The new emergency room of Kaiser Permanente hospital in Walnut Creek, CA, features the latest in high-tech equipment, including decontamination units for a major chemical spill or bioterrorist attack.

A six-shower bank.
There are no "front lines" on today's battlefields. And, those battlefields can be pretty much anywhere. Unfortunately, that's the world we live in. Any thought of separating military and civilian assets from geo-political conflicts has been dashed by radical regimes and "causes" that use terror as their principle weapon. As a practical matter, this means we all have to change our thinking, with respect to emergency preparations and facilities everywhere.

A great example of the new emergency preparation paradigm is located in Walnut Creek, CA. A spectacular $25 million, 32,000-square-foot expansion and renovation of Kaiser Permanente hospital's emergency facility was completed several months ago. Featuring the latest in high-tech equipment, including decontamination units for a major chemical spill or bioterrorist attack, the new emergency room is noticeably different than any other such facility around. And, at least to a point, it also offers a view of the future of industrial emergency preparation.

The isolation room.
The new facility offers 52 patient rooms, each separated by solid walls and doors, as opposed to the curtains used in the past. The idea was to provide greater privacy and comfort, as well as more direct care. All 52 beds have cardiac monitoring.

An on-site lab drawing station and digital imaging are available, which allows for emergency room patients to remain in the ER. This minimizes the need to move possibly contaminated or contagious patients to other departments.

A total of 140 computer monitors are located throughout the ER, facilitating rapid access to medical records and test results. Traditional x-ray equipment has been replaced with Digital Radiography-DR Technology-that allows digital images to be viewed by any Kaiser facility in Northern California for consultation purposes.

The Kaiser facility main entrance, showing the signage.
The most visible sign that emergency response thinking and ER design have changed is outside the Walnut Creek facility's main ER entrance. Subtly tucked in next to the main pedestrian entrance is a gated triage/prep area for victims requiring drench shower and/or eyewash treatment prior to administering emergency care. A row of six combination shower/eyewash units, including hand-held sprayers, stands ready for large-scale emergencies. In discussions with Richard West of Kaiser's National Facilities Services group, we were advised that the outdoor location was chosen based on the desire to (1) provide immediate showering and irrigation to mitigate further injury from contact with hazardous substances, and (2) to assure that those hazardous substances remain outside of the emergency room facility to the greatest degree possible, thereby protecting staff and other patients. In effect, the shower/eyewash configuration allows the main entrance to act as a sort of contamination barrier. Additionally, the facility features a single outdoor shower located next to the ambulance entrance for use prior to entering the facility with the more critically injured.

The ambulance entrance, with shower shown.
The facility also has three negative-pressure isolation rooms for cases involving highly contagious diseases or contamination cases. The main isolation room is also located next to the ambulance entrance, with a separate locked outside access. It has a built-in shower in addition to an impressive array of high-tech cardiac care and computerized diagnostic equipment.

While Kaiser's Walnut Creek facility is a case study in state-of-the-art emergency hospital design, many of the strategies employed can be transferred to the industrial sector. On-site plant emergency treatment facilities may be expected to handle an entirely new set of circumstances today-circumstances that include the potential for intentional damage and injury, as well as the use of biological and chemical agents heretofore not part of our thinking. Until now, we've addressed mostly accidental injuries in an open and direct manner. Today, we need to consider containment of the situation, due to the greater potential for the incident to still be in progress when we're brought into the picture. Bottom line: The rules have changed and we need to review and possibly change our approach to guarding the welfare of employees and others.