A Proposed Advance 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 the people died because of trauma. Decreasing the
burden of injuries is among the main challenges for public health in this country.

Accidents, injuries form hereon, are one of the leading

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

According to 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 ranks Philippines #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
Source: PSA 2015 (ICD-10)
largely non-existent for trauma patients.
And 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 this a more adequate representation of
local, major multi-system trauma.
Stated in the Philippine Statistics Authority 2015 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 accessible. If accessibility is not a problem in this region due to numerous health facilities,
we may investigate the affordability issue of accessing health care. Dying without the attention of a
medical doctor could be somehow 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
center services. None of these hospitals specialized for trauma patients and there was no ‘trauma
leveling’ or classification system for the level of care that hospitals in the Philippines can provide.
The leading best hospital in the Philippines is the Philippine General Hospital. Philippine General
Hospital is the pioneer in trauma care in the country, being the first to create a dedicated Trauma Service
in 1989.
PGH pediatric trauma review from ER, 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. They admit
about 1600 patients every year, and has 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 was stab
wounds, vehicular crashes, gunshot wounds.

Multiple organ failure/sepsis was the most frequent causes of

death, followed by the exsanguinations, central nervous system
failure. And 66 patients who died within the first 24 hours died
from Exsanguinations, while 66 of the 8 patients who died after
72 hours died from Multiple organ failure/Sepsis.
Since Metro Manila is reported 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 Metro Manila, Quezon City
has the highest percentage of mortality rate because of accidents for the total of 16,073.
The 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. Quezon City has always been known as the City
of Stars.
The recent first Quezon City Tourism Stakeholders Summit, the city government has been clear with
its goals of adding “Wellness Capital of Asia” as a distinctive badge to its name. And this city 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 hospital in Quezon City but none of these prioritize trauma
services.
Therefore, this Advance Trauma Center is a specialized hospital that is equipped and staffed to provide
care for patients suffering from major traumatic injuries of that have been shown to significantly
decrease mortality. This project is a Level I Adult facility and also a Level II Pediatric Facility Trauma
Center with a Level II general requirements required by the Department of Health.
And a Level I Trauma Center is capable of providing total care for every aspect of injury – from
prevention through rehabilitation being the highest level of Trauma center .A Level II Trauma Center
is able to initiate definitive care for all injured people.
This project is a Trauma-Capable Facility – a DOH licensed hospital designated as Trauma Center. It
is a Specialized or Tertiary Hospital that is categorized in treatment of a particular type of illness or
particular condition requiring a range of treatment.

District Population
1 409,162
2 668,773
3 324,669
4 446,122
5 535,798
6 531,592
Source: Quezon City Disaggregated population 2019 for all ages

There are 6 districts in Quezon city and the most populous district-District 2 is being the utmost prone
to accident area.
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 for 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
(2005-2010). And This project for an average new hospital construction costs, excluding equipment is
about 1 billion pesos.
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 advance and To integrate the latest advancement and
essential for Emergency Department with a low- efficient design of Emergency Department and
cost initiative treatment of Trauma Center. assimilate a Revolutionary Design that focuses
on the human connection between nature and
built environment of Trauma center.

Minor Problem Architectural Objectives

1. What are the best materials to use in
designing of specialized hospital that is
advance and essential for Trauma Center
with a low-cost initiative treatment?
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. What is the best method to implement 2. To integrate the clinical requirements,

an advance and essential Emergency functional needs and practical size
Department for Trauma Center that will requirements of an Emergency Department.
help to improve emergency services of 2.1 Functionality – an Emergency
the Trauma center? Department’s design needs to be practical and

3. What is best planning concept that will
provides a state-of the art care hospital
and achieve a low-cost initiative
treatment?
4. How the project will be uniquely
connected to the place, climate and
culture through Place-Based
Relationships?
5. How the project will be transformed by
deliberately incorporating nature
through Environmental Features, Light
and Space, and Natural Shapes and
Forms?
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 device 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. 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, toxin levels and
ventilation.
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.
 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.
 Revolutionary Design
- also refers to a Revo Architecture that in architecture believes it shapes our environment.
 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

The Advance Trauma Center is a specialty hospital devoted to treatment of a particular type of
illness or for a particular condition requiring a range of treatment with a Trauma Care system
that is designed to meet the needs of all injured patients. A Trauma Center that is licensed
hospital, accredited by the Department of Health (DOH) which has been designated as a Level
I and 2 Trauma Center, affiliated with a level 2 general hospital requirements required by the
DOH.
A Level I and II trauma center shall have appropriate pediatric equipment and supplies and be
capable of initial evaluation and treatment of pediatric trauma patients. And Level I trauma
center shall have a minimum of 1200 trauma programs hospital admissions or a minimum of
240 trauma patients per year.
1.5 Conceptual Framework

INPUT PROCESS OUTPUT

Studied and reported that higher The number of death and
trauma center patient volumes disabilities
were not associated with resulting from incidents of
improved patient outcomes, physical trauma can be
thereby refuting previous substantially reduced by
findings suggestive of a improving these
mortality benefit at trauma medical care systems.
centers with higher patient
volumes.
Some of the Hospital that Providing a
delivers trauma services don’t comprehensive, organized
have assigned trauma catchment system to provide for the access,
area, geographic jurisdiction or response, triage, field
triage area. stabilization, transport, hospital
stabilization, definitive care, and
A proposed Advance Trauma rehabilitation of patients
Center of all ages with respect to
emergency medical services.
A better understanding of how Given the complexity of
infrastructure, staffing and traumatic injuries, Trauma
patient characteristics within a Center is, by design, large,
trauma center is impacted by the resource-intensive
proportion of patients requiring environments, capable of
advanced trauma care is critical providing patients with a wide
for better trauma system array of trauma and non-trauma
management. care services, including access
to complex diagnostic
equipment, intensive care unit
(ICU) beds, and trauma care
clinical expertise through varied
medical and surgical specialists.