Accident &

Emergency Centre
By: Mohtady Mohamed | 5317388

Design II
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PURPOSE:
The ACEM Emergency Department (ED) Design Guidelines are intended to support
clinicians in the design process, and inform government, health planners, architects
and designers about what constitutes a contemporary Emergency Department.

BACKGROUND:
The Emergency Department plays a pivotal role in providing the public with access
to acute health care, and the provision of support to primary health care and
community services. An Emergency Department is also an important interface to the
many inpatient and outpatient services offered by its parent hospital and the health
service of which it is a part. In addition, a large proportion of the total acute
admissions to inpatient wards are via Emergency Departments.

Design
The design of an efficient Emergency Department in which care is coordinated and
carried out in an appropriate environment depends on the productive collaboration
between a number of key stakeholders involved in the building or redevelopment
process. The process of Emergency Department design should consider:
• Functionality – an Emergency Department’s design needs to be practical and
reflect how health professionals manage and treat their patients who have
different clinical conditions.
• Form – spatial considerations and relationships that promote effective
interaction between staff and patients, relatives, carers, and the flow of clinical
care. Consideration that Emergency Department models of care will change
over time is needed, as well as consideration of the relationship between the
Emergency Department and the greater hospital. Over time, clinical treatment
spaces will be reallocated, so many spaces need to have flexibility built into
them to ensure future proofing.
• Patient and staff needs – the aim of health care is not only to treat disease, but
also to create a healing environment for patients that is safe and free of
psychosocial elements created through poor design. Additionally, the
workplace needs of Emergency Department staff can be promoted through
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the application of Occupational Health and Safety (OH&S) standards that

ensure a work environment that is as safe as possible. The psychosocial
wellbeing of staff should be considered through design and space use. This
should not be underestimated given that staff will occupy the Emergency
Department spaces much longer than any patient, relative or carer.
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BUILT ENVIRONMENT: SPECIFIC ROOMS

AND FUNCTIONAL REQUIREMENTS:
1. Ambulance bay/ambulance reception:

Purpose: An ambulance bay is used for the delivery of both ambulant and
non-ambulant (trolley bound) patients to the Emergency Department by the
ambulance service.
Size:
- Size is governed by the potential number of ambulances attending the
Emergency Department at any one time.
- A minimum of two spaces for each 4 x 6m per vehicle is required. There must
be an allowance for an unloading space at the rear of the vehicle’s side door
opening and pedestrian access along both sides of a parked vehicle.

- Adequate circulation space is required at the rear of parked ambulances in

order to manoeuvre stretchers.
- Sufficient space is required in front of parked ambulances to enable
manoeuvring of vehicles consistent with the turning circle of local vehicles.
- Lifting should be minimised by the provision of a plinth or a similar system if
drop-down stretchers are not used by the local ambulance.
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2. Decontamination room/area

Purpose: A decontamination room is used to decontaminate patients prior to

entering the Emergency Department, including those who have potentially or
actually been exposed to, or contaminated with toxins, chemicals, radioactive
materials and other hazardous substances.

Size:
- Decontamination of one to two persons e.g. farm exposure to insecticides.
- Decontamination of up to ten people e.g. facility chemical leakage
- Large scale decontamination e.g. Mass Casualty Incident involving local or
state emergency response.

3. Waiting room
A waiting room is intended for patients to wait in both before and after triage,
for entry to treatment areas, for waiting for transportation post-discharge, or for
accompanying persons waiting.

4. Trauma and resuscitation rooms

A trauma room provides reception, assessment and initiation of treatment of
patients who have been subjected to major trauma. A resuscitation room
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provides reception, assessment and initiation of treatment for patients who

have life threatening or time critical illness.

5. Isolation rooms
Isolation rooms should be provided for the treatment and possible resuscitation
of potentially infectious patients, or for the protection of immunocompromised
patients.

6. Pharmacy/Medication room/Clean utility

A pharmacy/medication room is used for storage and dispensing of
medications, and the preparation of drugs (including IV administered).
The pharmacy/medication room/clean utility room should be a minimum
12m2.

7. Staff room
The clinical environment is often stressful. Well-designed staff facilities provide
time out, relaxation and add to morale and staff functioning. The staff room is
used by staff to consume meals, for social events and for the celebration of
achievements. The kitchen area may be incorporated within the staff room or
immediately adjacent to it. Staff should be able to prepare hot and cold drinks
and prepare or heat food. Depending on the size of the Emergency
Department, the kitchen area may also be used for the preparation of
beverages for patients.
8. Appendix A. Emergency Helicopter Landing Facilities (EHLF)
A-1. General. Preplanning emergency landing areas will result in safer and more
effective air-support operations. These facilities comprise rooftop emergency facilities
and medical emergency sites. Use the following as a guide for developing
emergency helicopter landing facilities (EHLF).

A-2. Notification and coordination. In addition to any requirements to provide notice

under part 157, advise the local Terminal Approach Radar Control or the local Air
Traffic Control facility manager in writing of the EHLF.
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A-3. Rooftop emergency facilities. Review local building codes to determine if they
require structures over a specified height to provide a clear area on the roof capable
of accommodating a helicopter to facilitate fire fighting or emergency evacuation
operations.

a. Building code requirements. State and local building code requirements apply to
rooftop facilities. Develop the landing surface to the local fire department
requirements based on the size and weight of the helicopter(s) expected to engage
in fire or rescue operations (see Figure A-1). Find additional information in various
National Fire Protection Association (NFPA) publications. For more reference material,
see Appendix D.

b. TLOF.

(1) Size. Design the TLOF to be square, rectangular or circular in configuration and
centered within the EHLF. Design the length and width or diameter to be at least 40
feet (12.2 m)

(2) Weight capacity. Design the TLOF to accept a 13,500-pound gross weight (GW)
helicopter plus an impact load of 1.5 times GW.

(3) Access. Provide two pedestrian access points to the TLOF at least 90 degrees
apart with a minimum of 60 feet (18 m) TLOF perimeter separation.

(4) Drainage. Design the surface so drainage flows away from pedestrian access
points, with a maximum slope of 1.5 percent.

c. FATO. Design the FATO to be at the same level as the TLOF.

(1) Size. Design the FATO to extend a distance of at least 45 feet (13.7 m) in all
directions from the center of the EHLF. For safe operation, provide clearance of one
third of the rotor diameter (RD) of the largest helicopter expected but not less than 20
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feet (6.1 m)between the helicopter ’s main and tail rotor blades and any object that
could be struck by these blades.

(2) Obstructions. As an option, design the FATO to be an imaginary surface outside

the TLOF and extending beyond the structure edge. Design the FATO to be
unobstructed and without penetration of obstacles such as parapets, window
washing equipment, penthouses, handrails, antennas, vents, etc.

d. Safety area. Provide a clear, unobstructed area, a minimum of 12 feet (3.7 m)

wide, on all
sides, outside and adjacent to the FATO.

e. Safety net. If the platform is elevated 4 feet (1.2 m) or more above its surroundings,
Title 29 CFR Part 1910.23 Guarding Floor and Wall Openings and Holes, requires the
provision of fall protection. The FAA recommends such protection for all platforms
elevated 30 inches (76 cm) or more. However, do not use permanent railings or
fences, since they would be safety hazards during helicopter operations. As an
option, install a safety net, meeting state and local regulations but not less than 5 feet
(1.5 m) wide. Design the safety net to have a load carrying capability of 25 lbs/sq ft
(122 kg/sq m). Make sure the net does not project above the level of the TLOF.
Fasten both the inside and outside edges of the safety net to a solid structure.
Construct nets of materials that are resistant to environmental effects.
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Space Area in Square Meters

Administrative Service
Lobby
Waiting Area 0.65/person
Information and Reception Area 5.02/staff
Toilet 1.67
Business Office 5.02/staff
Medical Records 5.02/staff
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Space Area in Square Meters

Office of the Chief of Hospital 5.02/staff
Laundry and Linen Area 5.02/staff
Maintenance and Housekeeping Area 5.02/staff
Parking Area for Transport Vehicle 9.29
Supply Room 5.02/staff
Waste Holding Room 4.65
Dietary
Dietitian Area 5.02/staff
Supply Receiving Area 4.65
Cold and Dry Storage Area 4.65
Food Preparation Area 4.65
Cooking and Baking Area 4.65
Serving and Food Assembly Area 4.65
Washing Area 4.65
Garbage Disposal Area 1.67
Dining Area 1.40/person
Toilet 1.67
Cadaver Holding Room 7.43/bed
Clinical Service
Emergency Room
Waiting Area 0.65/person
Toilet 1.67
Nurse Station 5.02/staff
Examination and Treatment Area with Lavatory/Sink 7.43/bed
Observation Area 7.43/bed
Equipment and Supply Storage Area 4.65
Wheeled Stretcher Area 1.08/stretcher
Outpatient Department
Waiting Area 0.65/person
Toilet 1.67
Admitting and Records Area 5.02/staff
Examination and Treatment Area with Lavatory/Sink 7.43/bed
Consultation Area 5.02/staff
Surgical and Obstetrical Service
Major Operating Room 33.45
Delivery Room 33.45
Sub-sterilizing Area 4.65
Sterile Instrument, Supply and Storage Area 4.65
Scrub-up Area 4.65
Clean-up Area 4.65
Dressing Room 2.32
Toilet 1.67
Nurse Station 5.02/staff
Wheeled Stretcher Area 1.08/stretcher
Janitor’s Closet 3.90
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Space Area in Square Meters

Nursing Unit
Semi-Private Room with Toilet 7.43/bed
Patient Room 7.43/bed
Toilet 1.67
Isolation Room with Toilet 9.29
Nurse Station 5.02/staff
Treatment and Medication Area with Lavatory/Sink 7.43/bed
Central Sterilizing and Supply Room
Receiving and Releasing Area 5.02/staff
Work Area 5.02/staff
Sterilizing Room 4.65
Sterile Supply Storage Area 4.65
Nursing Service
Office of the Chief Nurse 5.02/staff
Ancillary Service
Primary Clinical Laboratory
Clinical Work Area with Lavatory/Sink 10.00
Pathologist Area 5.02/staff
Toilet 1.67
Radiology
X – Ray Room with Control Booth, Dressing Area 14.00
and Room
Dark Toilet 4.65
Film File and Storage Area 4.65
Radiologist Area 5.02/staff
Pharmacy 15.00
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References
• Opens, R. et al. (2016) ‘The Emergency Department —’, pp. 11–12.
• November, H. (2004) ‘Manual on Technical Guidelines for Hospitals and Health
Facilities Planning and Design.’, (November), pp. 1–6.
• Aviation, F. and Design, H. (2012) ‘Advisory Circular’.