THIS ITEM DOES NOTCIRCULATE

mm*

FALLOUT PROTE

PE HOS

U.S„ DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE

Public Health Service

PROTOTYPE HOSPITAL:

FALLOUT PROTECTED

Prepared by

Architectural and Engineering Branch

U. S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFAREPublic Health Service

Division of Hospital and Medical Facilities

Public Health Service Publication No. 791

Ill

FOREWORD

This publication reports a study of recognized fallout radiation pro-

tection design measures as applied to hospitals. The implications of

chemical and biological contaminants were also studied and are included as

part of this report. The primary purpose of this study is to develop criteria

and standards for the protection of hospital patients, personnel and vital

functional components compatible with normal functional planning and effi-

cient day-to-day operation. It is hoped that this information will also

encourage the development of integrated community civil defense plans in

which the potentialities of the local hospital are fully utilized.

Detailed design criteria and other technical information on incorpor-

ating fallout shelter in new hospital buildings and in additions to existing

hospital buildings are being prepared.

This project is an activity of the Hill-Burton Program of the Public

Health Service, developed by the Architectural and Engineering Branch of

the Division of Hospital and Medical Facilities under a grant from the

Office of Civil and Defense Mobilization.

Jack C. Haldeman, M.D.Assistant Surgeon GeneralChief, Division of Hospitaland Medical FacilitiesAugust 1960

IV

Associated on this project were:

Robert W. Hegardt, Architec-tural Consultant, New York

Peter W. Bruder, EngineeringConsultant, New York

Armour Research Foundation,

Blast Consultant, Chicago

Technical assistance and review of

specific details by:

Army Chemical CorpsArmy Corps of EngineersCommunicable Disease Center,

PHSNavy Bureau of Yards and DocksOffice of Civil and Defense

Mobilization

V

CONTENTS

PAGE NO.

FOREWORD III

THE NEED FOR PLANNING PROTECTION 1

CONSIDERATIONS FOR PLANNING PROTECTION 2

FUNCTIONAL ASPECTS OF THE HOSPITAL 8

SHELTER SPACE 12

SLEEPING 15

SHIELDING 15

FOOD 16

ELECTRIC POWER 17

AIR 18

WATER SUPPLY 20

HEATING 20

SANITATION 21

PLUMBING 21

COST 22

PROTECTED ADDITION TO AN EXISTING HOSPITAL 23

1

PROTOTYPE HOSPITAL -

FALLOUT PROTECTED

THE NEED FORPLANNING PROTECTION

The Public Health Service has, for

a number of years, been conscious

of the responsibility hospitals haveto the community over and beyondthose health problems which arise

during the course of everyday living.

Meeting these usual health needs is,

indeed, a formidable task in itself

and a hospital might feel justifiable

pride in successfully accomplishing

this objective. However, it is in

time of disaster when the servicesand skills which the hospitals repre-sent are most urgently needed. Forthe hospital to come forth at this

time with the means by which it

could be the focal point for getting

medical care, shelter and comfortto the sick and injured would be the

expression of its fullest purpose.

2

A number of hospitals have, onoccasion, successfully met the de-mands of natural and man instigated

disasters because they were pre-pared to do so, and thus had earnedthe gratitude of the citizenry. Theseexperiences have created a stock-pile of knowledge from which ex-

cellent guidelines for disaster plan-

ning have been developed.

More complex however, is the

situation with regard to nuclearwarfare. Here again, the role of the

hospital must be one of readiness to

serve the community should this

threat materialize. Present knowl-edge of the effects of modern war-fare upon a particular communityare highly theoretical. Neverthe-less, this threat remains. Our un-derstanding of the effects of nuclearwarfare indicates that, in its reali-

zation, the disaster health servicesand facilities of the Nation wouldface their most critical test. It

is a well known fact that no com-munity can be certain of escapingthe effects of fallout. A better

understanding of the implications

of nuclear disaster will enable the

responsible authorities to develop

realistic community civil defense

plans.

Tne detonation of a nuclear

weapon produces four major effects,

namely, blast, heat, initial nuclearradiation and residual radioactivity

due to fallout. The first three ef-

fects will be limited to an areasurrounding the immediate vicinity

of the detonation. The fourth item,

fallout radiation, could, however,affect practically the total popula-tion of the country.

The National Shelter Policy, an-nounced by the Office of Civil andDefense Administration in 1958,states as follows, "The Administra-tion has conducted exhaustivestudies and tests with respect to

protective measures to safeguardour citizens against the effects of

nuclear weapons. These several an-alyses have indicated that there is

a great potential for the saving of

life by fallout shelters. In the eventof nuclear attack on this country,fallout shelters offer the best singlenonmilitary defense measure for the

protection of the greatest numberof our people."

"The Administration’s nationalcivil defense policy, which now in-

cludes planning for the movementof people from target areas if timepermits, will now also include theuse of shelters to provide protec-tion from radioactive fallout."

To implement this establishedpolicy* the Public Health Service hascollaborated with Office of Civil and.Defense Mobilization to develop cri-

teria and standards for protectivemeasures in hospitals.

CONSIDERATIONS FORPLANNING PROTECTION

A prototype hospital of 150 bedswas selected as a basis of designbecause it is typical of the sizelikely to be built in the periphery of

an urban community or in the dis-tant suburbs of a potential target

area. Because of its location, the

hospital would be spared the de-

3

SITE PLANSCALE 0 50

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3

structive effect of blast and heat but

could be subject to some fallout

radiation. It was also felt that the150 bed hospital would be the opti-

mum size for presenting the com-plex normal problems of departmentrelationships, traffic

,and commu-

nications in conjunction with theessential features of shelter withoutobscuring the obvious characteris-tics of either. A fundamental re-quirement was that the protectivemeasures must in no way impair thenormal functional aspects of the hos-pital design. Therefore, the result-ing design would be useful as a guidefor planning a hospital with varyingdegrees of protection, from maxi-mum to minimum, depending uponthe determination of the commu-nity's civil defense program.

The protection of the patients andstaff of the community hospital,

while important, is only one aspectof total community defense. Theexistence of the protected hospitalmust be accompanied by a well con-ceived disaster plan which must becoordinated with the overall com-munity plan for civil defense. Sug-gested arrangements for housingpatients and staff are shown forthis project, but the determinationas to the patients, staff members,and other individuals for which thehospital will be responsible duringa disaster is one to be made byappropriate local authorities. Theextent of the clinical and otherservices to be protected, in additionto the space needed for housing, is

also a local determination.

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8

FUNCTIONAL ASPECTS OF THEHOSPITAL

This project presents a soundbasic hospital of 150 beds designedto serve the needs of an averageAmerican community. It demon-strates that protective measuresagainst fallout can be incorporatedin the planning and construction of

hospital buildings at reasonable cost

without sacrifice of functional oroperational requirements.

The hospital is basically com-posed of a protected unit and anunprotected unit joined by a circu-lation unit containing connectingcorridors and elevators.

The protected unit contains only

those elements whose function or

9

THIRD FLOOR PLAN

use would not be jeopardized, in anymanner, by being located in a win-dowless environment. For example,the concept of placing clinical anddiagnostic areas in a windowlessstructure is already widely ac-cepted as an efficient planningarrangement. Similarly, the serv-ice facilities, central sterilizing andsupply, stores, laundry, and dietaryare located on the lower floor of the

protected unit in a manner consist-

ent with normal practice. Theseareas provide ample space for the

maximum population of the hospital

and, in fact, will permit limited

shelter capability for others com-mensurate with the requirements of

the community civil defense plans.

Since the administrative areas areclosely interrelated with the main

10

FOURTH FLOOR PLAN

entrance and lobbies which are gen-erally arranged for easy accessfrom the street, these areas areplaced in the unprotected unit of

conventional construction. Thenursing units are similarly locatedbecause of present building coderequirements as well as widespreadpublic prejudice against windowlesspatient rooms.

For shielding purposes, accessopenings into the protected unit arelimited to the minimum necessaryfor functional use. On the first floor,

the public enters the outpatient de-

partment with ready access to x-ray,

pharmacy, laboratory and physical

therapy. The other entrance is

limited to staff and inpatients and

leads to surgery, obstetrics and the

11

clinical services common to the out-

patients. In like manner, the lowerfloor has a public entrance to the

dining facilities and a separate doorfor service and housekeepingfunctions.

During the period of fallout emer-gency, all main doors to the protec-

ted unit will be closed and access to

and egress from this structure, if

necessary, will be via the autopsyand morgue. This is arranged with

air locks and suitable washing facil-

ities to permit the radiological de-

contamination of individuals whomay have been subjected to the fall-

out environment.

The site plan is designed to sepa-rate service traffic from staff, em-ployees, and visitors. Convenientparking is provided for visitorsnear the main entrance and the

overflow, if any, can be accommo-

dated, in the main employees andstaff parking area at the side. Thejudicious use of landscaping andtree plantings serve to, minimizestreet noise and dust as well asimprove the view of the hospital

occupants.

Flexibility to permit expansionwas seriously considered in this

plan. The dotted lines on the plansof the protected unit indicate logical

directions for increasing the clinical

and service departments, and this

construction may be protected orunprotected as deemed necessary.The surgery department could beexpanded into the obstetrics areawhich could be placed on the secondfloor of the protected unit along with

a future maternity and nursery de-partment. Additional medical andsurgical nursing units could be con-structed over the new obstetricsunit as well as over the existingnursing units.

12

SUGGESTED SLEEPING ARRANGEMENTS FOR EACH FLOOR OF

THE PROTECTED UNIT OF THE GENERAL HOSPITAL ACCOMMO-

DATING A TOTAL OF 750 PERSONS.

SHELTER SPACE

In the event of nuclear attack,

under normal weather conditions,

significant amounts of fallout do not

arrive outside the blast area earlier

than about one-half hour after the

explosion. It is reasonable, there-

fore, to assume that a hospital (if

located outside the blast area) wouldhave some time to prepare for the

fallout emergency if promptly noti-

fied of a nuclear attack.

Upon such warning, all patients,

staff, and others in the unprotected

13

wing of the hospital would be evacu-ated to the protected area. The doorclosures consisting of loose keyedmasonry blocks would be arrangedto seal the door openings. The me-chanical and electrical systemswould be switched on to the pre-

designed civil defense emergencyoperating condition, and sufficient

cots would be set up to accommo-date the number of persons to besheltered. Based on the usual civil

defense requirements, it is assumedthat the fallout emergency situation

14

HOSPITAL OCCUPANCY TABLE

NORMAL STAFF PEAK POPULATION

Total Male Female Total Male Female

ADMINISTRATIVE 20 4 COrH

4

18 3 15

X-RAY 7 4 3 7 3 0

NURSING 105 5 100 52 2 50

LABORATORY 9 5 4 9 5 4

DIETARY 24 4 20 18 2 16

HOUSEKEEPING 28 14 14 21 10 11

PLANT OPERATION 10 10 0 7 7 0

LAUNDRY 10 2 8 10 2 8

PHARMACY * 2 1 1 2 1 1

OUTPATIENT DEPT. 7 2 5 7 2 5

PHYSICAL THERAPY 2 1 1 2 1 1

CENT. STER. SUPPLY 10 0 10 10 0 10

PHYSICIANS OB 5 5 0 2 2 0

SURGERY 20 20 0 10 10 0

GEN. PRACT. 20 20 0 10 10 0

OTHERS 7 7 0 3 3 0

VOLUNTEERS 3 5 0 5

VISITORS 20 20 10 10

OTHERS (SALES,SERVICE) 10 10 10 0

OUTPATIENTS 20 20 10 10

AMBULANT POP. 341 243 94 149

INPATIENTS 120 120

TOTAL 461 363

may last as long as two weeks and

sufficient food, fuel and other sup-

plies should be stored for this timeinterval.

Since an attack may occur at any

time, the hospital should be pre-

pared to act without undue delay and

be able to provide shelter accommo-dations at least for all individuals

within the hospital at the time of the

alert. A study of the peak popula-

tion of a 150 bed general hospital is

estimated to be 363 as outlined in the

accompanying table and this wouldserve as an indication of the mini-

mum arrangements that should beprovided. The type of basic hos-

pital plan selected would strongly

influence the extent of the protected

area that would be available. Onthis project, for example, it is pos-sible to protect the entire clinical-

diagnostic-service unit and to ac-

commodate a total of about 750

people at little additional cost overthe amount required to provide pro-tection for the bare minimum popu-lation. This additional capacitycould be an important adjunct to the

community civil defense program byproviding the capability for shelter-ing additional hospital and medicalpersonnel and the public.

SLEEPING

Single cots are provided for thecritically ill patients whose medicalcondition indicates the need for in-

tensive nursing care. The remain-ing patients would be assigned to

double-deck cots.

The administrative staff of the

hospital would be on call around

OPERATIONAL SCHEDULEOF SHELTER ACTIVITIES

0=00

THIS CHART DEPICTS A SUGSE8TED ROUTINE FOR THE

DAILY ACTIVITIES OF THE SHELTER INHABITANTS BASED

ON DIVIDING THE DAY INTO THREE EIGHT-HOUR SHIFTS.

the clock during the shelter emer-gency, and it is recommended that

they be assigned permanent spacesin double deck cots. All other non-

patients would be organized on a

three- shift per day program of

work-rest-sleep and three personswould be assigned to each double-

deck bunk unit for sleeping purposes.This would tend to eliminate the

(

hot

bunk' problem without requiring ex-

cessive sleeping accommodations.Bedding (a sheet or unlined sleep-

ing bag) would be furnished eachoccupant in a kit that would also

contain a number of indispensablepersonal hygiene items.

SHIELDING

Utilizing the principles outlined

in this project, any degree of pro-

tection from fallout radiation com-mensurate with the community civil

16

defense plan can be incorporated in

the hospital design. The specific

shielding requirements for a par-ticular hospital should be evaluatedby the local authorities on the basisof its location with respect to proba-ble target 'areas, direction of pre-vailing winds, potential for evacua-tion, and other civil defense orientedfactors

For this study project, a radiationprotection factor of 1000 was adoptedfor the protected unit. This wouldbe adequate for the heaviest fall-

out areas. As a result, the exposedwall construction is equivalent to amass thickness of 315 pounds persquare foot (about 26 inches of con-crete) and the roof is 230 psf (about20 inches of concrete). If a lessershielding value is selected, a lesserthickness of wall and roof construc-tion would ^hen be requiredSince the requirements other than

shielding (i.e., mechanical, electri-

cal, and architectural) will be the

same for all degrees of fallout pro-

tection; it is readily apparent that

the protection capability is con-

trolled by the amount of shielding

provided. Because small increases

in mass thicknesses which producelarge increases in shielding are

comparatively inexpensive, the ulti-

mate cost of better protection fromfallout is insignificant.

A vital factor in obtaining a reas-onably uniform shielding valuethroughout the protected unit is to

plan it with as few openings to the

outside as possible. It is difficult to

protect doors, windows, stair

towers, elevator shafts and simi-

larly large openings with any effi-

ciency. A circuitous entrance pat-

tern or maze will reduce radiation

penetration (although not to the sameextent as a direct closure) but doesimpose the problem of hinderingtraffic flow. Direct closures of ex-

terior wall openings by temporarybaffle walls or massive doors, onthe other hand, can be made as ef-

fective as the basic wall construc-tion without affecting traffic in anyway.

Since efficient traffic patterns area functional requirement in hospital

planning, it is recommended that the

direct closures of exterior wall

openings be used. Temporary baffle

walls are more practical from aneconomic point of view when a high

degree of shielding is specified,

and were, therefore, used in this

study project. Heavy doors wouldbe more suitable when the specified

radiation reduction factor is of a

low order.

The elevator and stair shafts

were removed from the protected

unit without sacrifice to hospital

function, thereby eliminating the

need for any protective measuresin connection with these elements.

FOOD

Since the dietary department in-

cluding food stores is in the pro-

tected unit, all food reserves in the

hospital at the beginning of the alert

would be available for use during

the civil defense emergency. Underan average hospital’s normal pur-chasing policy, this stock of food

supplies, when rationed to the shel-

ter occupants at subsistence levels,

might last as long as a week. Thismeans that prepacked food rations,

strictly for emergency use, wouldthen have to be furnished for only

another week. Cooking should bekept to a minimum, being limited to

soups and beverages warmed on the

electric cooking appliances.

For maximum utilization ofwork-ing personnel and facilities within

a normal three meals per day sched-ule, food can be served every six

hours around the clock as indicated

on the shelter operational chart.

Except for bed- ridden patients,

cafeteria style serving lines using“Single service paper plates and cupsare recommended if sufficient water

is not available for washing dishes.

ELECTRIC POWER

Electric service for a protectedhospital of the type described hereinoperates in the same manner as for

an ordinary nonprotected hospital.

Occasional interruption of the util-

ity service is expected for any hos-pital during the normal course of

time and events. An emergencyelectric service, usually of limitedcapacity, is required for all hos-pitals to assure continuity of criti-

cal functions within the hospital.

Many public utility service facili-

ties will not be protected againstfallout radiation; hence it must beassumed that such services will notbe available during such an emer-gency. Accordingly, emergencyelectric generating facilities must

be installed in the protected sections

of the hospital and must be of suffi-

cient capacity and have the correct

electrical characteristics for oper-ation of the selected lighting, pumps,fans and other essential motorizedequipment, and for cooking or warm-ing food. A supply of fuel and lubri-

cants for operation of the generating

unit at full load continuously for not

less than two weeks should be pro-vided.

This hospital is divided into twoprincipal sections, one section pro-tected against fallout radiation, the

other an unprotected section. Dur-ing an ordinary interruption of the

utility service, the emergency serv-ice would be connected in both the

protected and the unprotected sec-tions. During fallout conditions, the

emergency service would be dis-

connected from the unprotected sec-tion. The emergency electric capa-city thus saved could then be ap-plied in the protected section to

operate additional equipment not

emergency operated during an ordi-

nary short time interruption of the

normal utility service. It is ex-

pected that the emergency powercapacity required for operation of

the protected section alone, underfallout conditions, would be approxi-mately equal to the total requiredfor operating both protected andunprotected sections during ordi-nary short-time interruptions of

utility service.

In both the protected and the un-protected sections of the hospital,

the selected lighting circuits should.be automatically connected to the

emergency service when the normalservice is interrupted, but motors,except fractional horsepower mo-tors, should be arranged for manualstarting in such a sequential manneras not to overload the generator.

Overload protection of feedersshould be so provided that an inter-

nal fault in one section of the hos-pital will not cause an interruption

of service in the other section.

It is recommended that consider-

ation be given to providing cir-

cuitry to permit convenience of

alternately operating certain equip-

ment and also for possible future

connection of additional generating

capacity.

AIR

The normal air components for

physical comfort and well being with

which we are primarily concernedare oxygen, carbon dioxide and watervapor. However, not to be over-looked in the overall planning aresuch toxic, noxious, and pathogenic

constituents as: chemical, biologi-

cal and radiological warfare agents,

carbon monoxide, combustible gasesand odorous substance.

The capacity of the air condition-

ing system provided for the averagemodern hospital will usually exceedthe requirements for shelters. How-ever, certain modifications are re-

quired to adapt the system for

shelter use. Air purity, temper-ature and humidity must be kept at

suitable levels during the emer-gency. The totally enclosed natureof the shelter spaces and their com-

paratively high occupancy during the

emergency means that air condition-

ing including cooling will be a re-quirement in most areas of the

United States.

Temperature and humidity mustbe maintained within reasonablecomfort levels, particularly for the

benefit of hospital patients. Effec-

tive temperature, which is an arbi-

trary index representing the effect

of warmth or cold felt by the humanbody is the best available index of

ambient atmospheric conditions in

relation to the physiological re-

sponse of man. An effective temper-ature not to exceed 75° is recom-mended for hospital shelter areas.

This provides a range of temper-atures and humidities somewhatabove normal design practice for

comfort but well within tolerable

limits.

Although the broad emphasis has

been placed upon failout protection,

it is strongly recommended that

sufficient space should be provided

and the design of the ventilation

system should permit the installa-

tion of a combined chemical, bio-

logical and radiological (CBR) filter

unit. The system should be designed

to permit the bypassing of all out-

door air through the CBR filter unit

during the emergency to provide

additional protection by removinggas and bacteriological warfareelements.

In view of the space requirementsof the CBR filter units, it may be

desirable to hold the introduction of

outdoor ventilation air to a mini-

mum.

19

THIS GRAPH REPRESENTS THE COMBINATION OF TEMPERA-

TURE AND HUMIDITY CONDITIONS REPRESENTED BY AN

EFFECTIVE TEMPERATURE OF 75°.

Oxygen and carbon dioxide mustbe maintained at suitable levels.

This may be accomplished by the

introduction of outdoor air. Oxygenreplenishment from normally stored

supplies is not recommended for

emergency periods, although if

available, should not be overlookedas a reserve resource. Absorptionor closed regenerative systems arenot recommended for maintenanceof oxygen and carbon dioxide levels

when outdoor air is available.

Minimum outdoor air ventilation

rates to maintain suitable levels of

oxygen and carbon dioxide are de-pendent upon the per capita spaceallotment of the shelter area. Theaccepted rate for mass public shel-

ters is 3 cfm per occupant, perhour, for normally healthy persons.However, because of the physicalcondition of many of the occupantsof the hospital shelter and becauseof the specific ventilation require-ments of certain clinical areas,which may be active during the

emergency, a minimum of 5 cfm perperson, per hour of outdoor air is

recommended for hospital shelters.

Higher ventilation rates are de-sirable to provide greater flexi-

bility in controlling the air pres-surization of the shelter area whichis necessary as a protection against

the infiltration of contaminants.Higher ventilation rates will also

contribute to odor control. Wherethe air supply is limited to the mini-mum activated charcoal filters in-

stalled in the ventilation system arerecommended for odor control.

Good hospital design assumesgood filters in the normal outdoorair intake ventilation systems. Fil-

ters with a minimum of 80 percentefficiency according to the National

Bureau of Standards "Dust Spot

Method" of testing offer ample pro-tection against radiological fallout

particles. An abrupt change of di-

rection of air flow after entering theintake and prior to the filters will

materially aid in deposition of largecontaminated particles, thus re-ducing the filter load. As the

settling chamber and the filters maybecome highly contaminated withradiological particles, it is manda-tory that a protective barrier beinterposed between them and the

shelter area.

To maintain the boiler and elec-tric generator rooms uncontami-nated for the operating and mainte-nance personnel while supplyingcombustion air for this equipment,normal exhaust air from selectedareas within the shelter may bebypassed through these rooms.

As no filters have been devisedwhich will remove carbon mon-oxide, it is important that outdoor

20

air inlets be remotely located fromany possible source of fire such asadjacent combustible buildings.

Evaporative condensers are rec-ommended for the discharge of heatfrom the shelter air conditioning

system to eliminate any possibility

of carrying radioactive contami-nants into the shelter through the

cooling system.

WATER SUPPLY

Because of the possibility of ra-

diological contamination of public

sources of water supply such as im-pounded reservoirs, rivers and

water sheds, and because of the

possible destruction or contamina-tion of community distribution lines,

it is essential that a reliable sourceof water be provided for the emer-gency. Ground water, which is

available in a large part of the

country, offers a ready solution to

the problem, in that wells can bedeveloped within the shelter area.

A well, in addition to providing

safe water may eliminate the needfor restricting water usage for do-

mestic purposes. Where the waterfrom a well source is not potable,

consideration should be given to its

use for sanitary purposes such as

cleaning, toilet flushing, etc. In this

case, storage must be provided for

a minimum of 1 gallon of potable

water per occupant per day. Thisstorage must be placed in series in

the regular distribution lines to in-

sure continuous turnover of the

water so that it will be fresh at the

beginning of the emergency.

HEATING

Boiler rooms are usually designedwith large windows and other open-ings to provide light and ventilation.

These openings make the boiler

room a particularly hazardous anduntenable area in case of radioactive

fallout. Proper operation and main-tenance of this vital equipment maybe impossible under certain fallout

conditions. (Unprotected public

utility services may suffer fromsimilar circumstances.) For this

reason, an emergency source of heat

must be provided. There are twomethods of providing this heat whichmerit investigation: (1) Diesel en-

gine electric generator heat loss

recovery and, (2) a small emergencyboiler. Of the two heat sources, the

boiler is more adaptable to hospi-

tal operation. Under usual condi-

tions it is recommended a smallhigh pressure boiler be installed

within the protected area for useduring the emergency period. Somedesigns may lend themselves to a

normal usage of this boiler, but for

economy in design and operation,

under most circumstances, this

boiler would serve only for the

emergency period. The capacity of

the boiler should be kept to a mini-

mum to serve only those vital func-

tions required during the emer-gency, such as: space heating, waterheating, and operating a sterilizer.

Because of the high density popu-

lation and the confined nature of the

shelter area, space heating regard-

21

less of the season will be a minimalload. Heat requirements will usu-ally be supplied through the ventila-

tion system. The hot water load will

depend upon the availability of a

water supply and may therefore varyin different areas of the country.

Where water supply is dependentupon hospital storage facilities, aus-terity will be invoked and the boiler

load will probably be considerablyless than where a well water supply

is available. During the early stages

of fallout and confinement, it is

anticipated that the sterilization

needs will be taken care of by onepressure sterilizer.

Oil is recommended as the emer-gency period fuel because of the

ease of storage of an ample supplyfor the emergency period and be-cause it eliminates dependence uponan outside source of supply. Wherea boiler is installed solely for useduring the emergency, considerationshould be given to combining the

storage of boiler and the emergencyelectric generator fuel oils. Thiswould provide some turnover of thestored oil and place it under moreconstant supervision.

SANITATION

Provision for the disposal of rub-bish and human waste must be care-fully planned. A certain amount of

rubbish in the form of garbage,heavy cartons, bottles and cans will

pose the greatest problem. The useof garbage grinders for the disposalof food waste and the use of inciner-ators for the disposal of food wasteand rubbish should be explored

.

However, garbage grinders are de-

pendent upon an ample supply of

water and incineration is not effec-

tive for bottles and cans. A rubbish

storage room located within or ad-

jacent to the decontamination areaoffers a solution to the problem.This area will not be a part of the

general circulation area for the

population, and storage there wouldnot be objectionable. It is antici-

pated that as outdoor levels of

radiation intensity decrease, it will

be possible to periodically removethe accumulation of waste mate-rials to the outdoors.

PLUMBING

The plumbing system for the hos-pital shelter area poses no particu-

lar design problems. Where the

shelter area is a part of the normalhospital, water, sewer, gas, oxygenand other service distribution sys-

tems will serve both the shelter and

the non-protected portions of the

hospital. In such cases, in so far as

possible, a grouping of these sys-

tems at one point of entry to the

shelter area with cut-off valves

within the shelter, will facilitate

shutting off these services to the

unused portion of the hospital, if

necessary, at the time of the emer-gency. Where a well is available,

the normal water distribution sys-

tem will be cross-connected with

the well system.

Where well sources are available,

the use of flushing type fixtures is

recommended for human waste.

Chemical type toilets will usually

be required in situations where no

22

well source is available and it is

necessary to store potable water.

Toilet facilities for hospital shel-

ters are recommended as follows:

Water Closets 1 for each 25

patients and1 for each 35non-patients

Lavatories 1 for each 35

personsShower Baths 1 for each 60

patients and1 for each 120

non-patientsBecause local sewage disposal

facilities may not be protectedagainst radiation and therefore maynot be staffed or in operation duringthe emergency, it is necessary to

provide a means for removal of

sewage. For this purpose, it is

recommended that a bypass fromthe normal building drain be madeto a sewage sump within the shelter

from which sewage may be pumpedto the outside. Where chemicaltoilets are required, their contents

may be periodically disposed of

through the sewage sump.

Leaders for conducting rainwaterfrom roof surfaces should not passthrough the shelter area because of

the danger of creating hot spots in

the conductor system in case of rain

during the emergency.

COST

A major objective of this study is

to demonstrate that protectivemeasures against fallout can beincorporated in the planning and

construction of hospital buildings at

reasonable cost. Although true cost

figures are singularly elusive undernormal circumstances, they tend to

be particularly so in a study wherecomparative costs must be deter-

mined without benefit of definitive

contract prices. However, prelimi-

nary construction cost estimates,

based on mid- 1960 costs in the NewYork City area, have been completedand indicate that the cost of con-

structing the prototype hospital in-

corporating protective measures as

described herein would probably bein the range of three to five percent

more than the cost of a similarly

planned hospital of conventional con-

struction that would be completelyair conditioned.

The low additional cost can beattributed to a number of factors:

1) Little additional space is re-

quired solely for protective

purposes. Only space for the

storage of emergency supplies

(food, cots, etc.), civil defense

communications, emergencyboiler, air intake and filter,

and air exhaust, is in excess of

that required for normal hos-pital purposes.

2) Little additional equipment is

required solely for protective

purposes because a hospital is

well supplied with mechanicaland electrical equipment that

is readily convertible for shel-

ter use.

3) The hospital areas involved

permit a high degree of effi-

ciency in providing maximumshelter capability.

PROTECTED ADDITION TO AN EXISTING HOSPITAL

2 3

A satisfactory nation-wide pro-gram of protected health facilities

obviously cannot be achieved in a

reasonable time by the construction

of new protected hospitals. There-fore, the role of the existing hos-pital in this respect becomes veryimportant. The implications of in-

corporating protective measures to

the expansion of existing hospitals

has been studied.

Since the planning requirementsfor each addition would vary witheach hospital, it is difficult to pro-pose very specific planning recom-mendations. Whether or not an addi-

tion could be designed with all the

requisites for fallout protection withthe high efficiency of a new hospital

would ultimately depend upon the

kinds of services to be located in

the addition. In some instances,

space in excess of immediatelyplanned needs may be necessary to

fulfill the protective requirementsfor fallout. In these cases, areassuch as meeting rooms, training

facilities, etc., which are difficult

to justify on a hospital’s tight bud-

get, might be acceptable when usedin connection with the shelterprogram.

The services selected for the pro-totype addition to an existing 150

bed general hospital were found to becommonly lacking or greatly out-

grown in many present hospitals.

They are also highly efficient froma shelter point of view and, becauseof this, the protected unit shown is

oncmcm

cm

AIR EXHAUST

2 4

probably as small as can be devisedto house the scheduled peak popula-tion of 363. In all probability, if

other types of hospital services areused, a larger area will result.

The shielding, sleeping, electric,

and mechanical characteristics of^

this project are essentially similar

to those discussed in the new hos-

pital project.

25

o

FIRST FLOORSUGGESTED SLEEPING ARRANGE-

MENTS FOR EACH FLOOR OF THE

PROTECTED ADDITTON TO AN

EXISTING HOSPITAL ACCOMMO-

O

Preliminary cost figures have notbeen developed sufficiently for pre-sentation and discussion at this timebut it appears that the relative cost

percentage of the addition would bein a higher range than that discussedfor the new hospital project.

\

Public Health Service Publication No. 791