This report originally appeared in the December 2010 issue of DOTmed Business News

Successfully getting larger pieces of pre-owned medical equipment from point A to point B requires de-installation, rigging, crating, transport and a few steps repeated once the piece arrives on site. Although many companies provide all of these services, each part of the equation is critical and provides its unique challenges.

Those challenges are even greater when point A and point B are separated by international borders and oceans.

Lynn Larsen, director of marketing for Diggins and Rose Moving Systems, explains that customers are not always aware of the size limitations in overseas containers.

"As international machinery movers, we are particularly sensitive to sizes and weights. All too often equipment designers and manufacturers assume that a particular machine or crate will fit into a 20' or 40' standard or high cube overseas container without taking into account the interior and door dimensions of these containers," she says. "The result is that the machine or equipment is required to be either shipped by flat rack or air-freighted, a much more expensive option."

It really is a game of inches and missing by even one can be a very costly mistake, so it's important that companies determine exactly what the dimensions of a machine or piece of equipment will be and educate customers on the difficulties that exist with shipping internationally by ocean.

"We also encourage our customers to modularize where possible," Larsen says. "For example, designing and building a long and wide automation assembly line so that it can be easily disassembled into practical-sized sections for shipping."

According to Todd Partridge, vice president of MoveIt Specialized Logistics, international regulatory changes are always a challenge in transporting medical equipment.

In 2010, the Transportation Security Administration implemented 100 percent cargo screening, and to compensate for the added expenses, many air cargo companies have added a security surcharge, or just a general rate increase.

MoveIt specializes in "white glove" medical equipment shipping, including shipment preparation, inside pickup and delivery, and trucking and air freight.

"On the trucking side, the Surface Transportation Board has enacted tougher Hours of Service laws, which cut driver hours, and now include service hours like loading and unloading. This means ultimately fewer driving hours and leads to a general increase in costs," Partridge says. "As a TSA authorized Indirect Air Carrier, that also [translates to] additional procedures."

"The TSA and Department of Homeland Security are constantly considering and reconsidering the government mandated security programs to keep bombs off of aircraft," says Diane Gibson, president & CEO of Craters & Freighters. "A big issue in the industry today is cargo security as it concerns air freight. This issue will become more critical in light of the Yemen bomb plots."

Chaz Beadling, owner of American X Ray Equipment Sales & Service, says import laws are changing every day and it's important to stay on top of them all.

Based on the new regulations, air-freight companies must now be inspected by TSA personnel for compliance and must undergo security training.

"Only 'known shippers' can ship goods on passenger aircraft and to qualify, site inspection and paperwork [is necessary], including proper personal ID," Partridge says. "Without this, a same day air shipment is not possible."

FedEx - on the map and across the globe
As the leading worldwide carrier of goods, FedEx also provides services focused on transporting medical equipment.

"For shipments outside the U.S., every country is a little different about what they will require for customs clearance," says Carl Asmus, vice president of marketing with FedEx HealthCare Solutions. "Some countries require an import license and/or health department permit for medical equipment, while others just require a commercial invoice."

Internationally, FedEx HealthCare Solutions offers an express option using air or, for less time-sensitive shipments, ocean freight options.

Although the standard maximum dimensions for a FedEx Express Freight shipment are 119"L x 80"W x 70"H and a weight of 2,200 pounds, shipments can be heavier if dimensions are kept flexible, depending on the positioning with the aircraft.

"For example, FedEx has moved 20,000 pound magnets for an MRI, and we have moved pieces that are well over what may be considered a standard size," Asmus says.

"FedEx also tries to reduce packaging by having vehicles with, straps, load-locking bars and power lift gates to ensure safe securement and transport of each shipment," Asmus says.

Build relationships
Mary Fowler, director of new business development for The Espie Service Group, has dealt with FedEx to assist with a huge project for domestic shipping and international shipping on small packages and also palletized freight.

"They were 'Johnny on the spot' and came to meet with me, made us a great offer and discount and their effort will earn them $500,000 in new business next year partnering with us," Fowler says. "Networking is the only way to operate and remain competitive."

As Gold Medallion members of the World Cargo Alliance, MoveIt relies on its agent partners in other countries to advise them on pertinent regulations, as they ship to more than 206 different countries.

"Tariffs, duties, certificates, and other import and export procedures change regularly. On the U.S. side, our customs brokerage partners keep us abreast of requirements," Partridge says. "The best advice I have for an international shipper is to find someone knowledgeable that you trust and stick with them. International shipping is a good case-in-point where mistakes can cost a lot of money. If you have a good relationship with your forwarder, they will have your best interest at heart, instead of trying to make money on a one-time transaction."

When it comes to crating, most agree the biggest challenge is getting the customer to provide exact details and dimensions of the items needing to be crated. Another issue is the different methods and durability of the crating.

"Product being moved by air needs a far better crate as it is handled multiple times, by the trucking company and by the airlines and the airlines are much harder on the equipment than anyone else," Fowler says. "When it is going by sea, it is handled one time after the crating-into the container-and there it sits until it arrives at the destination port."

With sea freight, especially important for delicate medical equipment, there is an option of a vapor barrier to protect the unit from the elements, spray, sea air and even leaks onboard the ship.

"It is a sad state of affairs when a $150,000 MRI arrives at a destination ruined because someone covered it with shrink wrap and put it in a crate they made themselves with treated lumber from Lowe's or Home Depot," Fowler says.

Avoid fly- or drive-by-night companies
Users of medical equipment transportation services should be aware that there is no shortage of truckers to move freight between points, but experts warn that many of these have been, or will be in business for relatively short-term periods of time.

"They attempt to capture available shipments with whatever technique seems to work for them at the time-over-commitment on transit time, cargo protection, illogical pricing," says Jack Kendrick, director of medical transport for Specialty Moving System/Atlas Van lines. "Based on the needs and objectives of the customer, such sources are typically successful only on a random basis. But for ongoing and consistent damage-free, on-time, local or cross-country transportation with inside delivery and placement, the number of available providers narrows dramatically."

Transport trends good and bad
Unfortunately for the industry as a whole, the fuel surcharge is a burden shared by everyone from the trucking company or owner operator, to the dealer or manufacturer and ultimately by the customer.

"All of the leading transportation indexes point to increased freight demand. Orders for shipping containers, drivers and trucks are all increasing," Partridge says. "This presents both a challenge and an opportunity. The challenge is to keep prices down for our customers as prices increase. The opportunity is being able to provide service when resources are stretched."

"There are so many advancements in medical technology and equipment, we just have to stay on top of them, and find the safest way to move, install, and de-install them," says Steve Lewis, owner of Brandon Transfer & Storage Co., a full-service medical mover.
"I have noticed though that more animal clinics are getting sophisticated equipment such as MRIs."

Gibson is also seeing more of a demand for environmentally friendly ways to ship goods.

"Our industry has a very negative environmental impact so we're constantly searching for ways to [reduce] our carbon footprint," Gibson says. "There are more innovative methods of packaging that avoid propylene-based products and are entirely biodegradable. We are studying methods to build reusable crates to impede the need for new lumber which, in turn, reduces cost to the customer for new crates."

Jeff Knapp of Industrial Craters and Packers believes the availability of lumber will continue to be an issue in the crating business.

"The economy the past few years has depleted the number of operating lumber mills. In past slowdowns these mills would temporarily shut down or go to minimal operations; this time they went out of business," he says. "Also, dealing with international market demand, all of August and September, every call to lumber brokers/suppliers noted that China was buying up their stock at higher pricing than the U.S. market would support. The projections that the U.S. will soon not be the top of the food chain for consumption are coming to pass."

A shortage of crate lumber has the potential to put the brakes on everything. If equipment is de-installed, it may have a place to go, but it can't get there safely.

The deal with de-installs
"The biggest thing is planning ahead. Sometimes you walk into a room and you weren't given all the information needed," says James Gant, owner of KNJ Tech Service. "Our biggest issue we run into is that cables running underneath the floors in the ducts and those could be in sterilized rooms and you can't get in until certain hours."

Other things to consider: all software needs to be off, medical personnel need to be notified, equipment unplugged and the rooms need to be cleared of anything not going.

"There are times we walk into cath labs and they still have everything in-all the needles, all the IVs and they need to take it all out or it won't be sterile when we are done."

Rigging rules
Many of these problems can also be found with the rigging part of the equation.

The best advice from all riggers is to plan ahead. Experts recommend contacting a rigging professional, or several, and have them make an on-site visit and survey to evaluate not just the piece of equipment or things needing to be moved but to also take inventory of the building, halls and doors.

"Each job is different. Some riggers will ask for the equipment model number or manufacturer and go online and look at the piece and give a quote, never taking into consideration that the customer has stairs, elevators, low ceilings, support poles or other equipment that might impair a move," Fowler says. "A rigger making an on-site will show up for the job prepared for whatever situations he or she may discover. No one wants to receive a bill after the fact."

"Keeping people safe, keeping the equipment safe, and rigging thousands of pounds many stories high is definitely a challenge," Lewis says. "The equipment that we move is sometimes worth millions of dollars and one wrong move can render it useless."

Emerging technology offer respite
As technology advances, companies are more capable of providing customers with real- time tracking and tracing capability.

"There are new devices that can travel with the freight that identifies where the shipment is at all times," Gibson says.

The emerging robotics economy is a hopeful sign that manufacturing may slowly return to the U.S., and this is something that will benefit the rigging and crating industries.

"The robotics industry is entering a new era in which man and machine will work in partnership. This has very positive implications for American business, the medical industry and for the New England area, in particular," Larsen says. "We have crated and shipped thousands of machines all over the world because manufacturing overseas has been more profitable and cost-effective than in the United States. The emergence of a new robotics industry with man-machine partnerships has been projected to bring manufacturing production and jobs back to the U.S.A. for the first time in several decades."

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DOTmed Registered Ocean, Air and Truck Freight/De-installation, Crating and Rigging Sales & Service Companies
Names in boldface are Premium Listings.

Domestic
Zachary Wakefield, ABF Freight System, Inc., AR
Cathy Benz, Wrapit Express, Inc., CA
Andrew Bonin, Pacific Medical, CA
DM 100
David Cabral, Colonial Van and Storage, CA
Brian Dombrowski, Legacy Transportation Services, Inc., CA
James Flores, ZRG Inc., CA
Dan McGuan, Viable Med Services, Inc., CA
DOTmed Certified
DM 100
Patrick Lawson, Lawson Drayage, CA
Veronica Alvarez, Vercarmed, CO
Robb Morgan, Navis Pack & Ship, CO
Michael Doyle, Diversified Transportation Services, DE
Yolanda English, Engineering & Network Systems, Inc., FL
Steve Lewis, Brandon Transfer & Storage, FL
Mary Fowler, Espie Service Group, GA
DOTmed Certified
Todd Partridge, MoveIt Specialized Logistics, IA
DOTmed Certified
Ted Turano, X-Stream Medical Inc., IA
DOTmed Certified
Art Gutierrez, International Packing & Crating,IL
Jack Kendrick, Specialty Moving System/Atlas Van lines , IL
William King, KING Equipment Services Inc., IL
DOTmed Certified
Keith Tholan, AIT Worldwide Logistics, Inc. , IL
Bruce Watkins, Med Flight Auctions , IL
Steve Vest, Nationwide Equipment Transportation, Inc., KS
James Gant, KNJ Tech Service , IN
Dan Diogo, MacDonald Moving Services - United Van Lines , MA
Chaz Beadling, American X Ray Equipment Sales & Service , MD
Glenn R. Hammerquist, Berrien X-Ray, MI
Bob Holt, Quickway Rigging & Transfer, Inc. , MN
Dennis McGrath, MDX, MN
Delwin Nesset, DelMed, Inc., MN
Lynn Larsen, diggins & ROSE Moving Systems , NH
Victor Cruz, Logical Solution Services, Inc. , NJ
DOTmed Certified
Robert Feeney, NVC Logistics Group, NJ
Torsten Hofmann, Transgroup Worldwide Logistics , NJ
Douglas Gleiber, Abbot & Abbot Box Corp , NY
Ward Peterson, Transgroup Worldwide Logistics , OH
Jeff Knapp, Industrial Craters and Packers , OR
Frank Boseman, BMI, SC
Dane Vickery, DAMAX Service Team Inc. , SC
Mary Brafford, Rowe Transfer , TN
Mary Brafford, Molecular Imaging Solutions , TN
Chris Carithers, Clearview Equipment Services , TX
Paul Zahn, Mobile MedTech , WI
DOTmed Certified
DM 100

International
Bastian Berkel, Tomovation GmbH , Germany
DOTmed Certified