Deep within the Mojave Desert, a two-lane road leads to an isolated U.S. Army base, where our nation’s soldiers prepare for war amidst the dry and sparse expanse that surrounds them. It’s on this site where a design team has been charged to offset the stark realities of that environment by creating a “medical oasis.”

The 215,000-square-foot Fort Irwin Replacement Hospital located 37 miles northeast of Barstow, California, is the latest on a recent list of military medical facilities showcasing the U.S. Department of Defense’s “world-class” healthcare design initiative.

However, on top of its evidence-based design principles including both patient- and family-centered care, the facility also stands to become the first net-zero, carbon-neutral hospital that will generate all of its energy needs from solar power and renewable energy systems.

“It needs to be something different. It needs to restore these soldiers and warriors, and bring them back to health as well as take care of their families. So that was a real priority for us right from the get-go,” says Steve Langston, director of design for RLF, which designed and engineered the facility through the design documents stage and now provides construction support services as part of a joint venture with Ellerbe Becket.

Turner Construction Co. was selected to build the $160 million hospital that replaces the Weed Army Community Hospital currently on the base, with groundbreaking expected in August 2012. Occupancy is scheduled for March 2015.


Defining goals
From the outset, the Fort Irwin project presented a unique challenge—the “client.” Ownership consists of seven separate military entities, including the Assistant Secretary of Defense for Health Affairs; the Department of Defense (DOD) and the U.S. Army; the U.S. Army Health Facilities Planning Agency; the U.S. Army Corps of Engineers; the U.S. Army Corps of Engineers, Los Angeles District; the garrison commander of Fort Irwin, representing the hospital itself; and the Department of Public Works.

“It is very multifaceted, and we have to be the design team that threads the needle, so to speak, and so we worked through all of the various requirements from the various agencies to bring it together to get their approval on time and on budget,” says Ronald A. Lowry, AIA, chairman of RLF’s board of directors.

That objective was no easy task, either, with a very tight schedule that gave RLF just 40% of the time normally allotted for design in a traditional Army project model, says Keith Holloway, AIA, project/BIM technology manager for RLF.

Ken Wing, PE, district project manager for the U.S. Army Corps of Engineers, who managed the design contract for the government, concurs, noting a directive was given by the Office of the Assistant Secretary of Defense to award the project by March 30, 2012. “This direction drove the entire process and we accelerated the design schedule to allow complete design documents in a 14-month period,” he says.


A ‘world-class’ oasis
Fort Irwin is home to an armored regiment, but it also has another highly important mission: serving as the location for the Army’s National Training Center (NTC), a fact that served as a critical guide for how the design of the replacement hospital took shape.

“They constantly have battalions rotating through, one right after the other, before each of the brigades can deploy—that’s their mission. The mission of the hospital is to support the troops and their families, and any eligible retirees around the Fort Irwin area,” Lowry says.

So while the replacement facility will include inpatient and outpatient care, it is also equipped to handle treatment of soldiers wounded in training, often from an area of the NTC called the “Box”—what Lowry describes as similar to a Hollywood movie set where actors take on various guises, from Afghan villagers to insurgents, to prepare soldiers for deployment.

“Because the action is so realistic and live ammunition is used, they sometimes will get as many as four helicopters that are bringing injured personnel from the Box back to the hospital. So there is an emergency department with a helicopter landing zone right next to it,” he says.

One more objective critical to the project is another directive, this from the DOD, that all military medical facilities be built to the department’s world-class standards.

“’A medical facility achieves the distinction of being considered world-class by doing many things in an exceptional manner, including applying evidence-based healthcare principles and practices, along with the latest advances in the biomedical, informatics, and engineering sciences,” states the “Achieving World Class” report by the National Capital Region Base Realignment and Closure Health Systems Advisory Subcommittee of the Defense Health Board.

Keeping the world-class standards in mind, RLF was also challenged and inspired by Fort Irwin’s location. With the closest town about an hour’s drive away, the base’s hospital needed to be completely self-contained while also providing a design solution that combats the seclusion.

“If you look at Fort Irwin, it’s very industrial-looking. They’ve done a nice job of addressing their residential needs and have some nice housing, but basically their day-to-day operations facilities are fairly industrial,” Holloway says. “We envisioned that the hospital would bring something nice for them at Fort Irwin, something they would appreciate at a facility level.”

Part of that process was bringing a restorative aesthetic to the building design, so the team set out on reflecting the sense of an oasis in the desert by designing a lobby “crevasse” of precast concrete simulating rock and slanting in distinct geometric patterns similar to rock groupings found in oases in the Mojave Desert, as well as using a ceiling-mounted trellis system that simulates light streaming through palm tree fronds.

Recognizing the world-class directive’s support of evidence-based design principles, the Fort Irwin design also incorporates natural light, staff respite areas, family member accommodations, patient controls, and limited travel distances.


Solar systems
Citing exceptional use of engineering sciences, as well as stating a “world-class medical facility regularly goes above and beyond compliance with professional, accreditation, and certification standards,” the DOD’s design directive also inspired sustainability efforts, which resulted in a goal of LEED Platinum as well as the pursuit of a net-zero, carbon-neutral standing.

The design and engineering team came together to determine what would best suit the facility and established a number of preli
minary initiatives for the client to consider, using energy models to determine whether future savings validated the upfront cost, says David Fishel, senior energy analyst at RLF.

“We ended up with seven major energy-efficiency measures that only added a few percent to the budget and had a payback of fewer than 10 years,” Fishel says.

Those tactics included the use of occupancy controls, high-efficiency chillers and boilers, and variable frequency drives. Such measures alone reduced the building’s overall energy costs to half of the average for a similar building in California. “Right away, we were getting close to a pretty sustainable goal,” Fishel says.

However, a location with the highest solar irradiance in the United States, a reported rainfall of just four inches per year, and hardly any cloud cover jointly pushed the design of a solar program that would take the project the rest of the way toward its goal.

 “We have both a photovoltaic system making electrical [power] and a solar hot water system that makes most of the hot water for the hospital,” Fishel says. “This is what got us the other half of the way toward being carbon neutral.”

The team next had to design how the facility would support those solar features. Engineers and architects again used energy models that took such factors as average wind speeds, temperature, humidity levels, and cloud cover over an entire year and aligned those with different schematic designs to see what building orientation would best optimize energy savings.

In the end, it was decided that the facility would be constructed partially underground, using an existing natural hillside, to take advantage of the cooling at night. The building envelope was also optimized for the right amount of insulation that would reduce energy costs over the life of the building.

During the design phase, the team relied heavily on BIM models to communicate when decisions had to be made and to provide visual documentation for the client to help them make those decisions quickly, especially in light of the tight schedule. “We had the ability to show them very specific places in the building and even specific analysis. We could show them analytical data and back it up with graphical data,” Holloway says.

Moving toward its goal of being carbon-neutral and net-zero, as well as having a LEED Platinum designation, the team hopes the project will serve as an example of inventive ways to combat energy usage—after all, if achieved in a temperature-swinging location like the desert, such sustainability measures should be achievable in locales that require less extreme heating and cooling measures.

 “We are hoping it’s going to be an inspiration to other people. Intuitively, there were a lot of things we thought we were up against—it’s the middle of the desert, it gets up to 120 degrees Fahrenheit in the summer, and it also gets really cold. We’re hoping it’s going to challenge other people to think, ‘If they can do it there, we can certainly do it in San Diego [for example].’ We’re really excited for the implications for the industry and hope to be a catalyst for others,” Lowry says.   

For more information on Fort Irwin, please visit For more information on RLF, please visit Jennifer Kovacs Silvis can be reached at