Title: First aid care, speedy transport, special centres Life saving elements of a new accident service
Pages: 30 - 33
Author: James Fairley and Charles Scott
Text: First aid care, speedy transport, special centres Life saving elements of a new accident service
Accidents are one of the nastier facts of life. Personally tragic, economically weakening, nationally demoralising. Attack them with a quick, efficient, organised service, and they lose a lot of their venom. Such a service - specialist, concentrated is now being set up in Britain. How will it work? by James Fairley and Charles Scott
Accidents range from the trivial, involving slight injury to only one person, to the disastrous-train smashes, mine explosions, earthquakes in which many are killed or maimed. But whatever their nature, the effect is to cause not only a personal tragedy but also an increasing drain on economic and human resources.
For people between the ages of one and 35, accidents are the biggest killers. The resulting personal and public damage can be considerably reduced by correct and prompt action. It is essential to establish an organised, coordinated accident service in order to save life, to cut permanent disability and personal suffering to a minimum.
The three main elements of such a service are first aid care, speedy transportation and special accident units or centres. Education and persuasion will be necessary to obtain the co-operation of the public and the staffs of hospitals in directing accident cases only to where adequate facilities exist - even if this means by-passing hospitals on the way. This will be necessary because the accident units will be situated in the developing district hospitals, and only one will be provided in any particular area.
The concentration of the accident service in only a very limited number of hospitals is necessary for many reasons, but the five most important are: 1 Availability of adequate skilled medical staff at all times, day and night; 2 Available empty beds staffed by nurses who are trained and experienced in accident and emergency work; 3 A readily available operating theatre; 4 A 24 hour x-ray, pathological and anaesthetic service with a blood bank; 5 Concentration of an unpredictable, urgent service, which thus avoids disorganisation of routine and less urgent work in other hospitals of the area.
It is possible to adjust existing buildings: but to be really effective, special designs are necessary to meet these functional and organisational requirements.
The flow pattern of patients, staff and visitors is all important, so that the casualty can proceed from admission through the various areas - examination, resuscitation, x-ray department, operating theatre - to the beds without hindrance from cross traffic..
The annual cost of running a hospital is about 40 per cent of its capital cost. The salary bill is about 70 per cent of the running cost. And the amount of equipment used in hospitals is increasing. It is becoming more complex and more costly to install and maintain. The task of the designer is, therefore, to produce a building which
holds in balance a number of different factors: the needs of the patient; the skilful efficiency of an adequate labour force; and the provision of the essential accommodation and equipment-which is itself selected according to the balanced criteria of functional value, and initial and maintenance costs (including savings on manpower otherwise required). The emotional tensions from which all patients suffer can be materially relieved if the designer can provide surroundings that are both sensitive and uncomplicated and, as well, respect the dignity of the patient as a human being.
These principles are relevant to any hospital or department. Their application produces finite design in a form influenced by precise function and local conditions. The recently completed accident, emergency. and x-ray department at St Nicholas Hospital, Plumstead, London, is one example of the application of the philosophy discussed above. It has now been in use for over 12 months, and appears to justify its design concept- in fact, its flexibility has led to its being occasionally used to relieve general out-patient consultative clinics in other parts of the hospital. It is illustrated and discussed in some detail on the following two pages.
Accident and casualty units
1 and 2 The ground floor level of the accident, emergency and x-ray department at St Nicholas Hospital, Plumstead, London, is shown in ', and the flow diagram in 2. Ambulance cases have a separate entrance, but both streams are controlled from a single reception/enquiry area. Children wait in a separate room, adults in a series of communicating zones for consulting and for the two primary forms of treatment which share a common supply zone of presterilised dressings, packs and other materials.
The consulting rooms can be used as demand requires, though one is particularly convenient for a minor casualty coming by ambulance. A more serious injury is taken to an adjoining examination room equipped for resuscitation, and then usually passes to the major treatment area or is received into the hospital as an in-patient. A recovery area of six beds and supporting facilities adjoins both the major and minor treatment zones, and is also used as a holding unit for an in-patient
received during the night (to avoid disturbance to a sleeping hospital ward). The design attempts to achieve zones of varying function, each possessing the facilities required by that activity but with an overall flexibility in use to meet changing volume demand and with service zones (eg, sterile supply local to need but gravitationally placed in relation to the accommodation as a whole).
The building is the first phase of a larger department; these diagrams show how it is integrated. It can be seen that, although the overall design has been dictated by a considerable fall on the site, the entrances and the several departments stem from a common vertical circulation of lights and a staircase. The
planning of departments as cur-de-sacs from a common circulation permits future lateral extension, but a building constructed in phases usually suffers the disadvantage of some temporary illogicality in planning, either within itself or by disassociation from supporting services. For example, pathology, pharmacy and car parking are at present elsewhere in the hospital, but will ultimately be transferred to new accommodation within the umbrella of the integrated gut-patients' department.
4-5 The fundamentals of patient psychology, functional efficiency and correct use of finishes and equipment also determine the design of the individual rooms. The children's waiting room,
4, is decorated and finished as a passive play room with a toilet annexe. The floors of the adult waiting areas are carpeted to avoid a clinical atmosphere, to reduce general sound level, and to trap grit from footwear to prevent its transference to clinical areas. The ceilings are suspended and of an acoustic nature. Walls are papered in selected areas and curtains are chosen to fulfil the three needs of privacy, noise reduction and aesthetic sensitivity,
5. Finishing generally is of simple strength covered either in neutral colours of pvc or fabrics for cleaning.
'Deep' planning is frequently used in hospitals to attain the closest integration of rooms and departments. This invariably requires air-conditioning and permanent supplementary artificial lighting, but the absence of natural lighting is unnoticed if the electrical installation is sensitively arranged, s.
6 The building has a structural frame encased in a dry construction of standard size stove vitreous panels (selfcleaning to combat the high dirt saturation of the atmosphere in the area). This structural sensibility, and the internal finishes, decor, furniture and drapes, was the responsibility of the architect, and benefits by possessing an overall design concept.
James Fairley MD, BChir, left, is the senior administrative medical officer of the South East Metropolitan Regional Hospital Board, a governor of Guy's Teaching Hospital and a governor of King's College Teaching Hospital. Charles Scott ARIBA, DipTP, has been the regional architect to the South East Metropolitan Regional Hospital Board since 1950. Before that, he worked on schools and housing, and in private practice.