the struggle for raw materials - dräger - usa...drÄger review 119 | 1 / 2019 5 yassine tajouaout,...

Dräger Review Technology for Life 2019

D

räger Review

119

First issue 2019 R

aw M

aterials and Resources

The future of humanity depends on resources

The Struggle for Raw Materials

HarmonyHow the traditional and modern are combining in a Chinese hospital p. 20

Freezing ColdFirefighters also respond in Greenland when things get too hot p. 30

Farmyard SmellSwiss scientists want to cut ammonia concentrations p. 46

2 DRÄGER REVIEW 119 | 1 / 2019

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RUNNING ON RAW MATERIALS

Rare earth elements get e-mobility up and running. The resources in the

materials we use to build the future are generally rare. The struggle for them

is fascinating and even creative.

40 LOOK UP

Most people associate organ donation with hearts, kidneys, or livers. Yet corneas are transplanted in Germany much more frequently. The procedure can save a person’s sight. One of the biggest centers specializing in this treatment is the eye clinic at University Medical Center Mainz. Several hundred corneas are transplanted here every year.

62 A GOOD NOSE

In some respects, military working dogs make better comrades. No technology in the world can beat them when it comes to highlighting dangers. What device can sniff out explosives, bark loudly, and bite on command? Germany’s armed forces breed their own, allowing them to train them when they are young.

Around 3,700 kilometers was the distance traveled

by the ash cloud after the Kilauea volcano erupted in May 2018,

south-westerly from Hawaii to the Marshall Islands – turn to page 68.

Contents 119

3DRÄGER REVIEW 119 | 1 / 2019

The articles in Dräger Review pro-

vide information on products and

their possible applications in gen-

eral. They do not constitute any

guarantee that a product has spe-

cifi c properties or is suitable for

any specifi c purpose. Specialist per-

sonnel are required to make use

exclusively of the skills they have

acquired through their education

and training and through practical experience. The

views, opinions, and statements expressed by the persons

named in the texts as well as by external authors of ar-

ticles do not necessarily represent those of Drägerwerk

AG & Co. KGaA. Such views, opinions, and statements

are solely the opinions of the people concerned.

© Drägerwerk AG & Co. KGaA, 2019. All rights reserved.

This publication may not be reproduced, stored in a data

system, or transmitted in any form or using any method,

whether electronic or mechanical, by means of photocopy-

ing, recording, or any other technique, in whole or in part,

without the prior permission of Drägerwerk AG & Co. KGaA.

Not all of the products named in this magazine are avail-

able worldwide. Equipment packages can vary from coun-

try to country. We reserve the right to make changes to

products. Up-to-date information is available from your

Dräger representative.

Information on how personal data is processed in line with

the provisions of the EU General Data Protection Regulation

can be found here:

https://www.draeger.com/en_corp/Home/Data-Protection

Dräger Safety AG & Co. KGaA, Lübeck, manufactures the

X-plore 3500, the MRC 5000, the X-am 8000 (all p. 12), the

chemical protective suits (pp. 28, 32 f.), the breathing appara-

tus (p. 28), the ammonia sensor (p. 46 ff.), the Polytron C300

(p. 51), the Alcotest 5820 (p. 55), the X-am 5000 (p. 70), and

the Pac 8500 (p. 72). Drägerwerk AG & Co. KGaA, Lübeck,

manufactures the Fabius Tiro (p. 24), the Oxylog 3000 plus

(p. 38 f.), the gas management system (p. 58 f.), the Movita

ceiling supply unit, and the Polaris 600 OR light (p. 58).

P U B L I S H E R : Drägerwerk AG & Co. KGaA,

Corporate Communications

E D I T O R I A L A D D R E S S : Moislinger Allee 53–55, 23558 Lübeck,

Germany

E-mail: [email protected]

E D I T I N G : Björn Wölke (editor-in-chief), Simone Binder

Tel. +49-451-882-2009, Fax +49-451-882-2080

E D I T I N G C O N S U L T A N T : Nils Schiffhauer

A R T D I R E C T I O N , D E S I G N , I M A G E E D I T I N G , A N D C O O R D I N A T I O N :Redaktion 4 GmbH

F I N A L E D I T I N G : Lektornet GmbH

P R I N T I N G : Lehmann Offsetdruck GmbH

I S S N : 1869-7275

C O D E N U M B E R : 90 70 452

www.draeger.com

IMPRINT4People going placesZhou Xujian works as a senior

nurse in China. Yassine Tajouaout

is a trainee in Hesse.

6Coveted resourcesThe demand for raw materials

is growing, but the supply is limited.

The global economy is in a quandary.

What solutions are there? From

recycling to asteroid mining!

20Tradition meets modernityPeople around the world are

physically similar. Yet in China things

are somewhat different.

26Summoning spiritsGermans also distill whisky. And

the stuff made in Baden-Württemberg

is well worth tasting.

30Storm over Greenland Where there is ice, there is also fire.

And where there is fire, the fire

department is generally never far away –

this also goes for the community of

2,000 people in the east of the island.

36Surgery on Deck TwoDream job on a dream boat? Maybe,

or at least a little! Everyday life on board

for the ship’s doctor is one thing above

all else: challenging and demanding.

40Ultrathin layersIf the eye’s cornea goes cloudy,

it must be replaced. The transplant

technique is fascinating.

46Breathing in the calf shedAmmonia smells unpleasant, even

to the cattle. It is formed when dung

and urine decompose. Gas detectors

are helping to reduce the impact.

52High and dryWorking at sea calls for maximum

concentration and readiness for

action. There is no room for alcohol

and drugs here.

56Doctor Reddy’s hunt for the recordThe world’s biggest hospital specializing

in gastroenterology is being built in the

Indian city of Hyderabad.

62More or less best friendsGermany’s armed forces train their

working dogs in their own school, where

they learn to act independently and

courageously – to protect the soldiers.

68Built on fireBubbling volcanoes are part of everyday life

on Hawaii. Since the latest eruptions, the

local fire department has been using portable

gas detection equipment from Dräger.

71Our contributionProducts from Dräger found in

articles in this issue.

72Pac 8500This device measures two gases

simultaneously, providing an acoustic and

visual warning signal as well as vibrating.

EXPERIENCE FROM AROUND THE WORLD

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Zhou Xujian, 30, senior intensive care nurse at the Central Hospital in Lishui, Zhejiang province/China

“I have been working at this hospital for more than nine years; our unit has 29 beds. I wanted to be a nurse for two reasons: Firstly, it is easy to find a job anywhere in the world in this profession. Secondly, thanks to my training I am also in a position to offer expert assistance to other people when I am not at work, especially my family and friends. The three-year bachelor’s course was tough. I was pleased that my achievements

earned me a scholarship – even during the one-year internship that accompanied the course of study. After getting started, I joined the intensive care unit some years later, although I had to complete a special three-month training course beforehand. It was especially unsettling at the beginning. We had a 90-year-old patient who had been with us for a year, and I cried when he passed away. The fate of my patients continues to affect me to this day, even though I now keep a more professional distance. It wouldn’t be possible to do the job on a long-term basis other-wise. Helping people in difficult situa-

tions always makes me happy. Since we also involve relatives in our work, I sense the success of our team all the more. Although I have already achieved quite a lot professionally, I would like to go even further. That is why I am taking continuing professional development courses here at the hospital and in my free time. I would love to enroll on the ISPN* program, work internation-ally as a nurse, and get involved in research projects. I like to embroider in my spare time. It helps me to switch off – and the works I produce can also be given to people as gifts.”* International Standards for Professional Nurses

DRÄGER REVIEW 119 | 1 / 2019

PeopleGoing Places


Yassine Tajouaout, 21, trainee pipe, sewer, and industrial works specialist at Raunheim/Rüsselsheim City Services, Hesse/Germany

“Safety is our number one priority. We maintain a network of sewage pipes around 350 kilometers in length, together with the pump stations. This often involves the sewage workers inspecting underground systems. In such cases, they carry a mobile gas detector and a self-rescuer. A colleague secures them with a cord. I know how important such safety precautions are – to protect us from sewer gases and other hazardous substances that we may encounter in the sewer network. At the vocational college we also learn about the physical and chemical background to our work. The job is extremely diverse and technically demanding. This is also evident in our “helicopter” – an orange and red four-axle truck designed specifically for sewer work. It is named after a helicopter because its jib can spin on its own axis with the flushing hose. We don’t just carry out inspections, maintenance, and cleaning work underground, but also take care of natural sites, where surface water collects and drains off. The thing I find interesting about the sewer network in both of our cities is the fact that you can see how they have developed over the years. Some areas are older than others and the technical design is completely different – and the development continues. The sewer system is growing along with the new residential and commercial areas – like a city beneath the city.”


FOCUS RAW MATERIALS

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TRE The global economy’s insatiable demand for RAW MATERIALS is

compelling mankind to remain resourceful – from intelligent recycling and underground robots to planning for asteroid mining.

Text: Steffan Heuer

THE BIG

In mid-July 2018, the world’s longest and biggest robot set off

on a journey in North Western Australia. The locomotive was pull-

ing 28,000 metric tons of iron ore from the mine in Tom Price

to the port in Cape Lambert. The fully autonomous goods train

belonging to the mining corporation Rio Tinto was monitored by

a control center located around 1,500 kilometers away in the city

of Perth. It was the first time that such a ghost train had made

a journey with nobody on board, marking an important test run

for establishing how resources can be mined and transported

more safely, quickly, and cost-effectively in the future. According

to its own figures, Rio Tinto is investing almost one billion dol-

I lars in the automation of its railroad network in Australia’s Pil-bara, a sparsely populated region and uncultivated wilderness

covering an area thousands of square kilometers in size. This is

where 200 locomotives transport ore from 16 mines to four dif-

ferent ports. As part of the “AutoHaul” program, trains and rail-

road crossings have been fitted with cameras, and monitoring

software has been developed. As a result, the employees in the

control center only occasionally have to check the situation on

the ground. The robots in the outback are just one chip in the

global game of resource roulette. The growing global population

is striving for material prosperity, for which a constant and grow-

ing supply of resources is needed. This is also the reason why

there is a danger of a gap soon opening up between supply and

demand for many minerals, which is pushing up prices and stok-

Ghost train: These days, people merely look on from the control center as thousands of

metric tons of iron ore are trans-ported by fully automated goods

trains – like here in Australia – to terminals on the Pacific coast


ASURE HUNT

FOCUS RAW MATERIALS


ing fears of shortages. It is by no means a question of raw materi-

als running out in the foreseeable future, but rather a question of

how and where the right quality of such materials can be found,

efficiently mined, processed, and ultimately recycled. When it

comes to the life cycle – from the mine to the garbage heap –

there is a high level of economic, geopolitical, and ecological

interest. Germany alone imported raw materials worth 61.8 bil-

lion euros in 2016, with the country almost completely reliant

on the import of metals. Meanwhile, in the US minerals worth

75 billion dollars were produced in 2017 (this figure does not

include energy sources such as oil, gas, and coal).

A striking example of the unpredictable nature of the rela-

tionship is the element cobalt, which experts from the United

States Geological Survey (USGS) rate as “critically important” to

the global economy. The gray and malleable heavy metal enjoyed

a stellar career very early on: Long before chemistry became an

exact science, cobalt ore and other compounds were already well-

known and used as heatproof blue pigments for dyeing glass,

ceramics, and porcelain. Archaeologists have discovered it in

Egyptian statues, Persian jewelry, and Chinese vases. Cobalt’s

name dates back to the superstitious Middle Ages when people

thought it was silver or copper ore, only then to discover that

it was difficult to work with and gave off noxious vapors when

heated. So what could be more obvious than suspecting the

kobolds of having eaten the would-be valuable silver and cast an

evil spell on it? Only in 1735 did a Swedish chemist examine the

metal more closely and give it its name.

It is no longer possible to imagine many key industries cop-

ing without cobalt, because it is ferromagnetic and heat-resistant,

doesn’t corrode, and is a good conductor of both electricity and

heat. Its widespread use began in the early 1990s when the first

lithium-ion batteries came onto the market. Thanks to a com-

paratively high energy density, these cells are especially suitable

for mobile applications – from the laptop to the electric vehicle.

In particular, the many new cars with their thousands of tight-

ly packed lithium-ion cells have contributed to soaring demand.

At present, 42 percent of global production is used to manufac-

ture batteries, primarily in the automotive industry. The new

Tesla Model 3, for example, contains around 4.5 kilograms of

cobalt, while the first version of the Model S contains 11 kilos.

Even though engineers are getting more economical and chem-

ists are working on developing new kinds of batteries without

the “bewitched element,” experts have been warning of short-

ages for quite some time. The International Energy Agency (IEA)

expects the number of electric vehicles to rise from today’s fig-

ure of three million to at least 125 million by 2030.

The hunger for raw materials is becoming a problem“The future of electric vehicles depends on the demand for

scarce resources,” say the IEA experts in their report on electric

mobility published in May 2018. “The shift to electric vehicles

will increase demand, especially for cobalt and lithium. Ongo-

ing developments in battery chemistry aim to reduce the cobalt

content.” Yet even then, warn the experts, demand in the auto-

motive industry is expected to be 25 times higher by 2030. There

is already little leeway between demand and production. Accord-

ing to a study, the global demand for cobalt in 2017 was around

136,000 metric tons and is set to double to 272,000 metric tons

by 2025. Production of new cobalt plus recycling amounted to

between 127,000 and 140,000 metric tons and is expected to rise

to between 250,000 and 265,000 metric tons by 2025. Demand

for electric vehicles is the big unknown quantity here. “There

will probably be sufficient material available on the market until

2025. However, if an aggressive growth scenario occurs, cobalt

could become scarce by as early as 2022,” warn the consultants.

The German Mineral Resources Agency is similarly concerned.

Even though the precise figures fluctuate depending on which

expert is asked, the general forecast tends to be much the same

and explosive for two reasons. With such a thin buffer between

QUANTITY MINED IN 2017: Globally 3,150 t; China 440 t; Australia 300 t; USA 245 tABUNDANCE: 0.004 ppm (ranked 72 by parts per million in the earth’s crust) – worldwide reserves: 54,000 tUSE: Gold is one of the first metals that mankind worked on. It has been a coveted material for ritual objects or jewelry for thousands of years and was used as a payment method as early as 600 BC. The precious metal is soft and easily malleable. It remains highly desirable to this day.PRICE TREND: Its function as a manufacturing material and stable financial investment is constantly driving up the price of gold to 1,355 dollars per troy ounce (2018).

GOLD196,967

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Au Aurum

This metal has the greatest attractive force – on explorers, moneymakers, and jewelers. It provides the best connections in the field of electronics.


The Super Pit in Australia’s outback

is 3.5 kilometers long, 1.5 kilometers wide, and more than 600 meters

deep. Around 28 metric tons of gold are

mined here annually

When progress

moves entire mountains

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On a long leash: Initial tests in the Pacific

by companies like Nautilus Minerals have shown that

valuable resources such as copper and silver can be mined

on the sea bed using robots

Treasures four kilometers

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RAW MATERIALS FOCUS


supply and demand, the price is subject to wild fluctuations.

The price of cobalt rose from around 24,000 dollars per metric

ton in 2013 to around 80,000 dollars in 2018 – also due to spec-

ulators who, in anticipation of a sustained boom, are stashing

away the material in the same way as conservative savers hoard

their gold. This doesn’t mean that we will soon run out of cobalt.

Known global reserves total 7.1 million metric tons.

When will there be a shortage of certain resources?Geologists suspect that there is considerably more cobalt in the

earth’s crust on the seabed of the Atlantic, Pacific, and Indian

Oceans. Aside from the speculative bubble surrounding cobalt

and lithium, both of which are essential elements in the pro-

duction of batteries, geologists are also concerned about oth-

er resources, but equally warn against scaremongering. Around

80 percent of the cobalt produced in the world currently comes

from the Congo. Chinese mining companies recently secured a

majority shareholding in one of the biggest mines there, along

with exploration rights to another site. These are strategic invest-

ments. China is the world’s biggest vehicle market and there are

already 500 manufacturers of electric vehicles here. Companies

such as Tesla and Daimler are building their own battery facto-

ries. That is why experts at Germany’s Federal Institute for Geo-

sciences and Natural Resources in Hannover look toward the

future with as much concern as their US colleagues. “From a

purely geological perspective, we consider the supply of mineral

resources to be largely secure,” they write. In the short to medi-

um term, however, there may be shortages in terms of the techni-

cal supply. So when will there be a shortage of certain resources?

This question concerns economists like Roderick Eggert. He is a

professor at the School of Mines in Colorado and the deputy direc-

tor of the Critical Materials Institute. The CMI is an association of

raw material companies, universities, and public research labora-

tories under the aegis of the US Department of Energy. Together

they want to examine the question of short-ages. “The prospect of

running out of resources is a popular subject for public debate,

although there is no urgent need to make any hasty decisions,”

says Eggert in a reassuring manner. “I am more worried about

the fact that we are mining a growing number of resources of

inferior quality. We are moving more rocks and using more water

and energy to do so.” This involves considerable economic and

ecological costs – unless technological innovations can improve

efficiency in the field of mining and mineral extraction. This

especially applies to the minor metals such are rare earth ele-

ments – a group of 17 metals found in the earth’s crust that first

have to undergo complex procedures to isolate them before they

can be further processed. Their reserves are concentrated in

China. The economist also mentions unusual elements such as

neodymium, a base material for permanent magnets found in

smartphones and motors.

“It is often the case that no more than a few hundred or

thousand metric tons of these metals are produced each year,”

explains Eggert. “A new application area can quickly lead to

a surge in demand and drive up prices. This uncertainty can

cause manufacturers not to use this resource.” In other words,

the innovative strength of an economy can be impaired by

Valuable nodules: Robotic arms harvest polymetallic nodules

off the coast of Papua New Guinea. The

deposits, which have built up over thousands

of years, are rich in copper and cobalt

QUANTITY MINED IN 2017: Globally 110,000 t; Congo 64,000 t; Russia 5,600 t; Australia 5,000 t ABUNDANCE: 25 ppm (ranked 32 by parts per million in the earth’s crust) – worldwide reserves: 7.1M tUSE: Cobalt is an important by-product of copper and nickel mining. The gray and malleable heavy metal is ferromagnetic, heat-resistant, and doesn’t corrode. Accordingly, it is hugely important to key industries such as aircraft manufacturing and the automotive industry. Around 40 percent of global production is used for batteries, including in electric vehicles and smartphones.PRICE TREND: Following fluctuations in the 1970s and 1980s, the price of the heavy metal is once again rising sharply; since 2013 it has risen from 24,424 dollars per metric ton to 80,491 in 2018.

COBALT58,933

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Co Cobalt

The material that provides the blue color used in ceramics, glass, and paint. It is now indispensable for the production of high-powered batteries.

FOCUS RAW MATERIALS

12 DRÄGER REVIEW 119 | 1 / 2019

actual or perceived shortages, because people do without cer-

tain products or switch to other resources. Experts like Eggert

keep a constant eye on the balance between supply and demand

to ensure that it doesn’t come to this. They try to sort raw mate-

rials by their geographical concentration, growth forecast, and

price trend. In March 2016, for instance, a US committee of

experts produced a hit parade of “critical minerals.” Ultimate-

ly, 17 elements exhibited sufficient risk factors to be included on

the red list – from yttrium and mercury to wolfram and cobalt.

The latest state of knowledge must firstly be cataloged in order

to draw the right conclusions from this and start searching for

substitutes. That is why Germany’s Federal Ministry of Educa-

tion and Research has developed a research and development

program involving “economically strategic resources for Germa-

ny as a high-tech location.” The aim is to link German research-

ers to colleagues all over the world, improve the acceptance of

raw material extraction, and enhance training and profession-

al development. The focus is on “metals and minerals that play

a pivotal role in the economy and have to be available to us in

sufficient quantities for future technologies.” It is already clear

that the continuing growth of the global population and the

associated rise in industrial manufacturing necessitate a secure

and reliable supply, particularly when it comes to the impor-

tant resources. According to the World Economic Forum, China

alone consumes 57 percent of all the nickel and 50 percent of all

the steel and copper. Since copper is in demand for all kinds of

products (from wires to semiconductors), experts expect glob-

al demand to outstrip supply within ten years.

This brings us back to the role of mining companies.

From Rio Tinto and Codelco to BHP, Glencore, and Freeport-

McMoRan, they are all facing the same challenges: deeper, fur-

ther, pricier. “Mines are getting older and going even deeper

underground, while the production and concentration of ores

is sinking,” says Rüdiger Leutz, CEO of Porsche Consulting in

Brazil. The consultancy works with, among others, Codelco , the

QUANTITY MINED IN 2017: Globally 19.7M t; Chile 5.33M t; Peru 2.39M t; China 1.86M t ABUNDANCE: 60 ppm (ranked 26 by parts per million in the earth’s crust) – worldwide reserves: 790M tUSE: Alongside gold, silver, and tin, copper was one of the first metals that humans learned to make use of. The soft metal is used in pure or alloyed form for electrical and electronic installations. Due to its high conductivity, it is particularly suitable for heat exchangers, cables, jump wires, electrical machines, and motors.PRICE TREND: Copper has experienced price peaks since the 1970s. In the fall of 2018 the price was around 5,700 dollars per metric ton; in 2016 it was 4,800 dollars.

COPPER

Ventilation: Clean breathing air provides the basis for working safely underground, yet it soon becomes a significant cost factor. The more sprawling and complex the mine, the more carefully the supply of breathing air must be planned and monitored. Both stationary and mobile gas detectors are used here, including the X-am 8000, which simultaneously measures up to seven toxic and combustible gases and vapors as well as oxygen.

63,55

29

Cu Cuprum

Safety underground:

Escape: The bigger and deeper the mine, the more complex the escape and emergency concept. Dräger supplies a wide range of solu-tions – from the personal escape apparatus to the refuge chamber. The MRC 5000 (right) provides protection for between eight and 20 people (for up to 96 hours).

Breathing protection: Dust, aerosols, and toxic gases can be released when mining and processing ores. Dräger supplies both filter-ing breathing protection and compressed airline equipment for use in hazardous areas (including the Dräger X-plore 3500 half-mask).

In the history of human evolution, this metal lent its name to the Copper Age, the period between the Stone Age and Bronze Age.


world’s biggest producer of copper from Chile, which operates

seven mines in the country and produced almost two metric

megatons of copper in 2017. Even though Codelco operates what

is now the world’s biggest copper mine in El Teniente, which

boasts over 3,000 kilometers of underground tunnels, the qual-

ity of copper ore is diminishing. The quality has almost halved

since 1990. On top of this, there is the lack of trained personnel

capable of handling the latest technology. Thirdly, says Leutz,

mining companies are not only under commercial pressure,

but must also meet stricter requirements in matters relating to

environmental protection and safety regulations. “The answer

to these challenges lies in digitalization, automation, the inte-

gration of data streams, and process optimization.” According-

ly, Codelco and its competitors have ordered a modernization

program. Priority has also been given to artificial intelligence

and drones studded with sensors. This not only helps to locate

new deposits, but also mine existing minerals using less ener-

gy and water. Artificial intelligence monitors and maintains

huge drilling machines underground before they break down.

Such developments are inexorable even where we humans are

concerned. In some Australian mines, for instance, intelligent

helmets are already being used, which record the brain-

waves of drivers and warn them of fatigue. Leutz explains that a

great deal more can be done with the acquired data to increase

productivity. Mine planners can identify the critical points on

roads and ramps and thus take measures to moderate danger-

ous inclines, bends, or intersections.

Gold on the garbage heap There is another key factor involved in the relationship between

supply and demand: How to take a sustainable approach to de-

vices that have already reached the end of their useful life. Those

who collect old cell phones, computers, and batteries and prop-

erly separate and recycle their components can prevent met-

als, precious metals, and rare earth elements from ending up

on a landfill site forever. More than 7,500 metric tons of sil-

ver and 320 metric tons of gold are used annually around the

world for manufacturing electronic devices. Their value adds

up to around 21 billion dollars. If electronic waste is exported

to a developing country, only half of the valuable components

Deeper, further, pricier: Codelco in Chile is the world’s biggest copper producer. Mines like this one in the Atacama Desert are being excavated

ever deeper and further and operated with robotic vehicles in order to satisfy the global demand

Robots help in the hunt for copper

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14 DRÄGER REVIEW 119 | 1 / 2019

are generally recovered. However, if the devices are recycled in

a modern economy, the recovery rate for gold, for example, is

95 percent. When looked at in this way, there is a little mine in

every modern cell phone.

The US Environmental Protection Agency (EPA) has done

some calculations: Almost 16 metric tons of copper, 359 kilo-

grams of silver, 34 kilograms of gold, and 15 kilograms of palla-

dium can be recovered from one million recycled smartphones.

According to the Institute of Scrap Recycling Industries (ISRI),

there is as much gold in one metric ton of old computers as

there is in 17 metric tons of ore. These quantities soon add up,

because in the US alone around 4.5 million metric tons of elec-

tronic waste is disposed of each year. Global research is being

conducted to find ways to return valuable resources to the cycle.

The Fraunhofer Institute, for example, is working on a new pro-

cess called NEW-BAT with several companies from the recycling,

battery, and plant manufacturing sectors in order to improve

the recycling of battery components. This involves shredding

lithium- ion batteries in a water bath using shock waves, making

it possible to not only recover metals, but also split composite

materials in a contactless process at the interface of the differ-

ent materials, including compounds of lithium, nickel, cobalt,

and manganese, high-quality carbons, and alloys made of earth

elements. Since the number of electric vehicles will continue

to rise, countries such as Japan and China are currently devel-

oping concepts for their own infrastructure in order to create

the widest possible network of recycling points for old batteries.

The People’s Republic presented a corresponding standard for

municipalities and vehicle manufacturers and in Japan the first

recycling factory for car batteries opened in March, not far from

the site of the nuclear reactor disaster in Fukushima. There are

even hidden treasures in plastic. Another project set up by the

Fraunhofer Institute for Process Engineering and Packaging is

examining the question of how the critical metals antimony and

titanium can be rescued from old devices before they end up on

the garbage heap. Both are contained in the additives for plas-

tic housing, among other things; the former as a flame retar-

dant, the latter as a white pigment. The Add Resources project

Treasures also lie dormant in old electronics

The ongoing recycling problem: The more electronics humans use and

dispose of, the higher the mountains of electronic waste grow – like here in

Wuhan, China, it can be recycled in-stead of ending up on the garbage heap

PH

OTO

S:

PIC

TU

RE

AL

LIA

NC

E/R

EU

TE

RS

(2)

, D

NN

87/

WIK

IME

DIA

RAW MATERIALS FOCUS


investigated the recyclability of metals and reached the conclu-

sion that the stumbling block is essentially neither the tech-

nology nor the economic viability. Project manager Dr. Mar-

tin Schlummer considers the biggest hurdle to be insufficient

action – a lack of the requisite recycling infrastructure in Ger-

many to separate plastic containing flame-retardant material

from other types of plastic, for example. The more the garbage

heaps grow, the more pressing the problem becomes. While Chi-

na and India accept the most electronic waste from around the

world, one million metric tons of old electronic devices pile up

each year in West Africa alone, according to the calculations of

the United Nations – with little prospect of sustainably recover-

ing the valuable components. Since humans will produce about

three billion metric tons of waste by 2030, experts are thinking

about urban mining – the process of obtaining valuable metals

from urban garbage heaps.

The search for mineral resources doesn’t stop on terra firma.

Geologists at the USGS have been devoting their time to miner-

als in the deep sea since the 1970s. Marine researchers brought

strange nodules to the surface as early as the nineteenth centu-

ry and deep-sea cameras are constantly delivering impressive

images of hydrothermal vents that bubble from the fissures in

the earth’s surface beneath the ocean. Towering smokestacks

form as soon as the black mineral clouds cool down. But who is

allowed to go prospecting underwater? According to the Unit-

ed Nations Convention on the Law of the Sea, nations can lay

claim to a so-called exclusive economic zone for all resources

within 200 nautical miles (around 316 kilometers) of their coast,

including the raw materials that are lying dormant several kilo-

meters below the surface.

Deep-sea mining: treasures on the seabedResponsibility for the management of the huge deposits of man-

ganese, cobalt, nickel, and copper in international waters has

been assigned to the International Seabed Authority (ISA) based

in Jamaica, even though it continues to work on the fine detail

of the guidelines for mining: “Commercial deep-sea mining will

begin within the next five years,” says the Californian geologist

Dr. James R. Hein, who heads the USGS’s Global Ocean Miner-

al Resources project. The ISA experts have defined three main

categories for undersea resources: polymetallic nodules, poly-

metallic sulfides, and ferromanganese crusts. The last resources

on this list are the result of volcanic activity and are therefore

rich in cobalt and nickel. They can be found in shallower waters

from a depth of 400 meters and are thus often located in the

exclusive economic zone of individual countries. “There are

still plenty of unanswered questions, but it is highly likely that

the resources on the seabed exceed the deposits on land,” says

Amy Gartmann, marine researcher and USGS project manager

Hein’s second in command. Experts estimate that around 21 bil-

lion metric tons of polymetallic nodules lie in the Clarion-Clip-

perton Zone in the Pacific alone. They can be between two and

twenty centimeters in size and – in addition to manganese and

iron – contain traces of coveted elements such as nickel, copper,

cobalt, and rare earth elements. Some countries have already

begun the initial experiments for mining underwater. Japan, a

QUANTITY MINED IN 2017: Globally 43,000 t; Australia 18,700 t, Chile 14,100 t; Argentina 5,600 tABUNDANCE: 20 ppm (ranked 33 by parts per million in the earth’s crust) – worldwide reserves: 16M tUSE: The rise of e-mobility and smartphones and other connected devices would be inconceivable without this soft, silvery white light metal, because (almost) nothing works without the standard lithium-ion battery these days. Lithium is mixed with many different materials to make it harder and more elastic and durable.PRICE TREND: Lithium continues to get more expensive; the price rose from 1,550 dollars per metric ton in 2003 to 16,500 dollars in 2018.

LITHIUM

Consumer society: There is a little mine in every smartphone – if manufacturers recover the gold and silver integrated within them

6,94

3

Li Lithium

Initially only used as a lubricant, it has become ever more important and is now accelerating e-mobility with lightweight batteries.

FOCUS RAW MATERIALS

16 DRÄGER REVIEW 119 | 1 / 2019

country dependent on imports, hit the headlines in September

2017 when it sunk a yellow caterpillar vehicle off the coast of

Okinawa, which brought several metric tons of ore to the surface

from a depth of 1,600 meters. According to the government, the

haul included gold, copper, lead, and zinc. Commercial mining

is set to begin in the Pacific in 2020, because Japanese research-

ers have discovered a total of six ore deposits in the area around

Okinawa and believe that there is as much zinc in one of the

fields as Japan’s industry uses in a year. A second project off the

coast of Papua New Guinea is not going quite as smoothly. Test

excavations at a depth of 1,600 meters beneath the Bismarck

Sea have uncovered copper, gold, and silver. The Canadian firm

Nautilus Minerals, which has the backing of investors from Rus-

sia and Oman, wants to mine the metals. The government in

Port Moresby has issued the licenses needed to begin mining in

the Solwara One field at the end of 2019. However, the project

has been met by protests organized by local resident initiatives.

They are concerned that the underwater mining could stir up

huge amounts of sediment.

“Humanity’s shared legacy” The largely unknown environmental consequences are one of

the many unanswered questions surrounding the hunt for raw

materials on the sea bed. “Deep-sea biologists have begun to take

an interest in the subject. They want to know what lives down

there and how it would be affected by the mining,” says USGS

marine researcher Gartman. Anyone who brings metalliferous

crusts or nodules to the surface on a large scale will inevitably

stir up huge amounts of silt. Researchers have only just begun

to catalog the worms, fish, and snails that have made places

like hydrothermal vents their homes. On one of her latest expe-

ditions, Gartman and other marine researchers released arti-

ficial sediment clouds in the Pacific Ocean off the coast of San

Diego and used a 3D sonar system to record how the particles dif-

fuse underwater and where they settle on the seabed. Here, too,

the science is in the early stages. Another side effect of the min-

ing is well known on land: slag heaps and sewage ponds where

metals and acids accumulate before eventually ending up in

the environment. The same can occur when releasing sulfides

underwater, warns Gartman. Nobody knows how much addi-

tional acidity the sea can buffer. “It depends on the scale of the

work being carried out underwater.” Whether we humans can

really satisfy our continuing need for metals in the depths of the

world’s oceans also depends on the economic viability. And it is

by no means certain, as Richard Roth, professor of material sci-

ences at Massachusetts Institute of Technology (MIT), has cal-

culated. He presented the findings at a meeting of the Seabed

Authority in March 2018 in Jamaica. His report states that the

initial investment for a hypothetical deep-sea mine would cost

between three and four billion dollars, plus between 600 million

and 1.1 billion dollars annually for ongoing operations.

The lion’s share of the costs is not attributable to a floating

metallurgical factory, but a plant on the mainland where nickel,

copper, cobalt, and manganese have to be painstakingly extract-

ed, predicts Roth. The mineral quartet makes up 30 percent of

the nodules taken ashore. From an annual haul of three million

QUANTITY MINED IN 2017: Rare earth elements approx. 130,000 t (of which just neodymium: around 7,000 t); China 105,000 t; Australia 15,000 t; Russia 2,800 t ABUNDANCE: 42 ppm (ranked 28 by parts per million in the earth’s crust)USE: Neodymium belongs to the group of rare earth elements, which only occur in conjunction with other metals. Their extraction is associated with considerable environmental problems. The metal is used as a neodymium-iron-boron alloy for powerful permanent magnets, which are essential components in the electronics of smartphones and autonomous vehicles, among other things. That is why Western industrial nations are concerned that more than 80 percent of rare earth elements are mined in China.PRICE TREND: The price of neodymium has continued to rise sharply over the past two decades – it cost around 15,000 dollars per metric ton in 2009, by 2011 it had risen to 250,000 dollars, and in 2017 the price was hovering around 95,000 dollars.

Neodymium

Well-drilled: A NASA mission is set to start in 2020 to reach the

Psyche asteroid, which revolves around the

sun between Mars and Jupiter. The aim is to

examine potential nickel and iron deposits

144,242

60

Nd Neodymium

This material is used for extremely strong permanent magnets, like those used for high-powered wind turbines or hard drives.


Recycling at Dräger:Whether gold, aluminum, or soda lime, many devices remain valuable even at the end of their life cycle.www.draeger.com/119-17

metric tons of deep-sea nodules, an estimated 6,375 metric tons

of cobalt and 32,400 metric tons of copper would remain. Such

a mine would generate an annual turnover of almost 2.4 billion

dollars, which is no guarantee of being in the black given the

fluctuating price of many metals. The biggest question for Roth,

however, is how to fairly distribute the expected profits among

the operating companies and their investors, nations to whose

jurisdiction they are subject, and “humanity’s shared legacy.”

After all, unlike mines, the oceans belong to everybody. That is

why not all experts are convinced that the future lies on the sea-

bed. “The technical hurdles are dauntingly high and it is hard

to imagine that we will ever extract raw materials from here

on a large scale – apart from maybe high-quality resources,”

says the economist Roderick Eggert, voicing his concern. “The

subject is as exciting as a science fiction story, but we should

always bear in mind that only some science fiction ultimately

becomes reality.” When viewed in this way, it seems somehow

reassuring that mankind already has the next goal in its sights:

asteroids, the moon, and other planets. Millions of asteroids are

orbiting in the solar system. At least 1,000 of them are of inter-

est to companies such as Deep Space Industries and Planetary

Resources, because they are big and close enough to the earth

and contain valuable minerals. Luxembourg has already passed

a law that gives operators of future mines in space the go-ahead

to reap their extraterrestrial profits. Planetary Resources keeps

the Asterank database, in which more than 600,000 asteroids

are listed in detail, together with their natural resources and

economic value. NASA is planning to send a probe to the Psyche

asteroid in 2022, which revolves around the sun between Mars

and Jupiter. According to astronomers, it is the core of a former

planet that is made up of nickel and iron. So it is little wonder

that Chris Lewicki from Planetary Resources recently stated that

“the next Iron Age will occur in space.”

Robots that catch asteroids

Universally present: Scientists have identified around 1,000 asteroids on which space mining may be worthwhile. NASA is already practicing how to mani pulate rocks weighing several metric tons with robotic grippers here on earth

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227 years

372 years

387 years

1,200 years

FOCUS RAW MATERIALS


Mining Annual extraction of the most important metal ores (in 1,000 metric tons; 2017). As chemical elements, some belong to the groups of metalloids and transition metals.

Origin The five most important mining regions for each metal and the percen tage of the total global production mined.

Metals have fascinating properties,

during processing as well as when in

use. They are indispensable in today’s

world. They provide buildings with sta-

bility, make aircraft lightweight, and

they drive electronics and electric cars.

Metal ore deposits are distributed across

different parts of the globe. Some (often

politically fragile) countries have a virtual

monopoly on certain metals with a big

future, such as cobalt. The graphs answer

questions relating to the origin of the met-

als, the quantities mined, and how they

are used. The limited supply is a remind-

er to use metals carefully and consider

recyc ling, which is making progress every-

where. Even though today’s recoverable

reserves and existing resources are limit-

ed, mankind has proven to be quite flexi-

ble in this regard!

Scarce ResourcesThey make it possible to manufacture a wide range of goods: METALS can befound in a variety of different products, including smartphones, cars, and packaging.

39% CHN

Iron ore

26% AUS13% BRA6% IND3% RUS

54% CHN

Aluminum

6% RUS5% CAN5% IND4% UAE

48% RSA

Chromium

17% KAZ10% IND9% TUR3% FIN

28% CHI

Copper

12% PER9% CHN6% USA5% AUS

39% CHN

Zinc

11% PER10% IND8% AUS6% USA

51% CHN

Lead

10% AUS7% USA6% PER5% RUS

19% INA

Nickel

11% PHI10% CAN10% NCL9% AUS

35% CHN

Tin

18% INA18% MMR9% BRA6% BOL

45% CHN

Molybdenum

20% CHI15% USA9% PER4% MEX

73% CHN

Antimony

9% TJK5% RUS3% AUS2% TUR

58% COD

Cobalt

5% RUS5% AUS4% CAN4% PHI

89% BRA

Niobium

9% CAN1% RUS1% COD

43% AUS

Lithium

33% CHI13% ARG7% CHN2% ZWE

22% MEX

Silver

18% PER10% CHN6% RUS5% BOL

14% CHN

Gold

10% AUS8% RUS8% USA6% CAN

3,30

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4,70

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11 years

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Aluminum

Chromium

Lithium

Cobalt

Lead

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Resources The length of time left until all currently known deposits are exhausted. These estimates are based on unchanging conditions in terms of mining, consumption, and recycling.

PurposeThe most important applications for the selected metals.

RecyclingThe percentage of recycled material used in metal production.

51%

33%

<1%

40%

31%

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52%

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42%

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17 yea

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21 y

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40 y

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62 y

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67 y

ears

20 DRÄGER REVIEW 119 | 1 / 2019

TraditionTraining: Listening to the heart and lungs, taking the temperature – the trainees soon forget that it is only a virtual patient lying in front of them

21DRÄGERHEFT 404 | 2/ 2018

TThe rhythmic screech of the cicadas can be heard outside the

open window, through which the fresh morning air wafts, provid-

ing an indication that it will be tropical in just a few hours’ time –

with a temperature of 36 degrees Celsius and more than 60 per-

cent humidity. The view stretches beyond high-rise buildings as

far as lush green mountains that will soon disappear in the haze.

On the floor is a selection of wall tiles. A slim gentleman enters

the meeting room. For the past twenty years, Professor Wei Tie-

min has been president of the biggest hospital in Lishui, a city

with a population of around 2.5 million people in Zhejiang prov-

ince, roughly a three-hour express train journey southwest of

Shanghai. “We are a central municipal hospital as well as a school

of medicine attached to Zhejiang University,” he explains. Lishui

Municipal Central Hospital is one of around 30,000 hospitals in

the People’s Republic of China and also one of the most modern.

Responsible for 3,000 employeesThey have a great deal here: from the emergency department by

the entrance to state-of-the-art imaging techniques such as mag-

netic resonance imaging (MRI) and positron emission tomog-

raphy (PET). There is also a dental clinic, along with a num-

ber of different rooms for teaching, training, and conferences.

The 60-year-old is proud of what has been achieved. “Our hospi-

tal was founded in 1971, initially as a small clinic that entered

Meets ModernityInsights into Chinese hospitals are rare, especially outside the big cities on the east coast. Yet Professor Wei Tiemin proudly showspeople around the LISHUI MUNICIPAL CENTRAL HOSPITAL – and provides insight into the management and daily work that goes on here.

Text: Nils Schiffhauer Photos: Patrick Ohligschläger

ASIA HOSPITALS


22 DRÄGER REVIEW 119 | 1 / 2019

People and their relationship with one another are crucial

At eye level: Concentrated expressions that say more than words – they are like a drill before the impending operation to which these doctors are heading

22


service two years later. Today we have 1,650 beds; around 18,000

people pass through our doors every day,” says the man respon-

sible for 3,000 employees, who has actually already reached the

retirement age for doctors in the country, but has extended his

contract at his own request as well as that of the city and univer-

sity. Professor Wei says that there are two reasons why the hos-

pital has grown to encompass around 45 departments, includ-

ing ophthalmology, a tumor center, cardiac surgery, neurology,

and nephrology: “On the one hand, the population of our city

has mushroomed; on the other, the introduction of health insur-

ance in China has led to a greater influx of people to the spe-

cialist hospitals.”

Professor Wei not only has his eye on the hospital’s growth

in terms of patient numbers. He has also guided it to a leading

position with the right equipment – primarily, of course, with

diagnostic technology (including, for example, “one of the most

modern automated laboratory systems in the whole of Asia”) and

therapeutic equipment, as well as a sophisticated training pro-

gram for its employees, which includes analyzing medical find-

ings with the aid of virtual reality. Also striking is the interior

architecture, which has been carefully coordinated both in terms

of its practicality as well as its design and color scheme. “Yes,”

says Professor Wei, pointing to the tiles on the floor, “I initial-

ly studied architecture before switching to medicine for health

reasons and becoming a cardiologist.” Later, during a tour of

the VIP ward on the 25th floor, he points out a bedside cabinet

that he developed, which is patented in China, whose form and

function is downright impressive – including the compartment

tailored to accommodate the large thermos flasks of hot water

that are indispensable in the country. “I had a pullout drawer

fitted underneath to catch the dripping water.” It may be just

one small detail, but it also serves as an example of how he effi-

ciently manages the hospital on a day-to-day basis.

More than 4,000 medical devicesProfessor Wei has summarized his experiences and recommen-

dations in a book: Detail-Oriented Management of Hospitals.

While China’s typical five-year plans set the strategic and finan-

cial framework, the hospital president is able to concentrate pri-

marily on managing his employees on a daily basis. “We get most

of them from the reservoir of 2.5 million people in our city and

train them here,” he says, before going on to say that the peo-

ple and their relationship with one another are a crucial aspect

of managing a hospital. Among these people are also heart spe-

cialists. Professor Wei opens the door to a room in which human

organs stand tightly packed next to one another, preserved in a

fluid produced in a special department. He points to the cross

section of a large, calcified heart. “The man from whom we

removed this heart before implanting another continues to enjoy

the best of health to this day!” In a figurative sense, the technical

equipment must also be in the best of health. “Together with a

team of ten engineers,” he explains, “I am responsible for ensur-

ing that more than 4,000 medical devices work correctly.” These

devices are becoming ever more efficient, but also more com-

plex. As such, the smooth service provided by the manufacturer

plays a key role. So it is little wonder that he warmly welcomes

Real composure: Professor Wei Tiemin has made Lishui Municipal Central Hospital one of the most modern of its kind in the region. The secret of its success lies in the professional expertise of the cardiologists, good employee management, and networking

Order and discipline are part of the Chinese desire for harmony. This is no different by the beds on the intensive care unit (below) to nature’s seemingly randomly arranged greeting (left). After all, mankind is just another part of nature

ASIA HOSPITALS

DRÄGERHEFT 404 | 2 / 201824 DRÄGER REVIEW 119 | 1 / 201924

the arrival of Ni Jianwei. Until recently the engineer was respon-

sible for servicing the Dräger equipment in this hospital and

clearly carried out his work to the satisfaction of everybody. “Like

many people, we Chinese also don’t like waiting,” says Ni. “If

they need us, they contact a call center, which in turn informs

the relevant Dräger Service employee.” This person then imme-

diately gets in touch to get to the bottom of the problem and solve

it, even in the middle of the night or at the weekend if need be,

because “most of the equipment remains where it is, such as in

the operating room or on the intensive care unit.”

The washing machines had to goThe intensive care unit is managed by Dr. Xin Tian. “We have

29 beds here and a further eight beds on another unit,” explains

the 45-year-old. His unit is also equipped with state-of-the-art

medical technology, although even at first glance it differs from

other intensive care units. It is much brighter and more open.

Visiting and supporting relatives also tend to paint a portrait

of a completely normal unit. “Technology helps to save lives

here,” says the doctor, pointing out the many different Dräger

venti-lators, “but technology alone isn’t everything in China.”

Traditional Chinese medicine (TCM) also plays a major role.

“We achieve good results with it – among those who present with

stomach complaints, for example,” says Dr. Xin, and even sees a

growing trend in the use of TCM, a form of treatment that is

constantly regenerating itself. Yet it is not just the demand for

TCM that is growing. “Overall, our patient numbers are set to

grow further over the coming years,” says Professor Wei. The

hospital is prepared for this. Two large buildings on the vast

hospital site are currently under construction at a pace typical of

the country (“three floors per month”).

After the tour, one wonders what is actually typically Chi-

nese about this hospital. Apart from the menu in the cafete-

ria, of course, it is the spirit: a general openness as well as a

certain sense of calm in spite of the workload. And the laundry

room, where the patients or relatives can wash their clothes in

a large basin. “We initially equipped it with washing machines,

but for reasons of tradition they weren’t used or accepted,”

recalls Professor Wei. Tradition in China is also due to the

commitment of the doctors in the area of prevention, even though

legend has it that doctors were once paid only for as long as their

patients remained healthy. Nowadays, lifestyle diseases such as

obesity and diabetes are rampant. “We inform the population

of the risks, primarily in schools. We have to identify diseases

as early as possible to maintain an efficient health care system.

In addition, I advise the government with regard to taking

the right measures,” says Professor Wei, who incidentally is a

member of the Jiusan Society rather than the Communist

Party. When you leave the hospital after spending the day there,

the heat hits you like a wet towel. And the cicadas invisibly

continue to make their noise.

Ever ready:Dr. Xin Tian man-ages the intensive care unit with 29 beds – equipped with the latest medical technology

“Chinese customers want the best”

The world is reflected in people:How traditional Chinese medicine is modernizing and becoming integral to the thinking of both doctors and patients.www.draeger.com/119-25

ASIA HOSPITALS


Dräger has been present in China since 1994. Dietmar Roethlinger has been head of the subsidiary in Shanghai since 2015. “China is currently the third-biggest market for Dräger, after Germany and the USA. We serve this market from Shanghai and Beijing with a total of seven organizations. According to Medical Equipment Magazine (2018), we are even the market leaders in the areas of anesthesia and ventilation. We also occupy this position in the field of mining, particularly in the mines rescue business. China has one of the strongest-growing populations in the world and we have by no means fully exploited this potential yet. Chinese customers always want the best so that they in turn can offer their customers the best. Dräger benefits from this with its products, but also with its service. Two trends will determine the future: One of them is a level of growth which will be further accelerated by the privatization tendencies. The other is the demand for local content – products that are developed and manufactured in the country for its own market. We are also well prepared for this with our own manufacturing operation in Shanghai. We have exploited just 40 percent of the premium hospital segment in China. There is still also ample potential among smaller hospitals in the middle price segment.”

Patient numbers are set to grow further over the coming years

Shoulder to shoulder: The health of a patient is in their hands. They are on the way to the operating room to help him

A watchful eye:This anesthetist uses the tech-nology to monitor the patient’s condition during the operation

Delighted by China and Dräger: Dietmar Roethlinger, CEO

26 DRÄGER REVIEW 119 | 1 / 2019

Rothaus Baden State Brewery’s seven natural springs bubble

far, far away from Scotland. Yet even here, 1,000 meters above

sea level, in the heart of the Black Forest, the art of the single

malt whisky is flourishing. If it sounds like a humorous schnapps

idea, the transformation from beer to whisky is an obvious one

for the experts. After all, single malt is made from almost exact-

ly the same ingredients as beer. The Scots are as uncompromis-

ing as the Germans and their Beer Purity Law (Reinheitsgebot)

in this regard. Pure spring water and barley malt form the mash,

while yeast ferments the mixture, transforming the malt sugar

into alcohol. The distillers only leave out the hops used by the

Rbrewers. So it is little wonder that whisky is in demand in Ger-

many, traditionally a nation of beer lovers. Around three dozen

distilleries alone currently belong to the VDW, an association

formed in 2012 to represent the interests of German whisky dis-

tillers. The distillery locations extend from the deep south (such

as Slyrs in Schliersee) to the far north (Hinricus Noyte’s in Wis-

mar). VDW members have been presenting their wares at “Ger-

man Whisky Day” since 2017.

Double distilled in copper pot stillsThe beer brewer Rothaus (whose products include “Tannen-

zäpfle”) began summoning fine bottled spirits in early 2000,

From beer to SINGLE MALT WHISKY – Rothaus Baden State Brewery has taken the step from one to the other. Particularly coveted are the special releases, like the Highland Cask Finish Edition.

Text: Peter Thomas

Summoning Spirits

in the Baden

Highlands


FOOD AND DRINK INDUSTRY

initiated by the then master brewer Max Sachs. “Turning this

vision into reality wasn’t easy,” says his successor Ralf Krieger.

That’s because the Baden State Brewery no longer possessed

private distilling rights, so simply taking the pot stills that now

stand in the museum and heating them up again wasn’t an

option. And finding a distillery in Germany that was willing

and able to carry out the double distillation process in copper

pot stills proved difficult. The company ultimately found what

it was looking for in Karlsruhe – and it turned out to be part of

its own history. This is due to the fact that Rothaus Black For-est Single Malt Whisky is made by the Kammer-Kirsch distill-

ery, which also belonged to the Grand Duchy of Baden 100 years

ago alongside the brewery, which is still owned by the state of

Baden-Württemberg to this day.

Rothaus bottled the first whisky and launched it onto the

market back in 2009. Since then, the single malt made with sum-

mer malting barley from Baden-Württemberg and soft water

from the Black Forest has acquired a good reputation. Partic-

ularly coveted are the special releases, like the Highland Cask Finish Edition – named after the highland region of the Black

Forest rather than the Scottish Highlands – which goes from

being an almost colorless, freshly distilled spirit to an amber-

colored whisky as it matures in the brewery’s vaulted cellar. The

maturation process is a journey through time and aromas. It

starts with the whisky ageing at Rothaus in American bourbon

casks. The Highland Cask Edition is then aged to perfection

in new oak casks during the so-called “finish.”

Ralf Krieger dips the glass whisky thief into the bunghole of

one of the casks, which are made by cooper Christof Schlegel

for Baden State Brewery. The light oak comes from the forests

by banks of the nearby lake known as Schluchsee. The engineer,

who specializes in brewing and beverage technology, draws up

an amber-colored fluid and drops it into a small stemmed glass

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Good things come to those who wait: The single malt whisky from Rothaus matures in these cellars at the Kammer-Kirsch distillery (left). The exclusive Highland Cask Finish Edition ages in the old vaulted cellar of the brewery itself, where master brewer Ralf Krieger (above) demonstrates the difference between young, almost colorless spirit and amber-colored whisky

28 DRÄGER REVIEW 119 | 1 / 2019

with a bulbous body. The bouquet is sweet, soft, and warm. It

tastes spicy, like herbs and a little caramel. There are other

special releases besides the Highland Cask Finish Edition. The

whisky then ages in red wine casks from the renowned Franz

Keller winery in Baden, for example.

Whisky production is a business based on reciprocity: Just

as the spirit absorbs flavors from the wooden casks and reacts

with the carbon layer on the inner wall, the whisky also releases

alcohol into the atmosphere at the same time. Since the

process cannot be precisely controlled, the alcohol concen-

tration of the cask strength editions always varies slightly. The

“angel’s share” is the name given to the alcohol that evapo-

rates in the cellar. It may sound poetic, but it is also an ethanol

emission that is subject to an occupational exposure limit (OEL) of

380 milligrams per cubic meter of air (based on TRGS 900 –

Germany’s Technical Rules for Hazardous Substances – dat-

ed June 7, 2018). Thomas Strecker, who is responsible for

occupational health and safety at Baden State Brewery, seeks

to reassure: “The company fire service has taken a whole

range of measurements in the cellar since the ageing process

began – the concentrations in the atmosphere have always been

perfectly safe.”

The firefighters at the brewery have a history that dates

back more than one hundred years. The company fire ser-

vice was founded in 1904 after a serious fire that was start-

ed by a lightning strike. It was evident at the time that the

state fire department took too long to reach the factory located

1,000 meters above sea level in the middle of the forest in the

event of an emergency. The risks have changed since then. For

instance, the barley is no longer malted on the premises, which

means that less dust is created, thereby significantly reducing

the corresponding risk of explosion. This is also the reason why

a wet mill is used nowadays to grind the delivered barley malt

without creating dust. However, the company fire service (cur-

rently a 24-man team, 13 of whom wear breathing apparatus)

remains important to the brewery and its 246 employees. Large

quantities of ammonia are stored for the extensive refrigera-

tion systems used to manage the temperature of the fermenta-

tion and storage tanks.

Ice-cold businessThe company fire department is prepared to deal with any

spillage: Blue Dräger chemical protective suits are hang up

between the fire trucks, ready to be worn at a moment’s notice.

The breathing apparatus, also from Dräger, is maintained in a

special workshop. Drills are carried out with the professional

Angels are silent partners in the cask cellar

There are around 1,500 breweries in Germany – many do good business in their niches. Highly moderntechnology is also used

at Rothaus for beer and whisky production

Traditional beer and modern brewing: The Rothaus State Brewery based in Grafenhausen in the highland region of the Black Forest is wholly owned by the state of Baden-Württemberg and is one of the biggest breweries in southwest Germany

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FOOD AND DRINK INDUSTRY

fire department from Freiburg, among others.

“The high-powered refrigeration technology is critical to

the products,” explains Ralf Krieger. That’s because Rothaus

relies on low temperatures and long processes for brewing its

beer. With the bottom-fermented beers this means a fermenta-

tion process at atmospheric pressure and ten degrees Celsius

for a good week, followed by a four- to five-week storage period,

during which the temperature is kept between ten degrees Cel-

sius and just below freezing point.

Anyone who stands in the brewing plant will first and fore-

most feel the heat, despite the thick insulation beneath the cop-

per lids of the mash tun, lauter tun, and brew kettle. In oper-

ation since 2005, the modern technology in the brewing plant

immediately cut the brewery’s energy consumption by a fifth.

But why is there a need for the high temperature that is sup-

plied to the various vessels via water and process steam? Sug-

ar and other materials are released from the grist by hot water

during the mashing process. Lautering then serves to separate

the solids from the liquid. The raw beer is heated with steam in

the brew kettle until it is almost boiling. The aroma hops from

Tettnang are then added, which help to give the Rothaus beers

their characteristic flavor. Once everything has cooled down,

the finished wort comes into contact with the yeast for the first

time. The brewery uses its own pure yeast, which is continu-

ously cultured in-house. To this end, the brewers take active

yeast cultures from each batch for the next round of produc-

tion. Two special strains are used. Bottom-fermented yeast – for

pilsner, Märzen (or “March beer”), and the naturally cloudy Maidle – accounts for the majority of production. Rothaus also

uses this yeast for making whisky. Top-fermented yeast is used

for wheat beer. The finished product is pumped into the stor-

age tanks once the fermentation process is complete. It mellows

here for at least a month until it can be sold. The brewery has

67 storage tanks, each with a capacity of 180,000 liters. “This

allows us to adhere to our meticulous process in times of high

demand without sacrificing quality,” says the master brewer.

A bottle roller coasterOnce the storage period is over, however, there is no longer any

peace and quiet for the beer. The bottles now whizz along fully

automatic lines from the sorting and cleaning stage to the fill-

ing and picking section. The state-owned company has invested

around 30 million euros in the latest building measures, includ-

ing the filling and sorting plant. Hundreds of millions of 0.33-

and 0.5-liter bottles leave the brewery every year. In contrast,

with around ten thousand 0.7-liter bottles, whisky production

only accounts for a fraction of the overall figure. In no other

product, however, can the spirit of the Black Forest be found in

such concentrated form as in Rothaus Black Forest Single Malt Whisky. Its classic cask strength variety is diluted to 43 percent

ABV – with the very same water from the seven Rothaus springs

used to steep the mash.

The company fire service is well equipped, says

Thomas Strecker, who is responsible for occupational

health and safety

Hundreds of millions of bottles are filled in the brewery every year. Turnover of around 74.8 million euros was generated last year with a workforce of 246 employees

FIREFIGHTING ABROAD

30

CANADA

MEMEMEMEMEEEEEEMEMEMEEMEEMEEEXIXIXXIXIXIXIIIIIXXIIIIXX KKKKKKKOKOKOKOKOKOKKKKKKKKKKKKKKKKKKKKKKKKKKKOKKKKKKOOOKKKKKKKOKOOK

USA

ALASKA/USA

Piteraq“When the

Brightly colored world:In Tasiilaqs new quarter (left) colorful houses line the fjord, which is frozen for eight months of the year. As such, the Greenlanders frequently use dog sleds or snowmobiles to reach the hunting village of Tiniteqilaaq



Tasiilaq

Qaqortoq

Nuuk

Ilulissat

GREENLAND

ICELANDTiniteqilaaq

Comes, Everyone Stays Indoors”

OOn the dark red building is a sign

that says Arsaanneq Inerteqqutaavo-qmit, together with the Danish transla-

tion: Boldspil Forbudt (no ball games).

Yet as is often the case with such warn-

ing signs, Tasiilaq’s youngsters love to

play football right in front of it – because

it makes such a wonderful clatter when

the ball hits the big metal doors of the fire

station. Plus here in Tasiilaq – the largest

(and only) town in the east of the country

with a population of 2,000 – there are not

many places where they can play.

Fire chief Hendrik Andreassen sits in

his office next to the garage. The 49-year-

old hardly registers the clatter anymore; he

In East Greenland, the fire service functions well. However, things get difficult when the storm from the inland ice rages

through the region. In 1970, it hit the town of Tasiilaq (pop. 2,000) with hurricane force winds reaching 200 miles per hour.

Text and photos: Barbara Schaefer

hears it every day. The Greenlander with

bristly, short black hair and a blue uniform

has been with the fire service for 28 years.

Why? He rummages through a stack of

framed photos and picks out one that shows

a burned-out house. “The man had can-

cer. He murdered his wife, set fire to the

house, and burned to death with his young

son.” Back then, Andreassen rushed to the

fire, as did half of the town. “Everyone

helped with buckets of water. This made

me think that there must be a better solu-

tion – more organized and professional.” In

the following year, the electrician by trade

began working with the fire service along-

side his normal job and took advantage of

every training course it offered. When his

boss, a Dane, retired, he said to himself,

“The next fire chief must be a Greenlander.

As things turned out, in 2001, it was me.”

Water in the fuel tankTasiilaq and a handful of villages are dot-

ted over a wide area. There are no roads

between them, and the local people trav-

el with dog sleds or snowmobiles. Helicop-

ters fly in essential provisions to the vil-

lages. Nowadays, not only Greenlanders

travel around the region; tourists have also

begun to visit the white wilderness. Expe-

ditions planning to cross the ice cap usu-

ally start out from the east coast. Officially,

the police are responsible for responding

to the incidents that happen every now and

FIREFIGHTING ABROAD

32 DRÄGER REVIEW 119 | 1 / 2019

News exchange: People meet on the brow of the hill near the fire station.

Youngsters play football or do a few laps on their mountain bikes. The adults tell

each other the latest news

Polar bears, mercury, and Mother Nature

again in the wilds of nature, but Andreas-

sen wanted to train his crew for this, too.

Training is a matter especially close to his

heart. He opens a trekking rucksack and

takes out climbing gear, ropes, a sleeping

bag, a camping stove, and snow probes.

An outdoor specialist, born in Greenland

and trained in Alaska, passed his skills on

to the firefighters. “Amongst other things,

he taught us how to find people buried by

avalanches.” The rucksack also contains

trekking food, sealed bags with freeze-dried

rations – even labskaus (a kind of corned

beef hash). Andreassen doesn’t think

much of it. “My people prefer to take food

from home with them: dried fish and Mat-tak, whale skin with blubber. It’s much

more nutritious.” Then this: A man from

Tasiilaq was on his way to the village of

Tiniteqilaaq on a scooter, but didn’t arrive

there as expected. His wife alerted Andre-

assen. It turned out that water had gotten

into the fuel tank and the man continued

his journey on foot. “As he was crossing an

icebound fjord, he turned and saw a polar

bear. He ran as fast as he could to the safety

of a hut on the shore.” The man wouldn’t

have stood a chance, but the bear wan-

dered off. He found three tourists in the

hut. They gave him some tea and a chance

to get warm by the stove. “That’s where we

found him.” Think ahead and be prepared:

It sounds like a mantra when Andreassen

talks about his callouts – like the incident

involving chemicals at the local school. At

first, the teachers hadn’t even noticed that

the children were playing with little balls

of mercury. Andreassen and Bianco Kallia,

the second full-time firefighter, alerted the

other members of the crew. They didn’t

have the right equipment, so he sent them

all home and swept up the mercury with

a brush and shovel. “After that, I sat down

and ordered two Dräger chemical protec-

tion suits from the colleagues at headquar-

ters in the capital, Nuuk, right away.”

On thin iceThe fire station, the low building up on the

hill, was built in 1961. It was the first on the

remote east coast, known in Greenlandic

as Tunu (which means “backside”). “The

Danes first came here in the late 1890s,

which makes us one of the youngest towns

in Europe.” The inaccessible coastline is

icebound for eight months of the year. So

if there’s a fire, where do you get the water

to fight it? “That is not a problem,” says the

fire chief. “There are enormous water tanks

and hand pumps in all the villages, and here

in the city we have hydrants every couple

of hundred yards. We also have a total of

around 2,000 feet of fire hoses.” They had to

come up with a clever idea to dry them after

use. The buildings in Tasiilaq are all low,

and nobody would think of building a tower


Provident: When fire chief Hendrik Andreassen had to deal with mercury using a brush and shovel following a chemical accident at a school, he immediately ordered this chemical protective suit

Lifeline: A helicopter links Tasiilaq to the rest of the world, bringing guests, locals, and fresh fruit – or urgent online

orders. If it can wait, however, it only reaches Greenland’s east coast in the summer

Totally analog: The mobile network is considered unreliable, so Tasiilaq’s firefighters rely on fire alarms – 500 of them are installed in the town

Command center Tasiilaq is on the coast – where else? The hinterland is covered with an ice cap that can be up to two kilometers thick. Around 2,000 people live in the largest settlement on the east coast. The region just below the Arctic Circle was first populated by Inuit tribes from Alaska around 4,000 years ago. The region was unpopulated for a long time due to worsening climatic conditions. The first permanent settlements here were established in the 14th century. Neither the Vikings, nor later European whalers, ever set foot on the east coast. The first non-Greenlanders arrived unbelievably late – in 1884, when the Dane Gustav Holm spent the winter close to the present location of Tasiilaq. Holm was fascinated by the culture and traditions of the indigenous tribes, and was followed by trading companies and missionaries. Life began to change. Although disease and alcohol decimated the Inuit, better and more food helped the population to recover and rise again.

because of the harsh weather conditions. So

the hoses are dried with the aid of a hot-air

blower in a long and narrow room. From

there, there’s a door into the garage where

the firefighting vehicles are kept. One of the

vehicles is a rugged 1972 Unimog. “It only

has 2,500 kilometers (1,550 miles) on the

clock so far. That’s because there are only 16

kilometers (10 miles) of streets in the whole

town.” In contrast, the Magirus Deutz is a

newer model from 1989. Hendrik Andreas-

sen stands next to it and asks what is strik-

ing about it. He answers his own question

straight away. “It’s too big for us Greenland-

ers.” They had to cut steps into the side pan-

el before the men – and two women – could

even get into the cab. At five foot seven, he’s

pretty tall for a Greenlander. “But it’s even

too high for me,” he says. On top of this, the

fire hoses weigh in at around 60 pounds

apiece. “We have to roll them out at head

height. In the long run, that’s not exactly

good for your health.” They really need a

new vehicle – one built specifically to meet

the needs of Greenland and its people. The

firefighting regulations from Denmark –

FIREFIGHTING ABROAD

34 DRÄGER REVIEW 119 | 1 / 2019

Sermiligaaq – there are 112 firefighters on

call. What are the most frequent causes of

fires? “There’s not much chance of it being

old electrical wiring,” explains Andreassen.

And definitely not fish smoking ovens – we

don’t have them here. Fish are simply hung

out to dry on racks in the dry Arctic air. The

remaining causes are just like anywhere

else: forgotten pans of food on the stove or

a combination of alcohol and cigarettes.

Smoking appears to be a national sport in

Greenland. On the streets, almost everyone

smokes – men and women, young and old.

There has never been anything even close

to a real inferno here. The spaces between

the houses are large, and their wooden

walls are painted with a fire-retardant lime

wash that protects them for around an hour

when a fire breaks out. The modern terrace

houses are made up of individual cells, so

when there’s a fire, only one part of the

building burns, and not the entire building.

The fitting of smoke detectors is mandato-

ry in all public buildings, in the two hotels,

in the pizzeria, the bar, and the supermar-

kets. There is also a small firefighting unit

at the heliport, the lifeline of the region

for the greater part of the year. Fire alarms

can be seen on the walls of buildings and

on lampposts throughout the town – 500 of

them in all. “We don’t have an emergen-

cy number here because the mobile net-

work is too unreliable – alerts are forward-

ed to us via satellite from Nuuk. Classic fire

alarms work much better. If there’s a fire,

we can get to any place in town within 15

minutes – except when the Piteraq comes.”

The Piteraq (“that which attacks you”) is a

cold fall wind that originates on the Green-

landic ice cap and sweeps down the east

coast. It brings gales of up to 180 mph, but

can also gust at up to 185 mph or more.

“When that happens, everyone stays

indoors.” There was a fire at the music hall

once, but nobody went out. Andreassen has

four children and his eldest son is a police

to which Greenland still belongs, despite

its autonomy – are also no great help. As in

Denmark, training was stepped up in the

aftermath of 9/11. “Only the problems we

face here have nothing to do with skyscrap-

ers and commercial airliners. We have to

know how to rescue people who get stuck

after breaking through thin ice.” That’s

why the equipment includes cold protec-

tion suits, a floatable rescue sled, and two

snowmobiles. There’s a rope as thick as a

man’s arm hanging on the wall. A piece

of rescue equipment? Andreassen laughs:

‘No, that’s for the tug-of-war competitions

we sometimes have with the crews of visit-

ing ships in the summer.”

112 firefightersIn Tasiilaq and the seven neighboring vil-

lages – from Tiniteqilaaq and Kuummiit to

It’s only a drill: When it snows lightly, the car pulls the fire truck out of the garage. Now the children have to play football elsewhere

Thunderstorm? Greenland has other causes of fire!

35

Tied up: Hunter Salo often takes tourists to Tiniteqilaaq, beyond the bay. On the return journey

he generally packs fresh seal meat on the sled – food for the dogs as well as for him

Head north – and then keep going. Right outside the tourism

office with ice cream shop, these signs in Tasiilaq point the way

officer. There’s no problem at all recruit-

ing new firefighters. “Thankfully, there’s

a long waiting list.” He takes care of this

in his own professional way. “From those

that I train here, hardly any leave – none

to Nuuk, none to Denmark.” He convinces

anyone who proves to have the right talents

to learn more. “More training and further

education are essential.” For instance, he

helped ten young people to secure a place

on vocational training courses. “I’m very

proud of that.”

Not so long ago, there was a big moor-

land fire on the west coast. Has there ever

been anything like that here? Andreassen

recalls a firefighting mission near Kuum-

miiut in the 1990s. “We were taken in

by helicopter.” Someone hadn’t properly

put out their campfire. “It burned a cou-

ple of feet into the ground.” It was nev-

er established whether it was tourists or

locals. Couldn’t the fire have been caused

by lightning? Andreassen laughs out loud.

He’s absolutely certain that it wasn’t: “It is

simply far too dry. I’ve never seen a thun-

derstorm here in my life.”

So many words for snow?Many people have heard that the Inuit have more than one hundred different words for snow. But, as is often the case with certain “facts” thought to be common knowledge, they are not always right. The author Kathrin Passig explains why in a story for which she was awarded the Ingeborg Bachmann Prize in 2006: “As our uninformed compatri-ots often profess in conversation, the Eskimos have countless words for snow. This is probably to point out the long-since lost perceptions of nature amongst city dwellers.” As Passig says, she has no patience with people who permanently relate this banal misconception. “The Eskimo languages are polysynthetic, which means that even rarely used descriptions such as ‘snow that falls on a red T-shirt’ are contracted into a single word.” Greenlandic, the language known locally as Kalaallisut, is an Inuit lan-guage that is totally unrelated to other linguistic families. Anyone who learns Inuktitut, the Inuit language of Canada, will understand about as much in Nuuk, the capital city of Greenland, as someone from Portugal in Romania. In East Greenland, however, the people speak a quite different dialect. A couple of useful words: Maybe – uppa. Yes – Iiiji. No – eeqqi (with a very gutturally pronounced “q”).

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New ship, seasoned seafarer: Dr. Christian Ellendorff is the ship’s

doctor on board the Mein Schiff 1 owned by TUI Cruises – for a few weeks each year. Back on land, he works as a

registered internist

36

Consultation Hour


He hardly slept last night: At sea, between the Danish islands

of Bornholm and Møn, a helicopter had to winch an acutely

ill passenger from on board and fly them to an onshore hospi-

tal. And early in the morning, in Kiel, three ambulances were

already waiting for the passengers who Dr. Christian Ellendorff,

the ship’s doctor, had referred to hospital for further treatment

at the end of a ten-day cruise around the Baltic Sea. “An absolute

exception,” says the 69-year-old, who takes a seat in his waiting

room just after midday. “I am just about to train new crew members

on how not to infect themselves with bloody plasters or used insu-

lin needles that some passengers leave behind in their cabins.”

And then he is on his way. Ellendorff uses his English and Span-

ish skills for the training, because the crew members of Mein Schiff 1 come from all four corners of the earth – most of them

from the Philippines. He is back within half an hour.

A room with a view“On average, between 30 and 40 patients visit our medical facil-

ities on board the ship every day.” The heavy fire door on Deck

Two is open six hours a day, 365 days a year – from 8 till 11 a.m.

and from 5 till 8 p.m. The first hour is reserved for crew mem-

bers, while the rest are for the passengers. This much time is

needed. After all, up to 4,000 people (approx. 2,900 passengers

and 1,100 crew members) inhabit the new TUI Cruises flagship

on its tours around the Baltic Sea and Canary Islands. “There

are always two doctors on board,” explains Dr. Ellendorff. “We

alternate on a daily basis; the other is then on call.” You have

to enjoy it. There are hardly any days off and the cabin is rather

small on a deck further down, where the crew lives – although

a porthole does provide a view of the outside world. A dream job

on a dream ship? The question is not really apt, because being

a ship’s doctor is more of a role than a job. Back on land, Ellen-

dorff works as a registered internist in Hamburg, but he has to

get out. Since 2010, he has been regularly providing medical

H


There are no more continents to discover, yet more passengers than ever are traveling on cruise ships. The SHIPS’ DOCTORS take care of their medical well-being – like on the new ship Mein Schiff 1 owned by TUI Cruises.

Text: Olaf Krohn Photos: Patrick Ohligschläger

on Deck Two

CRUISES FORUM

Emergency ventilation:

An Oxylog 3000 plus from Dräger is available on board when treating critically ill patients and transporting them – by helicopter, for example

Emergency room: The stretcher team is on hand with the necessary equipment to quickly transport patients to the onboard hospital in the event of an accident

care as self-employed locum doctor for several weeks at a time

on board ships owned by TUI Cruises. Even when he was still a

student, Ellendorff was always fascinated by the huge vessels on

the Elbe and wondered whether it might also be for him. At the

age of 60, he has finally given an affirmative answer to this ques-

tion. Ellendorff, who could also retire if he wanted to, appreci-

ates the diversity and multicultural life on board. Furthermore,

as someone joining the maritime world from a different career

background, he holds the rank of an officer and occupies a posi-

tion immediately behind the captain and his deputies within

the ship’s hierarchy. From a medical perspective,

he is subordinate to nobody in his onboard hospital.

General practice meets emergency roomAnyone who wishes to be a ship’s doctor must essen-

tially be a general practitioner, internist, or surgeon

and also possess a qualification as an emergency doc-

tor – the job requirements on board a cruise ship

sway between these poles. On the one hand, the on-

board hospital functions as a general practice that

treats several thousand people a year with their

minor ailments and injuries. On the other hand,

the doctors and care staff must be able to react pro-

fessionally around the clock – to heart attacks and

strokes as well as occupational accidents among the

crew. Anyone who books a cruise with TUI Cruises

ultimately does so with the certainty that if the worst

should happen – either on the high seas or in the

port of Montego Bay – they will receive medical care

in line with German standards and in the German

language. “In accordance with international guidelines, we

only really have to have one doctor on board, but we have two,”

says Angelina Koehler. The head of the Medical Department at

TUI Cruises has built up the onboard hospital since it was estab-

lished ten years ago. She previously managed onshore hospitals.

“The spheres of influence are completely different to those on

land. In addition, we have to observe numerous international

regulations at sea.” Even though a growing number of young

people are coming aboard, cruise ship passengers traditionally

tend to be somewhat older, because this form of travel primarily

allows aged people, who aren’t always so steady on their feet,

to visit exotic places. These guests, who often also have chronic

and preexisting illnesses, pay particular attention to the level of

medical care provided on board.

The ship’s doctor also holds the key to the well-stocked on-

board pharmacy. “This is another aspect of my role, because

at sea I have a pharmacist’s license in addition to my doctor’s

license,” says Ellendorff. “This wouldn’t be allowed onshore.”

It is immediately evident just how much this experienced

Only on board can the doctor also be a pharmacist

FORUM CRUISES

38 DRÄGER REVIEW 119 | 1 / 2019

On prescription: The pharmacy in the onboard hospital is well stocked. Since space is limited and the next port is often far away, the ship’s doctor and his team must think ahead when reordering

The call of the sea: Nurse Julia Bauer has swapped her job at a hospital in Cologne for one on board Mein Schiff 1

315.7 meters made Mein Schiff 1 the longest cruise ship on the German market in the summer of 2018. It was built in Finland and sails under the Maltese flag.

1,100 people from more than 40 different countries work on board, with Filipinos, Indonesians, and Germans most strongly represented.

30–40 passengers and crew members attend the six-hour consultation hour at the onboard hospital every day, 365 days a year.

2,200,000 German citizens went on a cruise in 2017; the figure in 1997 was 283,000.

physician enjoys this work with its complex processes. He has

to decide quickly whether a patient who has suffered a heart

attack, for example, can be treated on board or can wait to be

admitted to hospital at the next port, or even whether a rescue

helicopter immediately has to be scrambled at sea. In emergency

situations, he consults with his captain about whether the

course and speed of the ship should be altered to give the patient

the best possible treatment. A transfer to an onshore hospital is

therefore sometimes the preferred option, because an onboard

hospital is generally not suitable for inpatients staying a num-

ber of days. Among other things, the small intensive care unit

is equipped with an emergency ventilator (Type: Oxylog 3000)

and has room for a maximum of two patients – there are nor-

mally three beds available in the patient room. “We nonetheless

aim to make sure that the ill guests can continue their vacation

on board,” explains TUI Cruises Head of Medical Department

Angelina Koehler. With some broken bones, for instance, a cab-

in with a balcony is ultimately also suitable as a patient ward.

The team has recently gained support. “We have launched a

cooperation partnership with the University Medical Center

Hamburg-Eppendorf (UKE),” says Angelina Koehler. X-rays tak-

en on board the Mein Schiff fleet are sent to the UKE’s radiol-

ogy department online. “Our ship’s doctors then get a second

opinion within 30 minutes, allowing us to improve the quali-

ty of diagnostics.” This is why TUI Cruises wants to extend tele-

medicine to other areas in the future.

Many people work here – in a tight spaceThe Doc, as he is known to everybody, is on the move once again.

There is a great deal to organize before the ship weighs anchor

again this evening in Kiel. Two hours before it is due to set sail,

Julia Bauer mans the reception in the onboard hospital. The

nurse had been working in a large hospital in Cologne since com-

pleting her training, but her career has now changed course.

“Many people work in a tight space on board a cruise ship. The

whole world is received here,” says the 28-year-old. Unlike Dr.

Ellendorff, she is employed full-time on a four-month contract.

At least she is able to satisfy her wanderlust a little while on

board. “What you learn above all else here is the art of impro-

visation.” In the beginning she often got lost on board the huge

vessel. She now knows her way around, even in an emergency.

“When the ‘Starcode’ is sounded, we immediately head to the

scene with the first-response bag. And if she needs support, the

stretcher team is never far away. These specially trained crew

members bring sick or injured people to the onboard hospital

as quickly as possible.

“Sometimes,” says Julia Bauer, “I forget which day of the

week it is.” After all, there is no weekend to give the crew a sense

of time and order. In the onboard hospital, Christian Ellendorff

and his team can also forget whether it is light or dark outside.

But the Doc has a remedy for this: “I switch on one of our mon-

itors that relay images from the bow or stern camera.”

Facts and figures


4040 DRÄGER REVIEW 119 | 1 / 2019

Most of our sensory information is acquired via the eyes. The cornea functions as a kind of windshield here. If it becomes cloudy or overly bulges outward, often only a TRANSPLANT can prevent blindness. Nowadays, individual layers are preferably transplanted rather than the entire cornea.

Text: Dr. Hildegard Kaulen Photos: Patrick Ohligschläger

Ultrathin

A miracle of nature: Crystal-clear, tear-resistant, and durable. A cornea con-tains no blood vessels – it

is sustained by the lacrimal fluid and aqueous humor

HEALTH CARE EYE OPERATIONS

4141DRÄGER REVIEW 119 | 1/ 2019

Everything is prepared. The diseased

eye of Bernhard P. has been marked above

the eyebrow – only his eyes and nose are

still visible on his face. Today, the associ-

ate professor Dr. Adrian Gericke will give

the 49-year-old a new lens and replace

the diseased cornea with a donor graft.

Dr. Gericke is senior physician in the

eye clinic at University Medical Center

Mainz and is head of the section of corneal

diseases. In Bernhard P’s case, the cells

in the innermost corneal layer are grad-

ually dying. The surgeon will operate on

the other eye in a few weeks’ time, which

is routine in Mainz as one of Germa-

ny’s most important cornea transplant

centers: 245 donated corneas were trans-

planted here in 2017, many of them by

Dr. Gericke.

He actually wanted to be a cardiolo-

gist. With his dexterity and three-dimen-

sional sense of direction, it would have

been a simple task for him to guide a

catheter safely around the vascular sys-

tem. Yet things turned out differently.

The tissue that Dr. Gericke regularly

holds in his hands these days has not one

single blood vessel, because the cornea

is sustained by the lacrimal fluid and

aqueous humor. However, his skill and

sense of direction are no less in demand

in the field of ophthalmology. That’s

because transplanting a cornea requires

an especially sensitive touch, particularly

since just the inner two of the five cor-

neal layers are generally used rather than

the entire donated cornea. Bernhard P.

will also only have the innermost cor-

neal endothelium layer replaced along

with Descemet’s membrane above it.

This complex of endothelium and mem-

brane is about 20 micrometers thick,

which is roughly equivalent to a third of

the thickness of a woman’s hair. “It is

often only this layer that is responsible

for the cloudy cornea, which is why we

only replace the endothelium and Des-

cemet’s membrane above it and leave the

rest of the cornea intact,” says Dr. Ger-

icke. The procedure is known as a DMEK.

The abbreviation stands for Descemet membrane endothelial keratoplasty.

E

Layers

42 DRÄGER REVIEW 119 | 1/ 2019

HEALTH CARE EYE OPERATIONS

“The surgery is less invasive than replac-

ing the entire cornea, because only small

incisions are made in the corneal periph-

ery, via which the inner corneal layers

are replaced within the enclosed sys-

tem. This is less prone to complications,

because the intraocular pressure is nev-

er lost during the operation. The opera-

tion is also shorter and can be performed

under local anesthesia. The cornea

and visual acuity recover more quickly

than after the replacement of the entire

cornea.”

Late innovation The process of transplanting individu-

al cornea layers was pioneered by the

Dutchman Dr. Gerrit Melles between

1998 and 2006 and the procedure really

caught on in other hospitals in the years

that followed. It became possible because

the individual layers are not firmly joined

together, but can be separated from one

another without leaving behind any dam-

age. “Up until a few years ago, we were

essentially still operating in the same way

as the Viennese ophthalmologist Eduard

Zirm had done at the start of the twen-

tieth century. Zirm performed the first

penetrating corneal transplantation

in 1905,” says Dr. Gericke. “Not until

almost one hundred years later did the

procedure evolve significantly by trans-

planting individual layers.”

Sight is our most important sense. It is

also the one that humans acquire last of

all. We can hear, feel, taste, and smell in

the womb, but we only learn to see after

we are born. This sense cannot func-

tion without the cornea. It is the outer-

most layer of the eye, protecting it from

infection and injury. Its curved shape

is responsible for most of the necessary

light refraction and its material proper-

ties are unrivalled. The cornea is crystal-

clear, tear-resistant, and durable. Super-

ficial scratches are repaired within a

matter of days through the regeneration

of the uppermost epithelium layer. How-

ever, the innermost layer does not have

the same ability to repair itself. Once the

corneal endothelium layer has degener-

ated, it is lost forever – as in the case of

Bernhard P. The inner layer dehydrates

the middle layer (the so-called corneal

stroma); the middle layer swells up with-

out the intact endothelium and the cor-

nea becomes cloudy. Even though experts

have been working on artificial corneas

for a number of years and different prod-

ucts are in various stages of development,

The employees at the cornea bank in Mainz inspect the quality of the donations. They are given to the recipient a minimum of ten days later, once all the investigations are complete

43DRÄGER REVIEW 119 | 1/ 2019

“The material properties

of the cornea are unique”

Dr. Adrian Gericke, senior physician from the eye clinic at University Medical Center Mainz

Precision work: During a cornea transplant, often only the diseased innermost endothelium layer is replaced alongside Descemet’s membrane above it. This complex of endothelium and membrane is not even as thick as a single hair of a woman

there is still no widely acknowledged

approach that would make donors

unnecessary. Dr. Gericke is also work-

ing on a product in conjunction with

Professor Werner E. G. Müller, a material

scientist from the Institute of Physio-

logical Chemistry at Mainz University.

“The shape of an artificial cornea is quite

simply an outwardly curved disc,” says

Dr. Gericke. “The properties are the prob-

lem. The tear resistance, for example,

is proving difficult for us. A full trans-

plant must be sutured. If the material

is made more tear-resistant by adding

extra fibers, it becomes less transparent.

That is a dilemma,” says the ophthalmol-

ogist. “It is also important that the mate-

rial is durable and doesn’t disintegrate

or alter over time. The artificial cornea

must reliably seal the eye and be designed

to allow the outer epithelium layer, which

constantly regenerates itself, to grow

over the material. We simply haven’t got

there yet!”

Tiny roll of wallpaperWhen is a cornea transplant necessary?

Accidents, chronic inflammation, con-

genital illnesses, or a bulging and thin-

ning cornea are often reasons for surgery.

Dr. Gericke is operating on Bernhard P.

under general anesthesia. He starts by

replacing the lens behind the cornea. To

do this, he makes a small incision into the

edge of the cornea, opens the lens capsule,

reduces the contents to small pieces, and

vacuums it all out. He then inserts an arti-

ficial lens into the empty capsular bag.

Only then does he begin to transplant the

endothelium and Descemet’s membrane,

which he separated from the donor’s cor-

nea with a high-precision instrument

before the operation. Dr. Gericke has

also made tiny marks so that he can dis-

tinguish the front from the back during

the operation. The corneal layers are then

placed in sterile liquid on the instrument

table and resemble a tiny roll of wallpa-

per. Dr. Ge ricke removes the diseased lay-

ers from the recipient before he rolls out

the new ones on the inside of the cornea

via the small incision. An air bubble will

press the transplanted layers against the

rest of the cornea for a few days until they

44 DRÄGER REVIEW 119 | 1 / 2019

Organ Transplant Act (Transplantations-gesetz), according to which it is only per-

missible to procure a cornea if the donor

has given their consent while still alive

or if the relatives opt for such a donation

based on the donor’s presumed consent.

Unlike an organ with a blood supply, how-

ever, the corneas can still be procured

up to 72 hours after the donor’s death.

In such cases, the deceased is also quite

obviously dead in the eyes of the rela-

tives. Brain death alone makes it diffi-

cult for many relatives to opt for organ

donation, because even though they can

see that the brain has ceased to function,

the body is still alive thanks to modern

intensive care medicine. This problem

doesn’t arise with corneas. As such, the

donor situation is less dramatic than in

the case of organs. The cornea is also not

Removal is possible up to 72 hours after death

ILLU

ST

RA

TIO

N:

SH

UT

TE

RS

TOC

K

adhere on their own. They are not sewn

into place. A gas mixture ensures the air

bubble is not reabsorbed too quickly.

Dr. Gericke will later transplant a

complete cornea for his patient Christina

N. The 69-year-old suffers from scarring

involving all corneal layers. This proce-

dure will also be performed under gen-

eral anesthesia. During a full-thickness

transplantation, the central part of the

cornea is exchanged with all its layers. To

do this, Dr. Gericke starts with punching

a circular disc out of the donor’s cornea

under the microscope and does the same

with the diseased cornea. The donated

fragment is then positioned in the eye

and sutured. Dr. Gericke uses a nylon

thread that is also thinner than a wom-

an’s hair. The sutures are not removed for

at least a year in order to ensure that the

transplant has taken correctly.

Good long-term resultsHow high is the risk of rejection? Since

the cornea has no blood supply and thus

doesn’t really come into contact with

large quantities of defense cells, the risk

is rather low. Most patients must use eye

drops with an immunosuppressive agent

for a year. Only at-risk patients receive a

general suppression of the body’s defense

system, but in most cases this isn’t for

the rest of their lives, as is the case after

transplanting an organ with a blood sup-

ply. “We also don’t normally need to

ensure that the tissue characteristics

match in the same way as we do for an

organ transplant,” explains Dr. Gericke.

“This is only necessary for the cornea in

exceptional cases.”

Dr. Gericke and his team get the cor-

nea donations from the eye bank linked

to the eye clinic, which has been man-

aged by Dr. Melissa Apel for the past six

years. In the same way as organ trans-

plants, the cornea transplant is also

subject to the provisions of the German


EYE OPERATIONS HEALTH CARE

A sensitive touch is vital:The innermost corneal layers must be separated from the rest of the cornea before they can be transplanted. To do this, the doctors take the tissue from the transport container and place it in a special device with the inner side facing upwards. They then mark it for later orientation purposes and remove the layers

How does a cornea bank work?And how are the donors even recruited, corneas removed, and the quality checked?www.draeger.com/119-45

an organ, but a tissue, so it is a tissue

donation rather than an organ donation.

By nature, not all donated corneas

possess the necessary quality. The tissue

must not be scarred and the endothelium

layer must have at least 2,000 cells per

square millimeter for most transplanta-

tions, otherwise the number of cells is

insufficient for good visual acuity. Of the

715 corneas received by the eye bank in

Rhineland-Palatinate in 2017, 397 were

transplantable. The operations were per-

formed either in Mainz or in one of the

cooperating hospitals across Germany.

The need for transplants, however, is

greater. It remains to be seen whether

artificial corneas will be a solution in the

near future.

Seeing is a complex process: In principle, the eye generates an image whose brightness values are then transformed into electrical impulses – like in digital photography – and then processed into a sensory perception by the brain. Even though the brain can compensate for many deficiencies of the eye based on experience, only a healthy eye can guarantee the optimal input. It does so as follows: The filtered and mostly reflected ambient light enters the eye via the protective cornea (1) and the anterior eye chamber (2) (with its nutrients and anti-bodies) and falls on the lens (3). Beforehand, the light passes through the iris (4). This regulates the eye’s exposure to light so that it isn’t dazzled. The shape of the lens is changed by the ciliary muscle and zonular fibers (5) to allow a sharp image to be projected onto the retina (6) with its many nerves. The nerves converge on the blind spot (7). The optic nerve (8) passes the image information, which has been trans formed into electrical impulses by the rods and cones in the retina, onto the brain for processing (visual cortex). The vitreous body (9) has a supporting function and fills the greatest part of the eyeball. The choroid (10) supplies the eye with blood, among other things. It is protected by the outer sclera (11). The dynamic range of the eye is about 20 stops – high-end cameras can only manage around twelve. Between ten and 15 blinks per minute, each lasting around 350 milliseconds, regularly moisten the cornea with lacrimal fluid to prevent it from drying out.

Get the picture!

1

2

3

4

5

6

10

11

9

7

8

46 DRÄGER REVIEW 119 | 1 / 2019

AGRICULTURE LIVESTOCK HUSBANDRY

Breathing


C

in the Calf Shed

For cleaner air in the shed: Professor

Samuel Kohler, head of the Swiss research project,

checks one of the portable gas detectors together

with the ammonia sensor

Country air is healthy, so the saying

goes. Cattle shed air could be healthier: It

contains gases that can damage the body.

This is no big problem for us humans.

We can simply go outside at any time and

breathe freely. The animals, however, live

there. A good climate in the shed is there-

fore critical to their health and well-being.

A sensor developed by Dräger is now

helping Swiss scientists to better under-

stand how ammonia, the main harmful

gas in the shed, forms and spreads and

how it affects the animals. It is the gas

that prickles the noses of visitors to cattle

sheds and public toilets and brings tears to

their eyes. Ammonia is the simplest com-

pound of nitrogen and hydrogen (NH3)

and plays an important role in the chem-

ical industry – in the production of artifi-

cial fertilizer, for example, which provides

plants with the nutrient nitrogen. In the

AMMONIA is an aggressive gas that develops in cattle sheds and affects the animals’ health. For the first time, Swiss scientists now want to use a Dräger sensor to measure the concentrations right by the animal and over longer periods of time.

Text: Tobias Hürter Photos: Patrick Ohligschläger

48 DRÄGER REVIEW 119 | 1 / 2019

shed the gas primarily forms when dung

and urine mix on the floor and are subse-

quently decomposed by microorganisms.

The problem is less serious with mature

dairy cows, because they are ruminants

with a fully developed digestive system,

which reduces the formation of ammo-

nia. Calves, however, are not yet rumi-

nants. The rumen that allows cows to

digest grass and hay has not yet developed.

In addition, they lie on the ground more

frequently and their organs and immune

systems have not yet matured. As a result,

they especially suffer from the ammonia

that they produce themselves, because

it affects their respiratory passages and

mucous membranes. Several calves of a

similar age along with germs and stress

make the young animals more susceptible

to infectious diseases. “We deal with lung

problems very often in the area of calf

rearing,” says Professor Samuel Kohler, a

veterinarian who teaches animal health

and husbandry at the School of Agricul-

tural, Forest and Food Sciences (HAFL)

in Bern. “And we therefore also deal with

a high level of antibiotic use.” So it would

be an important step in the right direc-

tion to get a better grip on the formation

of ammonia in calf sheds.

Excessive antibiotic useIn addition, ammonia in the shed air pre-

sents a risk that also affects humans – even

vegetarians and vegans. That’s because

the preventive administering of antibiot-

ics in the shed is resulting in a growing

number of bacteria becoming resistant to

them. This creates a risk of patients being

at the mercy of an infection. The World

Health Organization (WHO) estimates

that several hundred thousand people

die every year as a consequence of antibi-

otic resistance. That is why the Swiss gov-

ernment launched its National Strategy on Antibiotic Resistance (StAR) back in

2015. The aim is for various authorities

and institutions to work together to fight

the development and spread of new forms

of resistance.

Two years ago, Dräger entered the

field of agriculture with a new electro-

chemical sensor capable of withstand-

ing long-term exposure to harmful gas

and presented a new portable device for

measuring the ammonia content in cat-

tle sheds. Gas detection tubes had gener-

ally been used up until that point. They

are tried and trusted, but only provide a

snapshot; a value at a certain moment

in time. In order to gain a better under-

standing of how ammonia forms and the

effect it has, however, it must be possible

to measure the fluctuating concentra-

tions throughout the day or, better still,

the entire two- to three-month fattening

period. There was previously no reliable

measuring method that was both practi-

cal and affordable. Ammonia was the big

unknown quantity in the shed. Markus Sax

from Agroscope, a Swiss agricultural cen-

ter of expertise, was one of the first peo-

ple to approach Dräger two years ago. He

has been examining ammonia levels in

calf sheds for a long time. What drives up

the concentration? How can it be reduced?

Such questions couldn’t be answered

with the resources available five years

ago. “Then this sensor emerged,” recalls

Sax, and with it the chance to finally find

answers to these questions. The first aim

of the ammonia project, which is being led

by Professor Samuel Kohler, is to under-

stand the level of pollution to which the

calf is exposed in a shed – over the course

of a day and throughout its life. It is also

about understanding the effects of ammo-

nia and reducing its presence by optimiz-

ing shed management. “The calves should

grow up in an environment where they

remain healthy,” says Professor Kohler.

How much is enough?The researchers record their measure-

ments in a test shed near Lenzburg, a

small town in the canton of Aargau. It belongs to the feed producer Ufa. Two

groups of calves live in the shed, each

group containing 36 animals. They are

put in the stalls and taken to slaughter

at the same time as each other. The toxic

effect of ammonia on man and beast has

essentially been known for a long time.

In the chemical industry there is a lim-

it of 20 ppm (parts per million). That is

the highest permissible concentration

to which humans can be exposed – eight

hours a day, five days a week. The same

limit has been set for animals in Germa-

ny. Switzerland is even stricter – the reg-

ulatory authorities have recommended a

Fresh air: The calves in the test shed (seen here aged about one

month) in the Swiss canton of Aargau

can also go outside


LIVESTOCK HUSBANDRY AGRICULTURE

Cooperation: Dräger provides the measuring technology in the shed

Ammonia was previously the biggest unknown quantity in the shed

50 DRÄGER REVIEW 119 | 1 / 2019

limit of 10 ppm in the sheds here. How-

ever, the Swiss researchers are critical.

They say that this level has been arbitrari-

ly set and only applies to the air in the

shed in general. In other words, there is no

definition of how much ammonia a calf can

inhale, although it hasn’t been possible

to verify this until now. Farmers and

inspectors generally rely on their noses.

A measuring device is only used if the

smell is noticeably strong and unpleasant.

However, it generally stays in the hand

of the person taking the measurements

and can reveal so little about the dose that

enters a calf’s lungs when it is lying in

the other corner of the shed with its nose

above the dung-covered floor.

In the spring of 2018, the Swiss

researchers teamed up with Dräger to

test whether the sensor can be used to

measure how much ammonia a calf

actually inhales. They slipped foal hal-

ters onto the animals, to which a detec-

tor was attached – fitted with a minia-

ture version of the ammonia sensor as a

prototype. Even though the data initially

only serves as preparation for a scientific

study, it has already revealed that the lev-

els to which the calves were exposed sig-

nificantly fluctuated, while the ammonia

levels recorded on the probes installed

in fixed positions remained below the

permissible values. The devices them-

selves must also be capable of withstand-

ing quite a lot. The calves rub themselves

against them or chew and suck on them.

At the end of 2018, the scientists want to

take the first systematic measurements,

which involve the animals wearing a sec-

ond sensor that constantly displays their

location. Is the animal currently stand-

ing by the drinking trough, sleeping in the

corner, or walking around outside in the

fresh air? All of these aspects influence

the ammonia exposure levels.

Regular fresh air supplyPeople might think that the ammonia

problem is easy to solve: Simply let the

air blow through the window! But it isn’t

that simple. Calves are generally fattened

in an enclosed shed, shielded from germs

and other environmental influences to

the greatest possible extent. Furthermore,

the temperature in the shed would be too

low if the windows were left open in win-

ter – the calves need heat to grow quick-

ly. At the same time, they are constantly

standing on a layer of dung that is getting

ever bigger. Extra straw is continuously

being added and the shed is only mucked

out approximately every two months. This

is known as the deep litter system. Oth-

er sheds are fitted with perforated floors,

but this doesn’t change the level of ammo-

nia in the air, because the dung is mere-

ly one level further down. “This means

that high emissions end up in the shed

air as a result of the dung fermentation,”

says Markus Sax. Accordingly, the animals

need a constant supply of fresh air. When

viewed in this way, the subject of venti-

lation in calf sheds is a highly sensitive

matter. The farm manager wants to set

it so that the animals have the best possi-

ble conditions for growth in combination

with the lowest possible risk of infection.

Highly technical, computer-controlled

ventilation systems that consider param-

eters such as temperature, humidity, and

carbon dioxide content in their manage-

ment routines have been standard for

a number of years. “We now also want

to include the ammonia concentration

here,” says Sax.

If the Swiss project could help farm-

ers to stay within the existing ammonia

limits in the sheds, it would already be

classed as a success. Yet it can go even fur-

ther by providing a better understanding

of how the ammonia affects the animals.

“It is clear that ammonia is an essential

factor in the health of the calves, but as yet

there are no clear results on the precise

effects and interactions (connected with

the shed environment),” says Marion

Zumbrunnen, an agricultural scientist

involved in the project. Some researchers

suspect that even concentrations signifi-

cantly below the limits may carry consid-

erable health risks. As such, the measure-

ments could ultimately bring about more

meaningful limits. Everybody should have

an interest in achieving a better climate

within the calf sheds, including those who

never even enter one.

The ammonia levels fluctuate much more than previously thought

Stubborn germs: What do cattle sheds have to do with hospitals? More than you might think. www.draeger.com/119-50


LIVESTOCK HUSBANDRY AGRICULTURE

Good for man and beast: Less ammonia in the shed means fewer antibiotics are used – and thus fewer resistant germs

Fine tuning: The researchers are testing how well the mobile devices and ammonia sensors (above and below) can be attached to the calves, but also investigating where the fixed probes (Type: Dräger Polytron C300) can be best positioned within the shed

52 DRÄGER REVIEW 119 | 1 / 2019

The eternally inebriated sailor character created by Joachim Ringelnatz is but a legend. Shipping has become a sober industry that generally not only bans the CONSUMPTION OF ALCOHOL AND DRUGS on board, but also onshore. The shipping company is responsible for enforcing the ban.

Text: Constanze Sanders

PH

OTO

: P

ICT

UR

E A

LL

IAN

CE

/EM

PIC

S

Maritime accident on the west coast of Scotland: Half a liter of rum was imbibed before starting a shift on the bridge – according to the investigation report, a drunken sailor was responsible for this cargo vessel running aground in February 2015

When the British cargo vessel Lysblink Seaways ran aground in the early hours

of February 18, 2015, on the west coast of

Scotland on its way to Norway, the first

officer on duty had fallen asleep. After con-

suming half a liter of rum, he had forgot-

ten to activate the navigation safety sys-

tems at the start of his shift. The breath

test required by the shipping company and

carried out by the captain three hours lat-

er revealed a value of 2.71 mg/l. The cap-

tain and second officer were sober. The

officer on duty was fired; the vessel was

scrapped after being recovered. It was

human error – the cause of between 80 and

90 percent of all accidents at sea. Alcohol

W

High and

SHIPPING PANORAMA


Dryconsumption may play a role, but only in

a handful of cases. And yet: If someone

in charge was drunk on the bridge, this

seemingly confirms excessive drinking rit-

uals on the world’s oceans. But it is often

no different to the situation on land, even

though people like to consume alcohol on

board merchant vessels in their free time.

The notorious equator-crossing ceremo-

nies and all-night parties in the mess, how-

ever, are a thing of the past.

Seafarers have a stressful job that

remains hazardous, although safety stan-

dards have improved considerably in

recent decades. Due to the high stress lev-

els, shipping crews are among the occupa-

tions with an increased risk of addiction.

monitored as life on board these vessels.

The International Safety Management

(ISM) Code requires every shipowner,

manager, or charterer to adopt a Safety

Management System (SMS) that in-

cludes an employment agreement on the

use of drugs and alcohol. The shipowner

is responsible for ensuring that every-

body complies with it. Anyone who wants

to work on board a ship needs a seafarer’s

medical fitness certificate. Examining

the individual’s addictive behavior is

an integral part of the medical checks,

which must be carried out at least every

two years. Around 20,000 seafarers were

examined annually between 2009 and

2015. On average, around three percent

“Alcohol quickly numbs the anguish associ-

ated with the job and softens the transition

from work to private life,” says the Har-

vard sociologist Cassandra Okechukwu.

However, there is little room for maneu-

ver in the global merchant fleet. Many

an onboard smoking lounge has decayed

into a dusty old cabin, because a growing

number of shipping companies are adopt-

ing a dry ship policy and completely ban-

ning alcohol, which means that the sea-

farers remain dry even when they are on

shore leave.

Tens of thousands of ships navigate

their way around the seven seas, more

or less unnoticed by the rest of the world.

Yet few areas are as strictly regulated and

54 DRÄGER REVIEW 119 | 1 / 2019

failed. “However, addictive disorders

only played a subordinate role,” says Dr.

Philipp Langebuch, head of the marine

medical service at the German employ-

ers’ liability association responsible for

transport (known as BG Verkehr). “We

found 40 addicts last year, 24 of whom

were alcohol-dependent.” The latter

group thus accounts for 0.12 percent of

those examined. Every day, almost two

million seafarers worldwide ensure that

the crew, ship, and cargo safely reach

their destination. Tankers, bulk carri-

ers, freighters, and container ships are

constantly transporting goods around

the globe. Without them there would be

no cheap consumer goods, food, or raw

materials. “There are working time reg-

ulations, but at certain times I am sim-

ply unable to take a break,” says the cap-

tain of a container ship with more than

40 years of professional experience. The

same goes for the crew.

Checks at sea and in portsSince January 1, 2017, there has been

a breath alcohol limit of 0.25 mg/l on

all of the world’s oceans, equivalent to

0.50 mg/ml in the bloodstream. On

tankers and vessels carrying hazardous

cargo, alcohol has long since been taboo.

“The international regulations require

effective prevention with clear limits

and tolerances and mandatory testing

devices,” explains Dr. Stefan Steinmeyer,

product expert for impairment checks at

Dräger and responsible for alcohol and

drug testing. “Random checks must be

scheduled while safeguarding the priva-

cy of those being tested.” Checks are also

carried out in ports. Every oceangoing

vessel that arrives in Hamburg, for exam-

ple, receives a visit from the river police.

“We go on board as quickly as possible so

that we find those on board in the same

state as they were when the ship berthed,”

says Ulf Petereit, chief investigator at the

river police department in Hamburg-

Waltershof. The visual examination for

alcohol and drug consumption is part of

every clearance procedure. If necessary,

the officers also offer a breath test on a

voluntary basis: “Almost everyone accepts

it,” says Peterait. At sea, social control

ensures that everyone remains fit to work.

All hands are needed here when 20 sail-

ors need to keep a 300-meter container

ship with a draft of 14 meters on course –

a pounding powerhouse with thousands

of horsepower that works on the basis of

clear laws. “We all want to return home

safely,” says one sailor. “If somebody

overdoes it with drink or marijuana, a

colleague will speak to them.” The aware-

ness of a community at risk informs life

among the wind and waves. Many seafar-

ers often spend six months at a time or

longer at sea. “In three months I was may-

be onshore three times for a few hours,”

reports the captain of another container

ship traveling between Northern Europe

and South America. There is hardly any

time for shore leave leisure activities. It

takes just 36 hours to clear a mega-carri-

er through customs, during which time

it has handled around 6,500 standard

containers.

Such a ship is an intense working envi-

ronment and it is difficult to get away even

during time off. It offers few home com-

forts and every crew is different: Constant-

ly changing nations, mentalities, and cul-

tures converge here. This all causes stress.

Having to get along with one another for

months at a time – in cramped, sway-

ing conditions, 24 hours a day – can lead

to conflict, with stress symptoms such

as insomnia, frustration, and general

The ocean is a dangerous workplace

Important visitor: Every seagoing vessel that arrives in Hamburg is inspected by the river police – a visual examination for alcohol and drug con sumption is part of every clearance procedure

PH

OTO

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S/A

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SHIPPING PANORAMA


exhaustion.“The problem is the isolation,”

says Langenbuch from the BG Verkehr.

“The sailors have no contact with their

families, wives, and children.” Once the

coast disappears from the horizon, there

is generally no cell phone network. The

ocean is one huge dead spot for those who

cannot afford a satellite telephone.

When cargo ships still sailed, hard

liquor flowed freely – due to boredom,

but also for health reasons. For centuries,

rum was the better alternative to drinking

water, which went stagnant in the basins

before the Madagascan rum. It was also

considered a remedy for scurvy. The defi-

ciency disease and spoiled food and drink

decimated entire crews until Captain

James Cook served his men sauerkraut in

the 18th century. The vitamin C contained

therein ended the sailors’ anguish and

also ruined the excuse for the rum intoxi-

cation. Yet it wasn’t just Kuttel Daddeldu,

the fictional character created by the sea-

faring poet Joachim Ringelnatz, who con-

tinued to get tipsy. Until the second half

of the 20th century, “the sailors were out

to alleviate their various pains,” recalls

another captain. “Wine, women, and song

were an effective way of doing this. As long

as the duty officer on the bridge had his

wits about him to some extent, there was

no real danger on the high seas.” Rapid-

ly changing weather conditions and pira-

cy, however, made the ocean one of the

world’s most dangerous places to work.

Around 2,000 sailors lose their lives every

year. In 2016, there were 2,611 accidents;

85 ships sank. Most of the accidents hap-

pen in bad weather. Thanks to modern

communication technology and sophisti-

cated rescue services, help now arrives on

board comparatively quickly.

A new generation of sailorsHuman error nonetheless remains the big-

gest risk. Crewing agencies that hire the

personnel for the global merchant fleet are

considered the first line of defense against

alcohol abuse at sea. In Manila alone there

are hundreds of such recruitment agen-

cies. Almost half a million Filipinos are

employed on the oceans, approximately

one quarter of all sailors worldwide. Most

of them are far away from home, trans-

ferring billions of US dollars back to their

families every year. Even though the con-

sumption of alcohol plays a similar role in

their homeland as it does in other coun-

tries, Filipinos often drink less. A study

has revealed that this restraint is due to

their socially recognized status as family

ambassadors and breadwinners. There is

almost always a karaoke machine in their

mess, a national sport for which they cul-

tivate real ambition. Everything that has

ever conquered the pop charts is sung –

sometimes with, but also without alcohol.

“There is a new generation of sailors.”

This observation was made by Ulf Petereit

and his river police colleagues at the bor-

der checkpoint, which every ship has to

pass through before it can leave the port

of Hamburg. “This generation thinks dif-

ferently and drinks less.” His trained eye

can quickly tell if somebody is under the

influence of alcohol. “But problems are

exceedingly rare,” says Petereit, who has

20 years of professional experience behind

him. The job of a sailor is a lonely one these

days. So what could make a sailor happy?

Above all else, an Internet connection on

board the ship for contacting the family.

The maritime industry has recognized this

problem and is increasingly providing lei-

sure and sports activities. Relaxing enter-

tainment and the ability to switch off are

no longer a luxury, but a necessity, while

also attracting well-qualified personnel.

A well-equipped lounge helps the crew to

bond. Films are watched together or cards

played during the coffee break or after the

evening meal. A ship that has a good chef

and celebrates birthdays, Christmas, and

New Year is a good ship. If the company pol-

icy allows it, there is sometimes also beer,

wine, or spirits. Four hours before a shift

begins, however, only soft drinks are gener-

ally served. Most ships carry testing devices

such as the Dräger Alcotest 5820 so that a

crew member can be tested at any time. A

growing number of ships have an absolute

zero alcohol limit. “Captains are required

to carry out random testing,” says shipping

investigator Petereit. “The results are docu-

mented and presented to the shipping com-

pany in order to show the measures tak-

en on board.” However, the captain always

has the final say. He himself can ban alco-

holic drinks even if the shipping company

allows them.

0.0 BAC: Many ships now carry measuring devices like this (Type: Dräger Alcotest 5820). There is generally a zero tolerance approach to “alcohol at the wheel”

56 DRÄGER REVIEW 119 | 1 / 2019

The world’s biggest HOSPITAL SPECIALIZING IN

GASTROENTEROLOGY is being built in the Indian city of Hyderabad – and is designed to alleviate the lack of medical specialists on the subcontinent.

Text: Mathias Peer Photos: Harsha Vadlamani

Mehabub Halder* has traveled a long

way for his appointment. The man from

Calcutta sat on a train for 26 hours before

reaching the southern Indian city of Hyder-

abad. This is the workplace of Nageshwar

Reddy, currently one of India’s most in-

demand specialists in stomach, bowel, and

liver problems. Halder has had an unusu-

al swelling in his stomach for a number of

years and he wants to have it examined.

He is certain that he will find help here.

It is Tuesday morning in HITEC City, a district of Hyderabad where internation-

al companies such as Amazon, IBM, and

Deloitte have also opened offices. Hal-

der is heading for the dark gray, nine-sto-

ry building next to the city’s expressway.

At first glance, it could easily be mistak-

en for one of the modern shopping malls

that are increasingly vying for the business

of the middle-class people with purchas-

ing power in India’s cities. An automatic

glass door slides open at the entrance; a

guard x-rays the bags at the security check-

point. A vast hall with marble floors and

escalators opens up behind it. The build-

M

Doctor Reddy’s Hunt for

the Record

ing’s golden logo shines resplendently at

the other end: AIG. The three letters stand

for the Asian Institute of Gastroenterology, a hospital specializing in treating patients

with digestive tract problems. Dr. Nagesh-

war Reddy, the founder of the hospital, is

pursuing ambitious plans with his insti-

tute: The 62-year-old not only hopes that

it will become one of India’s leading pri-

vate hospitals, but also the world’s biggest

hospital specializing in gastroenterology.

Around 70,000 endoscopiesDr. Reddy has experience in caring for

a large number of people – he has been

In demand: Dr. Nageshwar Reddy is one of India’s most popular gastroenter-ologists. The waiting time for an appointment with him is several months

XXL dimensions: It’s easy to look lost in the lobby, in which a medium-sized railroad station would also fit

* Name changed


ASIA MEDICAL CARE

practicing in Hyderabad for more than

three decades. His good reputation has

been earned by treating patients from all

over India as well as neighboring states. In

his first hospital, which is located in the

city center near the heart-shaped Hussain

Sagar Lake, he and his team have recently

been treating more than 100,000 patients

per year and performing around 70,000

endoscopies. According to the hospital’s

own figures, it holds the world record for

the number of these ERCP examinations

performed annually. And since there is no

longer sufficient room for every patient,

Dr. Reddy is aiming to go one bigger

with the new building in HITEC City. It is set to take his life’s work to a new lev-

el: Around half a million patients could

be treated here each year. However, as

of August 2018 the large hospital is not

quite ready: Boxes are still waiting to be

unpacked by one of the entrances. Wires

are poking through the wall where ceil-

ing supply units will eventually hang, and

the drone of the drills constantly inter-

rupts the calmness that otherwise reigns.

The operating rooms and intensive care

units are not yet open, either, although

Reddy doesn’t want to lose any time: He

has been welcoming the first patients over

the past few weeks. With this so-called soft

launch he wants to test the procedures

and make sure that his hospital can cope

with the anticipated demand. Reddy walks

along the corridor in a white gown with

a group of visitors. There is a little bit of

rustling, because the shoes are wrapped

in blue plastic film for reasons of hygiene.

Reddy stops by one of the window façades

and points to the construction work in

the inner courtyard: “Hanging gardens

are being built here.” He says it is impor-

tant to give patients a view of green spac-

es from their rooms. Daylight can be seen

from almost every hospital bed. “I have

58 DRÄGER REVIEW 119 | 1 / 2019

Operation “Blue”: The lighting in the treatment rooms makes it easier for the doctors to concentrate on the monitors. The temperature can be controlled by voice recognition. Besides the gas management system, much of the equipment (below) is supplied by Dräger

ASIA MEDICAL CARE


visited more than 500 hospitals all over

the world and am very pleased with what

we have achieved here,” he says. “We have

created an infrastructure that is among

the best in the world.” There are 800

beds, 20 endoscopy suites, and 16 operat-

ing rooms: No other specialist hospital in

this field has as much capacity, according

to Dr. Reddy. “In second place is a hospi-

tal in China with 400 beds.”

Doctor and entrepreneurThe equipment in the rooms is like some-

thing from a science fiction film: The doc-

tors hold their hands up to a sensor in order

to enter. Without touching anything, the

large steel door opens. The endoscopy suite

is bathed in blue light – this is designed to

make it easier for the doctors to see the

monitors during the examination. Medical

staff can change the light and temperature

levels using voice command. Music can

also be played via a speaker system during

operations thanks to a terminal embed-

ded in the wall with touchscreen and USB

port. The gas management system, which,

like most of the equipment, comes from

Dräger, supplies medical gases. The image

relayed by the endoscopy camera can be

seen on a flat-screen monitor in 4K quality.

At the same time, another camera with an

integrated microphone is directed toward

the doctor, allowing the examinations and

procedures to be broadcast live to confer-

ences or students in an adjoining room,

complete with commentary. For Dr. Reddy,

the project marks the highlight of his

career, which has not only made him an

in-demand doctor, but also an entrepre-

neur. The man, who is easily recognizable

from a distance thanks to his dark, bushy

moustache, grew up in a family of doc-

tors. His grandfather and his father were

both professors of pathology. Reddy says

he already knew as a child that he want-

ed to be a doctor. He opted to specialize in

therapeutic endoscopy and traveled to Ham-

burg in the 1980s to further his knowledge.

He liked the fact that the streets were so

much quieter in Germany compared to

India, although he wasn’t so keen on the

weekends, because all of the shops were

shut. He was impressed by the precision of

the doctors and the efficient medical care.

Back in India he found a different situa-

tion: There were just 100 gastroenterolo-

gists in his country at the time. Reddy rec-

ognized a huge problem in the shortage,

which remains unresolved to this day: He

says that even though the number of spe-

cialists in this field has grown to 3,000,

Japan alone has ten times the amount,

even though its population is just a tenth

of that of India.

Diseases of the digestive tract are wide-

spread in India. There are many differ-

ent reasons for this: contaminated drink-

ing water, unhygienically prepared food,

genetic predisposition – but also the coun-

try’s rise in economic prosperity. Problems

such as obesity are also increasing along-

side the growing middle class, which can

cause fatty liver disease. Reddy estimates

that 30 percent of Indians suffer from gas-

trointestinal diseases – equivalent to 400

million people. “We would need at least

100 hospitals like this one to treat them

all,” he says. The lack of specialists makes

it difficult for patients like Mehabub Halder

to get the right treatment. Halder enters

the hospital wearing gray cloth trousers,

a short-sleeved shirt, and sandals with no

socks. He is strikingly slim. His medical

records are tucked underneath his arm.

In the still largely empty lobby, in which a

medium-sized railroad station would also

fit, men like him easily look lost. Employ-

ees responsible for admitting patients try to

put the newcomers at ease: They walk up

to the patients from behind their desk and

explain to them what happens next. After

an initial examination, the taking of a blood

sample, and laboratory tests, Halder enters

the room of his doctor, liver specialist Dr.

Nagaraja Rao Padaki. Halder removes his

sandals and shirt. The head physician uses

his hand to examine the swelling that has

bothered Halder for quite some time. “No

pain?” he asks. Halder quietly says no. The

doctor reads about blocked blood vessels

in the medical records – clearly the rea-

son for the enlarged spleen and the slight

physical stature of his patient. Dr. Padaki

says the condition can be managed. In his

Thorough checkup:

Dr. Nagaraja Rao Padaki examines

a patient with a stomach complaint.

He prescribes a protein-rich diet

Procedure testing during the soft launch

MEDICAL CARE ASIA

60 DRÄGER REVIEW 119 | 1 / 2019

view, an operation is not necessary at this

time. He prescribes a protein-rich diet to

build up the patient with another follow-

up appointment in 12 months. “Elsewhere

they might review him in six months,” he

says. But he has to remain pragmatic.

“People here cannot travel across half the

country every few months.”

Halder works in Calcutta at an out-

sourcing company that undertakes busi-

ness processes such as human resources

and logistics for other companies. It is a

good job that allows him to spend mon-

ey on his health care. He saved 20,000

rupees, about 250 euros, for the doctor’s

appointment in Hyderabad 1,500 kilome-

ters away – including travel costs and over-

night stays in hotels. That’s not an incon-

siderable amount of money to him. In

Calcutta it is the equivalent of an average

monthly salary in his sector. Many of the

patients at the AIG hospital have no health

insurance that covers their treatment,

which is why hospital director Reddy is not

only committed to providing high-quality

care. The treatment must also be afford-

able. Making efficient use of the large hos-

pital’s capacity should make this possible.

Since a very high number of patients can

be treated here, the average price is low-

er. The hospital has gone on the offensive

by launching an advertising campaign to

promote the costs. A poster hangs by the

entrance, advertising the price of a liv-

er examination: “Now just 2,500 rupees

instead of 5,740!” The hospital charges just

300 rupees, about 2.50 euros, for a sim-

ple consultation – regardless of whether

a young colleague or the hospital director

sees the patient.

Free treatment for those in needAccordingly, appointments with the head

physician are popular: Patients refer to

Internet forums to find out how to get an

appointment with Dr. Reddy. There is a

three-month waiting list, according to

the hospital. Celebrities and politicians

also want him to look after them. The vice

president of India, Venkaiah Naidu, was

one of the first VIPs seen by him in the

new AIG building. Afterwards, he pub-

lished a picture on his Twitter account of

him standing next to Reddy. “I have been

in many hospitals in this world,” he wrote,

“but this one here is truly outstanding

with its state-of-the-art infrastructure.”

The vice president came to the appoint-

ment with several dozen police officers.

Prominent patients will get their own

separate entrance in the future to make

it easier to meet their security require-

ments. Attracting affluent patients to the

hospital is critical to its success: Even

though they get the same medical treat-

ment as any other patient, they pay more

for the comfort. This allows the hospital

to treat people in need free of charge –

at the hospital itself and in mobile treat-

ment centers that the AIG sends to villages

with poor health care. More than ten

million patients have received free treat-

ment from Reddy and his team in this way.

The hospital founder describes himself as

a left-leaning, somewhat socialist person.

He doesn’t want to judge the success of his

company on the profit it makes, but rath-

er on its ability to reach as many people as

possible. “I prefer to treat the poor rather

than the rich,” he says, adding that poor

patients are especially grateful.

Reddy currently works with them less

often than he would like to. Just before he

reaches the door to the endoscopy suite,

an assistant stops him with a pile of doc-

uments. They have to be signed. A little

later, between two appointments, he is

approached by a young woman who wish-

es to apply for a job. The hospital direc-

tor holds a spontaneous job interview

there and then. Everybody wants some-

thing from him, but there is seldom time

for them all. Reddy has already been work-

ing 18-hour days for a number of years. He

says that he has paid a high price for this:

There is hardly any time left to spend with

his family, although his wife – a derma-

tologist – and his now grown-up daughter

have always supported him. They are well

aware: “You have to make sacrifices if you

want to achieve something.”

Advertising offensive with the costs

PH

OTO

: S

HU

TT

ER

STO

CK

(1)

Modern building: The Asian Institute of Gastro enterology (AIG) is in a good neigh-borhood. The nine-story building is situated amid the office sky-scrapers of inter-na tional companies in Hyderabad’s HITEC City

ASIA MEDICAL CARE

61

Light moments: There is daylight in most of the rooms,

designed to make the stay more pleasant for patients

Hyderabad is at the heart of India in every respect. With almost seven million residents, it is the country’s fourth-biggest city. It is one of the centers of biotechnology and the pharma industry. The northwest is also known as Cyberabad


* Name changed

62 DRÄGER REVIEW 119 | 1 / 2019

IIt is two o’clock in the afternoon near

Kabul. The summer heat is brutal: nearly

40 degrees with a light breeze. It is almost

unbearable in the observation vehicle –

58.4 degrees Celsius. The four German

soldiers remain calm, although the ten-

sion is etched on their faces. For the past

ten minutes they have been observing a

battered pickup truck 100 meters away.

Then something happens. As the wind

changes direction, Sergeant First Class

Egon K.* opens the window of his spe-

cial vehicle and leaves it ajar. Clóe may

still be unable to see the suspect, but at

least she can smell him now. Clóe is a

Malinois, the short-haired variety of the

Belgian sheepdog. “They always want

to work,” says the Sergeant First Class.

“That’s why they are first choice for using

as special military working dogs.” Musta-

fa G.*, the suspect, has been known to the

Afghan authorities for some time. He is

a suspected jihadist. He traveled to Pak-

istan, spending three months at a Tali-

ban school and subsequently staying at a

training camp in Afghanistan, where he

learned to manufacture explosives and

handle weapons.

Four-legged specialists“We have to assume that he is armed

and carrying explosives, which is why

Clóe is our preferred resource ahead of

the firearm,” says Sergeant First Class

K. Everyone in this team has a precise

role, even Clóe. As a military working dog,

she is accompanying the troop of soldiers

charged with the task of capturing Mus-

Dogs sometimes make better comrades for soldiers. They sniff out explosives, apprehend suspects, and keep guard. Germany’s armed forces train their DOGS AND

HANDLERS at a special school – and from then on they stick together through thick and thin for many years.

Text: Björn Wölke Photos: Matthias Jung

PANORAMA MILITARY WORKING DOGS

tafa G. in a swift operation. To do this,

they have come heavily armed and taken

up a position on this busy road a few kilo-

meters outside Kabul. Clóe has trained

her entire life for moments like this. The

five-year-old dog recently underwent a

special ten-month course to train as a

scout dog at the school for military work-

ing dogs (Schule für Diensthundewesen der Bundeswehr, known by its abbrevia-

tion SDstHundeBw). The SDstHundeBw

is in the town of Ulmen in the state of

Rhineland-Palatinate, around 60 kilo-

meters south of Koblenz – in the mid-

dle of a forest. Between 50 and 70 mili-

tary working dogs and as many handlers

are trained here every year on an area

occupying almost 70,000 square meters.

A former ammunition depot and its

51 bunkers have been converted for

this purpose and special courses that

More or Less Best Friends

Inseparable: Sergeant First Class Egon K.* and his military

working dog Clóe during a training exercise on the grounds of the school for military working dogs in Ulmen. Once he finishes

work, he takes the Belgian sheepdog home with him – she

is part of the family


Firmly under control: The dogs must even learn how to bite! There is a strict selection procedure. The animals must be stable, exhibit excellent social behavior, and appear very self-confident

Military dogs are now more important than ever to armies

64 DRÄGER REVIEW 119 | 1 / 2019

replicate potential deployment loca-

tions have been created: railroad tracks,

a derelict house, and a sewer tunnel

system. There is even a railroad station

concourse with a baggage handling

area here. It is not just the basics that

are taught in the bunkers. Further rea-

listic training, the key element of any

special course, must be given in as many

different places as possible (towns, railroad

stations, factory sites, shopping malls,

etc.) in order to familiarize the dogs

with the various scenes they will face –

including combat sound effects.

Dogs such as Clóe are now more

important than ever to military person-

nel. In the world’s trouble spots, the

adversaries are often no longer regu-

lar troops that appear in the open, but

but now the focus is on special working

dog teams. Why aren’t they used much

more often? “Even though the reality on

the ground has shown that such teams

are effective, the emphasis remains on

the technology, even though it can’t

always solve everything,” says Hampel.

Accordingly, he would like to see a coun-

tervailing trend in the future.

Incredibly effective animalsLieutenant Colonel Hampel knows the

kind of incredibly effective tool he will

get at the end of such a training period:

highly concentrated animals that can act

at lightning speed and carry out missions

exactly as required. A mine dog has to

be able to indicate the presence of small

amounts (a few grams) to large quanti-

ties (100 kilograms or more) of the usu-

al types of material without delay. New

canine recruits are either bought from

outside or bred by the armed forces.

Here, in the Eifel region, there is a strict

selection procedure, because particular-

ly high demands are made on a special

instead rebels or lone operators that

plant improvised booby traps in ambush-

es of all kinds. “The dogs help us to give

our comrades effective protection at any

time of the day or night,” says Lieutenant

Colonel Dr. Stefan Hampel, veterinary

surgeon and commander of the military

working dog school in Ulmen. “No tech-

nology in the world can beat a dog when

it comes to highlighting dangers. What

device can sniff out explosives, bark loud-

ly, and bite on command?” Germany’s

armed forces use hundreds of these ani-

mals. Hampel prefers not to reveal the

precise number currently deployed in cri-

sis zones, but he will say this much: “All

seven types of military working dog that

we train here are deployed.” Ever since

Germany has been involved in overseas

assignments, however, the dogs have to

do much more than just guard their own

barracks. It used to be the case that sen-

try dogs were almost exclusively trained,


A military exercise with a scout dog: At the end of the training the dogs can act at

lightning speed and carry out orders exactly as required – but this takes a long time

Lieutenant Colonel Dr. Stefan Hampel has been head of the military working dog school in Ulmen since 2016. Between 50 and 70 animals are trained here under his command every year


working dog. “The animals must be sta-

ble, exhibit excellent social behavior, and

appear very self-confident,” says Ham-

pel. Some animal welfare campaigners

view this instilled obedience with sus-

picion. They know how difficult it is to

teach dogs something. So how exactly

do you get young dogs to seek and find

explosives? They are primarily motivat-

ed by a playful approach. “That is abso-

lutely essential,” says Hampel. In addi-

tion, every aspect of the training must be

designed to ensure that the animals suc-

ceed, more or less leave the field a win-

ner, and always receive a reward.

The aim at the end of the training is

to turn the dog and handler into a reli-

able team that can safely carry out each

task required of it. At the same time, the

dogs themselves must work under con-

siderable stress and find mines, weap-

ons, and ammunition within a matter

of seconds. They must be able to enter a

building or vehicle and overpower ene-

mies. The animals shouldn’t always bite;

sometimes barking is enough. Achiev-

ing such results requires a significant

amount of trust – both from the animal

as well as the handler. They go through

thick and thin – day in, day out – to build

up this trust. “I spend more time with

“We are among the world’s best with our seven

types of working dogs.”Lieutenant Colonel Stefan Hampel, Head of the SDstHundeBw

Six of the best: By breeding the dogs, the armed forces can begin optimally training them when they are young



War in the mind: Many soldiers who suffer from post-traumatic stress disorders often struggle on a daily basis. Yet there is effective therapy: it barks and has four legs.www.draeger.com/119-66

my working dog than with my family,”

says one of the trainers at the SDstHun-

deBw. “The several hours of daily train-

ing help to create a bond.” The animals

generally live at home with their han-

dlers and are part of the family. A young

dog’s basic training alone takes several

months, during which it is acquainted

with its future tasks. The animals then

take special courses, also lasting several

months, to train as military police dogs,

explosive detection dogs, or narcotics

detection dogs. They are also used by the

air force and special forces as security

dogs or train to become weapons dogs

and mine dogs. The dogs undergo regu-

lar annual tests once they have complet-

ed the basic training and so-called “spe-

cialist training.” A dog is generally on

active service for five years.

The complex and intensive train-

ing pays off. Lieutenant Colonel Ham-

pel is confident that his working dog

school compares well internationally.

“In recent years, we have developed var-

ious working models and are now among

the best in the world – not in terms of

the quantity of working dogs, but rath-

er their skills.” There is no standing still

for Hampel. Everything is a dynamic pro-

cess. “We are in regular contact with mil-

itary working dog training schools in oth-

er countries and continue to develop the

relevant models on this basis.” Hampel

says that no German dog has ever died

while on duty. Should something happen

– if a dog picked up an injury while train-

ing, for example – the school has its own

hospital in Ulmen. It is the main cen-

ter responsible for the veterinary care

of all military working dogs. Veterinary

surgeons and nurses look after the ani-

mals’ well-being, taking care of every-

thing from nutrition and dental care

(even crowns!) to tricky operations. Var-

ious Dräger products are used in the

operating room, including OR lights.

The gas management system also comes

from Lübeck. When the time comes for

a working dog to retire, it often moves

in with its handler as a private pet. The

bond between the two is so close that the

handler adopts their companion as soon

as it is taken out of service for health or

age reasons. Others return to the train-

ing school where they are cared for and

also found homes with civilian families.

Outstanding sniffer dogsAt five years old, Clóe is still a long way

away from reaching this point. Her good

nose is responsible for the fact that she is

able to smell a suspect at a distance of 100

meters. Her nose has around 200 million

olfactory cells; a human nose only has a

fraction of this number. When Sergeant

First Class K. opens the side door of his

vehicle and gives the order, everything

happens very quickly – Clóe heads toward

the pickup truck at around 40 kilometers

per hour. A few meters before reaching

it, she leaps in a single bound through

the open window and bites Mustafa G’s

lower arm. The approaching soldiers now

have an easy task. Is there actually a med-

al for military working dogs? “No, not at

the moment,” says Lieutenant Colonel

Dr. Stefan Hampel, “but we’re working

on it.” Clóe has probably earned it.

In good hands: Veterinary surgeons and nurses look after the animals’ well-being at the

hospital, taking care of everything from nutrition and dental care to tricky operations

67DRÄGER REVIEW 119 | 1/ 2019

68 DRÄGER REVIEW 119 | 1 / 2019

Bubbling volcanoes are part of everyday life on Hawaii. Since the latest eruptions, the local fire department has been using PORTABLE GAS DETECTION EQUIPMENT from Dräger.

Text: Steffan Heuer

HOT SPOT

In full flow: Only a few volcanoes on earth are as active as Kilauea on Hawaii. Its lava flows and ash deposits have forced thousands to flee this year

VOLCANOES OCCUPATIONAL SAFETY


in the Pacific

Darwin Okinaka was born and raised on Hawaii’s Big

Island. As a native, he has known from an early age that the

paradise beneath the palm trees is built on fire. “By the time

I reached elementary school, it was clear to me that there was

at least one active volcano on our island,” says Okinaka, who

now deals with fires of all kinds in his job as a full-time fire-

fighter. “It can erupt at any time, but we weren’t prepared for

this scale of volcanic activity.”

The chief of the local fire department is referring to the erup-

tion of Kilauea, which has destroyed more than 700 homes with

lava flows and ash deposits along its eastern flank and forced

thousands of people to flee since the beginning of May 2018. Inci-

dentally, the Hawaiian word kilauea means “spewing” or “much

spreading.” Despite having modern seismographs and comput-

er models, geologists and volcanologists are unable to say how

long the eruptions will last or when they will increase in intensi-

ty once again (after a relatively calm phase). Yet they know that

they have to continue monitoring Kilauea using a dense network

of measuring stations and sensors – because there are a grow-

ing number of settlements in the immediate vicinity of the vol-

cano and gases escape from both the old and new fissures, prin-

cipally the invisible sulfur dioxide (SO2). The gases also pose a

threat to communities further afield. However, Hawaii wouldn’t

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OCCUPATIONAL SAFETY VOLCANOES

70 DRÄGER REVIEW 119 | 1 / 2019

Stand back! More than 700 homes have fallen victim to the Kilauea volcano since May 2018. Hawaii’s firefighters have been carrying portable gas detectors ever since

even exist if it weren’t for these formidable volcanic eruptions.

The eight main islands (and many smaller isles) owe their exis-

tence to the magma in the earth’s liquid interior, which makes

its way to the surface from a permanent hot spot beneath the

slowly shifting Pacific Plate..

The ash cloud traveled 3,700 km southwestThe result is so-called shield volcanoes: huge mountains of solid-

ified lava that rise high into the sky from the depths of the ocean

floor several kilometers down. Strictly speaking, Hawaii’s sum-

mits are therefore the highest in the world. Even though the vol-

cano known as Mauna Kea, north of Kilauea, only rises 4,205

meters above sea level, it is actually around 10,200 meters tall

when measured from its base in the ocean, putting even Mount

Everest (8,848 meters) in the shade. Of all the volcanoes on the

Hawaiian Islands, however, none has caused more devastation

than Kilauea. Its last big eruption at the end of the 18th centu-

ry claimed several thousand human lives. “Kilauea is showing

no sign of calming down in the foreseeable future – and the sur-

rounding area can no longer be described as remote,” says Oki-

naka, voicing his concern. It is therefore all the more vital that

the volcanologists, the Environmental Protection Agency (EPA),

and the Hawaii State Department of Health have set up sensors

around the volcano, which measure the concentrations of sever-

al different gases and inform the population of the findings. On

the official Hawaii Interagency Vog Information Dashboard, for

example, it is possible to track the “vog” in real time – the toxic

volcanic smog made up of water vapor, carbon dioxide, and sul-

fur dioxide. If SO2 is released into the atmosphere, it reacts with

oxygen, moisture, and sunlight. Fine dust particles form, which

can also reach other islands, depending on the wind direction.

This is how the volcanic smog from the latest eruption on Hawaii

reached the Marshall Islands, 3,700 kilometers away, within the

space of a month.

As part of the studies on the Kilauea eruptions in 1983 and

2008, scientists at the University of Hawaii in Manoa have set up

the Vog Measurement and Prediction Project (VMAP) in order to

be able to forecast the toxic mixture as accurately as possible.

The EPA and Hawaii State Department of Health also provide

constantly updated information about the general air quality and

SO2 concentration on their own websites. Although the measur-

ing stations run by the authorities and scientists are important,

first responders like Okinaka need accurate and reliable infor-

mation about hazardous gases when they are called out to a spe-

cific location. That is why the fire department on the main island

has owned a total of ten Dräger gas detectors (type: X-am 5000) since

May 2018. The device, the size of a cell phone, is both water- and

dust-resistant, and can measure up to five gases simultaneously.

“During the last eruption ten years ago, when parts of the

central crater collapsed and there were high levels of SO2 in the

air, we were lent devices by the Civil Defense Agency, which have

long since been returned,” recalls Okinaka. “Now we finally have

our own portable devices that can be attached to our firefighting

jackets, which means that we have them with us at all times. In

the event of impending danger, they warn us visually, acoustical-

ly, and haptically (by vibrating). It is both reassuring and conve-

nient.” The most important feature on the device for the firefight-

er is the SO2 sensor. Okinaka has distributed the ten detectors to

the ten fire stations on the Big Island that are either in the imme-

diate vicinity of Kilauea or are most affected by the gases and vog

due to the wind direction. As such, around 60 firefighters share

the devices in three shifts. “Nobody knows how long Kilauea will

remain active,” says Okinaka. “But in the long term we must gear

ourselves up to be prepared for anything.”

Eruptions are part of everyday life here

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INFORMATION SERVICE

71

Our Con-tributionAn overview of some of the Dräger PRODUCTS featured in this issue can be found here in the order they appear. Each product has a QR code which can be scanned with a smartphone or tablet. The relevant product infor mation will then be displayed. If you have any questions about a product or the magazine, write to us: [email protected]

X-plore 3500This half mask is the first choice for long-term and demanding use.Page 12

X-am 8000This gas detector simultaneously measures the presence of up to seven toxic and flammable gases as well as vapors and oxygen – in either pump or diffusion mode.Page 12

MRC 5000 This refuge chamber features redundant breathing air systems, guaranteeing a supply of pure breathing air underground.Page 12

Fabius Tiro This compact anesthesia workstation is perfect for use in tight spaces (such as the induction room).Page 24

Alcotest 5820 Breath tests can be performed easily with the help of this device – it can also measure passively (without a mouthpiece).Page 55

MovitaThis ceiling supply unit can be maneuvered into various positions for use in OR and ICU environments.Page 58

Polaris 600This OP light features intuitive operation, versatile adjustment options, and simply good light.Page 58

INSIGHT MOBILE GAS DETECTION TECHNOLOGY

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In certain workplaces, such as furnaces,

the dangers can be visible as well as

invisible. Take carbon monoxide (CO),

for example. Unnoticed by humans,

the gas prevents the blood from transport-

ing oxygen, which can lead to a loss

of consciousness and even death. On

the other hand, there may be an insuffi -

cient concentration of oxygen (O2) in

the air. This dual gas detector visually

warns the wearer of both dangers with

Double the

a 360° light 1 , acoustically via an

alarm 2 (at a piercing volume of 90

dB(A)), and mechanically by vibrating.

As part of the wearer’s personal protec-

tive equipment, the Dräger Pac 8500

is attached to the work clothing at chest

height by means of a fi rmly closing

crocodile clip ( 3 ; on the back). After

pressing the OK button 4 to switch it

on, the sensor located behind the replace-

able protective fi lter 5 measures the

concentration of O2 and CO (or – on

a different version of the Pac 8500 –

hydrogen sulfi de and CO). The version

can be determined by the color of the

surfaces ( 6 and 7 ). The light 8 ,

indicates that the device is ready for use.

The triple alarm will warn the wearer

if the gases reach one of the two (or

four in the case of oxygen) individually

adjustable limits. The wearer must

then take appropriate action. The display

9 shows the gas 10 that has been

detected, its concentration 11 , and the

status of the special battery 12 , which

guarantees power for between one and

two years, depending on the type of

device. A powerful battery that can be

replaced by the customer was one of

the features requested by users who saw

it as the only way of satisfying explosion-

protection requirements. The housing

13 is water- and dust-resistant (IP 68 rat-

ing). Certain functions and displays can

be controlled via the menu button 14 .

Both seen and heard:

This gas detector warns its wearer

visually and acousti-cally if there is too little oxygen or too

much carbon monox-ide in the ambient air

Protection

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the struggle for raw materials - dräger - usa...drÄger review 119 | 1 / 2019 5 yassine tajouaout,...

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