Literature study of EMERGENCY DEPARTMENT

By,
Balaji . N
Sub : Architectural Design - v
Nishath Affrosha . K
EMERGENCY DEPARTMENT:

• EMERGENCY - A serious,
unexpected, and often dangerous
situation requiring immediate action.
• AREA - The total internal area of the
emergency department, should be at
least 145m2(1560 ft2) for 100 bedded
hospital.

• Medical emergency is a situation

when patient requires urgent & high
quality medical care to prevent loss of
life or limb and/or to initiate action
for the restoration of normal healthy
life.
GENERAL REQUIREMENTS :

• Entrance for patients arriving by

ambulance, other modes of
transportation, or conveyances.
• Separate from main hospital entrance.
• Porch outside the lobby to protect the
unloading of the patients from rain &
sunlight.
• Approach to lobby should be in the
form of ramp & steps and it should be
appropriate to usage by the disabled.
• The emergency department entrance
mostly red and white sign is clearly
visible.
• Liaison with courts & police in a
medico-legal cases.
INTERFACE WITH OTHER CLINICAL AREAS:
• The ED must have ready access to those critical care areas and diagnostic
facilities necessary for modern Emergency Medicine to be practiced.
• Clinical areas which should be adjacent to the ED include.
• OT
• ICU
• Blood bank
• Laboratory
• OPD
• Mortuary
• Some authorities recommend a close relationship with
• CCU as well
• Many sub-depts. like OT, Diagnostics etc. may be required
• in the dept. itself

LOCATION OF THE EMERGENCY DEPARTMENT:

• EDs need to be placed in an area of the hospital
that is easily accessible to Emergency vehicles
entering the site.
• ED clinical areas should be on the ground floor.
• Located adjacent to OPD.
 GROUPING OF GENERAL HOSPITALS:

• For the purpose of this standard the hospitals have been divided into,
 The following five categories:
 Category A - 25 to 50 Reds.
 Category B - 51 to 100 Beds.
 Category C - 101 to 300 Beds.
 Category D - 301 to 500 Beds.
 Category E - 501 to 750 Beds.

• In hospitals of category C, D and E it should be an independent department working round the

clock like a mini hospital.
• In hospitals of category A and B it should again be independent but may be scheduled to function
outside working hours of other clinics in OPD.
• It should be located in the complex of the OPD for reasons of easy accessibility and sharing
medical facilities with the OPD
AS PER NABH STANDARDS :

The following data’s are based on the NABH standards.

• The minimum No. of beds for the hospital – 25 Nos.

Number of beds in the emergency department should be as per following criteria:

TOTAL NO. OF HOSPITAL BEDS MINIMUM BEDS REQUIRED IN ED

Up to 50 beds 02 beds

51- 100 beds 04 beds

101-200 beds 06 beds

201-350 beds 08 beds

More than 350 10 beds

FLOW CHART FOR THE ED :
Observation
Gynea. & Dirty Plaster Toilet For
Ward - 6Nos of
Obstetrics Utility - room - Patients -
Bed -
Room - 8 Sq.m 20 Sq.m 6 Sq.m
10 Sq.m
Isolation Cubicles
Resuscitation & Nurse Station -
Trauma - 4 Nos 4 Sq.m Toilet For
of Bed - Nurse Room Staff -
6 Sq.m
TRIAGE
Doctors Room
ROOM
Storage -
8 Sq.m Toilet For
Entry to Waiting Area Staff -
main 20 Sq.m 6 Sq.m
function LOBBY -
Depends on
Police Enquiry
the Funct.
RECEPTION &
Storage For Billing counter
Wheel Chair, Nos – 8 Sq.m
Stretcher
Portico -
Ambulance Bay –
60 Sq.m
2 Nos of 60 Sq.m
ENTRANCE DETAILS: PORTICO:
STRETCHER
• Separate from main hospital entrance.
• Should be well marked & illuminated. SPACE FOR WEATHER
PROTECTION
• It should open into spacious lobby.
• Porch outside the lobby to protect the
unloading of the patients from rain & sunlight. AMBULANCE

• Approach to lobby should be in the form

of ramp & steps. ALL ARE IN ‘M’

AMBULANCE BAY:

• The bay for 2 Nos of

ambulance.

ENTRANCE WITH PORTICO ALL ARE IN ‘M’

AMBULANCE BAY
CIRCULATION DETAIL :
CORRIDORS :
• Corridors provide patient, relative and staff
access to all parts of the Emergency
Department, as well as access to service areas of
the Emergency Department, to storage, and
access to equipment that is needed frequently or
urgently.
ALL ARE IN ‘mm’
• Clinical areas - the minimum must be to allow
2 trolleys/wheelchairs to pass easily with
associated equipment e.g. IV stands. A WIDTH FOR WHEEL CHAIR MOVEMENT
minimum width of 3m is recommended.

STAIRCASE & RAMP DETAIL :

• Width of the stair & ramp is Min.

1500mm.
• Riser – 120mm.
• Tread – 300mm. ALL ARE IN ‘mm’

STAIRCASE DETAIL
CIRCULATION DETAIL :
RAMP :
• The slope ratio for the ramp 1:10.
• And the width of the ramp also 1500mm.

HANDRAIL DETAIL :
• The handrails are
provided where the steps
& ramp used.

• And also handrails are

to be provide for
disabled people.
CIRCULATION DETAIL :
STRETCHER DETAIL :
CIRCULATION DETAIL :

WHEELCHAIR DETAIL :
MOVEMENT SPACE: TURNING RADIUS

LANDING SPACE CONSIDERATION

SIZE OF THE WHEELCHAIR :
RECEPTION AREA:
• Entrance should open in to a large
open space with reception desk in front.
• It should be adjacent to triage area.
• Should be close to waiting area.
• Should have communication links such
as telephones, Worship room, grief room,
flower, chemist & book shop.
• Space for medico-social worker, toilets,
registration & records.
• BIS has recommended 1.75 sq.m per
hospital bed for the reception area.
WAITING SPACE:
• Should provide sufficient & comfortable
space for waiting patients &
relatives/escorts.
• Area should be easily observed from
reception & triage areas.
• Should be appropriately furnished with
visual displays on health education &
hospital related information.
• Should cater for facilities such as
drinking water, ladies & gents toilets,
television & channel music.
• The space should be facilitate with
toilets.
NURSING WORK STATION:
• Centrally located to enable staff to
monitor patient care areas.
• Desk area of minimum 1.2m wide by
600mm deep, per individual work desk.
The staff station(s) must be at least 10m2
(108 ft2) in size.
• Aspects to be factored in include
ergonomics, such as computer monitors
being 800mm from eyes and at correct
height.
• Bench space around computers must
be adequate to allow for papers to be on
the desk. Desk height is ideally adjustable.

DOCTORS WORK AREA:

• Centrally locate for facilitating
response to an emergency.
• Should provide privacy.
• Locate such that doctors & nurses
able to view central cardiac monitoring
station.
EXAMINATION & TREATMENT AREAS:

TRIAGE AREA:
• A separate area or lobby may be used.
• A triage area is designed for the initial clinical
assessment of patients and allocation of an urgency.
EXAMINATION & TREATMENT AREAS:
ACUTE TREATMENT AREA :
• Utilized for management of patients with
acute illnesses
• Should be able to fit a standard mobile bed
with ample storage & usage space
• Area should include a service panel,
examination light, wall mounted
sphygmomanometer, emergency call Facilities.
• 2.4m of clear floor space between beds.
• Each treatment area requires space of 15 sqm,
doors at least 1.3m wide.
RESUSCITATION & TRUAMA CARE:
• Resuscitation and treatment of
critically ill or injured patients like
heart attack.
• Should have space to accommodate
specialized resuscitation bed, allow 360
degrees access to all parts of the patient
for facilitating procedures & monitoring.
• Minimum size for a single bed
resuscitation room is 25m2 (270 sq ft).
• Imaging facilities should include:
 Overhead X-ray.
 Lead lining of walls & partitions between
beds
 Radiolucent resuscitation trolley with
cassette trays
 X-ray viewing/digital electronic imaging
system
• An OT light should be made available

• All electric power should be on

emergency stand-by circuits
ISOLATION ROOM:
• Isolation of potentially highly infectious
patients.
• Isolation rooms may also be used to treat
patients with conditions that require separation
from other patients.
• e.g. patients who require privacy for clinical
conditions, or who are a source of visual or
auditory distress to others.

PLASTER ROOM :
• The Plaster room allows for the application of
Plaster of Paris (POP) and other splints for the
closed reduction under sedative or regional
anesthesia, of displaced fractures or dislocations.
• It must be at least 20 m2 (215 ft2) in size, excluding
crutch or splint storage areas.
DIRTY UTILITY/DISPOSAL ROOM:
• The dirty utility/disposal room is used for the disposal of clinical
and other wastes and soiled linen; for testing and disposal of
patient specimens; for decontamination and storage of patient
utensils such as pans, urinals and bowls; for cleaning and holding
of used equipment for collection and sterilisation elsewhere.
• This room should be a minimum of 12m2.
OBSERVATION WARD :
• Utilized for patients who have been evaluated & need extended treatment,
observation, re-evaluation or time consuming procedures Stabilized patients.
• A 6 to 8 bedded ward is recommended Needs supervision.
SPECIAL FUNCTION TREATMENT ROOMS:
• Designated room for ENT examination with full ENT set, head light, tuning forks, endoscopes,
ENT chair etc.
• Quiet rooms (see below)
• Ophthalmology assessment room with slit-lamp, black-out capability, Snellen chart etc.
• Private room for gynaecology.
• Plaster application room, with appropriate waste disposal Procedure room with operating
theatre standard lighting for suturing and wound care.
 MATERIALS TO BE USED :

FLOORING:
• The floor covering in all patient
care areas and corridors should have
the following characteristics.
• Non slippery surface
• Impermeable to water, body fluids
• Durable
• Easy to clean
• So, we use LVT (luxury vinyl tile)
flooring for the hospital interior.

ROOFING:
• The roofing with MINERAL
FIBRE TILE .
• Easy to install.
• Maintenance free.
• Easy to fit the lightings.
• Easy to clean.
AMBULANCE:
• Length =5.4m
• As per IPHS, For the 300 bed hospital 3 no's
of ambulance's are necessary . • Width =1.9m
• Based on our design problem you should
• Height =2.5m
provide 2no’s
• Turning Radius =6.5m
MOBILE XRAY MACHINE :

VENTILATOR:
SERVICE PANEL :
CENTRAL CARDIAC MONITOR STATION: WALL MOUNTED SPHYGMOMMANOMETER :

DEFIBRILLATOR : RADIOLUCENT RESUSCITATION TROLLEY

WITH CASSETTE TRAYS