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Soon after many governing bodies throughout the United States enacted stay-at-home governance to flatten the curve of COVID-19, Crain’s Chicago Business published an article about Crimson Contagion – an emergency exercise developed by the federal government that took place in Chicago. As an engineer focused on high performance building environments, this type of exercise is thought-provoking from the perspective of the complexity of decisions healthcare administrators make when building new facilities or adapting older ones.

Well before the Crimson Contagion emergency exercise, our team contributed to many of the design decisions Rush University Medical Center implemented as part of its campus improvement master plan – the most comprehensive construction and facilities renovation in its 167-year history. Developed soon after 9/11 and a number of anthrax incidents in the U.S., the master plan developed for Rush University included investments to prepare for mass-casualty events involving chemical, biological or radiologic agents, also known as CBR events.

The center brings an unprecedented level of preparedness to Chicago in the event of a bioterrorist attack, a deadly pandemic or an industrial accident with hazardous materials

-Dr. Dino Rumoro, Chair of Emergency Medicine, January 2012

What makes Rush University Medical Center capable of providing care for a large influx of patients seeking treatment during a CBR event? Rush University’s team made several programmatic investment decisions and engaged the design and construction team to develop creative solutions resulting in surge-mode operations capabilities – in other words, the ability to prepare for a potential sharp increase in patients.

Among these solutions are:

Flexible Negative Pressure Isolation Capacity
All hospitals have Airborne Infectious Isolation (AII) Rooms to be isolate infectious or contaminated patients from the rest of the patient population. Isolation rooms ventilation systems help to contain viruses and other contaminants with negative pressure. In these rooms a dedicated exhaust system removes more air from the space than is supplied – causing air from cleaner surrounding spaces to flow into that room to contain and eventually exhaust airborne particles to the outdoors.

In a CBR event, there can be a need for far more isolation spaces than typically needed for normal hospital operations. The HVAC system at Rush allows the Emergency Department treatment rooms in whole pods to be converted to negative air pressure environments for critical or infected patient care. Additionally, regular patient room ventilation in the tower was designed for quick conversion to negative pressure to expand the hospital’s capacity for a large-scale incident. In fact, 20% of all ventilated COVID-19 patients in Illinois are at Rush.

Medical Gasses and Power
During surge-mode operations, the entry lobby is converted into a non-critical/non-infectious patient treatment space. During design, access to medical gasses and additional electrical capacity was placed in the structural column cladding – providing easy access for temporary overflow operations as needed.

When our team started working with Rush University in the early 2000s, we were thinking about these issues with hope these spaces wouldn’t have to be activated for a pandemic. A recent article in Architectural Record offers additional details about the innovative solutions developed for this hospital over a decade ago that have made it a valuable resource for patient care during this pandemic.

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