicone belt, which has two main advantages: The belt standardizes the measuring ar-rangement and cuts the time needed to attach all the components down to just a few minutes. All that’s needed is to lift the upper body, pass the belt un-der the patient’s back, and fasten it at the front of the body. Then you can start measuring.

Another point of emphasis was the need to design the measuring and anal-ysis technology in a way that would en-sure that the relevant signals would be clearly distinguishable from interfer-ence in the form of noise. The problem is that the changing volume of air in the lungs causes changes in the imped-ance, which are – in relation to the ef-fects that can be produced outside the lungs – relatively minor. Dräger invested tremendous effort in developing a sensi-tive and robust electronic measurement device and its associated software. The speed of the impedance calculation is also a key factor. And last but not least, the display of the measurement data in

real time considerably boosts the prac-tical value of EIT.

The same applies to the clear pre-sentation of measurement results. The experts in Lübeck therefore visualized each individual tomogram at first as a color-coded image in the colors black, blue, and white. White represents the best-ventilated regions of the lungs, while nonventilated regions appear in black. The blue areas represent sections that are in a transitory phase between black and white or vice versa.

Finally, arranging the individual to-mograms sequentially results in a color-ful film that shows how these areas grow and recede in the rhythm of the patient’s respiration. This approach makes it pos-sible, over the course of many respira-tory cycles, to see if and how the healing process in the lungs is progressing. With early prototypes, the only way to display this trend indicator was with the help of external computers, making interpreta-tion of the measurement results – which included storing, copying, and process-ing – a considerably slower process. But with PulmoVista 500 the display comes at the push of a button and right at the patient’s bedside.

Crucial help from trend indicators

The great importance of being able to quickly access the trend indicators was shown by the beta tests Dräger carried out in the fall of 2010. The primary aim was to prove that the instrument could perform as expected in everyday use in hospitals. One member of the test team was Helena Odenstedt, an anesthetist

The trend indicators provide all the healing process-related data at a glance

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www.draeger.com/102/eit

and Head of the Surgical Intensive Care Unit at Sahlgrenska University Hospital in Gothenburg, Sweden. The unit cares for about 2,500 patients a year, people who must be mechanically ventilated fol-lowing major surgery. This is challeng-ing because the ventilators must be indi-vidually adjusted for each patient.

This is made much easier by the trend indicators of the PulmoVista 500. “With this instrument we gain entirely new insights into what is happening in the lungs,” said Dr. Odenstedt after the tests were concluded. “And the PulmoV-ista 500 enables us to optimize the fine adjustment of the ventilators right at the patient’s bedside.”

An attractive investment

Dr. Odenstedt was also positively sur-prised by the 15-electrode mode, which makes it possible to generate the EIT im-ages with only 15 electrodes instead of the 16 that are usually needed. This feature is of great help when a dressing has to be placed on the patient’s chest – for ex-ample, after inserting a drain – and the dressing prevents one of the EIT elec-trodes from making contact with the skin.

Will Dr. Odenstedt use the device when it becomes available on the mar-ket in mid-2011? “In the final analysis that comes down to a question of cost,” she says. “But if we are able to afford it, I believe it would be a sound invest-ment.” Frank Grünberg 

The helper’s helper: The 15-electrode mode generates an EIT with just  15 electrodes instead of 16. That’s very helpful when doctors have to place  a dressing on a patient’s chest.  

Trend analysis: With the PulmoVista 500, comparison of ventilation images that   have been taken at various times can be used to draw conclusions concerning the lungs’ healing process – at the push of a button, at the patient’s bedside.

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Digital Team Spiritwhat we have long known about people also applies to machines: They may be strong alone – but together they are even stronger. The University of Lübeck is examining possibilities for the ad hoc networking of SenSorS even in adverse environments – and thereby pursuing the vision of protecting human life more effectively through targeted information.

Chemistry means loud booms and bad smells. This might be a run-ning joke for high school stu-

dents, but it is a real danger faced every day by adults working on oil platforms and in refineries and chemical plants. For example, if a gas detector suddenly sounds an alarm, people know it is time to get away – and quickly. However, this information is very limited in its scope. The alarm does not tell you the direction from which a toxic wind is blowing, or where a fire may be about to start. And

in the most tragic cases, the information fails to reach the victims in time. Stefan Fischer, a professor at the University of Lübeck, is searching for alternatives to such alarm systems. “We’re studying sen-sor networks that sound an alarm at a very early stage and provide extensive in-formation,” he says.

From lone wolf to team member

Fischer, 43, is the director of the universi-ty’s Institute for Telematics and an expert on combining digital lone wolves to form

effective teams. The idea is to have indi-vidual sensors make their specific capa-bilities available to overarching networks that can provide more and better infor-mation than any single component ever could. Computer scientists refer to these as “wireless sensor networks,” or WSN. Fischer’s institute is one of the facilities that develops the software protocols, al-gorithms, and applications needed to op-erate such networks.

These networks offer great benefits for safety systems. Among other things,

ouTlook SenSor neT workS

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SenSor net workS     OutlOOk

63Dräger review 102 | May 2011

WSN can make work in the chemical and petrochemical industries much less dan-gerous. While it is true that stationary gas warning systems are already employed in these sectors, they usually aren’t in-stalled at temporary construction sites. And mobile sensors are often attached to relatively long cables which are also used to obtain energy and transmit in-formation. As a result, they’re not always ideal on rough terrain or in bad weather. “In order to achieve the greatest possible flexibility, the sensor networks must or-ganize themselves and be able to commu-nicate wirelessly,” Fischer explains. “In the extreme case, it must be possible to literally throw them out of an airplane and know they’ll take care of the rest.”

The advantages here are obvious. Self-organizing sensors can be set up rap-idly in any environment, and they can op-erate for only short periods of time if so desired. In the event of danger, they ex-

tend the warning period and improve the quality of the information provided. In such a setup, the first device to detect a gas leak or a fire sends the alarm to the entire network, which then adds per-tinent information as the process con-tinues. In certain situations, every other sensor in the network will contribute its own data – i.e., the first one might pro-vide data on oxygen content, the second on wind direction, the third on wind speed, and so on. The control system can then calculate an emergency plan at lightning speed and issue life-saving commands to affected personnel.

That’s the idea, at least – but the real-ity is still very different from what the re-searchers have in mind. The main prob-lem involves the energy that is needed for the mobile, autonomous sensors that communicate wirelessly. After all, a socket is not always available for quick recharging. Coating sensors with solar

Data is generated everywhere – but only 

networking can provide the big picture.

cells doesn’t help if the units need to be used in shady areas or in the dark. That’s why most sensors get their energy from either disposable or rechargeable bat-teries. However, the capacities of these batteries are quite limited, and that in-creases the risk of sensor failure, thus lowering the system’s reliability. Experts are therefore now developing highly effi-cient radio sensors.

uninterrupted networks

That’s far from the whole story, how-ever. Further requirements are as fol-lows: The radio sensors must be easy to operate and meet extremely stringent safety standards; the electronics must be able to function even in highly explo-sive environments; and it must be impos-sible for hackers to crack sensor codes, or for jamming stations to trigger a system failure. Data also needs to be channeled through the network so flexibly that an >

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64 Dräger review 102 | May 2011

alarm signal won’t be lost – even if an in-dividual node fails. Finally, the technol-ogy must be affordable in terms of both production and maintenance. The latter also includes remote maintenance op-erations in which repair programs and new software versions are sent out over the wireless network, thereby eliminat-ing the need for high-priced specialists to address issues.

There are still more questions than answers, but the situation is slowly im-proving. For example, the “Internet En-gineering Task Force” (IETF) standard-ization body has approved the 6Lowpan Internet protocol, which is designed es-pecially for wireless data transmission between very small mobile computers. In its basic version at least, the commonly used Internet protocol TCP/IP doesn’t offer much help with the management of self-organizing sensor networks be-cause it utilizes routines that require a relatively large amount of electricity and storage capacity.

More efficient diagnosis

An increasing number of research teams are now working to make the potential offered by WSN networks available to a broader audience. One thing they’re do-ing is using easily understood interfaces to depict sensor control commands that are normally programmed in a machine code that may save energy but is also very difficult to understand. “After all, the im-portant thing is that the people on site must be able to work with the systems,” says Fischer, who together with his team has set up a test network consisting of

several hundred sensors on the campus of the University of Lübeck. Developers from around the world can log on here to test their software. Dräger is taking advantage of the opportunities offered by the network to refine its mobile WSN gas-warning system. Sensor networking is also becoming more and more impor-tant for Dräger’s medical research ac-tivities as the number of operating room devices that generate large amounts of different types of data continues to in-crease. The full potential of all this data can only be realized if it’s rapidly and systematically condensed into useful information.

For example, the combination of data from patient monitoring systems, breathing gas analysis units, anesthetic gas dosage devices, and ultrasound and magnetic resonance equipment can pro-vide physicians with new starting points for the diagnosis and treatment of spe-cific patients. It is also conceivable that data from an operating room microscope could be directly linked to a remote con-trol unit for a surgical tool. The problem here is that, depending on the device and the manufacturer in question, the data is transmitted in different formats, which makes machine-to-machine communi-cation much more difficult. In fact, pro-prietary interfaces have been developed a long time ago, but the variety of formats has limited the adoption of these “inter-preter concepts.”

In an attempt to develop new approaches to address this problem, Dräger, the University of Lübeck, and a large number of companies and

Body area networks will transmit vital patient data to physi- cians in the future

Test network at the University of Lübeck: The potential of sensors can only be fully realized when they are used in networks. Professor Stefan Fischer and his team are developing such networks of the future.

>D-11118-2011

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SenSor net workS     OutlOOk

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organizations are now participating in the TeKoMed project. Their pri-mary focus here is on a service-oriented architecture (SOA) in which each device offers its functionality externally in a standardized form. Standardization ensures that other devices which are interested in this “service” will know how to use it. The project, which was launched in 2007 and runs until the end of 2011, examines how various data sources based on SOA technology can be networked reliably and in real time. The project also addresses how SOA can help automate processes in operat-ing rooms, for example, and what role established Web service technologies can play in all of this.

the new body network

TeKoMed is expected to produce ground-breaking results that will form the start-ing point of a long chain of innovations. It is hoped that these innovations will not only improve digital communica-tion in operating rooms and refiner-ies (and thus protect people more ef-fectively), but also form the basis of new types of body area networks (BAN). The latter consist of sensors that mea-sure parameters such as blood pressure, pulse, and the oxygen content of the air breathed by the patient and then trans-mit the data directly to physicians. All of these advances still sound very futuris-tic. “Nevertheless,” says Fischer, “these sensor networks have the potential to cre-ate completely new types of applications and services for medical and safety tech-nology alike.” Frank Grünberg

Networks consisting of linked sensors enhance safety on drilling platforms as well.

It is advisable for safety systems to be backed up by an effective sensor network.

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NEWBORNS    BABY ANIMALS

66 Dräger revIew 102 | MAY 2011

 Bearing Up Nicelywhen a female panda in the Madrid Zoo had tWiN cUBS, zookeepers had to play hide-and-seek with the mother so that the cubs could survive the first crucial days – with the help of an incubator from Dräger. This is the story of a european premiere.

A star waves at his enthusiastic fans: Panda cubs are a sweet sensation.

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67Dräger review 102 | May 2011

Double happiness: A second panda cub was born two hours after the first one.

Hua Zui Ba is a celebrity. She plays the starring role in a series of vid-eos on YouTube, has several do-

mestic servants, and even entertains visi-tors from the royal family of Spain. But when you get right down to it, the seven-year-old female panda at the Madrid Zoo isn’t really impressed by all the publi- city. Hua Zui Ba, or “Flowery Mouth” in Chinese, has very simple needs and, like all the other members of her species, is something of a loner.

However, not so long ago she sud-denly emerged from her sheltered life af-ter giving birth to two cubs in September 2010. Media all over Spain and abroad re-ported on the blessed event, for pandas are still an endangered species. Accord-ing to the latest estimates, today there are fewer than 2,000 free-ranging pandas in the world. All of them live in reservations in their native country, China.

Only eight pandas live in European zoos today; in addition to the four in Ma-drid, there is a family consisting of two parents and a cub in Vienna, as well as the 33-year-old childless senior Bao Bao in the Berlin Zoo.

Double happiness trumps apathy

“The birth was a moving and significant event,” says Maria Delclaux, the cura-tor who is responsible for mammals at the Madrid Zoo. “It was the first time in Europe that both cubs from a twin birth were successfully kept alive – thanks to months of hard work!” After a moment of silence she adds, “Let’s not forget that the birth of baby pandas is a rare and happy event in itself.”

The mating season for pandas lasts only two or three days a year, sometime be-tween March and May. During this time, the females emit a special scent and keep a special mating call in reserve.

The ten-year-old male Bing Xing (“Ice Star”) who shares the 1,200-square-meter enclosure with Hua Zui Ba was certainly aware of these seductive signals – but, as in previous years, his phlegmatic na-ture won out. “The male simply couldn’t be bothered to respond,” says Delclaux. “This kind of behavior is quite typical of macho panda males.” As a result, Hua Zui Ba had to be artificially inseminated.

The first two or three months of a panda pregnancy are a nerve-racking time, because only at the end of this pe-riod is the fertilized egg cell implanted into the uterine wall. After this obstacle was overcome, the zoo personnel in Ma-drid grew increasingly confident.

Starting two weeks before the due date, a video camera was used to observe the mother-to-be around the clock. But in spite of all the technology, no one real-ized that Hua Zui Ba was carrying twins. “In the advanced stages of her pregnancy she increasingly kept to herself, so we couldn’t make any more ultrasound ex-aminations,” Delclaux recalls. “That’s why the birth of twins was a big surprise for all of us.”

For an unprepared observer, the video of the birth is very dramatic be-cause by comparison with the mother, who weighs over 90 kilograms, a baby panda is very tiny at birth. A hairless, glossy whitish lump, it weighs just over 100 grams – on average, that’s only one

eight-hundredth of the mother’s weight. This difference in weights sets a record among the advanced mammals.

Sometimes mother pandas carry their newborns around by holding them in their mouths – a habit that might make an observer shudder. But the mother then immediately starts nursing her offspring in a way that seems almost human.

“The second baby panda was born two hours after the first one,” says Del-claux. “It was a surprise for us, and of course it was a happy one – but we had to intervene immediately and take it away from Hua Zui Ba.” Female pandas, who are single mothers by nature, as a rule do not have sufficient resources to raise two offspring at once. If twins are born to a free-ranging panda, one of the new-borns is normally abandoned.

That’s why the second baby panda was placed in one of the zoo’s incuba-tors a few minutes after it was born. Soon after that, it was moved to a Caleo in-cubator made by Dräger. “The temper-ature and humidity can be much more precisely set and regulated in the Caleo,” says Delclaux, “and we wanted to keep the risk to the very sensitive baby panda as small as possible.”

Both twins survive

The incubator, which was actually de-signed for neonates, can also be used without any problems for baby animals. The only difference is that the temper-ature and humidity values need to be adjusted according to the species in question. >

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68 Dräger review 102 | May 2011

Eye to eye with the Queen of Spain – pandas are always good for a state occasion

The Madrid Zoo staff immediately pumped off some of the mother’s colos-trum for the second baby panda, and then began to implement their own success-ful plan for raising twin pandas. From now on, the babies were alternately given to their mother for nursing for three to four hours apiece. The switchover was al-ways done secretly, and Hua Zui Ba never seemed to notice the difference.

During the short periods when she wasn’t nursing, Hua Zui Ba was given small amounts of honey and grapes. Such treats are not part of a panda’s normal diet, but they were happily accepted. “We had to fool Hua Zui Ba,” Delclaux admits.

“She can’t take care of two offspring by herself. But we can make sure that both babies survive.”

Even three months after the birth, Hua Zui Ba still didn’t know about the little trick that had been played on her for the sake of the species – a trick that succeeded thanks to the state-of-the-art incubator that was used. The small dif-ferences between the two twins are now more obvious to the zoo’s staff members than to their own mother.

The pandas remain Chinese

The baby pandas and the Caleo were first presented to the public on October 7,

2010, a month after the birth. Visitors to the zoo could now admire the tiny bears through a glass wall from a distance of two meters. The twins now weighed al-most a kilogram each and bore their characteristic color pattern: black legs, a black band across the shoulders, black ears, and black-rimmed eyes.

They could not yet look back at their admiring fans, because baby pandas open their eyes only 40 to 50 days after birth. However, when Queen Sofia of Spain vis-ited the glassed-in nursery on November 5, the baby pandas were able to look her in the eyes. The Queen petted the two lit-tle bears and briefly held them up to be

What is it like to be a panda? The philosopher Thomas Nagel asked this question about bats and concluded that human beings and animals live in completely different worlds and know nothing about one another. But pleasant illusions die hard...

>

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BABY ANIMALS     NEWBORNS

69Dräger revIew 102 | MAY 2011

filmed by the TV cameras positioned be-hind the glass wall.

Her Highness’ affection had a very personal background. The transfer of the twins’ parents, Hua Zui Ba and Bing Xing, to Spain in September 2007 was partly the result of the royal couple’s of-ficial visit to China the previous June.

During their stop in Chengdu, the capital of Sichuan province, King Juan Carlos and Queen Sofia visited the Chengdu Research Base of Giant Panda Breeding and signed an agreement re-garding the pandas’ transfer to the Ma-drid Zoo. Three months later, when a special airplane delivered the pandas in Madrid, almost 200 journalists were waiting at the airport. The zoo received two new stars, and in the following year the number of visitors increased by more than ten percent. A panda face was inte-grated into the zoo’s logo as early as 2007.

However, in spite of all the local pride, the pandas are still the property of the Chinese state. That applies not only to the parents but also to their twin offspring. Since the 1990s, pandas are permitted to leave their homeland only “on loan.” Zoos that want to house one or two pandas must guarantee that they will run supplementary research and educa-tional projects and pay an annual six-digit fee. This money is used to maintain the panda population in China and to safe-guard their natural habitat.

In view of all these precautions, it should be no surprise that two Chinese experts were flown in from Chengdu to Madrid to assist with the birth of the twins and the necessary postnatal care.

Three months after their birth, Hua Zui Ba’s offspring were moved from the Caleo to a huge wooden cradle. They continued to alternately have direct contact with their mother, but their diet of mother’s milk was supplemented with specially prepared milk from a baby bottle. Not un-til the winter was over were they allowed to leave the heated inner rooms and join their mother on an excursion into the out-door part of the enclosure.

By now the twins have grown their first set of teeth, a feature that will be es-sential for their adjustment to the typical

panda diet of bamboo stems and leaves. By the time the twins are three years old, they will be fully emancipated from their mother and will begin to pursue their typical solitary way of life. At that point they will have to make the long journey back to their parents’ homeland. Only in the distant future will it become clear whether they will one day become stars in another faraway zoo like their parents before them – or whether they have what it takes to be released into the wild to live a hard but free life roaming the high-lands of China. Merten Worthmann

Bearing diplomatic fruitPandas originally populated large swaths of present-day China and Burma, but today their habitat has shrunk to a few areas in the Chinese provinces of Sichuan, Shaanxi, and gansu. A panda’s diet consists almost exclusively of bamboo stems and leaves. Because bamboo contains very few nutrients, a panda must eat about 30 kilograms of it every day. Many forests that used to offer the pandas plenty of food have now been cut down to create agricultural land. The remaining panda population, which is estimated to consist of fewer than 2,000 individuals living widely scattered in the wild, is threat- ened by extinction, not only because of its shrinking habitat but also because of inbreeding and low birthrates. Only recently have programs been established to take some animals raised in captivity and return them to the wild. About 250 animals are now living in zoos or research centers.

Pandas are classified as large bears, but by contrast to the other species in this class they do not hibernate, because they cannot store enough fat to get them through the winter. Through the so-called “panda diplomacy” process which continued until 1984, the People’s republic of China gave a total of 23 pandas as presents to other states. Today the animals are “lent out” only under stringent conditions and in exchange for high annual fees. After neglecting protective measures for pandas for decades, China has now passed legislation that proactively supports measures to preserve the species. The panda sanctuary in Sichuan has been a UNeSCO world Heritage Site since 2006.

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Service   

70 Dräger review 102 | MaY 2011

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, 2011. all rights reserved. This publication may not be reproduced, stored in a data system, or transmitted in any form or using any method whether electronic or mechanical, by means of photocopying, recor ding, or any other technique in whole or in part without the prior permission of Drägerwerk ag & Co. Kgaa.

Dräger Medical GmbH, Lübeck, is the manufacturer of the following products: Savina + Savina 300 (p. 7), Fabius MRI (p. 37 ff.), Ponta (p. 42 f.), PulmoVista 500 (p. 59 ff.), Caleo (p. 67 ff.). The manufacturer of the Infinity M300 patient-worn monitor (p. 7) is Draeger Medical Systems Inc., USA. Dräger Safety AG & Co. KGaA, Lübeck, is the manufacturer of the Dräger DrugTest 5000 (pp. 6, 32 ff.).

corporate HeadquarterS Drägerwerk AG & Co. KGaA Moislinger Allee 53–55 23558 Lübeck, Germany

HeadquarterSDräger Medical GmbH Moislinger Allee 53–55 23558 Lübeck, Germany

Dräger Safety AG & Co. KGaA Revalstraße 1 23560 Lübeck, Germany

auStraLia Draeger Medical Australia Pty Ltd. Unit 97, 45 Gilby Road Mount Waverley, VIC, 3149 Tel 1800 800 327 (AU)Fax 1800 010 327 (AU)Tel 0800 559 186 (NZ)Fax 0800 559 185 (NZ)

Draeger Safety Pacific Pty Ltd. Unit 99, 45 Gilby Road Mount Waverley, VIC, 3149 Tel 1800 67 77 87 (AU)Fax 1800 64 74 84 (AU)Tel 0800 372 437 (NZ)Fax 0800 733 133 (NZ)

p. r. cHiNa Dräger Medical Instrument Co. Ltd. 229 Amber Road 201206 Shanghai Tel +86 21 38 11 60 00Fax +86 21 38 11 60 11

Beijing Fortune Draeger Safety Equipment Co., Ltd. A22 Yu An Rd, B Area, Tianzhu Airport Industrial Zone, Shunyi District, Beijing 101300 Tel +86 10 80 49 80 00Fax +86 10 80 49 80 05

SiNgaporeDraeger Medical South East Asia Pte. Ltd. 25 International Business Park #04-20/21 German Centre Singapore 609930 Tel +65 63 08 94 00Fax +65 63 08 94 35

Draeger Safety Asia Pte. Ltd. 67 Ayer Rajah Crescent #06-03 Singapore 139950 Tel +65 68 72 92 88Fax +65 65 12 19 08

BeLgiuMDräger Belgium N.V. Heide 101780 Wemmel Tel +32 24 62 62 11 Fax +32 24 62 62 01

Dräger Safety Belgium S.A. Heide 101780 Wemmel Tel +32 24 62 62 11Fax +32 24 62 62 01

uNited KiNgdoM Draeger Medical UK Ltd. The Willows Mark Road Hemel Hempstead Hertfordshire HP2 7BW Tel +44 14 42 21 35 42Fax +44 14 42 24 03 27

Draeger Safety UK Ltd. Blyth Riverside Business ParkBlyth, Northumberland NE24 4RG Tel +44 167 03 52-891Fax +44 167 03 56-266

itaLy Draeger Medical Italia S.p.A. Via Galvani 720094 Corsico/Milano Tel +39 02 45 87 21Fax +39 02 4 58 45 15

Draeger Safety Italia S.p.A Via Longarone 35 20080 Zibido San Giacomo (MI) Tel +39 02 90 59 49 1Fax +39 02 90 00 36 86

NetHerLaNdS Dräger Medical Netherlands B.V. Signaalrood 19 2718 SH Zoetermeer Tel +31 79 3464 800Fax +31 79 3422 747

Dräger Safety Nederland B.V. Edisonstraat 53 2700 AH Zoetermeer Tel +31 793 44 46 66Fax +31 793 44 47 90

SwedeN Dräger Medical Sverige AB Ekbacksvägen 22 168 69 Bromma Tel +46 8 564 598 00Fax +46 8 564 598 20

Dräger Safety Sverige AB Ögärdesvägen 19 D 433 30 Partille Tel +46 313 40 90 90Fax +46 313 40 90 99

rep. oF SoutH aFrica Dräger Medical South Africa (Pty) Ltd. PO Box 4676 Rivonia, 2128 Tel +27 11 557 23 00Fax +27 11 557 23 01

Dräger South Africa (Pty) Ltd. P.O.Box 68601 Bryanston 2021 Tel +27 114 65 99 59Fax +27 114 65 69 53

www.draeger.comP

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to see the future of dynamic pulmonary monitoring:

www.draeger.com/pulmovista500

PulmoVista® 500. Making ventilation visible.

Press PLAY

2811

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72 Dräger review 387 | May 2011

Close-up    Fire training

Firemen use this transportable fire container, which features around 40 square meters of exercise space, to practice firefighting tactics. the interior can be furnished in line with specific planned exercises, as shown here, for example. the trainer 1 not only con-trols the fires, which are fed with propane gas, but also monitors the complete facility from a double-walled cabin. He does this op-tically through the heat-resistant glass windows 2 as well as via microphones, video cameras, and gas and temperature sensors. the exercise scenario can either be varied from time to time or repeated in a completely identical way – a feature that would sim-ply not be possible with solid fuels. in the configuration shown here, the firefighters enter via a hatch 3 and are immediately confronted with a fire 4 on the stairway 5 in front of them. Once they have fought this fire, they have to deal with smoke and fumes 6 . Here a thermal imaging camera provides orientation. the camera can also

reveal lifelike, body-temperature dummies, which have to be “res-cued.” the firefighters then have to make their way into the stylized living room 7 , where their task is to put out a sofa fire 8 and a wall fire 9 . a deep fat fryer with burning fat – the type of fire you should never extinguish with water – can also be built into the envi-ronment here. Or the firefighters can take on a fire in an industrial setup. it is even possible to create a flashover 10 – which, of course, can be controlled. the exercise container, which is designed for realistic training, features emergency stop switches in every room entrance and temperature sensors on the walls at a height of one meter. temperature sensors located at the fire positions also moni-tor the success of the firefighting operation. when training is in pro-gress, the facility uses between five and 200 kilograms of propane gas per day, depending on the intensity of the training activities and the number of fire locations used.

 under Fire: Realistic Firefighting Training

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