Heads up: There are no amended sections in this chapter.
Appendix material, shown in boxes at the bottom of the page, is advisory only.
The provisions of this chapter shall apply to all outpatient facility projects.
A1.3-2 Access. Site design should encourage access by all facility users by integrating building and parking locations to support individuals arriving on foot, bicycle, and public transportation as well as in a vehicle.
Where site design is part of the project scope, building and parking locations, adjacencies, and access points shall be integrated with on-site and off-site vehicular and pedestrian patterns and transportation services.
A1.3-2.1 Availability of transportation. Facilities should be located convenient to public transportation where available, unless acceptable alternate methods of transportation to public facilities and services are provided. The transportation plan should support alternatives to fossil-fueled single-occupancy vehicles, including preferred van/carpool parking, bike parking and changing facilities, alternative vehicle fueling stations, and nearby transit access.
Outpatient facilities shall have security measures for patients, families, personnel, and the public that are consistent with the conditions and risks inherent in the location of the facility.
A1.3-2.2 Security plan. The development of a site security plan should reflect the principles of crime prevention through environmental design (CPTED). More detailed information can be found in Security Design Guidelines for Healthcare Facilities, published by the International Association for Healthcare Security & Safety. For information on development of a project security plan, see Section 1.2-4.7 (Security Risk Assessment).
Outpatient facilities shall have access to utilities (water, gas, sewer, electricity) to meet requirements in the facility chapters in this document.
The water supply shall have the capacity to provide for normal usage and to meet fire-fighting requirements.
The electricity provided shall be of stable voltage and frequency.
A1.3-3 Landscape design features
- Outdoor water features. Where provided, open water features should be equipped to safely manage water quality to protect the public from infectious or irritating aerosols.
- Landscape and gardens. Use and availability of views and other access to nature should be considered in the design of the physical environment, as indicated in Section 1.2-5.4.2 (Views of and Access to Nature). Subject to site constraints, health care organizations should consider opportunities to promote physical activity and/or outdoor uses for staff and visitors. Therapeutic uses of landscape elements such as healing gardens or natural landscapes should be integrated into health care facilities wherever possible. Consider a range of uses, including roof gardens, horticulture therapy gardens, walking trails, etc., to provide diverse outdoor experiences.Indigenous and low maintenance landscape materials and plants should be specified to reduce the use of water for irrigation and the life cycle costs of maintenance. See appendix section A1.2-220.127.116.11-d (Potable water quality and conservation-Irrigation water) for more information.
Site signage shall be provided to direct people unfamiliar with the facility to parking areas and entrances.
Site lighting shall be provided for the patient path of travel.
A1.3-3.2 Site lighting. Lighting controls should permit zoned operation, allowing facilities to provide multiple lighting levels or to designate night parking nearer the building. Lighting design for the site, roadway, and parking lots should control glare and minimize light pollution of the night sky or surrounding properties.
Paved roads shall be provided within the property for access to all entrances and to loading areas.
Paved walkways shall be provided for pedestrian traffic.
Outpatient facilities shall provide parking capacity to meet the needs of patients, personnel, and the public.
Parking needs shall be evaluated for each new facility, major addition, or major change in function.
In the absence of local parking standards or ordinances, refer to individual chapters governing specific facility types for required parking capacity. In all instances, review individual chapters for requirements for dedicated emergency vehicle, patient transfer, and service parking.
Unless otherwise prohibited by individual chapters, reduction of parking requirements shall be permitted, as acceptable to local authorities having jurisdiction.
A1.3-3.4.3 Parking requirements may be reduced in locations convenient to pedestrians, public transportation, or public parking facilities or where carpool, shuttle bus, or other alternative transportation arrangements have been developed.
A1.3-3.5 Other vehicular or pedestrian traffic should not conflict with access to the emergency services.
Freestanding emergency facilities shall have the emergency access well marked to facilitate entry from public roads or streets serving the site.
Access to emergency services shall be located to incur minimal damage from floods and other natural disasters. For additional information, see appendix section A1.2-6.5-b (Design to support emergency preparedness and management-Flood protection).
Where heliports are provided, they shall meet the requirements in this section.
Heliport landing pads and flight approach paths shall comply with applicable regulations governing placement, safety features, lighting, fencing, and other site elements.
A1.3-18.104.22.168 Refer to FAA Advisory Circular 150/5390-2C: Heliport Design for Information on design of heliports for health care facilities.
Facilities with heliports shall incorporate noise mitigation strategies to meet the acoustic requirements outlined in the Guidelines. See Section 1.2-6.1 (Acoustic Design).
A1.3-22.214.171.124 Noise considerations for heliports. The location of heliports on a health care facility site should be evaluated for noise impacts on the facility and community. Heliports can be located at ground level on the site or on a building roof. Helicopter noise at nearby residences and at the health care facility buildings requires special consideration under the following conditions:
- Where helicopter sound levels exceed 80 dBA at nearby residences. (This generally occurs when the slant distance from the helicopter to the residence is 700 feet (213.36 meters) or less. Slant distance is the minimum distance in feet directly between a residence and a helicopter at its closest approach. Patient transport agencies expecting to use the heliport can provide guidance on slant distances for various helicopter approaches. Helicopter approaches to a heliport are influenced by wind direction and locations of nearby buildings.)
- Where the number of helicopter operations exceeds three per day
- Where there are likely to be more than two helicopter flights per week between the hours of 10:00 p.m. and 7:00 a.m.
- Where the slant distance to the nearest residence is 1,000 feet (304.80 meters) or less
- Where the heliport is atop a building. (Special attention to the design of building windows is required when helicopters will land on the building. Sound levels at windows directly below the flight path to the roof can exceed 90 dBA and may require special acoustical glazing.)
- Where the heliport is located on the ground and situated so that helicopters will approach within 500 feet (152.40 meters) of a building
- Where military helicopters, which often are larger than civilian medevac helicopters, are expected to use the heliport more than once per week Helicopters, particularly military helicopters and large civilian helicopters, can induce low frequency vibration in building windows and facades that can vibrate building fixtures and furnishings. Such vibration is generally not acceptable; however, it can be difficult to predict. As a guide, unacceptable vibration can occur when low frequency sound levels (16-31 Hz) exceed 75 dB and when helicopters are within 500 feet (152.40 meters) of buildings.
The design, construction, renovation, expansion, equipment, and operation of outpatient facilities shall meet the provisions of applicable government environmental pollution control laws and associated agency regulations.
A1.3-4 Environmental pollution control. The design, construction, renovation, expansion, equipment, and operation of outpatient facilities are subject to provisions of several federal environmental pollution control laws and associated agency regulations. In addition, many states have enacted statutes and regulations that are substantially equivalent to or more stringent than federal regulations, thereby implementing national priorities under local jurisdiction as well as incorporating local priorities (e.g., air quality related to incinerators and gas sterilizers; underground storage tanks; hazardous materials and waste storage, handling, and disposal; storm water control; medical waste storage and disposal; and asbestos in building materials). Consult the appropriate U.S. Department of Health and Human Services (DHHS) and U.S. Environmental Protection Agency (EPA) regional offices and any other federal, state, or local authorities having jurisdiction for applicable state and local regulations pertaining to environmental pollution that may affect the design, construction, or operation of the outpatient facility, including management of industrial chemicals, pharmaceuticals, radionuclides, and waste from the facility, as well as trash, noise, and traffic (including air traffic).
- Permits. Outpatient facilities regulated under federal, state, and local environmental pollution laws may be required to support permit applications with appropriate documentation of proposed impacts and mitigations. Such documentation typically is reported in an environmental impact statement (EIS) with respect to potential effects on the environment and in a health risk assessment (HRA) with respect to potential impacts on public health. The HRA may constitute a part or an appendix of the EIS. The scope of the EIS and the HRA typically is determined in consultation with appropriate regulatory agency personnel and, if required, includes a meeting to which members of the interested public are invited to express their concerns.Once the EIS and/or HRA scope has been established, a protocol document should be prepared for agency approval.
- -The protocol should describe the scope and procedures to be used to conduct the assessment(s).
- -The EIS and/or HRA should be prepared in accordance with a final protocol approved by the appropriate agency or agencies. Approval is most likely to be obtained in a timely manner and with minimum revisions if standard methods are initially proposed for use in the EIS and/or HRA. Standard methods suitable for specific assessment tasks are set forth in EPA documents.
- Mercury elimination. Mercury encountered during construction or demolition of outpatient facilities (e.g., mercury accumulated in P-traps, air-handling units, sumps, etc.) should be collected and properly stored, recycled, or disposed of. Many states and municipalities have enacted bans on the sale of mercury-containing devices and equipment. Outpatient facility projects should comply with local codes and standards.In new construction, mercury-containing equipment, including thermostats, switching devices, CEL lamps, and other building system sources should not be used.For renovation of outpatient facilities, health care organizations should develop a plan to phase out mercury-containing sources and upgrade current mercury-containing lamps to low- or no-mercury lamp technology.
- Release of toxic substances from equipment. Equipment should minimize the release of chlorofluorocarbons (CFCs) and any potentially toxic substances that may be used in their place. For example, the design of air-conditioning systems should specify CFC alternatives and recovery systems as may be practicable.