A pandemic is the personification of a situation that is out of control, and it’s easy to feel anxious or helpless. Information is the antidote. Correction: Good information. Accurate information.
Today we have a Guest Post from Suzanne, our resident Architect Extraordinaire. She specializes in buildings related to healthcare, and she is here to tell us everything she knows about hospital design to share a bit of her practical knowledge and expertise in this area, and to answer our questions.
With that, I give you Suzanne!
Good afternoon, everyone. With all that is going on in the world, there have been a lot of questions about the built environment of healthcare facilities, and I thought it might be helpful if I gave a high-level primer on the issue.
For those of you who don’t know, I am a licensed architect and planner practicing in the healthcare market. I have been practicing for ten years and have been licensed for six years. I don’t want to talk about my company, clients, or projects specifically, but I am happy to share what I know here based on my professional experience. I hope it answers many of the questions you have. The two questions that I’ve heard the most are Why don’t we have more intensive care beds available? and Why don’t we just take some other building and turn it into a hospital? Bear with me here… there are reasons.
First off, there’s a few things to understand about buildings in general. There’s an array of codes and regulations that govern the built environment. These vary by municipality, county, and/or state, and there are also federal laws such as the ADA (Americans with Disabilities Act) and CMS (Center for Medicare and Medicaid Services) regulations that apply to buildings. However, most building codes in the US and Canada are based on the International Code (I-Code) series. For example, California has the California Building Code (CBC), but it’s really the International Building Code with some elements added and changed to apply to conditions specific in that state. The Building Code is where you find most of the governance for architectural and structural elements, most notably types of construction, allowable occupancy, means of emergency egress (this means how to exit the building), and so on. There are also codes and regulations around building systems, such as mechanical systems (HVAC), electrical systems, energy performance, plumbing, civil engineering, and more. Then there’s zoning regulations, which is another enormous—and boring–topic for another day.
I am not a code expert, and there’s no need to get into the particulars, but the essential thing to remember here is that the codes are written around a concept that the larger a building may be (either in height or area), and the more difficult it is to exit, and the more important it is to the functioning of society… that building is designed to be more robust. Buildings that are small, easily replaced, and don’t have a lot of occupants—such as houses and small multi-family residential buildings—are not really designed to survive events like fires. In contrast, a building like a 70-story high-rise office tower or an international airport terminal needs to remain structurally sound for a relatively long period in order to get everyone out safely in the event of an emergency. Hospitals tend to be large buildings, with a lot of risks present (like bulk oxygen). Also, they contain a lot of people, many of whom cannot evacuate under their own power, because they’re in wheelchairs, or have broken bones, or are under anesthesia, or are in the throes of dementia, etc. And in the event of an emergency such as a natural disaster, it is critical to the entire city/town around the facility that it remains operational. So the architecture and structural design of these buildings is significantly different than, say, a low-rise apartment building or strip retail center. I hope this sheds light on a lot of the questions people have about why one type of building is not easily repurposed into another.
Secondly, and specific to hospitals, there are also spatial and operational codes and standards that are meant to protect public health, safety, and welfare. These vary somewhat by state, but are all mostly written to address the same concerns. There are a few big issues present in hospitals that have led to significant regulation. First and foremost is the exceedingly high rate of hospital-acquired infections. This has led to big changes in the way hospitals are designed. Again, keeping this high-level… we now have to have more and separate spaces for patients. Other than in a few very specific situations, we don’t do shared hospital inpatient rooms anymore, and we almost never do open wards. We build more bathrooms. We build negative-pressure rooms for airborne infection isolation. We have more spatial clearance around operating tables. We install handwashing sinks all over the place. We use interior materials that are resistant to bacteria and viruses. Another significant issue has been accessibility for the disabled and patients of size. Essentially, people are bigger than they used to be, and modern hospitals are designed to accommodate those patients. A third issue of significance has been trying to reduce injuries and distances traveled by nursing staff by improving visibility and designing their space to their workflow. There are also issues around reducing medication errors, increasing security (think drugs and guns), protecting patient privacy, and more.
All of this is to explain why hospitals are such specialized environments, and as such, why they are so expensive and time-intensive and complicated to build.
In understanding why hospitals are built the way that they are, it’s also important to consider the economic environment. Healthcare buildings are incredibly expensive, because healthcare is incredibly expensive. Most hospitals are owned by corporations (either non-profit or for-profit), not the public, and it is a struggle to remain financially solvent. Certain service lines in hospitals are more profitable than others, and the business case for a hospital is written around that reality. A couple of generations ago, hospitals were fairly low-tech places, and you could check yourself in for a few days if you felt a little bit under the weather. That is obviously no longer the case. Patients have to meet criteria for admission, and length-of-stay is watched closely by insurance companies. Medicare is very strict about reimbursement. Ergo, health systems generally want to offer certain kinds of care and sometimes want to avoid others. Surgery tends to be very profitable. Behavioral health, especially prior to the passage of Obamacare, is not. The typical acute-care hospital room is relatively cheap to build and operate. Intensive care is not. The dream for a hospital system is to give you an expensive surgery after taking some expensive images and then send you home to be cared for by a home health worker, or your own family.
So, when wondering why the country is now facing a dramatic shortage of intensive care beds, the answer is: because they’re really expensive to build, they’re expensive to staff, and if we built enough to handle a crisis like COVID, they would mostly sit empty once the crisis is over. When building a hospital, every dollar has to support a business case. Beds have to be occupied a certain percentage of the time in order to justify their expense. Every square foot that I design has to return value, as it is an investment of capital. The shortage that we are facing is the result of thinking of hospitals as businesses that need to be self-supporting rather than investments in the health of a whole population.
I don’t want to make health systems sound greedy or nefarious. Most of the people I interact with are devoted to good patient care. Often, the C-suite people have clinical or research experience and truly want to do the right thing with the resources they have. The developers and project managers, for the most part, take the responsibility of building a place where lives are saved incredibly seriously. But the reality that they live in produces the results that we have.
With respect to COVID, it’s not going to be easy to ramp up intensive care capacity in time to meet this challenge. What is likely more feasible is going to be identifying infected people earlier in their disease process and hopefully giving them treatment to manage their symptoms before they need that ventilator. In the meantime, hospitals are going to end up using every available space they have for patients, such as pre-operative and post-anesthesia care areas (or maybe even labor and delivery areas, oh my God), in order to accommodate as many patients as they can. I believe that they’ll also try to use temporary facilities for less-sick people in order to reserve the hospital resources (medical gases, equipment, emergency power) for the sickest people.
If health systems can get their hands on more ventilators, I can imagine some field-hospital-esque scenario if it gets to a last resort. But a big open ward in, say, a high school gymnasium is really not a good environment for people who are infectious, and it certainly isn’t going to be good enough for the next pandemic. But there’s not any great options here. Workers who can build big, complicated buildings like a hospital are a limited resource. The supply chain for building materials is long. These buildings are expensive and take a long time to construct, and health systems don’t really build for these types of surges. There’s not enough healthcare staff out there, anyway. COVID is a 100-year event, and there are very few times we do anything in society for 100-year events. Flattening that curve and finding some effective treatment or a vaccine is what we need to do.
I’ll hang around for a bit to answer questions in the comments. I hope this has been informative and un-boring. Cheers.
~Suzanne
WaterGirl
Mic check for Suzanne…
Suzanne
@WaterGirl: Right here.
WaterGirl
@Suzanne: Excellent! Thanks for confirming.
WereBear
Thanks. I’m actually pleased so much thought goes into this.
Mnemosyne
So here’s an ignorant question: given that hospitals now need to be built with more separate spaces to avoid hospital-acquired infections, is there a way to design the rooms to be more modular so they can be quickly converted to isolation or ventilator rooms when there’s a surge and then converted back when the emergency is over? I’m assuming it couldn’t be done until, like, 5 or 10 years from now at least, but most infectious disease experts say this is just the leading edge of this type of epidemic. Thanks for all of the helpful information!
danielx
Specific question: do I recall correctly there is a type of concrete that is preferred because it rejects/repels bacteria, viruses, etc?
CaseyL
Thanks, Suzanne! I’ve worked at Medical Centers and see some of that expensive infrastructure up close.
Here’s another wrinkle: Some medical centers are old, or parts of them are. UW Medical Center is cutting edge from one end to the other in terms of the work and research done there – but the original buildings were constructed back when asbestos was routinely used to fireproof things, and formaldehyde was routinely used to treat wood. And sometimes large parts of the hospital – like, say its HVAC ventilation systems – are very old, too old, and start growing horrible things like, say Legionaires Disease.
Any medical center that has been around a while has had to undergo extensive remediation (tear stuff out and replace with new stuff) to get rid of things that weren’t considered health and safety risks way back when, or become health and safety risks due to age and disrepair. Remediating a hospital is a lot more complex than remodeling a house.
So it’s not only wildly expensive to build a hospital, it’s pretty damned expensive to maintain one.
Kent
It seems perfectly obvious why hospitals themselves are incredibly expensive to build. Watching one go up near my house it was obvious the amount of systems and detail was far beyond even the typical concrete and steel high-rise office.
What mystifies me is the temporary hospitals that seem to be going up. For example, they are building a tent hospital in Seattle on a soccer field: https://www.kiro7.com/news/local/temporary-field-hospital-being-built-shoreline-soccer-field/VC76H2XIWVCTNMRCUFIEWNTPRA/
How does this make any sense at all when every single school and university building in the city of Seattle is currently sitting empty? A temporary tent hospital on a soccer field is not going to have: indoor plumbing, robust electrical power, robust internet, kitchens, bathrooms, etc. What are they going to do? Put a bank of porta potties along the outside? Where is the running hot and cold water coming from? Presumably they can tie into the local electrical grid or else they will have a row of portable construction generators going 24/7 spewing diesel fumes, to keep power going.
By contrast, any modern elementary school built in the past 20 years or so is going to be ADA compliant, will have wide hallways, extensive power and internet in every room, bathrooms all over the place, commercial kitchens, plenty of parking. Clear out a dozen classrooms and you have an instant convalescent ward. College dorms might be even better, especially those with private shower and bathrooms.
I understand the expense and complexity of building new permanent hospitals. I don’t understand the logic of temporary tent hospitals when entire cities are shut down and there are thousands of existing public buildings sitting empty.
Baud
I want solutions, dammit!
Thanks, Suzanne.
raven
There is a lot of talk about the University of Georgia dorms being used as emergency hospital space.
Leto
Suzanne: how did you come to specialize in hospital/medical related architecture? Always wonder how architects slot into their chosen field.
Gin & Tonic
I thought I might have a question, but this is a really good post and I can’t think of one right now. My dear wife has worked in hospital settings for most of her 40+ year professional career, and the changes in policies and procedures, as well as patient expectations, over that timespan – many of which you touch on from the infrastructure point of view – are really remarkable,
And yes, I was recently in the “expensive images followed by expensive surgery” market, and they actually wanted me to go home in the evening after an early-morning operation. I said NFW and at least stayed the night. A couple of decades ago I probably would have been there three days or so.
Thanks, Suzanne.
FelonyGovt
Thanks, Suzanne, really informative. Our two local hospitals have put up these temporary tent-like things (the kind you would have for a fancy outdoor event) in their parking lots, supposedly to handle the anticipated deluge. Doesn’t sound, though, like those would be suitable for intensive care patients, would they?
Suzanne
@Mnemosyne: There was a trend for hospitals for a while to design rooms to be “acuity-adaptable”, meaning that the room was designed to whatever the most stringent regulations were (usually ICU), and then you could put patients of any acuity in that room, and keep the patient in the same room rather than transfer them around. We don’t do it very much because it’s hard to staff…. the nurse-to-patient ratio is lower in ICU than in typical acute care. Also, it’s expensive. You build a lot of infrastructure that you end up not using too much. But it’s still done sometimes.
As for a building that actually has movable parts and pieces…. not so often. For fire code reasons, usually. Also more expensive. Corporate interiors does a lot of movable partition walls, but that’s hard for most hospital systems to store, maintain, replace, etc.
Sab
Thank you for this. Have family and inlaws in construction and in medicine, but not much overlap in my particular family.
Shortage isn’t just medical practitioners to staff the new hospitals. It’s also the builders. We have spent a generation squeezing skilled construction workers, so the kids just decided that the field is too risky, so they did other things.
Suzanne
@danielx: I’ve seen an admixture for concrete that says it’s antibacterial, but we have to put floor finish down, anyway.
mali muso
Thanks for doing this! Very interesting info. On the topic of every space in the building needing to turn a profit, is this the reason that hospitals like one of the more rural ones near me just shut down their L&D unit? Not enough babies being born and/or not enough money in it? Seems like a sad commentary on our system of care. :(
Suzanne
@Kent: Schools are probably pretty good candidates for temporary hospital use, as a typology. But there could be a thousand and one reasons why they aren’t used. Maybe something as prosaic as ambulance access or proximity to a highway.
Suzanne
@FelonyGovt: Those tents that I see images of are not likely to be ICU. Most don’t have medical gas or emergency power. But they could be for lower-acuity patients in a surge situation.
We are in any-port-in-a-storm territory here, yeah.
Roger Moore
@Mnemosyne:
My impression from what I’ve seen with my employer is that designing the rooms to be usable for anything just drives up the price so they’re all maximally expensive.
Suzanne
@mali muso: Yes, many rural hospitals across the country are closing due to financial pressures, and often staff shortages. If a hospital is expected to be financially self-supporting, it’s an entirely predictable outcome.
Ohio Mom
When Ohio Dad has his heart valve replaced two years ago, and I saw that he had a private room, unlike the shared room I had to put up with when I delivered Ohio Son twenty (!, the time flies) years ago, I thought it was some sort of amenities race.
That just like colleges are building things like rec centers with lazy rivers to attract students, I thought the hospital was trying to woo patients with well-appointed, private rooms.
But now I understand that the splendid privacy Ohio Dad enjoyed was for infection control. So I learned something,thanks Suzanne.
i will add that the hospitals here (and I assume everywhere) never seem up stop building.
They are always adding on to older buildings, making the most maze-like floor plans, where the only way to get to your destination wing involves things like taking one elevator to one floor, walking across one wing to take the elevator to another floor, to walk across a bridge, etc.
Suzanne
@Leto: Before I was licensed, I interned at a firm in their healthcare studio. They had an opening, I needed a job. I fell in love with it. The architects that like healthcare tend to be the ones who see rules and regulations as FUN CHALLENGES rather than CREATIVITY LIMITERS.
Kent
That’s why I would specify modern schools, built in the past 20 years or so. As a teacher I’ve seen extraordinary differences between old and new schools when it comes to that sort of thing. Modern schools are built with ramps, elevators, etc. for ADA accessibility and usually have wide drives for fire trucks and such because of modern codes. Old schools in old neighborhoods are an entirely different prospect. Even something as simple as power. Schools built in the past 10 years probably have 10x the number of electrical outlets than one built 75 years ago.
Due to mainstreaming of Special Ed students on wheelchairs and such, modern schools are usually built so that school vans and buses are easily accessible for disabled students. I would think that would work for ambulances as well. That wasn’t the case with old historic schools with big grand front step entries and such.
Mnemosyne
Interesting and on-topic — apparently NYC is preparing their convention center as a makeshift hospital:
https://mobile.twitter.com/NYGovCuomo/status/1242181379015794689
Roger Moore
@Kent:
I don’t know if it applies in the case you’re describing, but one of the things they’re using tent facilities for is triage. Patients coming in are put in the tent area while they undergo initial tests to decide if they’re COVID-19 patients or something else. So it’s really a short-term holding facility, and it makes more sense to put it as close as possible to the hospital it’s serving than it does to make it maximally functional as a hospital.
Sab
All purpose blog here.
Thanks, Suzanne.
Suzanne
@Ohio Mom: Hospitals are often really old and gnarly buildings. They get added on to, piece by piece. What happens at some point is that it is not financially or temporally feasible to renovate the old stuff. I worked in multiple hospitals with tiny column grids, and low floor-to-floor heights, and it is next to impossible to make modern healthcare happen in buildings like that. So they get demolished and replaced in pieces.
Brachiator
@Suzanne:
Great post. Much appreciated.
I had to have a hospital procedure done a few years ago, and it struck me that the hospital had to serve at least three functions well.
It had to accommodate medical treatment
It had to accommodate nursing and some rehabilitation. And here nursing is not just providing care, but monitoring the condition of the patient
It had to function like a hotel, with various forms of room service. Even the timing of some medications sometimes had to accommodate meals.
I was also struck by how the space had to accommodate a patient being moved around on a gurney (or whatever they call it), including allowing for space on elevators.
There were some floors where it seemed cramped and even medical personnel had difficulty navigating between and around patients
Anyway, a few thoughts from when I was a patient looking up from a hospital bed
West of the Rockies
Very informative post, Suzanne! Thank you. So, why don’t we just, like, turn a mall into a hospital?//
The Dangerman
Interesting read, thanks.
This may be a dumb question but just up from a nap; in my first life, things like natural frequency were important, so we get to see the Tacoma Narrows Bridge thing in freshman physics. Later, as things get a little more advanced, things like fatigue failure (not why I take a nap, but close) and Liberty ships are considered. Oopsie.
So, do hospital architects get a heavy dose of the hospital that failed during the Sylmar quake (1971)? I recall that quake vividly. I thought cats were fighting under the bed.
As I recall, it took them some time to take that hospital down; it must have been studied like crazy.
Kent
That’s what the military has learned with its all-in-one fighter jets.
NotMax
@raven
Yeah, the Corps of Engineers supposedly has announced plans based on designs just whipped up by FEMA (but not publicly released) to, for all intents and purposes, use dorms or hotels and seal each room with what amounts to a gigundo Baggie, with a single nurse assigned to the hallway of each floor. Drawbacks inherent with the plans, things like maintaining disinfection of surfaces and appurtenances (items as mundane as carpets and light fixtures, for example) not designed for such treatment – nor installed with such in mind – are multiplicitous and glaringly obvious to any but the most blinkered.
Baud
@Kent:
All in one stadiums were a bust too.
Gary Ratner
@raven: Far better bet to use Emory main campus dorms – some are very close to Emory U Hospital!
mvr
I don’t know if your expertise covers this, but I’ll ask. Suppose you were trying to ramp up something not necessarily permanent, and perhaps more specialized to deal with this particular outbreak. What would you suggest? Are there things that need to be in the rooms for this kind of outbreak that are essential? Are there other things we could do without? If things get bad enough I’m expecting municipalities will be happy to waive code requirements for short term purposes. Maybe I’m wrong
Suzanne
@Kent: Yes, modern schools are built to be ADA compliant. Fun fact: even though the ADA was passed in the early 90s, the ADAAG, which is the design guide for the ADA, was given a big overhaul in 2010.
Suzanne
@mvr: Most municipalities will work with a hospital owner to move things forward in a timely fashion in an emergency like this. Some of my clients are pulling permits for emergency temporary construction. Contractors are rerouting crews. We all know what kind of situation we’re facing.
Suzanne
@The Dangerman: In school, we look at lots of building failures. It’s upsetting.
raven
Ever see this picture of a Viet Cong hospital?
NotMax
@RogerMoore
Hospital here has a triage tent set up which all have to pass through before being approved to go to the ER.
raven
@Gary Ratner: It may be all hands on deck and we do have the Medical College of Georgia Campus here (about 2 blocks from where I sit.)
Goku (aka Amerikan Baka)
In my county, there used to be three hospitals. One closed over two years ago. The county has a population of over 200,000 people. I imagine closed hospitals would be easier to set up for COVID-19 patients. Of course the logistics of equipment and personnel would be a challenge
Roger Moore
@Suzanne:
I know that here in California the building codes were substantially revamped after the Northridge earthquake, to the point that a lot of older hospitals had to be replaced because it was impossible to bring them up to code. It gets back to what you were saying about hospitals needing to remain functional after a natural disaster. We had a disaster and realized a lot of our hospitals couldn’t be trusted to function through the next one, so they had to be replaced. It was really expensive, but at least we have new, high-tech hospitals for our trouble.
Suzanne
@mvr: One of my clients is building low-acuity fast-track space in a parking garage so they can keep COVID people in the hospital itself. I have not seen a temporary solution that I think it’s going to be good for patients who need intensive care. It is just not a thing that can be flexed up and down quickly. But here’s a thing to think about…. in every hospital, most of the people who come to the emergency department don’t need to be there. They go because it’s faster, or because urgent care won’t see them for financial reasons, or they can’t get a hold of a doctor otherwise. So there is much to be said for keeping those patients away from the hospital for a while.
WaterGirl
@NotMax: Always? Or just for the current situation?
Kent
That’s not what they are doing in the Shoreline area of Seattle in the article that I linked to. The location is a suburban soccer field complex that is probably at least 2 miles from the nearest hosptial. Here’s the map link: https://goo.gl/maps/3wKBosmQJ7FhGfb87
The article says:
raven
@Suzanne: Our regional hospital (Piedmont ate it) is having a big addition built right now. We live very close and I wanted to ask, do they have some building techniques that keep noise to a minimum?
Suzanne
@Roger Moore: Yes. Hospitals are classified as Seismic Importance Factor 2.
NotMax
@WaterGirl
New procedure in the current situation, put up earlier this month.
Eric S.
An excellent post, Suzanne. Thank you.
Suzanne
@Kent: That sounds like a low-acuity environment. In China, if people were infected but not too sick, they were forced to go to one of the temporary hospitals that they built. That patient would typically be sent home here in the US. That sounds like a person who needs maybe IV fluids or oxygen via a cannula (sp?), but not intensive care.
Suzanne
@raven: Building techniques for minimizing noise….. hmmm. That’s more of a general contractor question. We are doing a lot more prefabrication these days, which makes construction faster and probably quieter. But I don’t know any way to make, say, drilling caissons any quieter.
Wapiti
Thanks, Suzanne. Just this last week both of my in-laws were in the hospital and my wife asked if they could share a room – the nursing staff just said “we don’t do that anymore”. We thought it was just a Covid-19 precaution, but now we know the rest of the story.
Baud
@Suzanne:
What’s a factor 1 building?
Suzanne
@Goku (aka Amerikan Baka): That’s a possibility. Buildings that sit unused for too long often have their systems degrade, though.
Suzanne
@Baud: Like a nuclear power plant.
raven
@Suzanne: That makes sense. They have been working on it for a couple of years and, while there is congestion, it just hasn’t seemed very noisy (except for the new chopper pad) !The contractor is staging around the cornered and they have this big thing that looks like a model of a window mockup. I’ll have to take a picture of it and post it,
BruceFromOhio
Many, many thanks for this primer. It takes a very broad view of a very complex set of ideas, and makes it easy to understand why things are the way they are.
That’s the money shot right there, figuratively and literally. Put that quote in the liner notes.
Leto
@Suzanne: The hospital I stayed at for six weeks was similar to this. I got to know quite a bit of it because I was wheeled to one part for MRIs, another for X-Rays, was quartered in different parts… you could tell where the expansions had taken place.
Thanks for the post. High informative and much appreciated.
Suzanne
@Wapiti: Any shared rooms that still exist are a holdover from a past time. We still do shared rooms in behavioral sometimes.
Another Scott
@Suzanne: Thanks very much for this – very interesting.
Is a hospital ending up on a “historic registry” ever an issue that you’ve come across in a remodel/upgrade? I would hope not, and I understand the need to preserve history, but working buildings do become obsolete and trying to upgrade them while preserving the footprint and the (ugly) facade introduces all kinds of compromises… :-(
Cheers,
Scott.
Suzanne
@Leto: MRIs require such specialized construction that it is often impossible to put them in older buildings.
For fun, look at videos of MRIs quenching on YouTube.
Redshift
@Suzanne:
Or because most of us have no idea how to decide which is appropriate. I tripped and fell a few years ago and thought I had dislocated my shoulder, so I went to urgent care. Turned out I had a broken collarbone and a separated shoulder, and they said I really should have gone to the ER. I don’t think I would have known that even if my diagnosis hasn’t been wrong, I just knew the ER always takes forever and I was hoping to avoid that.
Great post, thanks for informing us!
Suzanne
@Another Scott: Actually, yes. The facility used the historic part for offices after they couldn’t use it for patient care.
There are quite a few old “lunatic asylums” on the National Register.
raven
@Leto: When I broke my back in 1975 I spent 2 months in Grady Hospital, the big public hospital in Atlanta. The place was wild, after the surgery I was on a ward with 4 other people and they did some nasty procedures right there. The upside was that when I got better the orderlies would push me and another dudes beds by the windows and we’d fire up!
Elizabelle
Suzanne: thank you for sharing your expertise. You write so clearly and succinctly.
Really interesting topic. I hope you will do a few more as the virus plays out.
Suzanne
@raven: That’s cool. I love when we get to do mockups.
mvr
So that suggests making emergency rooms the temporary thing, or perhaps having an intake that is temporary with routing to the appropriate place afterwards. Am I following your suggestion?
Redshift
@Leto: Yeah, our major local hospital is like that. It can be a maze if you don’t know the right parking lot for where you need to go. There are hallways with a slight incline because the floor levels in different sections aren’t quite the same.
raven
@Suzanne: I couldn’t think of the correct term, thanks!
L85NJGT
HVAC and HEPA are pretty complicated – some areas need negative pressure, some positive, some are using recycled air, some require outside air. Smaller and resource squeezed facilities are more likely to be nearer to the carrying capacity of the equipment in any event, so throwing patients in every nook maybe not such a good idea.
Even if you can move beds around, they still need a bunch of power for ventilators and monitors, etc, etc. Plus a lack of drops for IT, and at that scale and criticalities, cowboying some more APs into an existing WIFI cloud is a no-go.
It takes time, exposes tradespeoples, and uh… are these areas going to be empty during the work??
Suzanne
@BruceFromOhio: Yeah, I don’t think people really grasp this. Building owners are used to thinking about their facilities as investments that must provide a return. So when someone asks me, “Why don’t they do [insert really awesome design feature here]?”, the answer is most assuredly, “Because really awesome design features cost money to build and maintain”. In certain markets, like high-end hospitality, you get to do more of that stuff, but that’s because those developers are using their facilities as competitive advantages.
raven
@Suzanne: Is that why there are the endless awards they give each other?
Roger Moore
@Suzanne:
Not too surprising. I’m thinking about the hospital where I was born. When I was still in school, it was replaced by a nice, new hospital on the other side of town and was repurposed into the school administration building. When they built a new school administration building, it was renovated into senior apartments. I guess the senior apartments might have benefited from some of the old hospital features.
Suzanne
@mvr: Emergency Department bays have at least one oxygen supply and some emergency power. In an absolute crisis, you could use that for someone who is critical. The space that it seems like Kent’s link is describing could be for COVID people who are less sick so the really sick people can stay in the ED.
ET
@Kent: I wonder if it has to do with what might be hidden in carpet fibers, air ducts, etc when all the patients leave and they have to get ready for student again. Post Katrina they permantly close Charity Hospital because of all the germs, mold, etc that had built up… There was no way to environmentally remidate it.
Suzanne
@L85NJGT: One of the hospitals in my city is literally maxed out on power. There is no more power available at the street for expansion. There are soooo many factors as to why things are the way they are.
skerry
Maryland Gov Hogan plans to use the Baltimore Convention Center and the nearby Hilton Hotel as temporary field hospitals.
L85NJGT
@Roger Moore:
You see this in old timey downtown skyscrapers. The floor plates can’t fit cube farms, so they sit empty, or maybe get converted into tres chic hotels or condos.
raven
never mind
Roger Moore
@Suzanne:
It’s interesting to see what you can learn about the economics of a business by looking at their architecture. The example I like to use is from museums. If you look at most contemporary museums, you’ll see they have huge, mostly empty lobby areas that seem like a huge waste of space. Those big, empty lobby areas are there as party spaces, since most of their money comes from hosting parties- either for patrons or anyone who wants an interesting venue- not from the regular visitors.
raven
@L85NJGT: Ah, floor plans. . . took me a minute.
Miss Bianca
Well I, for one, feel very informed and equally un-bored, so brava, Suzanne!
mvr
@Suzanne:
What constitutes emergency power? Does an extension from the main hospital’s panel, with perhaps generator backup count?
raven
@Miss Bianca: Indeed.
Suzanne
@mvr: Generator backup.
NotMax
@Suzanne
And then there’s old facilities such as All Souls.
:)
Suzanne
@Roger Moore: Museums are also status symbols. The donors have expectations for their money. That’s why there’s been so much starchitecture in that market.
Brachiator
@Suzanne:
As another poster noted, most people can’t self-triage. They don’t know whether an ailment or injury should be taken to an ER rather than urgent care.
Also, there seems to be a certain number of people who go to an ER because they think that they will be seen by the best doctors and have the latest equipment available to them.
mvr
@Suzanne:
So that makes it sound like a temporary space would work with the right backup wired in.
Goku (aka Amerikan Baka)
@Suzanne:
Speaking of which, typically, how many days of power do hospital generators have, such as big city hospitals? I assume they are diesel powered and so it would depend on a lot of factors.
CaseyL
@Suzanne: Whoa: those are some crazy videos. I had no idea it was downright dangerous to decommission an MRI scanner.
Suzanne
@mvr: If you can get a big enough generator and the belly tank, and meet all the fire code separations in case of a fire at the fuel tank….. I think you see my point. Emergency power is a difficult thing.
Look, anything is possible with money. But a huge part of my job is helping owners decide how to spend their limited funds. I spend a lot less time drawing than you think. Very rarely would an owner just make a decision like that without understanding all of the financial ramifications. That’s how projects go over budget.
Alex
@Suzanne: do you know anything about certificate of need requirements? Do they help control prices? Would we have more icu capacity without them?
Sab
@Suzanne: My stepson went to detox three times at our repurposed historic tb sanitarium.
They ran an excellent detox rehab outfit. Very high success rate. I was crushed when they closed it. Our kid is thriving thanks to them.
But hot shot on the board is owner of a big construction firm that does lots of medical construction. I guess he looked at the old repurposed sanitarium and was appalled. So he shut it down.
I hadn’t looked at it in light of the construction. And that is probably all he saw. All I saw was excellent program gone. All he saw was horrifyingly unhealthy building gone. I will revise my opinion on the whole matter. As always there were two correct diametricslly opposed points of view
My stepsons great-grandfather and grandmother got tb treatment there. old old builing.
Suzanne
@Goku (aka Amerikan Baka): It varies, but probably three days at most. If a hospital loses power for too long (and I mean more than a few hours at most), patients have to be evacuated. And evacuating a hospital is dangerous and it is entirely possible that patients will not survive it.
Goku (aka Amerikan Baka)
@Suzanne:
That’s true. Hopefully two years, in my area’s case, isn’t a very long time for that to happen
Leto
@Redshift: The hospital I stayed at was def a maze. Though by the end I could navigate it via ceiling… :P
@raven: you always have the craziest stories about the 40s :P
The second room I was put in, after the ICU, had this funky L shaped design. On the end of the L was where the window was, so I couldn’t really see out of it. I wasn’t missing much as it was facing another building, but being able to see the change from day/night/day was appreciated. I don’t think I ever mentioned this but after they brought me back up from the coma, I didn’t sleep for almost 3 weeks. That was… an experience I hope to never repeat.
NotMax
@Suzanne
Need extra space for all those plaques, too.
“This doorknob dedicated by the Murhortz-Glotelkorn family.”
;)
Suzanne
@Alex: That is a question that is above my pay grade. I do know about Certificate of Need requirements, but as for understanding if we would have more or fewer beds without them…. I would defer to an economist on that. My feeling is probably not, but I don’t know.
Buckeye
I’m not sure that’s allowable here in Ohio due to regulations. A few years ago, at the hospital I was working at, we were at capacity in every area, except Mom/Baby and L/D. The nurse manager of the med-surg units below the Mom/Baby floor wanted to move some patients to M/B and was told ‘you can’t do that, we could be shut down’
That hospital I was working at was closed two years ago, for a variety of reasons, but primarily as an older hospital it was becoming difficult financially to continually renovate and maintain.
Gin & Tonic
@Suzanne: I overnighted post-surgery in a shared room in the state’s leading hospital just three years ago (three years ago tonight, as a matter of fact.) It was just me there when I came in, but they brought some other guy in in the middle of the night.
Suzanne
@Sab: I did some projects in a facility that was an old TB sanatorium, though not in that area. The 1960s-era buildings on that campus were absolutely dreadful, so I’m sure the earlier buildings were…. not good.
We generally design buildings on a 30-year cycle.
dmsilev
@CaseyL: There’s a lot of energy stored inside one of those big magnets. Released slowly, it’s fine. Released all at once, Problem.
J R in WV
Thanks Suzanne, excellent write up, great answers to hard questions.
Wife spent 2.5 months in local teaching hospital, parts brand new, parts older. Weeks in MICU on a vent, then acute care, collapsed lung, back to SICU, then in double rooms with cardiac patients because her immune system was impaired, nurses standing in her doorway to keep potentially infected patients out.
I learned a lot about hospitals, how to do first aid for a sucking chest wound, in case her chest tube(s) came out, etc. She doing well now, quarantined with me and the dogs and cats.
Best of luck moving east. I couldn’t do Phoenix AZ for very long. Take care, keep in touch!
J R
mvr
Yes, I get that part. I guess I’m thinking in terms of what do we do now when it isn’t normal times. That has both good and bad features. We need adaptations to our dire situation more. OTOH, some of the legal and bureaucratic things that stand in the way may be less immutable.
Auntie Anne
I just want to thank Suzanne. This has been a fascinating post – very informative and interesting.
coin operated
Just a ‘funny…weird’ thing to share. Went to nursing school at the old Brooke Army Medical Center in San Antonio. The cardiac operating theaters were in a converted calvary barracks. Getting patients in and out was a challenge, to say the least. Have no idea how we would have gotten everyone out if there was a fire…
Suzanne
@Buckeye: The regulations that are in place are not really adequate for the situation that we’re facing with COVID. Are hospitals supposed to use L&D spaces for infectious people? Oh hell no. Will it happen in at least a couple of hospitals? Count on it.
In these kinds of hundred-year events…. hospitals are gonna do what they can do and then pick up the pieces later.
Dorothy A. Winsor
Great information, Suzanne. Thanks.
Sab
@Suzanne: I vividly remember Piers Morgan trying to flay that NY hospital guy on TV after Hurricane Sandy.
Hospital guy was so proud of his nurses and doctors who got all the babies in icu out, many of them on ventilators, that the medical staff had to hand-pump while going down multiple staircases to the ambulances. Most of the babies survived.
And Piers Morgan was bitching about why weren’t there generators on the roof. And hospital guy was WTF we did the best we could in the building we were in.
I am still steaming about that. Piers Morgan lost his show for being a bit too obnoxious for late night America.
Miss Bianca
@Leto: What, you mean you *didn’t* sleep, or you literally, could not, fall asleep? Like, a medical thing, or a “holy shit, I can’t ever fall asleep again!” thing?
A coma – man. And you came out of it. I was only knocked out for under an hour, I guess, when I had my accident – I came to in the ambulance, that was freaky and a half – but a coma…
So glad you’re back. You and Avalune bring a real spark to the old joint.
raven
@Leto: Some stuff stays with you. I was in a single room while they waited for the swelling to go down so they could put the rods on my spine. I was on this striker frame with pivots at each end and, somehow in the middle of the night, it broke loose and I couldn’t reach the call button so I layed up against the straps for a couple of hours. The was another Nam vet and the ward and we watched the end of the war on tv in a demerol haze.
CaseyL
@dmsilev: I only saw one video where they just took the old MRI out to a field and let it blow up. The others had controlled decommissioning, which was still plenty dramatic when the helium vented out the rooftop exhaust.
Chris
I design the MEP (mechanical-hvac electrical plumbing) for lots of smaller facilities and the occasional ambulatory surgery bldg. I was amazed at the 1 week time of construction in China. I wonder what they built? I couldn’t get the hvac TESTED in my last ambsurg bldg in a week much less built.
Suzanne
@Leto: There is a staggering amount of research about the positive effects of daylight and views on patient outcomes in hospitals. It is now a CMS requirement for every inpatient room to have a window with a maximum sill height of 3’ so that patients can look out. In some older hospitals, they have to get waivers because they can’t achieve it. There’s a lot of old ICU rooms without windows.
raven
@Miss Bianca: It was an induced coma, no?
Gin & Tonic
@Goku (aka Amerikan Baka): Data centers (which I know a little about) require backup power, and a diesel generator will run as long as you keep supplying it with fuel. Only question is truck access to fill the tank, but otherwise they can run more or less indefinitely.
Suzanne
@Chris: They have next to no building code. I have a friend who is a building code consultant who has done work over there. He says that it is close to anarchy in that industry.
raven
@Suzanne: When I was in Grady there was a parking deck across from my ward (right in front of Fulton County Stadium) . My people brought my doggie Ralphie to the top deck so I could see him!
L85NJGT
@mvr:
In a perfect world?
2N – full redundancy. Connect to two separate power grids and IT networks.
Alex
@Brachiator: and some people need the best imaging and diagnostic resources even for something that would be minor in someone else— my dad has so many comorbidities that urgent care won’t even look at a rash for him. He goes straight to the ED at the local teaching hospital now after 3 times in a row being sent there whenever he went to urgent care.
OldDave
See: F-111. And then forget the lesson and do it again – see F-35.
Sab
@Buckeye: and Suzanne :
My 95 year old dad worked for years in a hospital that is now this weird maze of old and new interconnected parts that you have to leave breadcrumbs behind to find your way back to the entrance you came in. I used to be able to find my way around easily.
Now I understand.
Suzanne
@Sab: I get so pissed off when I see preening idiots like Piers Morgan saying dumb shit like that. Why aren’t there generators on the roof? Well, dude, are you paying for that? Oh wait…. NO.
Taking babies on ventilators down stairs…. JESUS. What a mindfuck.
Chris
@Suzanne: I was assuming that. I am guessing the actual building was a tent (or some kind of membrane structure)
Sab
@Suzanne: China has even it’s new bridges collapsing. Fast isn’t necessarily better.
Suzanne
@Sab: Fast is usually not good.
NotMax
@Suzanne
What experience I’ve had related to me by others involving Certificates of Need is that the need is shorthand for “politicians/board members X, Y and Z need new boats/cars/vacation condos; your contribution expected under the table.”
Martin
@The Dangerman: There’s a great podcast/Youtube series about engineering disasters. VERY snarky. Not for the easily offended.
They cover Grenfell Tower, Hyatt Regency, and Sampoong department store.
Leto
@Miss Bianca: I was in a medically induced coma for a week to let my body heal. When they brought me out of it, I just couldn’t sleep. Like I’d lay there, close my eyes, and nothing would happen. I’m not really sure why, have a few theories, but eventually my mom got them to bring a sleeper mattress into my room and she stayed with me. That seemed to work. Can’t tell you how good I felt after I’d had 5 hours of sleep!
@raven: that’s wild. The hospital I was in was also a teaching hospital so I was subjected to various students learning how to do different stuff. It helped that I was heavily medicated (lots of “happy” drugs) so I was fairly tolerant of most stuff. But there were a few things that no amount of medication was able to help.
Buckeye
@Suzanne:
It would mean getting exemptions from the State, which would mean things were getting very bad. I suspect they’d rather find other options for less acute patients. I’ll note that in our case we are a large hospital and with no elective surgery patients coming in now we have capacity to transfer people around if need be. We’ve tweaked one floor of our ‘new’ patient tower for C19 patients, which gives us about 60 beds on that floor. We’ve got C19 pts now, but not that many, yet.
Miss Bianca
@raven: Oh, right – I forgot. Those were some harrowing posts, I think I blanked out on some of the details.
Suzanne
@NotMax: I’ve heard that, too. But I also know that we do not have enough beds of certain types according to the needs projections because it isn’t profitable. And in some places, hospital systems can’t build more because then they have over 50% of the beds of a certain type in a geographic area, which isn’t allowed for antitrust reasons sometimes. It’s so complicated.
Martin
@Suzanne: It’s slowly getting better, but they have a lot of ground to cover. Friend of mine went over to Doha for a big civil engineering project. They were asking him to sign off on the plans for a tunnel that was already half completed. He noped the fuck out of there the next day.
Yutsano
@Miss Bianca: I remember when I was in hospital for three weeks, I woke up and started talking to my mom. I was casually chatting through my CPAP mask (I was constantly rejecting ventilators) and I mention it was unusual for her to be here on a Friday.
Mom looked at me. “It’s Saturday!”
We had an argument for the next few minutes until I was told I had slipped into a comatose state for the last 24 hours. It’s a VERY creepy feeling.
delk
I used to live near a hospital. It was the big landmark in my neighborhood. It was a constant reminder to me that no matter how shitty I felt, someone was looking out the window wishing they had my problems.
Sab
Suzanne,
Thank you so much for this post. We need to hear from people who know what they are talkimg about. We will be hearing a lot more nonsense as we are swept onto the oncoming maelstrom.
raven
@Leto: I lived in Urbana when this happened and I had never met anyone who thought pro wrestling was real. This brother on the ward loved and I couldn’t believe it! My other buddy had a badly fractured leg with a pin in it and it broke. They came right on the ward with a drill, shot him up and fired that baby up on his knee. The brother thought this was funny as shit and he also laughed like mad when they took the stitches off my hip. The skin had grown over it and it was a big owie! Well, this dude kept bitching about wanting to go home so they took him down and put him in a plaster cast from his neck to his toes with a bar holding his legs apart and an opening for his unit! He went nuts but they wheeled his ass out and sent him home to be flat on his back! Did we ever laugh at that!
Leto
@Suzanne: I’ll be honest when I say that I don’t exactly remember the right side of my ICU room… which sounds weird? I asked Avalune just now if it did and she remembers it having one. I think it did because I remember there being day light in there, but I honestly can’t tell you much about that side of the room. I’m glad they have rules about that now.
Suzanne
@Martin: I haven’t worked in that part of the world, but I have heard crazy stories from some of my colleagues who have. It makes me incredibly grateful for the regulatory state. I know rules are a PITA, but they are all there for a reason.
?BillinGlendaleCA
@Roger Moore: UCLA’s medical center was replaced after Northridge, and named after a b-grade movie actor.
L85NJGT
Generators aren’t going to carry anywhere near the full load. There are calculations on the equipment power draws and what the genset can provide and choices are made.
Yutsano
@Leto: You had me thinking about the last ICU unit I was just in last November. I don’t recall the room having a window. This is also in a 100+ year old Catholic hospital as well. It’s entirely possible I was way deep inside.
Suzanne
@L85NJGT: Yes. Generators are there to keep things going in limited capacity for a short period. They’re not a long-term thing.
Martin
@Suzanne: There’s different kinds of speed. Slowing down so the civil engineers can do their thing – good. Slowing down so the finance guys can do their thing – not good.
Rapid urbanization is frightening. The Burj Khalifa was built impressively quickly but isn’t hooked up to a waste system. They have to truck out the waste from the building. That’s bananas.
Leto
@Suzanne: I’ve read stories about the workers who were/are constructing all the World Cup stadiums in Qatar, as well as the associated infrastructure with that, and JFC is that some of the grimmest shit I’ve read concerning workers/worker’s rights.
@Yutsano: Deep enough to find the Arc of the Covenant? :P
Suzanne
@Martin: The exterior skin of the Burj Khalifa has also caught fire. Scary stuff.
rikyrah
Suzanne
@Leto: I heard that they lost more workers constructing the World Cup buildings in Qatar than were lost on 9/11 or something. Just staggering.
frosty
Thanks for this Suzanne! Very informative and great job on the answers.
WaterGirl
@Suzanne:
That is a terrifying statement, and I don’t even know what it means.
Martin
@Yutsano: We have a catholic hospital near us that would make Suzanne insane. It was like 2 or 3 different buildings that over a span of 50 years had continuous expansion until it congealed into a single building. It’s the most fucking byzantine structure I’ve ever been in. I generally have a very good sense of direction, but 10 seconds after entering that building I had no idea what direction my car was in. There was no logic to the layout. Hallways wound here and there. You went through a stretch that felt like the interior of a building, emerged into something that felt like a lobby only to realize that there were no windows – it was still the middle of the building – a different building, and you were going to snake through some others.
It was like a medieval walled town in hospital form.
NotMax
OT.
Changed channels and caught only the last couple of minutes of Maddow’s show. She looked as if she hasn’t slept for days.
/end OT
laura
Suzanne the plans to made put an end to us. Oh, I’ve seen Fire and I’ve seen Rain…
But seriously, others have said it better, but how fortunate for all of us that you’ve shared an expert perspective that is so illuminating – and the synchronicity of this full service blog. I’m humbled to have stumbled in on a friendly forum that is populated by really stellar individuals. So much deep knowledge and elan in equal measure. Its soothing in this time where so much of the news feels like covid19 porn that is overwhelming and underinforming.
Thank you Suzanne.
WaterGirl
@Leto: @Suzanne:
Dave Zirin wrote a lot about that – he could see that coming before the work ever started. Horrifying.
Martin
@Suzanne: Did it? I know a tower next to it caught fire in the same manner as Grenfell one new years eve. Same exterior metal cladding.
Martin
@NotMax: My daughter basically hasn’t. Her anxiety level is at 11 pretty much 24/7 now.
Sab
@rikyrah: On an architecture and engineering thread here we are. Facts with political implications aren’t facts unless we have the votes. Silly, because the facts will still be facts, even if we recognize them too late or never.
Trump thinks…never mind. That’s ridiculous speculation.
Goku (aka Amerikan Baka)
@Suzanne: @Gin & Tonic:
Thanks!
Ruckus
@Gin & Tonic:
A lot of procedures that at one time were very invasive can be done much less so these days. IOW the cure isn’t almost as toxic as the disease. This is a major change in the lifetime of many of us commenting here. For example, heart surgery. It’s routine these days, 60 yrs ago it really was crude if done at all. My grandfather and one of his daughters both died in their 40s from heart defects that are routinely fixed now. I was in my teens when my aunt died. And the list goes on. I’ve had an angiogram and I walked in and out the same day. Not even put under.
WaterGirl
Suzanne, thank you so much for doing this!
We’ve been lucky to have Suzanne here for over two hours, so she may have left for the evening, and if not, she may very well leave soon.
We’ll check the thread in the morning for any more questions.
Suzanne
@WaterGirl: Yeah, baby is being a little bit fussy, she has an ear infection. I’ll try to hop back on later.
QuestionMark
@Suzanne
This post is great! Super informative and sexy. Whatever lurker you’re married to is a lucky guy!
WaterGirl
@QuestionMark: I’m guessing that you, QuestionMark, are married to Suzanne?
Lucky guy, indeed.
L85NJGT
In hospitals everything power & IT goes through conduit pipe. The conduit for IT cable pulls are always full. So either ID the dead drops and pull them out or put in new conduit runs.
In a perfect world architects would always stack riser closets ??
rikyrah
He didn’t tell them ???
Martin
@L85NJGT: Academic buildings have the same problem. It’s infuriating.
Ruckus
My VA clinic is the VA hospital in LA.
It was built in the 50s. Well designed for then but a lot of the things that Suzanne has stated create problems for modern health care. Had an operation and the rooms had 4 beds per room, the pre-op was one room, there were at least 10 to 12 of us in pre-op at a time. It felt sort of government hospital, like the navy one I was in for 9 days during boot camp. Wards, not rooms, about 20 or so beds, the patients had to get up and make their own beds every day. Amazed that anyone actually got better. The VA hospital had 20 beds for the ER and most of the beds were in 2 rooms, with 5 or 6 individual rooms for really bad off patients. They have been enlarging the ER, the amount of construction suggests that they are changing to modern design of one patient per room. I hope to never have to find out……
WaterGirl
@rikyrah: Not to be unsympathetic, but if you’re working for Rand Paul and you don’t know that he’s a selfish near-sociopathic prick, you haven’t been paying attention.
Goku (aka Amerikan Baka)
@WaterGirl:
Saw some comment on LGM about a staffer of Paul’s curb-stomping a female protester’s head. Terrible people draw terrible people to work for them
The Pale Scot
Army’s got plan about how to build out ICUs. I see the fail point being leaving it to the states to come up with the staffing and equipment. Staffing will be cross, Trump hesitating to enact mandatory production are the nails. Fuck, dog forbid Wall Street leaves some money on the table.
Lt. Gen. Todd Semonite has drunk way too much coffee
aka
USACE Support to COVID-19 Response
JaneE
Two anecdotes to reinforce two points that Suzanne made.
1: Back in the nineties, the city I lived in was growing like crazy. We lifted a 5 year building moratorium to build out water supply infrastructure and builders went nuts. We had no hospitals before, but some medical offices. After the boom we had two big hospitals, and within 5 years of being built, one was shuttered and vacant. Not enough patients, even though there were quite a few, and it served the southern half of the city. It sat vacant for several years, and then was turned into some kind of convalescent center. I moved, and I don’t know what the state of it is now. If it wasn’t profitable hospital, it wasn’t an open hospital.
2: Where we moved in 2005, the local hospital serves a very small county – 20K people total. When the hospital 60 miles south ran into financial trouble and closed (and opened and closed, I really don’t know whether it is open now or not) the local decided to build a newer more modern facility. Part of the new construction was a state mandated requirement that foundations be built to withstand earthquakes. When the expansion was originally approved and planned, those regulations were not in force (which tells you how long it takes to get anything done here), and just that portion of the building added several million to the construction costs. People here were really angry that their hospital couldn’t be built just like any other building, since it cost more. Needless to say, it was constructed to withstand earthquakes. I have been in other buildings built to meet those standards, and if I was having surgery when an earthquake hit, I would be very happy to know that my surgeon would never know it was happening. But it was very expensive.
Yutsano
@Leto: Ha. I think Martin was more on course to find it than I was.
chris
Just checking.
Thanks, Suzanne.
Amir Khalid
@Leto:
Someday you all should come to my town and take a look at Kuala Lumpur Hospital. My dad was a radiologist there when it was a cluster of colonial-era single-storey brick and wooden buildings. Over the past half-century it has evolved piecemeal into a vast (bigger than, say, downtown Rochester, Minnesota, which I have been to) mazy complex of modern buildings. A hospital really shouldn’t be that big or that hard to find your way around.
WaterGirl
@chris: What a face!
Leto
@Suzanne: This was an article from 1 Oct 2013:
Human rights issue raised in Qatar
Amnesty International has a whole section of reporting just about them.
Martin
@Yutsano: I hadn’t considered that might be in there. Wouldn’t doubt it though.
The Dangerman
@?BillinGlendaleCA:
I thought the old hospital was way cool; read someplace you could have a marathon with the length of it’s halllways. Massive. Never been in Reagan Medical Center.
One time, there was a false alarm of same nature at the old hospital; it was towards the end of my time there, so 1983 or 84ish, and I think I was out for the night in the Village. Anyway, LAFD sent everybody and everything. It was an amazing response but, again, as I recall it, it was a false alarm.
Ang
I know ships aren’t your field but during the Diamond Princess I remember hearing people worrying about shared ventilation on the interior (no window) cabins. Someone official-sounding was trying to claim that the cabins all had _individual_ ventilation and I was like, no way – show me the plans.
It seemed to me that the powers-that-be understood that many/most of the passengers were already likely exposed and that since they didn’t have facilities to disembark and individually quarantine 3600+ people they always just intended to let the virus burn itself out on the ship (while only evacing people as needed for higher level medical care) – but nobody could say that out loud. The ‘cold equations’ are a b1^*h…
Uncle Jeffy
If I was still teaching, I would assign Suzanne’s post to my Econ classes. The lessons are so clearly laid out that I’m in awe.
?BillinGlendaleCA
@The Dangerman: My roommate and I would explore ways to go thought the hospital to get to Westwood, one time we ended up at the plaza in front of the Jules Stine Eye Institute and Henry Mancini was performing for Stine’s memorial service.
Mary G
I chose an excellent day to have a long nap and missed the president’s crazy time show, and just finished reading all the comments on the thread. I have been very upset that the giant medical corporation closed our little community hospital after promising not to, but after reading all this I can see why. The MRI was outside in a trailer in the parking lot. Thank you Suzanne and all the jackals. This kind of thing is good respite for me.
tomtofa
Thanks for the post and your replies in the thread, Suzanne. Did you ever, by chance, read Connie Willis’ novel Passage? To some she’s an acquired taste (I acquired it); an important character in this book is an old maze of a hospital.
BellyCat
I’m also an architect (31 years) and echo the high commendations for Suzanne!
As you may have concluded, providing intensive care for demand that (exponentially) exceeds current infrastructure quantities is an incredibly difficult problem. There is simply no way to produce significantly more “critical care” infrastructure in the timeframe that will be needed.
What is likely to happen, as we are beginning to see in a number of locales, are efforts to accommodate large numbers of people who can ride this out with less intensive infrastructure, saving “the good stuff” for those who need it most desperately.
The single biggest concern is air quality and, ideally, atmospheric isolation for infected individuals is what is needed. This is why converting dormitories is not so ideal. The spaces work (physically) for beds but the air is shared. Not good.
Remember that crazy 1976 movie “the boy in the plastic bubble” with John Travolta? (I was 10 and it blew my young mind).
Essentially, and conceptually, that is the sort of thing that is needed. Air isolation is the base requirement for every infected person. My guess is that the most expedient way to do this is likely a collection of plastic tents that have filtered air provided by portable supply and exhaust units. These tents would have to be located in a very large space with a very high number of air changes per hour so that non-infected workers would be safe to attend to infected people who are isolated in these tents. Sounds bizarre because, well, it is. But that’s the sort of thing that will be needed. If not tents, some other volume of space occupied by only one person.
Ideal spaces for these “tents” could possibly be covered sporting venues or things like airplane hangars so temperature can be controlled, weather protection provided, and safety exiting maintained for large numbers.
This is a game changer and having enough equipment and trained staff is only one part of a huge logistics problem with a very compressed timeframe.
Good thing the president has it all under control. (Sigh…)
ballerat
@Roger Moore: Good point. On a macro scale one can also learn a great deal about the values of a culture by looking at the architecture and public spaces of their cities.
A hundred million for a new football stadium, or a hundred million for public libraries?
Whenever I visit a new place I always check out the libraries. What they chose to build and where they chose to put it reveals the truth.
jonas
This caught my eye because a few months ago I happened to be in a local emergency room (checking in on a relative) and a nurse was taking me back to the exam room and I passed a wheelchair parked in the hallway the size of a loveseat. She saw me sort of stop and do a double-take at it and then remarked, “Oh, yeah, and some of our patients don’t even fit in those…” It suddenly struck me that there are people who are so large, they can’t normally leave their home, but when they need to go to the hospital, there have to be wheelchairs and gurneys and x-ray tables and other equipment to accommodate them.
piratedan
As an IT guy on the hospital side there is one overwhelming challenge and that is network connectivity. Every system in the hospital uses their own equipment which can conflict with others… so that radiology can be in conflict with lab versus pathology etc…
Also speaking to what is going on now… the hospitals that i support are already doubling up ICU beds in the same rooms for COVID patients and planning on triage and recovery tents…. this is in Tacoms….
andy
@FelonyGovt: we got that here in Brainerd, MN- they are probably for drive through testing. the way they do it here is if you feel you have symptoms, you do an e-visit with the clinic, and you either get advice on how to care for yourself in place from your doctor, or you are referred for a test, and you drive up, get a swab taken, and are sent home. sometime later you are contacted at home. if you have a manageable case you stay home, and if you are bad off they bring you in for more extensive care.
JaySinWA
The Shoreline WA tent facility was constructed in 5 days. the 200 beds are part of 3000 beds planned.
It is hard to imagine retrofitting an existing building this quickly.
Other sites to be outfitted and used are Motels and other sites under consideration.
https://www.shorelineareanews.com/2020/03/recovery-center-building-shells-finished.html
https://www.shorelineareanews.com/2020/03/a-letter-from-councilmember-rod.html
Robert Sneddon
@dmsilev: Folks who don’t know much about big superconducting magnets look at the emergency-quench ducting in an MRI facility and ask “What’s that subway tunnel doing there?”
Friend of mine, a professional author had a scene in an SF thriller he was writing where a quantum computer running in liquid helium was suddenly shut down. I told him about what happened during a big quench and he delightedly included it in the story.