As the largest hospital in California and one of its comprehensively equipped Level 1 trauma centers, Loma Linda University Medical Center‘s recent campus redesign required that the new hospital have some very special precautions built in.
From handling mass-casualty events to the challenges hospitals face dealing with a global pandemic, this modern hospital had to be ready for the worst. As if that weren’t enough, the hospital sits about a half-mile away from the San Jacinto fault, a branch of the tumultuous San Andreas, capable of causing earthquakes measuring up to 7.8 on the Richter scale. The redesign called for a resilient hospital able to handle both extreme medical emergencies and extreme seismic activity.
The new $1.5 billion hospital opened in Loma Linda earlier this summer and features a variety of design features intended to improve its resiliency in the face of these hazards. Designed by the architecture firm NBBJ and engineers from Arup and built by the general contractor McCarthy Building Companies, some of its most innovative protections are hidden away in the basement in the form of a unique and relatively uncommon system that will allow the quaking earth to move beneath the main hospital building without any but the most intense shaking felt above.
More than 120 bearing-like structures known as base isolators were placed in between the foundation and the tower, forming a kind of sliding buffer between the two. Each 10-ton isolator works like a nested set of sliders, able to move laterally while still carrying the weight of the building. In the event of an earthquake, the building will be able to accommodate up to 42 inches of movement in any direction.
“It’s easy to visualize the building moving on the isolators, but it’s actually the opposite,” says Simon Rees, a principal at the Los Angeles office of Arup. “The building remains still and the ground is allowed to move underneath.”
These base isolators, common in Japan, are a relatively novel structural element in the U.S., Rees says. In Japan, they are “employed much more widely because that risk is so much more at the forefront of society’s mind,” he says.
Other resiliency elements include the hospital’s spatial design. With specialized sections for both adults and children, the hospital is a two-in-one. Its emergency departments, one for adults and one for kids, are colocated instead of being in separate facilities, as is common. Being right next door, one can provide extra space for the other during mass casualty events or when something like a pandemic floods the emergency department.
“In a surge event, you can flex into the children’s ED exam and treatment center, or flex into the adults’,” says Jose Sama, an architect at NBBJ. “So there’s this wiggle room.”
This kind of flexibility is also part of the way each of the patient rooms was designed, with the potential for a medical exam room to be converted to handle higher-intensity illnesses as an intensive care unit by bringing in different equipment, for example.
The hospital floor plan helps make this possible. The building’s long wings were designed at a width that only required a single row of central beams for structural support, opening up more space for nurses stations, and making it easier to move large equipment from one room to another.
“They limit the amount of structure to create more flexibility,” Sama says.
They also allow large windows at the ends of the hallways for more light to spill into the hospital floor, and windows from individual exam and patient rooms to bring more light into central nurses stations and family waiting areas. Windows may sound like basic architectural elements, but natural light in hospitals is not a given.
Aside from improving the flow of equipment and healthcare workers, these touches also have benefits for patients and families. Sama says these design elements are intended to improve the resiliency and flexibility of the hospital in the face of traumatic events, but are also ways to reduce the traumatic experience of needing to be in the hospital in the first place.
It’s something his family knows well. His son recently had to spend several days at another children’s hospital, and Sama says the lack of light and the crowdedness of the space added to the discomfort. “I can’t tell you how abysmal those spaces were, how much we felt like we were in a cave,” he says. “Here I am designing things [my son] hates. I’m trying to let him understand there are better ways of taking care of people.”