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Hosea: Emerging Horizons of Clinical Engineering in Disaster Preparedness and Management

J Global Clinical Engineering Vol.3 Issue 1: 2020  10

Received April 21, 2020, accepted June 15, 2020, date of publication June 30, 2020

Emerging Horizons of Clinical Engineering in Disaster 
Preparedness and Management: Proposal for an 
expanded professional identity 

By F. Hosea 

Yachay Tech University, Ecuador.

ABSTRACT

The COVID-19 pandemic of 2020 has exposed a wide range of systemic deficiencies in public health strategy, poor alignment 
of global health and economic institutions, insufficient budgeting, and the urgent need for real-time management of scientific 
resources, rapid-cycle clinical innovations, competent political decision-making, and supply chain logistics under disaster condi-
tions. This article proposes that a new model of multi-disciplinary professional skills is needed globally to re-engineer existing 
public and private healthcare systems for both normal and disaster conditions. Clinical engineers are recommended to play a 
growing role in future global disaster management and systems integration activities, owing in large part to their multifunctional 
expertise in technology assessment, hospital operations, and as stakeholders in healthcare innovation. Twenty-six recommen-
dations are presented as foundational strategies to create a 21st century model of globally aligned healthcare systems, centered 
on the growing role of clinical engineers as subject matter experts in both normal and disaster conditions.

Keywords – disaster preparedness, clinical engineering, systems engineering, alternate sites of care, health technology 
design, dual-use infrastructure.

Copyright © 2021. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY): Creative Commons - Attribu-
tion 4.0 International - CC BY 4.0. The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) 
are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is 
permitted which does not comply with these terms.

INTRODUCTION

GLOBAL DISASTER UNPREPAREDNESS 
The global COVID-19 crisis of 2020 has thrown a 

global spotlight on the many ways in which healthcare 
systems,1,2 governments,3,4 medical industries,5 markets,6 

and healthcare professions7 have been unprepared, 
under-resourced, tragically slow and uncoordinated in 
responding to the most disruptive medical disaster of 
our times. Despite numerous threat-analysis studies,8 

detailed pandemic scenarios,9 and simulations by state 
and federal agencies,10 despite trillions of dollars spent 
on post-9/11 international disaster preparedness,11 and 

repeated top-levels warnings by epidemiological and public 
health experts, the world’s governments, markets, and 
healthcare systems have failed to prepare and prevent a 
health disaster from exploding into a multidimensional 
catastrophe. 

The fragmentation of plans and competencies across 
sectors – complicated by political decision-making – 
clearly demand mission-critical re-organization among the 
institutional players, with more coordinated, integrated, 
and systems-oriented professional approaches worldwide, 

and active cultivation of public health intelligence. For the 
reasons that follow, clinical and biomedical engineers are 
among the best-suited health professionals to assume 
an expanded and more comprehensive leadership role 
as subject matter experts in this urgently needed trans-
formation, “particularly following the recent adoption of 
the recommendations of the UN High-Level Commission 
on Health Employment and Economic Growth, the WHO 
Global Strategy on Human Resources for Health, and the 
establishment of national health workforce accounts.” 
In particular, the WHO analysis and recommendations 
in “Human Resources for Medical Devices” provide a 
transformational vision for Biomedical and Clinical En-
gineering worldwide that strongly harmonize with the 
recommendations contained in this article.12 

WHY CLINICAL and BIOMEDICAL ENGINEERS? 
Traditionally, Clinical Engineers and Biomedical Engi-

neers are professionally prepared to perform a very broad 
range of overlapping clinical, technical and operational 
tasks – working from bench innovations to bedside care, 
including the design and assessment of medical devices and 
their internal components,13 to the management of complex 
hospital infrastructures and supply chains, encompassing 
possibly hundreds of device families, models, network 
interfaces and “care-anywhere” services via telehealth 
and telemedicine. For the purposes of this article, the 
term “Clinical Engineer” (CE) will be used to encompass 
both biomedical and clinical engineers, because clinical 
engineers (and clinical systems engineers) typically have 
the widest, multi-systems professional orientations and 
skillsets that are well-suited to the often improvisational 
complexities of disaster preparedness and management 
in healthcare systems.14,15 

Beyond individual hospital operations, CEs may also 
be involved extramurally in standards development 
and technology assessment organizations, research and 
clinical trials, innovation consortia, startups, professional 
associations, and consultations to ministries of health 
and the World Health Organization. As such, they can 
have wide-ranging, inter-institutional experiences that 
are directly relevant to the multi-systems challenges of 
disaster preparedness and management. Although they 
may work with different job titles and tasks different 

professional education and certifications around the 
world, CEs share a common mission to optimize safety, 
efficiency, cost controls, and healthcare quality through 
the application of systems-oriented engineering expertise 
that encompasses not only devices, but processes, human 
resources, procurement, risk management, and strategic 
planning. These integrative skillsets take on even greater 
importance in disaster circumstances. Compared to many 
other vertically-specialized professions in healthcare, 
the multi-disciplinary, intersectoral span of professional 
relationships in CE provides a unique foundation to 
bring a more coherent, rapid-cycle integration of science, 
technology, standards, regulation, institutional strategy, 
planning, and execution.

As science and technology have advanced with in-
creasing velocity and scope, these life-saving engineering 
professions are also evolving and expanding to incorpo-
rate new tools and processes into increasingly complex 
healthcare systems.16 The successful incorporation of 
existing knowledge and urgent innovations under disaster 
circumstances requires new categories of professional 
expertise and institutional alignments. Because of their 
wide-ranging organizational knowledge and technical 
skills, CEs are uniquely prepared to become the next gen-
eration of multifunctional experts who can help cultivate 
the systemic organizational intelligence and planning that 
is increasingly indispensable for modern healthcare, as 
well as for disaster preparedness and management. 

PROPOSAL FOR AN EXPANDED PROFESSIONAL 
IDENTITY

THE GROWING NEED FOR SYSTEMS EXPERTISE 
FOR BOTH NORMAL AND EMERGENT 
CONDITIONS 

As innovators in the medical device industry, CEs may 
be involved in highly specialized research aimed at de-
signing or improving diagnostic devices,13 monitoring,17 
or therapeutic devices that are technically complex,18 

multifunctional, networked,16 and designed for “preci-
sion medicine” that may disrupt traditional clinical and 
business practices. As managers of a clinical operations 
infrastructure, CEs may be responsible for the 24 × 7 
hospital requirements for maintenance and repairs, for 

http://www.globalce.org
http://globalce.org
http://globalce.org


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Hosea: Emerging Horizons of Clinical Engineering in Disaster Preparedness and Management

assessing new technologies, managing installations and 
upgrades, project and team coordination, scheduling 
maintenance and repairs, coordinating IT integration, 
facility design consultation and new facility provisioning, 
cross-functional troubleshooting with IT, end-user train-
ing, vendor and supply chain management, surge capacity 
planning, replacement planning, service-level agreements, 
budgeting, technology assessment, risk management,19 
hazard alerts and recalls, and emergency preparedness. 

Because CEs may span such vast areas of expertise20–23 

that are essential to the quality and reliability of day-to-day 
healthcare services, they are at the same time uniquely 
positioned to be recognized as systems-oriented, subject 
matter experts who can help repair and re-engineer the 
prevailing fragmentation in disaster preparedness and 
management.

AN ACTION PLAN FOR THE FUTURE
This article provides a very condensed compilation of 

technological, organizational, and professional recommen-
dations that will enable CEs, clinical systems engineers, 
and biomedical engineers to build upon their existing 
system lifecycle expertise and assume wider institutional 
roles in disaster preparedness (DP) and disaster manage-
ment (DM). Although the current global concerns are for 
pandemic response, the following topics will be equally 
relevant for all-hazards disaster conditions. as well as for 
improving normal strategic and operational efficiencies 
and resilience of clinical systems, ensuring a more robust, 
integrated infrastructure for future events. Because of the 
inherent complexities of normal healthcare operations, 
where it is necessary to work in a 3-to-5-year planning 
window to make significant changes, it is likewise neces-
sary to begin planning now during the 2020 COVID-19 
pandemic, to deliver the global systemic improvements 
that will be necessary to prevent, mitigate and better 
manage future disaster challenges 5 to 10 years from now.

These expanded CE competencies will fill critical gaps 
in the ways that healthcare systems plan and manage 
their future DP/DM programs, which often suffer from 
lack of functional integration, staffing, and budgets. While 
most of the current responses to the COVID-19 pandemic 
are necessarily focused on near-term endpoint devices, 
therapies and protections, this article will offer a wider, 

panoramic, long-term systems-of-systems view that will 
strengthen the organizational, technological and profes-
sional underpinnings of both normal operations and DP 
that should dramatically improve the global response to 
future threats to public health.

These recommendations are organized in a series of 
highly concentrated topics and specific actions that can 
be executed incrementally over time to expand the pro-
fessional competencies and institutional roles of CEs for 
DP/DM. Each topic can easily be expanded as a workshop 
or academic course to provide the necessary technical 
or operational details needed for full implementation. 
While some of the recommendations can be enacted at 
an individual level of persons and organizations, others 
will require scaling up through new regional, national, 
and international collaborations. 

Ongoing programs between WHO,24 the International 
Federation of Medical and Biological Engineering (IFMBE, 
through its CE Division25), the ICEHTMC (International 
CE and Health Technology Management Congress26), the 
American College of CE (ACCE),27 the Chinese Society 
of CE, The Association for the Advancement of Medical 
Instrumentation (AAMI),28 the European Alliance for 
Medical and Biological Engineering & Science (EAM-
BES),29 and the Global CE Journal30 are creating new, 
global frameworks for research,31 professional develop-
ment, conference coordination, standards development, 
credentialing, regulatory frameworks, and consultation 
to establish more coherent, innovative and dynamic 
capabilities across healthcare systems. In many cases, 
the ability to ask systemically relevant questions will be 
more important than the application of known, but overly 
specialized answers which may risk delivering obsolete 
or disjointed solutions. The world is clearly in need of 
professional expertise that can help compress and align 
the scientific, technological, and operational timelines for 
life-critical innovations and successful implementation 
under extraordinary circumstances.

We cannot allow these monumental challenges to de-
ter us from the necessity, now being proven worldwide, 
to forge a radically different, long-term model of public 
health stewardship and institutional capabilities that 
are suited simultaneously to both normal and disaster 

conditions. The world is already fortunate this day to 
have many gifted CEs around the world who are ready for 
such a noble quest – highly educated, energetic, caring, 
creative, expert in the complex lifecycles of healthcare 
systems, and now, tested by the high-velocity change, 
logistical chaos, global uncertainty, economic disruption 
and human sufferings imposed in the 2020 pandemic. In 
the coming years, let there be no doubt how these quiet 
heroes rose to the occasion. 

RECOMMENDATIONS
(Note: Additional information and links for many of 

the following recommendations can be found in the RE-
SOURCES section at the end of this document, grouped 
by topic) 
1. Understand your existing local, national, and inter-

national frameworks of DP and Management. Don’t 
re-invent the wheel. Investigate with your Ministry of 
Health and Emergency Preparedness agencies, public 
health agencies, and local hospitals to identify existing 
agreements, processes, and resources.
a. United Nations, WHO, OCHA, CADRI, UN Clusters 

(UNISDR, UNHCR, IFRC, IOM, FAO, WFP, UNDP, UNICEF, 
Save the Children), IFRC, ICRC, Sendai Framework, 
GDACS, OSOCC, INSARAG (See Resources section)

b. Your national frameworks: National Incident 
Management and Emergency Operations Centers.

c. Your state/province and local hospital and public 
health frameworks.

d. Conduct interviews and document existing gaps at 
any level of preparedness or response capabilities 
and discuss proposals to remediate them.33 Arrange 
to attend training and simulations, and become 
subject matter expert in one or more areas of DP/
DM.32–35

2. In your organizations (hospital, professional 
association, standards organizations, R&D con-
sortium, government agency, legislative and regu-
latory bodies), promote Clinical and Biomedical 
Engineers as Subject Matter Experts for System 
Lifecycle Management, with specific applications in 
DP/DM. Develop DP/DM skillsets and experience 
through the following:

a. Schedule specialized DP/DM coursework, in-
terdisciplinary and cross-functional workshops, 
conferences, credentialing and certification.

b. Re-write job descriptions for CEs to include DP/
DM as a required competency; set aside time for 
dedicated assignments to organizational emergency 
preparedness teams and practice drills. Include 
readiness research, conferences, and publication 
in scientific and professional journals36,37 as CE 
performance evaluation criteria.

c. Arrange for CEs to be permanent delegates to 
organizational Emergency Preparedness Teams – 
local, regional, and national. 

d. Delegate CEs to serve on standards committees 
and medical device design consortia to promote 
inclusion of DP/DM performance factors in design 
standards for medical devices and systems.38 

e. Contribute to the design of table-top exercises 
for DP/DM, with emphasis on functional inter-
dependencies and risk/failure points that other 
stakeholders might ignore.

3. Promote regional and national purchasing coop-
eratives to maximize cost-savings over the lifecycle 
of devices and services, including specific disaster-
related terms and conditions.

4. Promote Health Technology Design among CEs as 
the front-end of the Device Lifecycle management 
process to integrate best disaster practices into 
future designs.

a. Formalize device and system design to provide 
real-time networked performance feedback of device 
data to manufacturers (as feedforward into next-
generation device/system design, with all necessary 
safeguards for patient privacy and confidentiality). 
Formalize consulting relations between CEs and 
manufacturers to conduct regular design consulta-
tions as part of the contractual relationship. 

b. Define, design, and enforce Universal Mini-
mum Functionality for medical devices (UMF). 
Most medical device manufacturers emphasize 
product differentiation from their competitors, 
and this produces highly specialized devices that 
may be perfect for normal circumstances, but be 



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sub-optimal or dangerous under disaster condi-
tions, when there may be a transfer of life-support 
patients to other sites of care, significant rotation 
of staff across locations, and staff who have to use 
medical devices that are different from what they 
are accustomed to. The specialized differences in 
user interfaces, IT connectivity, consumables, and 
performance characteristics may cause significant 
risk to patient safety. We need to promote UMF 
requirements for procurement of all medical de-
vices to ensure the lowest common denominator of 
safety, performance, and user interfaces as a default 
setting under disaster conditions, to support rapid 
transport and accurate continuity of patient care 
across locations, caregivers, and device brands. 
With the push of a button, the UMF functions can 
be invoked to provide a specific menu of minimum, 
universally standardized functions, and user in-
terfaces. UMF device design and training would 
support patients with generic functionalities that 
would assure higher overall population benefits 
than what would result from overly specialized 
functions that could put patients at risk due to in-
appropriate use by untrained staff. Include supply 
chain guarantees and contingency plans to ensure 
technical support for diverse disaster locations, and 
plan for universally standardized consumables. 

c. Develop Capability Maturity Roadmaps to iden-
tify strategic pathways for medical technologies 
and services with a 5- to 10-year performance 
horizon. Adjust roadmaps for different economic 
conditions.39,40 

d. Promote formal collaborations between IT and 
biomedical forecasting institutions such as Gartner 
and ECRI, professional and industry associations. 
Produce joint assessments of innovative technolo-
gies and plot on Biomed/CT/IT hype cycles and 
magic quadrants.

e. Design to Cascade – Devices should be designed for 
extended use and re-use across diverse economic 
development zones so that UMF functions even-
tually become available to LDCs (less-developed 
countries) through redeployment, using local 
refurbishing and production where possible, and 
strictly-managed donations. This will gradually 

create a predictable minimum of standardized 
device functionality globally that will increase the 
safety and efficiency of clinical efforts by clinicians 
who at times must work at remote and unfamiliar 
disaster sites. 

5. Include Smart Design requirements for all medi-
cal devices with computing capabilities so they have 
extensive, built-in capabilities for universal time 
synchronization, self-monitoring, self-reporting, self-
updating, self-diagnosis, and self-healing. Real-time 
location, performance readiness, configuration, and 
mobility of medical devices will be critical for rapid 
emergency deployment and redeployment conditions 
(e.g., patient transfer to an alternate site of care, with 
infusion pump and ventilator).

a. Specify multicore device design, which will segregate 
clinical and device lifecycle operations functions 
on separate computing cores, with a hypervisor 
bridge. This will enable highly secure, real-time 
asset, service, and configuration management 
to be executed without interfering with clinical 
performance. This includes device identification, 
location, configuration history, component prov-
enance, performance and service history, making 
the device an active partner in managing its asset, 
and service lifecycle. Architect devices to internalize 
and support external service, security and process 
controls so that devices themselves become active 
players in managing routine monitoring, compli-
ance, and reporting activities. 

b. Leverage emerging IPv6 capabilities41 Envision 
devices as intelligent members of the extended IoMT 
(Internet of Medical Things). Device components 
can be independently addressed and managed via 
IPv6 addressing, to significantly improve security, 
remote patient monitoring, and cloud management 
of IoMT data which will become increasingly im-
portant in “care-anywhere” and behavioral health 
services.

c. Build “developmental headroom” into device 
hardware and software architecture, to extend 
usable life and afford built-in capacity for new 
functionality without burdensome replacement 
costs and inefficiencies. 

d. Coordinate CE tightly with IT asset management 
and service management to develop aligned 
processes, data dictionaries, configuration man-
agement, and roles that will support standardized 
service and performance analytics for primary, 
transitional and Alternate Sites of Care, including 
ambulance services and military locations having 
other network, security, and compatible consum-
ables standards.

e. Explore secured, cloud-based product development 
partnerships for device design and prototyping. 
Promote interdisciplinary, intersectoral alliances, 
and collaboration frameworks.

6. Adopt the ITIL framework of service strategy and 
service management. The Information Technology 
Infrastructure Library (ITIL) is the global standard 
for business process engineering, based on IT life-
cycles, for ensuring alignment and coherence of all 
services provided within an organization and between 
organizations. It is an indispensable tool to ensure 
that all organizational services support healthcare 
activities that are safe, efficient, effective, and expertly 
managed. Careful mapping of service processes and 
accountabilities during normal operations should be 
used to create parallel process maps that are adapted 
to disaster conditions. 

a. Obtain training and certification for CE staff in 
basic ITIL concepts and methods (3-day course).

b. Create end-to-end service process maps for your 
organization for normal and disaster conditions, 
working closely with all stakeholders, escalation 
paths, and decision points.

c. Where feasible, explore how business process 
automation can improve workflows during di-
saster conditions by guiding staff through auto-
mated, pre-defined checklists and options so staff 
doesn’t have to improvise randomly amid stressful 
circumstances.

7. Prepare Professionally for Alternate Sites of Care 
(ASOCs). Certain disaster situations will overwhelm 
existing hospital facilities and small-scale surge prepa-
ration, requiring the setup of emergency hospital capa-
bilities at schools, warehouses, hotels, sports arenas, 

field tents, military bases, factories, and other sites. 
CEs should play a major role in anticipating, planning, 
and executing on ASOC logistics, deployment, testing, 
and site readiness certification.

a. Anticipate the need to prepare to work rapidly 
and closely with local, national, and international 
military, National Guard, national and local police 
authorities to manage dynamic disaster conditions 
and coordinate efforts to plan and deploy ASOCs.

b. Clarify in advance the hierarchy of decision-
making authorities, geographical jurisdictions, 
and processes. Use scenarios to anticipate potential 
decision crises.

c. Evaluate facility Surge Area design, setup, device 
requirements, disinfection, patient identification, 
tracking, and medical record continuity, patient 
transfer processes, patient monitoring, surge 
capacity limits. Conduct periodic drills. Establish 
criteria for transfers from hospital or surge areas 
to ASOCs.

d. Develop technology-mediated patient transfer 
protocols and process maps to ensure continuity 
of care: patient transport, infusion pumps, medi-
cations, belongings, device tracking, ventilators, 
vital signs, family contacts, data interfaces with 
electronic medical records, wireless or cellular 
connectivity.

e. Evaluate and acquire Early Situation Awareness 
software, pre-load critical infrastructure loca-
tions, facilities and profiles. Update annually. This 
will enable instantaneous activation of a regional 
incident tracking utility, enabling Emergency Op-
erations Centers to know exact the GPS location 
of incidents, deployed responder vehicles, and 
dangerous conditions.

f. Evaluate facility needs for backup power, space 
management coordination, utilities, wireless ac-
cess, medical gasses, waste management, security, 
maintenance and repair parts, disinfection, IT 
coordination.

g. Arrange to serve as a multifunctional Engineer-
ing expert and consultant in Disaster Resource/
Emergency Operations Center design, simulations, 
response roles.



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h. Evaluate the need for additional equipment 
for decontamination, generators, mobile or field 
operating rooms, Rapid Assembly Shelters, Con-
tainerized Clinics.

i. Perform quarterly updates of ASOC status to 
identify any significant changes in readiness, re-
sources, staffing, plans.

j. Evaluate the role of portable Emergency Elec-
tronic Medical Records and mobile connectivity 
to medical devices for vital signs, medications, 
infusions, treatment plans, etc.

k. Review Supply Chain Management practices to 
address specific disaster conditions. 

i.  Use multi-professional scenarios to iden-
tify probable stress points, gaps, failures, 
and decision-making bottlenecks that 
may impede rapid ramping up of disaster 
response actions: vendor contracts, pre-
orders, 3-D printing, open-source online 
design specifications, delivery, receiving, 
storage, distribution, security, configura-
tion for ASOCs. 

ii.   Anticipate the need to coordinate with 
national military logistics agencies and 
ensure that minimum compatibility 
standards for devices and consumables 
are applied in the procurement process. 

iii.  Identify critical trigger points in early 
disaster awareness that will prepare 
manufacturers to shift from just-in-time 
production to large-scale emergency 
production standards.

l. Pre-define equipment lists, rapid supply chain 
strategies, and ASOC requirements to manage the 
possibility of multiple-hazard disasters and re-
sulting health threats (e.g., simultaneous pandemic 
and earthquake victims).

m. Identify multiple constituencies/stakeholders 
who need to be involved in normal and ASOC ca-
pability planning: Building science professionals 
(air quality, negative pressure, decontamination, 
medical gasses), contractors and vendors, childcare 
providers, disaster survivors, emergency managers 

and personnel, fire services, community safety 
associations, disabled persons, language transla-
tors, time-sensitive treatments (chemotherapies, 
pregnancy, dialysis, etc.), livestock owners, parents 
and teachers, pet owners, individuals with physical 
access and mobility needs, media contacts, tribal 
representatives, university research partners, 
volunteer coordinators. 

n. Consult with anthropologists, ethologists, social 
psychologists and historians to evaluate the im-
pact of cultural, ethnic, religious, and linguistic 
differences that will significantly affect patient 
treatment and possible interactions with families, 
relatives, loved ones, ambulance services, forensic, 
morgue and funeral services, burial, and grieving 
practices.

8. Establish Dual-Use Infrastructure - The dual-use 
concept in traditional military usage refers to civil-
ian materials or processes that can also be used or 
altered for terrorist purposes. But in our case, the 
Dual-Use-Infrastructure concept requires that all 
medical equipment that may be used under disaster 
conditions shall be designed for maximum compat-
ibility between civilian and military services, and 
shall include a least-common-denominator of clini-
cal functionality, data standards and user interfaces 
that enable instant usability by trained clinical staff 
anywhere, regardless of brand. 

a. Build on military alliances for large/complex 
disasters; identify and establish formal liaisons 
and schedule periodic meetings to keep current 
of developments.

b. For all-hazard risks, identify relevant medical 
devices needed for each risk category, includ-
ing multiple disaster situations (e.g., simultane-
ous earthquake, tsunami, radiation), and ensure 
cross-compatibility between military and civilian 
applications.

c. Align military and civilian procurement processes, 
inventory synchronization, and decision-making 
for disaster procurement, especially for national 
stockpiles.

d. Ensure interoperability of electronic identity 
management applications and processes so that 

military and civilian professionals can interact 
without obstruction or delay.

e. Review and establish trusted domain rights on 
DM networks; update credentials as needed for 
instant, uncontested sign-on in ASOCs.

f. Negotiate with government and commercial net-
work providers to establish dedicated network 
priority bandwidth during disaster conditions, 
providing top Quality of Service for all medical 
system users and devices, and research partners.

g. Require universal wireless location of medical 
devices and high-value, mobile capital equipment 
by using built-in radio-frequency identification; 
use this function to support patient and device 
transfer to ASOCs and timely return of outgoing 
devices; formalize control of network credentials, 
login, and device recovery processes.

9. Ensure Cross-border credentialing database exists 
to enable rapid verification of professional skills for 
ASOCs. 

a. Volunteers and retirees from other regions/states/
countries may arrive to assist in disaster response 
activities, and it is important to verify in advance 
their identities, relevant skills, and credentials, 
and issue necessary identification badges, vests, 
or wristbands to enable rapid access to different 
areas of disaster control

10. Research and compose Mutual Aid Agreements at 
all levels and ensure clear jurisdictional authorities 
at each level.

a. Obtain Master Service Agreement templates42 and 
confer with local public health agencies to identify 
existing agreements.

b. Meet with actual and potential partners to review 
MSAs and adjust as needed.

11. Research and Incorporate Rapid Deployment 
Technologies for DM

a. Hastily formed networks. 
b. USHAHIDI (an online tool for aggregating informa-

tion from the public for use in crisis response).
c. Sahana (open-source DM software).

d. Google Crisis Response, Google Public Alerts, and 
Fusion Tables.

e. Solar-powered wireless access points.
f. Failsafe communications: Bluetooth walkie talkie; 

ham radio.
g. SMS messaging.
h. Mobile refrigerated morgue trailers.

12. Plan for Standard Tests and Point-of-Care Diagnostics 
to supplement or replace centralized laboratory use

a. Evaluate rapid turnaround, automated, and self-
administered COVID-19 tests.

b. Evaluate conformal electronic vital signs monitors 
and wireless links to nursing station monitors or 
telemedicine monitoring stations.

c. Assess telemedicine/telehealth and automated 
monitoring technologies annually to determine the 
best combination of onsite clinicians, offsite moni-
tors, and automated alerts to manage patients who 
may be treated at home, in ambulance, in hospital, 
at ASOCs, or post-discharge.

d. Evaluate: 
i.  Bluetooth proximity monitoring technolo-

gies on smartphones as early detection 
and contact tracking tools. 

ii.  Smartphone diagnostic attachments: 
microassays, flow cytometry.

iii.  Miniaturized mass spectrometry.
iv.  Lab on a Chip.
v.  Electrochemical detection.
vi.  Saliva test.
vii.  Antibody test.
viii.  Antigen test.
ix.  Molecular/PCR test.
x.  ELISA, IFA tests.
xi.  CRISPR.

13. Identify and track emerging Treatment Modalities 
(COVID-19 examples)

a. Blood purification, apheresis, and adsorption.
b. Convalescent plasma transfusion.



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c. Antivirals.
d. Interferon.
e. Monoclonal antibodies.
f. Hydroxychloroquine.

14. Refine Triage and Fatality Management resources 
and processes

a. Isolation tents with diagnostic and sterilization tools.
b. Wireless patient identification and vital signs 

monitoring, location monitoring. 
c. Backup plans for wireless infrastructure during 

disasters that can include cell towers and Hastily 
Formed Networks.

d. Refrigerated morgue trailer.

15. Test DP routinely to point of failure, to identify weak 
links in plans and performance. 

a. Large-scale stress testing.
b. Intersectoral simulations.

16. Include Failsafe and High-Reliability Communica-
tions to ensure basic communication capabilities if 
commercial wireless or Internet services fail or are 
overloaded.

a. Ham radio.
b. Dedicated medical Wi-Fi spectrum. 

17. Acquire Early Situation Awareness platform ca-
pabilities and integrate into Emergency Operations 
Centers.43 

a. Evaluate software options; acquire and install the 
application in Emergency Operations Center and 
dedicated cellphones.

b. Pre-load regional database with critical infrastruc-
ture sites, profiles, contacts.

c. Establish criteria for distributed use of cellular 
reporting application by responsible staff and 
civilians to ensure data reliability.

d. Conduct training and simulations.

18. Negotiate Trigger Criteria and Rapid Execution 
Timelines and Industry Workplans. Negotiate spe-
cific terms under which Early Disaster conditions 
will be officially declared which will trigger initial 
work plans of academic, professional, government, 
and industry partners, to prepare for ramping up 
of pre-defined research activities and production of 
essential equipment and supplies.

19. Evaluate and Negotiate Manufacturing Alliances 
for DP/DM to establish contractual agreements 
that obligate manufacturers to prioritize emergency 
production requirements specific to the disaster type.

20. Promote an organizational culture of Information 
Sharing and Tactical Flexibility for DP/DM

a. Promote professional and organizational norms of 
informational openness to ensure that decisions are 
made based on evidence, not rumor or guesswork.

b. Promote professional and organizational norms 
that optimize the ability to be tactically flexible 
and adaptable to changing circumstances and 
information. Build in specific secondary role as-
signments and responsibilities (role-shifting) in job 
descriptions for all CEs and disaster-related staff.

21. Define need for Role Shifting. During early and 
mid-disaster conditions, routine clinical roles and 
responsibilities and reporting relationships may need 
to change significantly to enable proper execution of 
disaster protocols. Doctors, nurses, CEs, facility, and 
administrative staff may be shifted to other tasks that 
over-ride normal job descriptions. 

a. Identify most likely disaster scenarios for your 
location or region, including the possibility of 2 
simultaneous disasters. 

b. Based on projected needs for equipment, staffing, 
and ASOC, estimate which types of activity will be 
de-prioritized (such as elective surgery, non-critical 
preventive maintenance, training), and which 
activities will become mission-critical. 

c. Identify secondary roles for each job family to be 
invoked under disaster conditions and obtain cross-
training as needed. Specialists may be re-deployed 
as hospitalists. Hospitalists may be re-deployed 

as call-center staff for telemedicine screening; 
CEs may be re-deployed to set up field hospitals 
or other ASOCs and work closely with IT staff to 
integrate ASOC devices into IT networks. Identify 
the rescheduling and re-prioritization criteria for 
corrective and preventive maintenance services.

22. Form Strategic Health Intelligence Alliances be-
tween academic, government, provider, and medical 
industry partners.

a. Develop comprehensive models of healthcare 
ecosystems to complement the increasing clinical 
specializations and technical granularity that often 
lack proper integration or rational cost controls.

b. Coordinate 5-year outlook analyses to identify, 
assess, and prioritize candidate technologies to 
provide new efficiencies and DM capabilities.

c. Establish routine evaluation sessions to review 
device and system performance data and discuss 
any strategic implications for next-generation 
device/system design.

d. Explore academic and professional channels for 
joint degree and certificate programs with medi-
cal and nursing schools, to build stronger career 
relationships between CEs and other clinicians.

23. Establish or link to Data Fusion and Monitoring 
Centers to monitor emergent, multi-hazard condi-
tions that may require rapid changes in disaster re-
sponse – flooding, landslides, biohazard dispersion, 
disruption of transport or supply chain plans, power 
outages, gas leaks, tsunamis, firestorms, etc. Establish 
formal membership for CE liaisons with fusion and 
monitoring centers.

a. Establish hourly conference calls to review inci-
dents, discuss options, and coordinate decisions.

24. Establish an International CE Rapid-Response 
Network for rapid-response information sharing in 
the early stages of any disaster. Convene daily online 
consultation meetings.

a. Establish a dedicated website and teamwork tools 
to compile findings, promote problem-solving, 
and maintain, professional focus under difficult 
circumstances.

b. Compile improvised and emerging good practices 
for ongoing evaluation and validation, using a 
standardized ontology for technologies, pharma-
ceuticals, clinical trials, prototyping, dilemmas, 
and other relevant topics of concern.

25. Establish Inter-professional Innovation Partnership 
Networks to coordinate brainstorming, prototyping, 
troubleshooting, problem-solving, resource-sharing, 
team formation, standards promotion, process engi-
neering, best-practice identification, and dissemination. 

a. Form a dedicated DP/DM team to sustain multi-
year innovation efforts and report results in all 
relevant professional journals and associations. 

b. Use virtual meetings and conferences to sponsor 
Inter-professional Design Forums and scenarios 
to ensure – in advance of disasters – the alignment 
of cross-functional activities, data exchange, device 
interoperability, status updates, and prioritization 
criteria. 

26. Work with Media Liaisons to help elevate social 
expectations that DP is a social priority and that 
political leadership will be expected to understand 
and incorporate preparedness recommendations into 
public policy and budgets.

a. Invite media and other clinical professionals to CE 
and DM conferences, simulation exercises, and dis-
seminate proceedings of events to media outlets, 
including social media.

CONCLUSION
Taken together, these aspirational recommendations 

offer a comprehensive, but not yet exhaustive set of ac-
tions that can improve outcomes and alter the historical 
trajectory of the CE profession and DM capabilities world-
wide. Certainly, other topics and recommendations can 
and must be added to the agenda, but this list does offer 
a plausible foundation of starting points with sufficient 
breadth and detail to begin the transformational work with 
a collective framework of efforts. Working individually 
and in teams and associations, the daunting magnitude 
of the challenge can be mastered over time, building on 
the global presence and growing leadership of CEs. 



Hosea: Emerging Horizons of Clinical Engineering in Disaster Preparedness and Management

21 J Global Clinical Engineering Vol.3 Issue 1: 2020J Global Clinical Engineering Vol.3 Issue 1: 2020  20

Hosea: Emerging Horizons of Clinical Engineering in Disaster Preparedness and Management

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Hosea: Emerging Horizons of Clinical Engineering in Disaster Preparedness and Management

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https://link.springer.com/article/10.1186/s13673
https://ced.ifmbe.org
https://www.un.org/en
https://www.who.int
https://www.unocha.org
https://www.cadri.net
https://www.who.int/health-cluster/about/cluster-system/en
https://www.who.int/health-cluster/about/cluster-system/en
https://www.undrr.org/about
https://www.unhcr.org
https://www.ifrc.org/en
https://www.iom.int
http://www.fao.org/home/en
https://www.wfp.org
https://www.undp.org/content/undp/en/home.html
https://www.undp.org/content/undp/en/home.html
https://www.unicef.org
https://www.savethechildren.org
https://www.ifrc.org/en
https://www.paho.org/en/health-emergencies/disaster
https://www.paho.org/en/health-emergencies/disaster
https://www.undrr.org/publication/sendai
https://www.undrr.org/publication/sendai
https://www.gdacs.org
https://www.gdacs.org
https://www.insarag.org
https://www.fema.gov/emergency
https://www.fema.gov/emergency
https://www.ncbi.nlm.nih.gov/pubmed/24830057
https://www.ncbi.nlm.nih.gov/pubmed/24830057
https://www.ifrc.org/en/what-we-do/disaster-management/preparing-for-disaster/disaster-preparedness-tools/training
https://www.ifrc.org/en/what-we-do/disaster-management/preparing-for-disaster/disaster-preparedness-tools/training
https://www.ifrc.org/en/what-we-do/disaster-management/preparing-for-disaster/disaster-preparedness-tools/training
https://www.ifrc.org/en/what-we-do/disaster-management/preparing-for-disaster/disaster-preparedness-tools/training
https://www.gsa.gov/buying-selling/purchasing-programs/gsa-schedules/schedule-buyers/state-and-local-governments/state
https://www.gsa.gov/buying-selling/purchasing-programs/gsa-schedules/schedule-buyers/state-and-local-governments/state
https://www.gsa.gov/buying-selling/purchasing-programs/gsa-schedules/schedule-buyers/state-and-local-governments/state
https://www.gsa.gov/buying-selling/purchasing-programs/gsa-schedules/schedule-buyers/state-and-local-governments/state
https://www.gsa.gov/buying-selling/purchasing-programs/gsa-schedules/schedule-buyers/state-and-local-governments/state
https://www.embedded.com/processors
https://publications.europa.eu/resource/cellar/d2eeb993-5e7c-403d-b0bc-fda57388d211.0001.01/DOC_1
https://publications.europa.eu/resource/cellar/d2eeb993-5e7c-403d-b0bc-fda57388d211.0001.01/DOC_1
https://publications.europa.eu/resource/cellar/d2eeb993-5e7c-403d-b0bc-fda57388d211.0001.01/DOC_1
https://publications.europa.eu/resource/cellar/d2eeb993-5e7c-403d-b0bc-fda57388d211.0001.01/DOC_1
https://www.techdesignforums.com/practice/technique/enabling
https://www.techdesignforums.com/practice/technique/enabling
https://www.cdc.gov/coronavirus/2019-ncov/hcp/alternative-care-sites.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fhealthcare-facilities%2Falternative-care-sites.html
https://www.cdc.gov/coronavirus/2019-ncov/hcp/alternative-care-sites.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fhealthcare-facilities%2Falternative-care-sites.html
https://www.cdc.gov/coronavirus/2019-ncov/hcp/alternative-care-sites.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fhealthcare-facilities%2Falternative-care-sites.html
https://www.cdc.gov/coronavirus/2019-ncov/hcp/alternative-care-sites.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fhealthcare-facilities%2Falternative-care-sites.html
https://www.cdc.gov/coronavirus/2019-ncov/hcp/alternative-care-sites.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fhealthcare-facilities%2Falternative-care-sites.html
https://www.cdc.gov/coronavirus/2019-ncov/hcp/alternative-care-sites.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fhealthcare-facilities%2Falternative-care-sites.html
https://www.basecampservices.com
http://www.cidrap.umn.edu/sites/default/files/public/php/258/258_acstools.pdf
http://www.cidrap.umn.edu/sites/default/files/public/php/258/258_acstools.pdf
https://asprtracie.hhs.gov/technical-resources/48/alternate-care-sites-including-shelter-medical-care/47
https://asprtracie.hhs.gov/technical-resources/48/alternate-care-sites-including-shelter-medical-care/47
https://asprtracie.hhs.gov/technical-resources/48/alternate-care-sites-including-shelter-medical-care/47


Hosea: Emerging Horizons of Clinical Engineering in Disaster Preparedness and Management

25 J Global Clinical Engineering Vol.3 Issue 1: 2020J Global Clinical Engineering Vol.3 Issue 1: 2020  24

Hosea: Emerging Horizons of Clinical Engineering in Disaster Preparedness and Management

TOPIC DETAIL URL

Mutual Aid Agreement Mutual Aid Template draft text for customizing to user needs https://emilms.fema.gov/IS706/assets/
WyomingTemplate.pdf

Rapid Deployment Blockchain Technology for Emergency Response https://scholarspace.manoa.hawaii.edu/
bitstream/10125/63814/0061.pdf

Rapid Deployment The Evolution of Hastily Formed Networks for Disaster 
Response

https://www.researchgate.net/
publication/221567937_ 

USHAHIDI

The Ushahidi Platform allows anyone to gather distributed 
data via SMS, email or web and visualize it on a map or 

timeline. Its goal is to create the simplest way of aggregating 
information from the public for use in crisis response.

https://www.ushahidi.com/

Sahana Open-source disaster management software https://sahanafoundation.org/

Google Crisis Response

Google.org supports nonprofits working alongside 
affected communities from the immediate aftermath of a 
crisis through long-tail recovery. This includes providing 
nonprofits with funding and connecting them to the right 

Google volunteers—whether they’re a data scientist, a 
communications expert, or an engineer.

https://crisisresponse.google/

Google Public Alerts Provides global map with data on floods, earthquakes, fires 
and other disaster conditions https://google.org/publicalerts

Solar-powered Wi-Fi Solar-powered wireless access points https://robotechvision.com/
solar-access-point/

Ham Radio Backup radio communication technology in case normal 
telephone and cell services fail

https://www.youtube.com/
watch?v=lLqC8cvH_Aw

Point-of-care testing
Geospatial Science and Point-of-Care Testing: Creating 

Solutions for Population Access, Emergencies, Outbreaks, and 
Disasters

https://www.ncbi.nlm.nih.gov/pmc/articles/
PMC6988819/

Point-of-care testing PATH diagnostics for low-income settings https://www.path.org/programs/
diagnostics/

Point-of-care testing
Innovations in Point-Of-Care Testing for Enhanced United 

States Disaster Caches – American Journal of Disaster 
Medicine

https://www.wmpllc.org/ojs/index.php/
ajdm/article/view/2135

Point-of-care testing Smartphone based medical Diagnostics
https://www.sciencedirect.

com/book/9780128170441/
smartphone-based-medical-diagnostics

Point-of-care testing Lab on a chip https://www.azolifesciences.com/article/
Health-Applications-of-Lab-on-a-Chip.aspx

Advanced Diagnostic Lab 
Technology Mass spectroscopy https://pubs.acs.org/doi/10.1021/

acsomega.9b03764#

Defense Production Act
Enables the government to commandeer national production 
capabilities in order to meet defense and national emergency 

needs.

https://www.fema.gov/
defense-production-act-program

Mobile Morgue Trailer Refrigerated body storage https://www.mopec.com/
mortuary-response-solutions/

TOPIC DETAIL URL

Mobile Hospital Solutions Mobile clinics, hospitals, prefabricated hospitals, hyperbaric 
oxygen chambers http://oxycare.com.tr/

Mobile Hospital Solutions Mobile medical, dental, mammography, blood mobiles, 
laboratories https://lifelinemobile.com/

Mobile Hospital Solutions
Modular disaster response solar-powered clinics in a mobile 

container; morgue unit; laboratory; radiology suite; maternal/
infant clinic; primary care exam

http://www.clinicinacan.org/#about

3D Printing 3D printing solutions for healthcare https://www.dynamism.com/healthcare.
shtml

3D Printing
Medical devices produced by 3D printing include orthopedic 
and cranial implants, surgical instruments, dental restorations 

such as crowns, and external prosthetics

https://www.fda.gov/medical-devices/
products-and-medical-procedures/3d-

printing-medical-devices

Supply chain management 
in disasters Prepared by US Center for Disease Control and Prevention

https://www.cdc.gov/cpr/
readiness/healthcare/

SupplyChainDisasterPreparednessManual.
htm

Disaster credentialing

Sample guidelines for Credentialing for volunteer physicians 
and allied health practitioners; need for credentialing of 
professionals, call-center staff, and volunteers from other 

states, countries

https://studylib.net/doc/7359857/
guidelines-for-credentialing-and-granting-

disaster-privil...

Common Operating 
Picture

Online mapping software that combines pre-loaded data 
about critical infrastructure elements with real-time, location 

specific (GPS) data about disaster incidents and conditions 
that are submitted via cellphone app. Helps track deployment 

of first responders and visualization of regional response 
activities in real time.

http://comopview.org/sfc/

Pandemic Planning 
Checklist

US Dept. of Health and Human Services checklist for 
pandemic planning

https://www.phe.gov/Preparedness/
COVID19/Documents/COVID-19%20

Healthcare%20Planning%20Checklist.pdf

Capability Maturity 
Roadmapping

PAHO Information Systems for Health Maturity Assessment 
Tool

https://www.paho.org/ish/images/docs/
about-IS4H-mm.pdf?ua=1

Capability Maturity 
Roadmapping

The Use of Maturity/Capability Frameworks for Healthcare 
Process Assessment and Improvement

https://www.semanticscholar.org/paper/
The-Use-of-Maturity%2FCapability-

Frameworks-for-and-S%C3%B6ylemez-Ta
rhan/30b0cdbcdb75b8f6a0105b59627d8d5

f2c015284

Research Coordination
The WHO R&D Blueprint is a global strategy and 

preparedness plan that allows the rapid activation of R&D 
activities during epidemics.

https://www.who.int/blueprint/en/

Action Research on 
Disaster Response

A proposal to IFMBE/CED to document best practices, 
problems and recommendations about management of the 

COVID-19 pandemic, led by Clinical Engineers.

https://www.dropbox.com/
s/9zgq5absdlno9fu/Draft%20proposal%20
for%20Disaster%20Mgt%20Research%20

program%20Rev3.pdf?dl=0

https://emilms.fema.gov/IS706/assets/WyomingTemplate.pdf
https://emilms.fema.gov/IS706/assets/WyomingTemplate.pdf
https://scholarspace.manoa.hawaii.edu/bitstream/10125/63814/0061.pdf
https://scholarspace.manoa.hawaii.edu/bitstream/10125/63814/0061.pdf
https://www.researchgate.net/publication/221567937_
https://www.researchgate.net/publication/221567937_
https://www.ushahidi.com
https://sahanafoundation.org
Google.org
https://crisisresponse.google
https://google.org/publicalerts
https://robotechvision.com/solar
https://robotechvision.com/solar
https://www.youtube.com/watch?v=lLqC8cvH_Aw
https://www.youtube.com/watch?v=lLqC8cvH_Aw
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6988819
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6988819
https://www.path.org/programs/diagnostics
https://www.path.org/programs/diagnostics
https://www.wmpllc.org/ojs/index.php/ajdm/article/view/2135
https://www.wmpllc.org/ojs/index.php/ajdm/article/view/2135
https://www.sciencedirect.com/book/9780128170441/smartphone
https://www.sciencedirect.com/book/9780128170441/smartphone
https://www.sciencedirect.com/book/9780128170441/smartphone
https://www.azolifesciences.com/article/Health-Applications-of-Lab-on-a-Chip.aspx
https://www.azolifesciences.com/article/Health-Applications-of-Lab-on-a-Chip.aspx
https://pubs.acs.org/doi/10.1021/acsomega.9b03764
https://pubs.acs.org/doi/10.1021/acsomega.9b03764
https://www.fema.gov/defense
https://www.fema.gov/defense
https://www.mopec.com/mortuary
https://www.mopec.com/mortuary
http://oxycare.com.tr
https://lifelinemobile.com
http://www.clinicinacan.org
https://www.dynamism.com/healthcare.shtml
https://www.dynamism.com/healthcare.shtml
https://www.fda.gov/medical-devices/products-and-medical-procedures/3d
https://www.fda.gov/medical-devices/products-and-medical-procedures/3d
https://www.cdc.gov/cpr/readiness/healthcare/SupplyChainDisasterPreparednessManual.htm
https://www.cdc.gov/cpr/readiness/healthcare/SupplyChainDisasterPreparednessManual.htm
https://www.cdc.gov/cpr/readiness/healthcare/SupplyChainDisasterPreparednessManual.htm
https://www.cdc.gov/cpr/readiness/healthcare/SupplyChainDisasterPreparednessManual.htm
https://studylib.net/doc/7359857/guidelines
https://studylib.net/doc/7359857/guidelines
http://comopview.org/sfc
https://www.phe.gov/Preparedness/COVID19/Documents/COVID
https://www.phe.gov/Preparedness/COVID19/Documents/COVID
20Checklist.pdf
https://www.paho.org/ish/images/docs/about-IS4H-mm.pdf?ua=1
https://www.paho.org/ish/images/docs/about-IS4H-mm.pdf?ua=1
https://www.semanticscholar.org/paper/The
https://www.semanticscholar.org/paper/The
https://www.who.int/blueprint/en
https://www.dropbox.com/s/9zgq5absdlno9fu/Draft
https://www.dropbox.com/s/9zgq5absdlno9fu/Draft
20Rev3.pdf


Hosea: Emerging Horizons of Clinical Engineering in Disaster Preparedness and Management

J Global Clinical Engineering Vol.3 Issue 1: 2020  26

AUTHOR BIOGRAPHY

Fred Hosea, PhD, has worked in different areas of 
health care and psychosocial development for over 30 
years, conducting research on professional development 
in philanthropy, conducting FBI research on convicted 
sex offenders, and working as a mental health worker in 
adolescent psychiatric wards, community-based residen-
tial care for adolescents, school-based counseling, and in 
a maximum security treatment center for the criminally 
insane. He has taught graduate-level courses in business 
and professional ethics, and has taught undergraduate 
courses in “The Art and Science of Innovation” at Yachay 

Tech University. He worked for 17 years with Kaiser 
Permanente, the largest non-profit hospital system in 
the US, responsible for annual clinical technology plans 
for Northern California, implementing a national pro-
cess re-engineering, asset management and IT service 
management systems, and most recently was Director 
of Research and Innovation in Clinical Technology. He 
has published articles on disaster management and the 
future of biomedical and clinical engineering professions. 
He edited Human Resources for Medical Devices in 2017 
for the World Health Organization to promote biomedical 
and clinical engineering as essential professions for mod-
ern healthcare systems worldwide. He lives in Cotacachi, 
Ecuador and is active in a variety of projects to strengthen 
indigenous Kichwa culture, improve local health ser-
vices, and promote sustainable models of development. 
Fred is currently a collaborating member of the Clinical 
Engineering Division of the International Federation of 
Medical and Biological Engineering, and has presented on 
the future of CE at international conferences in Beijing, 
Shenzhen, Visakhapatnam, Bangkok, Rome, Geneva, Sao 
Paulo, and Zagreb.


