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By Alan Joch

Washington Hospital Center, Washington, D.C.

Just blocks from the U.S. Capitol, the Washington Hospital Center (WHC), a 907-bed not-for-profit teaching hospital, feels a special responsibility to prepare for wide-scale emergencies in the post-9/11 world. The hospital recently completed the first phase of a $2.2 million, federally funded project that resulted in a prototype of a new emergency room called ER One, which is intended to handle the immediate medical challenges of a bioterrorist attack, a SARS-like epidemic, or a natural disaster.

Located near the U.S. Capitol, the Washington Hospital Center (above) has designed a prototype trauma center called ER One (below) to accommodate large-scale emergencies.

The ER One project will ultimately create a new emergency facility at WHC and provide an annotated architectural plan that hospitals throughout the nation can use for their own disaster-readiness planning. The design prototype was finished earlier this year, and the center is now refining it.

ER One is intended to serve 10 to 20 patients per hour, the average number of visitors the emergency department receives currently. However, if a wide-scale medical emergency occurs in the Washington area, the facility will be designed to handle as many as 300 patients per hour for the first two hours, and five times normal patient volume for the first four days. To accomplish this, the prototype had to break some rules, says Dr. Michael Pietrzak, director of the ER One Institute. “We are talking about having people design things that are not necessarily supported by the [building] codes,” he says. “Their first reaction is, ‘We don’t do things that way.’ But that doesn’t mean that codes shouldn’t be changed. In our initial work sessions, we spent time breaking some paradigms. At the same time, we had to have some credibility behind what we wanted to do, so we used simulation modeling and vulnerability analyses to create a logical, justifiable scientific basis for what we were doing.”

The red areas shown below are rooms where patients could be isolated for treatment in situations requiring quarantine. Health care workers would carry handheld organizers to receive patient information quickly. Photography and image: Courtesy Washington Hospital Center

WHC doesn’t want to build treatment rooms that languish unused, nor does it want to make large influxes of patients wait for treatment in corridors or cafeterias. Instead, the prototype calls for what’s termed a “graceful degradation” of services, says Dr. Craig Feied, director of WHC’s Institute for Medical Informatics. This means that, in a wide-scale emergency, patient housing wouldn’t be as private, nor would patients receive the same level of care as in nonemergency situations—but neither would they suffer in a far corner of the facility because health care workers wouldn’t be nearby. “We designed treatment rooms that are bigger than normal,” Feied says, “big enough for us to roll an X-ray machine into the room. In the event of overcrowding, we could turn a bed 90 degrees so that the room could accommodate two beds.”

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