The greening of a critical access hospital
If you have driven through the Midwest, you have seen dozens of towns similar to Greensburg, Kansas. The main streets of these towns are lined with historic buildings that a generation ago housed thriving businesses that were the backbone of the local economy. Their simple, dignified Architecture stirs our nostalgia for simpler times and a slower pace of living.
The tallest building is the local grain elevator, and its towering white shape defines the town's skyline. The houses are modest, yet well-maintained. Pickups and American-made cars are the preferred transportation. The residents are down-to-earth, friendly and work hard for their wages; and most of the towns are lucky to each have a couple thousand who still call it home.
But in spite of the similarities, each town has something that makes it unique. For Greensburg and its 1,500 residents, it was being home to the “World's Largest Hand-Dug Well” and a 1,000-pound Pallasite Meteorite. They were sources of pride for the community, and signs along the highway beckoned travelers to stop and take a look.
But everything changed for Greensburg on a stormy spring night last year. It was May 4, 2007, and the streets were quiet except for the wind and rain that had descended upon the city.
In the darkness 20 miles southwest of town, a massive tornado was forming. It first touched down and started moving toward Greensburg at 9:04 PM. The severe weather was being tracked by an astute weatherman with the National Weather Service. Moments after confirming the tornado, he issued the first warning. Two more urgent warnings were issued as it became clear that the tornado was heading directly for Greensburg. A final “emergency” warning was issued less than 10 minutes before impact. By the time the fearsome tornado entered Greensburg at 9:49, it churned with wind speeds of 205 miles per hour, and was more than a mile-and-a-half wide. It was the first EF5 to hit Kansas, and the only tornado of that magnitude to hit the United States in eight years.
Greensburg was destroyed. Eleven of its citizens were killed, and 95% of the buildings were no longer standing, including the hospital.
The next weeks would find the dazed people of Greensburg picking up the pieces of their lives and belongings. This small town was no longer like the others with which it had shared so much common ground. Now, to live in Greensburg meant to survive.
Greensburg goes green
The citizens of Greensburg had a decision to make: To stay and rebuild, or to leave? Most chose to stay. “You've got a lot of people here who've said there's no way they can let this city disappear,” says Steve Hewitt, city administrator for Greensburg.
But it quickly became clear that for Greensburg to succeed it would have to reinvent itself. The city was struggling to survive before the disaster, and the tornado could have been its death knell. But a few people, including the former mayor, Lonnie McCollum, had an idea: What if we make this town green?
It's an idea that Hewitt, who was born in Greensburg, is passionate about. “There's a good strong core of people who want to see this thing through,” Hewitt says. “Because of that, this community will make it.”
The city council approved a plan to make all of the public buildings in Greensburg conform to the Platinum level of the U.S. Green Building Council's Leadership in Energy and Design (LEED) standards. It will be the first city in the country to do so. The town's efforts have garnered national attention. Movie star Leonardo DiCaprio has produced a series currently airing on the Discovery Channel that chronicles the rebuilding of the city.
“If green wants to go beyond a trend, then Greensburg has to show it can be done,” Hewitt says. “If Greensburg can do it, why can't any other town do it?”
The rebuilding efforts of the community are also exemplified in Greensburg's medical facility, Kiowa County Memorial Hospital (KCMH), a Critical Access Hospital (CAH).
After the tornado, little of it remained: the walls were smashed, the equipment scattered and patient beds were strewn around the property (figure 1). In one of the many miracles that night, none of the patients or hospital staff were injured. They had been safely sheltered from the storm in the basement of the facility.
The powerful EF5 tornado devastated the city of Greensburg, Kansas, and destroyed Kiowa County Memorial Hospital. Its roof and many precast concrete beams were torn off, walls collapsed, and equipment was scattered. In spite of the destruction, all staff, patients, and some residents remained safe in the basement shelter of the hospital
About three years before, Mary Sweet, the hospital's administrator, had implemented changes in the emergency procedures that made the basement, not the hallways, the center of refuge. Now, the new hospital will be built for strength, and will also include a storm shelter in the basement. A recent reminder of its importance occurred in May 2008, when a funnel cloud passed directly over Greensburg and killed two people traveling on the highway east of town.
Sweet knows she needs that same foresight to make beneficial choices for the future hospital. “We are trying to make wise decisions that are 50-year decisions for the future of this hospital and for our world, too,” she says (figure 2).
The replacement facility for the Kiowa County Memorial Hospital will be 48,500 sq. ft. and will be licensed for 15 acute-care beds. The new Critical Access Hospital will include a five-provider clinic, a specialty clinic, an emergency room, a physical/occupational therapy department, a radiology department, lab, and other support areas including an on-site daycare facility
One such decision is economical use of resources, which is of utmost importance to small rural CAH facilities. Services will be consolidated and integrated to make the most of hospital staffing. Spaces must also be designed for multi-use to maximize reimbursement rates. Some parts of the hospital will also serve as meeting rooms for community groups.
“It's good to be building the hospital around how we are as a community, our values and needs, and at the same time provide for how we practice medicine today,” Sweet says (figure 3).
The hospital is currently housed in three trailers, and is still using four of the nine (M.A.S.H.) army medical tents that were set up in the aftermath of the storm
In the LEED
Some of the decisions getting the most attention at KCMH will involve energy efficiency, sustainability, and use of recycled materials. Decisions regarding these elements are intended to make KCMH the first LEED Platinum-rated CAH in the nation. A platinum rating requires that the facility earn 52 points out of a possible 69 on the LEED rating scale. Because a number of LEED credits are not available because of the project location and circumstances, and with a margin of only 17, each point matters.
A project goal is to have 30% of the aggregate material cost be for recycled material. To calculate and recalculate this figure each time adjustments are made using a spreadsheet and manual takeoffs would require days. Using the BIM feature of Autodesk Revit, though, it takes only seconds. The medical architect, Health Facilities Group of Wichita, Kansas customized this Revit quantity of materials feature to automatically track materials attributes, including the percentage of recycled material and the weighted monetary cost of each item. Design decisions could then be quickly evaluated for their impact on aggregate cost of recycled material in the overall project.
To achieve a LEED Platinum rating for a hospital, the architects, engineers, and construction management team have been challenged to maximize efficiency in the systems while still providing a constructible product. “Doing so compensates for the high energy consumption in the normal medical facility that is necessary to meet code-mandated requirements for air quality, ventilation, and infection control—it just makes good business sense,” says Phillip Schultze of Murray Company, construction manager. The team found one solution through a combination of heat recovery strategies and cutting edge HVAC technology.
“The way we approached it, some elements of a normal system were able to be eliminated because of the high efficiency of the selected systems and the specific combinations used,” says Tim Dudte, AIA, Health Facilities Group project manager.
Here's how it worked: In this region, there is typically a redundancy in the heating and cooling systems that involves three sources of power. Because of utility costs, natural gas is often used to heat boilers, while electricity is used to power the chilled water system used for air-conditioning. Fuel oil is usually the choice to provide redundancy as a backup fuel for the generator and boilers. This requires separate storage for both backup systems.
Because of the efficiency of the building envelope design, it became feasible to use electric boilers and electricity for all of the primary systems. The fuel oil boilers and all of the natural gas systems could be eliminated, significantly reducing the system first cost. This cost savings offset the additional expense of the heat recovery systems and a high efficiency magnetic chiller.
There are several other project highlights:
The new building will take advantage of natural light for daylighting 75% of the facility. This is made possible by optimizing sun angles, while the latest generation of high-performance glass also provides high insulation and blocks harmful UV radiation.
An on-site wind turbine will generate a portion of the power needed to operate the hospital.
To avoid the heat-island effect, the roof and parking lot will use lighter-colored materials to reduce heat absorption and improve reflectance.
The hospital will reduce waste water by 50% by processing it through a natural bio-swale filtration system. Rain water will also be captured and then used to flush toilets.
The interior finishes will incorporate recycled materials. For example, the majority of tile used throughout the building is manufactured regionally, made from recycled content, and has been evaluated for future recyclability.
By partnering with the National Renewable Energy Laboratory (NREL), the team was able to consult with experts on energy analysis and the latest technological advances. NREL modeled design options and provided energy analysis options for the building designed by the team.
None of these achievements would matter unless they allowed the hospital to sustain its most important resource: people. Research demonstrates that sustainable elements in healthcare environments both provide a better, healthier working environment for employees and support the mission of the hospital to promote healing.
For Greensburg, the hand-dug well and meteorite will always be part of its uniqueness. But if the city achieves its goal of becoming the nation's model “green” community, those attractions will be the icing on the cake.
Sweet's hopes and aspirations for the new hospital exemplify the care and effort being put into the rebuilding of Greensburg. “Even with the devastation of a tornado, we have to make something good come out of this,” she says.
So far, Greensburg is succeeding (figure 4)—with green. HD
The new hospital is designed to be the nation's first LEED Platinum Critical Access Hospital. Green features include on-site energy generation via a wind turbine and multiple reuse of water sources, including rain water. The construction will maximize the use of recycled materials. The shell of the building is designed to make the best use of daylighting and natural views and to control solar gain
Brent Castillo is Art & Communications Director for the Health Facilities Group, a medical planning and Architecture company in Wichita, Kansas.
Facility: Kiowa County Memorial Hospital
Architect and Planner: Health Facilities Group, Wichita, Kansas
Mechanical/Plumbing Engineers: Midwest Engineering, Inc.
Civil Engineering: Mid-Kansas Engineering Consultants, Wichita, Kansas
Electrical/Structural Engineers: Professional Engineering Consultants, Wichita, Kansas
Kitchen Design Consultant: Montgomery Hoffman Associates, Topeka, Kansas
Healthcare Design 2008 August;8(8):16-22