We are specialists in cooling the deceased (www.flexmort.com) and we utilize a range of cooling technology to do this including traditional refrigeration and other cooling technology. We have supplied thousands of CuddleCots to hospitals around the world including hundreds to the US; on a daily basis we deal with many US hospitals as well as deal directly with numerous US families and groups fundraising to provide CuddleCots to US hospitals. We have recently been asked by a number of US families and groups for advice on cooling systems because there are now “new” alternative cooling systems being marketed. We appreciate families have a difficult task in deciding what system to buy particularly if those offering these systems are not experts in in cooling the deceased, therefore we have provided some background to the development of the CuddleCot in the UK, as well as some questions to consider when making purchasing decisions. We advise families to closely examine any system and company before making any purchases as we all want hospitals to have a reliable cooling system which will help as many bereaved families over many years.
Whilst these baby cooling systems are being marketed in the US as “new”, families should be aware that in terms of technology they are simply the same “refrigerated” baby cooling systems that have been used in the UK for nearly 15 years and work the same way as your refrigerator at home. Refrigerated systems share 5 basic components: fluid refrigerant; a compressor, which controls the flow of refrigerant; condenser coils (on the outside of the chilled area); evaporator coils (on the inside of the chilled area); and something called an expansion device. They will be very heavy and the only difference is that different trolleys/cooling receptacles are being used in the US (i.e. they just look a bit different). There are many reasons why UK hospitals replaced these “refrigerated” systems and 97% of UK hospitals now use CuddleCots. Very occasionally we see a “new” refrigerated baby cooling unit appear in a UK hospital but these are very rare and hospitals still continue to prefer CuddleCots. We know a lot about this area because many years ago we initially manufactured “refrigerated” cots but after hospital trials/feedback, we stopped manufacture (and developed the CuddleCot).
There are some basic questions (as well as cost) that should be considered when buying cooling systems. We will cover these in this document but you should also think about things such as: How long has the company supplying them been in existence? What is their experience in providing cooling systems for the deceased? Do they supply a range of deceased cooling systems or just one product? (This helps you decide what risk there is for long term service support for hospitals) What service/repair teams do they have? How big is the company? Is the product certified for hospital use (ask for evidence)? What long term hospital trials have been undertaken (ask for evidence)? Does the company have product insurance etc (ask to see a copy)?
Furthermore, it is imperative that any cooling system has undergone medium/long term clinical trials at a hospital before being offered for sale to assess product reliability/effectiveness etc. We would advise US families clarify exactly what trials have been undertaken with these systems before making any purchases (trials are absolutely crucial and we have conducted numerous clinical trials over the years at Medical schools, Universities and hospitals). Problems with equipment can be very distressing for families, for example Hannah Biggs emailed us on 2nd August 2017 after using a “refrigerated” cot in the UK (we have permission to share this):
“Our experience with the refrigerated wooden cot was actually rather a terrible one. It mean that Lottie could stay in our room with us but it was a huge and bulky box on wheels which had to be plugged in and had to have the lid on when we were asleep. The night that Lottie was born, the midwife offered to wheel her closer to the bed for me, as she went to move the cot one of the wheels broke and it nearly fell over with Lottie in it. It was only the fact that my fiancé caught the cot that it didn’t tip over. As if I wasn’t traumatised enough by everything that was going in, this was a really distressing moment for me and led to me being in hysterics begging them to just give Lottie to me. Once we’d gone home, we came back to visit Lottie regularly but she was never in the cold cot again as it was being fixed.
Putting her in that horrible box just made everything seem so wrong and took away from what was my only time with my daughter. I want to donate the CuddleCot so that other people can have the experience that Lottie and I should have had so I am happy to give feedback and tell mine and Lottie’s story.”
We also know of a UK hospital that in 2009 had a family donate a refrigerated cooling system which actually damaged the baby’s skin and so the hospital refused to use the systems again (unfortunately wasting the family’s donation). The following year the hospital bought several CuddleCots. We are not saying that all “refrigerated” systems do not work, we just know that the technology has significant drawbacks and we know this from our many years of experience manufacturing deceased cooling systems.
Flexmort started through Warwick University Science Park in England and we manufacture a wide range of innovative deceased cooling systems used around the world. Our customers include hospitals, funeral directors, hospices, Governments and the Police. In 2009 we started looking at a system to cool babies in order that families could spend more time with their baby. Our research revealed there were already a few different types of cooling system for babies in the UK but they had not become widespread and only approximately 20/30 hospitals used them. The systems all used “refrigeration technology” cooling systems and were in use since about 2003. Some of these units looked very clinical as they were fixed to a trolley and were on wheels.
Examples of UK refrigerated baby cooling systems (note the lid next to the unit – we will discuss this point later)
We initially developed a system which used the same “refrigerated” technology but we tried to make it look less clinical by using a moses basket and covered the refrigerated system with a satin cloth. However, as it was very heavy (over 58lbs!) it all had to be fixed onto on a trolley with wheels.
Our first baby cooling system (using refrigeration)
During the trial it became clear “refrigerated” systems had significant limitations. Hospitals, stillbirth charities, families and us wanted to improve on this and come up with something better. The areas requiring improvement were:
- Less clinical look and more of a “home feel”
- Flexibility of cooling as needed something lighter (refrigerated units weighed over 58lbs/26kgs) – a heavy system could not be loaned to other hospitals very easily also could not be loaned to families to take baby home
- Improvement in Cooling efficiency – Eradicate the requirement for lids and eradicate the “hum” of traditional refrigeration which sounded like baby was inside a household refrigerator
- Reduce breakdowns and develop service support for hospital engineers
Therefore, Flexmort worked with the internationally recognised Stillbirth support group SANDS as well as numerous hospitals to develop the CuddleCot. Refrigeration is not the ideal technology for cooling babies so we developed a new baby cooling system which did not require refrigerant gas (now used in a number of our systems). The clinical trials were successful and as a result, within a few years the CuddleCot replaced virtually all of the refrigerated units that were in use and hundreds more hospitals began to use CuddleCots.
So why is the CuddleCot preferred over traditional refrigerated units?
- Refrigerated units use old technology. As a result they are VERY heavy and have to be mounted on trolleys/wheels which makes the systems look very clinical. Hospital staff/families wanted something that would look more like a cot used at home
- Refrigerated units usually need to have the cooling system fixed to the trolley – it cannot be easily taken apart and is usually one complete unit so makes cleaning more difficult as well as creating longer term servicing issues – see later
- Refrigerated units do not cool efficiently and make a “humming” which sounds like a home refrigerator
- With refrigeration there is no flexibility where the cooling occurs as it is one unit. Hospitals wanted a cooling unit that had a pad which could be used in any moses basket, or any small basket (particular as very premature babies looked tiny in a standard basket). Many hospitals had a variety of receptacles and wanted the choice particularly if Mom struggled to move from the bed and could not see into a trolley
Q: When looking at purchasing, closely examine the system. How heavy is it? Does it use “refrigeration” to cool? Does it look clinical i.e. on a trolley with wheels or like something that would be used at home?
The CuddleCot does not use any refrigerant gas. The CuddleCot is a modular system (so each part can be easily separated) and comes with a Schnuggle moses basket so looks homely rather than clinical and the only noise is a fan (so it does not sound like a fridge). As the CuddleCot cooling unit is not fixed to the basket and can cool in any receptacle. The CuddleCot has 2 different size pads (one small for premature babies) and this allows the hospital to determine which receptacle to use for cooling. Also, some Moms struggled to move from the bed, with the CuddleCot the baby can be cooled next to Mom in the basket for many hours rather than baby having to go “into a cooling unit with wheels” placed next to her on the bed. Finally, the CuddleCot is very simple to clean which is important for infection control reasons.
There is a growing requirement for “loan” cooling units as well as a growing recognition in hospitals that that some families wanted to take their baby home (shown recently in the case of Charlie Gard http://www.dailymail.co.uk/news/article-4762390/Charlie-Gard-s-parents-hours-son.html). Forward thinking hospitals wanted a “future proof” system that was much more portable and lightweight. Providing families with this option to take baby home is growing with a number of hospitals around the world adopting policies for this. This is incredibly difficult to do with conventional refrigerated cooling partly because the units are so big and heavy and also because refrigerated systems should be left to “settle” for 24 hours before being switched on else this can seriously damage the system. If you want your hospital in the future to potentially be able to offer families the choice to take baby home then a refrigerated system is not suitable.
Q: Ask the supplier how heavy is the cooling system? Is it portable? Can it be lifted easily by one person? Can it be easily sent by courier at a low cost? Question there understanding on refrigeration and how long it needs to left after being moved before being switched on
The CuddleCot cooling unit only weighs 8lbs (3.8kg) and is highly portable and can be sent by courier. It can be used immediately after delivery.
Efficiency – cooling effectively is not easy
- Refrigerated systems (like your home refrigerator) all work by cooling a plate which in turn cools the air. The problem of this type of cooling (called convection cooling) is you need to keep it contained – that is why you have an air tight door on your fridge. If not the motor has to work extra hard if the cold air is not contained. Therefore, whilst refrigerated systems initially work, there are often medium/longer term reliability problems due to the strain on the system. Any company with experience of cooling therefore provides “lids” for refrigerated units to increase cooling efficiency and to reduce the strain on the system (you can see a lid in the picture at the beginning of this document next to the wooden unit and also see Hannah Biggs talks about her lid in the testimonial at the beginning of this document). Of course, when Mom is awake, the lid is often left off the unit but is replaced when they were asleep. A lid can be distressing for families.
- For the best and most efficient cooling method, the baby really should be in direct contact with the cooling surface (called conduction cooling) but this means the baby would have to be placed directly onto the cold plate and with refrigerated systems this plate is too cold due to the physics of refrigeration technology (and also families do not like their baby lying on a metal plate). Therefore, mattresses are used. The problem is that when a mattress is placed in the refrigerated cot then this insulates the cooling mechanism (it would be like you placing insulation across the back of your fridge) and the result is reduced cooling and so babies condition deteriorates more quickly (basically families got less time with baby). This is exacerbated if a lid is not used.
Q: Is the system cooled using refrigeration? What testing has been undertaken in hospitals? How many units are in use across hospitals? What is the hospital feedback? Is a lid required for longer term use? If not, why not? What is baby placed on? – is it on a mattress, if so how is baby cooled? What is the longest amount of time a baby has been cooled on the system? What hospital evidence is there for this claim?
The CuddleCot is designed differently and uses direct contact through a pad to cool the baby (ie we use conduction cooling rather than convection) and our cooling is incredibly effective and fast. The soft pad can be placed on top of a comfy mattress and under a sheet so it is in contact with baby. This means baby is cooled in the most efficient and effective way possible whilst keeping them as comfortable as possible on a nice thick mattress. The CuddleCot helps keep the baby in a better condition than through refrigerated systems and we have numerous testimonials from hospitals on our website and many others available.
Servicing –very important!!
There are two types of service issues for hospitals, firstly annual servicing and secondly, breakdowns.
- Refrigerated machines contain refrigerated fluid and so annual inspections/preventative maintenance visits are often required by engineers to ensure the equipment. As CuddleCots do not have refrigeration, they don’t need annual servicing
- All electrical machines can breakdown. Refrigerated machines are heavy as they have lots and lots of moving parts which increases the risk of a breakdown
- Hospitals found that getting a refrigerated unit serviced was a big problem as the manufacture was often located hundreds of miles away. This means units were often unavailable to families and also engineer site visits were not only very expensive, but repairs often took weeks and weeks. The units were too heavy to simply be returned to the manufacture as pallets were required in order to send them. The availability of parts was also an issue.
Q: What are hospital servicing requirements if refrigeration is used? How is service undertaken should a fault occur? If the unit is heavy and cannot easily be returned for servicing then what local/trained engineers are available? What is the service response time? What is the timescales for availability of spare parts? Are spare parts held in stock?
The CuddleCot’s cooling technology means we have very few moving parts and so breakdowns are very rare especially when compared to refrigerant based systems. It also means our cooling unit is very light – it only weighs 8lbs (3.8kg). Traditional refrigerated systems weigh over 58lbs/26kgs! Therefore, in the unlikely event of a breakdown, we can provide simple instructions to fix the unit or the CuddleCot cooling system can simply be sent back for servicing (as it is so light and is modular) and we can turnaround a breakdown within a couple of days with our team of engineers – all this is important for hospitals. A number of UK hospitals replaced refrigerated units with CuddleCots simply because it was so expensive having to call out trained refrigeration engineers to attend site and breakdowns were taking weeks to resolve.
Flexmort has been recognised by the Her Majesty The Queen and were awarded the Queen’s Award for Innovation 2016.