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BURN TTUSM ENT ARCHITECTURE 422 NOLAN EDWARD BROWN DECEMBER 9, 1975 TABLE OF CONTENTS INTRODUCTION ACTIVITIES AND RELATIONSHIPS FINANCING CLIMATOLOGY SITE INFORMATION APPENDIX "A" (Excerpts from Uniform Building Codes) APPENDIX "B" (Excerpts from Lubbock Zoning Ordinance) APPENDIX "C" (Excerpts from OSHA Standards) APPENDIX "D" (Organizational Chart) DESIGN ANALYSIS BIBLIOGRAPHY 61 68 1 4 35 37 40 43 49 54 60 INTRODUCTION "A severe burn is one of the most complicated and devastating injuries that can happen to a human being. Each day, approximately 10,000 hospital beds are occupied by patients with burns, and each year nearly 6,000 patients die as a result of their burns. While it is possible to support the deranged physiological state in the early postburn period by application of time-proven resuscitation measures, the life of the patient with a severe burn still remains in constant jeopardy from invasive infection until either his wound has closed spontaneously or it is closed by the application of skin grafts. To reduce burn mortality in the future, the facilities for treating burns must not only be specialized intensive care units but also must offer a germfree environment in which to carry out this intensive care." ^ Texas Tech University School of Medicine plans to include in their curriculum a field of study dealing with thermal trauma and related conditions. Their objective is to (1) treat patients suffering from burns and restore their bodies by means of reconstructive surgery; (2) support a research program in burns aimed at advancing the treatment and reducing the mortality from burns; and (3) educate and instruct medical and supportive personnel in the treatment of burned patients. ^ MacMillan, Bruce G., M.D. "Color is the Key to Sepsis Control in Cincinnati Burn Center," Journal of the American Hospital Association - Hospitals. Volume 44 (February 16, T966). In order to meet their objectives they desire that a Burn Care facility be constructed near their present facility (under construction) on the Texas Tech University School of Medicine campus in Lubbock, Texas. Research of "hospital admission stitisties" of the South Plains area, as indicated on figure #1 revealed a need for a thirty (30) bed unit to serve as a regional facility. Lubbock is well suited for its selection as a site for Its location in the South Plains allows it to this Burn Center, fill a void in the areas now providing burn care. The Texas Tech University School of Medicine will also be a ready supply for personnel and support facilities. Its research labs will be used for a majority of the outside "burn care" research. -2- Indicates area to be served by the "burn" facility. FIGURE #1 -3- ACTIVITIES AND RELATIONSHIPS PATIENT CARE Bed areas (intensive, comprehensive, and convalescent care). In keeping with a concept of progressive patient care, there should be three separate bed areas for the burned patient. All bed spaces in each of the three areas should be similarly supplied and equipped the only major difference being the amount of "extra" work space around each bed in each area. Air conditioning for burn patient care is essential as it helps lessen cross contamination of patients with pathogenic bacteria. The following criteria is recommended for activities in this area: 1. Temperature 72 - 76 F 2. Relative humidity 55^ 3. Ten air changes per hour 4. 100% fresh filtered air 5. No recirculation of air 6. A positive air pressure maintained at all times to prohibit the entry of air from the corridor or other unsterile areas. 7. Exhaust eir taken off from a point near the floor in order to remove airborne dust. 8. Installed to conform to National Fire Protection Association recommendations which pertain to explosion hazards in hospitals. -4- The major design objective in the patient bed areas is to maintain separation of the three areas, maintain separation of the patients themselves, and yet achieve some of the free access and observation possible in an open ward.^ 1. Intensive Care: (Six (6) beds maximum) The patients require Each bed space should continuous nursing care and/or supervision. have its own nurse. All charting can be done at the bedside. It is desirable to maintain as much open floor space as possible to facilitate cleaning. If partitions between beds are used, windows should be provided to permit each nurse to observe at least two patients from any "work station." Due to the significant incidence of renal failure in large burns, one of the intensive care beds should have a hemodialysis sink and drain instead of the smaller bedside handwash sink. A portable hemodialysis maching can then be brought to the area when needed. Three medical personnel can be planned for around the patient at any one time. Intensive care should be located as close as possible to (in order of priority): (1) hydrotherapy, dressing and treatments, and surgery; (2) medication, clean utility handling; (3) equipment storage, supplies and linen, dirty utility handling, and nourishment, and avay from ambulatory patients. 2. Comprehensive Care: (Nine (9) beds) This is a transitional phase for the patient who was initially admitted for intensive care. ^Feller, Irving, M.D. Planning and Designing a Burn Care Facility. Institute for Burn Medicine, Ann Arbor, Michigan: T97I. p.41. -5- In some cases, a less severe burn will be admitted directly into comprehensive care. The equipment is the same as in the intensive care unit, but one less person can be planned for around the comprehensive care bed. However, it is possible that a third person can be involved in emergency space-consuming activity (e.g., cardiac arrest). This area should have the same relationship to other activities as intensive care. 3. Convalescent Care: (Fifteen (15) beds) This phase is for the convalescent patient. Its space and equipment requirements would be no different from a general surgical ward bed. The convalescent patient is encouraged to ambulate most of the day, and to lay down only for examinations (inspect bandages, skin grafts and splints); minor treatments (changing bandages, removing stitches, changing or adjusting splints, cleaning and medicating wounds and certain physical therapy exercises); and sleeping. However, the probability of having to admit comprehensive care and intensive care patients to facility emergencies of excessive case loads justify equipping it for such use. The activity around the bed would be similar to that of comprehensive care. The activity should take place near patient bath and showers and toilets. -6- EQUIPMENT (Intensive care, comprehensive care, and convalescent care activities) Bed Base cabinet with counter Wall cabinet Chair Counter Linen receptacle (under counter) Trash receptacle (under counter) Hand wash sink (or Hemodialysis sink) (24"x 36"x 30" high) Stool (under counter) 4. Hydrotherapy: for two reasons: Plinth (a padded table) Plinth hanger CircOlectric anterior Frame hanger Television Chart desk Paper towel dispenser Soap dispenser Bulletin board Clock Overbed table Hydrotherapy is included in the facility high incidence of use, and patient protection. a. High Usage. Frequent dressing changes and cleaning of the wound is necessary. b. Patient Protection. Hydrotherapy treatment should be located within the Burn Center to prevent the spread of infections from or to the burn patient. One physical therapist is required to administer the treatment. In the process, a thin plastic sheet is placed over the entire tank. The tank is then filled with water and cleansing solutions. The soaking of the wound makes bandage removal easier for the staff -7- and the patient. After the patient is removed from the tank, the solution is drained and the plastic sheet removed and discarded. ' Air temperature around this activity should be main^ tained up to 80 F. The patient is usually weighed when he comes out of the tank. Special load-cell equipment can be utilized and a true weight obtained when the patient is lifted from the tank with no dressing or clothing. This equipment requires a 4" to 8" rail beam on the The ceiling height ceiling to facilitate the lifting machanism. must be a minimum of 9*6" at this location. At least one tank is required for every eight to ten patients. Thus, two Hubbard tanks and two smaller hip tanks will be sufficient for this facility. Only the equipment and supplies necessary to hydrotherapy should be included in this room. All other supplies are brought into the room as needed, then used and disposed of or cleaned before the next patient is brought into the area. Hydrotherapy location, in order of priority, is recommended as follows: (1) admitting; (2) intensive care; (3) comprehensive care; (4) operating; (5) dressing and treatment, and (6) bath and showers. It should be away from ambulatory patients and visitors' gowning. Duffek, George. Burn Unit Technical Coordinator. Interviewed by Nolan E. Brown. Dallas, Texas: November 7, 1975. (Mr. Duffek has 20 years experience in burn care and treatment.) -8- EQUIPMENT Base cabinet with counter (24" wide x 48" long) (2) Hydrotherapy tanks, Hubbard (78" x 106" floor space; 34" high tank; and 48" working space completely around the tank) (2) Hydrotherapy tanks, mobile combination arm, leg, and hip (40"x 20"x 33" high) Mixing valve assembly Paper towel dispenser Read out panel for load cell Soap dispenser Linen receptables (2) Bulletin board Trash receptacles (2) Clock 5. Arrival/Departure: Patients will be arriving at the Burn Floor scales Shelf over sink Hand-wash/utility sink High stool with steps I-Beam with suspension lift (9'6" ceiling) and load cell transducer Wall hangers for plinths Center by ambulance or in some cases by helicopter, or other similar emergency vechicles. Provisions should be made to receive patients conveyed in this manner. There should also be an enclosed (physical) connector between the Burn Center, Texas Tech University School of Medicine, and the Lubbock County Teaching Hospital (under construction). The connector would facilitate the transfer of administrators, outpatients, technicians and other hospital staff members to and from these other areas without leaving the enclosed environment. 6. Admitting: Some place other than the patient's bedside is needed to admit the burned patient to the facility. This activity -9- can be combined with the hydrotherapy since a thorough cleansing of the body by tubbing is part of the admission procedure. The admitting process involves starting I.V.'s (this requires that needles, tubing, I.V. hanger and from two to three bottles of glucose be readily available for this activity); catheterization (utilization of a catheter to obtain specimens. Usually Laryngeal or Retrourethral catheterizations are performed to obtain larynx secretions or urine. The appropriate catheter must be readily available); physical examination (examination of burned areas as well as checking vital signs - blood pressure, pulse rate, temperature. Blood samples could be taken at this time if needed. This examination gives direction to the ordering of medical supplies for this patient's needs); cleaning and shaving of the body (this requires hydrotherapy and razor); and applying dressings using aseptic techniques. (At this stage the patient is ready to be moved into Bandages should be readily available.) the aseptic environment. This activity will require from two to four members of the burn team, depending on the condition of the patient. EQUIPMENT Base cabinet with counter Wall cabinet Kick bucket Linen receptacle Trash receptacle Shelf over sink Hand wash sink -10Hi-Lo stretcher Prep tables (2) Paper towel dispenser Soap dispenser Bulletin board Clock 7. Dressings and Treatment: Performing all dressings and treatments in one central area is far more effective than conducting these procedures at the bedside. Assuming the hydrotherapy area is nearby, it is possible to handle all wound care and treatments in these areas. A centrally located dressings and treatment activity precludes the need for storage of dressing carts and supplies at the bedside. EQUIPMENT Tub with shower and agitator Linen receptacle Clothes hook Wall shelves (approx. I'x 8') Emergency call buzzer Trash receptacles 8. Surgery: Surgery within the facility is as necessary as Stool Wastebasket hydrotherapy, for similar reasons, namely (1) high frequency of use for debridements (removal of devitalized or contaminated tissue from infected lesion in order to expose healthy tissue) and skin grafts; and (2) elimination of patient trips outside the facility. Because all burns are infected and considered "contaminated," the use of different rooms for various procedures poses the problems of contamination cf the entire operating suite. Also, transportation of the severely burned patient through corridors increases 4 Feller, op.cit., p. 49. -11- his susceptibility to added infection as well as the chances of spreading the infection to other areas of the unit. Surgery should be located within the isolation unit. A treatment area, i.e., for cutdowns (creation of a small incised opening, sometimes over a vein, to facilitate withdrawal of blood or administration cf fluids); tracheotomies (surgically inserting a tube into the trachea); debridement; and dressing changes which do not require general anethesia may also take place in the same area as operations. Additional advantages are that the patient may be taken directly to the operating room and the procedure performed while he is in his own bed. This allows proper positioning for post-operative care and eliminates shifting the patient from bed, to cart, to operating room table, to cart, and back to bed. When the operating room table is used, it may be taken directly to the patient's bedside, eliminating the need for a cart to transport the patients. Air conditioning requirements for surgery are the same as those listed for patient bed areas. In a maximum situation, the surgery team varies between four and seven persons. The team consists of a surgeon, an anaesthesiologist and two assistants who aid with ligatures (tieing a vessel), retractors (instruments which hold a wound open during surgery), etc., a scrub nurse who works with the surgeon during the operation and passes instruments as required. -12- The staff needed for the more routine minor surgery would be one RN, one OR Technician, and one attending aide or orderly. No special skills are required other than the usual operating room training. EQUIPMENT Storage cabinet Kick buckets (2) Lifts (2, stacked) Mayo stand Linen receptacle Trash receptacle Soap dispenser Double ring stand Bulletin board Single ring stand Clock Shelf over sink Scrub sink 9. Patient Toilets: One toilet and lavatory should be pro5 Stools Operating table (30"x 72") Back table Prep tables (2) (30:x 72") Ceiling mounted extremity suspension vided for the intensive care and comprehensive care patients. Another toilet and lavatory should be provided for the convalescent care patients, who will usually be ambulatory. EQUIPMENT Bedpan hoppers/washer/ sterilizer (intensive/ comprehensive care patients only) 5 Ibid., p. 51. Toilet paper dispenser Paper towel dispenser -13- EQUIPMENT Shelf over lavatory Lavatory Toilet Grab bar (by toilet) (continued) Soap dispenser Paper cup dispenser Mirror with light and outlet Emergency call buzzer 10. Adult Visiting and Recreation: The purpose of this activity is to permit the patient to escape institutional life without leaving the facility. Activities taking place would consist of eating, conversing with fellow patients, family members, or other visitors during visiting hours. (This is mentioned even though visiting would be highly restricted). Not more than five visitors would be in this area at one time. Recreation would consist of mental games (rather than physical) such as puzzles, cards, dominoes, etc. Any school activities needed would take place here. The atmosphere should be a "home" oriented one. It should be near the entrance, convalescent care, toilets and nourishment. EQUIPMENT Base cabinet with counter (for storing recreational games and puzzles) Lounge chairs (to facilitate patients and visitors) Chairs (to facilitate students during school activities) Color Television Radio Clock ^ Ibid., p. 54. -14- 11. Ambulatory Children's Play and School Activity: Thisis analagous to Adult Visiting and Recreation but modified to meet children's needs. I t s purpose is essentially the same. EQUIPMENT Base cabinet with counter (for storing recreational games and puzzles and school supplies) Child's tables and chairs (for school activities) Television Toy chest/bench Assorted toys PATIENT SUPPORT ACTIVITIES Slide projector Wall mounted screen Record player Bulletin board Blackboard Folding playpen Infant's walker 1. Medication: Large quanities of medications, I.V.'s, and topical agents are required. A considerable amount of staff time will be spent stocking and preparing medication for distribution. Separation from other activities is desirable. However, it can be combined with the clean utility, supplies, and linen storage and/or the nourishment preparation facility if separation is not feasible. As many as three people can be planned for in this activity at any one time (one stocking, one making preparations, and one making medication pick-ups.) EQUIPMENT Base cabinet with counter (medication storage 10 cu. ft. per patient) Base cabinet with sink -15Counter (medication preparation) , . . ^ Refrigerator (under counter) EQUIPMENT Wall cabinets (4) Medication cart (under counter) Utility carts (2) one for blood drawing use (under counter) (continued) Open shelf urit Step stool Bottle warmer Bulletin board Clock 2. Patient Equipment Storage: A storage area is needed for patient equipment which is in frequent but not constant use, so as to avoid cluttering bed areas and hallways. Equipment usually stored is (1) all extra beds and most portable equipment (suction machines, wheelchairs, stretchers, etc.) and (2) I.V. hangers, spotlights, heat lamps, and blood pressure apparatus are built into walls and/or ceilings instead of taking up floor space when not in use. It is desirable to have the storage within the facility itself because: (1) easy access and (2) reduces cross contamination with the related facility. 3. Clean Utility, Supplies and Linen: Burn patients use an extraordinary amount of linens and dressing materials as well as the usual sterile supplies. Beds are changed with at least the same frequency as are dressings (usually twice, but as much as three times per day). (Approximately three sets of linen and three blankets per patient per day.) Also, the large number of operations, hydrotherapy, dressing changes, and treatments require advance setup of supplies and equipment preparatory to use. These storage and processing functions could be combined advantageously. necessary. Medication preparation may also be included here if -16- This function should be located near intensive and comprehensive care, dressing and treatment, and surgery. At least three people can be planned for in this activity at any one time. EQUIPMENT Base cabinets with counters (storage of clean utilities and supplies) Wall cabinets (storage of clean linen) Utility cart (for distribution to usage areas) Sterilizer 4. Pre-Cleaning: In an isolation facility, it is essential Stool, chair height Step stool Bulletin board Clock Open shelf unit to pre-clean all instruments, supplies, and equipment after use. Gross "soil" is removed before equipment and instruments are sent out of the center or to a cleaning facility for further cleaning and processing. A "washer-sterilizer" expedites this procedure and avoids the problem of transporting contaminated material past other patients. This function should be near intensive and comprehensive care, dressing and treatment, and surgery. One person will be involved in pre-cleaning and one person transporting the equipment and instruments. EQUIPMENT Base cabinet with counters (Storage for cleaning chemicals) Utility carts (2) -17Trash receptacle (under counter Double sink EQUIPMENT Counter Linen receptacle (under counter) (continued) Washer-sterilizer (36"x 36") Bulletin board Clock 5. Nourishment: Many burned patients require high oral fluids and high caloric intake. A nourishment prepared within the facility is important. Unless a complete diet preparation process is planned, this function can be combined with virtually any clean area (e.g., medication dispensing). It should relate to intensive and comprehensive care and ambulatory patients. There should be dieticians assigned specifically to meet patient needs. Two dieticians will be required for this facility. Approxi- mately thirty (30) ir.inutes per day per patient should be scheduled (five (5) minutes to discuss individual patient preferences, ten (10) minutes for calorie count, and fifteen (15) minutes investigating patient's needs). Distribution of trays to the patients will be executed by the dieticians with the help of the nurses on duty. EQUIPMENT Base cabinet with counter Sink Utility cart (under counter) Ice machine Refrigerator Counter Hot plate Toaster Coffee pot Blender Bulletin board ^^" ^^^ -18- 6- Pick-up and Delivery: Because entering and leaving isola- tion facilities requires special precautions (e.g., changing, gowning, etc.), storage should be available directly within the entrance for delivery of supplies, equipment, nourishments, etc., and for pick-up of specimens, equipment, and supplies to be returned to other areas within the facility. EQUIPMENT Open storage unit (I'x 6'x 8') TEAM ACTIVITY 1. Male Changing and Toilets: All persons who contact the patients should remove street clothes and change into scrub clothes and gown. Consulting M.D.'s should remove their hospital coats and cover their street clothing with a clean gown. Storage for coats and street clothes should be provided for each male employee. Handwashing before entering and when leaving the facility is important. The use of a shower is recommended for comfort and cleanliness when working in a highly contaminated area. For this size facility, plan for a maximum of ten (10) men to be involved in this activity at any one time. EQUIPMENT Facilities for changing and storing street clothes Linen receptacles (2) Trash receptacle Toilet Mirror Paper towel dispenser -19- EQUIPMENT Shower Hand wash sink Stool (continued) Soap dispenser Toilet paper dispenser Bulletin board Clock 2. Female Changing and Toilet: Same function as male changing and toilet. However, a maximum of fifteen (15) women should be planned for at any one time. EQUIPMENT Same as male facilities 3. Conferences and Teaching: The team approach dictates frequent meetings between team members--(most members do not have office space within the facility). Orientation and in-service teaching will also be used. Since these activities occur only a few times daily or weekly, they may utilize the same place but at different times. A minimum of twenty-five (25) people should be planned for in order to accomodate each burn team (one team per shift). EQUIPMENT Base cabinet with counter Stacking chairs (25) Folding tables (5) Wastebasket Projection screen (wall or ceiling mounted) Slide projector Bulletin board Blackboard Clock -20- 4. Laboratory: A small laboratory is recommended within the facility to perform the large number of white blood counts and hematocrits required by burn patients. A maximum of two (2) lab technicians Kill be involved in laboratory activities. EQUIPMENT Base cabinets (2) with counters Base cabinet with sink Counter Stool Centrifuge Refrigerator (24"x 36"x 60") 5. Doctor supervision: A Doctor will be on duty 24 hours each day. As a teaching hospital there will also be residents, interns, fellows, etc., performing extensive chart review, conference and study. Since this activity may be required anytime during a 24 hour period, sleeping and resting activity will also take place. This area should be away from ambulatory patients. EQUIPMENT Desk chairs (2) Hide-a-bed lounge chair Single pedestal desks (2) Shelves over desks Wastebasket Desk lamps (2) Bulletin board Clock Microscope Hemoglobinometer Pipette shaker Bulletin board Clock -21- 6. Head Nurse Supervision: The head nurse (or equivalent) will conduct private conferences with staff members as well as administrative activity. This should be away from ambulatory patients. EQUIPMENT Desk chair Chairs (2) Desk Book storage (I'x 12') 7. Communications: Wastebasket Desk lamp Bulletin board Clock The "ward clerk" is responsible for all incoming calls, paper work, checking doctors' orders, intradepartmental communications, etc. The communications activities should be separate from, although adjacent to, conference activites in order to provide privacy for the conference yet have easy access to it in case of incoming calls for those in conference. Communications should be centralized directly inside the isolation unit, so that the ward clerk may monitor all traffic into and out of the unit. EQUIPMENT Wall cabinets (2) Desk chair Counter 8. Janitorial Equipment: Bulletin board Scheduling board Clock Cleaning and storing janitorial equipment, including the draining and filling of floorscrubbers, -22- should be separated from other activities. This activity may be combined with dirty utility. EQUIPMENT Auto-scrubber Storage cabinet Wall cabinets (3) Maid's cart Floor level sink Wet vacuum 9. Lounge: Due to the physical and emotional strain inherent in the care of severely burned patients, it is necessary to provide the staff members with mental and physical relief. This should preferably not be included as a part of another functional area, because the nurse (especially) requires activity away from patients where she can rest before returning to the turmoil of the acute care unit. At any one time, there would not be more than five nurses participating in this activity and at periods of about 15-30 minutes. EQUIPMENT Base cabinet with sink Wall cabinets Chairs (5) Couch Counter Refrigerator (under counter) Coffee table 10. Visitors' Gowning: Because visitors do not come into End table Coffee pot Toaster Warming oven Bulletin board Clock direct contact with more than one patient, they may gown over their -23- street clothes. Male and female visitors need not be separated for this activity. Storage should be provided for coats and other personal belongings. Handwashing before and after visiting is very important. This activity should be located near the entrance and communications desk and away from patients with low infection resistance. No more than five visitors will be involved in this activity at the same time. EQUIPMENT Coat and parcel storage Linen receptacle Trash receptacle Shelf over sink 11. Inhalation Therapy: Burn patients frequently require the Hand wash sink Paper towel dispenser Soap dispenser expertise of support hospital's Inhalation Therapy department, whether it be for equipment such as oxygen, ultrasonic nebulizer, IPPV machine, respirator, or for treatments. The basic function cf such a department is to maintain all respiratory and emergency oxygen equipment and to provide treatment for patients. Each inhalation therapy treatment for a burn patient requires at least 15 to 20 minutes for one therapist. No additional space is required in the associated hospital's Inhalation Therapy department or in the burn unit, with the exception of storage for emergency equipment in admission and intensive -24- care. Oxygen equipment, including a respirator, should be stored and maintained in the unit for emergency purposes. Oxygen, suction, and compressed air lines should be located at all patient's beds. As long as emergency supplies and equipment are located and maintained within the unit, the location of the Inhalation Therapy department is not a factor and can be within the support facility. 12. Occupational Therapy: The Occupational Therapy is an increasing demand for burn patients. Under the guidance of a physiatrist, the occupational therapist fits and applies the necessary splints to extrimities to prevent or control contractures. Range of motion exercises, crafts, and recreational activities are also provided to avoid contractures and help the patient return to selfsufficiency. Rehabilitation activity consist of activity which requires physical action by the patient, but are limited so as not to require vigorous activity nor any additional space other than that required for ambulating. Another important aspect of Occupational Therapy involves "activities of daily living" to encourage the patient to continue his self-care and independence as much as possible during his hospitalization. Throughout the entire hospitalization, supportive activities are used as a means of diverting attention from anxieties and releasing aggressions. An occupational therapist is an integral member of the burn team. For optimum care, one occupational therapist should be as- signed to ewery ten patients. However, two will be adequate for this facility. -25- The occupational therapist works primarily at the bedside, or, when the patient becomes ambulatory, in the O.T. department. age space should be available in the burn unit only for games, crafts, and a few splints; the occupational therapist should maintain a main storage area in the Occupational Therapy department in the support facility. The location of the Occupational Therapy department relative to the burn unit is not critical. Some specific O.T. activities include the following: ACTIVITIES OF DAILY LIVING A. Bathroom - requires space for manuvering a wheelchair, Stor- at least one commode with a 6" built up base, and grab bars on both sides. B. Bedroom - should have enough space to manuver wheelchair around the bed, chair, and dresser in order to duplicate normal housekeeping activities. C. Kitchen - should have specialized features (low cabinets and wheelchair space under sink) to accommodate wheelchair patients as well as standard counter and cabinet arrangements. D. E. Dressing - a standard clothes closet is recommended. Grooming - low mirror and easy access to sink and grooming supply storage. F. G. Eating and writing - provide table space. A gadget board (3' x 5' verticle mounted and adjustable) containing numerous items of hardware, light switches, faucets, -26- and other items frequently used should be made available.^ 13. Administration: The administrative unit of the center not only serves as the focal point for the internal organization of the building, but also is the point of initial contact for visitors to the center. burn center. The administrative director is responsible to the governing body for the total operations of the center's program. A business manager, or his equivalent, is immediately responsible for the accounting and administrative clerical staff. The responsibiliIt would be associated with the main entrance to the ties of the director and business manager are closely related. The director should be located so that he may be conveniently reached by visitors and the center's staff. The business manager should be near the accounting and administrative clerical staff. Many patients may wish to pay cash for services or may have inquiries regarding financial matters. Such matters are frequently of a private nature, and, consequently, require some degree of privacy. The cashier should not appear to be the dominant element to a visitor or a patient. The receptionist, who may, in some instances, be the switchboard operator, needs to be able to control traffic from the entrance. Outpatients and visitors upon entering the facility will need coat and wheelchair storage near by. ^ Salman, F. C. Rehabilitation Center Planning. Pennsylvania State University Press, University Park, Pennsylvania, 1970. p.78. -27- Administrative personnel, in many instances, will be physically handicapped an effective demonstration to visitors of efficient employment of the disabled. Planning of the administrative area should, therefore, incorporate the design requirements of the physically handicapped. Loading and unloading activities need to be sheltered but should be located so that the patient does not have to pass by administration activities. The principal visitors' entrance should net, however, be an inconspicuous nor a secondary feature of the building. 14. Orthetic and/or Prosthetic Activity. The scales of this project denotes a need for a small amount of orthetic and prosthetic activity within the center to provide close liaison between the patient and the medical team. This activity requires the production of small devices such as feeders and page turners , and the adjustments and repairs made to wheelchairs, braces, limbs, crutches, and splints. Major appliances can be obtained from commercial services and tailored to the patient's needs by the center's shop. a. Location within building. As the orthetic and/or prosthetic activity application will pertain to outpatients requiring minor adjustments or repairs to their devices, it should be easily cessible to the patient upon entering the Burn Center. The activity should be located in a noisy zone, and, if possible, near exercise activities so that the patient may try out his prosthesis or braces. -28ac- b. Fittings. This activity consists of taking measurements Fitting and for the fitting and removal of prosthesis or braces. activities should be directly associated with the orthetic and prosthetic maintenance activity. accommodate wheelchairs. Equipment should include a treatment table with work space on both sides and at one end, a small desk, a chair, and hook strip for clothes, crutches, etc. Since a fitting requires the trying out of prosthesis or braces, the area should be large enough to hold a set of parallel bars 15 feet long by 3 feet wide; a set of stairs 3 feet by six feet; a ramp 3 feet by 6 feet wide; and a posture mirror. Privacy Allowances should be made to is preferred for this purpose as the patient is often disrobed when trying out prosthesis or braces. c. Workshop. Minimum shop facilities include a workbench, 3 feet by 5 feet with a limb vise; and 4% inch heavy duty swiveltype vise; and a 50 lb. anvil with work area around it (4' x 4'). The bench should have 36" clearance at both ends. Equip the bench with tool storage. Also include a 14" wood and metal cutting band saw (2'x 2'); a 3/4h.p. pedestal type buffer and grinder (can be wall mounted or utilize approximately 4'x 4' floor area, including work space. The sewing machine should be a combination patching and heavy duty type with a movable flat bed. with plaster bins. Provide a counter Equip a lavatory with a plaster trap, and pro- vide a medicine cabinet. -29- Provide storage space for replacement parts other and supplies, (approximately 100 cu. ft.) 15. Physical Therapy: There should be two major divisions of treatment activities, dry and wet. Dry activities include the exercise activities and treatment cubicles; whereas the wet activities include all hydrotherapy treatment, tanks, and related facilities which have already been discussed on page 7. The activities should be so that scheduled patients may proceed directly to physical therapy without interfering with circulation to other departments. As physical therapy may take advantage of certain outdoor activity, place the exercise activity near the outdoors and remove from quiet zones. 16. (Pertains to Clinical Physical Therapy only.) Food service. Facilities for meals and/or snacks should be provided for employees, visitors, and patient's family members. It should be close to the lounge and visitors area. Approximately 100 to 150 people would utilize its service through the day. However, it is not expected that over five people would utilize it at one time. A set of vending machines would be appropriate. 17. Other Activities Associated with the Burn Center and Located within the Center Proper: a. Director. The director of the burn care facility should be located in the unit, for matters which pertain specifically to the management of the facility. The director will require one secretary. -30- b. Social worker. This team member works closely not only with the patient and burn team, but with members of the patient's family and various agencies which may be able to assist in rehabilitating the patient. The social worker should be located near the visitors. will be required, c. Visitors' waiting area. Often families travel long distances to see the patient and maintain long vigils in or near the facility. Their waiting area should be located near the snack bar and should be provided with a minimum amount of entertainment, i.e., television. If the facility houses 30 patients, at least 60 visitors could be present at one time. This activity is closely associated with that of the social worker. d. Skin bank. Procurment of skin for the skin bank, as well For this facility one full time social worker as research activity, will be handled by Texas Tech University School of Medicine and the Lubbock County Teaching Hospital. The Burn Center will maintain a refrigerator to store the skin and a desk or counter for record keeping. e. Burn Clinic. For minor burns undergoing primary treatment on an outpatient basis, a typical clinic setting is adequate. However, it is important that larger injuries be followed, beyond the point of primary wound healing (isolation ward), at least until problems of scarring, contractures and/or psychosocial adjustment can be fully evaluated and definitive treatment planned. For these -31- patients undergoing rehabilitation, a clinical activity interrelated with or in close proximity to the isolation unit of the burn care facility is desirable since these patients should be seen by many members of the burn care team. There will be approximately three outpatients per hour ( 24 outpatients per day) involved in burn treatment or rehabilitation activities. f. Observation. The Burn Center will be involved in the medical school's activities and requires facilities for observing certain activities involving the patient, i.e., surgery, and patient monitoring, for educational and research data gathering purposes. 18. Personnel: Figure #2 gives a listing of the personnel required to adequately operate a Burn Center of this size. Figure #3 gives a listing of the personnel required to operate the facility at any one time as per a regular three shift day. -32- PERSONNEL A. FULL-TIME ASSIGNMENTS 1. Doctors** a. General Surgeon (Director) b. Surgical Resident c. I ntern Nurses a. Head Nurse b. Registered Nurses c. Licensed Practical Nurses d. Burn Care Technicians e. Nurses' Aides Other Paramedical a. Lab Technician b. Social Worker Service Personnel a. Janitor b. Maid c. Secretary-Cl erk FTE* Positions 2 2 2 2 39 16 8 8 2 2 6 6 4 2. 3. 4. B. PART-TIME ASSIGNMENTS 1. 2. 3. 4. 5. 6. Anesthetist Dietician Inhalation Therapist Microbiologist Occupational Therapist Operating Room Nurse and Technician 7. Pharmacist 8. Physical Therapist C. ON-CALL (For Full or Part-time assignment) 1. Anesthesiologist 2. Chaplain 3. Pediatrician 4. Physiatrist 5. Psychiatrist 6. Special Education Teacher *Full-Time Equivalent; i.e., 40 man-hours per week. **These doctors are usually responsible for more than 30 patients. That is, clinic outpatients, rehabilitation inpatients, and inpatients with small burns. FIGURE #2 -33- MASTER STAFFING PATTERN FOR BURN UNIT (THREE SHIFTS PER DAY) PERSONNEL Head Nurse Assistant Head Nurse Staff Nurse LVN II LVN 1 LVN Nurse Aide Ward Clerk Service Aide Burn Unit Technical Coordinator 7-3 1 1 10 2 0 1 1 1 1 1 3-11 0 1 10 0 2 2 1 1 1 0 V^l 0 1 8 1 1 1 1 1 0 0 EXTRA PERSONNEL - ROTATING SHIFT Assistant Head Nurse Staff Nurse Ward Clerk Service Aide 1 H 2 1 FIGURE #3 -34- FINANCING The financing of the original project will be arranged through funds and grants as shown in Figure #4. The financing and continued operation of the Burn Center, after construction, will fall under the direction of Texas Tech University Health Sciences Center. (See Appendix "D", page 60). Accounting procedures will be an extension of those already existing with the Medical School. All charges, billings, insurance claims and financing will be handled through existing offices which will be located in the main hospital building. The Burn Center will be required to maintain a cashier which will initiate the original charge on each patient and forward it to the Medical School's finance office. Salaries will be obtained from state funding (base salary), federal grants, and patient accounts. -35- FUNDING 50% STATE FUNDS 10% i-^'4rili 9!.X94f'jf'.ifif.i'i'.{'.,Z HILL-BURTON 40% FEDERAL GRANTS FIGURE #4 -36- CLIMATOLOGY INFORMATION 1. 2. 3. 4. 5. Lubbock, Texas Latitude: Longitude: Elevation: Temperature: A. Average: 1. 2. B. Daily max. 73.6 Daily min. 45.8 33 39' N 101 49' W 3250 feet above sea level Extremes: 1. 2. High = 1070 (July 1958) Low = -16 (January 1963) 6. Precipitation: A. Normal = 18.41 during a year B. Max. monthly = 8.85 C. Min. monthly = 0 D. 7. Snow - max. 12 inches in 24 hours Wind: A. Mean speed = 13.0 mph Average for year: 8. Humidity: A. B. C. D. time - 0000 = 59 time - 0600 = 71 time - 1200 = 46 time - 1800 = 40 -37- 9. Date March 22 Altitude Sun Angles: 8:00 a.m. 25 E 75 35 E96 25 E 75 10 E 54 12 :00 noon 60 0 82 0 60 0 35 0 W 5:00 p.m. 13 W 82 24 W 104 I3O W 82 *Declination July 22 Altitude Declination Sept. 22 Altitude Declination December 22 Altitude Declination 2 65 * Declination taken from south. -38- CLIMATOLOGY DESIGN CRITERIA 1. Temperature: A. Max. 90 B. Min. 10 2. Precipitation: A. 2" in 24 hours B. 6" in one month C. Serriarid D. Snow - 10" in 24 hours 3. Wind: A. 40 mph ^ Texas Almanac and Book of Facts. Doubleday and Company, Inc., Garden City, New York: (published annually). -39- SITE INFORMATION 1. OWNERSHIP: Texas Tech University School of Medicine (State of Texas.) 2. DISCRIPTION AND CONFIGURATION: Refer to Texas Tech University Campus Map #16b, sheet #2 of 2 - property south of 4th Street. 3. UTILITIES: Refer to Plat of utility easements, Texas Tech School of Medicine, exhibit B-1 and B-2. 4. ZONING ORDINANCES: None (state property). However, the uniform (See appendix building code will be adhered to. "A"). 5. EASEMENTS: Information is indicated on maps referenced in items 2 and 3 above. 6. DEED RESTRICTIONS: None (State of Texas). 7. APPLICABLE LINES OF STREETS, ALLEYS, PAVEMENTS AND ADJOINING PROPERTY: Same as referenced in #2 above. 8. EXISTING BUILDINGS (PRESENTLY BEING CONSTRUCTED). Refer to Texas Tech University School of Medicine project site plan. -40- SOIL ANALYSIS BORINGS (Fig.#5) 1 2 3 4 TYPE OF MATERIAL COMPRESSIVE STRENGTH (psf) 22,380 8,910 6,020 8,870 DEPTH Brown sandy clay Light tan and white sandy clay Brown sandy clay Light tan and white sandy clay 2'-0" 4'-0" 0'-6" 4'-0' Light tan and white sandy clay 8,350 10,690 0'-6'' 9'-0" 4'-0" Tannish brown sandy clay 21,920 -41- (INDIANA ST.) TEXAS TECH UNIVERSITY SCHOOL cf MEDICINE 00 CO to #1 #3 #5 o o #2 #4 #6 378 L 600' 600' -^ BORING LOCATION FIGURE #5 -42- APPENDIX "A" EXCERPTS FROM UNIFORM BUILDING CODES Sec. 901 Sec. 902.a Group "D" occupancy division 2 (fire zone #3). Type of construction can be type I or II. Type I does not have limits of area or height. Type II limits itself to three (3) floor height and area to 11,300 + (11,300 x 33 1/3%). (Lubbock city zoning laws limit A-M zoning to three (3) stories). Sec. 902.b Each story must provide horizontal exits or shall be divided into not less than two (2) compartments, accommodating approximately the same number of nonambulatory persons in each compartment, by a smokestop partition with a one-hour occupancy separation for a place of refuge. Corridor openings should have one-hour firedoors and ducts should have firedampers in the plane of the wall. Sec. 903 Exterior walls should have fire protection of two (2) hours if less than twenty (20) feet from adjoining building, and one (1) hour elsewhere. Exterior openings should have fire protection if less than ten (10) feet from adjoining structure and are not permitted if less than five (5) feet. Sec. 904 See Section 3318: A. Every room shall have access to at least two -43- approved means of egress from the building without passage through intervening rooms other than corridors or lobbies. All required exterior exit doors shall open in direction of exit travel. B. Every exit opening through which patients are transported in wheelchairs, stretchers or beds shall be wide enough to permit the passage of such equipment, but shall have a clear width of not less than 44 inches. C. The minimum clear width of a corridor shall be 44 inches, except that corridors serving any area housing one or more nonambulatory persons shall not be less than eight (8) feet in width. There shall be no change of elevation in a corridor serving nonambulatory persons unless ramps are used. E. Nonambulatory patients shall have access to a ramp leading from the first story to the exterior of the building at the ground floor level. F. Exit doors serving an occupant load of more than 50 shall not be provided with a latch or lock unless it is panic hardware. Patient room doors whall be readily openable from either side without the use of keys. -44- Sec. 905 All portions of Group D Occupancies customarily used by human beings shall be provided with light and ventilation by means of windows or skylights with an area equal to one-eighth of the total floor area, one-half of which shall be openable, or shall be provided with artificial light and a mechanically operated ventilating system. Sec. 908 All exterior openings in a boiler room or room containing central heating equipment if located below openings in another story, or if less than ten (10) feet from the other doors or windows of the same building, shall be protected by a fire assembly having a three-fourths hour fire-protection rating. Such fire assemblies shall be fixed, automatic, or self-closing. Every room containing a boil- er or central heating plant shall be separated from the rest of the building by not less than a One-Hour Fire-Resistive Occupancy Separation. Sec. 909 An approved fire alarm system shall be provided for all Group D Occupancies. Audible alarm devices shall be used in all nonpatient areas. Visible alarm devices may be used in lieu of audible devices in patient occupied areas. Sec. 1711 Toilet room floors shall have a smooth, hard, nonabsorbent surface such as portland cement, concrete, -45- ceramic tile or other approved material which extends upward onto the walls at least five (5) inches. Walls within water closet compartments and walls within two (2) feet of the front and sides of urinals shall be similarl> finished to a height of four (4) feet and except for structural elements, the materials used in such walls shall be of a type which is not adversely affected by moisture. Toilet facilities and water closet compartments shall have a clear and unobstructed access of not less than 32 inches, and a clear space, unobstructed by door swing, grab bars and similar items, of not less than 32 inches shall be provided in front of the toilet stool. Grab bars shall be provided on two sides or one side and the back of each toilet compartment. Sec. 1712 Where water fountains are provided, at least one shall have a spout within 33 inches of the floor and shall have up-front, hand-operated controls. When fountains are located in an alcove, the alcove shall not be less than 32 inches in width. Sec. 1715 A. Helistops may be erected on buildings or other locations if they are constructed in accordance with this Section. -46- B. The touchdown or landing area for helicopters of less than 3500 pounds shall be a minimum of 20 feet by 20 feet in size. The touchdown area shall be surrounded on all sides by a clear area having a minimum average width at roof level of 15 feet but with no width less than 5 feet. c. Helicopter landing areas and the supports therefor on the roof of a building shall be a noncombustible construction. Landing areas shall be designed to confine any flammable liquid spillage away from any exit or stairway serving the heli copter landing area or from a structure housing such exit or stairway. D. All Landing areas located on buildings or structures shall have two or more exits. For landing platforms or roof areas less than 60 feet in length, or less than 2000 square feet in area, the second exit may be a fire excape or ladder leading to the floor below. E. Before opening helicopters from helistops, approval must be obtained from the Federal Aviation Agency. Sec. 3802 Install automatic fire-extinguishing systems in ewery story, basement or cellar when floor area exceeds 1500 square feet and there is not provided at least -47- 20 square feet cf opening entirely above the adjoining ground level in each 50 lineal feet or fraction thereof of exterior wall in the story, basement or cellar on at least one side of the building. -48- APPENDIX "B" EXCERPTS FROM LUBBOCK ZONING ORDINANCE SECTION 12 AM (APARTMENT-MEDICAL) DISTRICT 12.1 PURPOSE The purpose of this district is to provide for quality medical and related development through proper planning and design. The regulations are intended to produce an attractive environment which will insure the compatibility between medical and other uses; encourage and protect future development; provide modern facilities for the public; provide proper accessory uses; and promote, stabilize, and enhance the City as a medical center. When proposed development in this district is adjacent to any residentially zoned property, the proposed development shall be designed to provide for maximum compatibility with the adjacent development. Architectural design, landscaping, screening, and parking areas shall be provided to insure maximum protection of the adjacent uses. 12.3 PERMITTED USES 12.3-2 12.3-3 Blood Bank Convalescent nursing, orphan, maternity, or geriatrics homes. -49- 12.3-5 Hospital, clinic or medical office, except veterinary facilities. 12.3-7 Administrative offices for the medical profession including independent management, legal, accounting and bookkeeping services for doctors, hospitals, clinics, and medical personnel. 12.3-9 Schools, private or public, directly related to the medical profession. 12.4 CONDITIONAL USES 12.4-7 Ambulance service and other medically related facilities of a primarily service type nature not provided for as permitted uses in this District. 12.6 YARD REQUIREMENTS 12.6-1 Front Yard. The minimum front yard shall be twenty-five (25) feet, except that when the entire front yard is landscaped and permantely maintained, the required front yard may be fifteen (15) feet. This section shall not be construed as to permit obstructions of any nature on corner lots within the visibility triangle as defined in Section 27.2-6-9-2. -50- 12-6-2 R^eaMTard. The minimum rear yard shall be five (5) feet. 1^.6-3 Sj^ejrard^. There shall be a minimum side yard of ten (10) feet on each side of any one (1) or two (2) story structure, and twenty (20) feet on each side of any structure with more than two (2) stories. 12.7 LOT WIDTH The minimum lot width shall be fifty (50) feet, 12.8 LOT AREA The minimum lot area shall be six thousand (6,000) square feet. 12.9 LOT COVERAGE The combined area of all buildings shall not exceed forty (40) percent, except that permitted accessory uses in apartment developments may cover an additional ten (10) percent of the development lot area. 12.11 HEIGHT LIMIT Buildings shall not exceed three (3) stories and shall not exceed forty (40) feet. Provided, however, the buildings may be erected to a height of seventy-five (75) feet when the front, side and rear yards are -51- increasi.' or.o (1) ddditional foot for each foot such buiidirms exert d forty (^0) feet. 12.12 OI-F-STRLLT F'Af>n]^i' 12.1:-1 Off-Strret [\irHng - Required. 12.12-1-? Hospital - two (2) spaces for each bed. 12.12-1-3 Clinic and Offices - one (1) space for each one hundred and fifty (150) square feet of gross floor area. 12.12-1-6 Medical, dental, or optical laboratories - one (1) space for each one hundred and fifty (150) square feet of gross floor area. 12.12-1-7 Schools - one (1) space for each one hundred and fifty (150) square feet of gross floor area. 12.12-2 Off-Street Parking - Provisions. 12.12-2-1 All parking spaces required herein shall be located on the same lot with the building or use served except that where an increase in the number of spaces -52- is required by a change or enlargement of a permitted use of building, the required additional spaces may be located a distance not to exceed three hundred (300) feet from the property line. 12.13 LANDSCAPING REQUIREMENTS 12.13-2 All Other Uses. 12.13-2-1 Ten (10) percent of the total development lot area shall be landscaped and permanently maintained. All of the required landscaping shall be located between the building lines and adjacent streets. 12.13-2-2 The parkway area shall be landscaped and permanently maintained This area shall be in addition to the required landscaping. -53- APPENDIX "C" EXCERPTS FROM OSHA STANDARDS 1. Cylinders. Compressed Gas a. Compressed gas cylinders shall be kept away from excessive heat, shall not be stored where they might be damaged or knocked over by passing or falling objects, and shall be stored at least twenty (20) feet away from highly combustible materials. b. Where a cylinder is designed to accept a valve protection cap, caps shall be in place except when the cylinder is in use or is connected for use. c. Oxygen cylinders, in storage shall be separated from fuelgas cylinders or combustible materials (especially oil or grease) a minimum distance of twenty (20) feet or by a noncombustible barrier at least five (5) feet high having a fire-resistance rating of at least 1/2 hour. 2. Drinking Water a. Potable water shall be provided in all places of employment, b. The nozzle of a drinking fountain shall be set at such an angle that the jet of water will not splash back down on the nozzle, and the end of the nozzle shall be protected by a guard to prevent a person's mouth or nose from coming in contact with the nozzle. -54- c. Portable drinking water dispensers shall be designed and serviced to ensure sanitary conditions, shall be capable of being closed, and shall have a tap. Unused disposable cups shall be kept in a sanitary container, and a receptacle shall be provided for used cups. The common drinking cup is prohibited. 3. Electrical Installations Every new electrical installation or replacement shall be installed or made and maintained in accordance with the provisions of the National Electrical Code. 4. Emergency Flushing, Eyes and Body Where the eyes or body of any person may be exposed to injurious corrosive materials, suitable facilities for quick drenching or flushing of the eyes and body shall be provided within the work area for immediate emergency use. 5. Exits a. Every building designed for human occupancy shall be provided with exits sufficient to permit the prompt escape of occupants in case of emergency. b. Where occupants may be endangered by the blocking of any single egress due to fire or smoke, there shall be at least two means of egress remote from each other. c. Exits and the way of approach and travel from exits shall be maintained so that they are unobstructed and are accessible at all times. -55- d. All exits shall discharge directly to the street or other open space that gives safe access to a public way. e. Exit doors serving more than 50 people, or at high hazard areas, shall swing in the direction of travel. f. Exits shall be marked by readily visible, illuminated exit signs. Exit signs shall be distinctive in color and provide The work "EXIT" shall be of contrast with surroundings. plainly legible letters, not less than six inches high. 6. Fire Protection a. Portable fire extinguishers suitable to the conditions and hazards involved shall be provided and maintained in an effective operating condition. b. Portable fire extinguishers shall be conspicuously located and mounted where they will be readily accessible. Extin- guishers shall not be obstructed or obscured from view. c. Portable fire extinguishers shall be given maintenance service at least once a year with a durable tag securely attached to show the maintenance or recharge date. d. In storage areas, clearance between sprinkler system defectors and top of storage varies with the type of storage. For combustible material stored over 15 feet but not more than 21 feet high in solid piles, or over 12 feet but not more than 21 feet high in piles that contain horizontal channels, the minimum clearance shall be 36 inches. The minimum clearance for smaller piles or for noncombustible materials shall be 18 inches. -56- 7. Flammable Liquids Incidental to Principal Business a. Flammable liquids shall be kept in covered containers when not actually in use. b. The quanity of flammable or combustible liquid that may be located outside of an inside storage room or storage cabinet in any one fire area of a building shall not exceed 25 gallons of Class lA liquids. 8. Floors a. All floor surfaces shall be kept clean, dry, and free from protruding nails, splinters, loose boards, holes, or projections. b. Where wet processes are used, drainage shall be maintained, and false floors, platforms, mats, or other dry standing places should be provided where practicable. 9. Housekeeping All places of employment, passageways, storerooms, and service rooms shall be kept clean and orderly and in a sanitary condition. 10. Lunchrooms a. Employees shall not consume food or beverages in toilet rooms or in any area exposed to a toxic material. b. Covered receptacles corrosion resistant to disposable material shall be provided in lunch areas for disposal of waste food. The cover may be omitted where sanitary -57- conditions can be maintained without the use of a cover. 11. Mats, Insulating Where motors or controllers operating at more than 150 volts to ground are grounded against accidental contact only by location, and where adjustment or other attendance may be necessary during operations, suitable insulating mats or platforms shall be provided. 12. Personal Protective Equipment a. Proper personal protective equipment, including shields and barriers, shall be provided, used, and maintained in a hazard from processes or environment that may cause injury or illness to the employee. b. Where employees furnish their own personal protective equipment, the employer shall be responsible to assure its adequacy and to ensure that the equipment is properly maintained and in a sanitary condition. 13. Toilets a. Every place of employment shall be provided with adequate toilet facilities which are separate for each sex. Water closets shall be provided according to the following: 1-15 persons, one facility; 16-35 persons, two facilities; 36-55 persons, three facilities; 56-80 persons, four facilities; 81-110 persons, five facilities; 111-150 persons, six facilities; over 150 persons, one for each additional 40 persons. -58- b. Each water closet shall occupy a separate compartment which should be equipped with a door, latch, and clothes hangers. c. Adequate washing facilities shall be provided in every toilet room or be adjacent thereto. d. Covered recepticles shall be kept in all toilet rooms used by women. -59- lO Ol .c: I! > o 1 - s> fd on < : OJ r CO + J <u U > +J r - CU 4-> S- c <u fo a a. cj < o < U) o c E E 4- O +J f- <_) =3 CD a: o c (U en a; on ^- tH1 4-> C > rr -M O U t/0 to (U cu 4-> C S- o a r- a; <D UJ a I o r^> s.. to CO C/) o <D i- X a. o a. o. l-i <_) </) c <u o s<u s- oo o 4-> - -> u s(U o r o . o t 3) / a; r ^ > 1 cu o o c cu ^ s3 T- OQ O (O 4J 13 r U C o L u c: cu UJ o (U r X ^ so +> 4-> r- o Q . cu to sO rrc O fO c o 0) 00 -o /) 4 J (U r &- fO O- (1) r(0 O h> 1 rc < =3 u O so 4-> CJ S- I/) _ x: fo oo cu c 4-> cu r C r CU r " rC_) Q &- -60- DESIGN ANALYSIS The final design for the Texas Tech University School of Medicine's Burn Center was developed through a series of proposals and subsequent revisions and refinement. These proposals, along with the final plan will be found in slide form at the end of this document. The following material is intended to detail some of the criteria on which the final design is based. The major considerations for the site selection was Lubbock's ever growing position as a regional center in the West Texas area. Also, the need for in-depth studies into improved care for the "burn" patient and Texas Tech University School of Medicine's interest in the field of thermal trauma made Texas Tech University School of Medicine's present site an ideal location for the Burn Center and its related teaching facilities. The existing buildings on the site played an important part in selecting exterior building materials and application of certain design elements. Although the building form in general was a result of a functional circulation pattern, the light-colored exposed aggregate precast wall panels; the dark horizontal band of insulated wall panels, or thermal glass; the dark reveal above the canted base; and the overall subtleness of the exterior features of the Burn Center were intended to blend in a compatable fashion with the enormity and the horizontal emphasis of the medical school and teaching hospital. Circulation among the buildings was achieved through application of sidewalks at the grade level for use during fair weather and -61- enclosed connections at the basement level for bad weather and access to service areas in the medical school and teaching hospital such as record storage, blood bank, decontamination and cleaning areas, food preparation, sterile supply and nursing wards. Vertical connections between the basement and the isolation units were achieved through elevators for personnel and a system of dumbwaiters for transporting sterile supplies, medication and nourishment and for removal of dirty linen, trays and refuse. This dual dumbwaiter system provides a means of total separation of dirty and clean articles and prevents a source of cross-contamination. The Burn Center proper is based on the "isolation" recovery concept. Its building, therefore, is isolated from the other struc- tures and its patients isolated from other activities, physically, by placing them on a second level. Within the second level, patients are isolated and separated into three areas of recovery, ICU, Comprehensive Care and Convalescent Care. The circulation patterns in the patient areas involve the flow of patients, medical staff, orderlies and visitors with the continual maintenance of isolation integrity. Study of the interior arrangements of the Burn Center reveals a need to orient the activities so that functional areas are developed which have activities of a similar nature and have relationships with adjacent areas such that cross-traffic and "double backs" are eliminated as much as possible. Some activities which have been developed with the above concept in mind have been the combination of nourishment, medication, and clean -62- linen into a central s u p r b . preparation, and distribution area. Dressing changes and admitting has also been combined and is located near hydrotherapy. Since most patients will be brought to the dressing change area 2 - 3 tir.es a day. the lab can also take advantage of this location and by being close at hand, preventing lengthy "specimen gathering trips" through the isolation facility. Physical therapy, occupational therapy, activities of daily living, hydrotherapy and dressing changes are more closely associated to the convalescent care unit because the ambulatory patients will use these facilities much rr.ore than the other patients, with the exception of approximately 50% of the hydrotherapy facility. There are two separate entrances into the isolation area in general to provide a separation between the visitors and support activities and patient arrivals. The visitors' entrance is located near the ward clerk. The support and patient entrance is central to the support activities and admitting. The concept of separation mentioned above has been carried out in the main entrances to the Burn Center with a distinct separation between the entrance of the visitors and clinic patient, and the ambulance (or patient) arrival area. Support for the emergency room is provided by arranging the emergency room near the outpatient clinic facility. The doctors on duty will then have an opportunity to determine if the patient (excluding referrals) will require isolation or if the burn is minor enough, to only require clinical attention and inrrediate release. -63- Within the main entrance, a centralized receptionist functions as a clinic receptionist and informant for visitor and/or family members. The reception area is directly connected with visitor areas on other floors by means of an elevator. Visual relief is a must for the patient who is restricted to a bed or convalescent area for extended periods of time. Windows which look out on a view of some type have been incorporated. The quality of each space is a major psychological consideration. Flexibility for growth has been provided by developing a structural system which allows for renovations to absorb the increase in patient load until the demand for space becomes such that major renovations and/or expansion will be required. When expansion is necessary, the configuration and structural system of the isolation units allows for vertical growth. A sample of the structural calculations is shown in Figure #6 on the following page. The mechanical system utilizes the steam, chilled water, and power generated by the existing power plant. The mechanical system selection was based on the availability of service from the existing plant and the necessity for low viberation levels within the isolation units. Therefore, the air handling equipment was located in the basement and cold air ducted throughout the Burn Center with terminal reheat units located within each zone. Ducting and piping occurs within chases provided and within an intersticial space located between each floor. -64- STRUCTURAL CALCULATION This example deals with one of the major beams t y p i c a l l y located i n the i s o l a t i o n u n i t s . 1,280 Sq.Ft. X 100 K/Sq.Ft. 40 Ft. 3.2 K/Ft. y7m7777//777777777777777777/77777//7/777/JT777\ 3.2 K/Ft, 40 Ft. f^nax = WL: 8 = 3.2 K/Ft. (40 Ft.)"^ 8 640 K Ft. = = 640 = 320 in. Use W24xl30 (From Tables) FIGURE #6 -65- The basic concept for distributing the air within patient spaces is to inject the air at ceiling level, allow it to pass over the patient, and to exhaust it near the floor. This procedure keeps cross-contamination via dust down to a minimum. General heat-loss calculations are shown in Figure #7 on the following page. -66- GENERAL HEAT LOSS Basement Item # 1 2 3 Surface or Item Basement walls Perimeter Floor slab TOTAL First Level 1 2 3 4 5 6 Ceiling Floor slab Thermal glass Glass doors Canted wall Insulated precast panel TOTAL Second Level 1 2 3 4 Ceiling Floor slab Thermal glass Insulated wall panel TOTAL 29,456 29,456 1,960 4,340 .45 .60 .53 .16 30 30 60 60 397,656 530,208 62,328 41,664 1,031,856 29,456 29,456 3,200 210 4,000 1,600 .45 .60 .53 1.13 .10 .09 30 30 60O 60 60 60 357,656 530,208 101,760 14,238 24,000 8,640 1,076,502 Area 6,850 685 f t . 30.032 U-Factor .26 .81 .10 T 15 15 20 BTUH 26,715 8,323 60,064 95,102 GRAND TOTAL (HEAT LOSS) 2,203,460 FIGURE 7 -67- BIBLIOGRAPHY American Hospital Association Annual Survey. American for the ren 1975. Standards Association. American Standard Specifications Making Buildings and Facilities Accessible to and Usable by Physically Handicapped. National Society of Crippled Childand Adults, Inc. Cnicago: 1961. Duffek, George. Burn Unit Technical Coordinator. Interviewed by Nolan E. Brown. Dallas, Texas: November 7, 1975. (Mr. Duffek has 20 years experience in burn care and treatment.) Feller, Irving, M.D. Planning and Designing a Burn Care Facility. Institute for Burn Medicine, Ann Arbor, Michigan: 1971. (Extremely good for determining areas of consideration) Lawton, Edith. Activities of Daily Living for Physical Rehabilitation. McGraw-Hill, New York: 1963. Local Climatological Data Annual Summary with Comparative Data. Lubbock, Texas: 1974. MacMillan, Bruce G., M.D. "Color is the Key to Sepsis Control in Cincinnati Burn Center," Journal of the American Hospital Association - Hospitals. Volume 44 (February 16, 1966). Putsep, Ervin. Planning of Surgical Centers. Lloyd-Luke (Medical Books) Ltd. London: 1973. (Has good information on surgery units.) Salman, F.C. Rehabilitation Center Planning. Pennsylvania State University Press, University Park, Pennsylvania: 1970. (Extremely good for relations and O.T. and P.T.) Texas Almanac and Book of Facts. Doubleday and Company, Inc., Garden City, New York:(published annually). (Climate information) Tov.c Tprh University Complex: Organizational Structure. Texas Tech University, L U D B O C K , lexas: 1975. Wallace. A.B. Rp^parch in Burns: Transactions of f^^^,^^!^ ., ., InternatioTiirrConqress on Research in Burns, t. & S. Livings ton, LTD., Edinburge:1966. (History) -68-

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