By David Deis, Anshul Puri & Anthony Haas
Climate change is causing weather around the globe to get more extreme, and natural disasters often don’t give much warning before they strike. Wildfires, floods, storms, droughts and record heatwaves are increasing in frequency and severity. Other natural events, such as earthquakes and landslides, can destroy multiple buildings in a matter of minutes.
Natural phenomena are impacting not just the construction of healthcare facilities, but also their design, code requirements and preparedness needs. The following are tales from the frontlines that share how healthcare architects and designers have evolved in knowledge and creativity to prepare for and respond to these increasing environmental challenges.
Facing down flooding + hurricanes
1. Storm retention tactics, flexibility
While expanding and renovating Manning Family Children’s|Children’s Hospital of New Orleans in Louisiana, design and construction teams immediately faced a weather-related challenge: New Orleans had changed a number of its stormwater retention strategies after Hurricane Katrina.
“We were one of the first projects out of the gate with these new stormwater management guidelines, which required a rigorous process with the city government,” says David Deis, managing director of Page’s Atlanta, Georgia office, who worked extensively on the project. “When it rains in New Orleans, a lot of water collects and needs to be managed.”
The project team was working on two large sites — where the existing hospital was located, and the site across the street. “Our teams had to handle all the rainwater, retain it and manage it before it was released into the city system,” he says. “Our strategy worked great, we created a lot of bioswales that filled up when there was a deluge of water and kept the site from flooding.” The problem, he said, was when it came time to release all the retained water into the existing infrastructure. It backed up into the site and the city had to clean out the downstream system.
In addition, although the construction site was on relatively high land, it was right on the levy.
When snow melts in states that feed into the Mississippi River, some of that additional water ends up in New Orleans. The Corps of Engineers monitors rivers to a certain level above sea level; above that, they shut down all construction within 350 feet of the levy.
“Every spring, the Iowa melt would come and shut down the site, so we had weather way out of the jurisdiction affecting construction,” Deis says. “We worked with the contractor and owner to shift priorities. This was a 34-plus phase project, so it allowed that kind of flexibility: Okay, we can’t dig the footings or do underground plumbing, but we can go over here and work on the renovation of this unit. Flexibility is key to overcoming the complexities from weather.”
The teams had a curtainwall system to handle hurricane force winds, fortunately, because the hospital was hit by a Category 4 hurricane the day after the ribbon-cutting ceremony — the deadly and destructive Hurricane Ida in 2021.
“The building did fine: despite hurricane-force winds, there were no leaks at all. The challenging part was the two weeks of lost power. Trucks came in filled with diesel fuel to keep the hospital running,” Deis says. “We got to see the hospital’s commitment to its surrounding community. Having back-up power, AC and lights, hospital leaders opened their clinic space to the neighborhood: the elderly, sick and those affected by having no power or water could come and stay in the exam rooms in the clinic building. At that point, the hospital became truly a community center.”
Shoring up for earthquakes
2. Seismic compliance, owner engagement + participation
More than half of the 410 hospitals in California have at least one building that probably wouldn’t be able to operate if a major earthquake hits their region. After several severe earthquakes on the West Coast, new codes were established for seismic activity in healthcare facilities in California. The state is taking a multifaceted approach to seismic activity; there is an enforcing agency, as well as two teams, one in office and one in the field.
All the state’s hospitals are mandated to undertake renovations and build new facilities to be able to withstand a major earthquake. Critical care units have been moved out of facilities that are not seismically safe.
Many facilities, however, say they don’t have the money to meet a 2030 legal deadline for earthquake retrofits. The state is now granting relief to some while ramping up pressure on others to get the work done, says a recent article in the LA Times.
“Seismic codes also require built-in redundancies and uninterrupted operations for inpatient critical care during, and immediately after, a seismic event,” says Anshul Puri, senior project manager at Page, who has managed several healthcare seismic retrofit projects in Southern California over the years. “Upgrading and retrofitting of hospitals within the state to meet these deadlines continues to pose significant financial and operational challenges for the hospital owners.”
Although several hospitals in large urban centers have managed to keep up to date with mandated seismic compliance, many other facilities — such as the ones serving smaller communities — have not.
“Such areas often have very few hospitals serving the entire regional population,” says Puri. “If even one shuts down due to seismic non-compliance, the impact is huge. The residents have no choice but to travel a long way to get to the nearest hospital for treatment, now several miles away, not to mention the overburdening of the remaining hospitals.”
Although the central theme of seismic compliance for hospitals is life safety, the architectural and engineering solutions are unique to every facility: to its existing structure, the layout of its buildings, current and future planned operations and the diverse communities it serves. This makes the process of coming up with effective solutions very rewarding and fulfilling,” says Puri.
Continuous engagement and participation of the owner, the users and the design and construction teams from the get-go is critical for the success of such projects.
Preparing for winter’s wrath
3. Forward-thinking solutions
Winters in Denmark are frigid, with more than two months of consistently below-freezing temperatures. It makes construction on building projects challenging, with rain, sleet, ice and snow pausing or interrupting work.
When Page, in partnership with Mikkelsen Architects, was awarded the first phase of a new development plan for the Bispebjerg Hospital campus in Copenhagen, which had just been completed with an expansion beginning, the team knew it would be facing weather challenges at the construction site.
Guarding against the harsh weather was nothing new on the Bispebjerg campus; underground tunnels already linked the historic buildings that made up the existing hospital, bed towers and support services, partly so people moving between the buildings could stay out of the elements.
A site was chosen adjacent to the existing campus to serve as a building block for a new laboratory and logistics building, the first step in the expansion plan. The Lab-Log building would be a newly constructed, four-story facility of 150,000 square feet. The building brought clinical and research laboratory spaces together under one roof, as well as housing a vivarium, GMO Class 2 laboratories, support spaces, logistics warehouse facilities, teaching facilities, the region’s blood testing center and a central biorepository.
The facility was designed to permit and sustain optimal logistic flow through the entire campus, increasing the overall efficiency of the hospital facilities.
“Many of the historic buildings were ‘listed,’ which meant they were protected,” says Anthony Haas, Page project executive and medical planner on the project. “We needed to decide on logistics for the construction of the Lab-Log building that were minimally disruptive. Delivery trucks were bringing equipment and supplies to campus, so we had to access the site and set up loading docks and warehouses, all without interfering with existing operations.”
But the question remained: During construction, how could workers be protected from harsh weather conditions?
The solution was a 30-meter-tall white tent, delivered by the Danish company SiteCover, which encapsulated the building site for about a year during construction. A foundation system to support the tent was poured that was separate from the foundation system of the building.
At first there was doubt that overhead cranes mounted on tracks under the tent could be used as effectively as traditional tower cranes, but the incorporated cranes proved capable of carrying out all lifting jobs related to the shell and façade. And the workers still had a full range of motion over and throughout the site, while having coverage.
The giant tent, which kept workers warm during the winter and cooler during the summer, minimized lost days and downtime. It was a completely different way of building, said the contractor and project managers, who were able to cut months off the schedule due to the use of the tent. It also allowed the installation work and electrical work to start earlier.
Neighbors thought the tent was the completed facility and were displeased with the look. But once the tent was taken off, the community was pleasantly surprised by the elaborate, striking design of the Lab-Log building. The time savings on the project was substantial, and the quality of the building was improved, as well.
It’s reasonable to expect extreme weather and other natural disasters to continue unabated into the future; the EPA predicts many will increase — including global warming, rising and more acidic oceans, the frequency and intensity of storms, extreme heatwaves and fire-related threats. Along with this likelihood, ongoing design and construction strategies should be built on a strong foundation of resilience. While these forward-thinking solutions won’t spare us from nature’s wrath, they can help minimize damage and protect life.
Article contributed by Page architects and medical planners David Deis, managing director; Anshul Puri, senior project manager and Anthony Haas, project director.
