FAR

INSTITUTE OF ARCHITECTURE AND FINE ARTS

DESIGN RESEARCH PAPER:

PROPOSED TRAUMA
CAPABLE CENTER

SUBMITTED BY:
MODINA, PATRICIA ANNE M.
DESIGN 741/ SEC 12

SUBMITTED TO:
ARCH. A.C. DE VERA

TABLE OF CONTENTS:
I.

INTRODUCTION

II.

DEFINITION OF TERMS

III.

DESIGN CONSIDERATIONS

IV.

DESIGN PLANNING

13

V.

CASE STUDY

15

VI.

PERTINENT LAWS

16

VII. CONCLUSION

20

VIII. LIST OF REFERENCES

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I.

Introduction:

Injury is an increasingly significant health problem throughout the world. Every day,
16000 people die from injuries,
and for every person who dies,
several thousand more are injured,
many of them with permanent
sequel. Injury accounts for 16% of
the global burden of disease. The
burden of death and disability from
injury is especially notable in lowand middle-income countries. By far the greatest part of the total burden of injury,
approximately 90%, occurs in such countries. Similarly in the Philippine experience, injuries
arising from accidents (external cause of death) are one of the leading causes of mortality.
By adopting improvements in trauma care and services, deaths and disabilities caused
by injuries and violence can be significantly lowered by provision of continuum of care from
pre-hospital phase, through trauma care in health facilities, to rehabilitation as an important
part of healthy systems strengthening. Evidence shows that up to 30% of trauma deaths can
be prevented through provision of prompt effective pre hospital and health facility care.
Justifying the need for a facility, House Bill 6035 by former Speaker F. Belmonte and other
leaders of the House of Representatives are pushing for the establishment of a medical
trauma center in Central Luzon.
A trauma center is a specialized hospital that treats victims of physical trauma.
Physical trauma is defined as blunt, penetrating or burn injury that requires immediate
medical treatment in order for the person who has sustained such injury to survive. Most
often, these types of injury are the result of falls, auto accidents, gunshots, stabbings and/or
burns. A trauma center is staffed 24 hours a day, 7 days a week with a trauma surgery team
that is specially qualified to attend to traumatic injury. After the patient is stabilized, his/her
continue of care is the responsibility of the trauma center staff until the patient is released
from the trauma center.
Trauma Center Levels:

Level I
Level I Trauma Center is a comprehensive regional resource that is a tertiary care
facility central to the trauma system. A Level I Trauma Center is capable of providing total
care for every aspect of injury from prevention through rehabilitation.
Elements of Level I Trauma Centers Include:

24-hour in-house coverage by general surgeons, and prompt availability of

care in specialties such as orthopedic surgery, neurosurgery, anesthesiology,
emergency medicine, radiology, internal medicine, plastic surgery, oral and

maxillofacial, pediatric and critical care.

Referral resource for communities in nearby regions.
Provides leadership in prevention, public education to surrounding

communities.
Provides continuing education of the trauma team members.
Incorporates a comprehensive quality assessment program.
Operates an organized teaching and research effort to help direct new

innovations in trauma care.

Program for substance abuse screening and patient intervention.
Meets minimum requirement for annual volume of severely injured patients.

Level II
A Level II Trauma Center is able to initiate definitive care for all injured patients.
Elements of Level II Trauma Centers Include:

24-hour immediate coverage by general surgeons, as well as coverage by the

specialties of orthopedic surgery, neurosurgery, anesthesiology, emergency

medicine, radiology and critical care.

Tertiary care needs such as cardiac surgery, hemodialysis and microvascular

surgery may be referred to a Level I Trauma Center.

Provides trauma prevention and continuing education programs for staff.
Incorporates a comprehensive quality assessment program.

Level III

A Level III Trauma Center has demonstrated an ability to provide prompt assessment,
resuscitation, surgery, intensive care and stabilization of injured patients and emergency
operations.
Elements of Level III Trauma Centers Include:

24-hour immediate coverage by emergency medicine physicians and the

prompt availability of general surgeons and anesthesiologists.

Incorporates a comprehensive quality assessment program
Has developed transfer agreements for patients requiring more comprehensive

care at a Level I or Level II Trauma Center.

Provides back-up care for rural and community hospitals.
Offers continued education of the nursing and allied health personnel or the

trauma team.
Involved with prevention efforts and must have an active outreach program
for its referring communities.

Level IV
A Level IV Trauma Center has demonstrated an ability to provide advanced trauma
life support (ATLS) prior to transfer of patients to a higher level trauma center. It provides
evaluation, stabilization, and diagnostic capabilities for injured patients.
Elements of Level IV Trauma Centers Include:

Basic emergency department facilities to implement ATLS protocols and 24hour laboratory coverage. Available trauma nurse(s) and physicians available

upon patient arrival.

May provide surgery and critical-care services if available.
Has developed transfer agreements for patients requiring more comprehensive

care at a Level I or Level II Trauma Center.

Incorporates a comprehensive quality assessment program
Involved with prevention efforts and must have an active outreach program
for its referring communities.

Level V

A Level V Trauma Center provides initial evaluation, stabilization and diagnostic

capabilities and prepares patients for transfer to higher levels of care.
Elements of Level V Trauma Centers Include:

Basic emergency department facilities to implement ATLS protocols

Available trauma nurse(s) and physicians available upon patient arrival.
After-hours activation protocols if facility is not open 24-hours a day.
May provide surgery and critical-care services if available.
Has developed transfer agreements for patients requiring more comprehensive
care at a Level I though III Trauma Centers.

II.

Definition of Terms:
1. Trauma
- refers to a serious or critical bodily injury
2. Resuscitate
- refers to revive a person who has lost consciousness
3. Surgery
- refers to treatment of injuries or disorders of the body by incision or manipulation,
especially with instruments.
4. intensive care
- refers to a special medical treatment of a dangerously ill patient, with constant
monitoring
5. Pre hospital care
- refers to a generic term for healthcare provided on-scene at a medical emergency or
major incident, and during transfer of casualties to definitive care facilities
6. Health facility
- refers to any location where healthcare is provided
7. Rehabilitation
- refers to the act of restoring something to its original state
8. Critical care services

refers as a physician's direct delivery of medical care for a critically ill or critically
injured patient.

III.

Design Considerations:

Hospitals are the

most complex of building
types. Each hospital is
comprised of a wide range
of services and functional
units. These include
diagnostic and treatment
functions, such as clinical
laboratories, imaging,
emergency rooms, and surgery; hospitality functions, such as food service and
housekeeping; and the fundamental inpatient care or bed-related function. This diversity
is reflected in the breadth and specificity of regulations, codes, and oversight that govern
hospital construction and operations. Each of the wide-ranging and constantly evolving
functions of a hospital, including highly complicated mechanical, electrical, and
telecommunications systems, requires specialized knowledge and expertise. No one
person can reasonably have complete knowledge, which is why specialized consultants
play an important role in hospital planning and design. The functional units within the
hospital can have competing needs and priorities. Idealized scenarios and strongly-held
individual preferences must be balanced against mandatory requirements, actual
functional needs (internal traffic and relationship to other departments), and the financial
status of the organization.
In addition to the wide range of services that must be accommodated, hospitals
must serve and support many different users and stakeholders. Ideally, the design process
incorporates direct input from the owner and from key hospital staff early on in the
process. The designer also has to be an advocate for the patients, visitors, support staff,
volunteers, and suppliers who do not generally have direct input into the design. Good
hospital design integrates functional requirements with the human needs of its varied
users.
1. Efficiency and Cost-Effectiveness
An efficient hospital layout should:

o Promote staff efficiency by minimizing distance of necessary travel between

frequently used spaces
o Allow easy visual supervision of patients by limited staff
o Include all needed spaces, but no redundant ones. This requires careful predesign programming
o Make efficient use of space by locating support spaces so that they may be
shared by adjacent functional areas, and by making prudent use of multipurpose spaces
o Consolidate outpatient functions for more efficient operationon first floor, if
possiblefor direct access by outpatients
o Group or combine functional areas with similar system requirements
o Provide optimal functional adjacencies, such as locating the surgical intensive
care unit adjacent to the operating suite. These adjacencies should be based on
a detailed functional program which describes the hospital's intended
operations from the standpoint of patients, staff, and supplies.
2. Flexibility and Expandability
Since medical needs and modes of treatment will continue to change, hospitals
should:
o Follow modular concepts of space planning and layout
o Use generic room sizes and plans as much as possible, rather than highly
specific ones
o Be served by modular, easily accessed, and easily modified mechanical and
electrical systems
o Be open-ended, with well planned directions for future expansion; for instance
positioning "soft spaces" such as administrative departments, adjacent to "hard
spaces" such as clinical laboratories.
3. Therapeutic Environment
Hospital patients are often fearful and confused and these feelings may impede
recovery. Every effort should be made to make the hospital stay as unthreatening,
comfortable, and stress-free as possible. The interior designer plays a major role in
this effort to create a therapeutic environment. A hospital's interior design should be
based on a comprehensive understanding of the facility's mission and its patient
profile. The characteristics of the patient profile will determine the degree to which

the interior design should address aging, loss of visual acuity, other physical and
mental disabilities, and abusiveness.
o Using familiar and culturally relevant materials wherever consistent with
sanitation and other functional needs
o Using cheerful and varied colors and textures, keeping in mind that some
colors are inappropriate and can interfere with provider assessments of
patients' pallor and skin tones, disorient older or impaired patients, or agitate
patients and staff, particularly some psychiatric patients
o Admitting ample natural light wherever feasible and using color-corrected
lighting in interior spaces which closely approximates natural daylight
o Providing views of the outdoors from every patient bed, and elsewhere
wherever possible; photo murals of nature scenes are helpful where outdoor
views are not available
o Designing a "way-finding" process into every project. Patients, visitors, and
staff all need to know where they are, what their destination is, and how to get
there and return. A patient's sense of competence is encouraged by making
spaces easy to find, identify, and use without asking for help. Building
elements, color, texture, and pattern should all give cues, as well as artwork
and signage
4. Cleanliness and Sanitation
Hospitals must be easy to clean and maintain. This is facilitated by:
o Appropriate, durable finishes for each functional space
o Adequate and appropriately located housekeeping spaces
5. Accessibility
All areas, both inside and out, should:
o Comply with the minimum requirements of the BP 344
o Ensuring grades are flat enough to allow easy movement and sidewalks and
corridors are wide enough for two wheelchairs to pass easily
o Ensuring entrance areas are designed to accommodate patients with slower
adaptation rates to dark and light; marking glass walls and doors to make their
presence obvious
6. Controlled Circulation
A hospital is a complex system of interrelated functions requiring constant
movement of people and goods. Much of this circulation should be controlled.

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o Outpatients visiting diagnostic and treatment areas should not travel through
inpatient functional areas nor encounter severely ill inpatients
o Typical outpatient routes should be simple and clearly defined
o Visitors should have a simple and direct route to each patient nursing unit
without penetrating other functional areas
o Separate patients and visitors from industrial/logistical areas or floors
o Outflow of trash, recyclables, and soiled materials should be separated from
movement of food and clean supplies, and both should be separated from
routes of patients and visitors
o Dedicated service elevators for deliveries, food and building maintenance
services
7. Aesthetics
It is closely related to creating a therapeutic environment (homelike, attractive.) It
is important in enhancing the hospital's public image and is thus an important
marketing tool. A better environment also contributes to better staff morale and
patient care. Aesthetic considerations include:
o
o
o
o
o

Increased use of natural light, natural materials, and textures

Use of artwork
Attention to proportions, color, scale, and detail
Bright, open, generously-scaled public spaces
Homelike and intimate scale in patient rooms, day rooms, consultation rooms,

and offices
o Compatibility of exterior design with its physical surroundings
8. Security and Safety
In addition to the general safety concerns of all buildings, hospitals have several
particular security concerns:
o
o
o
o

Protection of hospital property and assets, including drugs

Protection of patients, including incapacitated patients, and staff
Safe control of violent or unstable patients
Vulnerability to damage from terrorism because of proximity to highvulnerability targets, or because they may be highly visible public buildings
with an important role in the public health system.

9. Sustainability

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Hospitals are large public buildings that have a significant impact on the
environment and economy of the surrounding community. They are heavy users of
energy and water and produce large amounts of waste. Because hospitals place such
demands on community resources they are natural candidates for sustainable design.

IV.

Designing:

Designing a Landscape for a therapeutic environment:

When designing healing gardens, the same
considerations are used as in designing any

other

garden. However, these considerations take

on

special meaning in healing environments.

a. Functionality is imperative because

the

garden needs to accommodate the

limitations of the users of the space.
b. It is also important that the garden design be maintainable both for physical safety and
therapeutic benefits. At institutions such as hospitals, it is especially important that the
garden be easy to maintain because a poorly maintained garden could make patients lose
confidence that they are being well taken care of by hospital staff.
c. If the garden isn't environmentally sound, it could be detrimental to the users of the
space, especially those who are physically unwell.
d. Often times the funding for healing gardens is raised through donations and other
contributions. Therefore is it important that the garden design be cost effective.

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e. Finally, healing gardens are

meant

to provide pleasant
surroundings to produce
restorative effects for its

users.

The garden will not be

successful if it isn't visually
pleasing.
It is important to use the principles of
design to create unity within the healing garden design.
f. Simplicity is essential in designing healing gardens to keep the space easy to understand.
Many of the people using healing gardens are dealing with stress, therefore it is important
that the space not have too much "going on" to add any additional stress.
g. At the same time, the design should include a variety of form, texture, seasonal interest,
and color to provide sensory stimulation. Not having enough interest can also be stressful
to the users of the space.
h. It is important to create balance, whether symmetrical or asymmetrical, so the space feels
stable as a whole.
i. Use key, specimen, group, and mass plantings to create emphasis within the space. This
provides focal points to help people orient themselves in the garden.
j. Create sequence or smooth transitions from one area of the landscape to another. This is
especially important to create good flow when going from public gathering areas to more
private areas for solitude.
k. It is also important to use the appropriate scale. If the healing garden is located by a highrise building such as a hospital, use elements such as trees to bring the space down to a
human scale.

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V.

Case Study:
Cedars-Sinai Designing 'Operating Room of the Future' to Streamline, Improve Trauma Care
Cedars-Sinai has introduced several of its own innovations to streamline trauma care,

including:
-

Creating color-coded trauma bays, allowing staffers to more quickly locate supplies

and equipment.
Installing whiteboards in trauma bays that display key patient information such age,
gender, pre-hospital vital signs and field treatment, providing important facts as

trauma teams respond to fluid situations.

Developing an iPhone application that puts patient diagnostic data at the fingertips of
surgeons, nurses, pharmacists and other trauma team members as they converge on a

case from different parts of the medical center.

Conducting pre-briefings in trauma bays before trauma patients arrive, allowing
doctors, nurses and others to understand their roles and to ensure that correct
equipment and medications are ready.
The OR360 space takes up an entire floor in an old medical office building off the

main Cedars-Sinai campus. Its part meeting space for brainstorm sessions, part
simulation center. Of course, simulation is common practice at hospitals. But while most
simulation spaces aim to be a mirror of actual operating rooms, OR360 prides itself on its
ability to undergo chameleon-like transformation.
Cannon Design designed the space to be endlessly reconfigurable, by implementing a
gridded trolley system on the ceiling that allows the surgical lights, equipment booms and
the glass walls to be repositioned or removed altogether. Its no different than the erector
sets where everything could be screwed, unscrewed and changed very quickly without

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having to be an engineer, says Carlos Amato, Healthcare Design Leader for Cannon
Design.
The designers wanted OR360 to function more like a theater where doctors and
military professionals could set the stage for whatever scenario they needed to test. If
you really want to simulate, you cannot begin with a predefined box, says Amato.
Starting with a traditional simulation room where youre bound by the limits of the
space, suggests that you have to do things one way.

VI.

Pertinent Laws:
"Rules and Regulations Governing the New Classification of Hospitals and Other Health
Facilities in the Philippines"
They shall be classified according to the following:
According to Ownership
Government
-

The hospital is created by law.

A government health facility may be under the National Government, DOH, Local
Government Unit (LGU), Department of Justice (DOJ), State Universities and
Colleges (SUCs), Government-owned and controlled corporations (GOCC) and
others

Private
-

Owned, established, and operated with funds from donation, principal, investment, or
other means by any individual, corporation, association, or organization

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According to Scope of Services

General Hospital
-

A hospital that provides services for all kinds of illnesses, diseases, injuries or

deformities
It provides medical and surgical care to the sick and injured, maternity, newborn and

child care
It shall be equipped with the service capabilities needed to support board certified/
eligible medical specialists and other licensed physicians rendering services in, but

not limited to the following:

Clinical Services (Family Medicine, Pediatrics, Internal Medicine, Obstetrics and

Gynecology, Surgery)
Emergency Services
Outpatient Services
Ancillary and Support Services (Clinical Laboratory, Imaging Facility, Pharmacy)

Specialty
-

Specializes in a particular disease or condition or in one type of patient

A specialized hospital may be devoted to the treatment of the following:
Treatment of a particular type of illness or for a particular condition requiring a range

of treatment
Treatment of patients suffering from a particular diseases of a particular organ or

group of organs
Treatment of patients belonging to a group such as children, women, elderly or other

According to functional capacity

Level 1 General Hospital
A level 1 General Hospital shall have as minimum:
1. A staff of qualified, medical, allied medical and administrative personnel
headed by a physician duly licensed by the PRC
2. Bed space for its authorized bed capacity, in accordance with DOH Guidelines
in the Planning and Design of Hospitals
3. An operating room with standard equipment and provisions for sterilization of
equipment and supplies in accordance with:

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DOH Reference Plan in the Planning and Design of an Operating Room or

Theater
DOH Guidelines on Cleaning, Disinfection, and Sterilization of Reusable
Medical Devices in Hospital Facilities in the Philippines

4. A post-operative Recovery Room

5. Maternity Facilities consisting of Ward(s), Room(s), a Delivery Room,
exclusively for maternity patients and newborns
6. Isolation facilities with proper procedures for the care and control of infection
and communicable diseases as well as for the prevention of cross infection
7. A separate dental section/ clinic
8. Provision for blood donation
9. A DOH-licensed secondary clinical laboratory with the services of a consulting
pathologist
10. A DOH licensed Level 1 imaging facility with the services of a consulting
radiologist
11. A DOH licensed pharmacy
Level 2 General Hospital
As minimum, all of Level 1 capacity, including but not limited to:
1. An organized staff of qualified and competent personnel with Chief of
Hospital/Medical Director and appropriate board certified Clinical Department
Heads
2. Departmentalized and equipped with the service capabilities needed to support
board certified/ eligible medical specialties and other licensed physicians
rendering services in the specialties of Medicine, Pediatrics, Obstetrics and
Gynecology, Surgery, their subspecialties, and other ancillary services
3. Provision for general ICU for critically ill patients
4. Provision for NICU
5. Provision for HRPU
6. Provision for Respiratory Therapy Services

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7. A DOH licensed tertiary clinical laboratory

8. A DOH licensed level 2 imaging facility with mobile X-ray inside the
institution and with capability for contrast examinations
Level 3 General Hospital
-

As minimum, all of Level 2, including but not limited to:

Teaching and/or Training Hospital with accredited residency training program for
physicians in the four major specialties namely: Medicine, Pediatrics, Obstetrics

and Gynecology, and Surgery

Provision for physical medicine and rehabilitation unit
Provision for ambulatory surgical clinic
Provision for dialysis facility
Provision for blood bank
A DOH licensed level 3 imaging facility with interventional radiology

Specialty Hospitals
As described above
Trauma Hospitals
The trauma capability of hospitals shall be assessed in accordance with the guidelines
formulated by the Philippine College of Surgeons
-

Trauma Capable Facility is a DOH licensed hospital designated as a Trauma

Center
Trauma Receiving Facility is a DOH licensed hospital within the trauma service
area which receives trauma patients for transport to the point of care or a trauma
center

VII. Conclusion:
Trauma centers provide specialized medical services and resources to patients
suffering from traumatic injuries. Appropriate treatment has been shown to reduce the
likelihood of death or permanent disability to injured patients. Accredited trauma centers
must be continuously prepared to treat the most serious life threatening and disabling
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injuries. Even though trauma centers are within hospitals, they are not intended to replace the
traditional hospital and its emergency department for minor injuries.
The major component that differentiates a regular hospital from one that is a trauma
center is the requirement for 24-hour availability of a team of specially trained health care
providers who have expertise in the care of severely injured patients. These providers may
include trauma surgeons, neurosurgeons, orthopedic surgeons, cardiac surgeons, radiologists
and nurses. Specialty resources may also include 24-hour availability of a trauma
resuscitation area in the emergency department, an operating room, laboratory testing,
diagnostic testing, blood bank and pharmacy. Hospitals who pursue trauma center
accreditation must comply with the Standards of Accreditation. An aggressive trauma care
accreditation process is required to assure trauma care is delivered according to established
standards of care.

VIII. List of References:

http://www.amtrauma.org
https://www.wbdg.org/design/health_care.php
https://doh.gov.ph
https://www.cedars-sinai.edu/

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