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Sunday, June 14, 2015

Hospital vs. Storm: Designers Aim to Keep Hospitals Open During Disasters

When Hurricane Ike rolled over Galveston Island, Texas on September 13, 2008, the University of Texas Medical Branch (UTMB) received a knock-out punch. Winds reaching 110 miles per hour pounded the 100 buildings of the 85-acre medical complex, and a 15-foot storm surge washed through the campus, flooding the lower level of every structure.

When the water receded, the complex needed $1 billion in repairs and was shut down for months; the emergency department didn’t reopen for almost a year.

“I grew up here on the Gulf Coast so hurricanes are always an issue, but of all the work I’ve done here at UTMB, we didn’t really have the consistent guidelines to go by until the storm happened,” says Neil Skinner, construction director for Vaughn Construction of Houston, one of the firms involved in the reconstruction of UTMB. “The storm forced the issue.”

Hospitals across the country are newly focused on resiliency in light of climate change, and the U.S. Department of Health and Human Services has addressed the situation by publishing Primary Protection: Enhancing Healthcare Resilience for a Changing Climate.

The Primary Protection guide offers a five-element framework for creating climate resilient healthcare facilities: Assess the potential climate risks; plan your land-use and design effectively; protect your infrastructure; protect vital facilities and functions; and adopt sustainable practices.
Element 1: Multi-Hazard Assessment — Understanding Climate Risks and Community Vulnerabilities – Assessing the risks to your facility includes understanding the history of climate events, the potential for more, and the capacity for dealing with such an event.
Element 2: Land-use Planning, Building Design, and Regulation — Among the issues this element addresses are the location and orientation of the healthcare facility, and the community land-use policies surrounding it.

Because UTMB is located on an island, relocating to an area less likely to be affected by a hurricane was not feasible. But wisely orienting the buildings was.

“The hospital did wind studies and used a computer program that studies the wind within campus,” says Patrick Casey, regional program manager for the University of Texas System. “This information impacts the orientation of the buildings. For example, we don’t want a main entrance to be in a wind tunnel. All of that is considered in the design.”

An important part of the building design portion of Element 2 is strengthening the building envelope. This is an area UTMB focused on heavily as they rebuilt the campus.

For example, designers tested possible new exteriors by building mock-ups of walls and blasting them with water and wind to simulate a major storm. “We modified the designs based on the testing,” Casey says.

Metal is particularly prone to damage from salty moisture, so all exterior metal elements of the buildings are now made of stainless steel or PVC.
Element 3: Infrastructure Protection and Resilience – This section of the guide explains that a hospital’s concern with infrastructure must go beyond on-site generators. All the elements related to them – fuel supply, pumps, switching gear, distribution systems – also need to be considered.

UTMB has improved the resiliency of its infrastructure by getting most of it out of harm’s way.

“Our main goal is elevating the infrastructure or going underground with it,” Casey says. “For example, all of our distribution for chilled and hot water runs on stanchions, and the electrical and IT conduits run on the roofs of buildings on stanchions. It almost looks like an industrial plant. Plus all our generators are either in buildings or on platforms above 25 feet.”
Element 4: Protect Vital Clinical Care Facilities and Functions — This part of the Primary Protection guide addresses the fact that hospitals must remain open during a natural disaster, since injured community residents will be counting on them.

For hospitals in areas prone to high water, this can be a special challenge. At UTMB this problem was tackled by moving the emergency department and other vital areas above the ground level of the buildings, so the hospital can continue operating even if the island floods again. The ED is accessed via a ramp.
Element 5: Environmental Protection and Strengthening of Ecosystems — This section suggests that hospitals should do their part to protect the environment, such as by carefully managing water usage, planting sustainable landscaping, and using storm water for beneficial purposes.


The Primary Protection guide includes a section about measuring resilience, which it acknowledges is difficult but important. One attempt at measuring resilience is the Coastal Resilience Index, which the guide describes as “community-based approach to a self-assessment process to derive an index of resilience to storm events.”

Naturally, the best measure of resilience will be what every hospital leader hopes does not happen – the next big natural disaster.

“We hope we never have to find out how resilient the hospital is,” Skinner says. “But we have our fingers crossed!”

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