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Safety by design
PHYSICAL FACILITIES
Safety by Design Shock Trauma Center's helipad received special consideration during its planning and construction by Philip R. Militello, MD, FACS, and Ameen I. Ramzy, MD, FACS
The specially designed MIEMSS Shock Trauma Center in Baltimore, Maryland, took over eight years of planning, three years of construction.
On February 13, 1989 the new Shock Trauma Center opened in Baltimore, Maryland. The new building is named for Dr. R. Adams Cowley, the founder of the Maryland Institute for Emergency Medical Services Systems (MIEMSS). As the hub of the Maryland EMS system, the MIEMSS Shock Trauma Center treats the most critically injured in the state and also serves as a specialty referral center for head and spinal cord injured patients and for patients needing hyperbaric therapy. With 138 licensed beds, the trauma center treats more than 3,000 patients per year. A majority of these patients arrive by Maryland State Police Aviation Division helicopters. The new $44 million ShockTrauma Center, designed specifically for the
care of critically ill and injured patients, opened after more than eight years of planning and three years of construction. Of special consideration during the planning and construction process was the rooftop helipad. Helicopter transfers to MIEMSS in the past had been accomplished by landing on a nearby parking garage. Patients were offloaded and put into an ambulance, driven down seven floors of the garage and down the street to the back entrance of University Hospital, offloaded from the ambulance, wheeled down a long basement hallway to two general-use elevators, and taken to the first floor admitting area. This process took about eight minutes. While anticipating the advantages of direct patient transfer via a rooftop landing area, safety was a pri-
The Journal of Air Medical Transport • August 1990
mary focus in designing the new helipad. The major safety areas identified during the design of the new landing facilities at the Shock Trauma Center were: • Approach and Departure Routes for Aircraft: Primary, secondary and tertiary approach and departure routes were determined and documented by an engineering company, then forwarded to the FAA for review and approval. This is an important process that identifies potential hazards to aircraft and also places requirements on off-helipad builders. One year after the completion of the MIEMSS helipad the MIEMSS staff was contacted by a contractor regarding construction plans for an off-campus building. After meeting with the
15
PHYSICAL FACILITIES foam activation buttons (fled into the Fire Dept.), and fire extinguishers. * Emergency Exits: Emergency exits are located at each end of the helipad and at the helipad bunker. The exterior emergency exits lead personnel to an interior fire stairwell. Alongside each escape route is a telephone, foam activation button, hose reel, and fire extinguisher. * Fire P r o t e c t i o n
The helipad on the new building (at left under construction) is larger and more efficient than the old one on the right,
contractor it was determined that alteration of the proposed building plan was needed to prevent penetration of the extended approach/departure surfaces to the helipad. • Hospital Location: The helipad is located two floors above any care patient area. To properly use all the space available in the new center, facility support equipment usually found in the basement of most hospitals (heating, air conditioning, hot water, etc.) are located in the top floors directly below the helipad. • Landing Area Size: The landing area was designed to be large enough
to accommodate four helicopters (three parking places in addition to the landing area). The landing area size was also designed to be large enough to accommodate the larger helicopters used by the military. The overall size of the helipad is 196' 8" by 102'. The landing area is 100 feet in diameter (see Figure 1). • Receiving Team Protection:
The receiving team waits in a reinforced bunker area until the helicopter has safely landed and the crew motions them to assist with the unloading. Located in the bunker are direct phone lines to communications, fire fighting
CHAPI light set located next to an emergency exit.
16
Foam: A foam firefighting system was chosen for its fire suppression capability. This system allows for automatic blanketing of the helipad with foam or manual use with hose reels. In automatic mode, the foam is discharged over the rooftop area via three water-driven oscillating monitors. Drains: Drains on the heliport that are designed to carry off rain water are automatically closed when helicopters are using the pad to prevent an accidental fuel spill from contaminating the sewer system. • Snow Removal: A tractor is kept in the equipment storage room on the helipad for snow removal. Since snow cannot be pushed over the side of the helipad onto the sidewalk eight stories below, it is pushed into a snow melting pit on the rooftop level. Water produced by the melting of the snow is directed to the storm sewers. • Lighting: CHAPI (slope indicator lights, see photo at left), perimeter, deck, windsock, and deck flood lights were specified to exceed the recommendations set forth by the FAA. • Patient Transport: Three highspeed emergency patient elevators are located in a restricted core of the trauma center. This dedicated elevator system assures rapid transfer of patients from the helipad to an 11-bed trauma resuscitation/admitting area. The five trauma operating rooms are located adjacent to the resuscitation/admitring area. • Cleaning: An equipment storage and cleaning room was included in the design. A wash sink capable of holding a backboard, hose reel that reaches the helicopter parking area, locked
The Journal of Air Medical Transport • August 1990
PHYSICAL FACILITIES storage area (the aviation crews have the keys), and washrooms are available to aviation personnel for their use. Safety in an organization does not happen by chance. The Shock Trauma Center has been fortunate to work for years with a very basic helipad, then have the opportunity to design and implement an optimal helipad. Facilities alone will not make a system safe; policies and procedures, training, quality assurance, and commitment are just as important. A welldesigned facility can prevent an injury by preventing an incident. The expertise and leadership of the Maryland State Aviation Division were invaluable in the design of the helipad at the Maryland Institute for Emergency Medical Services Systems. The FAA and the helipad design guides they provided were and still are of immense benefit to the safety of the helipad. Copies of the design guide can be
Maryland State Police 365N-1 Dauphin 2 lands at the Shock Trauma Center.
obtained from your FAA Regional Airport Division Office. El
Philip R. Militello, MD, FACS, is deputy director at MIEMSS (Baltimore,
MD) and clinical director at the Shock Trauma Center (Baltimore, MD). Ameen I. Ramzy, MD, FACS, is deputy director at MIEMSS and State EMS Director.
Figure 1 Heliport Location Directory 1. 2. 3. 4.
5. Fire Escape Stairwell 6. Elevators (not to be used in the event of a fire) 7. Heavy Equipment Storage Room, Equip. Wash Rm. 8. Primary Landing Zone
Foaming System Nozzle Foaming System Hose Telephone (5075) Syscom Direct Phone Line
I,.,,.~_~11
i
II
I1
H
II ,,~ II
¢
2
CHAPI
ql~ NORTH
CHAPI_
1
196L8"
The Journal of Air Medical Transport • August 1990
17
Safety by Design Shock Trauma Center's helipad received special consideration during its planning and construction by Philip R. Militello, MD, FACS, and Ameen I. Ramzy, MD, FACS
The specially designed MIEMSS Shock Trauma Center in Baltimore, Maryland, took over eight years of planning, three years of construction.
On February 13, 1989 the new Shock Trauma Center opened in Baltimore, Maryland. The new building is named for Dr. R. Adams Cowley, the founder of the Maryland Institute for Emergency Medical Services Systems (MIEMSS). As the hub of the Maryland EMS system, the MIEMSS Shock Trauma Center treats the most critically injured in the state and also serves as a specialty referral center for head and spinal cord injured patients and for patients needing hyperbaric therapy. With 138 licensed beds, the trauma center treats more than 3,000 patients per year. A majority of these patients arrive by Maryland State Police Aviation Division helicopters. The new $44 million ShockTrauma Center, designed specifically for the
care of critically ill and injured patients, opened after more than eight years of planning and three years of construction. Of special consideration during the planning and construction process was the rooftop helipad. Helicopter transfers to MIEMSS in the past had been accomplished by landing on a nearby parking garage. Patients were offloaded and put into an ambulance, driven down seven floors of the garage and down the street to the back entrance of University Hospital, offloaded from the ambulance, wheeled down a long basement hallway to two general-use elevators, and taken to the first floor admitting area. This process took about eight minutes. While anticipating the advantages of direct patient transfer via a rooftop landing area, safety was a pri-
The Journal of Air Medical Transport • August 1990
mary focus in designing the new helipad. The major safety areas identified during the design of the new landing facilities at the Shock Trauma Center were: • Approach and Departure Routes for Aircraft: Primary, secondary and tertiary approach and departure routes were determined and documented by an engineering company, then forwarded to the FAA for review and approval. This is an important process that identifies potential hazards to aircraft and also places requirements on off-helipad builders. One year after the completion of the MIEMSS helipad the MIEMSS staff was contacted by a contractor regarding construction plans for an off-campus building. After meeting with the
15
PHYSICAL FACILITIES foam activation buttons (fled into the Fire Dept.), and fire extinguishers. * Emergency Exits: Emergency exits are located at each end of the helipad and at the helipad bunker. The exterior emergency exits lead personnel to an interior fire stairwell. Alongside each escape route is a telephone, foam activation button, hose reel, and fire extinguisher. * Fire P r o t e c t i o n
The helipad on the new building (at left under construction) is larger and more efficient than the old one on the right,
contractor it was determined that alteration of the proposed building plan was needed to prevent penetration of the extended approach/departure surfaces to the helipad. • Hospital Location: The helipad is located two floors above any care patient area. To properly use all the space available in the new center, facility support equipment usually found in the basement of most hospitals (heating, air conditioning, hot water, etc.) are located in the top floors directly below the helipad. • Landing Area Size: The landing area was designed to be large enough
to accommodate four helicopters (three parking places in addition to the landing area). The landing area size was also designed to be large enough to accommodate the larger helicopters used by the military. The overall size of the helipad is 196' 8" by 102'. The landing area is 100 feet in diameter (see Figure 1). • Receiving Team Protection:
The receiving team waits in a reinforced bunker area until the helicopter has safely landed and the crew motions them to assist with the unloading. Located in the bunker are direct phone lines to communications, fire fighting
CHAPI light set located next to an emergency exit.
16
Foam: A foam firefighting system was chosen for its fire suppression capability. This system allows for automatic blanketing of the helipad with foam or manual use with hose reels. In automatic mode, the foam is discharged over the rooftop area via three water-driven oscillating monitors. Drains: Drains on the heliport that are designed to carry off rain water are automatically closed when helicopters are using the pad to prevent an accidental fuel spill from contaminating the sewer system. • Snow Removal: A tractor is kept in the equipment storage room on the helipad for snow removal. Since snow cannot be pushed over the side of the helipad onto the sidewalk eight stories below, it is pushed into a snow melting pit on the rooftop level. Water produced by the melting of the snow is directed to the storm sewers. • Lighting: CHAPI (slope indicator lights, see photo at left), perimeter, deck, windsock, and deck flood lights were specified to exceed the recommendations set forth by the FAA. • Patient Transport: Three highspeed emergency patient elevators are located in a restricted core of the trauma center. This dedicated elevator system assures rapid transfer of patients from the helipad to an 11-bed trauma resuscitation/admitting area. The five trauma operating rooms are located adjacent to the resuscitation/admitring area. • Cleaning: An equipment storage and cleaning room was included in the design. A wash sink capable of holding a backboard, hose reel that reaches the helicopter parking area, locked
The Journal of Air Medical Transport • August 1990
PHYSICAL FACILITIES storage area (the aviation crews have the keys), and washrooms are available to aviation personnel for their use. Safety in an organization does not happen by chance. The Shock Trauma Center has been fortunate to work for years with a very basic helipad, then have the opportunity to design and implement an optimal helipad. Facilities alone will not make a system safe; policies and procedures, training, quality assurance, and commitment are just as important. A welldesigned facility can prevent an injury by preventing an incident. The expertise and leadership of the Maryland State Aviation Division were invaluable in the design of the helipad at the Maryland Institute for Emergency Medical Services Systems. The FAA and the helipad design guides they provided were and still are of immense benefit to the safety of the helipad. Copies of the design guide can be
Maryland State Police 365N-1 Dauphin 2 lands at the Shock Trauma Center.
obtained from your FAA Regional Airport Division Office. El
Philip R. Militello, MD, FACS, is deputy director at MIEMSS (Baltimore,
MD) and clinical director at the Shock Trauma Center (Baltimore, MD). Ameen I. Ramzy, MD, FACS, is deputy director at MIEMSS and State EMS Director.
Figure 1 Heliport Location Directory 1. 2. 3. 4.
5. Fire Escape Stairwell 6. Elevators (not to be used in the event of a fire) 7. Heavy Equipment Storage Room, Equip. Wash Rm. 8. Primary Landing Zone
Foaming System Nozzle Foaming System Hose Telephone (5075) Syscom Direct Phone Line
I,.,,.~_~11
i
II
I1
H
II ,,~ II
¢
2
CHAPI
ql~ NORTH
CHAPI_
1
196L8"
The Journal of Air Medical Transport • August 1990
17