Medical Construction & Design

JAN-FEB 2013

Medical Construction & Design (MCD) is the industry's leading source for news and information and reaches all disciplines involved in the healthcare construction and design process.

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DISASTER PLANNING & PROOFING The Southeast Louisiana Veterans Health Care System Replacement Medical Center is designed with a seven-day "defend in place" capability that allows it to operate independently during and after a natural disaster. systems and access — can prepare a hospital to "defend in place." AERIAL: NBBJ; ATRIUM: PAUL WARCHOL Programming As the earliest design phase, programming is where planning for disaster begins. Programming ideally should focus on two conditions — normal dayto-day operations and extreme events — without losing sight of the necessary flows and efficiencies. For instance, at the SLVHCS Medical Center in New Orleans, designers placed all mission-critical components, such as the emergency department and all inpatient rooms, on the second floor or higher, well above the 100-year flood zone. Less-obvious functions, such as the kitchen, were evaluated. In an emergency, a specific place to eat is not www.mcdmag.com required — just a place to cook. Therefore, the kitchen is on the fourth floor and the cafeteria at ground level. During normal operations, food travels from the kitchen to the cafeteria via an elevator, which is no less efficient than carrying food hundreds of feet horizontally across one level. Central sterile storage is another important mission-critical program, but during normal operations, it doesn't matter whether it is housed in the basement (a common location) or elsewhere, so it could be moved high above the flood zone on the fourth floor. "It was difficult and we had to be forward-thinking in our discussions regarding medical center programming and deviate from the traditional layout," said SLVHCS Director Julie Catellier. "To mitigate risk, we designed an 'upside-down' medical center. And in the end, there's no negative impact to patient care or overall efficiency if mission-critical support services are located in the basement or on the fourth floor." Elevating mission-critical components has become common practice in floodprone areas, but each facility's specific needs should determine which functions occupy the lowest levels. At MUSC's Ashley River tower, for instance, the first floor is elevated 11 feet above the existing grade, and the main entrance is accessed by a ramped driveway; generators and pumps are located on an upper floor, while at-grade levels primarily contain convenient short-term and disabled parking. The Virginia Mason Medical Center expansion features a similar capability. Built on the side of a hill, Seattle faces little flood risk, but earthquakes are a significant threat, and there is the potential for terrorist attack, as well — not all disasters are natural. The VMMC facility can stay up and running during a bioterror or contagious event inside the hospital. The air-handling systems are isolated floor-by-floor, so entire floors of the hospital can be isolated to prevent the spread of contagion. Another concept that shows promise is waterproofing individual floors. When floodwaters penetrate a building, contaminated water often wicks up through the walls, bringing mold and mildew to upper levels that were spared during the initial flooding. Creating a barrier by sealing the underside of a floor and installing stair doors and fire shutters that double Independent building systems Once the major programming decisions are made, building systems must be configured to support an emergency. The key is to have independent building systems that can continue to function in the event of partial failure. Centralized building systems can be a disaster, because if one part goes down, it takes the whole facility down: if water does penetrate the building envelope, or if a tornado blows out the windows, then what? Decentralized, independent building systems are more resilient in such an occasion. The atrium of Medical University of South Carolina's Ashley River Tower is light and open, even with a curtainwall designed to withstand missile impacts during a hurricane. January/February 2013 | Medical Construction & Design 35

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