Redistributed Manufacturing in Deployed Medical Care Network Plus

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, enhancing the capability to deliver personalised medicine. The EPSRC funded Re-Distributed Manufacturing in Healthcare Network (RiHN- www.RiHN.org.uk) was launched in Feb 2015 and delivered by a consortium of six universities (UWE, Loughborough, Nottingham, Cambridge, Newcastle & Brunel), representing disciplines from both the social sciences and engineering and led an agenda to advance the impact of UK medical manufacturing.
One area of significant research interest identified by RiHN has been the potential value of implementing RDM approaches in deployed medical care. 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. the Ebola crisis, Cyclone Idai and recent terrorist attacks), and the rapid treatment of injured military personnel in the field. 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 closer to the site of a medical emergency or in field hospitals; these include (but not limited to) blast injuries to skin and tissue, haemorrhagic shock and fractures.
The project will be led by a multi-disciplinary team bringing together subject matter experts that rarely meet, such as experts in trauma care, emergency medicine, innovation management and manufacturing, and will achieve the following outputs:

- A review of current research capability and knowledge- sharing of current breakthroughs
- Enhancing understanding of the use of RDM in deployed medical care
- Identification of and development of promising RDM technologies that support treatment pathways in deployed operations
- Capture of military and civilian emergency medical requirements and applications for RDM
- Systematic identification and comparison of needs, applications, technologies and resources

The overall outcome for the research will be the creation of 'communities of practice', producing real world demonstrators covering both the business and technical aspects of implementing RDM in deployed medical care, bringing the potential to advance the UK's capability in RDM, delivering impact to clinicians, practitioners and patients. The research will help shape how the UK Ministry of Defence, prime contractors in the defence sector, emergency and urgent care services and UK Research Council proceed with future R&D investment and resourcing. The outputs of the project will also be disseminated through a website, presentations at relevant national and international conferences, and research centres and a Special Issue journal (Health Services Management Research) and presenting the findings of the project at a showcase event. A final report will be produced, sent electronically to all interested parties, and made available digitally and via social media.

In summary, during a series of sandpit and workshop events, run by the EPSRC funded 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 proposed Network 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 Network, which will bring 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 further proposals investigating the feasibility of RDM applications.
The proposed Network 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.