WO2003020550A2

WO2003020550A2 - Intravehicular tertiary health care system

Info

Publication number: WO2003020550A2
Application number: PCT/IN2001/000153
Authority: WO
Inventors: Chandru Shahani Hamish
Original assignee: Chandru Shahani Hamish
Priority date: 2001-09-06
Filing date: 2001-09-06
Publication date: 2003-03-13
Also published as: WO2003020550A3

Abstract

Intravehicular tertiary health care system (10) for patients, requiring specialised medical procedures, including pre-invasive investigation and corrective surgical interventions. The system comprises a hyperbaric prefabricated modular suite for composite diagnostic and correction surgery , equipped for digital imaging and intensification; one pre and post operation antechamber; and one personnel wash and growing vestibule; wherein a web-enabled cyber-connected remote monitoring station is installed. The sensitive system is dynamically stabilised by multiple-stage pneumatic hydraulic impact-isolators that attenuate the effect of severe shocks; that are monitored by a plurality of 3-axis accelerometers.

Description

INTRAVEHICULAR TERTIARY HEALTH CARE SYSTEM

FIELD OF THE INVENTION

The present invention in general relates to the field of health care. Further and in particular this invention relates to Intravehicular tertiary health care system for patients requiring invasive medical procedures that include diagnosis by digital imaging and corrective surgical interventions. More particularly this invention relates to an intravehicular tertiary health care system for diagnosing life threatening diseases in patients and carrying out remedial invasive surgeries in the field without recourse to external land based medical support instrumentalities.

BACKGROUND

Patients in countries like India, with their resource-constraints cannot benefit from the technological advances made in the domain of medical art, particularly in specializations like investigative digital imaging necessary for pre-invasive preparation for corrective cardioangiology; organ replacements; prosthesis and occular implants.

The deferents are not only the exhorbitant cost of digital imaging systems such as advanced x-ray systems utilizing diverse radiographic modes including pulsed fluoroscopy supported by intensification of video images for precise diagnosis; but also, the availability and reliability of basic utilities like electricity; difficulties in obtaining and sustaining aseptic incision-site environment; difficulties of biohazardous medical waste disposal; and, the logistics of quick and repeated deployment to distribute the otherwise uneconomic investments necessary for such equipment. All of those imperatives respectively and collectively pose daunting financial and operational challenges to the medical fraternity for providing life saving health care.

The prior art citations recalled below have, each in their own way, attempted solutions to surmount these hurdles, the common means being to assemble with ingenuity and grasp of detail, all essential requirements into multiform mobile facilities for transport to remote areas that lack such health care infrastructure or to disaster sites where such local hospital system has been rendered ineffective. These solutions have proved deficient for countries deprived of developed roadways, as sensitive medical equipment is not yet designed and built for traversing such rough terrain in ready to use state while being subjected to severe gr-forces and impacts that adversely affect their reliability. DESCRIPTION OF PRIOR ART

US Patents 4181347 and 5727353 address and provide for mobile computerized tomography with means to insulate specific sensitive scanning equipment from vibrations and shocks. US Pat 5398986 likewise provides for prevention of misalignments of laser optics for occular implants and eye sight correction. All of those are adequate for developed countries where such means do not require hermitisation from inclement, dusty and rough terrain while being transported on damaged and cratered roads for random distances.

US Pat 4915435 discloses a prototypal mobile surgery centre without enhanced digital imaging, cardiac catherization requiring advanced fluoroscopy systems; which are indispensable for invasive procedure

US Patents 5755478, 5991947 and 6179358 and others, elucidate diversified features by proposing multiple transportable suites or expandable layouts, for adaptation at site by reassembly. Each of these disclosures has singular distinguishing attributes; but none have conceived or demonstrated features that overcome the problems of India and third world countries.

Reference the following US Patents namely 4957121, 5236390, 5755479, 5775758, 5833295 are also cited as prior art pertinent specification. These patents refer to embodiments, which are different from the unique features of the said invention.

These patents do not show concern about the primacy of aseptic environment, in terms of particulate density, both biologic and non-biologic, which is a prerequisite for carrying out surgical procedures. Travelling at 80 kilometers per hour, about 650 pascal differential pressure applies to the forward wall of the enclosing structure. To prevent infiltration of ambient contaminants and also Kcal load, unique sealing features would need to be incorporated in mobile medical units relying on prior art. SUMMARY OF OBJECTS OF THE INVENTION

Arising from above considerations, it is the main object of the invention to provide an intravehicular tertiary health care unit wherein efficacious life-saving medical procedures can be performed on patients in geographical locations lacking hospital infrastructure or preparatory investigative clinical equipment essential for invasive interventions. These patients suffering from life threatening diseases are thereby, unable to derive benefits of the new developments in medical technology. This invention creatively addresses singular requirements such as accessing population aggregates inhabiting remote locations; by incorporating novel and original devices and sub-systems; to ensure that full scope, autonomous diagnostic radiology and life saving invasive surgical corrections, comparable to specialised hospitals in metropolises; are made feasible by ensuring safe passage between points of its use, such that the sensitive equipment performs as intended.

Another object of this invention is to originate a fully hermitised intravehicular medical suite that becomes fully functional on arrival at site, as soon as the specialised medical personnel are cyber connected to previously mobilised panels of experts comprising diagnosticians; anesthesiologists; surgeons of all medical disciplines; and specialists in tertiary health care.

To achieve that object, atypical and unique devices and methods have been used to safeguard the sensitive electronic equipment not found to be necessary for road transportable units and systems deployed in developed countries. Other object of the invention will become apparent from a consideration of the drawings and ensuing description of one preferred embodiment that describes features that are important significant and produce valuable hitherto unrealized resorts.

Accordingly it is the primary object of the invention to invent a novel intravehicular tertiary health care system, which is unique.

It is yet another object of the invention to invent a novel tertiary health care system wherein unique sealing features are incorporated in a mobile medical system.

It is the main object of the invention to provide an intravehicular tertiary health care unit wherein efficacious life-saving medical procedures may be performed on patients in geographical locations lacking hospital infrastructure or preparatory investigative clinical equipment essential for invasive interventions.

Further objects of the invention will be apparent from the ensuing description. Accordingly the invention relates to an intravehicular tertiary health care system for patients requiring specialised medical procedures including pre-invasive investigation and corrective surgical interventions wherein the system comprises a prefabricated modular composite diagnostic and correction surgery suite equipped for digital imaging and intensification; one pre and post operation antechamber; and one personnel wash and gowning vestibule; wherein a web-enabled cyber- connected remote monitoring station is installed, the sensitive system is dynamically stabilised by multiple-stage pneumatic and hydraulic impact-isolators that attenuate the effects of severe shocks that are monitored by a plurality of 3-axis accelerometers.

In an embodiment of the invention a cardio catherization and imaging system being mounted on the impact isolated platform is incorporated.

In another embodiment of the invention unique sealing features for hermitising the suite and making it hyperbaric while in travel mode are incorporated in another embodiment of the invention unique suspension for pitch and role absorption at the articulation point or fifth wheel being incorporated so as to prevent mechanical breakdown attributable to the heavily cratered road surfaces.

In another embodiment of the invention a modular reconfigurable and structured enclosure disposed on a transportable surface to carry medical equipment that are susceptible to vibrations, shocks and are adversely affected by environment conditions.

In another embodiment of the invention a bioclean enclosure with rooms bounded by a plurality of prefabricated panels forming the walls in vertical orientation with doors, transparent windows, and utilities and analogous ceilings having filters and light fixtures with corresponding floor surfaces attached by detent means to a chassis.

In another embodiment of the invention panels are leadlined with air pathways and detent means for the elastomeric sealing materials that are compressed along the respective contiguous periphery of adjacent panels forming a planer surface by insertion into supporting channels to form a leak-tight fit, substantially preventing infiltration of airborne contaminants when the enclosure is subjected to air pressure differential of several hundred pascals.

In another embodiment of the invention panels have leak free doors for entering and leaving the work space within the enclosure without compromising the bioclean condition and for sealing the perimeters of the doors to prevent ingress of air from adjoining rooms held at static pressure of about ten pascals. In another embodiment of the invention panels has plenums to permit filtered air to recirculate at scavenging volumes of about thirty air changes per hour, for defumigation the said filtered air being recirculated through filters mounted on support grids integral to the ceiling panels, by means of air handlers.

In another embodiment of the invention having a floor that is mounted on a chassis with hydraulic isolators in association with pneumatic and helical spring devices for containing vehicular pitch, roll and yaw; and suppressing sinusoidal vibrations and dynamic impacts upto 3g caused by travel over craters and fossae.

In another embodiment of the invention has a floor having penetrations through which dedicated shock absorbing, impact isolating and vibration attenuating platforms are aligned with sensitive diagnostic radiology equipment deployed for preparatory investigations for invasive and corrective surgery.

In another embodiment of the invention has isolation platforms fitted with snap on accelerometers to provide 3 axis real time data about different parameters such as i) peak acceleration ii) change in velocity, ii) duration of event and related to base line values within which the specific equipment will function as intended on arrival at site where the intravehicular teritiary health care unit is parked.

In another embodiment of the invention has sensitive medical equipment protected from shocks and vibration stemming from the motion of the vehicle over surface and fossae by;

a) the articulation system is provided with 3 axis hydraulic anti pitching system having unique suspension for pitch and roll absorption.

b) the impact isolation system provided with a sunk in pneumatic cushioned deck set on spring mounted supports.

In another embodiment of the invention has a diagnostic radiology equipment with intensifiable digital video imaging systems, fitted with plurality of monitoring means such as snap on accelerometers. In another embodiment of the invention has a bioclean enclosure with rooms bounded by a plurality of prefabricated panels forming the walls in vertical orientation with doors, transparent windows, and utilities and analogous ceilings having filters and light fixtures with corresponding floor surfaces attached by detent means to a chassis; said enclosure comprising:

a) panels that are leadlined with air pathways and detent means for the elastomeric sealing materials that are compressed along the respective contiguous periphery of adjacent panels forming a planer surface by insertion into supporting channels to form a leak tight fit to prevent infiltration of airborne contaminants when the enclosure is subjected to air pressure differential about seven hundred pascals.

b) leakfree doors with perimeter seals to prevent ingress of air from adjoining rooms held at static pressure of about ten pascals and infiltration of air-borne contaminants while the enclosure is travelling at about eighty kilometers per hour.

c) plenums contained within the panels to permit filtered air to be scavenged at volumes of about thirty air changes per hour, to effect defumigation, the said filtered air being recirculated by air handling means through filters mounted on support grids integral to the ceiling panels.

In another embodiment of the invention on board medical facilities comprise:

a) pre and post operation patient recovery area b) surgical apparatus including servo adjustable surgical table, operating spotlights, implements and instruments trolley and crash resuscitation cart. c) anesthesia apparatii with monitors, electro cardiogram and defibrillation equipment d) a scrub area with airshower, distilled water supply, effluent plumbing and electrically operated doubledoor autoclave, with aseptic access to operation room. e) A fumigation apparatus In another embodiment of the invention has undercarraige facilities, that include retractable means for patient transfers, medical waste inactivation tank, lockers for medical gas cylinders, fumigators power packs, vacuum pumps and medical devices required for invasive surgery.

The following specifications describe the nature of the invention and the manner in which the invention is performed. The invention is fully and clearly described and illustrated having reference to the drawings accompanying the description.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 A and FIG 1 B are respectively a plan and side view of the intravehicular tertiary health care unit with contents statically disposed.

FIG. 2A depicts a cardio catherization and imaging system mounted on the impact isolated platform.

FIG. 2B illustrates the impact isolation system decomponentalized.

FIG. 3A and 3B are the perspective views of the modular suite indicating , ceiling mounted features and hermitising elements.

FIG. 4A is a sectional view showing the functional and operational ceiling hermitising the suite with sectional views of components going into the modular structure of the suite.

FIG. 4B is a perspective view of utility panel forming part of the suite walls.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT

In accordance with the present invention a typical embodiment of an unfettered, fully-augmented, intravehicular tertiary health care unit denoted as 10, in FIG.1A and FIG.1B is designed and engineered to be a composite diagnostic and corrective surgery suite adopted for transportation over rough terrain to demonstrate the objects, unique features and advantages of the present invention. It is dimensioned to be placed on approximately a twelve and half meter long flat-bed coupled to an articulated forward-cab. The preferred embodiment 10 is designed for all-weather use. It provides autonomous delivery of tertiary care for a plurality of patients in remote locations lacking medical infrastructure. The working space is about thirtynine square meters of work area, with the clear head-room of three meters, and is almost three meters wide. A one and half meter wide and five meter long fully retractable ramp 2 for bed-borne patient transfers is provided. This ramp tracks into guide-ways below the thermally insulated and pneumatically cushioned main deck 4. This deck is constructed from two steel plates, the lower one being rigidly attached to the chassis, and the upper plate resiliently mounted on an array of air cushions acts as the inner flooring of the suite, the access to which is by a personnel staircase 6 which inturn can collapse and fold into the service gap 8 available between the rear of the prime mover cab 12 and the forward exterior wall of the suite. This articulation space also houses the central control box 16. The facility has all of the basic appurtenances for field use as can be seen in the plan view of the suite denoted as FIG.1A. The side view FIG.1B shows under-carriage space 18 which is used for storage of gas cylinders, vacuum pumps and other essential devices. The aerofoiling 20 has an internal space used for storage of expendables. These elements of composition are being pointed out in passing, as they have relevance only in contexting the main objects and advantages of the invention being set forth below.

The association of interior space elements, in combination with HVAC, room pressurization and preparatory fumigation lighting and suspension are such that medical attendants can perform therapeutic maneuvers without recourse to a hub hospital or clinic. Trouble shooting technicians are not needed for the usual reset procedures, obligatory for the sensitive electronic equipment; as key elements have been continually monitored by snap on accelerometers that predetermine absence of damage from shock and vibration effects. A multitude of accelerometers are permanently installed at susceptible points on susceptible devices to monitor and record peak accelerations and velocity differentials were within acceptable thresholds and that frequency of impact events were within preset limits for that specific equipment during the transit to the new site. A unique suspension for pitch and roll absorption at the articulation point or fifth wheel, prevents mechanical breakdown attributable to the heavily cratered road surfaces that the facility is expected to traverse.

This is accomplished by replacing the conventional leaf springs and silent blocks with a hydraulic isolation system 22. The articulated fifth wheel or articulation system 24 similarly is fitted with a three-axis hydraulic anti-pitching system 26 to suppress sinusoidal behaviour while in motion over craters. These two features isolate the supporting floor of the facility. FIG.2A and FIG.2B particularly points out the novel impact-isolation systems comprising a sunk-in pneumatically cushioned deck 28 which is set on spring mounted supports 30. This sunk-in deck 28 carries an extended cardiac platform 32 with interventional cardiovascular capability, equipped with intensifiable digital video imaging system 34 that utilises pulsed fluoroscopy. According to this preferred embodiment particularly depicted in FIG.2A. The specific cardiac catherization system is SERIES 9800 mobile C-ARM manufactured by General Electric-OCE in United States. The C-ARM 36 is integral to the imaging system 38 which is cantilevered on a sliding linear motion arm 40. Any misalignments caused by impacts transmitted from the flat bed would render the C-ARM dysfunctional. The whole assembly is therefore mounted on the sunk-in deck 28 with backlash absorbing fixtures having silastic cushions 42 the mainframe castor wheels 44 and frame 46 restrain the C-ARM deflections in both the forward lateral planes. That is accomplished by air filled vibration attenuating mounts 48 which have variable tensioning elements to restrict disturbing frequency below hundred hertz, despite severe road engendered dynamic impacts. The air pressure in the inter-connected mounts is piped through a safety master regulator so as to allow easy inflation, ensuring a steady balanced operational base for the mainframe and the C-ARM. For this specific model only three isolators are adequate for the mainframe net load and one for the C-ARM, which also loads the forward isolator. They are so configured that on the application of brakes and concurrent drop into craters and fossae, the C-Arm metacentre shifts towards and between the mainframe mounts thus suppressing backlash. For terrains anticipated to subject the flat bed to the dynamic impacts in excess of three "g" quick acting toggle mechanisms in combination with turn buckles and silicone sheathed stainless steel guy-wires are used. Quick release clamps 50, 52, 54 detailed in FIG.2B fasten the entire C-ARM assembly to the vibration attenuation mounts 56. Snap-on accelerometers 58 manufactured by Instrumented Sensor Technology USA, are secured to all critical points for three-axis impact measurements against preset damage boundary curves that represents the maximum combination of peak acceleration and velocity change that the system can withstand without requiring realignment. Four different parameters are analysed; a) peak acceleration; b) change in velocity, c) duration of event; d) real time of impact. Threshold values are established by simulation trials starting with upto 3o>forces; encountered when any one of the tyres strikes a crater at reduced speeds of twenty kilometers per hour. Trend tracking and predicting software alerts the driver about road predicated safe speeds

FIG.3A and FIG.3B particularly point out to the other distinctive objective of this invention, which is to provide elements of composition that ensure aseptic and particulate free work space in the core area. Here the improvement over previous systems is owed to novel features such as the sealable partitions 60 utilising components 74 and the full perimeter door register 80 described in the ensuing text that ensures it is hyperbaric during transportation.

For invasive surgery it is obligatory to have Class 100 first air in conformance with US FED Std. 209F, with rate of scavenging in excess of thirty air changes per hour to bring work space bioburden to safe levels. FIG.3A and FIG.3B would illustrate to those skilled in the art how that object is achieved by sealable partitions 60 and ceiling 62 with comfort conditioning and filtration room pressuring and defumigating air handlers 64 complete with prefilters 66 HEPA filters 68 light fixtures 70 fire and smoke detection system 72.

A combination of components make it possible to achieve that level required for complete operational acute care and prevent infiltration of ambient contaminants and also KCal load when the facility travelling at eighty kilometers per hour, and contending with about six hundred and fifty pascals differential pressure thrust onto the nine square meter leading wall. Sealing elements are incorporated in the modular suite allowing the structure's flexural movements on rough terrain with declivities causing diagonal displacements of about thirty centimeters. Component 74 is an extruded aluminium section sealable edge to edge by silicone tubing 76 which can resist differential air pressure upto eight hundred pascals while allowing auxiliary gasket 78 to make the joints of the panel surfaces seamless, for mandatory clean down and disinfection, by applying silicone sealant. The door is with full perimeter register 80 that has a gasket 82 to maintain the inter-room pressuring profile in cascading values of six pascals., while the interior is kept pressurised during transportation.

FIG.4A shows all other distinctive elements. Illustrated are the variable open area return air grille 84 integral electrical plug socket 88 and switch with luminescent band 90, connected through heat resistent cables 92, the die formed room air connector 94 that flexibly couples to the air handler duct-work 74. FIG.4B is a cut-away view showing the extruded coving 98 with its detail depicting extruded coving with a four core cable 100 in a chase 102 and the method of flexible fastening by snap on register 104. The chase can also be used for gas, compressed air and WFI supply pipework. Also shown are the air pathway or return plenum 106; the coving support for the functional ceiling 108 and the operational ceiling 110 which is for maintenance outside the aseptic suite, 112 is the forward section a weather proofed ceiling for the vestibule over which is stored the distilled water system; vessels and pipe work distributed to points of use. The drain plumping for the liquid medical waste leads to an enzyme-dosed inactivation tank which is slung under the deck.

The three room suite thus, is a modular structure with its partitions secured by floor mounted channel frame corresponding to the layout, after proper bacteriocidal and fungicidal treatment. As illustrated by the above drawings the panels are fixed on an air cushion platform square section spigots and are held in position by a U- shaped contraption at the bottom and the top of the panels that allow distortion and deformation and prevent retransmission of the vibrations due to the elastic joints provided. The unique joints are made up of weather-resistant pliable material which includes features such as static dissipative surfaces. They are assembled together using silicon sealing systems in addition to inserted elastomeric polymers in tongue and groove sections. These surfaces posses a maximum surface resistance of 10^ ohms. The electric connections are secure at floor level.

Along the entry ways are provided one personnel air shower 114, aseptic hand and glove wash-down sink; one personnel change zone for aseptic surgical manipulations, one implements pass-through, doors are electrically interlocked with air tight door perimeters to sustain gradient pressures no less than six pascals between rooms on clean-to-dirty activity axis. The lighting system uses fluorescent tubes within recessed-sealed fixtures. The illumination provided is about four hundred lux maintained at one meter above the floor. There are fully grounded duplex electrical outlets located in each section on the peripheral walls. Flooring is seamless hospital grade re-inforced PVC with static dissipative characteristics. Thermally insulated Interior walls are prefabricated panels with laminated finish. Adequately thick lead sheets are sandwiched within the panels to protect patients and operating personnel from radiation stemming from diagnostic procedures. The insulated ceiling of the shell is self supporting and walkable. All required equipment, with the exception of the air handling, are mounted on the roof. The ceiling is designed to support such weight.

Each zone is provided with unitary modular air-handlers for comfort conditioning, filtration and recirculation of air covering the three room suite. Air flow is mixed flow, vertically orientated. The design has the terminal HEPA in the ceiling and the return air pick up at low levels through partition panels. Air filtering system includes pre-filters to trap gross particulates upstream from the HEPA. Efficiency of the pre-filters is in the 60-70% Ashrae range. Final filters are microflora tight HEPA type with 99.97% interception efficiencies for 0.3 micron challenge aerosols.

Glazings within the panels are smooth and are provided with rims. The four mm thick glass panels consist of one flushed glass, on each face. After the mounting of the double glazing on to the panels evacuation and filling of dry inert gas is carried out to prevent condensation in the interior space during the extreme temperature differential between ambient and functional room conditions.

Located behind the prime mover cab are a) integral plug-in type; self- contained engine driven power pack and b) condensing section, Both are externally mounted with a companion-motor drive when stationary for connecting to power supply locations having standard three-phase electricity grid. Power takeoff from transmission is incorporated, but is effective at engine speed over five hundred revolutions per minute. Holdover eutectic plate systems for storing replacement volume fluids good for intra-hospital drive durations upto eight hours, utilise the forward mounted condensing unit. These operate on plug-in power when the vehicle is stopped. A unique on-loading system for bed-borne patients and specialised equipment enable hub-hospitals to loan stand-by equipment and retrieve it before the Intravehicular tertiary health care unit departs for the next destination and is made ready for aseptic procedures after completing the fumigation cycle.

While the above description contains many specificities, these should not be construed as limitations on the scope of the invention, but rather as an exemplification of one preferred embodiment thereof. Many other variations are possible. Accordingly, the scope of the invention should be determined not by the embodiment illustrated, but by the appended claims and their legal equivalents.

Claims

I CLAIM

1. An intravehicular tertiary health care system for patients requiring specialised medical procedures including pre-invasive investigation and corrective surgical interventions the said system comprises a prefabricated modular composite

5 diagnostic and correction surgery suite equipped for digital imaging and intensification, one pre and post operation antechamber; and one personnel wash and a gowning vestibule wherein a web-enabled cyber-connected remote monitoring station is installed, the sensitive system being dynamically stabilised by multiple-stage pneumatic and hydraulic impact-isolators that attenuate the

^ Q effects of severe shocks.

2. An intravehicular tertiary health care system as claimed in claim 1 wherein a cardio catherization and imaging system being mounted on the impact isolated platform.

3. An intravehicular tertiary health care system as claimed in claim 1 wherein 5 unique sealing features for hermitising the suite being incorporated.

4. An intravehicular tertiary health care system as claimed in claim 1 wherein unique suspension for pitch and roll absorption at the articulation point or fifth wheel being incorporated so as to prevent mechanical breakdown attributable to the heavily cratered road surfaces.

20 5. An intravehicular teritary health care system as claimed in claim 1 wherein modular reconfigurable and structured enclosure disposed on a transportable surface to carry medical equipment that are susceptible to vibrations, shocks and are adversely affected by environment conditions.

6. An intravehicular teritary health care system as claimed in claim 1 wherein the 25 system has bioclean enclosure with rooms bounded by a plurality of prefabricated panels forming the walls in vertical orientation with doors, transparent windows, and utilities and analogous ceilings having filters and light fixtures with corresponding floor surfaces attached by detent means to a chassis.

30 7. An intravehicular teritary health care system as claimed in claim 1 wherein the system has panels that are leadlined with air pathways and detent means for the elastomeric sealing materials that are compressed along the respective contiguous periphery of adjacent panels forming a planer surface by insertion into supporting channels to form a leak tight fit substantially preventing infiltration of airborne contaminants by internal pressurisation when the enclosure is subjected to air pressure differential about seven hundred pascals on the forward wall.

8. An intravehicular teritary health care system as claimed in claim 1 wherein the system has panels having leak free doors for entering and leaving the work space within the enclosure without compromising the bioclean condition and for sealing the perimeters of the doors to prevent ingress of air from adjoining rooms held at static pressure of about ten pascals.

9. An intravehicular teritary health care system as claimed in claim 1 wherein the system has panels having plenums to permit filtered air to recirculate fumigants or exhaust at scavenging volumes of about thirty air changes per hour, the said filtered air being recirculated through filters mounted on support grids integral to the ceiling panels.

10. An intravehicular teritary health care system as claimed in claim 1 wherein the system has a floor that is mounted on a chassis with hydraulic isolators in association with pneumatic and helical spring devices for containing vehicular pitch, roll and yaw; and suppressing sinusoidal vibrations and dynamic impacts upto 3g caused by travel over craters and fossae.

11. An intravehicular teritary health care system as claimed in claim 1 wherein the system has a floor having penetrations through which dedicated shock absorbing; impact isolating and vibration attenuating platforms are aligned with sensitive diagnostic radiology equipment deployed for preparatory investigations for invasive and corrective surgery.

12. An intravehicular teritary health care system as claimed in claim 1 wherein the system has isolation platforms fitted with snap of accelerometers to provide 3 axis real time data about different parameters such as i) peak acceleration ii) change in velocity, iii) duration of event and related to base line values within which the specific equipment will function as intended on arrival at site where the intravehicular teritiary health care unit is parked.

13. An intravehicular tertiary health care system as claimed in claim 1, wherein the system has sensitive medical equipment that is protected from shocks and vibration stemming from the motion of the vehicle over surface and fossae by;

a) the articulation system is provided with 3 axis hydraulic anti pitching system having unique suspension for pitch and roll absorption. 1 b) the impact isolation system that is provided with a sunk in pneumati

2 cushioned deck set on spring mounted supports.

14. An intravehicular tertiary health care system as claimed in claim 1 wherein the system has the diagnostic radiology equipment with intensifiable digital video imaging systems is fitted with plurality of monitoring means such as snap on accelerometers.

15. An intravehicular tertiary health care system as claimed in claim 1 wherein the system has bioclean enclosure with rooms bounded by a plurality of prefabricated panels forming the walls in vertical orientation with doors, transparent windows, and utilities and analogous ceilings having filters and light fixturess with corresponding floor surfaces attached by detent means to a chassis; said enclosure comprising:

b) panels that are leadlined with air pathways and detent means for the elastomeric sealing materials that are compressed along the respective contiguous periphery of adjacent panels forming a planer surface by insertion into supporting channels to form a leak tight fit to prevent infiltration of airborne contaminants when the enclosure is subjected to air pressure differential of several hundred pascals. c) leakfree doors with perimeter seals to prevent ingress of air from adjoining rooms held at static pressure of about ten pascals. d) plenums contained within the panels to permit filtered air to be recirculated or scavenged at volumes of about thirty air changes per hour, the said filtered air being recirculated by air handling means through filters mounted on support grids integral to the ceiling panels.

16. An intravehicular tertiary health care system as claimed in claim 1 wherein the system has on board medical facilities that comprise:

e) pre and post operation patient recovery area

_* f) surgical apparatus including servo adjustable surgical table, operating spot lights, implements and instruments trolley and crash resuscitation cart. g) anesthesia apparatii with monitors, electro cardiogram and defibrillation equipment. h) a scrub area with airshower, distilled water supply effluent plumbing and electrically operated doubledoor autoclave, with aseptic access to operation room.

17. An intravehicular tertiary health care system as claimed in claim 1 wherein the system undercarraige facilities, that include retractable means for patient transfers, medical waste inactivation tank, lockers for medical gas cylinders, fumigants, power packs, vacuum pumps and medical devices required for invasive surgery.