Posts tagged with "Healthcare":

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State Department puts AIA alternative care sites tool to use around the world

After the American Institute of Architects (AIA) put out its original COVID-19 Alternative Care Sites Assessment Tool at the beginning of April, the tool is getting both a second version and is now being distributed around the world. The assessment survey was designed as an easy way for non-professionals and those without healthcare or emergency adaptive reuse experience to select sites suitable for “alternative care sites” for COVID-19 treatment. The second version of the survey, available here, was refined with help from the Centers for Disease Control and Prevention and the United States Army Corps of Engineers, according to the AIA, as well as other government agencies and practical feedback from healthcare workers. The new version of the assessment tool is also being translated and distributed internationally thanks to the United States Department of State. Now versions of the survey in Spanish, French, and Portuguese will be made available to embassies around the world for local use. The 13-page survey presents tips and requirements for not only scouting eligible sites to convert, but how to monitor care sites 24/7, care for patients at every stage of COVID-19’s progression, and how to address vulnerable economic and ethnic populations that would make use of such care sites.
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AIA and Kansas University Institute of Health + Wellness Design launch COVID-19 ArchMap

As part of an ongoing rapid response effort geared to help public officials more easily identify existing buildings that can quickly and safely be modified into makeshift coronavirus screening and treatment facilities, a special task force within the American Institute of Architects (AIA) has officially launched an interactive map to complement its COVID-19 Alternative Care Sites Assessment Tool. Developed in partnership with the Kansas University Institute of Health + Wellness Design, the COVID-19 ArchMap, however, doesn’t just strictly include project information related to conversions, but all COVID-19-related undertakings that are either completed or in-progress, as well as collaborative initiatives launched in response to the pandemic. Per the AIA, the task force developed the map “to help identify solutions to growing bed surge needs and to support the development of design best practices for alternative care sites that support pandemic response.” The map’s functionality is straightforward. To view projects, users can filter by region or by state, by project type (isolation transportation, face shield/mask production, conversion of non-health care spaces, construction of temporary structures, etc.) by category (homeless center, emergency care, screen, support services, non-acute patient care, diagnostic/treatment, etc.) and by conversion type (convention center, motel, gymnasium, arena, vacant warehouse, etc.) To contribute to the map, architects, designers, engineers, and facility owners are asked to complete a Project Information Form including all pertinent details of the project in question. The project/client name can be kept confidential. In addition to a U.S. map, there’s also a global map detailing COVID response projects worldwide. However, the only non-U.S. projects appearing at this time are from Germany, Canada, and Malaysia. Outside of the AIA COVID-19 ArchMap, individual architecture firms continue to share care facility conversion projects—not to mention a heartening and positively huge number of PPE production initiatives—on a larger scale as a means of engaging, inspiring, and showing others how it’s done efficiently and post-haste. Nebraska-based integrated design firm DLR Group, for example, recently shared news that it has converted an earlier educational project, Sheila and Eric Samson Pavilion at the Cleveland Clinic at Case Western University, into a fully functional 1,000-bed surge hospital for patients suffering from the coronavirus. Designed by Foster + Partners with DLR Group as the architect of record, the building, which features lecture halls, classrooms, study areas, and a large dining hall, was completed just last year.
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From parking garages to parks, these are the pop-up medical facilities of the COVID-19 pandemic

As American cities brace for a steep influx of patients suffering from or suspected to be infected by the novel coronavirus (COVID-19), the sprint is on to make up for a woeful dearth of available hospital beds. Per American Hospital Association data, there are 924,000 staffed hospital beds in the country, and more than two-thirds of those are usually occupied. And while the total number of additional hospital required during this mounting pandemic varies day by day, place by place, the only conclusion is that an impossible amount of more beds is needed. To make up for the narrowing availability, temporary hospitals have been erected or are in the process of being erected in some unlikely places. These urgent acts of emergency-level adaptive reuse, many of them spearheaded by city agencies, intergovernmental organizations, healthcare providers, the National Guard, and the Army Corps of Engineers, have taken root on fairgrounds, in football stadiums, in motels, and in Central Park. Not all of these converted spaces, however, are being used to treat COVID-19 patients, although many will. Some will provide housing to nurses and doctors, some will act as quarantine units, some will house the homeless, and others will serve as fully functional overflow hospitals dedicated to providing care to patients suffering from ailments that aren’t the coronavirus. To offer assistance in these conversions, the American Institute of Architects (AIA) has even formed a special task force which will release a comprehensive report in early April to help guide decision-making. “This is a race against time for healthcare facilities to meet bed surge capacity needs” said AIA Academy of Architecture for Health president Kirsten Waltz, AIA, ACHA, EDAC, LEED, who is the director of facilities, planning, and design at Baystate Health in Springfield, Massachusetts. “This task force will help inform best practices for quickly assessing building inventory and identifying locations that are most appropriate to be adapted for this crisis.” Below are some of the different buildings and facilities being adapted across the country to serve new purposes during the coronavirus outbreak.

Convention centers

Boasting boundless and easily adaptable floor space, robust loading docks for moving in and out a high volume of equipment and gear, high-powered ventilation systems, and more than a few ADA-compliant bathrooms, convention centers are natural places to establish temporary hospitals. Manhattan’s Jacob K. Javits Center, normally one of the busiest convention centers in the United States, was one of the first to undergo the transformation into a sprawling, nearly 3,000-bed capacity overflow hospital operated by the Federal Emergency Management Agency. (The Army Corps of Engineers, the New York National Guard, and a team of civilian staffers can be credited for the rapid turnaround.) A large number of other convention centers across the country are either being eyed as potential makeshift medical hubs or are currently being converted into them including the Kay Bailey Hutchison Convention Center in Dallas, the Ernest N. Morial Convention Center in New Orleans, Detroit’s TCF Center, McCormick Place in Chicago, the Baltimore Convention Center, the Los Angeles Convention Center, and the Santa Clara Convention Center in California’s Silicon Valley.

Parking garages

While many hospital parking structures are now home to drive-though coronavirus testing sites, in at least one major medical facility, Nashville’s Vanderbilt University Medical Center, beds are being moved into a parking garage to treat those potentially infected by the novel coronavirus at a safe distance from other patients.

Sports fields/stadiums

Originally and still largely used as a military term, field hospitals get their name from their strategic location on wide-open spaces in close proximity to sites of mass injuries and casualties such as, well, battlefields. Twenty-first-century field hospitals are now being erected on battlefields of a different kind that normally see a different sort of frenzied combat: football. CenturyLink Field, home to the Seattle Seahawks, is being converted into a large temporary treatment center by the Army and will be dedicated to treating patients with ailments not related to the coronavirus so that beds in overwhelmed Seattle area hospitals are freed up for those suffering from the deadly respiratory disease. Elsewhere in hard-hit Western Washington, another 200-bed field hospital will be erected on a turf soccer field in the Seattle suburb of Shoreline. Relatedly, football pitch-bound field makeshift hospitals are now somewhat de rigueur in countries like Brazil. A section of the famed Billie Jean King Tennis Center at Flushing Meadows, Queens–in better times, home to the U.S. Open—will also be covered into a 350-bed auxiliary medical center by New York City Emergency Management.

Decommissioned hospitals

Shuttered hospitals, many of which have never been closed in the first place, are coming back to life due to the coronavirus pandemic. A wide number of bed-equipped, recently closed medical facilities—including the old Sherman Hospital in Elgin, Illinois, San Francisco’s California Pacific Medical Center, and Laurel Regional Hospital in Maryland—have already or will potentially reopen to accommodate a surge of COVID-19 patients or patients in need of other types of urgent care in overburdened areas.

Dorms/college campuses

With students at an overwhelming number of colleges and universities dismissed from attending in-person classes for the rest of the academic year, an ample amount of available real estate has suddenly opened up. As COVID-19 first began to spread across New York City, New York University pledged to make available some of its now-vacated dormitories for COVID treatment-related purposes if needed. Student housing at New York’s expansive system SUNY and CUNY public colleges could also be potentially turned into emergency medical facilities, quarantine units, and/or temporary housing for healthcare workers. While dorm rooms can be easily retrofitted into treatment spaces, college and universities are also considering converting or already have converted other on-campus facilities into field hospitals. The McCormack-Nagelsen Tennis Center at the College of William & Mary in Virginia, and Liacouras Center at Temple University in Philadelphia, are two examples of non-dorm collegiate spaces that will serve a new purpose during the pandemic.

Central Park

Plenty of strange, sometimes disturbing sights can be seen within Central Park. None, however, quite match the surreally sobering heights of witnessing volunteers erect a tent-based respiratory care center in the middle of New York City’s backyard. Said facility, which will have a capacity of 68 hospital beds and also include an on-site morgue, was established this past weekend in Central Park’s East Meadow by humanitarian aid organization Samaritan’s Purse in partnership with Mount Sinai Health System to “provide care for patients seriously ill with COVID-19.”

Fairgrounds

Generally only used at a very high capacity for a few weeks of the year, fairgrounds over a vast amount of space with the needed infrastructure—electricity, water, various buildings, arenas, parking lots the size of a small town—already in place. The Santa Clara County Fairgrounds in San Jose, California, for example, will take advantage of this advantageous arrangement and temporarily house members of the region’s sizable, highly vulnerable homeless population during the pandemic. Elsewhere in California, the Orange County Fairgrounds are being mulled as a potential site to accommodate overflow from established medical facilities in the area; it’s a similar story at the Riverside County Fairgrounds in Indio. Outside of California, the massive Washington State Fairgrounds are being considered as an emergency medical site about 30 miles south of Seattle in the city of Puyallup. In Florida, where the virus is on the verge of exploding in certain areas, a 250-bed facility is already under construction at the Miami-Dade Fairgrounds. In several states, fairgrounds and their parking lots are already being used to host drive-up coronavirus testing sites.

Hotels and motels

Hotels and motels are perhaps the most versatile and, due in part to low occupancy rates brought on by the COVID-19 outbreak, the most readily available spaces to repurpose during a pandemic. Providing privacy, some level of comfort, and isolation, they can be used to treat non-critical patients recovering from the COVID-19-related illnesses, quarantine patients suspected to be infected, house exhausted, high-risk healthcare workers on the frontlines (in sometimes deluxe accommodations), and provide a temporary safe haven to vulnerable populations like the unsheltered. Officials in various cities including New York, Chicago, Seattle, New Orleans, and Oakland, California, have leased hundreds, even thousands, of hotel and motel rooms to be used in various capacities in the coming weeks, with the Army Corps of Engineers working to identify and then convert many of them into fully functional temporary medical facilities. Many, of course, have their own ideas as to which specific hotels should be used.
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New York’s Javits Center completes transformation into 1,200 bed emergency hospital

A 1,200-bed field hospital, established in response to the dire need for additional hospital beds as the novel coronavirus (COVID-19) overwhelms New York City’s existing medical infrastructure, opened today at the Jacob K. Javits Center. The Army Corps of Engineers, along with civilian staff and members of the New York National Guard, executed the dramatic transformation of the Javits Center from a normally bustling venue for trade shows and conventions to a fully equipped overflow medical facility in just one week. If needed, the makeshift hospital at the Javits Center can be expanded to accommodate 2,910 beds. This would make it one of the largest hospitals in America, regardless of ephemerality, according to ABC News. By comparison, New York-Presbyterian, the city’s largest hospital, has a 2,600-bed capacity. First floated as a potential field hospital earlier this month, the Javits Center, a vast green-roofed, glass-encased complex on Manhattan's far West Side designed by Pei Cobb Freed & Partners, is the first of several Army Corps-identified facilities across the five boroughs to be adapted into a temporary medical hub. Late last week, New York Governor Andrew Cuomo announced that the Army Corps, pending approval from the White House, will also convert four other facilities with considerable square footage into field hospitals: The Aqueduct Racetrack in Queens, the New York Expo Center in Bronx, CUNY Staten Island, and the Brooklyn Cruise Terminal in Red Hook. These four facilities will have the capacity for a combined 4,000 additional hospital beds as even more sites, including the Brooklyn Center Nursing Home and a Marriott hotel in downtown Brooklyn, are considered by state health officials as having overflow-need potential according to the Brooklyn Daily Eagle. Cuomo has also stressed the need for temporary hospitals in New York City-adjacent counties including Westchester, Suffolk, Nassau, and Rockland. As of this writing, 59,742 cases of the coronavirus have been confirmed in New York, the most of any state. Nearly 800 people have perished from the virus in New York City alone. Over the weekend, a non-Army Corps-initiated field hospital also began to take shape in Central Park’s East Meadow. Designed specifically as a respiratory care unit, the 68-bed Central Park tent hospital is being constructed by volunteers enlisted by the faith-based humanitarian aid organization Samaritan’s Purse in partnership with Mount Sinai Health System. Unlike the field hospital at the Javits Center, which will only provide care to those suffering from a range of health issues that aren’t coronavirus in order to take the mounting burden off of established hospitals grappling with New Yorkers stricken with the highly contagious viral disease, the Central Park facility is dedicated to treating “patients seriously ill with COVID-19,” per a statement released by Mount Sinai Hospital to BuzzFeed News. Back at the Javits Center, the transformation of the 1.8-million-square foot building’s cavernous exhibition halls into a Federal Emergency Management Agency-operated medical facility has been met with a positive response. And for those skeptical that the United States was capable of speedy, China-style turnaround in creating makeshift hospitals, the swift transformation of the Javits Center has proven that the Army Corps, when called upon, can get things done and get them done in an expeditious manner. (New York’s urgent need for ventilators and other supplies, however, is a whole other story.) All things considered, the temporary hospital at the Javits Center appears clean and comfortable. Individual beds contained within semi-enclosed “rooms” are shielded by three temporary walls and a curtained entrance made from seemingly the same materials formerly used to host booths in the space, while floor lamps, folding chairs, medical supplies, and side tables topped with (faux) potted plants complement the spaces. While the transformation doesn't appear to allow for individual treatment areas to include private plumbed fixtures, some online commentators have pointed out that a deficit of toilets at the Javits Center shouldn’t be a problem. “The Javits Center is an amazing facility,” ABC News reported Gen. Todd Semonite, head of the Army Corps of Engineers, as telling reporters at a press conference held last week. “Every 10 feet there's a great big steel door in the floor, you open it up in there is all the electrical; there's cold water, there's hot water and there's a place for sewers, so you can actually do things like sinks, right in the middle of a convention center to be able to make that happen.” Outside of New York City, the Los Angeles Convention Center, which was due to host the AIA Conference on Architecture 2020 in May, is in the process of being converted by the National Guard into a U.S. Department of Health and Human Services-run field hospital as demand for hospital beds in the greater L.A. area begin to surge. Hard-hit Santa Clara County, in the San Francisco Bay area, is also turning a large convention center into a temporary treatment center for COVID-19 patients presenting on-life threatening symptoms. Similar efforts are also planned or already underway at convention centers in Detroit, New Orleans, Baltimore, Dallas, Chicago, Seattle, and elsewhere. To help with this unprecedented effort, the American Institute of Architects (AIA) has launched a special task force to inform and offer guidance to public officials, architects, and healthcare facility operators as they convert existing buildings into temporary medical hubs at a pace never experienced before. The task force, according to a press statement, will develop a COVID-19 Rapid Response Safety Space Assessment for AIA members that includes “considerations for the suitability of buildings, spaces, and other sites for patient care. The assessment will be developed by architects with a wide range of expertise, including healthcare facility design, urban design, public health and disaster assistance.” “On a daily basis, I am hearing from our architects who feel a deep sense of moral duty to support our healthcare providers on the frontlines of this pandemic,” said AIA 2020 president Jane Frederick, FAIA. “As our communities assess buildings to address growing surge capacity, we hope this task force will be a resource to ensure buildings are appropriately and safely adapted for our doctors and nurses.”
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Help those in need with these healthcare solutions

Designing for someone who needs an extra hand around the house or at work? From taps to modular seating, these healthcare solutions make living easier. M-POWER Moen Look, Mom, no hands! This faucet is equipped with sensors to turn the tap on and off, touch-free. The range has a number of looks and is available for residential, hospitality, and commercial applications. Viccarbe Sistema Coalesse San Francisco–based furniture maker Coalesse teamed up with Spain-based healthcare expert Viccarbe on a collection of plush modular seating. Available in a range of bright colors, Viccarbe Sistema includes chairs, sofas, benches, and armchairs. Stacy Arper So fresh n' so clean! Perfect for schools and business-settings, this armchair is ideal for classrooms, cafeterias, and conference rooms alike. And, because it's made of plastic, it's easy to clean. SensoWash Starck - Darling New Duravit Mais oui! This remote control toilet lid was designed by French designer Philippe Starck himself. The product features an oscillating wash, and the seat can be heated. Oh, and, it's self-cleaning! Sunda 1 Allermuir Simple, yet beautiful, these nesting tables are just heavy enough to lean on, but light enough to be moved around. Laser cut from steel sheets, the Sunda 1 is available in an array of textured and smooth powder-colored finishes. [Sponsored Product] Accurate Lock & Hardware Ligature-resistant sliding door system for behavioral healthcare Improve safety. Safe space. Enhance patient dignity.

Healthcare Facilities Symposium & Expo

The mission of the Healthcare Facilities Symposium & Expo is to create a multi-disciplinary environment that inspires you to evoke change and the advancement of a better delivery of healthcare through the physical space. Competitors, clients, and colleagues come together as friends to collaborate, share research, hear fresh perspectives and participate in the ever changing conversation of your industry. The healthcare industry is poised for disruption.  Ground-breaking technologies, game-changing financing models, and market-shifting business deals are all converging.  Are you ready?  Join us in Austin, Texas for an unforgettable experience designed to prepare you for what’s ahead!
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Printed metal panels clad new healthcare facility in Minneapolis

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Reorganizing nearly two million square feet to offer centralized and accessible care for people who need convenient access to a doctor, same-day surgery, or cancer treatment, Hennepin County Medical Center’s latest project is a new six-story building that consolidates over 40 primary and specialty clinics currently spread across nine buildings. The healthcare project, led by local architect BWBR, has resulted in Minneapolis/Saint Paul’s largest teaching hospital. The project prominently features corrosion-resistant metal panel cladding printed with a “corten” patterning.
  • Facade Manufacturer McGrath, Pure + FreeForm (provided finished flat sheets only)
  • Architects BWBR
  • Facade Installer McGrath
  • Facade Consultants Ericksen Roed & Associates (Structural), Dunham Associates (MEP/Energy)
  • Location Minneapolis, Minnesota
  • Date of Completion 2018
  • System aluminum panels
  • Products Pure + Freeform Lumiflon (FEVE) off-set graveur direct paint system, AMA 2605 rated, Class A finish on 2mm thick Aluminum in custom finishes
BWBR’s design team said they worked closely with Pure + FreeForm from schematic design through construction administration to ensure the custom finish met aesthetic and budgetary criteria. “The early and constant collaboration was, in fact, what allowed BWBR to comfortably select and realistically defend a more radical solution to represent the character of the client and their facility.” The design team started out by creating a high-resolution mapping of rust steel and wood grains and manipulated them digitally to be suitable for an application massive in scale. The specific coloration, toning, and detailing of the imagery was finalized through an extensive process requiring several rounds of physical samples and on-site reviews. The collaborative design and manufacturing process allowed BWBR to control precisely the pattern and color that eventually was realized on the facade. Pure + FreeForm said the scale of the patterning and reflectivity of the samples played a role in final selections. “This process included examining the various conditions of natural light on the surface of the panels and how each condition would affect the perceived color, texture, or pattern. There is also a custom wood grain finish, for which we played with scale so that the pattern would be visible from the user’s point of view. By the end of our design process, we had completed five rounds of proofs and matching to arrive at the final design.”
The panels were “printed” using a Lumiflon ink, allowing for bright orange and red tones in the final finishes while offering corrosion-resistance, which would not be possible with other fluoropolymers. The refining of the panel configuration was a process of designer-contractor collaboration, which Pure + FreeForm’s custom finishes enabled: to blend patterns on a larger area in a way that was not visually repetitive. The team was able to downsize the metal panel to an economical dimension without sacrificing the perceived large pattern on the facade. This was achieved by combining three narrower panels with butt-joints and using the custom pattern to disguise the seam in between. Originally, the system was conceived as 3-millimeter plate panels, but moved to 2-millimeter flush panels, which more appropriately suited the budget. By varying the widths and locations of the panel joints, the team was able to create the appearance of larger panels. The 2-millimeter flush panels were attached to the building structure using #14 TEK 3 Long Life coated exterior fasteners. Coordination with the glazing manufacturer was required for the areas requiring flashing. There were two fabrication challenges, for which McGrath worked extensively with BWBR in the preconstruction and construction phases. First was the actual forming of the flush panels and creating the female pocket in 2-millimeter gauge. The second challenge was the panel layout and alignment with windows, in which BWBR required a layout for the panel reveals to align with the windows throughout. This meant panel sizes had to be carefully coordinated, adjusted both in fabrication design and in the field. The miscellaneous trims in the building did not use custom patterning, but rather a solid paint to match. This was achieved by working closely with McGrath and Mortenson to ensure the solid lines were not distracting from the primary jointing pattern and panel finishes.
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North America's largest healthcare project completes phase one

The first phase in the construction of three-million-square-foot Centre hospitalier de l’Université de Montréal (CHUM) created by CannonDesign and Montreal-based NEUF architect(e)s is now complete. Located in the heart of Montreal, the new campus is the first new hospital built in the city in 30 years and is the largest public-private healthcare partnership in Canadian history. In order to get the hospital up and running as fast as possible, phase one of the project focused on healthcare spaces. These include the 772 patient rooms, the operating theaters, and the diagnostic and therapeutic spaces. Phase two will build out the administrative offices, a conference center, more ambulatory spaces, and additional parking. “Walking through the completed spaces today, we feel a spatial quality that is in line with the ambitions of this great institution,” explained Azad Chichmanian, partner and architect with NEUF architect(e)s in a press release. “As the public finally begins to discover the architectural moments that have been created, from the inviting, light-filled public spaces to the state-of-the-art clinical facilities, we believe the building will succeed in completely redefining Montrealers’ image of what a hospital feels like.” CHUM covers two full city blocks, making it an important urban fixture in the city. Designed to be the anchor of Quartier de la Santé, Montreal’s new healthcare district, the entire complex was conceived to mend a large gap in the city’s fabric. The project’s large footprint included the historic structure of a 145-year-old abandoned church. While much of the church was demolished for the construction, its impressive steeple, along with the facade of a neighboring gray-stone mansion, were integrated into the overall design. Along with a number of indoor and outdoor public spaces, the campus will eventually include 13 large-scale public art pieces. Before the first phase was completed, the project was recognized and shortlisted for multiple awards. Some of those include awards for healthcare design, facade design and engineering.The second phase of the project is expected to be complete in 2021.
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A whole new breed of architecture can help fight drug addiction and save thousands of lives every year

On January 13, 2016, police found the body of a 31-year-old man, who had been dead for “at least” 12 hours, in a car parked on Pike Street in Capitol Hill, Seattle. He had died from a drug overdose in the shadows, which is common, as drug users often are too ashamed to seek help or use in the open. In the United States, 52,404 people died from overdoses in 2015.

In the eyes of some, this man’s death would have been preventable if he had attended a harm reduction facility—a new typology emerging in the developed world. Just over 100 miles away from Seattle, in Vancouver, one such facility oversees at least one overdose incident every day, on average. In its 14 years of operation so far, the facility has seen more than 5,000 overdoses, yet no one has died there.

The facility, called InSite, is a public place where drug users can go to consume their own substances in a safe, secure, and welcoming environment in Vancouver’s Downtown Eastside. For 13 years, the self-described “supervised injection facility” was the only one of its kind operating legally in North America. As of this May, three more facilities—all in Montreal—received approval and two are scheduled to open later this year.

There are now more than 100 legally operating supervised injection facilities across the world, the majority of which can be found in Continental Europe. The first opened in Bern, Switzerland, in 1986, and many European cities have slowly been adopting similar schemes.

None currently exist in the United States, but several models operating abroad and one prototype stateside might offer clues about how to make these places palatable for a U.S. political environment that is more centered around fighting a war on drug “crime” than on treating addiction as a public health issue.

Inside InSite

Canadian architect Sean McEwen designed InSite in 2002. With high ceilings, dark walls, and no Plexiglas inside to separate staff from visitors, the space eschews the notions of traditional medical institutions. Russell Maynard, who has been working at InSite for eight years, said that, “from a design perspective, it’s all about controlling the flow; that is more important than security.”

Three-phase-oriented circulation is a constant throughout almost all official drug-consumption spaces and can be summarized as: pre-consumption, consumption, and post-consumption.

Upon entering InSite, visitors are greeted by a receptionist. After providing a name (which can be fake), they are asked if they want to inject or detox and then are placed on a waiting list. The wait time is approximately seven minutes. According to Marilou Gagnon, a nurse at InSite and an associate professor at the School of Nursing, University of Ottawa, this is the period when InSite sees some visitors leave to shoot up outside, in a nearby alleyway, often using puddles to clean their needles.

“Needing to get a hit is like having chopped your finger off—you’re not going to want to wait very long or travel very far to fix it,” Gagnon said. Vancouver is a city of alleyways, and drug users favor them because they are discreet and easy to find. As Gagnon explained, however, this is problematic for two main reasons: Shooting up in an alleyway is unhygienic, and if you overdose, it’s not a great idea to be hidden.

Designing for anonymity and privacy, unfortunately, is paradoxical to health and well-being in the context of addiction. There is no hiding at InSite, but this is a good thing. Within the injection room, there are 13 booths, which line the interior perimeter, allowing nurses a clear line of sight into each.

These booths, each with their own lights, are mirrored to provide nurses and users with better visibility; this is particularly important for users, to help them avoid being surprised by approaching staff and when injecting into their necks. (Staff are not allowed to actually inject for users but can provide advice, prepare drugs, and clean needles, among other things.) Additionally, female users, who on average constitute a quarter of the visitors, often use the mirrors to do their makeup.

As the designer, McEwen also specified comfortable and easily cleanable chairs. “This may be the best seat users sit in all week,” he said. After injecting, users exit to a “chill-out” room, where they can speak to peers (usually former users), counselors, and nurses and find out about detox programs. Maynard stressed that visitors only enroll in such programs of their own accord.

Easing the Stigma

Politically, injection facilities are toxic. InSite went through a court case when the federal government attempted (unsuccessfully) to shut it down. “A common misconception is that people are shit-faced here; that’s not the case,” explained Maynard, speaking of InSite. “There are consumption sites everywhere for alcohol—they’re called bars. When you go into a bar, not everyone is off-their-face drunk, and that’s the case here.”

To avoid public conflict, almost all facilities have anonymous facades, with little or no signage. At InSite, zoning requirements for storefront retail meant the facility had to pretend to be a coffee shop to get development approval. More recently as a trial, the Canadian government funded the Narcomane Research and Help Center in Montreal, which provided heroin to registered users—a first for North American facilities. It was shrouded in secrecy at the time, and is now closed. “Not even the neighbors knew about it,” said its architect, Ron Rayside.

Margot Young, a law professor at the University of British Columbia, is interested in this aspect of the typology. She argues that the sight of InSite fuels the “larger political goal of putting injection drug addicts ‘in the sight’ of policy makers and governments.”

The sight of InSite, though, is in need of work. According to Maynard, the facility is operating at above full capacity, sometimes seeing more than 1,300 visitors a day; Hannah Leyland, a Master’s student covering InSite in her thesis, described it as looking “low budget,” noting chipped paint. InSite has annual operating costs of $2.15 million. A 2010 study into its financial wellbeing touched upon how the facility’s hygienic provisions prevent HIV infections. The study concluded that if InSite were closed, HIV infections would increase by 46 percent, costing Canadian taxpayers $12.9 million (CDN$17.6 million).

Ad hoc America

In the U.S., however, a cheaper solution is more politically viable. Dr. Gregory Scott, a visual sociologist, who has 17 years of experience in the field of drug-use harm reduction, is pursuing this route. He is traveling the U.S. with SAFE SHAPE, a “pop-up public health exhibit” that acts as a mock safe-injection site.

Scott designed SAFE SHAPE with architect Andrew Santa Lucia, of Portland, Oregon–based firm Office Andorus. The ten-square-foot pavilion uses two-inch-thick aluminum tubes to compose a white frame over which a bright-white, translucent spandex shell is stretched. It weighs less than 100 pounds and can be broken down and packaged into four ski bags and two storage tubs, allowing it to be easily transportable by plane.

“For me, design and aesthetics become heavily politicized in terms of the stigma associated with drug addicts,” said Scott. He wanted something that didn’t leap out at people as a place for users, instead adopting a “high-design” look that, semiotically, didn’t reference preconceived ideas surrounding drug addiction.

“Using a taut skin, we were able to produce a bright image that stands out in almost any landscape and becomes an icon,” explained Santa Lucia.

So far, only one SAFE SHAPE has been built. Scott erected the pavilion in Chicago as an actual consumption facility for both injectable and smokable (usually crack cocaine) drugs, albeit temporarily and illegally. Despite its small size, SAFE SHAPE is able to cater to two injectors or three smoking users at a time. The latter is a rarity for the harm reduction typology, due to issues of ventilation. SAFE SHAPE’s varied-height apertures, however, allow for such use.

Additionally, its size may be an advantage in terms of providing a safe place for drug consumption that can cater to drug users quickly and efficiently, but one thing SAFE SHAPE doesn’t provide is permanence. Many visitors to drug-consumption spaces do not have registered addresses, and time spent in such facilities can provide private moments to feel at ease and escape street life.

Scandinavian Sample

Another site that caters to smoking users is H17, in Copenhagen, Denmark. Occupying a former slaughterhouse in the gentrified, artsy district of Vesterbro, H17 cost $4.4 million and opened in August. It is more than 1,000 times larger than SAFE SHAPE and was designed by Copenhagen firm PLH Arkitekter. To Scott, “H17 is a fine example of bringing design and function together for the purpose of interrupting a criminalizing, moralizing discourse that really does harm people.”

PLH used a technique the firm calls “nudging” to encourage visitors on a linear path through the building and to separate pre- and post-consumers. “There are no 90-degree or smaller corners,” explained Lars Toksvig, a partner at PLH Arkitekter, which worked on H17. The facility’s entrance is open and employs a palette of cool “calming” colors.

The injection booths at H17 are wide and mirrored, and each has a hole on its stainless-steel desk that allows easy and safe disposal of used syringes, etc. A chill-out space is also provided, where inflatable furniture and warmer colors create a calm and less-clinical environment. “When we looked at precedents, we found many were insufficient in size,” said Toksvig. “When they get too small, users can become stressed inside and outside. It is important to cater to this.”

What is Next?

In Canada, some architecture firms are becoming more familiar with designing injection sites. Rayside said his Montreal practice, Rayside Labossière, has worked on five such facilities, most recently Spectre de Rue and CACTUS, both in Montreal and on course to open this year.

Meanwhile, back in the U.S., in Seattle, King County Executive Dow Constantine and Mayor Ed Murray granted approval for two injection sites, officially known as “Community Health Engagement Locations.” The two facilities could be America’s first. Currently, officials are in the process of finding the right locations and working out funding.

However, according to Mark Townsend, former executive director of the PHS Community Services Society, NIMBYism can slow proceedings. “Ideally, you want these spaces established before there is an overdose epidemic,” he said.

In addition to saving lives, drug consumption facilities can serve as paradoxical stepping-stones toward detox. They bring the very real work of designing for harm reduction into the public eye, while also providing private, dignified spaces that benefit both users and nonusers. Though these facilities are sadly only born out of crises, the progress in their design represents a change in public and political attitudes, an area in which the U.S. still has a long way to go.

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Staten Island's historic Seaview Hospital to become city's first integrated health campus

A proposed development in the middle of Staten Island could put the borough at the forefront of healthcare design. Borough President James Oddo, NYC Health + Hospitals President and CEO Dr. Ram Raju, and NYCEDC President Maria Torres-Springer were at the Old Sea View Hospital campus to reveal plans for Sea View Healthy Community, a mixed-use development that focuses on chronic disease treatment and prevention. The first of its kind in New York City, and the first publicly funded mixed-use health development in the country, Sea View Healthy Community will be constructed on the grounds of largely abandoned Old Sea View Hospital. The development will feature housing for seniors and people with disabilities, and existing medical tenants will enjoy upgraded facilities, plus a new "wellness center" designed for physical and occupational therapy. Patients, residents, and visitors will be able to dine at farm-to-table restaurants or purchase groceries from on-site stores that specialize in healthful and local food. Bike paths and hiking trails will link up with the adjacent Staten Island Greenbelt. “Sea View Healthy Community is not just the first health-focused, mixed-use campus in the city, it will be the first publicly planned and supported healthy community in the country,” said Torres-Springer. “And what better place to build it than the Sea View campus, which pioneered a holistic approach to healthcare for previous generations of New Yorkers. This extraordinary project will improve the quality of life for thousands of Staten Islanders, and keep New York City as a national leader in pioneering approaches to public health." The hospital, which opened in 1913 to help tuberculosis patients heal in a bucolic setting, sits across the street from the Landmark Colony, a former city-run poor farm that is being converted into senior living complex by Staten Island–based vengoechea + boyland architects. Today, both sites are part of the New York City Farm Colony-Seaview Hospital Historic District. The city will make capital funds available for infrastructure improvements on the 90-acre campus. Any development at the hospital must first garner Landmarks Preservation Commission (LPC) approval, but the commission is not opposed to new construction: In March of this year, the LPC okayed plans for a two-story building for the nonprofit Meals on Wheels on-site. Later this year, NYCEDC is set to release a formal Request for Expressions of Interest (RFEI) to solicit development proposals that align with the master plan.
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Indiana University Health hires HOK to masterplan medical campus in downtown Indianapolis

Healthcare in the Indianapolis area is getting a check-up, as a new masterplan seeks to streamline operations at one of South Central Indiana's biggest medical institutions. St. Louis–based HOK is leading the design team, which will take on three big jobs: merging Indiana University Health Methodist and IU Health University hospitals’ adult services into one academic medical campus in downtown Indianapolis; building a new regional academic health campus in Bloomington, Ind.; and bringing women’s services near Riley Hospital for Children closer to IU Health in Indianapolis. The project includes an expansion of IU Health's campus north of Indianapolis' central business district, and improving its connections to Riley Hospital for Children about 1.5 miles to the southwest. Several urban planning overhauls are underway in Indianapolis, including a contentious expansion of public transit.
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Can the Martin Luther King Jr. Community Hospital help heal South Los Angeles?

In 2007, Martin Luther King Jr.–Harbor Hospital in South Los Angeles was shut down after failing a federal inspection. The facility opened to the public in 1972 and served Watts and Willowbrook in the wake of Watts Riots. The groundbreaking was in 1968, the year of the assassination of Dr. King, the hospital's namesake. But instead of fostering healing by bringing good medical care to the community, the hospital was plagued by a series of allegations of poor care and patient deaths. The closing, however, left residents without a full-service medical center. At the time the New York Times reported the tangle of racial politics that led to the demise—a kind of political neglect that still is all too familiar today. “It suffered what has often been called the soft bigotry of low expectations, because the Board of Supervisors were aware that the hospital was being nicknamed killer king by people who lived in the neighborhood and they continued to hide the ball,” Joe R. Hicks, vice president of Community Advocates, Inc., a Los Angeles research group, told the Times in 2007. Eight years later, healthcare has returned to the neighborhood. The Martin Luther King Jr. Community Hospital was officially dedicated in a ceremony led by County Supervisor Mark Ridley-Thomas on August 7, just days before the fiftieth anniversary of the Watts Riots. Designed by HMC Architects, the 280,000 square foot, 120-bed facility began operation on July 14. The $210 million community hospital is adjacent to a multi-clinic outpatient center completed in June 2014 and part of a $650 million medical campus. A metal and blue-green glass entrance welcomes patients and visitors. In keeping with studies that show correlations between nature, health, and recovery, the new campus integrates landscape and accesses to natural environments with delighting and a warm color palette. Additionally, over one million dollars in public art projects, funded by the county, are installed throughout the hospital. “We wanted to create a beautiful, efficient hospital that would be as at home in Beverly Hills as in South Los Angeles,” said HMC Architects’ Kirk Rose “Too often economically challenged communities receive poor design, and we wanted to prove with this hospital that aesthetically pleasing, effective design doesn’t have to cost a fortune.”