A Proposed Advanced Trauma Center

Chapter 1
Background of the problem

1.1Problem Statement & Rationale

Introduction
The burden of death and disability from injury is particularly notable in low- and middle-
income countries. Injuries are one of the causes of traumatic disorders that are
increasingly significant health problem throughout the world. Every day, according to
World Health Organization, 16,000 people die from injuries. Philippines has the highest
number of people that died from trauma. Decreasing the burden of injuries is among the
main challenges for public health in this country.

Accidents, injuries from hereon, are

one of the leading causes of mortality
in the Philippines, which presently
are the 5th leading cause of death for
all ages.

The latest World Health Organization data published in 2017 Road Traffic Accidents
Deaths in Philippines reached 10,767 or 1.74% of total deaths. The age adjusted Death
Rate is 11.82 per 100,000 of population, this data justified why Philippines ranks #116 in
the world.
The top five leading causes of
death due to injury in the
Philippines for all ages, are
assault, transport accidents,
accidental drowning and
submersion, intentional self-harm
and accidental falls. Pre-hospital
care in the Philippines is largely
non-existent for trauma patients.
To be able to reduce the mortality rate of accident and injuries, almost 5,000 trauma
admissions at the major trauma referral hospital in the Philippines are needed in making
a more adequate representation of local, major multi-system trauma.
Stated in the 2015 Philippine Health Statistics, mortality rate showed that the highest
incidence of death by place of occurrence was in CALABARZON with 80,776 or 14.4% of
the total deaths, followed by NCR with 74,530 deaths or 13.3% and Central Luzon with
65,540 deaths or 11.7%. Percentage of deaths from these three regions alone, already
comprised to almost 40 percent (39.4%) of the total deaths due to accident.
But across all regions, National Capital Region is the only region in the country where at
least 54.1% of its deaths were attended by a medical doctor at the time of death than not.
It was still, however low, when we consider that NCR is a highly urbanized region and
where both public and private health facilities are available. If accessibility is not a problem
in this region due to numerous health facilities, we may consider the affordability issue of
accessing health care. Dying without the attention of a medical doctor could be in some
way an evidence of unaffordable health cost in the country.
On the authority of the latest statistics from the Department of Health, there are 476
government hospitals and 960 private hospitals in the country as of October 2017, and
only 70 hospital has a trauma service. None of these hospitals were specialized for trauma
patients and there are no ‘trauma leveling’ or classification system for the level of care that
hospitals in the Philippines can provide.
One of the leading hospitals in the Philippines is the Philippine General Hospital. Philippine
General Hospital is the pioneer health facility for trauma care in the country, being the first
to create a dedicated Trauma Service in 1989.
PGH pediatric trauma review from Emergency Room, it was noted that only 4% of cases
were seen by a physician prior to arrival, 7% were referred from another hospital and 79%
were self-transported to the hospital. Only 25% of patients arrived in less than 60 minutes
from injury, 37% from 1-4 hours and 9% more than 48 hours from time of injury.
Philippine General Hospital can only be able to provide initial care and stabilization of a
traumatic injury without the presence of specialized services to care for victims of major
trauma. Despite admitting about 1600 patients every year their hospital still have no
assigned trauma catchment area, geographic jurisdiction or triage area.
This highlights the need for prioritizing a public health approach to violence prevention in
the Philippines.
According to the PGH
review of patients records,
the most common
mechanism of injuries were
stab wounds, vehicular
crashes, and gunshot
wounds.
Multiple organ failure/sepsis was the most frequent causes of death, followed by the
exsanguinations, and central nervous system failure. About 66 patients who died within
the first 24 hours are most likely to die because of exsanguinations, while 8 out of 66
patients who died after 72 hours are due to Multiple organ failure/Sepsis.
Since Metro Manila is reported with 49 cases of non-fatal road injuries, and 1 fatality per
day in 2018. Incidents of damage to property occurred 270 times per day. And among the
cities in Metro Manila, Quezon City has the highest percentage of mortality rate of
accidents for the total of 16,073.
Therefore, this project will be located within Quezon City - the highly urbanized and dense
city within the National Capital Region with a population of 2,936,116 people.
The recent first Quezon City Tourism Stakeholders Summit was launched, in which the
city government has been clear with its goals of adding “Wellness Capital of Asia” as a
distinctive badge to its name. This city also aims to integrate and assess all these services
to better promote the city as medical tourism destination in the year 2020.

There are 16 government hospitals in Quezon City, but none of these prioritize trauma
services. There are 6 districts in Quezon city and District 2 is the most populated area,
being extremely prone to accidents.
Advance Trauma Center is a specialized hospital that is equipped and staffed to provide
care for patients suffering from major traumatic injuries, in order to significantly decrease
the number of mortality rate.
This project will be Level I Trauma Center with Level II general requirements as per
Department of Health. Level I Trauma Center is has the most comprehensive capability of
providing total care for every aspect of injury – from prevention through rehabilitation. This
project will also aid in managing high volume of the most severely injured trauma patients.
This project is a Trauma-Capable Facility – a DOH licensed hospital designated as Trauma
Center. It is a Specialized or Tertiary Hospital that is devoted in treatment of a particular
type of illness requiring specific range of treatment.
 This project will be governed by the Department of Health. Department of Health (DOH) is
the principal health agency in the Philippines. An agency that is responsible in ensuring
access to basic public health services to all Filipinos through the provision of quality health
care and regulation of providers of health goods and services. Philippine Department of
Health included injury prevention in the National Objectives for Health which include this
project for an average new hospital that will cost of about 2Billion pesos excluding the
equipment.

Project Objectives

 To improve emergency medical services and trauma.

 Injury specific objectives include: ‘mortality secondary to accidents should be
reduced to 450 deaths per 100,000 populations and those secondary to transport
accidents should be reduced to 66 deaths per 100,000 population’ by 2021.
 To implement the latest advances in trauma care and being a leader in continuing
improvement and education of trauma care providers throughout the region.
 To reduce burden of death and disability from injury such disparities by establishing
achievable and affordable standards for injury care throughout the city.
 To consolidate and improve the quality of the Trauma center on the burden of
disease from injury in order to increase the likelihood of meeting its National
Objectives of Health.
 To identify and promote such inexpensive ways of reinforcing trauma treatment
throughout the region.
Special Requirements

 Offices for different Surgeons

 Training facilities for specialized doctors
 Healing Spaces
 Chapel
 Luscious external landscape
 Visual Connection with Nature
 Blood bank center
 Emergency rooms for different category of major trauma

1.1.1 Major & Minor Problems

1.1.2 Architectural Goals and Objectives

Major Problem Architectural Goal

Design of specialized hospital that is To integrate the latest advancement and

advance and essential for Emergency
Department with a low-cost initiative
treatment of the Trauma Center.
efficient design of Emergency Department
and assimilate a Modern Design that
focuses on the human connection
between nature and built environment of
Trauma center.
 Minor Problems
1. What are the best materials to use in
designing an advance and essential
Emergency Department and achieve
a low-cost initiative treatment of the
Trauma Center?
2. What is the best method to
implement an advance and essential
Emergency Department for Trauma
Center that will help to improve
emergency services of the Trauma
center?
3. What is best planning concept that
will provides a state-of the art care
hospital and achieve a low-cost
initiative treatment for the trauma
patients?
4. How the project will be uniquely
connected to the place, climate and
culture through Place-Based
Relationships?
Architectural Objectives
1.To use an advance smart building
material to create connections between
spaces and technologies.
1.1 New forms of concrete.
1.2 Innovative wooden structure
1.3 Glass with enhanced qualities.
2. To integrate the clinical requirements,
functional needs and practical size
requirements of an Emergency
Department.
2.1 Functionality – an Emergency
Department’s design needs to be practical
and reflect how health professionals
manage and treat their patients who have
different trauma and clinical conditions.
2.2 Form – spatial considerations and
relationships that promote effective
interaction between staff and patients,
relatives, carers, and the flow of clinical
care.
2.3 Patient and staff needs – the aim of
health care is not only to treat disease,
but also to create a healing environment
for patients that is safe and free of
psychosocial elements created through
poor design.
3. To create a central orientating method
for hospital and use a Biophilic design
concept.
3.1 To translate an understanding of the
inherent human affinity to affiliate with
natural systems and processes.
3.2 To provide sufficient and frequent
human-nature interactions in both the
interior and exterior of the project to
connect the majority of occupants with
nature directly.
3.3 To maximize the creation of
therapeutic green spaces.
4. To achieve development at all scales,
where buildings define the most advanced
measure of possible sustainability in the
built environment and act to bridge the
gap between natural and artificial
environments.
4.1 Environmental benefits
4.2 Economic benefits
4.3 Social Benefits
 5. How the project will be transformed
by deliberately incorporating nature
through Environmental Features,
Light and Space, and Natural
Shapes and Forms?
5. To translate an understanding of the
inherent human affinity to affiliate with
natural systems and processes.
5.1 Optimizing and organizing the spaces
with a human focus.
5.2 Enhance air quality and toxin levels
for the immediate healing of the patients.
5.3 Improve natural ventilation and natural
lighting.

1.2 Definition of Terms

 Accident
- refers to unfortunate incident that happens unexpectedly and
unintentionally, typically resulting in damage or injury.
 Advance
- refers to an improvement of facilities or services through the combination
of architectural and modern technology.
 Biophilic Design
- refers to a design that includes elements that nurture the innate human-
nature connection.
 Center
- refers to a health care institution providing patient treatment with
specialized medical.
 Emergency Medical Services (EMS)
- refers to the arrangement of personnel, facilities, and equipment for the
effective and coordinated delivery of prehospital emergency medical
services required for the prevention and management of incidents. These
incidents may occur as a result of a medical emergency, an injury, a natural
disaster, or a similar situation.
 Emergency Room
- refers to a department of hospital that provide immediate treatment for
acute illnesses and trauma.
 Essential
- refers to a thing that is absolutely necessary or extremely important.
 Exsanguinations
- refers to the loss of blood to a degree sufficient to cause death
 General Hospital
- refers to a hospital that provides services for all kinds of illnesses, diseases,
injuries or deformities.
 Health Care
- refers to organized provision of medical care to individuals or a community.
 Hospital
- refers to an institution or building to diagnose and treat the sick, injured and
dying.
 Human affinity
- refers to the connection of human to other things.
 In-Hospital Trauma Alert
- refers to an alert issued by trauma center personnel to all trauma team
members to arrive promptly to the trauma resuscitation area for a trauma
alert patient not previously identified by EMS.
 In-Hospital Trauma Registry
- refers to a hospital wide database that integrates medical and system
information related to trauma patient diagnosis and the provision of trauma
care.
 Injuries
- refers to the instance of being injured or damage.
 Intensive Care Unit (ICU)
- refers to a hospital unit in which patients requiring close monitoring,
continuous attention and intensive or critical care are kept.
 In-patient hospital beds
- refers to all hospital beds which are regularly maintained and staffed for the
accommodation and full-time care of a succession of in-patients.
 Low-cost initiative treatment
- refers to a health care system improving the experience of care and
reducing the cost of treatment.
 Major Trauma
- refers to an injury that has the potential to cause prolonged disability or
death.
 Medical Center
- refers to a hospital staffed and equipped to care for many patients and for
a large number of kinds of diseases and dysfunction using modern
technology.
 Medical Services
- refers to a medical or health care services emphasize disease treatment
and care.
 Mortality
- refers to the statistics provide a baseline indicator that could define government
priorities in terms of health policy formulation and service provision.
 Neonatal Intensive Care Unit (NICU)
- refers to the hospital unit containing a variety of mechanical devices and special
equipment for the management and care of premature/preterm and seriously
ill newborns.
 Place-Based Relationship
- refers to a general planning approach, which emphasizes the characteristics
and meaning of places as a fundamental starting point for planning and
development.
 Primary Care Specialty
- refers to an internal medicine, family practice, general surgery, general
practitioner, and pediatric medicine. Hospitals should use caution when using
pediatricians to see adult patients in the emergency department.
 Post-Anesthesia Recovery/Post-Anesthesia Care Unit (PAR/PACU)
- refers to an area designated by the hospital for monitoring and treating patients
following anesthesia.
 Sepsis
- refers to a serious condition resulting from the presence of harmful
microorganisms in the blood or other tissues and the body’s response to their
 presence, potentially leading to the malfunctioning of various organs, shock, and
death.
 Specialty Hospital
- refers to a typically affiliated with larger hospitals or healthcare networks and
offer specific treatments.
 Therapeutic
- refers to the branch of medicine concerned with the treatment of disease and
the action of remedial agents.
 Trauma
- refers to an illness of patients suffering from major traumatic injuries such
as falls, motor vehicle collisions, or gunshot wounds.
 Trauma-Capable Facility
- refers to a DOH licensed hospital designated as a Trauma Center.
 Trauma Center
- refer to an emergency department and also known as a "casualty department"
or "accident and emergency" with the presence of specialized services to care
for victims of major trauma.
 Trauma Team
- refers to a group of health care practitioners available for the resuscitative
phase of trauma patient care.

1.3 Significance of the study

1.3.1 Architectural Significance

This Advance Trauma center will be the key determinant of everything that matters
when it comes to health interventions. The experience, cost, and results has been
hiding in plain sight, so in this project, this will provide a low-cost initiative treatment to
the patient by designing a building with an appropriate means of space.
From the size and layout of a room, whether a bed sits in the middle or against a wall
and even which wall, how much space is maintained for patients to walk versus how
many beds or operating equipment can be accommodated especially for the
improvement of Emergency Department.
Changing, as architect and health care organizations come together to incorporate
principles of social design into the built health care environment.
The layout and architecture of this center can improve the lives of patients. The new
conception of medical care facilities is moving away from monotonous spaces,
committing to the interpretation of color and light and also to the design of the building.
In this manner it will contribute to the spaces impact patients mood and bodily self-
image and it can help people recover more quickly.
The architectural attributes of this project provide a natural light, nature scenes,
and calm, clean rooms for patients contribute to a positive experience for the patient
with improve emergency medical services.
This project will contribute in the field of architecture by studying on how to bring nature
closer to the patient’s experience with outdoor and indoor gardens, glass panels for
enjoying light and the landscape, and the use of natural materials like wood and stone.
1.3.2 Significance to the Community

This Advance Trauma Center provides so many tangible and intangible resources to
the city and surround the community. And it is not easy for any health professional to
be aware of injury problems and safety issues within their own communities if their
main responsibility is not in this field.
In line with this hospital, it is providing the needs of the patients and focusing a care
for people who face major trauma in the city to decrease the mortality and morbidity
rate of accidents.
With an integrated and comprehensive approach to health development that endeavor
to make essential goods, health, and other social services available to all the people
at affordable cost. Also provide priority for the needs of the underprivileged sick,
elderly, disabled, women, and children.
And this Trauma Center will be design with connection to the nature or environment to
provide as one of the lungs of the Quezon City and serves as the center of all the
hospitals that specialized care for victim of major trauma. A hospital that is designed
and built to promote wellness and not just to fix and cure human beings.
This Center play an important role in all aspects of injury prevention and safety
promotion. This includes not only medical or surgical treatment for the injured patients
but also risk assessment, health education, community action, organizational
development and advocacy for policy to promote safety at a multi-level in the society.
This can be accomplished most efficiently through collaboration with diverse sectors
within a community, including hospitals, public health professionals, policy makers,
school boards, police departments, fire departments, citizens' coalitions and others.

1.4 Scopes and Limitations

SCOPES
1. Trauma Center Designation and
Level
2. General requirements as required
by the DOH
3. Structural, Electrical and
Mechanical and other utility needs
of the project.
4. General planning consideration for
Trauma Center.
LIMITATIONS
This project is a Level 1 trauma center
provides the highest level of surgical care
for trauma patients.
This project will only limit to a Level 2 as a
general requirement including all of Level
1 capacity of the General Hospital.
Stated in RA 9266, architect is bounded
up to structural, electrical, mechanical
and other utility concept.
This project does not incorporate the
other associated services like
rehabilitation center.
1.5 Conceptual Framework

INPUT PROCESS OUTPUT

trauma center patient The number of death and
volumes were not disabilities
associated with improved resulting from incidents of
patient outcomes. physical trauma can be
substantially reduced.

Some of the Hospital that Having a

delivers trauma services comprehensive, organized
don’t have assigned trauma system to provide for the
catchment area, geographic access, response, triage,
jurisdiction or triage area. field stabilization, transport,
hospital stabilization, and
definitive care.

A better understanding of Trauma Center is, by

how infrastructure, staffing design, large, resource-
A proposed Advance
and patient characteristics intensive environments,
Trauma Center
within a trauma center is capable of providing patients
impacted by the proportion with a wide array of trauma
of patients. and non-trauma care
services.
Too many hospital desires Trauma Center that has
for physician integration but simulation center for the
very few employed development opportunities
physicians. that enhance knowledge,
develop skills and enrich the
organization.
Improved survival and The effectiveness, including
functional outcome among patient satisfaction and
injured patients are efficiency, interact in
unaffordable. alternative treatment
modalities and treatment
programs.