Building Resilient Hospitals

Defensive design for extreme natural disasters

When disaster strikes, hospitals are on the front line for treating and caring for those in harm’s way. But what happens when those same disasters incapacitate the hospitals themselves? Hurricanes, tornadoes, and earthquakes cause widespread damage, and recent events demonstrate that with weather events becoming more and more extreme, healthcare owners may need to reassess the resiliency of their facilities.

The events of Hurricane Sandy one year ago taught the East Coast some hard lessons about hospital resiliency. At one New York City hospital, a 28-foot-deep foundation – comprising about 3,300 square feet that our team had excavated for expanding the emergency department was completely filled by floodwater. The storm surge filled the hole in two minutes.

The adjacent building’s basement was also completely flooded and the first floor took on 18 inches of water. The 14-foot-tall basement housed MRIs and other medical equipment – as well as Skanska’s project office. The water pressure was so intense that it knocked down walls. Everything in the office was lost. Three hundred patients had to be evacuated from the hospital after back-up generators lost power.

To better withstand future hurricanes, the hospital decided that electrical gear, formerly in the basement, should be moved to a higher floor. These are important steps toward resiliency but a challenge in a city where every inch of space is at a premium. So hospital administrators have to decide how to negotiate between removing clinical spaces to make room for generators and other emergency supplies.

But New York is not the first city to learn the need for hospital resiliency the hard way.

Lessons from Hurricane Andrew

When Hurricane Andrew hit Florida in 1992, Homestead bore the brunt of the Category 5 storm. The local hospital was incapacitated. It was without power and water and closed for a week. When construction on a new Homestead Hospital began in 2004, administrators were determined to build a facility that was more than ready to withstand another Category 5 hurricane.

The five-story, 392,000-square-foot replacement facility includes 120 beds and serves as an important resource for the expanding population of Miami-Dade County. The building’s facade is made from poured concrete, which was tested for hurricane preparedness by shooting a 2×4 piece of lumber at the walls to mimic the impact of flying debris. The windows, too, are designed to withstand incredible forces; in addition to the 2×4 test, these were sprayed with high-pressure water cannons to check for leaks. The new facility was built nine feet above ground level. Non-essential hospital services are on the ground floor, while essential emergency rooms and clinical areas are raised up.

In the face of a storm, keeping energy up and running is essential. Homestead’s equipment is designed to provide HVAC service during the kind of extended power outages that would be expected during a storm. The hospital is designed to last a week on its own in the case of a power outage in the area.

The University Medical Center has been designed to remain fully operational during flooding and other extreme weather.

Courtesy Blitch Knevel/NBBJ

Building a Resilient Hospital in New Orleans

When Hurricane Katrina devastated New Orleans in 2005, it ruined not only homes and businesses but also essential city infrastructure, including the city’s Charity Hospital. The University Medical Center, now being built by a joint venture between Skanska USA and MAPP Construction, will help restore the city’s healthcare capacity and will feature South Louisiana’s only Level 1 trauma center. To prevent future floods from impacting patient care, channeling and managing the flow of rising water will be essential to resiliency.


The University Medical Center has been designed to remain fully operational during flooding and other extreme weather. All critical hospital spaces and infrastructure are raised 22 feet above the base flood elevation (the computed elevation to which floodwater is anticipated to rise). Reasonable changes in the way we think about building these structures can have huge impacts when the floodwater comes. For example:

  • Before construction began, 283,000 cubic yards of Mississippi River sand was used to raise the site’s elevation to 22 feet above sea level – the level of flooding experienced during Katrina.
  • The building itself has been constructed to withstand a Category 3 hurricane, (111-129 mph wind speeds). 
  • The medical care floors will be located on the second floor.
  • Emergency room entrances will be located on the second floor, reached via a vehicular ramp.
  • Non-critical administrative space will be housed on the ground floor and designed to be sacrificed, should the water rise.
  • All major mechanical and electrical switchgear equipment will be located on the top floors for both main hospital buildings. With redundant primary power and emergency electrical back up power, the facility is designed to operate for a week in the event of a blackout.
  • On top of all these measures, there will also be a 7-day back-up supply of potable water.

The question facing healthcare facility owners is, what can they learn from these disasters? Will they be proactive and take the extra steps to make their hospitals and other buildings more resilient before extreme weather hits?  Or will they do so after the fact – with patient care likely impacted as their facilities are restored to full operations?



Andrew Quirk is senior vice president and national director of Skanska USA’s Healthcare Center of Excellence.

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