|Mitigation of Disasters in Health Facilities: Volume 3: Architectural Issues (PAHO)|
|Chapter 2: architectural design of hospitals|
|Characteristics of hospital design|
Once the accesses to the building have been defined, a brief description is needed of the areas into which a hospital is divided and of the possible interrelationships between its various services (Figure 2).
A hospital building is made up of five basic areas with very clear-cut and specific functions, which, in turn, must maintain vital interrelationships with one another for smooth operation. These areas are: Administration, Intermediate or Ambulatory Services, General Services, Outpatient Consultation and Emergency Care, and Inpatient Care (7). These areas are complemented with the very important exterior area, which, as previously mentioned, plays a particularly significant role in dealing with disasters.
Outpatient consultation: This is the area that receives outpatients or ambulatory patients for treatment or diagnosis of their ailments (Figure 3). In addition to medical consultations, this sector includes dentistry, injection and vaccination service, waiting rooms, etc. Emergency Care, with separate access, is included within this area and should be connected by means of an internal passageway. It is important to note that 90% of the patients circulate in this area, and consequently it would be wise to propose that the waiting-room areas in Outpatient Consultation be connected with Emergency Care so that they can be used for patient care in disaster situations, if required.
The many standards that regulate this sector have to do with size, function, and use, but none exist that provide for possible change of use in disaster situations. There are also many standards regarding specifications for finishes, but all are oriented toward asepsis, durability, and presentation, and none specify in any way what might be done to mitigate disasters. For this reason, special emphasis will be given to how mitigating elements could be included in standards by changing uses and the specifications of construction, distribution, and function. Change in the use of certain areas with specific functions could result in better use of hospital buildings in emergency situations.
Intermediate services: This area is also known as Diagnostic and Treatment Services. It is composed of the areas that provide X-ray, laboratory, and physiotherapeutic services, whose capacity is directly related to the size of the hospital (Figure 4). Since the Surgery and Obstetrics Unit also provides diagnostic and treatment services, it is located in areas close to the aforementioned areas.
It is important for the intermediate services to be directly connected to the external and internal circulation of the surgery area. There are very specialized standards for each of the spaces making up this area, and the areas of surgery and obstetrics are perhaps the most complex. Nevertheless, detailed standards for this area in terms of disaster mitigation have not been considered, and it would be useful to analyze matters such as the location of the Surgery Unit, which in most cases occupies the floors above the basic platform. This Unit could be located on the first floor, with direct internal communication to Emergency Care and a possible connection to the exterior in order to habilitate areas outside the hospital that could, if required, serve as a hospitalization area.
Administration: As its name indicates, this area manages scientific, financial, and organizational functions of the building (Figure 5). Its areas include the executive offices, accounting, management, etc. Also included are sectors that if located in strategic points could be used in the event of disaster. These include meeting and conference rooms, cafeterias, libraries, etc.
General services: This area includes the laundry, kitchen, storerooms, workshops, plants, boilers, etc. (Figure 6). So far, many mistakes have been made in planning this sector. Since the presence of boilers, fuels, gases, etc., which can become continuous time bombs, threaten the stability of the building, access to this area, as noted above, should be independent and direct from outside, and it should be related to the building by internal circulation.
In-patient Care: This area may be defined as the hotel area of the building. Although standards exist that prescribe its size, operation, and complementary floor services, very little so far has been written on evacuation of this area in the event of fire or what should be done in the event of an earthquake (Figure 7).