Yes, hospitals still use pneumatic tubes!

 

Earlier this year the technology magazine WIRED had a ground-breaking story - hospitals still use pneumatic tubes! I was reminded of how my fascination with pneumatic tubes began over 10 years ago now, by realising, that yes, hospitals use pneumatic tubes!

WIRED reports that the technology may seem "wonky and antiquated" but is surprisingly used in hospitals across the US. Just like other technologies, they state, the systems are prone to hacking. We've seen other cases of that in this blog, such as robbers trying to steal money from pneumatic tube cash points (and getting their arms stuck in the attempt). 

The threat of the hacks has been taken seriously because of the vital role that pneumatic tube systems play in modern day healthcare, moving the increasing number of tests and samples taken around hospital buildings. The hacks on the system could be on digital infrastructures guiding the tubes or on the hardware systems through the online manipulation of robotic arms or blowers.

The pneumatic tube systems and hospitals are on to it, looking into how to avoid such cyberattacks on these important infrastructural systems, systems that can work smoothly and so well that it is easy to forget the potential weaknesses in them as well.

Photo: my own, from one of my first visits to a hospital pneumatic tube system in Melbourne, Australia

pandemic post

I cannot blame the coronavirus pandemic for the lack of posts this year, but before I get onto cheerier topics, here is a public announcement from WHO:

Specifics for transport of samples to laboratory:

Ensure that personnel who transport specimens are trained in safe handling practices and spill decontamination procedures.

Follow the requirements in the national or international regulations for the transport of dangerous goods (infectious substances) as applicable.

Deliver all specimens by hand whenever possible. Do not use pneumatic-tube systems to transport specimens.

smart hospital

When the University of Virginia hospital had problems with some of their blood samples in their pneumatic tube system, they turned to one of the most increasingly ubiquitous and handy tools so many of us now have at our disposal: the smartphone.

Using their old smartphones' accelerometer to assess the forces acting on the blood samples during transit, a clinical chemistry postdoctoral fellow and a professor of pathology conducted an experiment. With one smartphone taking recordings and the other shedding light on the video, they sent their phones through the hospital's system. The footage was revealing - the longest track of tube was the problem, and they found frothiness and bubbles which dissipated soon after arrival. They concluded that the smartphone was a great way to monitor such systems.

The pneumatic tube experiment has been written up in the journal Clinical Chemistry. You can find the video footage which supplements the article here. Could this be the first time that tube cam footage has been submitted as scientific evidence??

Read more in the UVA Today article.

running outdoors

Long Branch Mike has alerted me to another amazing pneumatic tube system - the one running underneath Indiana University Health's People Mover, which connects several hospitals in Indianapolis.

These outdoor hospital tubes are pretty impressive - they remind me of riding the monorail to Disneyland as a kid. The gaps in the rails are designed to prevent the collection of snow. Although as Mike wonders, how do they keep the tubes from freezing in the winter? Must investigate.

Image by Dina Wakulchik from Indianapolis, Indiana, USA - Clarian Health Partners People Mover, CC BY 2.0, https://commons.wikimedia.org/w/index.php?curid=5193131.

how iphones helped solve a medical mystery

While hospital pneumatic tubes work well a lot of the time, sometimes there are mishaps - contents of containers might spill for example, or objects get stuck, or blood samples clot. There are all kinds of ways of finding out the problem spots in pneumatic tubes - I am currently writing a book chapter on how sound is used for example. But today I wanted to write about another method used recently at the University of Virginia - the iphone repair method.

Two pathology professors at the university theorised that it may be due to points of high pressure that there were problems and sent two iphones through their hospital tubes to check. One phone had a sensor app and a light source and the other recorded the journey of a blood sample. The footage surprised them - the blood's journey was like a blender, "like you are mixing a margarita". The hospital no longer sends their blood on long journeys to avoid the cocktail-effect.

You can read more and listen to the story here, on WVTF public radio.

coping with demand

Pneumatic tubes made news recently in Montreal, as the system at the McGill University Health Centre suffered from an extremely high workload. CBC News reported that the tubes broke down repeatedly over the summer but that the system had now been tuned to cope with the amount of traffic passing through. It is during moments of breakdown that these infrastructures are made more visible, not only to hospital staff, but the public too; those hidden little doors and pipes that many barely even notice.

My thanks to Robert DeDomenico for permission to use his photos of a hospital pneumatic tube system in Vineland, New Jersey, US. Robert is the inventor of the innovative transport network for small loads that has resemblance to pneumatic tubes, CargoFish Physical Internet.

taking the trash out

Taking the trash out seems to be increasingly becoming a pneumatic affair.

For decades residents of some Swedish suburbs have used pneumatic systems to dispose of their trash. The Swedish company Envac (previously CentralSug) have been making these tube systems since the 1950s, the first system for the disposal of medical waste being installed in Sollefteå Hospital in 1961. Later in the 1960s the company installed systems for household waste disposal in new suburbs, and now more recently in the historic city centre of Stockholm.

Further afield Envac's pneumatic tubes can be found in places such as the Garak Fish Market in Seoul, Copenhagen Cathedral in Denmark, Disneyworld and Roosevelt Island in the U.S. and since January 2015, a new eco-neighbourhood in Paris, France.

Residents of Clichy-Batignolles in the 17th put their garbage bags in green receptacles in the lobby of their buildings, which are then sped through pipes to a disposal centre 1.5 km away for treatment and recycling. The residents of the 20 billion dollar new Hudson Yards project in New York City will find a similar system in their designer neighbourhood while those working and living in one of the 112 tower buildings in the Gujarat International Finance and Tech-City in India, have since last month been using one of the world's largest underground waste disposal systems.

As eco-neighbourhoods, designer districts and techno-cities emerge across the globe, we may be seeing the disappearance of trashcans and garbage trucks, as pneumatic tubes find yet another way to spread their tentacles into daily life.

Image of Parc Clichy-Batignolles from David Fleg's photostream. Thanks to Cargofish for pointing me towards many aspects of this fascinating topic.

tracking objects

As I learned during my recent tour of a Dutch hospital, tracking and tracing is becoming ever more important in the circulation of objects in hospital pneumatic tube systems. Tracking systems are used in hospitals to not only keep a trace of the movement of capsules, but also link into other networks in hospitals, such as pharmaceutical information systems for example, or automated robots delivering medications. Through the use of barcodes, moving objects in the hospital can be counted, traced, and eventually, can become linked to the individuals who send and retrieve them. In hospitals everything needs to be accountable, and actions need to be traced in case things go wrong. 

How do such infrastructures work in practice though? As anthropologists have shown in their work in hospitals, work doesn't always follow flow-charts and checklists. Has someone written a social or cultural study of the hospital barcode I wonder? I am interested to learn more and to think further about how the traces of contemporary pneumatic tube transport may relate to those of the past, in postal systems for example, when a letter's journey was marked by stamps and creases.

Image from Wikipedia.

hospital maintenance and flying coke bottles

It’s lunchtime and across the hospital foyer doctors and nurses are hurrying to eat, patients are wandering around in back-less gowns gripping IV poles and white-coated staff are wielding trolleys of biological samples. I find Cees where he said he would meet in the central hall and introduce myself. Cees is a Dutch engineer with over 30 years of experience working with pneumatic tubes (currently at Swisslog). He has offered to give me a tour of the hospital’s pneumatic tube system, which he is currently working on. I have to thank Ilona from Swisslog for setting this meeting up, a connection made after we started corresponding about casino systems.

Cees is intrigued as to why I am blogging about pneumatic tubes and we soon enter into an animated discussion, as we make our way down a hospital corridor, of their many fascinations. He tells me that the system has now been closed at the hospital for almost two weeks while they have been doing some checks and updating the system (replacing circuitory boards, changing diverters, adding further maintenance stations and software updates). As a result the hospital has had to hire eight people during the day, five in the evening and four at night to transport blood and other tissues around the hospital. At a substantial cost. Pneumatic tubes it seems, saves this hospital a lot of money when they are in use.

Soon we veer off the busy corridors and stairwells into the loud hum of the service room on the 4^th floor (close to the laboratory on the 5^th). Whoosh, a capsule whizzes by overhead. We head over to the pneumatic tube system blowers, which wheeze and spin. A few more capsules arrive and are sent out again. 1200 – 1400 a day Cees tells me, when the system is fully operational, which is a lot for a relatively small system. We meet some other members of the repair team and together we head off to the cafeteria where we drink Coca Colas with our names on them and eat sandwiches. The team once worked together for Coca Cola, designing a system which would deliver drinks to customers at the front of stores by a tube (straight from the sky, Gods Must be Crazy style). The system was never rolled out on a large scale but a proto-type was installed in Copenhagen airport. You can watch the video of them installing the system here.

Over lunch we talk about how different hospitals use pneumatic tube systems differently. In some places there are few repairs needed, in others many. Mostly related to human error. They laugh over the story of a nursing student who was told to send some documents by pneumatic tube and put them straight into the system, without a capsule. Breakdowns can happen at any time, the engineers are on call. Their job is also to do preventive maintenance, which is why they are in the hospital. They are using a well-fitted-out capsule which tests g-forces, speed and shake, all factors which might disrupt the samples being carried. This special capsule replaces the samples of blood which were previously used to test the system, a problematic practice as Cees pointed out: not only expensive but ethically complicated considering the circumstances of donation.

After lunch we head back to the service room to see how the checks are going. There is a little storeroom out the back, stacked with capsules and sending and receiving stations. Cees shows me how they are updating the circuit boards, which now need to store a lot more information as tracking becomes more widely used. Everything he says needs to be traced, just in case there is “an incident”: not only where the capsule is but also what is in the capsule and who is sending it too. Barcodes are crucial in the tracing and one of the ways in which pneumatic tube systems are changing.

We talk for a while longer and Cees tells me a wonderful story about how engineers use the skill of listening to sound (one of my current research projects), what he called a “professional madness” in his field. If a capsule gets stuck Cees says, you can hear a particular sound, a sisssssss and you know where the blockage is. He had a colleague with a particularly “good ear”. During his visits to hospitals he would have his head cocked, listening for abnormalities in the system. The hospital staff wondered if he had escaped from the psychiatric unit. Things have changed now and the systems are more insulated, hidden away out of earshot.

Our tour is at an end and once again I am amazed and how this system continually adapts in each location and time period. Cees comments that he thought the industry might be finished with the invention of the fax machine, but here they still are. Pneumatic tube systems continually adjust to the market, changing it in the process. The need for this technology does not seem to be abating. Most new hospitals of a certain size have pneumatic tube systems installed. These systems need continual maintenance and repair, all happening in the service rooms and behind the walls of busy hospitals, the only sign of these systems in place being during moments of breakdown or stoppage, when the white-coated casual staff appear, wielding their rumbling trolleys with samples through the corridors.

Image my own.

contamination risk?

Can the use of pneumatic tubes to transport lab samples of a deadly virus lead to wider contamination? This is the fear of some hospital staff where an Ebola patient has been treated recently in Maryland, U.S.

The hospital, in an attempt to calm such fears, issued a statement declaring that while the lab samples of the patient did travel by pneumatic tube during his first visit to the hospital, at no time did they leak or spill from their bag or carrier into the tube system. During the patient's second visit, the pneumatic tube system was not used. Specimens were instead "triple bagged", placed in a container, placed in another container and then hand-carried to the lab via a "buddy system". Contrast this with health facilities in Guinea, where nurses don't even have an adequate supply of gloves, as reported in this blogpost, part of Somatosphere's intelligent coverage of the disastrous epidemic, Ebola Fieldnotes.

Image of biohazard bags for pneumatic tube system, my own.

invisible tubes

It is amazing how well pneumatic tube systems can be camouflaged: they are the embossed wallpaper of hospital ceilings and walls, there only if you look for them. I have spent three and a half months now in a hospital in Melbourne doing fieldwork about listening and sounds in medicine (see more details here). It seems I have had my ears out more than my eyes! For it has only be recently that I've spotted evidence of the hospitals' pneumatic tube system, in the emergency department.

A few emails later and I am being taken on a tour of the system by Scott, Operations Manager in the Pathology department. Scott takes me into the central pathology lab first, the hub of the system, where specimens are delivered and processed. As we talk a few capsules come flying in from ED. That is one point-to-point track in the system, the other heading to ICU and the private hospital. Someone is there nearby to organise the capsules, empty their contents and send back the tubes to where they came from. This system is all about pathology - no medical records or pharmaceutical items are transported.

The tour continues and we visit the plant room, walk corridors with tubes overhead, and visit the outpatients' department and the haematology department. In the haematology department, blood products, requests, visitors and capsules whizz by. As a trauma hospital, this lab works 24/7, the capsules arriving day and night, needing urgent attention. The outpatients' pathology department is less frenetic but no less busy - as many as 150 - 200 blood samples can be taken here a day.

We walk back to Scott's office and talk over some plans for future pneumatic tube systems in the new pathology department in the hospital, and the challenges of integrating systems from different hospitals, some quite some distance away. The plans are at the concept phase, the system one of possibility at the moment. I leave the pathology department and follow the corridors back to the main entrance. This time the sounds I pay attention to are not the coughs and beeps, but rather the rumble of pneumatic tube capsules overhead.

Photos are my own.

tube cam

While it has been a few months since I have blogged about pneumatics, they certainly haven't strayed too far from my thoughts - how could they! I've enjoyed novels and short stories about them, heard about fantastic pneumatic art projects, spent a day in a pneumatic tube factory and kept up-to-date with all of the latest hospital installations. Which means many interesting pneumatic posts to come, so stay tuned!

In the meantime, a video to share, posted by Exploratorium, called Science in the City: Pneumatic Tubes. It is a little documentary about the famous Stanford Hospital system which has inspired many creative adventures by pneumatic tube lovers. This one is special for its camera footage, dubbed by a commenter as "tube cam". The visuals and sounds are wonderful in this footage, which feels like a mix between a waterslide ride and an endoscopic exploration.

Still video image of inside a hospital pneumatic tube from YouTube, Science in the City: Pneumatic Tubes.

waiting and watching some tubes

Waiting for a baby to come - image by Andy from a radiology waiting room, Panti Rapih Hospital, Indonesia.

hospital design by doctor-architects: an exhibition

Readers of this blog may be interested in a new exhibition at the Osler Library in Montreal, Canada, about the contributions of doctors to hospital design. The exhibition is curated by Professor Annmarie Adams and showcases material from the library's architectural history collection. Alongside other themes, it examines the role of hospitals as tourist destinations, with objects such as hospital postcards and boardgames. Interestingly hospitals have now become a tourist destination for the retronaut, visiting pneumatic tube systems (see previous blog posts here, here and here).

The exhibitions runs through August 2013.
Architectural illustration by John Harris.

another tour of the lost technology

For the second time, the public was granted an insider's peak into Stanford Hospital's pneumatic tube system recently, opened again for Atlas Obscura.

Retronaut Annetta Black reported on the tour of the system (and Gever Tulley kindly uploaded photos from the tour onto his Flikr site for sharing). Black describes Standford's tubes as quiet and efficient (although ear plugs needed!), and surprisingly common place. The report appears amongst a series of essays and photographs about pneumatic tubes on the beautifully designed Atlas Obscura website. Not surprising considering that the pneumatic tube system at the New York Public Library made it to the site's top ten most popular places for 2012, and as Black states: "for many retro-tech enthusiasts, pneumatic dispatch is the holy grail of awesome lost technologies".

Image from Gever Tulley's photostream.

medicine and literature

A new issue of Granta is out which may interest some readers of this blog. It not only has a beautiful cover - evoking, amongst many things, Carl Zimmer's science ink - but also a wonderful range of fiction, non-fiction, poetry and photoessays.

Depending on where you live, there are a festival of events to coincide with the issue, such as "A Spoonful of Fiction" at The Last Tuesday Society (admission price includes the Granta issue and a Hendrick's gin and tonic - see also other lectures in this series, including Sam Alberti's upcoming history of medical museum and the field trip to St Bart's pathology museum) and other events in London at the Wellcome Library, The Freud Museum, The Horse Hospital and the Hospital Club.

irish pneumatics

I attended a medical sociology conference in Belfast recently, at the beautiful Queen's University. I wasn't expecting to talk about pneumatic tubes here (although Belfast is famous for a pneumatic invention of another kind), but rather about the healthcare professions.

One morning as I was preparing for the conference, I was listening to the BBC news and pneumatic tubes appeared on the hotel TV screen. A new hospital was opening its doors in Wolf Lough, near Enniskillen. The first new hospital to be built in Northern Ireland in over a decade, a sign of further rejuvenation of this previously troubled area.

Amongst the other "state to the art technology" being showcased was a "vacuum transfer system" to "allow for drugs, products and lab reports to be transferred around the hospital without being totally reliant on porters. It will also help speed up the discharge of patients who are often delayed awaiting prescriptions".

The hospital is said to epitomise "everything that is modern in a 21st century health service". There are no wards, just single rooms, each complete with flatscreen TVs and floor to ceiling windows said to promote therapeutic healing. The Royal College of Nursing is worried that there aren't enough nurses for this new layout.

Not enough nurses, too many porters. Although more nurses and porters are being hired for the hospital, these new hospital designs are shifting divisions of labour on the wards. What does it mean that the vacuum transfer system will make the hospital less reliant on porters? How will the work load of nurses change with these single bed rooms? Are architects now becoming a new healing profession, with their therapeutic window designs?

Pneumatic tube technologies and other aspects of contemporary hospital design raise these kinds of questions about how healthcare professions are continually evolving, and I had plenty to think about while joining the discussions at Queen's.

ghastly remnants of a dead medium?

Are pneumatic tubes dead? Or to use a Princess Bride phrase, "mostly dead"?

It seems so, according to the entry on pneumatic tubes in the wiki Dead Media Archive, although the wiki contributors acknowledge that there are "ghastly remnants" of the dead medium, including a limited rebirth in a hospital (sounds like something from Riget).

The Dead Media Archive is described as concerning "historical research into forgotten, obsolete, neglected or otherwise dead media technologies", qualities which do not seem to describe the pneumatic tube systems currently alive and well in institutions (and some homes!) all around the world.

Despite its eulogy style rendering of pneumatic tube systems, the dossier is very good, covering the origins of pneumatics in Ancient Greece, through to the hundreds of patents submitted for tube technology in the late 19th Century. Authors/editors ponder the difference between the telegraph and pneumatics, writing that "unlike the telegraph, which digitizes messages, the pneumatic letter retains analog meaning, which could range from your handwriting to the type of stationary you use".

For those interested, there is a fabulous list of resources at the end of the article too, with some important Scientific American papers, including one from 1873 entitled “Novel Mode of Locating Obstructions in Pneumatic Tubes”, which describes a method of isolating pneumatic tube obstructions utilising sound waves. 

There are also great dossiers on other dead media, including those which I remember from childhood (paperdolls, mixed tapes and walkmans), from my university days (microfilm and credit card imprinters), to those which still seem to be hiding in my parents' cupboards (phonebooks). And there is one article about a dead media which I wish wasn't so dead - shorthand - which I think would be wonderful to know as an ethnographer!

See the full list of Dead Media Archive dossiers here.

Image from Dead Media Archive of Albert Brisbane's pneumatic tube patent. Brisbane is often credited for 'inventing' the pneumatic tube, although its origins are reported in the dossier as a "hodge-podge" of previous patents and improvements.

hospitals of music and flowers

A beautiful series of photos in Colossal has been making the blog rounds recently, of Anna Schuleit's installation Bloom. This moving work involved the careful placement of twenty-eight thousand pots of flowers in various wards of a closed mental health hospital in New England, USA.

Usually photos of closed hospitals highlight decay, disuse and disrepair. Schuleit's installation on the other hand tells a somewhat more poignant story. Asked to create a sit-specific work for the closed hospital, which would be open to the public for four days, she chose to inundate the space with flowers, to reflect on the sad absence of flowers in psychiatric settings. After the exhibition closed, the flowers were then delivered to nearby shelters, half-way houses and psychiatric hospitals. This is not the first time that the artist has produced a site-specific work in a hospital. In 2000 she created a sound installation in another disused New England hospital called Habeas Corpus, where visitors listened to a recording of Bach's Magnificat pouring out of the shattered window panes.

Image from trendhunter and thanks to Daniele for sending me this link.

monitoring and maintaining the tubes

While pneumatic tubes are celebrated for their efficient transportation of solid objects, sometimes the system blocks, clogs, and stops. In hospitals this can require urgent repair. The Otago Times reported on one incident of emergency surgery that was needed on a pneumatic system in Dunedin, where the piping was cut in several places to retrieve samples that had become blocked.

At the Hospital of the University of Pennsylvania, a pneumatic tube work committee meets biweekly to review problems and concerns. Their troubleshooting guide is laminated and blu-tacked near each sending/receiving station.

Pneumatic tube company Pevco have recently released an automated mobile email alert system for hospital engineers, while their Houston branch offers three day training for hospital engineers including hands-on maintenance scenarios.

Pneumatic tube engineers need to be creative. In her Cabinet article, Molly Wright Steenson writes how in Paris, in the times of the Poste Pneumatique, a tubiste would relieve blockages in the system by reversing air pressure and drawing the carrier back to the station. When this didn't work, the tubiste would try another tactic - fire a pistol into the tube which created a sound wave that allowed calculation of the location of the blocked item. Surgery of this system required sloshing through Paris' sewers to the area of blockage.

For those interested in clogging tubes and engineering creativity more generally, you will want to see Gregory Whitmore's wonderful video about blockages and all other kinds of monitoring, maintenance and mayhem associated with pneumatic tube systems on Roosevelt Island, New York. The video was made as part of the Fast Trash exhibition in New York in 2010 (read the pneumatic post about the exhibition here and for more about maintenance here). Here is a sneak peak:

Nature Abhors a Vacuum :: EXCERPT - "JAMS." from gregory whitmore on Vimeo.

All images in this post are stills from this video. See here for the longer version.