CURA Is a Hospital in a Box

©. Carlo Ratti Architects

But does building it out of refurbished shipping containers make any sense?

We recently wrote about the Jupe flatpack units designed for instant hospital expansions during disasters, mentioning that shipping containers "are not always the best or most appropriate solution." But shipping containers do have advantages if you are shipping more than just an empty box.

section of container unit

© Carlo Ratti AssociatiItalian architect Carlo Ratti Associati has teamed up with the MIT Senseable City Lab to design Intensive Care Units (ICUs) that fill repurposed shipping containers with a lot of stuff – all the accessories needed to have an ICU including beds, respirators, monitors, everything you need. The architect describes it:

CURA is a compact Intensive-Care pod for patients with respiratory infections, hosted in a 20-foot intermodal container with biocontainment (thanks to negative pressure). Each unit works autonomously and can be shipped anywhere. Individual pods are connected by an inflatable structure to create multiple modular configurations (from 4 beds to over 40), which can be deployed in just a few hours. Some pods can be placed in proximity to a hospital (e.g. in parking lots) to expand the ICU capacity, while others could be used to create self-standing field hospitals of varying sizes.

hospital Configuration

Cura pods/CC BY 2.0

It's a clever solution that they say is as fast to set up as a tent, but "as safe as a hospital’s isolation ward to work in, thanks to biocontainment (an extractor creates indoor negative pressure, complying with the standards of Airborne Infection Isolation Rooms AIIRs)." The units are all separated from each other, connected by the pressurized corridor.

The genius of building in shipping container modules is that they are designed to move. "Shipping containers can easily be moved through different modes of transport - from ship to rail to truck - and re-used in different parts of the world, adapting to the needs and capacity of the local healthcare infrastructure."

Cura pod plan

Cura pods/CC BY 2.0

The problem with shipping containers is that they are designed for shipping, not for ICUs. So when you look at the plan, you see that there is 2258 mm or 88 inches inside. A standard ICU bed is 40 inches wide, leaving 44 inches.

Interior of curapod

Cura pods/CC BY 2.0

When you look at this rendering of the inside of the unit, there is someone standing on each side of the bed, but it is clearly not reality; everybody has lots of room in this picture. Is there enough room? What happens if something goes wrong and the patient needs resuscitation? Ariana Eunjung Cha of the Washington Post describes what happens then.

When a code blue alarm is activated, it signals that a patient has gone into cardiopulmonary arrest and typically all available personnel — usually somewhere around eight but sometimes as many as 30 people — rush into the room to begin live-saving procedures without which the person would almost certainly perish.

It takes a lot of equipment and a bit of room. It's described as being like a storm:

A team of nurses and doctors, trading off every two minutes, begin the chest compressions that are part of cardiopulmonary resuscitation or CPR. Someone punctures the neck and arms to access blood vessels to put in new intravenous lines. Someone else grabs a “crash cart” stocked with a variety of lifesaving medications and equipment ranging from epinephrine injectors to a defibrillator to restart the heart.

I am sorry, but it is going to be really hard to do this in a shipping container.

Cura assembly process

Cura pods/CC BY 2.0

Now there are a lot of people smarter than me involved in this project, architects like Carlo Ratti and "Humanitas Research Hospital (Medical Engineering), Policlinico di Milano (Medical Consultancy), Jacobs (Alberto Riva - Master Planning, design, construction and logistics support services), studio FM milano (Visual identity & graphic design), Squint/opera (Digital media), Alex Neame of Team Rubicon UK (Logistics), Ivan Pavanello of Projema (MEP Engineering), Dr. Maurizio Lanfranco of Ospedale Cottolengo (Medical Consultancy), with the support of the World Economic Forum: COVID-19 Action Platform, and Cities, Infrastructure and Urban Services Platform CURA is an open-source project."

But I wonder how many of them have spent time inside a shipping container. 7'-4" is narrow. Perhaps when they test the prototype that's being built in Milan they will realize that they can't work in such conditions. I will predict that if this thing actually gets built, they will be sticking two together with one wall removed. Not nearly so elegant a solution, but at least there is room enough to work.

cura pod long view

Cura pod/CC BY 2.0

I suspect also that they will find that putting all of this expensive equipment in an old steel box makes no sense, especially when the ceiling height in a regular container is under 8'. This rendering shows quite a bit of space over the doctor's head. This cannot just be called artistic license: It doesn't work. You can't walk under the respirator to get to the other bed. (On the plan, they show the respirators swinging around to the end of the bed, which doesn't seem practical to me when you have hoses connected to patients.) You can barely get under the ductwork or the horizontal racks that hold the equipment.

Yes, there are high-top boxes, but how many in the refurb market? They could build a new box to shipping container dimensions with higher ceilings, thinner, insulated walls, getting bigger, higher-quality space that they don't have to cut to pieces to get the windows and ducts in. Really, the box itself is a small part of the cost of this whole thing.

It is hard for me to admit that it is exactly fifty years since I won a prize at the University of Toronto School of Architecture for designing a summer camp that folded out of a shipping container; my dad was a pioneer in the industry and I grew up around them. I have been fascinated ever since by how excited architects get about them and what they try to squeeze into them. I am sometimes rueful that I didn't try to build a career out of them, but I concluded about 49 years ago that a box sized for freight simply doesn't work very well for people. It certainly doesn't work well for an ICU.