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Buildings
Project
Prepares Hospitals for Disaster Operations
Prototype
emergency room design stresses flexibility
(enr.construction.com - 05/31/04 issue)
By Elaine
Silver
When terrorists flew the planes into
the World Trade Center towers three years ago, the nation
watched as medical personnel gathered at New York City’s
emergency rooms waiting for casualties to stream in. Unfortunately,
the catastrophic nature of the attack left little for the
doctors, nurses and paramedics to do. But, even before the
Sept. 11, 2001, attacks, a nationwide initiative called Project
ER One brought together 200 experts to make recommendations
on how to make emergency rooms (ERs) better able to prepare
for large-scale disasters, such as terrorists attacks.
The federally funded project started
in November 2000 and involved MedStar Emergency, Washington
D.C., in collaboration with other medical centers, universities,
non-governmental organizations and federal agencies. The first
of two phases "was to compile design features and specifications
that hospitals could use as solutions to ER limitations,"
says Dr. Michael Pietrzak, director of Project ER One at Washington
Hospital Center. The group came up with over 700 suggestions.
The individual hospitals did a vulnerability and hazard assessment
to choose those features specific to their site and mission,
Pietrzak says.
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The second phase involves taking all
of the specifications and building a prototype at the Washington
Hospital Center. "It’s important to have a place
where people can see in a hands-on way how these ideas can
work," says Mark Smith, chairman of emergency medicine
at the hospital. Smith, Pietrzak and colleague Craig Feied
are the three key ER One project principals. Pickard Chilton,
New Haven, Conn., is the lead design architect and HKS Architects,
Dallas, is the lead planning architect.
The prototype has to address many of
the possible threats, such as biological, explosives, chemical
releases, dirty bombs with radiation and even a nuclear detonation.
"But, the facility still has to look and feel like a
healing environment, not a fortress," says Pietzrak.
In practical terms, this means a hospital
needs surge capacity to handle 20 patients at a time, or 20,000.
It also needs a robust decontamination facility and a communication
system that will work under any circumstances. Click
here to view chart
While the prototype waits for funding,
the ER One recommendations can have immediate impli-cations
for hospital design, renovation and operations. They not only
can improve the readiness of hospitals for large-scale disasters,
but also can increase hospital efficiency and safety.
"What we have here is a paradigm
breakthrough," says Smith. "What is important is
to be better prepared to handle daily operations with common
illnesses like multi-drug resistant tuberculosis." Smith
notes that half of the people who contracted the SARS virus
in Toronto were health-care workers.
A number of ER One ideas may help prevent
such outbreaks in the future. "In the immune room concept,
everything is portable," says David Vincent, senior vice
president at HKS Architects. An exam treatment room in an
emergency department would have life-support medical gasses,
lights and power all attached to a gurney rather than built
into the structure. This would allow hospital staff to move
a contagious patient with all equipment and not worry about
decontaminating the equipment after the patient left. This
idea already is being used in the U.S. military.
Under the concept, the immune room itself
should have a seamless environment, with smooth surfaces,
covered corners and blister covers on the light switches.
And the surfaces should be self-decontaminating with an ionic-silver
impregnation. Bacteria-harboring sink drains would be neutralized
by high-velocity water spouts.
The Centers for Disease Control estimates
that 90,000 patients develop hospital-induced infections each
year. The immune-room concept would reduce that number and
be cost-effective even without a terrorist attack or natural
disaster, according to the team.
Special immune-room ventilation procedures
also would protect hospital employees and patients from exposure
to airborne diseases such as tuberculosis, measles and Legionnaires’
disease. The ideal room should have a negative-pressure air-handling
system so that air in the room is removed through a dedicated
exhaust system and is not recirculated through the general
hospital system, according to the concept. This also is evident
in new ventilation standards established by CDC that require
isolation and decontamination rooms to use negative air pressure
systems that change the room air twelve times per hour.
Air coming into the hospital also must
be protected and cleaned. Vincent says most buildings have
air intakes that are unprotected. "So, if you want to
spread...
(continued...)
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