New designs for hospitals

Health centers have special characteristics as regards occupation, complexity, critical supplies, dangerous substances, dependency on public services and continuous interaction with the external environment. Since natural disasters are infrequent, very often they are ignored in the planning and design of hospitals and of other related installations, even in regions where the risks are well known. It is possible to predict with accuracy what may happen in an installation as a consequence of earthquakes or other types of disaster, but given the great variety of activities that may be underway in a hospital, it is necessary to carry out a careful analysis of possible scenarios in order to avoid a chaotic interruption in hospital services.

An unsafe building may suffer structural damage or even collapse. If such a collapse occurs the disaster is greater, since the hospital becomes a problem requiring a great deal of attention rather than an institution providing support for the affected community. Serious damage may lead to a complete evacuation of the hospital and, as a result, to loss of hospital services for a prolonged period of uncertain duration.

Architectural design

The conceptual design of a hospital involves making a series of decisions, including:

· Location of the building;
· Functional relations between hospital sectors;
· Geometry, shape or composition of the building;
· Structural system;
· Building materials.

These are decisions that should be taken jointly in the early stages of the execution of the project by the owners, health administrators, physicians and other medical personnel, architects, engineers, builders, and all those professionals who for some reason are involved with its conception and execution.

One should emphasize that, due to the complexity and close relationship to the spatial and formal layout of the construction, the problems of configuration should be tackled at the stage of preliminary definition of the spatial layout of the building, and throughout the formal and structural design stage. Thus, configuration is a subject that should be grasped in all its breadth by the designers and architects.

The seismic design of hospitals is a responsibility shared by the architects and the engineers. In particular, it is necessary to emphasize that it is shared with regard to the physical relationships between architectural forms and resistant structural systems, and it would be ideal if every designer working in disaster-prone areas understood those relationships. Unfortunately, international educational methods and practice have tended to reduce incentives for promoting this broad approach in a designer's way of thinking since training for new architects is separate from that given to new engineers and, in many cases, they remain distinct in practice. As it happens, some architects, by intuition or because of their intellectual background, have an excellent sense of structure, but this understanding on their part tends to occur despite their education and practice.

The costs involved are determined by construction techniques, the availability of materials, the nature of the equipment used, labor, and the time taken in construction, which is the reason why in some countries the responsibility for monitoring costs is entrusted to people trained in other disciplines, such as field supervisors. However, ideally, designers should from the beginning be able to count on a professional or a group of professionals who can integrate all aspects that have to be taken into account, among which are the requirements for dealing with natural disasters. In other words, the ideal would be to have a conceptual designer with sufficient experience in architecture, engineering, costing and construction, to enable him or her to consider aspects with which to achieve maximum efficiency in design.

Design requirements in engineering

Although this document does not attempt to be a manual on design for engineers, it is important to indicate that many problems in the design of health installations can be recognized by the owner of the services, the administrator, the planner, the architect or the engineer. They can also recognize the factors that may substantially increase the seismic risk of existing buildings or of the new ones to be constructed. These factors are:

· An appropriate evaluation of the seismic hazard, including the local conditions of the soil. The harm done to a building depends both on its resistance and the type of soil it is built on and the intensity and the characteristics of the seismic movement itself.

· The design of new health installations in accordance with the requirements of the seismic building codes of each country attempts to guarantee an acceptable level of safety from the economic and social point of view.

· The administrators of health facilities should consider how to implement additional performance requirements for earthquakes in order to protect the occupants and the internal components of the building.

It is suggested that seismic performance should be guided by the following objectives, in the case of health facilities:

· The damage caused by strong earthquakes should be reparable and should not be a threat to life.

· Patients, personnel and visitors should be protected during an earthquake.

· The emergency services of the health center should remain operational after the earthquake.

· The occupants and rescue and emergency personnel must be able to move about safely inside the installations.

These objectives attempt to guarantee that the is able to fulfill its role by putting into effect its emergency plan following a disaster.

The loss of life and property caused by earthquakes can be avoided by applying existing technologies and without going to enormous expense. The only thing that is required is the will to do it. Since around two generations are required before the current inventory of buildings in most communities gets replaced, as much attention must be paid to the structural improvement of existing buildings as to the design and construction of new buildings. At this time there exist very few technical limitations on the design and construction of most buildings to enable them to resist hurricanes, earthquakes, or other natural hazards which means that it is possible to minimize risks and damage if preventive measures are incorporated into the design, construction and maintenance of new health installations.