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Hospitals continually prepare to handle mass casualties transported from all manner of disasters. But are those hospitals prepared to continue delivering care when the disaster is at their doorstep?

A recently published article in the Southern Medical Journal suggests a new paradigm for the design of future hospitals - and details the development of All Children's Hospital Johns Hopkins Medicine (ACH JHM) in St. Petersburg, FL as an ideal example of this approach.

The article, "Complete Self-Sufficiency Planning: Designing and Building Disaster Ready Hospitals," (Brands, Hernandez, et al), points to events such as Hurricane Katrina which illustrated a major gap in disaster preparedness for at-risk institutions. Issues brought to light included: loss of back-up power due to flooding, inability to handle military helicopter traffic on hospital landing pads for multiple patient transfers, and entire facilities being forced to evacuate due to the inability to provide necessary temperature controls without functioning air conditioning. All these issues are best addressed in the facility design phase, the authors note.

"Disaster preparedness requires visionary yet pragmatic planning when new hospitals are constructed," says lead author Chad K. Brands, MD, Director of the Office of Medical Education at All Children's Hospital Johns Hopkins Medicine. "Considering institutional lessons learned is critical to the design phase."

When designing and building its new facility, All Children's conducted a comprehensive vulnerability assessment. This led to the development of a construct the authors have termed complete self-sufficiency planning (CSSP), useful for future disasters, either natural or manmade.  The critical core elements of CSSP are as follows:

• Generating power that will enable the operating systems of the hospital to function normally
  Protecting the structural integrity of the building and safeguarding electrical and mechanical equipment by placing these components into the heart of the building, away from hazards.
  
• Ensuring that vital day-to-day functions of the hospital will not fail (air temperature and quality, water supply, plumbing, sewage disposal).
  
• Storing essential supplies with which to operate the hospital for one month.
  
• Creating failure-proof transportation and security systems to provide for effective and safe transport of patients.
  
• Upsizing the capacity of the hospital to accommodate regional demands and needs.
  
• Building redundancy into all systems.
  
• Preparing for disasters that have occurred elsewhere but not necessarily locally.

The facility opened by All Children's in January, 2010 incorporated design elements to address these issues, including:

• A helipad designed to accommodate a Black Hawk military helicopter weighing up to 36,000 lbs. and having a 66-ft wingspan. The helipad is connected to transport elevators that are immediately adjacent to critical patient areas of the hospital for ease of transfer and acceptance of patients during disasters, as well as the upsizing of the hospital that is anticipated during a regional disaster.
  
• A Central Energy Plant for completely redundant (100%) power in the hospital, with six 2000-horsepower generators capable of delivering power for all systems for a duration of 21 days.
  
• A well that provides water to the cooling towers, enabling continuous air conditioning services, which are viewed as critical for the well-being of patients and employees in Florida's heat and humidity.
  
• A reverse osmosis system capable of providing potable water was developed so that the hospital would fulfill CSSP principles in the event of disruption of local government-supplied power or services. This innovative system, available at only a select number of hospitals, allows for the proper handling of human waste, maintains a pressurized sewer system, and allows plumbing to function normally.

"There is no substitute for the best preparation in planning for the worst," the authors conclude. "If a disaster strikes, then ACH JHM is prepared to rely on the principles and pragmatics of CSSP and to function as an island of security in the midst of the storm."

The complete article is available at:

http://www.allkids.org/workfiles/pdfs/articles/Complete_Self_Sufficiency_Planning_Designing_and_Planning_Disaster-Ready_Hospitals.pdf)