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Project ER ONE Medical Facility Design for Today’s Threats

Project ER ONE Medical Facility Design for Today’s Threats. Michael P. Pietrzak, MD, FACEP. Hospital Design Objectives. Competing Priorities?. 1. Function Clinical, administrative, operational Support Medical Consequence Management 2. Esthetic Healing environment Image 3. Protection

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Project ER ONE Medical Facility Design for Today’s Threats

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  1. Project ER ONEMedical Facility Design for Today’s Threats Michael P. Pietrzak, MD, FACEP

  2. Hospital Design Objectives Competing Priorities? • 1. Function • Clinical, administrative, operational Support • Medical Consequence Management • 2. Esthetic • Healing environment • Image • 3. Protection • From Elements • Security

  3. New Environment • New threats • New public expectations • Protect • Preparedness: respond and manage • Implication-- scalability • Approach to design • Multi-objective optimization • Approach not new-- just more objectives

  4. New Objectives • Medical Consequence Management • Capability to handle the existing and emerging threats • Scalability • Ability to gracefully scale response in time of surge • Threat Mitigation • To minimize the consequences to the facility, assets and individuals within

  5. ER One Premise • Hospitals are a key part of domestic preparedness response effort • Hospitals should provide protection and capability • If this were so, the “system” would be stronger • What is the best way to do this? • Integral to planning or after design?

  6. ER One Premise • MCM, threat mitigation and scalability features could be “designed-in” • Operational requirements and facility mission-- still the primary drivers • Financial, site, zoning realities • What can be achieved within the given template and constraints?

  7. History: Hospitals • Teutonic Knights- Threat Mitigation • Crusaders and Hospitallers

  8. Hospitals:History • Knights of Malta-1160 • Renaissance • Hotel like St. John’s Hotel Dieu

  9. Hospitals: History • 50s and 60s • Efficiency in terms of walking distances (Yale study) • Windowless rooms to ensure ‘seal’ • 70s • Patient comforts begin to enter equation • 80s • Facilities to attract patients Dartmouth shopping mall • 90s • Cost constraints • 2000s ???? Carolinas

  10. Early ER OneDesign Concepts • Traffic Management Strategies • Scalability Features • Immune Building Concept • Blast Mitigation • Advanced Security Technologies • Intrusion Detection Systems • Flexible Treatment Area Configurations Da Vinci

  11. Traffic Management • Operational vs. Security Requirements • Operational Access Paramount • Ease and abundance • Airport concept • Access Control • Barrier systems • Landscape obstacles • Lock-down capabilities • Multiple-portals

  12. Traffic Access Management

  13. Separated Traffic Flows

  14. Robust Scale-ability ER One Washington Hospital Center

  15. Point of Service Capabilities ER One Washington Hospital Center

  16. Specialized Mobile Units ER One Washington Hospital Center

  17. Threat Mitigation Da Vinci wrote to Duke Ludovico Sforza in 1483 as an engineer-- To make bridges 'indestructible by fire and battle’ Build 'chariots, safe and unassailable’ To this he added at the end that he was also an architect, a sculptor and a painter. Ravelin

  18. Facility Operational Needs Assessment Threat Assessment Vulnerability Analysis Define Constraints Define Critical Axis Establish Desired Threat Mitigation Features and Priorities Select Solutions: Multi-objective Optimization Achieving Threat Mitigation A Process

  19. Prioritization • What is most vulnerable? • High access areas • External perimeter • What needs to be protected most? • Critical axis • ED, ICU, Surgery, Critical lab, Imaging, Command and Control, Environmental support systems, Connectivity • High human density areas

  20. Portal Concept • Portals: Imply function/purpose and control Citadel of Turin

  21. Entry Portals: Not a New Concept St. Bartholemew’s Hospital

  22. Traffic Portals Features - Under vehicle surveillance - Detector systems - Active Barriers - Identification - Impedance - Imaging

  23. Traffic Portals Features - Under vehicle surveillance - Detector systems - Active Barriers - Identification - Impedance - Imaging

  24. Security Technologies: Portals • Features: • Access Control • Detectors • Chemical, Explosive, Biological • Bio-metric Identification • Tagging for ID and Tracking • Decontamination

  25. Biometric Identification • Must be Rapid, Accurate and Non-intrusive • Options • Finger Print, DNA • Facial Scan, Retinal Scan • Iris Scan • Design Implications

  26. Intrusion Detection Systems • Individuals, Objects or Substances • Sensors Connected to Alarm Monitoring • Balanced magnetic door switches/contacts • Passive infrared/microwave sensors • Smoke, fire, glass break • Perimeter sensors

  27. Immune Facility Features

  28. Surface Technology • Decontaminate-able Surfaces • Smooth • Seamless, corner modifications • Outlet issues- blister controls • Friction coefficient • Immune/Self Decontaminating Surfaces • Antibiotic impregnated • Photocatalytic • N-halamines (bind chlorine) • Rechargeable • Silver ion in metallic surfaces

  29. Advanced Ventilation Systems

  30. System stack Waste Conveyor Thermal Oxidizer Waste Material Thermal Converter Shredder/ Pelletizer Char Waste Heat Boiler Steam Turbine Generator Bio Waste = Energy Thermal Oxidizer operates between 1600 & 2600°F Thermal Converter operates between 1200 & 1800°F Waste-heat Boiler pressure = 250 psi Multi-stage steam turbine generator

  31. Decomposes oxygen free, converts to gas and carbon char Thermal destruction with direct flame and high oxygen High air flow (high Nox) Low air flow (low Nox) No toxic emissions (no Furans or Dioxins) Generates Furans and Dioxins 90-95% reduction in volume and weight Maximum 80% reduction Uses energy Creates energy up to 10BTU Secondary control device rarely required (Scrubber or Dust Collector) Secondary control device always required Pyrolytic Gassification

  32. Associated Benefits • Easier to clean • Decrease in hospital acquired infections • 88,000 deaths per year due to nosocomial infections • Decreased allergen exposure • Bio waste elimination with energy production • Applicability to other construction

  33. Blast Mitigation • Fundamental Blast Damage Mechanisms • Pressure wave • Projectiles • Mitigation Strategies • Standoff • Withstand - hardening • Release - opening • Absorption - softening

  34. Blast Mitigation Options • Wall Technology • Reinforcement: internal in wall or external • Energy absorbing materials: blast side • Surfacing materials: protectee side • Kevlar, Paxcon (polymer) • Serial Wall Strategy

  35. Blast Mitigation Options • Glass • Glazing: PVBs reduce sharding • Polyesters • Engineered stress profile (ESP) glass • Pentagon • positive results Ballistic result

  36. Pressure Engineering • Overpressure Release • Deformable composite blast panels • Openings, vents • Expansion • Tent? • Blast Doors

  37. Blast Mitigation

  38. Foxbat Concept Mig-25 F-15

  39. Architecture as a Therapeutic Agent What defines a healing environment?Conflicts with threat mitigation?

  40. Healing Environment vs Mitigation

  41. Resolving Threat Mitigation and Healing Environment

  42. Resolving Threat Mitigation and the Healing Environment

  43. Impact on Construction Industry • New Construction • Retrofit • Application of New Technologies • More Interdisciplinary Interaction • Solutions from other disciplines • Expansive market

  44. Summary and Conclusions • New Threat Environment • New Paradigms in Hospital Design and Construction • Design to Protect and Provide Healing Environment • Build to Allow Future Choices of Technology • Impact on Construction Industry

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