SIMPOSIO "EL SECTOR SALUD FRENTE A GRANDES DESASTRES" 22-23 de Nov de 2010

1. Disaster Response from A-Z!
Preparation
Response
Reconstitution

2. “Change is Hard”

3. Begin with the
end in mind
FINISH

4. It is time for
innovation!
Change Is Hard

5. Recommendations for
Post Disaster Recovery
1. Preparation is critical to success.
2. Response must be properly planned and practiced.
3. Reconstitution must start very quickly:
a. Soft sided shelters right now are the only “hours”
response.
b. Component construction can provide a meets all
standards healthcare facility in months, not years. This
step gets you out of tents, back to “meets standards”.
c. Long term earthquake resistant multi-story buildings can
then be constructed, using existing models, in 18-24
months if needed for the long term.
d. Once the multi-story is complete, you can dismantle the
component construction, put it in other areas of the country
that are under-served, use it daily, and then you have a
strategic reserve if another disaster occurs.

6. Disaste
r
Preparation
Local
Response
Reconstitution
Basic Equation to Solve Disasters
Time 2 8 16 24 32 40 48 56 64 72
Regional
Response

7. Natural History of
Disasters That Produces
Casualties
Or
Destroy Medical Facilities

8. CapacityofMedicalCare
Time 2 8 16 24 32 40 48 56 64 72
Steady State
Capability
Medical Capacity
Demand
“When Disaster Strikes”
Demand Driven
Demand
Disaste
r
Demand
exceeds
supply
Unmet demand = excess deaths

9. CapacityofMedicalCare
Time 2 8 16 24 32 40 48 56 64 72
Steady State
Capability
Medical Capacity
Demand
“When Disaster Strikes”
Demand Driven
Demand
Disaste
r
Demand
exceeds
supply
Unmet demand =
excess deaths

10. CapacityofMedicalCare
Time 2 8 16 24 32 40 48 56 64 72
Steady State
Capability
Medical Capacity
Demand
“When Disaster Strikes”
IF local facilities and people are
intact THEN they can respond
Demand Driven
Demand
Local Surge can fill
to a certain degree!
Disaste
r
Unmet demand = excess deaths

11. CapacityofMedicalCare
Time 2 8 16 24 32 40 48 56 64 72
Steady State
Capability
Medical Capacity
Demand
“When Disaster Strikes”
IF local facilities and people are
intact THEN they can respond
Demand Driven
Demand
Local Surge
Disaste
r
Unmet demand = excess deaths

12. CapacityofMedicalCare
Time 2 8 16 24 32 40 48 56 64 72
Steady State
Capability
Medical Capacity
Demand
“When Disaster Strikes”
IF local facilities and people are
intact THEN they can respond
Demand Driven
Demand
Local Surge
Disaste
r
Excess deaths
down to
steady state
from trauma.
Unmet demand = excess deaths

13. But

14. CapacityofMedicalCare
Time 2 8 16 24 32 40 48 56 64 72
Steady State
Capability
Medical Capacity
Demand
“When Disaster Strikes”
IF local facilities and people are
intact THEN they can respond
Demand Driven
Demand
Local Surge
Disaste
r
Unmet Demands =
Excess Deaths
Increase due to lack of
food, clean water and
sanitation.

15. Disaste
r
Preparation
Local
Response
Reconstitution
Basic Equation to Solve Disasters
Time 2 8 16 24 32 40 48 56 64 72
Regional
Response

16. For Example- Chile
Preparation
Disaste
r
Chile as a country has been preparing for
such disasters since the last big
earthquake in the early 1960s.
I have been involved with them since
1995, bringing what the USA had learned
about disaster training and response.
The FACH ERSAM led the world in
disaster response capability since 1998!
They have deployed the ERSAM multiple
times over the past 12 years and saved
many lives!
They have also taught disaster response
courses to the region since 1996.
Time 2 8 16 24 32 40 48 56 64 72
I cannot imagine a better planned and
executed preparation phase anywhere
in the world!

17. CapacityofMedicalCare
Time 2 8 16 24 32 40 48 56 64 72
NGO,
PVOs,
WHO, etc
Steady State
Capability
Medical Capacity
is gone!
Needs
Surge
Needs
Demand
20-
25%
“When Disaster Strikes”
Demand Driven
Demand
Regional
Response
International
Response
Preparation

18. How to meet the demand
Disaster Equation

19. If local facilities function
“When Disaster Strikes”
IF local facilities and people are
intact THEN they can respond

20. CapacityofMedicalCare
Time 2 8 16 24 32 40 48 56 64 72
Steady State
Capability
Medical Capacity
Demand
“When Disaster Strikes”
IF local facilities and people are
intact THEN they can respond
Demand Driven
Demand
Local Surge can fill
to a certain degree!
Disaste
r
Unmet demand = excess deaths

21. CapacityofMedicalCare
Time 2 8 16 24 32 40 48 56 64 72
Steady State
Capability
Medical Capacity
Demand
“When Disaster Strikes”
IF local facilities and people are
intact THEN they can respond
Demand Driven
Demand
Local Surge
Disaste
r
Unmet demand = excess deaths
Local Surge can fill to a
certain degree, but there
are limits!

22. Local Surge
1.Cancel elective surgery
2.Close all elective admissions
3.Call everyone in from home
4.Surge in place
If surge is only 20-25% of
normal demand, local
response can handle it

23. If local facilities destroyed
or damaged.
“When Disaster Strikes”
IF local facilities and people are not intact
THEN they cannot respond

24. CapacityofMedicalCare
Time 2 8 16 24 32 40 48 56 64 72
Steady State
Capability
Medical Capacity
Demand
Demand Driven
Demand
Local Surge
Disaste
r
Excess deaths
down to steady
state from
trauma.
Unmet demand = excess deaths
“When Disaster Strikes”
IF local facilities and people are not intact
THEN they cannot respond

25. Now you have a two-fold
problem!
1. Must fill in for basic services
that have been lost.
2. Must meet all of the demand
equation OR have an excess
loss of life!
Disaster Equation

26. Now you have a two-fold
problem!
1. Must fill in for basic services
that have been lost.
2. Must meet all of the demand
equation OR have an excess
loss of life!
These are two very
different problems
to solve!
Disaster Equation

27. Time 2 8 16 24 32 40 48 56 64 72
in hours
Disaste
r
Local
Response
For Example- Chile
The Chilean
military
deployed
immediately to
the disaster
area to save
lives.
Regional
response came
to help quickly.

28. CapacityofMedicalCare
Time 2 8 16 24 32 40 48 56 64 72
NGO,
PVOs,
WHO, etc
Steady State
Capability
Medical Capacity
is gone!
Needs
Surge
Needs
Demand
20-
25%
“When Disaster Strikes”
Demand Driven
Demand
Regional
Response
International
Response
Local
Response

29. COUNTRY FACILITY LOCATION
Chilean Army 25-bed medical facility with specialized services and hospitalization capacity. Talca
Chilean Army 25-bed medical facility with specialized services and hospitalization capacity. Curicó
Chilean Army 25-bed medical facility with specialized services and hospitalization capacity. Chillán
Chilean Army 25-bed military field hospital w/ med ward, laboratory, sterilization facilities. Talca
Chilean Army 25-bed military field hospital with hospitalization capacity. Constitución
Chilean Army Tent hospital with medical ward and hospitalization capacity. Curanilahue
“When Disaster Strikes”

30. Disaste
r
Basic Equation to Solve Disasters
Time 2 8 16 24 32 40 48 56 64 72
Regional
Response
1. Peru
40-bed facility with 2 medical wards, 4 ICU and
200 cots. Location: Penco
Lirquén
2. Cuba
Hospital facility with one surgical unit, ICU,
ultrasound, lab, med ward. Location:
Rancagua
3. Argentina
Medical facility and two medical wards
Location:
Parral, Cauquenes y Curicó
4. Spain
Hospital facility with one surgical unit,
medical ward. Location:
VIII Región
5. Brazil
400-bed hospital. Location:
Santiago
6. USA
10-bed med/surgical (EMEDS) field hospital.
Location: Angol
Regional
response was
rapid and had an
impact!
It was enough to
carry the load for
both immediate
trauma and re-
establishing the
basic healthcare
system.

31. CapacityofMedicalCare
Time 2 8 16 24 32 40 48 56 64 72
NGO,
PVOs,
WHO, etc
Steady State
Capability
Medical Capacity
is gone!
Needs
Surge
Needs
Demand
20-
25%
“When Disaster Strikes”
Demand Driven
Demand
Regional
Response
International
Response
Regional
Response
I cannot imagine a better planned and
executed response phase anywhere in
the world!

32. Disaste
r
Preparation
Local
Response
Reconstitution
Basic Equation to Solve Disasters
Time 2 8 16 24 32 40 48 56 64 72
Regional
Response

33. Reconstitution
Disaste
r
For Example- Chile
This phase of the
response is to:
1.get out of
temporary, do not
meet standards for
daily healthcare,
2.and replace or repair
what has been
destroyed or
damaged.
3.This should occur
as quickly as
possible!
Time 2 8 16 24 32 40 48 56 64 72

34. Only then do you begin to address the
issues of reconstitution!
Modern construction methods can replace
damaged or destroyed medical facilities in
a short period of time!
“When Disaster Strikes”

35. It is time for
innovation!
Change Is Hard

36. Component Construction
and its Potential for Disaster
Reconstitution

37. Value equation
1.Cost- the same or less.
2.Quality- the same or better.
3.Time- is always shorter
because you are doing work in
two places, one of which is
unconstrained by weather!
Component Construction

38. • We have multiple
examples of
factory built
medical facilities
to share with you.
• We are talking
any type of
medical
construction
here- outpatient
or inpatient!
Component Construction

39. • We have multiple
examples of
factory built
medical facilities
to share with you.
• We are talking
any type of
medical
construction
here- outpatient
or inpatient!
Component Construction

40. Medical and Construction
Innovations
Three broad areas will be discussed:
1.Component construction
techniques- medical.
2.Mobile Medical Units.
3.Growing a Hospital concept.

41. • We have multiple
examples of factory
built medical
facilities to share
with you.
• Buck’s County, Pa.
was the first
component built
hospital. It is a
hybrid facility, part
site built and part
factory built.
Component Construction

42. Component Built Woman’s Health
Facility in Buck’s County, Pa.
This medical
facility was
completed in less
than one year! It
combines the
beauty of
traditional
architecture with
the functionality of
component
construction!
It is in Bensalem,
Buck’s County, Pa.

43. 90% in Factory
• Fully functional standard units constructed
in factories in USA.
• Inspected to meet all codes in the USA, then
split apart to ship.
• Quick connect fittings for electrical, medical
gases, computer connections and telephone
connections
• Standard fittings for water and sewer
• Erector set mentality to rejoin functional
units.

44. Standard steel
framework,
concrete
floors, ceiling,
HVAC, lights,
insulation, are
all built in a
factory!
Factory Site Construction

45. This is a 24 bed
ward that is
nearing
completion in
the factory in
the USA. It was
licensed and
certified as
meeting all
standards
before leaving
the factory!
Factory Site Construction

46. Components are
then split apart,
open areas covered,
and then loaded on
transporters for
movement to
permanent location.
Factory Site Construction

47. 10% On Site
• Site preparations, foundation of pier
and beam, and utilities.
• Erector set putting together the
functional standard units previously
split apart – numbered and sequence
for easy final construction
• These would be delivered in logical
sequence of construction to allow for
optimization of all utility interface

48. This is pier
and beam
construction
with piers
designed to
support the
component
weight.
On Site Building

49. This pier is
designed to
support its
corresponding
component, per
contract
specifications.
On Site Building

50. Factory
construction
component
then arrives
when site
prepared for
them. This
allows parallel
construction
time lines.
On Site Building

51. This picture
shows the
components
being placed
on site. This 24
bed patient
ward was
placed in 4
hours.
On Site Building

52. This photo
shows the 24
bed ward being
placed. All the
observers are
amazed at how
quickly this
has gone!
On Site Building

53. These
integration
pictures are
from 27 July
2006. Each
functional unit
would be
lettered and
numbered for
ease of
construction.
On Site Building

54. Component Construction
Bensalem, Pa., Women’s Hospital
The
finished
product
from the
inside!

55. Component Construction
The
finished
product
from the
inside!
Bensalem, Pa., Women’s Hospital

56. Component Construction
Bensalem, Pa., Women’s Hospital
The
finished
product
from the
inside!

57. Component Construction
The
finished
product
from the
inside!
Bensalem, Pa., Women’s Hospital

58. Component Construction
The
finished
product
from the
inside!
Bensalem, Pa., Women’s Hospital

59. Component Construction
The
finished
product
from the
inside!
Bensalem, Pa., Women’s Hospital

60. Component Built Woman’s Health
Facility in Buck’s County, Pa.
This medical
facility was
completed in less
than one year! It
combines the
beauty of
traditional
architecture with
the functionality of
component
construction!
It is in Bensalem,
Buck’s County, Pa.

61. You say, “Give me a break! That
looks exactly like any other
hospital construction!”
EXACTLY!
Component Built Woman’s Health
Facility in Buck’s County, Pa.

62. Component 50 Bed Hospital
Aspen Street Architects 21Jan10

63. Component 50 Bed Hospital
Aspen Street Architects 21Jan10
These component architectural
plans are already completed!
This could be at a port in the
USA in three months!

64. Aspen Street Architects 21Jan10
Wings-16 rooms per wing,
two stories high= 126 single
rooms, 256 bed double
occupancy.
Core-4 OR, 16 bed ICU, 10
room ED, one trauma of 2
beds, 4 radiology suites,
two docking stations.
Component: 250 Bed Hospital
First Floor

65. Aspen Street Architects 21Jan10
Second
floor
patient
wings.
Second Floor
Component: 250 Bed Hospital

66. Value equation
1.Cost- the same or less.
2.Quality- the same or better.
3.Time- is always shorter
because you are doing work
in two places unconstrained
by weather!
Component Construction

67. Medical and Construction
Innovations
Three broad areas will be discussed:
1.Component construction
techniques.
2.Mobile Medical Units.
3.Growing a Hospital concept with
Portable Buildings.

68. Yahoo.com 10Dec07
Portable Buildings-Licensed
Medical Facility in USA
This portable
building is due
to be put in
use in
Michigan in
May 2008,
assembled on
top of a
traditional
hospital to
solve an acute
space problem.
It has been
fully certified
by the State for
hospital use.

69. The rooms
are
spacious,
well
appointed,
and meet
all
standards
of care!
Portable Buildings-Licensed
Medical Facility in USA

70. Patient closet to
place valuables and
clothes.
Portable Buildings-Licensed
Medical Facility in USA

71. The
window
from the
corridor
looking
into the
patient
room is
3x4 ft in
size.
Portable Buildings-Licensed
Medical Facility in USA

72. Portable Buildings-Licensed
Medical Facility in USA
Note board
on wall for
patient
reminders.

73. Bathrooms are
American Disabilities
Act compliant and
easy to use.
Portable Buildings-Licensed
Medical Facility in USA

74. Fold down seat
for the shower
makes bathing
easy for patients.
Portable Buildings-Licensed
Medical Facility in USA

75. Hand washing
station outside the
patient room.
Portable Buildings-Licensed
Medical Facility in USA

76. Every room is
independently
controlled for
temperature.
Portable Buildings-Licensed
Medical Facility in USA

77. Corridor
view
into
patient
room.
Portable Buildings-Licensed
Medical Facility in USA

78. Built platform from ED
to trucks and portable
building
Surgery unit Surgery unit ICU unit
Portable building
for Pharmacy
Galveston in Hurricane Ike
Sept 2008

79. Johnson Portables
This 24x32 ft
building of 768
sq ft was set
up in 1.5 days
in the parking
garage outside
the ED
entrance in
UTMB
Galveston to
function as
their pharmacy
after a
hurricane.

80. Johnson Portables
This 24x32 ft
building of 768
sq ft was set
up in 1.5 days
in the parking
garage outside
the ED
entrance in
UTMB
Galveston to
function as
their pharmacy
after a
hurricane.

81. Johnson Portables
This 24x32 ft
building of 768 sq ft
was set up in 1.5
days in the parking
garage outside the
ED entrance in
UTMB Galveston to
function as their
pharmacy. All
components are
steel or aluminum
and click together.

82. Johnson Portables
This 24x32 ft building
of 768 sq ft was set
up in 1.5 days in the
parking garage
outside the ED
entrance in UTMB
Galveston to function
as their pharmacy.
The only thing
temporary is the
foundation!
Note how easily it
copes with an uneven
surface!

83. Facility would cost from $110 to
$180 per square foot depending on
the amount of bathrooms, private,
semi-private, or ward style patient
care areas. Beaumont is all private
rooms with full bathrooms. Theirs is
closer to the $180/sf number.
Portable Buildings for
Medical Facilities

84. Hardsided Facility
Attach medical trailer so
that every facility
becomes the hospital that
is needed at the time-
configured daily!
Administration
CLINIC
Only requirement is to lay pad and connection for unit
Minimizes bricks
and mortar to
maximize flexibility
and save money

85. Johnson Portable Buildings
This building
was assembled
in 6 hours by
an
inexperienced
crew during
the hurricane
aftermath of
Katrina.

86. Mobile Surgical Unit Mobile Intensive Care Unit Mobile Diagnostic/Treatment Unit
Mobile Laboratory/Pharmacy Unit Mobile Laboratory/Pharmacy/
Patient Diagnostic Unit
Mobile Breast Care Unit
Mobile Medical Units

87. Mobile Women’s Diagnostic/
Treatment Unit
Mobile Cardiology Unit
Mobile CT Scan
Mobile Dental Unit
Mobile Dialysis Unit
Mobile Ophthalmology Unit
Mobile Medical Staff Unit
Mobile Personal Recovery Unit
Mobile Medical Units

88. Mobile Surgery Unit
•Operating room designed to U.S.
healthcare standards
•Pre-op / post-op recovery area
with capacity for two or three
patients (depending upon
configuration)
•Centralized nurses station
designed for easy visual and
electronic monitoring of all
systems
•Soiled utility room designed
separate from the “clean” area
•Clean utility room designed to
maintain proper sterilization of
instruments
•Integrated medical gases zoned
for activation with required shut-
off valves
In use around USA

89. Mobile Intensive Care Unit
•Standard configuration 6
beds
•Equipped with state of the
art medical equipment for
either triage and treatment
or intensive patient care
systems
•Can be utilized for
additional surge capacity
in large scale disasters
•Two utility rooms for
project specific needs; can
be readily equipped for a
variety of uses

90. Modular Hospital
Minimizes
bricks
and mortar
to
maximize
flexibility
and save
money

91. Modular Hospital –
Small Clinic
Attach medical trailer so
that every facility
becomes the hospital that
is needed at the time-
configured daily!
Administration
CLINIC
Only requirement is to lay pad and connection for unit
Minimizes bricks
and mortar to
maximize flexibility
and save money

92. Modular Hospital –
Large Clinic
Minimizes
bricks
and
mortar to
maximize
flexibility
and save
money

93. Health Orbit 11Dec07
Mobile Surgical Suite
Heading into Iraq!

94. Let us get
specific for
Chile!
“When Disaster Strikes”

95. 8.8 magnitude earthquake on 27 Feb 10
Death toll was 799
6 of Chile’s 13 regions were affected
Home to 80% of the population
Chile had 27,336 hospital beds (71% filled)
Area affected had 77% of the total hospital beds (20,950
of 27,336)
Hospital status in affected area:
4 severe, 6 minimal, 8 normal operation, 3 under evaluation
Chilean response: 6 field hospitals
Other assistance: Peru, Cuba, Argentina, Spain, Brazil,
USA
Earthquake In Chile

96. Earthquake In Chile

97. Angol’s 190-bed regional surgical/referral
hospital damaged beyond repair
Provided medical care over 63,000
80 inpatients, no deaths or serious injuries
Earthquake In Chile

98. Earthquake In Chile
Your earthquake
affected large areas of
your country!
Unfortunately, it was in
the most populated area
of the country!
Still have 11 field
hospitals running in
Chile, so reconstitution
is important!

99. For Example- Chile
Preparation
Time 2 8 16 24 32 40 48 56 64 72
in hours
Disaste
r
Chile as a country has been preparing for
such disasters since the last big
earthquake in the early 1960s.
I was involved with them since 1995,
bringing what the USA had learned about
disaster training and response.
Their ERSAM led the world in disaster
response capability since 1998!
They have deployed the ERSAM multiple
times over the past 12 years and saved
many lives!
They have also taught disaster response
courses to the region since 1996.
I cannot imagine a better planned and
executed preparation phase anywhere
in the world!

100. CapacityofMedicalCare
Time 2 8 16 24 32 40 48 56 64 72
NGO,
PVOs,
WHO, etc
Steady State
Capability
Medical Capacity
is gone!
Needs
Surge
Needs
Demand
20-
25%
“When Disaster Strikes”
Demand Driven
Demand
Regional
Response
International
Response
Local
Response
Regional
Response
I cannot imagine a better planned and
executed response phase anywhere in
the world!

101. Reconstitution
Disaste
r
Time 2 8 16 24 32 40 48 56 64 72
in hours
For Example- Chile
This phase of the
response is to:
1.get out of
temporary, do not
meet standards for
daily healthcare,
2.and replace or repair
what has been
destroyed or
damaged.
3.This should occur
as quickly as
possible!

102. How do you get back to meets all standards healthcare and
not break the bank?
1.Go component now to replace what you have lost. This
could be up in 4-6 months.
2.Take down tent hospitals as soon as component facilities
are up and running.
3.Put up a more earthquake resistant multi-story
replacement facility over 18-24 months.
4.Once the earthquake resistant facility is up and running,
then take down the component facility.
5.Move the component facility to other locations in Chile,
use them daily, and you have a strategic reserve for future
events!
6.The components can be moved multiple times!
Earthquake In Chile

103. Reconstitution
Disaste
r
Time 2 8 16 24 32 40 48 56 64 72
in hours
For Example- Chile
This phase of the
response is to:
1.get out of
temporary, do not
meet standards for
daily healthcare,
2.and replace or repair
what has been
destroyed or
damaged.
3.This should occur
as quickly as
possible!

104. How do you get back to meets all standards healthcare and
not break the bank?
1.Go component now to replace what you have
lost. This could be up in 4-6 months.
2.Take down tent hospitals as soon as component facilities
are up and running.
3.Put up a more earthquake resistant multi-story
replacement facility over 18-24 months.
4.Once the earthquake resistant facility is up and running,
then take down the component facility.
5.Move the component facility to other locations in Chile,
use them daily, and you have a strategic reserve for future
events!
6.The components can be moved multiple times!
Earthquake In Chile

105. Aspen Street Architects 21Jan10
Wings-16 rooms per wing,
two stories high= 126 single
rooms, 256 bed double
occupancy.
Core-4 OR, 16 bed ICU, 10
room ED, one trauma of 2
beds, 4 radiology suites,
two docking stations.
First Floor
Component: 250 Bed Hospital

106. Aspen Street Architects 21Jan10
Second
floor
patient
wings.
Second Floor
Component: 250 Bed Hospital

107. How do you get back to meets all standards healthcare and
not break the bank?
1.Go component now to replace what you have lost. This
could be up in 4-6 months.
2.Take down tent hospitals as soon as component
facilities are up and running.
3.Put up a more earthquake resistant multi-story
replacement facility over 18-24 months.
4.Once the earthquake resistant facility is up and running,
then take down the component facility.
5.Move the component facility to other locations in Chile,
use them daily, and you have a strategic reserve for future
events!
6.The components can be moved multiple times!
Earthquake In Chile

108. Earthquake In Chile
The soft sided
shelter
system has
served well
for a short
period of time.
Then it is
time to fold it
up for future
use.

109. How do you get back to meets all standards healthcare and
not break the bank?
1.Go component now to replace what you have lost. This
could be up in 4-6 months.
2.Take down tent hospitals as soon as component facilities
are up and running.
3.Put up a more earthquake resistant multi-story
replacement facility over 18-24 months.
4.Once the earthquake resistant facility is up and running,
then take down the component facility.
5.Move the component facility to other locations in Chile,
use them daily, and you have a strategic reserve for future
events!
6.The components can be moved multiple times!
Earthquake In Chile

110. Earthquake Proof Hospitals!
The Time is Right!
Rees Brochure
USC University Hospital
Teaching Hospital
Los Angeles, California
1. Building Type
Healthcare
2. Size
350,000 square feet
3. Client
University of Southern
California University
Hospital

111. Earthquake Proof Hospitals!
The Time is Right!
Rees Brochure
Description
Failures are often more widely publicized than
successes. One exception is the USC Medical
Center Hospital designed by Rees Associates, Inc.
As the world’s first hospital designed and
constructed with base-isolation seismic
technology and the world’s first
“seismically isolated” hospital, the initial
construction costs were reduced and, the
repair costs typically caused by a 6.8
earthquake were virtually eliminated.

112. Earthquake Proof Hospitals!
The Time is Right!
Rees Brochure
REES’ unique success story has been widely
publicized. It is important to understand this
success story by investigating the different
behavior of two neighboring hospitals hit by the
Northridge, California earthquake of January
17, 1994, which measured a Moment Magnitude
(Mw) of 6.8 and damaged 31 Los Angles
hospitals, forcing 9 to fully or partially
evacuate. Content damage ran into billions of
dollars.

113. Earthquake Proof Hospitals!
The Time is Right!
Rees Brochure
Not only did the USC Medical Center hospital
suffer:
1.no structural damage,
2.but none of the equipment or key contents
were damaged in the earthquake,
3.and the facility remained in operation
throughout the crisis and beyond.

114. Earthquake Proof Hospitals!
The Time is Right!
Rees Brochure
The Los Angeles Hospital had been designed
and built according to:
1.traditional standards.
2.Damage to it was so severe it could not
continue to operate
3.and was eventually closed.
4.Another hospital, one kilometer away,
suffered $389 million in damage and had to
permanently close two wings.

115. Computational biology — Modeling of primary
blast effects on the central nervous system
NeuroImage 24Feb2009
An architecturally very
appealing building!
Beauty runs clear
through!

116. Earthquake Proof Hospitals!
The Time is Right!
Rees Brochure
The idea of seismic base-isolation is to
separate the structure from the shaking
earth. The 350,000 square foot, 283 bed
hospital rests on 68 lead-rubber isolators
and 81 elastomeric isolators which isolate
it from the full lateral force of an
earthquake. The foundation is a spread footing
and grade beams on rock.

117. Earthquake Building Protection
Base isolators in laboratory tests—(left) undeformed isolator, (right) deformed isolator with sizeable
horizontal displacement (see red arrow on right side of photo on right). Such displacement of
isolators prevents large displacements of floors of the building above.

118. Earthquake Proof Hospitals!
The Time is Right!
Rees Brochure
The USC Medical Center Hospital was instrumented by
the California Strong Motion Instrumentation Program
(CSMIP) soon after its completion, and digitized
acceleration, velocity, and displacement recordings
from the Northridge earthquake have been made
publically available.
The seismic performance of the REES designed
USC Medical Center Hospital are very encouraging
in that they represent the most severe test of an
isolated building to date.

119. Earthquake Proof Hospitals!
The Time is Right!
Rees Brochure
With this technology, USC Medical Center
Hospital is expected to:
1.withstand an earthquake of up to 8.2 on
the Richter scale,
2.while decreasing the amount of steel
needed to stabilize the structure.
3.By decreasing the amount of steel needed,
construction costs were substantially
reduced.

120. Earthquake Proof Hospitals!
The Time is Right!
Rees Brochure
With seven above-grade
and one below-grade
floor, USC Medical
Center Hospital is a full
service acute care
teaching hospital and
includes nuclear
medicine, research
laboratories, a 30 bed
psychiatric unit and
many other research
and treatment facilities.

121. How do you get back to meets all standards healthcare and
not break the bank?
1.Go component now to replace what you have lost. This
could be up in 4-6 months.
2.Take down tent hospitals as soon as component facilities
are up and running.
3.Put up a more earthquake resistant multi-story
replacement facility over 18-24 months.
4.Once the earthquake resistant facility is up and
running, then take down the component facility.
5.Move the component facility to other locations in Chile,
use them daily, and you have a strategic reserve for future
events!
6.The components can be moved multiple times!
Earthquake In Chile

122. They can be taken down as
easily as they were set up!
Taking a
component
building
down is as
easy as it
was to put
it up!
December 20, 2008

123. How do you get back to meets all standards healthcare and
not break the bank?
1.Go component now to replace what you have lost. This
could be up in 4-6 months.
2.Take down tent hospitals as soon as component facilities
are up and running.
3.Put up a more earthquake resistant multi-story
replacement facility over 18-24 months.
4.Once the earthquake resistant facility is up and running,
then take down the component facility.
5.Move the component facility to other locations in
Chile, use them daily, and you have a strategic
reserve for future events!
6.The components can be moved multiple times!
Earthquake In Chile

124. CapacityofMedicalCare
Time 2 8 16 24 32 40 48 56 64 72
NGO,
PVOs,
WHO, etc
Steady State
Capability
Medical Capacity
is gone!
Needs
Surge
Needs
Demand
20-
25%
Demand Driven
Demand
Regional
Response
International
Response
“When Disaster Strikes”
Only then do you begin to execute
the issues of reconstitution!
You should already have a long
term game plan in place!

125. Production – total of 3 hospitals in 6 ½ months
1 Component
Hospital
Built in 3
months
Full Production
each
component
hospital built in
6 weeks after
learning curve
2nd Component
Hospital
Built in 2 months
after
learning curve
Hospital Production (learning curve)
(single production facility)

126. 5 Component
Hospital
Built in 3
months
Full Production
each
component
hospital built in
6 weeks after
learning curve
5 Component
Hospitals
Built in 2
months after
learning curve
Hospital Production
(five production facilities)
Production – total of 15 hospitals in 6 ½ months
If 5 production facilities producing 1
hospital every 6 weeks then 25
additional hospitals could be ready for
delivery in approximately 8 months.
We could receive 50 hospitals ready for
set up in approximately 15 months.

127. Component Hospitals for Disaster Areas
Hospitals Completed
15 20 25 30 35 40 45 50 55 60
2 yrs
6.5
months/ 26
weeks
Hospital Production
(five production facilities-
full production)
32 Weeks
38 Weeks
44 Weeks
50 Weeks
56 Weeks
62 Weeks
68 Weeks
74 Weeks
18 months/
80 Weeks

128. How do you get back to meets all standards healthcare and
not break the bank?
1.Go component now to replace what you have lost. This
could be up in 4-6 months.
2.Take down tent hospitals as soon as component facilities
are up and running.
3.Put up a more earthquake resistant multi-story
replacement facility over 18-24 months.
4.Once the earthquake resistant facility is up and running,
then take down the component facility.
5.Move the component facility to other locations in Chile,
use them daily, and you have a strategic reserve for future
events!
6.The components can be moved multiple times!
Earthquake In Chile

129. “Change is Hard”

130. Begin with the
end in mind
FINISH

131. It is time for
innovation!
Change Is Hard

132. Recommendations for
Post Disaster Recovery
1. Preparation is critical to success.
2. Response must be properly planned and practiced.
3. Reconstitution must start very quickly:
a. Soft sided shelters right now are the only “hours”
response.
b. Component construction can provide a meets all
standards healthcare facility in months, not years. This
step gets you out of tents, back to “meets standards”.
c. Long term earthquake resistant multi-story buildings can
then be constructed, using existing models, in 18-24
months if needed for the long term.
d. Once the multi-story is complete, you can dismantle the
component construction, put it in other areas of the country
that are under-served, use it daily, and then you have a
strategic reserve if another disaster occurs.

133. Questions?
Dr Paul K. Carlton, Jr.
Lt Gen, USAF, Ret
Director, Office of Innovations and Preparedness
The Texas A&M University System Health Science Center