Resilience in Health Care Facilities

The hurricanes that pounded portions of the East Coast of the United States in recent years left record-setting destruction in their wake. But they also taught valuable, if painful, lessons about resilience — what works, what doesn’t, and what’s needed to ensure that the built environment can withstand the predicted increase in these cataclysmic weather events.

These storms, as well as wildfires in the West and tornadoes, hailstorms and extreme flooding throughout the South and Midwest, also drove home the message that hospitals and other health care facilities face unique challenges during times of crisis. They must continue operating to ensure the wellbeing of their patients, meet the needs of staff members who are caring for those patients, and admit additional patients, many of whom may have been injured during the storm. Hospitals frequently house ongoing research and millions of dollars of scientific work could be destroyed if power is lost, or a lab is flooded. Health care facilities are often called on to serve as emergency command centers for entire communities, even during extended utility outages and transportation infrastructure disturbances, and provide such basic necessities as food and water. In fact, in a 2014 report, FEMA cited hospitals, along with public shelters, vital data storage centers, power generation and water and other utilities, and installations which produce, use, or store hazardous materials, as critical facilities “for which the effects of even a slight chance of disruption would be too great.” In other words, hospitals must be able to provide “a standalone level of resilience” independent of the surrounding community and its infrastructure.

The same FEMA report points out that demographics are working to make hospitals even more essential during a crisis, pointing out that the aging population of the United States “will place additional stresses on health care infrastructure.” Finally, while hospitals understand how to organize for the unexpected, other “sub-acute” residential health care settings such as nursing homes, dialysis centers, rehabilitation centers and retail pharmacies tend to be less focused on the stresses that an emergency could put on their systems. Nonetheless, these non-hospital settings need to plan for worst-case scenarios and fully assess their physical vulnerabilities.

Given the increasing frequency of cataclysmic natural events, there has been a growing awareness that rebuilding health care facilities in the wake of a storm is not a viable approach: to fend off the impact of future storms, it will be necessary to incorporate increased structural resilience to protect both patients and staff during extreme events. In many instances, hospitals have responded, ensuring that their built environment incorporates features that were unheard of even a decade ago.

The Importance of the Roof

In any building, the continued functioning of the roof is essential to protect the interior from water or wind damage, and to maintain a comfortable level or heating or cooling for the interior space. In a health care setting, especially when flooding is an issue, the roof must perform additional essential tasks such as serving as a potential location for evacuation of patients or delivery of essential supplies and personnel. For instance, in the wake of Hurricane Katrina at Tulane Medical Center, the hospital’s engineering staff was called on to fashion a makeshift helipad on a parking garage roof to evacuate 200 patients and 1,500 personnel beginning two days after the storm, as generators ran out of fuel or failed and it became apparent that no fuel would arrive. Patients were transported in passenger pickup trucks, as ambulances were too tall to access the parking deck.

Additionally, roofs may be required to support heating and cooling equipment. At Spaulding Rehabilitation Hospital in Boston, opened in 2013, all critical mechanical and electrical infrastructure was placed on the roof and above flood elevations to minimize possibility of interruption. In fact, hospitals in flood-prone regions are being planned and designed “upside-down” with critical infrastructure on rooftops and electromechanical distribution systems fed from the roof downward.

To help the health care sector better prepare for increasingly extreme weather, the Department of Health and Human Services (HHS) has produced the U.S. Climate Resilience Toolkit, devoting one specific section to Building Health Care Sector Resilience. The guide was developed through a public-private partnership with the health care industry and provides an introductory document as well as a suite of online tools and resources that showcase “emerging best practices for developing sustainable and climate-resilient health care facilities.” The guide also provides case studies of organizations that are finding innovative ways to deal with the threats posed by extreme weather events.

The toolkit also provides a checklist to help gauge the resilience of a building, focusing in part on conducting a critical building inventory. Questions specific to the roof, or partly pertaining to it, include:

  • Have you compiled building envelope and performance vulnerabilities for each critical building?
  • Have you reviewed building code design baselines against extreme weather intensities (wind speeds, rainfall volumes, etc.) for each critical building?
  • Have you incorporated expected climate change data over time into building vulnerability assessments?
  • What are the design wind loads for roofs?
  • What are the design snow loads for roofs? Have rooftop structures and equipment (and their attachments) been reviewed for anticipated wind speeds?
  • Have rooftop structures and equipment (and their attachments) been reviewed for extreme precipitation and/or hail vulnerabilities?

A Case in Point

As with most issues related to roofing, the people who have been on the front lines, helping to create a resilient system, are the real experts. Chuck Anderson is Construction Program Director at the University of Texas Medical Branch in Galveston. When Hurricane Ike struck in September 2008, the hospital, encompassing 100 buildings, suffered tens of millions of dollars in damage. Anderson has been one of the people charged with ensuring that the hospital campus, located on a vulnerable low-lying barrier island, is protected from similar future losses. The hospital campus is also required to be self-sustaining for two weeks during and after a storm. As far as priorities for building a resilient roof, Anderson says, “Number one, it is the product. Number two, the installation.” Anderson advocates for a fully adhered system. “You can have the best product in the world, and if it’s not applied correctly, that’s going to blow off.”

Anderson also points out that it’s essential to use a membrane that will withstand “any little blowing object that might put a hole in your roof.” But ultimately, along with state-of-the-art materials and installation methods, Anderson says that additional care is needed; when a storm is predicted, he and his staff walk the roofs to clear them of any debris that could create damage if it becomes windborne. High-tech roofing and low-tech, step-by-step attention to detail — a winning combination to help protect the built environment against increasingly destructive weather events.

To access the U.S Climate Resilience Toolkit and its guide, “Enhancing Health Care Resilience for a Changing Climate”, go to https://toolkit.climate.gov/image/662.

For information on incorporating resilience into a roofing system, go to http://epdmtheresilientroof.org.

About the Author: Louisa Hart is the director of communications for the Washington-based EPDM Roofing Association (ERA). For more information, visit www.epdmroofs.org.

Project Profiles: Health Care

Mount Carmel New Albany, New Albany, Ohio

Team

Roofing Contractor: Smith Roofing, Columbus, Ohio

Bellaforté Slate composite roofing in Smokey Gray was installed on the 117,668-square-foot hospital.

Bellaforté Slate composite roofing in Smokey Gray was installed on the 117,668-square-foot hospital.

Roof Materials

Bellaforté Slate composite roofing in Smokey Gray was installed on the 117,668-square-foot hospital. The composite roofing has achieved a Class A Fire Rating in the ASTME E 108 fire test and withstands straight-line winds up to 110 mph in the ASTM D 3161 test. The roof tiles also resist impact, severe weather conditions and wind-driven rain. Bellaforté Slate tiles not only add safety to the structure, they also add aesthetic appeal.

Composite Roofing Manufacturer: DaVinci Roofscapes

Roof Report

The 60-room hospital features eight operating rooms and specializes in outpatient and inpatient orthopedic, neurologic and musculoskeletal care. The roof was installed in May 2015.

PHOTO: DaVinci Roofscapes

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Project Profiles: Health Care

Union Printers Home, Colorado Springs, Colo.

Team

ROOFING CONTRACTOR: Interstate Roofing, Colorado Springs

Roof Materials

Interstate Roofing recommended Valoré Slate in the Villa color blend of medium and dark grays for the reroofing project. Valoré synthetic slate roofing tiles are made using proprietary VariBlend technology to form varying shades from tile to tile, creating an infinite number of color shades. Each single-width synthetic slate roofing tile is crafted using virgin polymer resins to guarantee a sustainable product. Valoré Slate tiles come in 12-inch tile widths with a 1/2-inch tile thickness, making it a lightweight yet realistic slate roofing tile option. (The Valoré Slate product line no longer is available.)
VALORÉ SLATE MANUFACTURER: DaVinci Roofscapes

Interstate Roofing recommended Valoré Slate in the Villa color blend of medium and dark grays for the reroofing project.

Interstate Roofing recommended Valoré Slate in the Villa color blend of medium and dark grays for the reroofing project.

Roof Report

Fondly known in Colorado Springs as the Castle on the Hill, the Union Printers Home has a long history of caring for people. Built in 1892 by members of the International Typographical Union to offer specialized health care to their union members, the facility today serves the general public with a multitude of services, including assisted living, nursing care, rehabilitation and hospice.

In 2012, extreme hail damage made it essential to replace the roof on the structure, which is a State of Colorado Historical Site. Interstate Roofing removed more than 50-year-old asbestos tiles on the roof and recommended polymer roofing tiles that complement the existing architectural style. “Considering the age, condition and historical value of the structure, we needed a roofing product that could work with the building while ensuring longevity to the structure,” says Scott Riopelle, owner of Interstate Roofing in Colorado Springs.

Although Riopelle was confident in the selection of the roofing product, there were many challenges for this project. The 50-man crew first had to complete the safe removal of the existing asbestos-laden tiles.

“We had to erect scaffolding 5-stories high to access the roof,” Riopelle says. “Due to the 12:12 roof pitch and the multiple turrets on the structure, building containment areas and debris removal were extremely dangerous. During the entire process, we performed continuous air-quality testing to ensure the safety of the home’s residents, staff and our crew.”

The team worked through the winter months and experienced continuous rain, wind and snow. Riopelle explains: “This means we had abatement processes, plywood redecking, dry-in and loading crews, heavy-equipment contractors, installers and supply companies all working in extreme-weather conditions. For this project, logistics and coordination went minute-to-minute.”

The temporary removal of the large historic clock on the front of the Union Printers Home created the next challenge. Because of its age, there was concern for the clock’s condition. Staff at the home asked that the hands of the clock not be moved; they were permanently set at 8 o’clock to represent the union’s efforts in the past to encourage an eight-hour workday.

Reroofing the turrets on the project was easier because of the Turret Package from DaVinci Roofscapes. Interstate Roofing provided DaVinci with four dimensions (the distance from the peak to the turret to the edge of the drip cap, the turret pitch, the turret cap length and the coursing exposure). From that information, Turret Packages were created, including the starter tiles, numbered field bundles custom-engineered for each course and a turret map diagram to guide the team through installation.

The three-month project had a gratifying outcome for Riopelle and his team. “This was a once-in-a-lifetime project,” Riopelle says. “Although we’ve completed projects much larger and more complex, this one was special because of the history associated with the Printers Union Home and the importance of the facility to the community.”

Interstate Roofing embraced the challenge of tying the old historic structure in with the new technology of the polymer slate products. “The results are amazing. This historic structure has a new life thanks to this roof,” Riopelle observes. “And since the roofing tiles are impact- and fire-resistant, there’s greater peace-of-mind for the staff and residents at the Union Printers Home.”

PHOTO: DaVinci Roofscapes

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NRCA Releases Statement on 2014 Midterm Elections, Calls for Breakthrough of Partisan Gridlock

The following statement is attributable to William Good, executive vice president of the National Roofing Contractors Association

“We are pleased a vast majority of candidates supported by the National Roofing Contractors Association (NRCA) and ROOFPAC, our political action committee, prevailed in the 2014 midterm congressional elections on Tuesday. In particular, we are pleased to see a pro-business majority has been elected in the U.S. Senate. We look forward to working with returning and new lawmakers in both parties to break through partisan gridlock and advance the policy agenda NRCA has been supporting for years. This includes pro-growth tax policies, relief from burdensome regulations, legislation that addresses the workforce development needs of our industry, and replacement of the so-called Affordable Care Act with market-based reforms to our health care system.

ROOFPAC, the voice of the roofing industry in Washington, D.C., was very active in the 2014 congressional elections, investing more than $300,000 in support of nearly 75 pro-business candidates during the 2013-14 election cycle. NRCA and ROOFPAC will continue to support members of Congress and other candidates who support government policies that enable roofing industry entrepreneurs to start and grow businesses.”

An Atlanta Neighborhood Receives Much-needed Health and Community Services All Under One Roof

Fulton County, Ga., administrators believe policy drives the conditions in which people live and work. When socio-economic conditions are poor and there are few public services, administrators believe the physical and mental health of community residents suffer. As such, in 2008, Fulton County’s Health and Human Services departments were charged with identifying opportunities to improve community health through programs and policies.

Adamsville Regional Health Center is a hybrid building that not only provides primary-care, dental and behavioral health clinics, but also offers child-care facilities, housing resources and access to the library system, as well as a workforce development center.

Adamsville Regional Health Center is a hybrid building that not only provides primary-care, dental and behavioral health clinics, but also offers child-care facilities, housing resources and access to the library system, as
well as a workforce development center.

As part of the resulting Common Ground initiative, county administrators now are providing services to underserved areas. Adamsville, a predominantly African-American neighborhood located on the southwest side of Atlanta, was identified as a community in need. Fulton County’s solution was construction of a hybrid building that not only provides primary-care, dental and behavioral health clinics, but also offers child-care facilities, housing resources and access to the library system, as well as a workforce development center. The space also has approximately 500 square feet available for future use. The county hoped the new building would not only provide assistance to residents but also entice additional businesses and housing development in the area.

Although the project was smaller—34,000 square feet—than most completed by the Atlanta offices of architectural firm Stanley Beaman & Sears and general contractor Whiting-Turner Contracting, the design-build team was attracted to the concept. “We thought it was a good story,” says David Deis, project manager with Stanley Beaman & Sears, a firm that specializes in healthcare design. “It’s kind of a community center that taps into all that Fulton County has to offer, and we were both intrigued by that.”

As the team got started, it quickly realized putting all the disparate parts and pieces together into one facility during the 275-day timeframe Fulton County required was going to be challenging. Teamwork and a roof that identifies this “beacon for the community” brought it all together on schedule and within budget.

ROOF AS METAPHOR

As the design-build team began laying out the building’s program requirements, team members realized something had to organize the many services the new Adamsville Regional Health Center would provide. Deis says the team devised an interior “street” visitors can walk down to access the individual departments. “Visitors can see where the dental clinic is, where the primary care and behavioral health are,” he says. “It’s almost like you’re walking down the mall or a street and you’re seeing all these services.”

The roof is like a “quilt”, bringing all the departments and services together in one space. It also is a predominant feature on the site.

The roof is like a “quilt”, bringing all the departments and services together in one space. It also is a predominant feature on the site.

The team immediately knew the roof would be important. Not only would it be like a “quilt” bringing all the departments and services together in one space, but it also would be a predominant feature on the site.

Built along Martin Luther King Jr. Drive, a state highway that leads into downtown Atlanta, the building would be seen by a lot of traffic. The site itself is street level next to Martin Luther King Jr. Drive but dramatically drops farther from the street. The design-build team opted to create a 2-story building in which the second story is level with the roadway. Parking and access to the first level were built in the back where the site plummets. The location of the building and the site’s topography dictated a roof that would capture the attention of passersby.

“Once we set the building and looked at it formally, we didn’t want people driving down the street and looking down onto a typical gable-type roof,” Deis says. “We knew the roof would be very dominant and we wanted to keep it clean and allow it to claim the corner at the intersection.”

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