All it took was two feet of water to debilitate the Veterans Administration Hospital in New Orleans in the wake of Hurricane Katrina.
Once the flooding infiltrated the basement-level windows, it destroyed the emergency generators that the entire hospital depended on after municipal power cut out. Life support systems, lights, and heating and cooling were knocked out. At Memorial Hospital, also in New Orleans, an even more dire situation arose involving power failure, the inability to sustain patients in intensive care, and building evacuation. Forty people died there as a result of the storm,点燃医学伦理辩论about how to handle patients in disaster situations. (A doctor and two nurses were arrested for expediting the deaths of four patients; they were not convicted and the charges were expunged.)
现在，在卡特里娜（KatrinaNBBJ这体现了卡特里娜飓风的教训。
弹性的结构
在自然灾害之后，医院是一条字面的生命线。作为治疗现有患者的地方，他们变得更加必不可少，承认因灾难而受到伤害的人，并为各自的社区提供紧急救济。在危机时期不应失败。
卡特里娜飓风揭露了医疗中心的结构缺陷和脆弱性。在新奥尔良地区，在暴风雨两年后，有16家具有急性护理中心的医院中有7家仍关闭。负责重建设施的建筑师面临着一个挑战挑战：重建医院，以便在发生类似甚至更强的风暴时，建筑物的建筑物仍然充分实力且自给自足。
“It’s unfortunate, but right now the maps where we draw the extent of vulnerable areas are expanding, and areas that weren’t considered vulnerable before, are,”瑞安·赫林格（Ryan Hullinger），NBBJ的校长说。“在越来越多的医院中需要这些技术。”
新医院被认为是关键任务设施”弗吉尼亚州，这意味着它需要在几乎任何类型的灾难中生存并保持运营：自然，例如飓风，地震或人造，例如爆炸。从结构上讲，外围可以承受三类风暴，墙壁被坚硬以抵抗爆炸，弹道攻击和撞击。此外，建筑物的骨头旨在防止进行性崩溃–meaning that if one part of the building is destroyed, it won’t cause a domino effect and lead to a full collapse.
建立医院“颠倒”是另一种关键的弹性策略，这也是纽约正在建设的医院的核心构想。（大约10年前，NBBJ首次尝试了这种策略南卡罗来纳州医科大学阿什利塔。）它们没有放在地下室和地面上，而不是将所有连接到市政电网的动力系统和急诊室放置所有类似于操作的发电机，而是将其升高。急诊室位于二楼，车辆通过坡道访问它，如果地面水域阻碍了通道，这也可以作为船只发射，这是将人们送往医院并在必要时撤离建筑物的有用举动，这是一个问题旧建筑。(A helicopter landing pad on the roof of the adjacent parking structure can also help with accessing the hospital.) All of the power systems are on the fourth floor and fill lines for the generator’s underground 32,000-gallon fuel tank are also elevated above the 500-year-flood line, so they can be accessed during high waters.
如果发生灾难，该建筑物可以保持五天的全面运营。一个6,000平方英尺的现场仓库为1,000人提供食物和水。此外，屋顶上的雨水集水系统减轻了径流，并进食地下水箱以备后供水。如果医院需要作为紧急避难所，所有病房都可以从单身到双人居住。
“This is a poster child for resiliency,”Doug Parris, the project manager and a partner at NBBJ, says.
For Veterans, By Veterans
除了弹性挑战外，NBBJ的建筑师还负责为非常具体的人口 - 军事退伍军人设计与平民不同的需求。医院serves more than 70,000 veterans在该区域。为了了解新设施需要什么，建筑师对100多名退伍军人和近200名员工进行了访谈；他们还举办了21个研讨会，以形成和完善概念。并花了75个小时观察患者。由于医院是一个全新的建筑，因此NBBJ几乎可以重新设计经验的每个部分，从流通到布局和耐心的旅程。
“It’s a unique culture with unique hopes and aspirations,” Hullinger says.
Patients at the hospital come from the New Orleans metropolitan area as well as from outlying rural areas. To better understand what the veterans wanted, NBBJ traveled to the neighborhoods and areas where they lived and interviewed them in informal settings to strike up a rapport and really get to know them. During evaluative sessions, NBBJ took notes on what the veterans wanted to see. Then the architects created renderings and mock-ups of concepts based on the interview content. Next they presented the ideas back to the same groups, to ensure that nothing was lost in translation.
“We wanted to make sure there wasn’t a disconnect between what we heard, the implications, and how that informs the space,” Hullinger says.
与平民相比，退伍军人更有可能遭受身体残疾，流动性有限，肥胖率和听觉挑战。此外，在设计中，还有一些心理健康考虑因素，例如女性退伍军人的PTSD，抑郁和性侵犯。例如，建筑物中的颜色故意避免军队中通常使用的色调，例如绿色，灰色和沙子。在其中一个讲习班中，设计师展示了一种纺织品，该纺织品使一些钢丝的退伍军人想起了一些。
“We didn’t see it, but they did and that was very informative,” Parris says. Another design move? Ensuring that there was no bamboo–a popular plant to use in humid climates like in New Orleans–in the gardens, which could potentially be a PTSD trigger. “That’s one of the nice things about being able to talk with the veterans there. Even with existing research, some things aren’t readily apparent.”
过度维护是NBBJ以人为本的研究出现的另一个主题。赫林格说：“退伍军人曾经处于威胁性环境中，他们一直在寻找门的位置和逃避这个位置的手段。”“这些反射在回到平民生活时并不总是消失，因此，设计使老兵放松的空间是一个很大的驱动力。”
Prospect and refuge theory- 一种环境心理学概念，解释了人们为什么寻求让他们在保持僻静的同时观察的空间 - 影响了这个角度。赫林格说：“我们需要设计的是，老兵可以在开放的空间中看到，并且感觉好像没有被看到。”例如，楼梯没有任何折返，因此使用它们的人不会觉得自己的背部转过身。候车室位于窗户附近的结构周围。建筑师还努力确保没有任何紧密的空间或黑暗的角落。
赫林格说：“我们采访的退伍军人通常比他们应得的要少，而且他们确实应该得到一栋支持他们身体，情感和精神需求的建筑。”
Borrowing From Hospitality And Office Design
为了设计超出预期的空间，NBBJ从其他学科（例如酒店和公司办公室设计）借用，分别为医生和护士的患者体验和工作流程提供了信息。赫林格说：“我们希望灌输一种尊重（退伍军人）牺牲的尊严和民事意义。”“这是关于让他们进入医院后立即感到赞赏。”
到达序列受酒店设计的严重影响。帕里斯说：“有些人开车两个小时到达这里，并在他们第一次到达那里时了解他们的需求很重要。”“他们需要交通协助吗？有礼宾服务吗？附近有浴室吗？他们到达校园的第二秒钟，他们的欢迎方式表达了他们的需求。”
建筑师还指定了天然和温暖的木墙覆层和石板灰色地板瓷砖的饰面，这是典型的防腐医院材料的对立面。家具需要更稳定，坚固，并具有可以适应所有身体和能力水平的尺寸。退伍军人和平民之间的另一个大区别是在医院里的社会方面。平民对自己和家人保持着，但是NBBJ发现退伍军人喜欢交换故事和交谈，这也是在设计上。
“Camaraderie and getting to know each other, what was your experience, that sense of storytelling was important to them,” Hullinger says. “Seating arrangements that are supportive of conversations were important. Then you have to be inclusive of someone of a wheelchair so they can pull up into a social circle.”
外面的庭院为患者和工作人员提供了新鲜空气的空间，还可以帮助校园内的轻巧和开放性，使该结构感觉不像一个大盒子。
The layout of the in-patient floors also affects the patient-provider experience. Typical hospital floors are arranged like a racetrack with a nurses’ station in the center and patient rooms along the perimeter. The VA’s floors have patient rooms flanking a core dedicated to staff. Borrowing from corporate workspaces, NBBJ divided the area into areas for specific types of work: collaborative; quiet, focused work; and also space for families. To further refine workflow, nurses and doctors communicate via a wireless system instead of through noisy pages over an intercom system. “That’s all tied to the emerging understanding of a nurse as a knowledge worker that can benefit from the techniques of Silicon Valley,” Hullinger says.
All told, the VA Hospital embodies the idea that a resilient structure should not compromise on safety, patient experience, or the ability for providers to offer the best care.
赫林格说：“如果您只是根据标准设计，那么风暴的弹性以及对飓风和弹丸的要求可能会飞行，这是一个区域。”“然后，您将基于安全性和爆炸保护的详细要求覆盖，您可以轻松地将建筑物是一栋掩体，不受欢迎和灵魂搅动的建筑物。那就是设计变得有趣的地方。”
[所有照片：通过NBBJ]