Re-Distributed Manufacturing in Deployed Operations - Workshop

Lead Research Organisation: University of the West of England
Department Name: Faculty of Business and Law

Abstract

The EPSRC funded Re-Distributed Manufacturing in Healthcare Network (RiHN) (www.rihn.org.uk) was launched in Feb 2015 and is being delivered by a consortium between six universities (UWE, Loughborough, Nottingham, Cambridge, Newcastle & Brunel), representing disciplines from both the social sciences and engineering. Investigators from RiHN working with the Ministry of Defence's Defence Medical Services organisation propose to lead a specialist workshop to explore a new compelling area of research, exploring the potential of Re-Distributed Manufacturing (RDM) in deployed operations. This encompasses the application of new RDM-related technologies and systems (e.g. Bioprinters, Additive Layer Manufacturing) in expeditionary military and civilian emergency and humanitarian operations.

Re-Distributed Manufacture (RDM) is defined as: "Technology, systems and strategies that change the economics and organisation of manufacturing, particularly with regard to location and scale" . In healthcare, RDM involves bringing production closer to the point of clinical need or use and enhancing the capability to deliver personalised medicine. RiHN is leading an agenda to advance the impact of UK medical manufacturing research.

Whilst RDM includes the notion of a shift from centralised towards decentralised production, extant research continues to assume a degree of stable environmental conditions and fixed static location (e.g. hospitals/clinics/home). However, RDM can deliver life-saving benefits in mobile medical scenarios, where there is urgent and unforeseen demand in changing and remote locations, such as in response to natural disasters and emergencies (e.g. recent Ebola crisis), and the rapid treatment of soldiers in battlefield scenarios. This often requires a reverse supply chain perspective, starting with the requirement based on patient need. There are a variety of medical conditions that could benefit from rapid response treatments in deployed operations, these include and are not limited to blast injuries to skin and tissue, haemorrhagic shock, and bone and muscle repair.

The EPSRC funded workshop aims to: "review and identify applications for RDM in deployed operations and create an agenda for delivering R&D pathfinders that will radically transform medical treatments and patient outcomes". The workshop provides an opportunity to (a) define both medical and manufacturing requirements, and (b) take stock of UK R&D capability in this specialist area. It also provides a unique forum for learning and exchange between civilian and defence organisations. In order to authoritatively explore the potential of RDM in this emerging specialist area, the team will engage a range of experts and stakeholders, to include key decision-makers in MoD, emergency medicine practitioners, and researchers in medical engineering.

The RiHN team will use the outputs of the workshop to inform a future funding proposal, which will set out detailed justification for specific target areas for investigation, as well as research leads and partners who will implement these studies. Where relevant, this proposal will consider RDM applications (civil and defence) that will benefit from Early Supplier Involvement (ESI) and Innovate UK/Catapult involvement in the development of products and services that have the potential to transform healthcare delivery to front line services. Relevant insights will also feature in a wider RiHN white paper offering guidance to healthcare stakeholders for future RDM in healthcare R&D investment.

Planned Impact

In summary, during a series of sandpit and workshop events, run by the RiHN, the potential value of implementing RDM approaches in deployed, frontline operations was identified. Working with MoD Defence Medical Services (DMS), members of the RiHN team seek to open up a new line of investigation that has the potential to radically transform support to medical treatments in deployed operations, where there is urgent and unforeseen demand remote and changeable locations. The workshop will allow us to bring together a number of key experts and disciplines and advance a robust, structured agenda for further research with the aim of advancing the UK's capability in RDM and delivering impact to clinicians, practitioners and patients. This agenda will help shape how MoD, defence prime contractors, emergency services and UK Research Council proceed with future R&D investment and resourcing.

Beneficiaries include SMEs and defence prime contractors (suppliers of 3D printers and scanners, and manufacturers specialising in customised parts and therapies), clinicians within the NHS and MoD Defence Medical Services, who will define requirements and will be end users of new technologies and and systems that will allow the rapid, tailored and localised treatments of life-threatening and debilitating injuries, resulting in better patient outcomes. If there were a significant adoption of RDM, soldiers would receive an enhanced level of critical care when it is most required, which has the potential to reduce complications and long-term care costs incurred by the Ministry of Defence.

Clinicians operating in deployed operations often have to administer treatments in extreme conditions, facing needs that may help define future take up by the NHS. The practice of emergency and military medicine can be employed to evaluate novel healthcare approaches, and identify where RDM can add the most value in healthcare delivery.

Finally, the academic community will benefit from the workshop, which brings together those from diverse backgrounds to investigate applications beyond the mainstream clinical settings. For those from the social sciences, this will allow them to explore the role of lead users in shaping novel manufacturing technologies and systems, and an improved comprehension of the diffusion of disruptive innovations. For those from engineering and science, they will be provided with an insight into the working environment and issues of emergency and military medicine. All academic participants will have the opportunity to explore and critique their ideas leading to proposals investigating the feasibility of RDM applications.

RiHN is well connected to key researchers in engineering and management, centres of innovative manufacturing, and specialists in military and emergency medicine - ensuring effective participation, dissemination and exploitation.

Publications

10 25 50
 
Description A significant part of the workshop discussion focused around deploying without the ability to resupply, and the support required to improve speed of treatment and diagnosis and benefits that can be derived from miniaturisation of production technology particularly in the context of pre-hospital field care (both in defence and civilian scenarios), where medics are limited as to what they can carry. A related point was made about the need to reduce the logistics burden of delivering medical care in mobile and deployed scenarios and to consider the potentially harsh operating environment (i.e. limited power, water and sterile conditions). Discussion of requirements and operations were an important part of scoping where future manufacturing research should be directed (presented in the research hypothesis and objectives section).
Material from a roadmapping exercises was grouped and presented back to a panel of cross-disciplinary experts. The following clusters were identified: (a) protection requirements, (b) manufacturing requirements, (c) in-field medicinal manufacture, (d) RDM products, (e) cell and tissue therapies, (f) additive layer production technology, (g) training and skills, (h) governance, and (I) infrastructure and logistics. These clusters were aggregated and considered against requirements cited in the 'background' section, which identified the following research priorities:
1 - Development of military and emergency medicine requirements in deployed operations
2 - Evaluate additive manufacturing capability for the creation of custom medical devices; and (2) To focus on three priority areas, which include: wound cleaning/sterilising and closure; surgical devices/instruments, and; compression/splinting/immobilisation.
3 - Evaluate cell and tissue therapy manufacturing capability
4 - Clinical Fluids Manufacturing Capability - demonstrate the capability to rapidly produce intravenous fluids under deployed conditions, utilising portable, efficient and adaptable production equipment
5 - Pharmaceutical Manufacturing capability - to advance the development of miniaturised portable device platform(s) and techniques capable of producing small-molecule active pharmaceutical ingredients (APIs) and therapeutic proteins (e.g. analgesics, anaesthesia, antibiotics)
6 - Innovation, assessment and adoption for deployed operations - integrate learning to systematically establish innovation route maps for RDM in deployed operations
Exploitation Route The future funding proposal will be submitted to the EPSRC 'Manufacturing the Future' call. This proposal will set out detailed justification for specific target areas for investigation, as well as research leads and partners who will implement these studies. Where relevant, this proposal will consider RDM applications (civil and defence) that will benefit from Early Supplier Involvement (ESI) and Innovate UK/Catapult involvement in the development of products and services that have the potential to transform healthcare delivery to deployed
front line services.

It is often the case that new technologies and systems are tested first in defence and emergency situations and lessons learned are transferred to the UK National Health Service for later adoption. Relevant outputs from the workshop have been shared directly with delegates and via the RiHN website supported by social media.

An ongoing dialogue has continued with relevant organisations in MoD during the exploitation,dissemination and new proposal stages. This has included engagement with the MoD defence acquisition and logistics communities to make sure there is an advance perspective of commercial/procurement decisions that must be considered when acquiring and transporting new manufacturing capabilities and (if applicable) integrating them for use in existing/future platforms (land vehicles, ships and aircraft) or deployed clinical environments.
Sectors Aerospace, Defence and Marine,Agriculture, Food and Drink,Digital/Communication/Information Technologies (including Software),Energy,Environment,Healthcare,Government, Democracy and Justice,Manufacturing, including Industrial Biotechology,Pharmaceuticals and Medical Biotechnology,Security and Diplomacy,Transport

URL http://www.rihn.org.uk
 
Description In June 2017, the findings of the workshop were presented as a poster at a MoD Defence Medical Services strategy refresh meeting and was ranked as high priority based on the potential to enhance prolonged field care. The urgency and need to be able to rapidly deliver life-saving treatments was further highlighted at a meeting of NHS England Emergency Preparedness, Resilience and Response (ERPP). In a discussion concerning the emergency services response to recent terrorist attacks in UK and Europe, NHS Supply expressed strong interest in RDM and how it might benefit from a UK NHS perspective, underlining the saliency of this research. In December 2018 RiHN released its White paper which incorporated the workshop findings in order to provide an overview of the research agenda for RDM in healthcare The future funding proposal is in development which will be submitted to the EPSRC 'Manufacturing the Future' call. This proposal will set out detailed justification for specific target areas for investigation, as well as research leads and partners who will implement these studies.
First Year Of Impact 2017
Sector Aerospace, Defence and Marine,Healthcare,Government, Democracy and Justice,Manufacturing, including Industrial Biotechology,Pharmaceuticals and Medical Biotechnology,Security and Diplomacy
Impact Types Societal

 
Description Additive bio-manufacturing: 3D printing for medical recovery and human enhancement
Geographic Reach Europe 
Policy Influence Type Participation in a advisory committee
URL https://epthinktank.eu/2017/11/10/what-if-we-could-3d-print-our-own-body-parts-science-and-technolog...
 
Description DMS MoD 
Organisation Defence Medical Services
PI Contribution The research team provided overall leadership of the workshop workshop planning, delivery and follow up, including managing project funds and operational preparation of the workshop (workshop design, invites, speaker engagement, break out exercises, creation of materials). The research team capitalised on its network membership (built through EPSRC RiHN) and partner networks to identify academic researchers working on technologies and systems that had applications relevant for use in deployed operations scenarios
Collaborator Contribution Defence Medical Services secured participation from professors of military medicine from a range of relevant disciplines and secured attendance from industry and university researchers interested in participating in this workshop. MoD Defence Medical Services provided provided support through a variety of means such as co-hosting the workshop, providing the Royal Centre for Defence Medicine as a venue, and arranging guest speakers from the defence sector. Staff from Defence Medical Services provided administrative support leading up to the workshop in terms of promoting the event. Brigadier Hodgetts from MoD defence Medical Services presented at the workshop, outlining potential of Re-Distributed Manufacturing (RDM) in deployed operations.
Impact 1. Workshop report,providing overview of the key findings of the workshop 2. Findings of the workshop were incorporated into the RiHN White Paper 3. Draft full EPSRC bid proposal
Start Year 2016
 
Description @EPSRCRiHN twitter account 
Form Of Engagement Activity Engagement focused website, blog or social media channel
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Public/other audiences
Results and Impact RiHN has set-up its own twitter account @EPSRCRiHN which has a good following from a broad array of individuals and organisations. All events have had allocated Twitter feeds enabling 'live reporting' which is also linked to the network website.The Twitter account had stimulated greater interest in RiHN and its activities as evidenced by messages sent via Twitter and tweets and retweets of issues relating to RiHN and RDM.
Year(s) Of Engagement Activity 2015,2016,2017
URL https://twitter.com/EPSRCRIHN
 
Description EU parliament Workshop on Additive bio-manufacturing: 3D printing for medical recovery and human enhancement 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Policymakers/politicians
Results and Impact Invited by the European Parliament to be involved a scenario development workshop at the EU Parliament in Brussels. The interactive working session wasdedicated to exploring the future of 3D-bio printing technology via a set of 'story-based scenarios'. These are stories that are designed to support the exploration of social, ethical and regulatory issues under a range of different future scenarios of technical development.
Year(s) Of Engagement Activity 2017
URL https://epthinktank.eu/2017/11/10/what-if-we-could-3d-print-our-own-body-parts-science-and-technolog...
 
Description MoD Defence Medical Services strategy refresh meeting 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact The research priorties identified during the workshop were presented as a poster at a MoD Defence Medical Services strategy refresh meeting and were ranked as high priority based on the potential to enhance prolonged field care.
Year(s) Of Engagement Activity 2017
 
Description NHS England Emergency Preparedness, Resilience and Response (ERPP) 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact The urgency and need to be able to rapidly deliver life-saving treatments was further highlighted at a meeting of NHS England Emergency Preparedness, Resilience and Response (ERPP). In a discussion concerning the emergency services response to recent terrorist attacks in UK and Europe, NHS Supply expressed strong interest in RDM and how it might benefit from a UK NHS perspective
Year(s) Of Engagement Activity 2017
URL https://twitter.com/Defence_Medical/status/877555418058428416
 
Description Redistributed manufacturing in deployed operations workshop, Birmingham, Feb 2017 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact This was a workshop led by the RiHN team but that had acquired additional funding from the EPSRC. RiHN had identified that, currently, the vake of RDM in healthcare lies in niche applications particularly in front-line services, most notably defence. RiHN had engaged with the Royal Centre for Defence medicine and developed a successful proposal to fund a workshop to scope out the research priorities for RDM in emergency and military medicine. Through road-mapping exercises the participants scope out key research packages which could be taken forward into larger scale research projects. The audience was composed of mainly defence staff, particulalry nurses, surgeons and clinicians.
Year(s) Of Engagement Activity 2017
URL https://goo.gl/UsFbfc
 
Description RiHN LinkedIn Network 
Form Of Engagement Activity Engagement focused website, blog or social media channel
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact RiHN has established a LinkedIn Group which comprises a multi-disciplinary network including academics, practitioners and industry representatives providing an online forum to define the challenges of realising Re-Distributed Manufacture (RDM) in healthcare.
Year(s) Of Engagement Activity 2015,2016,2017
URL https://www.linkedin.com/groups/8238989
 
Description RiHN website 
Form Of Engagement Activity Engagement focused website, blog or social media channel
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Public/other audiences
Results and Impact The RiHN Website (www.rihn.org.uk) has been set up to inform interested parties of the Network's activities and outputs. Via RiHN's social media strategy the network coordinator has ensured that all activities of the network, feasibility studies and organisations relevant to RDM in manufacturing are communicated through the website and outputs and specifically produced materials such as videos are uploaded to the site. The website provides an overview of the feasibility studies funded by the project all of the feasibility studies have been required to produce a two minute summary video of their topic and signpost their activities as a condition of receiving network funding and these have been added to the website. The Website has expanded RiHN's outreach as evidenced by the web traffic and the request for further information and network membership appications.

The website is updated regularly and informs network members of and interested individuals of developments in the area of RDM in healthcare. Through the website, those who would like to know more about the RiHN's work can access information and can join the network.

The RiHN website is evolving into a repository of expertise with the potential to persist beyond the life of the network
Year(s) Of Engagement Activity 2015,2016,2017
URL http://www.rihn.org.uk