Emergency

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Emergency departments often have different practices as some are set up for major trauma, burns victims ,x ray and resuscitation rooms, some specific for one or all the above.

If we are to suggest a design with the ability for future upgrading and vision for the ongoing changes with clinical care we then have to combine a bit of everything that you need with the services that may be required into the future.

The most important factor without a doubt is the size of the working environment. How often do we get this wrong? Almost every time we consult nursing staff about their new department the criticism is mainly focus on the space available for all equipment the obstructions caused by trolley mounted equipment and the overcrowding when serious cases are admitted. It is important to note that pendants and lights are harder to manoeuvre/position when the area is surrounded by wall cupboards that overhang into the patient treatment area mounted too close to the back wall or mounted in low ceilings.

If the use of any gantry style rails are fixed to the ceilings either for patient lifters or Xray gantry as shown on some of our pictures than you must consider the following.

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  1. The ceiling should be set a 3000mm FFL, the gantry will seat approx. 200mm below that, the pendant arms another 300mm and the light seats below all that allowing a tall individual to work comfortably under the lot.
  2. The area for the gantry should not be fitted with any devices that could clash with the moving equipment or restrict access to vital devices.
  3. Examination/procedure lights need to be small and light weight yet able to provide the Lux, and colour correction close to those used in operating Theatres.
  4. Lights monitor arms etc should all be suspended from one single point as too many posts will hinder the ability to move the pendants (along with medical gas outlets power sources and other devices pendant mounted) close to the clinicians.
  5. More posts or devices hanging off the ceiling the greater the risk of costly collisions, frustration by users and limitations to the gantry systems.

If no gantry systems are being installed now or in the future than some of the concerns listed above may be disregarded.

In this instance the minimum FFl requirement is 2700mm

A light at the head and another at the foot is not a common feature as most lights can reach both when the pendant is mounted at 1500mm off the back wall (proportional to bed position) and the light mounted on the underside of the pendant this also cuts costs as less steel structures are fitted to the concrete soffit (see attached pic 951 ) light does reach foot without impeding pendant movement. Pic 3991 pendant rotation is limited by light post. Two supplier’s two separate installs.

The number of arms is also a variable as in most ED’s a doctor’s arm and a Nurse arm is provided to be used a separate ends of the patient, commonly these are fitted with 6 to 12 Gpo’s with at least 2 being UPS all others generator backup, staff assist and cardiac (emergency call buttons) should be fitted on both arms facing the patient not the walls. A distressed patient often grabs hold of staff and the ability to reach the call buttons is critical.

Data and image points should be fitted and cables factory fitted throughout the pendant into the ceiling space for easy connection to wall mounted monitors (these typically mirror the data obtained by the monitoring equipment and allow a superior view field as pendant mounted monitors are usually behind other nursing staff.

The placement of medical gases power points and all other communications is vital as in these departments time constraints are parallel to challenging procedures, in short power and gas outlets should be fitted on all faces of the pendant console or special care needs to be taken when designing this part of the pendant. Light switches mounted at the light head and the arms be as articulated as possible. Led technology will overcome blown bulbs and be far smaller in size, weight etc.

The pendants should have mounting rails that are able to accommodate for all makes and models of ED equipment monitor arms and diagnostic sets, catheters, suction jars, ambu bags Iv poles and if necessary ventilator shelves.

Drawers are an optional item as many users already have allocated the consumables elsewhere, In the attached pictures drawers are fitted in modules of 1,2 or 3

Pneumatic brakes are a must so when people are rushed in and space is limited pendants  often get driven through the walls, brakes only allow movement to the user whilst push buttons are being depressed and the user is in control.

If most of the equipment is to remain on trolleys then you may consider motorised booms that allow the console be raised up to 2000mm height, again a higher ceiling is a benefit.

If a single arm is to be fitted, the nurse pendant as shown than you must fit power and medical gases on the back wall closest to the doctor

The services are not as flexible considering cords need to be longer and often cross the path of the staff, this can become a workplace issue and careful consideration be taken on how to handle such an obstruction.

The medical gases are comprised but not limited to Oxygen 3x medical air 2x and suction 4x if Entonox is a requirement for burns victims than the fit out of Nitrous oxide and a scavenger inlet is added. Oxygen and N2O blender also fitted as a group 3 item.

The provision of the steel structures above the ceiling can easily be attributed to the pendant supplier or to the builder however if builder is to provide and install these early consultation with pendant supplier is essential in order to minimize costly delays.

The pendant supplier should provide all their requirements at the tender time with a demarcation point document where clearly all trades meet with their services and provide tests sheets, and commissioning

We strongly recommend that whatever area you are designing needs to be modelled around an existing one or as soon as the hospital has one room erected with walls or simply the framing one demonstration unit be installed (temporally) and the placement of all other devices medical outlets etc be put to a trial with the most relevant staff, this can often highlight issues not easily spotted on 3D modelling or drawings and the retrofitting of a model is far cheaper and easier to archive than a complete multitude of working areas. Other factors to consider, people that participate in the design cannot react, reject or complain about the end product and often feel privileged on the decision making, this ensures loyalty, extended contractual arrangements and minimizes the risk on the work environment as they are very familiar with the ins and outs of their workplace.

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