‘When you treat COVID-19 patients,” says Dr. Netanel Horowitz of Rambam Health Care Campus in Haifa, “the biggest challenge is how to protect medical personnel from infection, and at the same time, provide the best medical treatment.” Horowitz wears several hats at the hospital. He is the head of the hospital’s hematology ambulatory care unit, a member of the management team, and oversees new technology at the hospital’s sprawling campus. It was in this last capacity that he spoke with The Magazine about the new technologies being developed at Rambam to assist medical teams in the safe treatment of COVID-19 patients. In order to avoid infection, medical personnel must wear special personal protective equipment (PPE) – gowns, gloves, masks, and goggles – to protect themselves from droplets from coughs, sneezes and other bodily fluids that come from infected patients and contaminated surfaces. The protective gear is expensive, difficult to wear, clumsy, and can become uncomfortable very quickly. Some of the new technology that is being tested and adapted at Rambam enables medical personnel to overcome the limitations in comfort and communication that occur when these protective garments are worn. Currently, PPE worn by medical personnel is disposable and can become hot and uncomfortable after several hours. These factors, explains Dr. Horowitz, affects the length of shifts in the hospital, and the number of people required on shifts. After the corona pandemic reached Israel, one of the IDF’s elite units approached the hospital and designed, in conjunction with hospital’s specifications, a new type of PPE with a ventilation system that can overcome these difficulties. Unlike the disposable clothing that has been worn until now, the new gowns and aprons being designed by the IDF are reusable. The fact that they can be used multiple times will save money that can be used for other needs. In addition, medical personnel will have continuous air ventilation in the protective suits through special tubing that is connected to the medical gas supply systems in hospital rooms and inserted into the protective gowns. The Technion–Israel Institute of Technology in Haifa has also been working with Rambam to develop a portable filter that cleans the air inside the gowns, ensuring that medical teams wearing PPE are breathing clean air. 
DONNING PROTECTIVE gear designed by an IDF special unit Additional challenges when wearing protective gear are the difficulties in sight, speech and overall communication. “Everyone looks the same. It is very noisy, and they can’t hear each other,” says Horowitz. Compounding the issue, the Health Ministry asked Rambam to designate a specific area in which to treat the many expected COVID-19 patients. The facility selected the Sammy Ofer Fortified Underground Emergency Hospital as the site. Both factors – the inherent difficulty in communicating while wearing gloves, goggles, and gowns; and using an underground ward, located far from above-ground systems – can lead to difficulties in communication between hospital staff. “There will be hundreds of medical personnel underground, and above ground there will be a facility of command and control that needs to communicate with the medical staff. It’s not only a medical issue but a control issue,” explains Horowitz. To address this issue, Rambam connected with Elbit Systems, the Haifa-based defense contractor, which modified a communication system that had been first used by the IDF, for hospital use. THE SYSTEM provides medical staff with a multi-user communications network that allows staff to communicate with each other using their cellphones, and easily locate other members of the team throughout the facility – both above-ground and underground – with instant video, text and voice messaging. Each member of the team can communicate with other members across all locations with one-button access. Hospital managers can locate team members with indoor, 3D geo-positioning of all members. The system enables enterprise-wide communication and connectivity, including data gathering and analysis, immediate data transfer, shared location of all users, a real-time situational picture, remote communication, and management of numerous groups within an organization. “Because it is so impressive,” says Horowitz, “the Ministry of Health would like to adopt it for all hospitals in Israel if there is a major increase in the number of corona patients.” Unlike the use of beepers or announcement on the hospital’s public address system, use of this technology provides a live picture of the entire medical force that is deployed around the campus, and makes it easier to allocate resources where needed. Horowitz explains why this specific solution can be useful. 
DONNING PROTECTIVE gear designed by an IDF special unit. “When you have to treat patients in a mass event, the challenge is not only dealing with a medical event but managing the logistic event. Controlling and managing a logistic event must be centralized. One needs to know where staff is located, and which medical devices to put in. Even simple things, like beds and linen have to be controlled. On the other hand, you can’t write down everything, because it is hot and difficult to work. This gives us a new way to do these things.” The innovations in dealing with COVID-19 at Rambam are not only directed at medical personnel, but ultimately at providing better treatment for patients. Intubated corona patients can require several devices, including respirators, monitors and digital syringes. Horowitz explains that the respirator has its own monitor and intubation data. In addition, there is a separate monitor that records pulse rate, oxygen saturation rate and blood pressure. Digital medical syringes are set to infuse specific amounts of drugs. “You have to see all of these and combine them in order to monitor the patient and provide appropriate instructions,” says Horowitz. The difficulty is that many of the devices were developed by different companies, and some have their own, customized data protocols. In addition, some of the machines are old, and can’t transfer or broadcast data to another facility. Rafael Advanced Defense Systems, also located in Haifa, has developed a stationary cellphone camera that, when directed at the various monitors, uses advanced image processing, broadcasts a picture of the data to the hospital’s control system, and shows medical staff all of the relevant data from different devices, all on one screen. This development promises to lead to better treatment of COVID-19 patients. The need to prevent transmission of the coronavirus has also led to improved use of robots to interact with patients. Horowitz explains that a joint team, composed of Technion students and engineering students at the Reali High School in Haifa, built a robot for use in the Sammy Ofer Fortified Underground Emergency Hospital. The robot is a prototype that carries equipment, takes lab samples and brings medicines in and out of the compound. Horowitz notes that, independent of this effort, robots are being used in numerous hospitals when there is a need to prevent contact between medical personnel and patients. The robots can be sent to wards to deliver drugs and equipment, and can also bring laptops with cameras and microphones to the patient in order to help maintain communication with friends and family6 outside the hospital. Historically, Rambam Health Care Campus has been one of Israel’s most innovative medical centers. Its development in treating COVID-19 will undoubtedly serve it in good stead until the pandemic is over. This article was written in cooperation with Rambam Health Care Campus.
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