Making a resilient and flexible emergency department to handle community needs and crises

As the healthcare landscape continues to shift and evolve in the United States, so is the scale of illness, injury and community support managed by emergency departments (EDs) across the country. With crisis like the coronavirus pandemic, the mental health epidemic, ongoing violence and more, these facilities are often pushed to their limits, resulting in longer wait times, overworked staff and less than optimal patient care.

UC Health’s Emergency Department, a Level 1 Trauma Center in the heart of Cincinnati, is using lessons learned from the pandemic and other large-scale crisis events to create a one-of-a-kind Emergency Preparedness and and Response Center (EPRC). The space, adjacent to the main ED, can easily expand or contract to accommodate anything from a community recognition ceremony to a mass casualty situation to another pandemic or infectious disease scenario. 

“The built environment cannot be a static monument that can’t evolve or change with the needs of healthcare,” said Dr. Ben Bassin, an Emergency Medicine physician at the University of Michigan and a Blue Cottage of CannonDesign Innovation Fellow who was part of the UC Health design team. “The environment needs to be dynamic, flexible and resilient.”

The space’s origin partly ties back to two formative crisis events it experienced in the last four years.

Like many emergency departments and hospitals, UC Health had to improvise when confronted with the sheer number of patients needing care early in the pandemic. They constructed drive through testing sites on their campus, created more infectious disease inpatient units in the hospital along with many other adaptations created out of urgent need. Contactless check-in, socially distanced waiting rooms and changes to HVAC systems are other here-to-stay healthcare adaptations.

In January 2023, Buffalo Bills football player Damar Hamlin collapsed while playing the Cincinnati Bengals. After being resuscitated from cardiac arrest, he was taken to UC Health in critical condition, and he remained hospitalized for nine days. Media from all around the country camped outside the hospital, providing live updates from the emergency department parking lot throughout the duration of Hamlin’s stay at the hospital. This created logistical hurdles and frustrations for emergency vehicles trying to drop off critical patients, and for those driving to the ED on their own.

The goal of the Emergency Preparedness and Response Center, says Brian Silva, one of the lead designers and planners of the project, is to allow the ED to safely handle crises such as those that tested UC Health recently while still letting the main ED function normally. It was designed with the intention to handle incidents such as an emergency responder injury, a community event such as a mass shooting, an infectious disease scenario and an assembly space for events or press conferences. Day-to-day in non-crisis situations it will act as a lounge space for those waiting for test results or patients to be discharged or transferred.

“Ultimately the space looks to simplify what is actually a complex program,” says Silva. “But its main functions are people management, emergency situation management and to allow for bigger assemblies on campus, all without disrupting patient care and flow throughout the ED and beyond.”

To accommodate varying levels of patient acuity and demand, up to 50 patients can be treated (in addition to regular ED capacity) in divided care bays. Hidden behind discreet removable panels are medical gas devices and emergency power outlets, allowing for higher levels of care and flexibility to address minor to major injuries and illness.

“The flexibility not only of the headwalls but also the furniture and equipment storage is crucial for how quickly this space may need to be activated, and how a patient’s status can change in an instant,” says Ellen Leise, another healthcare planner on the project.

The space is projected to open in August 2024, and because of its flexibility it can easily respond to staff and patient feedback after its initial uses. UC Health received local, state and federal funding for this project as it will benefit the readiness of this Level 1 Trauma Center to better serve the community with a future-proof, resilient facility. The different space activation methodologies and crisis scenarios will be folded into regional readiness training for emergency scenarios and serve as a nationwide example.