Thesis report

ADVANCED TRAUMA CARE CENTRE

A PROJECT REPORT

Submitted by

C.SARAYU

in partial fulfillment for the award of the degree of

BACHELOR OF ARCHITECTURE SCHOOL OF ARCHITECTURE, MEENAKSHI COLLEGE OF ENGINEERING, CHENNAI 60078

ANNA UNIVERSITY : CHENNAI 600 025 MAY 2016

ACKNOWEDGEMENT

I hereby express my sincere gratitude to School of Architecture, Meenakshi College of Engineering, Chennai for giving this opportunity to carry out this Thesis Report as part of my course work.

I also owe my thanks to _______________________________________

DATE: 11th May 2016

Signature of the Candidate

SCHOOL OF ARCHITECTURE MEENAKSHI COLLEGE OF ENGINEERING ANNA UNIVERSITY CHENNAI 600 025

BONAFIDE CERTIFICATE

Certified that this project report “ADVANCED TRAUMA CARE CENTRE” is the bonafide work of SARAYU C who carried out the project work under my supervision.

Signature HEAD OF THE DEPARTMENT

Signature

DIRECTOR

Signature THESIS CO-ORDINATOR

DESIGNING AN ADVANCE TRAUMA CARE CENTER

submitted by SARAYU C 311411251052 of BACHELOR OF ARCHITECTURE in SCHOOL OF ARCHITECTURE MEENAKSHI COLLEGE OF ENGINEERING ANNA UNIVERSITY CHENNAI 600 025 MAY 2016

SCHOOL OF ARCHITECTURE MEENAKSHI COLLEGE OF ENGINEERING ANNA UNIVERSITY CHENNAI 600 025

DECLARATION

This is to certify that the Thesis Report of SARAYU C V year (Batch 2011-216) School of Architecture, Meenakshi College of Engineering, Chennai has been approved on 11.05.2016.

Submitted for the university Thesis VIVA – VOCE Examination held on _____________

INTERNAL EXAMINER

EXTERNAL EXAMINER

TABLE OF CONTENTS Chapter

Topic ABSTRACT

1

INTRODUCTION RATE OF DIFFERENT TRAUMA INJURIES IMPROVEMENTS THROUGH ARCHITECTURE THRUST AREA HIERARCHY LEVELS OF TRAUMA CENTERS

2

LITERATURE STUDY PLANNING ASPECTS ZONES INFECTION CONTROL LAYOUT OF A SURGICAL FLOOR ZONING AND FLOW OF OPERATING FLOOR SPACE PLANNING & CRITICAL DESIGN FEATURES HEALTH CARE SCENARIO ELEMENTS ELEMENTS OF A LEVEL I TRAUMA CENTER

3

CASE STUDY CASE STUDY 1 – SPARSH HOSPITAL, BANGALORE CASE STUDY 2 – JIPMER, PONDICHERRY

4

NET STUDY NET STUDY 1 •

ZAYED MILITARY AND TRAUMA HOSPITAL, ABHUDHABI

•

STRATEGIC PLANNING INITIATIVES

NET STUDY 2

5

•

RESTON HOSPITAL, VIRGINIA, USA

•

ENHANCING PATIENT SAFETY & SATISFACTION SATISFACTION

SITE ANALYSIS AND STUDY SITE DETAILS

6

INFERENCE

ABSTRACT A trauma center is a hospital, equipped and staffed to provide comprehensive emergency medical services to patients suffering traumatic injuries. Trauma centers grew into existence out of the realization that traumatic injury is a disease process unto itself requiring specialized and experienced multidisciplinary treatment and specialized resources. A Trauma Center is also called an "emergency department (ED)", also known as "accident & emergency (A&E)", "emergency room (ER)", or "casualty department". The trauma level certification can directly affect the patient's outcome and determine if the patient needs to be transferred to a higher level trauma center.

WHY ADVANCED TRAUMA CENTER Everyday around the world almost 16,000 people die from various injuries. Injuries represent 12% of the global burden of disease. It is startling to note that the lower and middle income groups of India contribute about 90% of the global burden of injury mortality, thus highlighting the disparities in outcome of trauma between the high, middle, and lower income nations. Injuries affect the productive youth of the country. In addition to excess mortality; there is a tremendous burden of disability from extremity, head, and spinal injuries.

Therefore, trauma effects the productive youth of the country, which is otherwise healthy and free from chronic disease. In India, most of the available literature regarding trauma epidemiology is pertaining to road traffic injuries and there are hardly any studies done on the other causes of trauma. Trauma is caused by a wide variety of risks e.g., fall (common in pediatric patients, firearm injuries, poisoning, burns, drowning, intentional self-harm (suicides), assault, falling objects, and natural and man-made disasters. The improvement and organization of trauma services or systems is a cost effective way of improving patient outcome and is achievable in almost all settings.

SCOPE Healthcare in India is in a developing stage and it needs a radical policy shift at government level to usher in the changes to face the challenges of the future. Under the umbrella of health care providers are outpatient set-ups, nursing homes, hospitals, medical colleges, health spas, diagnostic centers, hospices, old age homes and more. Most of these institutions will have varied needs, which will differ vastly in terms of their planning needs. Health care provision in India is different in rural and semi urban settings where it is more unorganized to today’s super specialty centers where it more institutionalized.

The sector suffers from long years of neglect by the government in terms of priority funding despite being a basic need of the community. The rapid growth of the insurance sector is equally helping the community to face the problem of spiraling health care costs.

The organization of a trauma system has four impact pillars: organization of pre-hospital care facilities, hospital networking, communication systems, and organization of in-hospital care (acute care and

definitive care). An integrated approach is required at all levels: human resources (staffing and training), physical resources (infrastructure, equipment, and supplies) and the process (organization and administration).

Compared to the western world, the trauma care services in India lack each of the elements listed above.

Most of the physical resources for in-hospital care in terms of infrastructure and equipment are already available at secondary and tertiary care hospitals and need moderate upgrades.

Therefore, the thrust areas in the field of trauma services are as follows: 1. Provide physical resources for pre-hospital care and communication systems.

2. Provide well-trained staff at all levels of care from pre-hospital to definitive trauma care.

3. Providers should be well trained and should understand the critical needs of a trauma victim.

4. Organize and integrate pre-hospital services with definitive care facilities (hospital) so that a patient is shifted to an appropriate facility in the shortest possible time.

The Government of India has planned this organization in an apex to the base format.

The establishment of the Jai Prakash Narain Apex Trauma Center (JPNATC) at the All India Institute of Medical Sciences in New Delhi is a step forward in providing an apex institution for quality trauma patient care facilities, which will act as a role model for other institutions and centers providing trauma care in the country.

More than providing the best patient care facilities, the role of this apex trauma center has been envisaged as an apex research and training institution that will help the nation's administrators formulate policies regarding the organization of trauma care facilities throughout the country.

Focal areas: Hospital planning has a lot of areas that has to be taken care. The building invokes a sense of cleanliness in one’s mind. So, obviously any kind of hospital design has to be thought about, allotting a space for services.

Beyond technical requirements that modern medicine demands, the designer has to cope with a host of more subjective issues like the anxiety of the patient, the stressful work environment of the staff and the need to build a sustainable and healing building which brings us to; designing an environment targeted at the patient’s psychology that helps them feel comfortable and at home. The thesis aims at developing a concrete relationship between built-environment with the reactions of traumatic patients and to that of the city it is built in.

HIERARCHAL LEVELS

TRAUMA CENTER LEVEL

-I

LEVEL - II

LEVEL - III

LEVEL - IV

HIERARCHAL REQUIREMENTS A Level I trauma center is required to have a certain number of the following people on duty, 24 hours a day at the hospital:

•

surgeons

•

emergency physicians

•

anesthesiologists

•

nurses

•

an education program

•

Preventive and outreach programs.

A Level II trauma center works in collaboration with a Level I center. It provides comprehensive trauma care and supplements the clinical expertise of a Level I institution with 24-hour availability of all essential specialties, personnel, and equipment.

A Level III trauma center does not have the full availability of specialists, but does have resources for emergency resuscitation, surgery, and intensive care of most trauma patients.

A Level IV trauma center exists in some states where the resources do not exist for a Level III trauma center. It provides initial evaluation, stabilization, diagnostic capabilities, and transfer to a higher level of care.

A level V provides initial evaluation, stabilization, diagnostic capabilities, and transfer to a higher level of care. It may provide surgical and critical-care services, as defined in the service's scope of traumacare services. A trauma-trained nurse is immediately available, and physicians are available upon patient arrival in the Emergency Department [Not available for 24 hours].

1.INTRODUCTION 1.INTRODUCTION

A trauma Center is a hospital equipped and staffed to provide comprehensive emergency medical services to patients suffering traumatic injuries. The trauma level certification can directly affect the patient's outcome and determine if the patient needs to be transferred to a higher level trauma center

RATE OF DIFFERENT TRAUMA INJURIES As per the records of the surveys taken by the Indian Journal of Critical Care Medicine, there has been a tremendous scale of increase in the trauma rates. Their reports state that the death rates are also alarmingly increasing every year for the past ten years, due to the nascent stage of development in the Trauma Care industry. Their charts compare three major aspects; Number of injured versus the Number of Accidents and the Mortality rate due to improper care.

Further, a more detailed study was conducted in 2012, by the Indian Society for Trauma and Acute Care. According to the ISTAC, there is a 1:4 ratio of road accident to all trauma incidents, and a death

every 1.9 minutes due to trauma; making road Accidents 22.8% responsible for overall trauma Incidents in India.

IMPROVEMENTS THROUGH ARCHITECTURE

THRUST AREA The thrust areas in the field of trauma services are as follows: 1.

Physical resources for pre-hospital care and communication systems.

2.

Organize and integrate pre-hospital services with definitive care facilities (hospital) so that a

patient is shifted to an appropriate facility in the shortest possible time.

HIERARCHY LEVELS OF TRAUMA CENTERS

2. LITERATURE STUDY

PLANNING ASPECTSASPECTSLOCATIONLOCATION•Quiet environment •Away from traffic •Away from contamination & cross infection •Close proximity to Emergency, OT, Recovery rooms, and nursing units •Closer to vertical transportation •Isolated from traffic & noisy area •Away from contamination & cross infection •At close proximity to Emergency / cathlab •Dedicated lift & dumb waiter to CSSD

CONSIDERATIONS •Segregation of clean & dirty traffic •Sub-zone to ensure sterility •Triple corridor system -Dirty / Clean/ Sterile •Circulation pattern •Separation of movements -Doctors/staff / patients / materials •Unidirectional air flow (clean to unclean) •Selection of good materials •Sharing of sub sterile /scrub / sluice with other OR with hatch opening •Isolation rooms for air borne diseases •Step down ICU or HDU •Double corridor system-Outer corridor & sterile corridor •Centralized nursing station ICU ZONES Zones are area of varying degrees of cleanliness in which the bacteriological count progressively diminishes from the outer to the inner zones (operating area) and is maintained by a differential

decreasing positive pressure ventilation gradient from the inner zone to the outer zone. They are of following types.

I.

Protective Zone:

•

Reception

•

Waiting area

•

Trolley bay

•

Changing room

II.

Sterile Zone:

•

Operating Suite

•

Scrub Room

•

Anesthesia Induction room.

•

Set up Room

III.

Clean Zone:

•

Pre-op room

•

Recovery room

•

Plaster room

•

Staff room

•

Store

IV.

Disposal Zone:

•

Dirty Utility •

Disposal corridor

The essential principles that should be followed in planning the physical layout of operating room suite are: - Exclusion of contamination from outside the suite with proper traffic patterns within the suite and separation of clean areas from contaminated areas within the suite.

- ORs require specialized planning because surgical facilities represent a central life saving activity.

- Depending on their functional efficiency, it is a major cost center in the establishment of the hospital,

are responsible for an appreciable quantum of quality in private sector and no one plan suits all hospitals.

- A scientific and detailed planning is required while designing an OT in order to ensure its smooth functioning, efficiency and effective utilization.

INFECTION CONTROL It is important to have an infection free atmosphere.

•

DEFINED CIRCULATION CORRIDORSCORRIDORSIdentified corridors for-staffs/ doctors / patients &materials

•

STAFFS/ DOCTORS a. Shoe change area b. Slippers & Dress change room c. Air showers

•

PATIENTS a. Separate transfer area (Change over of stretchers) b. Transfer zone links Pre-operative areas

•

MATERIALS a. Exclusive transportation route b. Handling Clean/ Dirty materials c. Connectivity of functions

LAYOUT OF A SURGICAL FLOOR

ZONING AND FLOW OF OPERATING FLOOR

SPACE PLANNING & CRITICAL DESIGN FEATURES - Inadequate for serving the needs of growing population - Efforts are made up to create Infrastructure and to provide Manpower - Built up Appropriate linkages between the various centers

HEALTH CARE SCENARIOSCENARIOHOSPITAL BEDS TO POPULATION

India -0.9:1000 Developed Countries Japan-14:1000 U.S.A-5:1000 U.K-5.5:1000 German-10:1000 France-9:1000 Italy-7:1000 Canada-6:1000 Sweden-6.5:1000 South Korea-5:1000

ZONING –Hospital / institutional /residential / service -Separate parking for visitors / staff -Separate entry for staff / patients / visitors / material -Separation of OPD & IPD with negative space in between with courtyard

OUTER ZONE •Reception, Registration •Admission, Administration •OPD / Emergeny INTERMEDIATE ZONE •Diagnostic/Pathology •Therapeutical & •Pharmacy NUCLEUS •Surgery suite •ICU INNER ZONE •IPD •Patient rooms

ELEMENTS OF A LEVEL I TRAUMA CENTER 24-hour in-house coverage by general surgeons, and prompt availability of care in specialties such as: - Orthopedic surgery - Neurosurgery - Anesthesiology - Emergency medicine - Radiology - Internal medicine - Plastic surgery - Oral and maxillofacial - Referral resource for communities in nearby regions.

- Provides leadership in prevention, public education to surrounding communities.

- Provides continuing education of the trauma team members.

- Incorporates a comprehensive quality assessment program.

- Operates an organized teaching and research effort to help direct new innovations in trauma care.

- Program for substance abuse screening and patient intervention.

- Meets minimum requirement for annual volume of severely injured patients.

DETAILS OF FACILITIES TO BE OFFERED IN THE HOSPITAL

3. CASE STUDY CASE STUDY – I SPARSH HOSPITALS, BANGALORE

Location-Bangalore, Bangalore, Bommasandra Industrial Area Area – 1700 sqm per floor Year of completion-2006 Beds: 150

PHYSICAL SETTING The hospital is a part of a envisioned med city, flanked by five different entries for the five different hospital.

Sparsh Hospitals is located somewhat in the rear of the campus, allowing emergency entrance also easily. Along with Sparsh, the campus also houses:

1. A Heart Care Foundation.

2. An Eye care hospital.

3.

A super specialty hospital.

4.

A genetic research center.

5.

Mazumdar medical center

6. . Sparsh Trauma Care

Basement floor is easily accessed through the secondary entrance. The basement floor is exclusively built for all the services unit, diagnostic department, and administration and education department.

The areas include:CT- Scan, X-Ray,MRD, Ultrasound,UPS room, Maintenance room, Manifold room, Pump & Sump Room, Electric Panel room, CSSD, Prosthetics room Gym & Physiotherapy and Admin block.

GROUND FLOOR The entry into the hospital can either lead to the OPD with a center atrium and a reception or the connecting corridor to Emergency department. The hospital has an area for:Resuscitation & Emergency room, Diagnostic department, the insurance department and a plastics room.

The ground floor also has: Consultation rooms, Plaster room Treatment room, Seceretary room Cafeteria

FIRST FLOOR The first floor has the in-patient department with the OR complex, the pre-op and Post-ops, the ICU, Pre-operation room, HDU, the visitor lounge, the MD and Chief Surgeon’s cabin, all circumscribing the central atrium. The OR complex is completely shut off from the other parts.

SECOND FLOOR The second floor is designed to give patients a sense of calm as the entire floor is alloted to house different types of patient rooms: General, Semi-Private, Private and special private rooms. The atrium below is covered with a therapeutic garden that gives an amazing view of the entire med-city.

TERRACE The terrace is fully equipped with the complete services: The AHU unit, seperately for the ORs and the ICUs. They have three water tanks; one for raw water(Restrooms and Flushers); one for RO water(Drinking and washbasins), and the other one for equipment operation.

They have four tanks on the ground level; of capacities 100,000 l - firework, two 75,000 l tanks for raw water, and one 75000 l for RO.

HOSPITAL SERVICES ELECTRICITY: - 1000 KVA Transformer- EP Room(HT - 11KV)- LT 440 KV Panel room 2nd SOURCE: Generator of 625 KVA 3rd SOURCE - 2 UPS of 40 KVA (used only for ORs and ERs) The electricity is supplied from the transformers to the EP room, to each floor with a circuit box, through the false ceiling.

AIR CONDITIONING 100 Tons chiller - Water coded chiller - mainly for ORs and ICU

CASE STUDY – 2 JIPMER PONDICHERRY Location- Pondicherry Area – 195 acres campus Year of establishment: 1863 (by the French Imperial Govt.)

Beds: 1600 beds in total; 200 bedded trauma center Architects - Larson & Turbo (L&T)

PHYSICAL SETTING The hospital is a part of a medical campus with its entry located on the west of Pondicherry. The campus has a vast education institute and hospitals which take in interns from the same campus.

JIPMER trauma center is located on the straight stretch that has a super specialty block.

I GROUND FLOOR

The ground floor has the emergency room and resuscitation area, and the diagnostics. The trauma triage chart dominates all the actions in the flow of patients. The rear side also has a ramp up and down, and a set of staircase and elevator.

II FIRST FLOOR

The first floor is equipped with more labs. The floor also has a temporary ward for female and male: the medicine wards: Used in case of level 3 trauma. The flow of the hospital in these areas is quite simple.

III. SECOND FLOOR The second floor has the minor and trauma Operation suites - 2, which is used to bring the emergency people from the triage assessment or the observation beds/ICUs in case of a sudden fiasco. The floor also has the post-op room, the Coronary Care Unit and a cath lab. The operation suite is secluded with glass doors visible from the stairway, right next to the post-op. On the right said, the CCU and Cath Lab are placed within yet seclusion. The floor, in general is sterile and only for critical flow. Patient flows are contained only within the corridors.

FLOW: 1. DOCTOR: ENTER COMPLEX - DOCTOR’S/NURSE CHANGING SUITES - SCRUBS - OR - SCRUB 2. PATIENT: ENTER COMPLEX FROM THE FLOORS BELOW - OR - POST OP - RECOVERY ROOMS IV. THIRD FLOOR The third floor is much similar to the second floor in its critical level and the restriction of patient flow.

This floor contains the major ORs, again in a separate complex secluded from the other parts.

Apart from the ORs, the floor has the supporting facilities like the ICU/CCUs, Post-ops to house the patients to observe them, immediately after the surgery. For convenience purposes, all the nurse lounges, stations etc., are also given in the near vicinity.

The design of the OR is okay on the facade, but on deeper analysis, we find that that though there is provision of a sluice room, there is no separate - dirty corridor to carry them to the CSSD. We’d have to

take the clean corridor to go out, thereby defeating the purpose of a sterile OR.

V.FOURTH FLOOR The fourth floor has the recovery unit, for the final goodbyes of the stay. There is a surgical counter, the wards, and the required bathrooms. Also, there is a small seminar room, which is now being put to use as a discussion room.

THE ECS TRIAGE SYSTEM

4. NET STUDY NET STUDY – 1 ZAYED MILITARY AND TRAUMA HOSPITAL - Location: Abu Dhabi, United Arab Emirates.

Beds: 500 Architects: Cathryn Bang + Partners, New York Area: 117000 Sq. M ~ 28 Acres (Campus Area)

STRATEGIC PLANNING INITIATIVES The proposed Stacking Plan promotes Quality and Efficiency through: Minimize Patient Movement & Optimize efficiency Decrease space by eliminating unnecessary redundancies Separate, yet connected four pillars: Inpatient. Diagnostic and Treatment, Outpatient & Dental Road ways are shown within the complex with driveways to the following: - Loading Dock - Main Hospital Entrance - Secondary Entrance from Parking Structures - Emergency and Trauma Center - Walk-in Entrance - Emergency and Trauma Center Ambulance Entrance Dedicated Psychiatric Medicine Entrance - Outpatient Clinic - Building Entrance - VIP dedicatedentrance.

SITE PLANNING Clear Site Entries Clear Circulation Routes Zoned Building Development Linkage of IP, D&T, Support and OP Services Open Park-like Setting Concerns for Residential Neighborhoods Curve massing will minimize the negatives of linear building; not consists of visible long corridors and doors that constitue conventional institutional environment Road ways are shown within the complex with driveways to the following: - Loading Dock - Main Hospital Entrance - Secondary Entrance from Parking Structures - Emergency and Trauma Center - Walk-in Entrance - Emergency and Trauma Center Ambulance Entrance Dedicated Psychiatric Medicine Entrance - Outpatient Clinic - Building Entrance - VIP dedicatedentrance.

BASEMENT FLOOR Most of the general support departments are located in the basement level. A connecting corridor connects the D&T building with the Outpatient Building thus achieving optimal consolidation, integration and collaboration of the general support services. The inpatient pharmacy will dispense medication through the ‘dumb waiter’ to D&T departments above for vertical transport and via pneumatic tube system throughout the Medical Center. CSSD is dedicated ‘2 smart elevators’ (separate clean and soiled) for vertical transport of case carts to Endoscopy and Surgery Departments.

GROUND FLOOR

FIRST FLOOR The Radiology Department: located above the emergency department for easy access by a dedicated elevator to some of the most sophisticated equipment.

SECOND FLOOR

THIRD FLOOR &ABOVE Executive Administration, Nursing Administration, Financing, and Quality Control/Utilization Review/Risk Management Services are proposed to be located on this top floor of the D&T Block that provides both required privacy as well as public access to provide high patient relations services. The proposed location has direct adjacency to Education.

All of the Acute Care areas are located from the third floor and above.

This vertical connectivity will promote the desirable collaborations and cooperation between similar services.

The Triangular effect of the Acute Care areas will provide greater visibilities from the Nurse Station to the Patients rooms and improved patient care.

THIRD FLOOR

MultiMulti-story high Atrium Lobby ďż˝ Energy efficient Atrium is located between the Front Entrance and the Diagnostic and Treatment

Building which opens from the roof to the ground floor thus creating a modern ambience.

Courtyard as Place of Respite � Courtyard is located on 3rd Floor to provide secured, respite space for patients, staff, and family members.

Nursing Unit Design � Curved triangular nursing units where the visibilities from the Nurse Station to the Patients rooms are greater to meet the increasing higher acuity patient populations’ needs.

NET STUDY – 2 RESTON HOSPITAL, VIRGINIA, USA

The hospital has four entries in total, each for its own purpose. The main entry is dedicated for its basic outpatient rooms, with a generalized waiting place for the patients and relatives. On either sides of the main entrance, the hospital has its entry for Emergency entrance and an admin entry on the west that leads to the HR department. The core of the hospital has its operating room complex (OR, Pre-op, Postop, and waiting.)

The first floor and above occupies only a quarter part of the entire building, with just enough facilities.

The first floor is dedicated for uncontrolled maternal-neuro complications

The second floor has sterile continuity from the floor below with patient rooms and a couple of pediatric center rooms.

The third floor is solely built for the purpose of private and semi private rooms for the patients. An orthopedic center was opened in 2013 to accommodate the then current rate of bone injury.

The final and the fourth floor were recently renovated to housing a community education center for the interns that the hospital has started taking in.

ENHANCING PATIENT SAFETY & SATISFACTION A connection to the outdoors and natural light is known to speed up the healing process and increase patient, family, and staff satisfaction.

Naturally lit spaces also have operational and sustainable benefits by decreasing reliance on electrical energy. A major design goal was to bring daylight as deep into the space as possible and provide views to gardens and the Virginia cityscape.

Patient rooms feature full-height windows, and a five-story garden atrium and exterior bamboo garden bring daylight deep into the patient tower, providing rooms along the core of the building access to natural light and views to the outdoors.

5.SITE 5.SITE ANALYSIS AND STUDY

SITE DETAILS

AREA: AREA Primarily residential and industrial. The surrounding hospitals in and around a couple of kms are either children’s hospital or just a clinic. The existing southern railway hospital is on the verge of demolition, just as soon as the project goes up fully.

The justification lies in the fact that the area is known for its industrial sector: the loco works, ICF, Carriage works, where the accident is almost prevalent every day.

Also, the road accidents are

prevalent around the flyover region and on the Konnur High Road (about 3 kms away).

ROAD ACCESS The roads around the proposed project are all Two way roads, enabling easy access within 5-10 minutes from the accident nodes to the hospital.

Apart from the patient/public access, there are 6m roads abutting the site, that can be used for service paths.

TRAUMA DATA PER DAY The trauma (accidents, burns, other injuries) go upto a maximum rate of 30 patients/cases per day, which are now taken by the existing hospital. Other neighboring areas are also attended by this hospital, from time to time.

For detailed drawings of the site, please refer to the appendix.

6. INFERENCE

A comparison of Indian hospitals and the way they are built, comparing them with foreign diverse location are given in the following tables .

A basic comparison of the net case studies and live studies show the minds of different planners work when it comes to serving the best to patients.

APPENDIX