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DISASTER PLANNING & PROOFING 'Defend in place' KEY STRATEGIES TO PREPARE HOSPITALS TO WITHSTAND EMERGENCIES BY DOUG PARRIS H ospitals are a vital part of civic infrastructure, and never more so than during natural disasters. When a crisis occurs, people naturally gravitate to hospitals, not only for immediate medical needs, but also because of order and stability, with 24/7 activity and the expertise to deal with emergencies. Therefore, it is essential that hospitals remain operational throughout an extreme event. As hospital executives develop emergency plans and occupant protection strategies, "defend in place" approaches are being added to evacuation protocols. Determining which strategy is most appropriate depends on a variety of factors, but it has become clear that buildings must be designed with robust abilities to remain in operation. It's easy to focus on the obvious material and structural solutions that achieve this: glass that withstands high winds and missile impacts in hurricane- and tornado-prone areas, or base isolation in seismic zones. Certainly these features are essential. But equally important, and sometimes overlooked, are the features necessary to keep the facility running both during and after an event. Healthcare architects are learning 34 Medical Construction & Design | January/February 2013 that unexpected details can make a big impact. Such features have been put in place at the Virginia Mason Medical Center East Campus Expansion in Seattle, Wash.; the Medical University of South Carolina Ashley River Tower in Charleston, S.C. and the forthcoming Southeastern Louisiana Veterans Health Care System Replacement Medical Center in New Orleans, La.; among others. Each of these cities face its own unique challenges: Seattle lies within an active seismic zone, New Orleans is all too susceptible to hurricanes and flooding and Charleston regularly pummeled by hurricanes, flooding and earthquakes rivaling those on the west coast. There are advantages and disadvantages to each region, but a few key principles — among them programming, independent www.mcdmag.com