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DISASTER PLANNING & PROOFING as water barriers help prevent moisture from traveling up the building. The hope is that, if floodwaters do enter the building, everything at grade can be removed and rebuilt, sparing the mission-critical levels above. However, more research is necessary before such a strategy becomes feasible. Access and infrastructure Because MUSC's Ashley River tower is located adjacent to the Ashley River and Charleston Harbor, the facility was designed to withstand flooding, hurricane winds and earthquakes. down some of its elevated viaducts, but if a major earthquake strikes, those freeways could collapse and prevent people from reaching the hospital. And New Orleans' potential for catastrophic fl ooding that prevents hospital access became all-too apparent during Hurricane Katrina. The SLVHCS Replacement Medical Center Emergency Department's vehicular ramp can double as a boat launch, and its parking garage can support the weight of Blackhawk-class helicopters in case evacuation is required. Healthcare providers must engage in a dialogue with their communities, to understand the potential obstacles to hospital access and to put contingency plans into place. Providers should also get involved in the conversations to re-evaluate benchmarks: when New York gets hit by two 100-year storms in a two-year period, it's time to start challenging the 100-year data. Though many models now predict what's going to happen, civic and healthcare leaders must exhibit intelligence and leadership in order to motivate change. For all the talk about threats and risk, let's not lose sight of the unique opportunities that each region can provide for emergency operations. Some cities are fortunate enough to sit above underground aquifers that can provide a built-in emergency source of fresh water. Some can employ geothermal wells for off-the-grid building climate control. Others have abundant sunlight that can help power critical photovoltaic backup systems. The key is to strategically balance risk and opportunity into a resilient facility that can "defend in place" under the most extreme circumstances. A partner in NBBJ's Columbus, Ohio office, Doug Parris, AIA, drives innovation in design and construction methodologies for the firm's healthcare and higher education clients. Southeast Louisiana Veterans Health Care System Replacement Medical Center. The "upside-down" medical center places all critical infrastructure on the fourth floor, high above the floodline. 36 Medical Construction & Design | January/February 2013 www.mcdmag.com HARBOR: FRANK OOMS; ENTRY: NBBJ Unfortunately, a hospital's ability to care for the public during an extreme event may hinge on circumstances beyond its control. For example, upon what city infrastructure is the facility dependent, and how are those support systems set up? Of course, backup generators are standard practice for keeping hospitals operational when the power grid fails. Fresh water and sewer services are also critical: the SLVHCS facility's "defend in place" capability allows it to process its sewer needs onsite for fi ve to seven days. In cities with centralized steam lines, such as Seattle, hospitals must also make alternate provisions for emergency heating. Another essential consideration is access for patients, staff and emergency personnel. Charleston has above-ground power lines, which pose the hazard of live wires falling and blocking streets to MUSC in a storm. Seattle is working to tear