severe shock? Massive earthquakes? This $1.5 billion hospital is a reality

As the largest hospital in California and one of the comprehensively equipped Level I trauma centers, the recent campus redesign of Loma University Medical Center required the new hospital to have some very special precautions built into it.

[Photo: Benjamin Benschneider]From dealing with mass casualty events to the challenges hospitals face in dealing with a global pandemic, this modern hospital had to be prepared for the worst. As if that weren’t enough, the hospital is located half a mile from the San Jacinto Fault, a branch of turbulent San Andreas, capable of causing earthquakes of up to 7.8 on the Richter scale. The redesign called for a resilient hospital capable of handling severe medical emergencies and severe seismic activity.

The new $1.5 billion hospital in Loma Linda opened earlier this summer and features a variety of design features aimed at improving its resilience to these risks. Designed by architecture firm NBBJ and engineers from Arup and built by general contractor McCarthy Builders, some of the most innovative protections are hidden tucked away in the basement in the form of a unique and relatively uncommon system that allows the sliding floor to move under the main hospital building without feeling any extreme vibration in the the above.

[Photo: Benjamin Benschneider]More than 120 bearing-like structures known as base insulators were placed between the foundation and the tower, forming a kind of insulating slip between the two. Each 10-ton insulator acts like a staggered set of sliders, able to move horizontally while still bearing the weight of the building. In the event of an earthquake, the building would be able to accommodate up to 42 inches of movement in any direction.

“It’s easy to imagine a building moving on insulators, but the opposite is true,” says Simon Reese, Arup’s Los Angeles office manager. “The building remains static and allows the land to move under it.”

[Photo: Benjamin Benschneider]These basic insulators, common in Japan, are a relatively new structural component in the United States, says Ries. In Japan, “they are being employed on a much larger scale because this risk is at the forefront of society’s minds,” he says.

Other elements of flexibility include the spatial design of the hospital. With specialized departments for both adults and children, the hospital is a two-in-one hospital. Emergency departments, one for adults and one for children, were placed on the same site rather than in separate facilities, as is common. Being right around the corner, one can make extra space for the other during mass casualty events or when the emergency department is overwhelmed by what looks like a pandemic.

[Photo: Benjamin Benschneider]“In a surge event, you can treat yourself to a pediatric ED test and treatment center, or indulge in an adult,” says Jose Sama, an architect at NBBJ. “So there’s a lot of wiggle room.”

This kind of flexibility is also part of the way each of the patient rooms has been designed, with the examination room being able to be transformed to handle severe illnesses as an intensive care unit by bringing in different equipment, for example.

A hospital floor plan helps achieve this. The building’s long wings are designed with a width that requires only one row of central beams for structural support, opening up more space for nursing stations, and making it easier to move large equipment from room to room.

[Photo: Benjamin Benschneider]“They reduce the size of the structure to create more flexibility,” Sama says.

They also allow large windows at the ends of the corridors to let more light flow into the hospital floor, and windows from individual examination and patient rooms to bring more light into the nurse’s central stations and family waiting areas. Windows may seem like basic architectural elements, but natural light in hospitals is not a given.

Aside from improving the flow of equipment and healthcare workers, these touches also have benefits for patients and families. Sama says these design elements are intended to improve the hospital’s resilience and resilience in the face of traumatic events, but are also ways to reduce the traumatic experience that might result from having to be in the hospital in the first place.

[Photo: Benjamin Benschneider]It’s something his family knows very well. His son recently had to spend several days at another children’s hospital, and Sama says the lack of lighting and the crowded place added to the annoyance. “I can’t tell you how bad those spaces were, and how much we felt like we were in a cave,” he says. “Here I design things [my son] Dislikes. I try to make him understand that there are better ways to take care of people.”

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