TTUSM BURN ENT

ARCHITECTURE 422

NOLAN EDWARD BROWN

DECEMBER 9, 1975

TABLE OF CONTENTS

INTRODUCTION 1

ACTIVITIES AND RELATIONSHIPS 4

FINANCING 35

CLIMATOLOGY 37

SITE INFORMATION 40

APPENDIX "A" 43 (Excerpts from Uniform Building Codes)

APPENDIX "B" 49 (Excerpts from Lubbock Zoning Ordinance)

APPENDIX "C" 54 (Excerpts from OSHA Standards)

APPENDIX "D" 60

(Organizational Chart)

DESIGN ANALYSIS 61

BIBLIOGRAPHY 68

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 suf­

fering 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) ed­

ucate 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

this Burn Center, Its location in the South Plains allows it to

fill a void in the areas now providing burn care. The Texas Tech

University School of Medicine will also be a ready supply for per­

sonnel 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 pro­

hibit 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

continuous nursing care and/or supervision. Each bed space should

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 nourish­

ment, 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 com­

prehensive 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 con­

valescent 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

Plinth (a padded table)

Plinth hanger

CircOlectric anterior

Frame hanger

Television

Linen receptacle (under counter)

Trash receptacle (under counter)

Hand wash sink (or Hemodialysis sink) (24"x 36"x 30" high)

Chart desk

Paper towel dispenser

Soap dispenser

Bulletin board

Clock

Stool (under counter) Overbed table

4. Hydrotherapy: Hydrotherapy is included in the facility

for two reasons: 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 dis­

carded. '̂ 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 ob­

tained when the patient is lifted from the tank with no dressing

or clothing. This equipment requires a 4" to 8" rail beam on the

ceiling to facilitate the lifting machanism. The ceiling height

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 be­

fore 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

Read out panel for load cell

Linen receptables (2)

Trash receptacles (2)

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

Paper towel dispenser

Soap dispenser

Bulletin board

Clock

5. Arrival/Departure: Patients will be arriving at the Burn

Center by ambulance or in some cases by helicopter, or other simi­

lar 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 con­

nector 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 cleans­

ing 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, tempera­

ture. 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 asep­

tic techniques. (At this stage the patient is ready to be moved into

the aseptic environment. Bandages should be readily available.)

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 Hi-Lo stretcher

Wall cabinet Prep tables (2)

Kick bucket Paper towel dispenser

Linen receptacle Soap dispenser

Trash receptacle Bulletin board

Shelf over sink Clock

Hand wash sink

-10-

7. Dressings and Treatment: Performing all dressings and

treatments in one central area is far more effective than conduct­

ing these procedures at the bedside. Assuming the hydrotherapy

area is nearby, it is possible to handle all wound care and treat­

ments 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 Stool agitator

Wastebasket

Clothes hook

Emergency call buzzer

Linen receptacle

Wall shelves (approx. I'x 8')

Trash receptacles

8. Surgery: Surgery within the facility is as necessary as

hydrotherapy, for similar reasons, namely (1) high frequency of

use for debridements (removal of devitalized or contaminated tis­

sue 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 pro­

blems of contamination cf the entire operating suite. Also, trans­

portation 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 in­

cised 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 anaesthe-

siologist 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

Double ring stand

Single ring stand

Shelf over sink

Scrub sink

9. Patient Toilets: One toilet and lavatory should be pro­

vided for the intensive care and comprehensive care patients.

Another toilet and lavatory should be provided for the con­

valescent care patients, who will usually be ambulatory.

Stools

Operating table (30"x 72")

Back table

Prep tables (2) (30:x 72")

Ceiling mounted extremity suspension

Soap dispenser 5

Bulletin board

Clock

EQUIPMENT

Bedpan hoppers/washer/ sterilizer (intensive/ comprehensive care patients only)

Toilet paper dispenser

Paper towel dispenser

5 Ibid., p. 51.

-13-

EQUIPMENT (continued)

Shelf over lavatory Soap dispenser

Lavatory Paper cup dispenser

Toilet Mirror with light and outlet

Grab bar (by toilet)

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 con­

sist 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 con­

sist 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 Color Television (for storing recreational games and puzzles) Radio

Lounge chairs (to facilitate Clock patients and visitors)

Chairs (to facilitate students during school activities)

^ Ibid., p. 54.

-14-

11. Ambulatory Children's Play and School Activity: Th is is

analagous to Adult Visiting and Recreation but modified to meet

children's needs. I ts purpose is essentially the same.

EQUIPMENT

Base cabinet with counter Slide projector (for storing recreational games and puzzles and school Wall mounted screen supplies)

Record player Child's tables and chairs

(for school activities) Bulletin board

Television Blackboard

Toy chest/bench Folding playpen

Assorted toys Infant's walker PATIENT SUPPORT ACTIVITIES

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 Counter (medication storage 10 cu. ft. (medication preparation) per patient) , . . ^

Refrigerator (under counter) Base cabinet with sink

-15-

EQUIPMENT (continued)

Wall cabinets (4) Open shelf urit

Medication cart Step stool (under counter)

Bottle warmer Utility carts (2)

one for blood drawing use Bulletin board (under counter)

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 advan­

tageously. Medication preparation may also be included here if necessary.

-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 Stool, chair height (storage of clean utilities and supplies) Step stool

Wall cabinets (storage of Bulletin board clean linen)

Clock Utility cart (for distribu­

tion to usage areas) Open shelf unit

Sterilizer

4. Pre-Cleaning: In an isolation facility, it is essential

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 Trash receptacle (Storage for cleaning chemicals) (under counter

Utility carts (2) Double sink

-17-

EQUIPMENT (continued)

Counter Washer-sterilizer (36"x 36")

Linen receptacle Bulletin board (under counter)

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 Hot plate

Sink Toaster

Utility cart (under counter) Coffee pot

Ice machine Blender

Refrigerator Bulletin board

Counter ^̂ ^̂ "̂

-18-

6- Pick-up and Delivery: Because entering and leaving isola­

tion facilities requires special precautions (e.g., changing, gown­

ing, etc.), storage should be available directly within the en­

trance 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 im­

portant. 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 Toilet storing street clothes

Linen receptacles (2)

Trash receptacle

Mirror

Paper towel dispenser

-19-

EQUIPMENT (continued)

Shower Soap dispenser

Hand wash sink Toilet paper dispenser

Stool 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 fre­

quent meetings between team members--(most members do not have of­

fice space within the facility). Orientation and in-service teach­

ing 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 Slide projector

Stacking chairs (25) Bulletin board

Folding tables (5) Blackboard

Wastebasket Clock

Projection screen (wall or ceiling mounted)

-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

Microscope

Hemoglobinometer

Pipette shaker

Bulletin board

Clock 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, con­

ference 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) Wastebasket

Hide-a-bed lounge chair Desk lamps (2)

Single pedestal desks (2) Bulletin board

Shelves over desks Clock

-21-

6. Head Nurse Supervision: The head nurse (or equivalent) will

conduct private conferences with staff members as well as admini­

strative activity.

This should be away from ambulatory patients.

EQUIPMENT

Desk chair Wastebasket

Chairs (2) Desk lamp

Desk Bulletin board

Book storage (I'x 12') Clock

7. Communications: The "ward clerk" is responsible for all

incoming calls, paper work, checking doctors' orders, intra-

departmental communications, etc. The communications activities

should be separate from, although adjacent to, conference activi-

tes 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 iso­

lation unit, so that the ward clerk may monitor all traffic into

and out of the unit.

EQUIPMENT

Wall cabinets (2) Bulletin board

Desk chair Scheduling board

Counter Clock

8. Janitorial Equipment: 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 Maid's cart

Storage cabinet Floor level sink

Wall cabinets (3) 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 End table

Wall cabinets Coffee pot

Chairs (5) Toaster

Couch Warming oven

Counter Bulletin board

Refrigerator (under counter) Clock

Coffee table

10. Visitors' Gowning: Because visitors do not come into

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 Hand wash sink

Linen receptacle Paper towel dispenser

Trash receptacle Soap dispenser

Shelf over sink

11. Inhalation Therapy: Burn patients frequently require the

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 excep­

tion 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 in­

creasing demand for burn patients. Under the guidance of a physiat-

rist, 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 self-

sufficiency. 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 en­

courage 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 di­

verting 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. Stor­

age space should be available in the burn unit only for games,

crafts, and a few splints; the occupational therapist should main­

tain 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,

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. Dressing - a standard clothes closet is recommended.

E. Grooming - low mirror and easy access to sink and grooming

supply storage.

F. Eating and writing - provide table space.

G. 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. It would be associated with the main entrance to the

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 ac­

counting and administrative clerical staff. The responsibili­

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 admini­

strative 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. Out­

patients 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 ad­

ministration 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 ad­

justments 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 ac­

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 pros­

thesis or braces.

-28-

b. Fittings. This activity consists of taking measurements

and for the fitting and removal of prosthesis or braces. Fitting

activities should be directly associated with the orthetic and

prosthetic maintenance activity. Allowances should be made to

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

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 swivel-

type 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. Provide a counter

with plaster bins. Equip a lavatory with a plaster trap, and pro­

vide a medicine cabinet.

-29-

Provide storage space for replacement parts and other 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 activi­

ties include all hydrotherapy treatment, tanks, and related facili­

ties 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. (Pertains to Clinical Physical Therapy only.)

16. 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 ap­

propriate.

17. Other Activities Associated with the Burn Center and Lo­

cated 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 re­

habilitating the patient. The social worker should be located

near the visitors. For this facility one full time social worker

will be required,

c. Visitors' waiting area. Often families travel long dis­

tances 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

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 inter­

related 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 ap­

proximately 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 FTE* Positions

1. Doctors** a. General Surgeon (Director) 2 b. Surgical Resident 2 c. I ntern 2

2. Nurses a. Head Nurse 2 b. Registered Nurses 39 c. Licensed Practical Nurses 16 d. Burn Care Technicians 8 e. Nurses' Aides 8

3. Other Paramedical a. Lab Technician 2 b. Social Worker 2

4. Service Personnel a. Janitor 6 b. Maid 6 c. Secretary-Cl erk 4

B. PART-TIME ASSIGNMENTS

1. 2. 3. 4. 5. 6.

7. 8.

Anesthetist Dietician Inhalation Therapist Microbiologist Occupational Therapist Operating Room Nurse

and Technician Pharmacist 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 7-3 3-11 V^l

Head Nurse 1 0 0 Assistant Head Nurse 1 1 1 Staff Nurse 10 10 8 LVN II 2 0 1 LVN 1 0 2 1 LVN 1 2 1 Nurse Aide 1 1 1 Ward Clerk 1 1 1 Service Aide 1 1 0 Burn Unit Technical 1 0 0

Coordinator

EXTRA PERSONNEL - ROTATING SHIFT

Assistant Head Nurse 1 Staff Nurse H Ward Clerk 2 Service Aide 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%

10%

40%

STATE FUNDS

i-^'4rili£9!.X94f'jf'.ifif.i'i'.{'.,Z HILL-BURTON

FEDERAL GRANTS

FIGURE #4

-36-

CLIMATOLOGY INFORMATION

1. Lubbock, Texas

2. Latitude: 33° 39' N

3. Longitude: 101° 49' W

4. Elevation: 3250 feet above sea level

5. Temperature:

A. Average:

1. Daily max. 73.6°

2. Daily min. 45.8°

B. Extremes:

1. High = 1070 (July 1958)

2. Low = -16° (January 1963)

6. Precipitation:

A. Normal = 18.41 during a year

B. Max. monthly = 8.85

C. Min. monthly = 0

D. Snow - max. 12 inches in 24 hours

7. Wind:

A. Mean speed = 13.0 mph

8. Humidity: Average for year:

A. time - 0000 = 59

B. time - 0600 = 71

C. time - 1200 = 46

D. time - 1800 = 40

-37-

Date

March 22

July 22

Sept. 22

December 22

9. Sun

Altitude

*Declination

Altitude

Declination

Altitude

Declination

Altitude

Declination

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

5:00 p.m.

13°

W 82°

24°

W 104°

I3O

W 82°

2°

W 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

building code will be adhered to. (See appendix

"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 TYPE OF MATERIAL COMPRESSIVE DEPTH (Fig.#5) STRENGTH (psf)

1

2

3

4

Brown sandy clay

Light tan and white sandy clay

Brown sandy clay

Light tan and white sandy clay

22,380

8,910

6,020

8,870

2'-0"

4'-0"

0'-6"

4'-0'

Light tan and white 8,350 0'-6'' sandy clay

10,690 9'-0"

Tannish brown sandy clay 21,920 4'-0"

-41-

(INDIANA ST.)

TEXAS TECH UNIVERSITY SCHOOL cf MEDICINE

00 CO

to

378

#1

#2

600'

#3

#4

600'

#5

o o

#6

L

-^« BORING LOCATION

FIGURE #5

-42-

APPENDIX "A"

EXCERPTS FROM UNIFORM BUILDING CODES

Sec. 901 Group "D" occupancy division 2 (fire zone #3).

Sec. 902.a 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, ac­

commodating approximately the same number of non­

ambulatory persons in each compartment, by a smoke-

stop partition with a one-hour occupancy separation

for a place of refuge. Corridor openings should

have one-hour firedoors and ducts should have fire-

dampers 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 re­

quired 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 cor­

ridor 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 with­

out 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, automa­

tic, 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 de­

vices may be used in lieu of audible devices in

patient occupied areas.

Sec. 1711 Toilet room floors shall have a smooth, hard, non-

absorbent surface such as portland cement, concrete,

-45-

ceramic tile or other approved material which ex­

tends 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 spill­

age 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 struc­

tures 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, ap­

proval 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, base­

ment 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 plan­

ning and design. The regulations are intended to pro­

duce an attractive environment which will insure the

compatibility between medical and other uses; encour­

age 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 adja­

cent development. Architectural design, landscap­

ing, screening, and parking areas shall be provided

to insure maximum protection of the adjacent uses.

12.3 PERMITTED USES

12.3-2 Blood Bank

12.3-3 Convalescent nursing, orphan, maternity,

or geriatrics homes.

-49-

12.3-5 Hospital, clinic or medical office, ex­

cept veterinary facilities.

12.3-7 Administrative offices for the medical

profession including independent manage­

ment, legal, accounting and bookkeeping

services for doctors, hospitals, clinics,

and medical personnel.

12.3-9 Schools, private or public, directly re­

lated to the medical profession.

12.4 CONDITIONAL USES

12.4-7 Ambulance service and other medically re­

lated 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 obstruc­

tions 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 ad­

ditional 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 main­

tained. All of the required

landscaping shall be located be­

tween the building lines and

adjacent streets.

12.13-2-2 The parkway area shall be land­

scaped 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 exces­

sive heat, shall not be stored where they might be dam­

aged 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 fuel-

gas cylinders or combustible materials (especially oil or

grease) a minimum distance of twenty (20) feet or by a non-

combustible 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 in­

stalled 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 pro­

vided 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

contrast with surroundings. The work "EXIT" shall be of

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 de­

fectors 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 ex­

ceed 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 pro­

jections.

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 con­

dition.

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 in­

jury 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-

< o

<

CD a: o

X

o

a. o.

U) +J c (U en a; on ^-o

• a s.. to o CO

= 3 t -H-

1 4-> C

•a • I —

C/) <D i-a.

.c: o s> f d OJ CO

<u

lO Ol

• I —

• ! - >

• 1 —

> • r -+J U

on <:

L

•l-i c <u

<_)

</)

u c: cu

c o 0) 00 -o «/) (U &-

O-

<u

4J r— fO (1) rc

O =3 •r->•

h-1—

^ -o

to (U o

• r -> s-<u

s- oo o

4->

u (U

•r—

o a; >

• 1 —

4 J 13 U (U X

-»-> s-o o. 3

t / )

r ^ (O o

• r -C

• r -

—̂ UJ o

o c E E

4- O «f- <_)

t/0 > •r-

r— -M O U

•r- a; <D UJ

+J c <u

•r- CU 4-> S-fo a a . c j

_

S- I/) cu c x: fo 4-> cu o o

cu 4-> C S-cu o

o c cu ^ s-3 T -

OQ O

fO

+-> • r -Q . to O rc

s-o

4->

o cu s-

• r -O

(0 O

•r— C

•r— r " C_)

s-o

•4-> CJ CU &-

• r -Q

-60-

DESIGN ANALYSIS

The final design for the Texas Tech University School of Medi­

cine'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 de­

sign 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 over­

all 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 nourish­

ment 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, Com­

prehensive 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 suprb. 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 excep­

tion 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 am­

bulance (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 (exclud­

ing 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 struc­

tural system which allows for renovations to absorb the increase in

patient load until the demand for space becomes such that major reno­

vations 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 vibera-

tion 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 inter-

sticial space located between each floor.

-64-

STRUCTURAL CALCULATION

This example deals with one of the major beams typ ica l ly

located in the iso la t ion un i ts .

1,280 Sq.Ft. X 100 K/Sq.Ft. 40 Ft. 3.2 K/Ft,

3.2 K/Ft. y7m7777//777777777777777777/77777//7/777/JT777\

40 Ft.

f̂ 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

Item #

1

2

3

1

2

3

4

5

6

1

2

3

4

Basement

Surface or Item

Basement walls

Perimeter

Floor slab

TOTAL

First

Ceiling

Floor slab

Thermal glass

Glass doors

Canted wall

Insulated precast

TOTAL

Second

Ceiling

Floor slab

Thermal glass

Level

panel

Level

Insulated wall panel

TOTAL

GRAND TOTAL (HEAT LOSS)

Area

6,850

685 f t .

30.032

29,456

29,456

3,200

210

4,000

1,600

29,456

29,456

1,960

4,340

U-Factor

.26

.81

.10

.45

.60

.53

1.13

.10

.09

.45

.60

.53

.16

T

15°

15°

20°

30°

30°

60O

60°

60°

60°

30°

30°

60°

60°

BTUH

26,715

8,323

60,064

95,102

357,656

530,208

101,760

14,238

24,000

8,640

1,076,502

397,656

530,208

62,328

41,664

1,031,856

2,203,460

FIGURE §7

-67-

BIBLIOGRAPHY

American Hospital Association Annual Survey. 1975.

American Standards Association. American Standard Specifications for Making Buildings and Facilities Accessible to and Usable by the Physically Handicapped. National Society of Crippled Child-ren and 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, LUDBOCK, 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-