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This report originally appeared in the September 2009 issue of DOTmed Business News

The high gas prices that plagued the mobile transportation industry last year seem to have leveled off, but a number of transportation companies have seen the downward economy wreak havoc during the past 12 months.

"I think just like every other industry influenced by the economy, the transportation industry has been very slow over the last year," says Cliff Hess, owner of Texas Medical Mobile Services. "We have seen things start to ramp up over the last few weeks, but I don't know if that is a trend that will continue."

Some feel a down economy can actually be a good thing for the mobile industry, as hospitals and clinics may look to rent mobile equipment, rather than spend money on upgrading and buying new systems.

"Stuff still needs to be moved, so business has been steady," says Paul Zahn, Director of Sales and Marketing at Mobile MedTech. "Gas prices are not the concern that they were and customers are still utilizing us to bring their trailers where needed."

Considering mobile medical trailers are utilized for transporting equipment that can be valued in the millions - some holding a ten-ton superconducting MRI magnet with over 240,000 miles of coiled wire bathed in a thousand liters of liquid helium at -452.1 degrees Fahrenheit below zero - obviously they're not dealing with run-of-the-mill freight.

The Open Road

Mobile trailers and their cargo are sensitive machines that require specialized care and a host of exacting procedures to get from point A to point B safely and securely. Once there, the job still isn't done. There's still the task of setting up the trailer.

"This is not something that just any truck driver can do and our customers really depend on us to represent them when we set up a trailer at a hospital," says Hess. "The drivers need to be able to deal with any problems on the road and once they get to their destination, they need to get everything situated so the equipment is ready to be used by the technician or doctor when they are ready to scan."

Before hitting the open highways, drivers have to make sure the gantry is locked in the correct position for transport, check suspensions for leveling, make sure the load won't shift and double-check that paperwork and instructions have been documented properly.

"A company will call or e-mail us to arrange for us to pick up the trailer and move it somewhere," says Lee Bernier, General Manager and CEO of Sage Point Transportation, LLC, with headquarters in Upland, CA, and terminals in Texas, New York, and Washington. "We provide a tractor equipped with air-ride and we have experienced drivers who will go and check the trailer to make sure everything is stored, put away and tied down, dismantle the stairs and railings, hook it up and drive to wherever they want it. Then, set the trailer up, level and don't leave until someone from the hospital comes out and approves that everything is set the way they want it."

Experienced Drivers Wanted

Driver responsibilities include being able to restart the chiller, making sure the air conditioning is connected, knowing how to restart the cold head or compressor if necessary, and knowing how to plug and unplug the unit into a Russelstoll 480-volt power source in exactly the right sequence, or else potentially catastrophic problems could arise.

That's why transportation companies are so stringent when hiring new drivers.

"We have our drivers spend two weeks of training prior to ever getting out on the mobile road, learning how to set up and tear down the trailers," says Zahn. "We only use experienced drivers who are responsible for getting everything ready, from top to bottom, on delivery."

Hess concurs that his company will not let anyone on a medical trailer who has not gone through extensive training.

"We bring them to our facility and they learn all about what a medical trailer is and the logistics of everything," he says. "They learn what an MRI looks like, what to do with a cold head, what needs to be done when they pick a trailer up and when they drop one off. When they are ready, they are equipped with all the knowledge they need."

Money Issues

Gas fees aren't the only wavering issue that transportation companies are faced with. Insurance is a must (umbrella policies of $1 million or more) and special permits for oversized or overweight trailers need to be obtained.

"It depends on how new they are, but we've picked trailers up that have been as much as $2.4 million over the years," says Bernier. "You need to carry a lot of insurance, so we cover even more than that. That's one of the reasons why hauling is expensive, because you need to have that insurance in case something ever did go wrong."

Bernier also stresses the importance of understanding it's a "portal to portal business," and that to maximize profits, you should do whatever you can to keep a tractor from returning empty, resulting in what is known as bobtail miles.

Storage Solutions

Mobiles aren't usually rented out every day of the year. During the days when they are not in demand, they need to be properly stored. Once a trailer comes in, it is plugged into power (although a CT trailer doesn't need to be on power, in most cases it still is) and then closely monitored.

"We have to rig it in, connect it to power, run the gas compressor and cold head, check the chilled water connection and monitor daily. We look at helium levels and check compressors," says Clark Wilkins, President of JDI Solutions. "We'll look to see if any maintenance needs to be done and usually we do some special work on the trailers."

Because of the trailers being used so regularly, they often need some maintenance to get them looking top-notch. For this, most storage companies also offer a full selection of maintenance and refurbishing services that a trailer can undergo while awaiting its next run. The mobiles can get trailer repair and reconditioning, PMs, deinstallations, reinstallations, cold head and compressor maintenance, helium and internal magnet pressure monitoring, and A/C service.

"A storage yard needs to be able to give the trailer a planned maintenance," says Michael Profeta of Magnetic Resonance Technologies. "One trailer we just had in, we ended up re-servicing the generator, replacing the batteries, adjusting the brakes, changing all the bulbs and running lights, cleaning the air filters in the A/C unit-all the service related issues not part of the equipment, but part of the trailer."

Once a transport-heavy company, Texas Medical Mobile Solutions has seen its storage business increase to the point that they are now doing more storage than transport, tripling its customer base in the past six months. They now can accommodate 30 trailers on power.

"Any trailer that's stored here gets checked every single day and we can work on every single part of the trailer except the medical equipment inside," says Hess. "From a flat tire to brake lights, from painting to reconditioning; we are checking all the assembly that goes into a medical trailer."

The company also does something unique in that they publish a report about each stored trailer on a web site, so their customers can check on how their trailer is doing every day.

"We want to take care of our customers and like them to think of us as their service station," Hess says.

Mobile MedTech has storage and power available at facilities in Council Bluffs, IA and Cottage Grove, WI.

"Our guys walk the yard every morning and we monitor and report the cryogen levels and make sure the air conditioning is working, Zahn says. "Ideally, you want to make sure the environmentals are working; they are there for a reason."

Industry experts estimate the cost of running a chiller on an MRI anywhere from $50-$150 a day.

Bernie Bartoszek, Executive Vice President for MagnaServ Inc., says that business is profitable in this sector of the company.

"We have OEMs who pick up units and instead of hauling them back to their corporate locations, they pay rent to us and we store them for them," says Bartoszek about the company, which can store up to nine MRIs in its Stuart, Fla. location. "We have customers bring in the mobiles and they need to be refurbished back to their original specs, and we can do all that. It's a good business."

When it comes to MRI mobiles, a bit more is required than storing a CT or PET mobile. Helium levels need to be checked every morning. Magnet pressure needs to be kept track of constantly. Chillers need to be attended to and each unit has to be kept permanently plugged into a 480-volt Russellstoll outlet for the duration of its storage.

Mobile MRI units are often subjected to more vibration than a fixed site unit, so it is very important that the integrity of the helium venting system not be compromised.

"Our team of field-service technicians are trained to inspect all seals and perform lead detection on the systems to ensure that they have not be compromised," says Thomas Freund, Director of MRI Services for Oxford Superconducting Technology, a division of Oxford Instruments. "In the event that the system is exposed to atmosphere, [our] technicians are trained to clear any visible ice and restore the system back into normal operation. In extreme cases of helium vessel icing, there may be a requirement to warm the system to room temperature and then re-cool it to liquid helium temperature."

Power Down?

Mobiles were not meant to be stored, as they can't make money if they are sitting on a lot. Still, some of the mobiles sit for weeks or even months at a time.

"From a cost perspective, if it's stored too long, it can become problematic," says Chris Eaton, sales and service manager for Polaris Medical Imaging. "You're basically using cryogens and power and not using your machine. You have to calculate if it's worth keeping it on power."




If someone has a magnet and puts it in warehouse without power and it goes warm after a few weeks, the cost to cool it down again with new helium would be more expensive than it would be to keep it cold during that time as a cool down would cost from $30,000 to $40,000. However, Profeta says at some point, it does make sense to pull the plug if they are not getting used.

"There is a break-even point, usually after six months, so if you know it will be sitting that long, let it warm up and cool it down again," he says. "Sometimes people get stuck hanging on to something for a year and don't need to be paying $36,000-plus to let it sit for that long."

Problem Solving

The two critical elements in keeping a magnet cold involve ensuring that the helium level is monitored and topped off as required, and making sure that the refrigeration system is operating within specification.

Poor maintenance and servicing procedures can often lead to a quench, and recovering from a quench will be costly and time consuming.

"Magnet technology has gotten better and with experienced engineers, quenches don't happen near as often as they used to," says Michael Webster of Legacy Medical Imaging. "A black quench means the magnet shorted or burned up and is not repairable (in the field). A soft quench you can replace the baffle, check magnet resistance, check for signs of ice, fill it up with cryogens and try to ramp it."

Freund offers that the most important aspect is addressing the problem as quickly as possible, minimizing any air ingress and ensuring that the system does not go warm.

"As soon as the quench subsides, the venting needs to be inspected to ensure that all valves have closed, bursting discs are inspected to ensure that they have not been compromised," he says. "O-rings are often overlooked and also need to be inspected. Once the venting integrity has been established, the system needs to be checked for any air/ice ingress. If clear, the system can be re-filled with liquid helium and re-ramped to field. A frequency check and shim check should be included with this part of the service to ensure the system is within specification."

Helium Costs Rising

The worldwide consumption of helium has increased by between 5% and 10% a year in the past decade, with the biggest growth in its use as a coolant for the superconducting magnets in MRIs. Present helium consumption is estimated to be about 100 million cubic meters a year, and is predicted to continue rising by 4% to 5% a year.

"Helium costs have doubled all at once for a lot of people. Some people still have good numbers because their contracts aren't up, but eventually they will all be paying that much," Profeta says, pointing to the shortage of helium as the reason. "Our price almost doubled."

According to those doing the renting, the medical mobile industry continues to do well, and the transportation, storage and keep-cold businesses concentrate on providing top customer service to keep the overall industry strong.

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DOTmed Registered Mobile Trailer Transportation, Trailer Storage, MRI Keep Cold Service Equipment Sales & Service Companies
Names in boldface are Premium Listings.

Domestic
Steve Gregson, Sage Point Transport, LLC, CA
Bernie Bartoszek, MagnaServ, Inc., CO
Gene Miller, MobileMed Support Services, CT
Dennis Giuzio, Mobile Radiology, Inc., FL
Jack Stoner, Medical Transit Services, Inc., GA
Darlene Bishop, Global Transportation, Inc., GA
DOTmed Certified
Dan Feeley, National Mobile Medical Transport, IL
Jennifer VanDerMolen, Powersource Transportation, Inc., IN
Clark Wilkins, JDI Solutions, Inc., NC
DOTmed Certified/100
Christi Kukes, DMS Health Technologies, ND
Thomas Freund, Oxford Instruments, NJ
DOTmed Certified/100
Michael Profeta, Magnetic Resonance Technologies, OH
DOTmed Certified
Jack Barker, Rowe Transfer, Inc., TN
Michael Webster, Legacy Medical Imaging, TX
Chris Eaton, Polaris Medical Imaging, TX
Cliff Hess, Texas Medical Mobile Services, TX
Paul Zahn, Mobile MedTech, WI
DOTmed Certified

International
Adam Kubisch, Inmed Medizintechnik, Germany

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