Post-earthquake Function of Medical Facilities

Jordan Bartlett. Director & Resilience Planner, Proactive Design

Earthquakes are natural hazards that are defined as a ‘Disaster’ when the built environment fails. The Australian and New Zealand building codes have resilience measures (standards) for these events, although they are often misunderstood, overlooked or discounted through inaction or avoidance. In new construction & upgrade of facilities, there is strong reliance upon the construction industry to make resilience decisions without critical review by resilience specialists or specific direction from facility owners, operators or the end client.

The National Construction Code of Australia requires 'holistic design' to meet its many parts, but what happens when constant change results in vulnerabilities in our systems, and worse: Are the perceived 'minimum standards' adequate or holistically met? Is there capacity for post-disaster function built into our medical facilities? Who's measuring/testing these resilience measures? Where does business continuity influence facility design?

This paper is generally focused on the Australian experience, although the New Zealand experience for earthquake resilience is still in need of significant advancement. This paper attempts to address these shortfalls and hopefully disrupt the comfort of facility stakeholders (Yes, you, the reader) before medical facilities are shaken & stirred.

Medical Facilities

Of the many lifelines of any society, medical facilities are critical infrastructure maintaining business-as-usual (BAU) and occasionally post-disaster functions. During BAU, these facilities provide daily, life-sustaining, critical services to the most vulnerable in our community and emergency/accident support when needed. Notably, it’s post-disaster that medical facilities become even more critical during the Response phase with life-saving services, and essential to Recovery with the re-establishment of life-sustaining services and repairing the injured.

Markedly, we’ve spent (and continue to spend) a pretty coin on them through a great deal of work: they had better be ‘up-to-code’ and resilient. A large team of professionals designed these facilities in accordance with the Australian Health Facility Guidelines and the relevant building code as they understood them. The structural engineers designed the structure for the specific earthquake design event, but are we sure the essential architectural and building service elements had adequate treatment to remain serviceable? Can it operate as an ‘island’? And for how long?

Business Continuity Planning

Across the corporate and government world, we embed Business Continuity into our processes, IT, equipment purchasing, consumables, supplier selection, and the training of people. A significant part of BC planning for medical facilities is a resilient facility and work environment, i.e., remaining fit for purpose, especially when complex services require specialised equipment. Operational shortfalls may see an organisation require an improved facility and build a new, upgrade an existing, or acquire an existing facility:

For your consideration: Does your organisation or trusted client provide their business continuity needs as part of the property search or design and construction brief?

These are complex ‘fit-for-purpose’, expensive buildings with specialised systems: is relocating post-disaster an easy option or even possible? Also, Earthquakes can affect a vast area. Resilience to stay in place is highly desirable. Still, earthquake is hardly ever considered in the Business Continuity plan, let alone the required system resilience delivered well in the built environment.

The Resilience Challenge

We have a disconnected system of practice:

1.     Business continuity plans (BCP) of medical practices without earthquake (EQ) considerations.

2.     Medical facilities designed for business-as-usual operation without BCP considerations;

3.     Expert consultants delivering perceived minimum requirements of the relevant building codes (generally without systems resilience to EQ).

This results in an active medical facility that is vulnerable to EQ and incapable of providing essential services during the Response or Recovery stages of a disaster.

Introducing AS1170.4 & the IL4 Special Study

Earthquake actions in Australia (AS1170.4:2007) were incorrectly considered only a structural engineer's obligation. Section 8: Parts and Components constitute 75-85% of a medical facility build cost: these are the architectural and building services (including machinery/equipment and attachments to the facility). Commonly referred to as Seismic Design of Non-Structural Elements (NSE), it is still unknown in some construction circles even today, even though it has been mandated in full by the National Construction Code (NCC) since 2010.

All structures are assigned an Importance level based on the NCC, and the structural engineer utilises AS1170.4 to design the structure accordingly. The structural performance for forces and displacement are then designed and accommodated by the architectural and building services. It’s a risk-based process considering life safety systems, explosive energies, moving elements, etc. It’s worth noting that Importance Level 4 (IL4) facilities are generally with a post-disaster function or a hazardous facility.

In Section 2.2, a paragraph and a table introduce the requirement for an IL4 facility to have a Special Study to ensure it ‘remains serviceable for immediate use’ following an Importance Level 2 design event (1 in a 500-year earthquake). This minor sentence does not appear with a definition, although it has its origins in international standards, guides and similar literature.

For a detailed explanation of AS1170.4 and Special Study requirements, the Australian Earthquake Engineering Society has published the ‘AS1170.4-2007 Commentary: 2nd Edition’ for free download here: https://aees.org.au/as-1170-4/

Earthquake Resilience Solutions

How do you deliver a seismic-compliant facility?:

1.     Your organisation or client updates their BCP to consider how they wish their facility to perform post-earthquake, which may focus upon the essential services only, operating times with lifeline network loss (such as power, water, sewer, internet), limited supply chains and staffing.

2.     Prepare a Special Study considering the many systems within the building, their importance to the operation of the facility post-disaster, capacity to run offline, systems for assisted operation (i.e. septic suction truck access), overflow areas for increased operational capacity, etc.

3.     Ensure designers of architecture and systems make clear the Special Study requirements are enshrined in buildable systems, with seismic design considerations incorporated.

4.     Actions, not words: if someone is checking it, then it’s more likely to be done. If that checking is early and often, there’s no avoiding it.

5.     Test the systems and compare the delivered elements to the BCP, the Special Study, the design documentation and the as-built drawings. Identify the gaps, correct anything that needs attention, and then update the BCP company-wide to ensure the learnings are repeated for future upgrades or new facilities.

In conclusion:

Healthcare supports some of society's most vulnerable people, and during natural hazard events, they represent the most significant loss of lives. The performance of non-structural elements in healthcare facilities requires greater attention to avoid these shortfalls. Business continuity planning should guide the design to the commissioning process of new and upgraded facilities in alignment with  AS1170.4 and the Special Study for post-disaster facilities.

Jordan is a Facility Resilience Planner specialising in the resilience design requirements to ensure facilities remain serviceable post-disaster with an ‘All-hazards approach’. Providing support from Concept through to Post-Occupancy Evaluation, Jordan engages with government, constructors, designers, installers and manufacturers to create resilient facilities prepared for business continuity under disruptive conditions. 

Connect with Jordan

Join us at the upcoming IHEA National Conference to hear Jordan speak further on the topic at 12:05 PM on Wednesday May 28 - Day Three of the IHEA National Conference.

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