Resilient Hospital Design: From Crimean War to COVID-19

OBJECTIVES

Serious COVID-19 nosocomial infection has demonstrated a need to design our health services in a different manner. Triggered by the current crisis and the interest in rapid deployable hospital, this article discusses how hospital building layouts can be improved to streamline the patient pathways and thus to reduce the risk of hospital-related infections. Another objective of this work is to explore the possibility to develop flexible and scalable hospital building layouts through modular construction. This enables hospitals to better cope with different future demands and thereby enhance the resilience of the healthcare facilities.

BACKGROUND

During the first wave of COVID-19, approximate one-seventh to one-fifth COVID-19 patients and majority of infected healthcare workers acquired the disease in NHS hospitals. Similar issues emerged during the Crimean War (1853-1856) when more soldiers died from infectious diseases rather than of battlefield casualties in Scutari Hospital. This led to an important collaborative work between Florence Nightingale, who looked into this problem statistically, and Isambard Kingdom Brunel, who designed the rapid deployment Renkioi Hospital which yielded a death rate 90% lower than that in Scutari Hospital. While contemporary medical research and practice have moved beyond Nightingale's concept of contagion, challenges of optimizing hospital building layouts to support healing and effectively combat nosocomial infections still pose elusive problems that require further investigation.

METHODS

Through case study investigations, this article evaluates the risk of nosocomial infections of airborne transmissions under different building layouts, and this provides essential data for infection control in the new-build or refurbished healthcare projects.

RESULTS

Improved hospital layout can be achieved through reconfiguration of rooms and concourse. Design interventions through evidence-based infection risk analysis can reduce congestion and provide extra separation and compartmentalization which will contribute the reduced nosocomial infection rate.

CONCLUSIONS

A resilient hospital shall be able to cope with unexpected circumstances and be flexible to change when new challenges arise, without compromising the safety and well-being of frontline medical staff and other patients. Such an organizational resilience depends on not only flexible clinical protocols but also flexible hospital building layouts. The latter allows hospitals to get better prepared for rapidly changing patient expectations, medical advances, and extreme weather events. The reconfigurability of an existing healthcare facility can be further enhanced through modular construction, standardization of building components, and additional space considered.

Connecting Contemporary Trauma Care to Florence Nightingale's Visionary Work

The impact of Florence Nightingale's visionary work continues to influence the delivery of nursing care in the contemporary emergency department (ED). Her foundational work in the Crimean War resulted in data-based recommendations for using the environment to promote healing and wellness among sick and wounded British soldiers. She advocated for attention to environmental details, including ventilation, air, warmth, drainage, cleanliness, natural light, and low noise levels. These important environmental concepts play a significant role in the nursing management of trauma patients in today's ED. This article features an application of Nightingale's environmental concepts to a trauma patient case exemplar and demonstrates the enduring impact of her work for trauma patients who receive care in the ED.

Skin disease and military conflicts: Lessons from the Crimean War (1854-56)

In the Crimean War (1854-56), infamous for its high death rate from disease at 212 per thousand British troops annually - one third of which was due to cholera or dysentery - skin disease was common, accounting for 13% of all admissions and 4.2% of all deaths. Excluding typhus, skin disease caused 252 per thousand annual admissions and 8.8 per thousand annual deaths, with an overall case fatality of 3.4%. The commonest skin diseases were: localised cellulitis/abscess, ulcer, venereal disease, frostbite, scurvy, eruptive rashes and scabies. The biggest number of skin disease-related deaths were from frostbite and scurvy. Cutaneous afflictions with the highest case fatality were erysipelas (27%), gangrene (25%), smallpox (21%) and frostbite (19%). Problems from frostbite lessened during the better provisioned second winter. The experience of skin disease in the Crimea highlights the importance of public health and personal sanitation to skin health in the military context, and shows that skin-related infections and nutritional deficiencies easily develop if environmental conditions deteriorate.

Britain's forgotten military medical school at Fort Pitt, Kent (1860-1863)

This article considers the history of Fort Pitt (1780-1922), its military hospital (founded 1814) and, in particular, its Army Medical School (1860-63). The museum and library were the work of the hospital's first directors: Dr David MacLoughlin and Sir James McGrigor, the latter the renowned reformer of military medical education. Central to the foundation of the medical school was Florence Nightingale who visited the site in 1856. The school opened in 1860 with five sets of students attending before it was transferred in 1863 to the Royal Victoria hospital, Netley, Hampshire. Fort Pitt was a "practical" medical school with students attending for 4-9 months of clinical experience. This included "instruction in tropical medicine" delivered by members of the Indian Medical Service. The foundation of a military medical school fulfilled an ambition dating back to at least 1796. Nightingale's role (exerted through Sidney Herbert) was omitted from contemporary newspaper reports. Fort Pitt continued as a military hospital until 1922 when it was converted to a school. The medical school constitutes a landmark in British military medicine, a response to the failure of British medical care in the Crimean war (1853-1856) and a forgotten legacy of Florence Nightingale.

[Florence Nightingale was a reference hygienist and statistician for Pedro Felipe Monlau.]

Pedro Felipe Monlau was a prominent Spanish hygienist and defender of the Miasmatic Theory of Diseases. By the nineteenth-century, Spain had not enough health infrastructure. Monlau's publications became a powerful source of transmission of the dominant scientific ideas of European hygienism. Levy, Londe, Villermé, Chadwick, Farr and Smith were personalities who influenced the thinking of the Spanish hygienist. The aim of this paper is to show whether the Florence Nightingale's hygienist doctrine influenced Spain through the work of Monlau. A review of primary documentary sources was carried out and the results were analysed from the hermeneutic perspective. The Digital Newspaper Library of the National Library of Spain was used as the main resource. Monlau referred to Nightingale eleven times. Nine fragments responded to Monlau's Hygienic Aphorisms. He recommended Nightingale's ideas regarding ventilation, lighting and housekeeping, among others. In addition, Monlau suggested the need for hospital statistics following Nightingale's proposal. In this sense, the surgeon Rubio y Galí was a clear example of its applicability in the Institute of Therapeutic Surgery. Monlau also recognized the work of Nightingale in the Crimean War. The results show the need to make women scientists visible in contemporary history, revisiting the biographies written so far.

[Reminiscing the pioneers of modern nursing during Covid-19 epidemic: 200th anniversary of Florence Nightingale's birth]

Before Florence Nightingale, nurses lacked special skills and training. The nursing mainly relied on nurse's religious passion and feelings to carry out nursing activities, and some vulgar and ignorant women took care of the job. Nightingale, who well-educated, born in an aristocratic family, devoted herself to nursing career despite the opposition of her family. She travelled around the world to investigate the hospital and nursing status. Nightingale practiced her concept of nursing work in the Crimean war. After the investigation of the wounded soldiers, she pointed out that the high mortality rate of British soldiers was related to poor nursing. She put forward suggestions to strengthen military nursing education; then she established modern nursing education institutions and created a new nursing education model, which was the beginning of modern nursing career.

Old Tricks for New Dogs? John Caddy and the Victorian Origins of TCCC

The success of Tactical Combat Casualty Care (TCCC) in reducing potentially preventable combat deaths may rely on both specific interventions (such as tourniquets) and the systematized application of immediate care. Essential elements of a combat care system include clear specification of immediate care priorities, standardized methodology, and inclusion and training of all nonmedical personnel in early response. Although TCCC is fairly recent, the construct is similar to that first suggested during the mid-nineteenth century by John Turner Caddy (1822-1902), a British Royal Navy staff surgeon. Although naval warfare engagements at the time were relatively infrequent, casualties could be numerous and severe and often overwhelmed the small medical staff on board. Caddy recognized that nonmedical personnel properly trained in the fundamentals of combat injury management would result in lives saved and greatly improved morale. The novelty was in his attempt to make procedures simple enough to be performed by nonmedical personnel under stress. However, Caddy's guidelines were completely overlooked for nearly two centuries. The principles of best practice for managing combat trauma injuries learned in previous wars have often been lost between conflicts. Understanding the historical roots of combat first responder care may enable us to better understand and overcome barriers to recognition and retention of essential knowledge.

Mary Seacole statue campaign epitomises the strength of nursing

On the morning of 30 June in the grounds of St Thomas's Hospital in London, overlooking the Thames and the Houses of Parliament, the statue of Mary Seacole was unveiled.

Seacole an inspiration for all nurses

After more than 12 long years of fundraising a memorial statue to Jamaican-Scottish Crimean War nurse and businesswoman Mary Seacole was unveiled on 30 June. The sun shone brightly and it was one of my proudest days.

Seacole event so inspirational

I was at the unveiling of the statue of Mary Seacole.

The Seacole statue comes at just the right moment

In the wake of Brexit, a tribute to the pioneering black nurse should offer inspiration in the battles against racism.

[Work of medical official and the Sisters of Charity during the Siege of Sevastopol in 1854-1855]

Work of medical officials and the Sisters of Charity during the Siege of Sevastopol in 1854-1855. The article is devoted to work of the medical officials and the Sisters of Charity during the Siege of Sevastopol in 1854-1855. At the present time on the territory of Sevastopol Naval Clinical Hospital accommodate a memorial complex dedicated to the memory of medical officials, worked in the besieged Sevastopol. Referring to the historical sources of the work of medical officials and the Sisters of Charity of Krestovozdvizheskaya community the authors emphasize the importance of and the need for the installation of the memorial complex.

Visiting the Lady with the Lamp

You have two options if you want to see the Florence Nightingale museum. London's St Thomas' Hospital is visitor-friendly with a beautiful display, but if you want context you have to fly to Turkey.

100 Years of British military neurosurgery: on the shoulders of giants

Death from head injuries has been a feature of conflicts throughout the world for centuries. The burden of mortality has been variously affected by the evolution in weaponry from war-hammers to explosive ordnance, the influence of armour on survivability and the changing likelihood of infection as a complicating factor. Surgery evolved from haphazard trephination to valiant, yet disjointed, neurosurgery by a variety of great historical surgeons until the Crimean War of 1853-1856. However, it was events initiated by the Great War of 1914-1918 that not only marked the development of modern neurosurgical techniques, but our approach to military surgery as a whole. Here the author describes how 100 years of conflict and the input and intertwining relationships between the 20th century's great neurosurgeons established neurosurgery in the United Kingdom and beyond.

Lights in the shadows: Florence Nightingale and others who made their mark

Florence Nightingale, the 'lady with the lamp' became the image of 'heroic womanhood' (Bostridge 2004) when she returned from the Crimean War an iconic figure and ever since she has remained fated to wear the mantel of nursings' leading light. But she wasn't the only woman who made their mark or who undertook to risk their live caring for the sick and injured, wounded and dying in the Crimea. Sadly, Nightingale's iconic status has also succeeded in overshadowing the existence and the achievements of the many others who nursed during the Crimean war. These women, nuns, ordinary nurses, lady volunteers and others, working in Nightingale's shadow, contributed much to the comforts of the wounded and dying and this article seeks to illuminate their presence and contribution. It also highlights other aspects of Nightingale's work and in doing so, allows us to look into the shadows and shed more light on the others who were also there.

[Nikolai Illarionovich Kozlov--a scientist, a doctor, an outstanding organizer of Military Medicine (To the 200th anniversary of the birth)]

To Kozlov N.I. (1814-1889) belong numerous achievements in the organization of military medical unit during the Crimean (1853-1856) and the Russian-Turkish (1877-1878) wars, the introduction of women's medical education in Russia, establishment of an improvement system for the military doctors, edition for their medical guidelines, the organization of military health care in Russia.

Seacole Statue Appeal reaches another important milestone

As associate director of the NHS Confederation, I am delighted to have been appointed an ambassador for the Mary Seacole Statue Appeal.

New light on Seacole

The discovery of a signed letter by Crimean nursing heroine Mary Seacole to a War Office official may give an important clue that she was lobbying to be allowed to nurse British soldiers in India. Together with a letter from another anonymous nurse, and contemporary news reports, it reveals and active and well regarded nurse leader who knew how to network.

[Mineral springs on the north-east of Caucasus and its role in the treatment of soldiers of the Russian army in XIX--beginning XX c]

The article is concerned to the history of formation of sanitary-treatment stations on the North Caucasus, in Chechnya (Goryachevodsky and Mikhailovsky mineral springs) till 1917 year. The basis of the article are archive documents, scientific papers of contemporaries and official documents. Goryachevodsky and Mikhailovsky mineral springs were more than 70 years the one the best recreative base of the Caucasian standing army including the caucasian cossack troop. The sanitary-treatment stations were of great importance during the active military actions with Hill people within the territory of Chechnya and Dagestan, during the Crimean War (1853-1856), The Russo-Turkish War of 1877-1878 and the First World War (1914-1918), when the amount of the wounded and ill soldiers increased.

[Personality and work of Florence Nightingale--creator of modern nursing and public health pioneer]

INTRODUCTION

Through her "calling to service", Florence Nightingale worked as a nurse, manager, researcher, reformer, writer and teacher. The aim of this study is to present Florence Nightingale in all these roles, pointing out all complexity and multidimensionality of nursing profession.

PERSONALITY AND WORK OF FLORENCE NIGHTINGALE

Having come from an aristocratic English family, Florence Nightingale was very educated She considered knowledge as a way, and statistical method as an instrument for discovering the rules of the world. Her work during the Crimean War was one of her most important deeds and made her a national hero. After the war, she devoted herself to reforming nursing and public health in Britain and in the world. Since she was bedbound after the Crimean War due to her illness, writing became the most powerful tool she had in achieving her goals. Florence Nightingale wrote many letters to politicians and statesmen, many newspaper and scientific articles. One of her greatest works "Notes on Nursing" was not written only for nurses, but for all women. By founding Nursing school at St. Thomas Hospital in 1860 she aspired to train and educate nurses.

CONCLUSION

Her complete and lifelong devotion to the ,,calling" directed all her activities, contributions and achievements, not only towards nursing but also towards statistics, epidemiology, public health and social sciences.

A history that lives on

The contribution of Florence Nightingale and Mary Seacole was immense. Their similarities and differences are described in this article.

A soldier's champion

Betsi Cadwaladr overcame huge obstacles to nurse the sick in the Crimea. Camaignes hope to create a lasting memorial to her achievements.

["Medicine of the future is preventive medicine"--N.I. Pirogov]

The role of N.I. Pirogov is shown in the study of infectious factors significance in high mortality during the Crimean war combats. He recommended important organizational, sanitary and therapeutic measures both in war and peacetime conditions.

The death of Florence Nightingale: BJN 100 years ago

This August marks the centenary of the death of Florence Nightingale, who died at 2 o'clock on Saturday 13 August 1910 at her home, 10 South Street, Park Lane, London. The following are some snippets which appeared in the BJN of the 20 and 27 August 1910. It was not until the announcement of her death in the morning papers of Monday 15 August that the country heard about Nightingale's death. In her last hours she was attended by Sir Thomas Barlow and two nurses from the Nursing Sisters' Institution, Devonshire Square, founded by Mrs Elizabeth Fry in 1840.

Display of dedication

Florence Nightingale's birthdate this week sees the reopening of the museum dedicated to her work and the nursing profession. It has been completely revamped and now has interactive exhibits.

Relighting the lamp

Florence Nightingale transformed the public's perception of nursing and laid the foundation for nursing schools and community nursing.

Mary Seacole: self taught nurse and heroine of the Crimean War

Mary Jane Seacole was born Mary Grant in Kingston Jamaica in 1805. Her father was a Scottish army officer and her mother a free Jamaican black, (slavery was not fully abolished in Jamaica until 1838). Her mother ran a hotel, Blundell Hall, in Kingston and was a traditional healer. Her skill as a nurse was much appreciated, as many of her residents were disabled British soldiers and sailors. It was from her mother that Mary learned the art of patient care, and she also assisted at the local British army hospital.