One of the most important tasks of the departments of Defense (DoD) and Veterans Affairs (VA) is ensuring that warfighters and veterans – especially those wounded in combat – receive the best, fastest, and most complete medical care possible. That need grows significantly during a war.
In addition to vastly improved medical training for all service members, medics and corpsmen, and forward-based surgeons and other doctors, both departments have upgraded existing medical facilities and built numerous new ones with state-of-the-art technologies.
In addition to vastly improved medical training for all service members, medics and corpsmen, and forward-based surgeons and other doctors, both departments have upgraded existing medical facilities and built numerous new ones with state-of-the-art technologies.
Military medical facilities include hospitals, medical and dental clinics, and some research labs. What is common to all is the high degree of technical complexity that goes into those buildings to gain accreditation when completed.
Almost every military structure must meet local and DoD building codes, but hospitals and labs also must meet other special codes, especially when built on federal installations. For example, rooms where some types of research are done may require negative air pressure or doors with specialized seals. Some hospitals also require interspatial areas between floors to support some types of equipment and may have special conditions for certain gases, sanitation, etc. The whole building has to be designed to accommodate those.
A mannequin lies inside one of the new operating rooms at the Grand Junction Department of Veterans Affairs Medical Center, Grand Junction, Colo., March 23, 2012. The U.S. Army Corps of Engineers Sacramento District oversaw construction of the $13 million surgery floor addition, which adds two specialty operating rooms and two general operating rooms. U.S. Army Corps of Engineers photo
The U.S. Army Corps of Engineers (USACE) and the Naval Facilities Engineering Command (NAVFAC) are DoD’s technical agents for facilities design and construction worldwide.
“We and NAVFAC have a very good working relationship within DoD. We collaborate to make sure we are supporting standards for the unified criteria, and our processes are similar,” USACE Military Programs Director Lloyd Caldwell, PE, SES, explained. “Engineering, design, and construction is a unique business that requires knowledgeable folks working together to achieve the desired outcome.
“We are assigned different parts of the world – in some cases based on historical presence, in some based on capabilities – to execute the construction needs and sustainment. So either of us may work for any of the services, based on that. Generally, we are aligned so the Corps does more Army and Air Force work and they do more Navy, but we both do both in some locations.”
According to USACE Medical National Program Manager Stephen Premo, a major driver for new construction is that older facilities were not designed to provide the levels of rehabilitation required in a world-class facility.
“When we do the final outfitting and commissioning, we also have to incorporate new technologies and equipment that come along while we are building a facility,” he said. “Those changes in technology are something we deal with all the time to make sure we are providing the best in care.”
Caldwell noted facilities built for DoD typically are MILCON- (military construction) or contingency-funded specifically to support U.S. forces, although USACE also provides for reconstruction of host-nation medical facilities. Outside architects and engineers are contracted on both design and construction.
“MILCON, whether overseas or in a contingency environment, supports COCOM requirements. But the COCOMs also identify strategic engagement plans with host nations, which often include medical facilities on which we assist in terms of design and construction to build or renovate those facilities,” he explained.
Medical facility construction has been especially significant in the past eight years, targeted primarily toward raising military healthcare worldwide to state of the art, with a focus on the immediate physical and mental healthcare of returning warriors.
“There also is a relationship with IIS [USACE Interagency and International Services] because the skills and knowledge needed to build those also are provided to the VA on occasion. Our ability to do that is based on the fact we have developed the experience and capabilities out of our MILCON efforts.”
Medical facility construction has been especially significant in the past eight years, targeted primarily toward raising military healthcare worldwide to state of the art, with a focus on the immediate physical and mental healthcare of returning warriors, according to Premo. Examples he cited include the new complex at Fort Belvoir, Va., and the Walter Reed National Military Medical Center, which replaced the Bethesda National Naval Medical Center and Walter Reed Army Medical Center.
“There are many projects under way right now [in the United States]. The larger ones, under the stimulus program, are alteration or clinic programs at Eglin [AFB, Fla.] and Fort Carson [Colo.] and a replacement medical center at Fort Hood [Texas]. We also have a hospital replacement, just under $960 million, at Fort Bliss [Texas], replacing the old William Beaumont Army Medical Center on a new site. The old facility will be taken over by the VA,” he said.
“Landstuhl [Regional Medical Center, Germany] is by far our largest [overseas] at just under $1 billion; funding started in FY 10 and runs through FY 17, with construction continuing through 2021. The current hospital will continue to be occupied through construction of the new facility at a new location. Elsewhere, a new facility is planned in South Korea, and construction was completed about a year ago on a Navy hospital on Okinawa.”
Major contingency facilities built in theater since 9/11 include a high-level hospital at Camp Anaconda in Iraq, where USACE also built more than 100 host-nation clinics, and a $4.8 million, 28-bed hospital in Herat province, Afghanistan. Construction of hospitals and clinics, from 2007 through 2017, is valued at more than $6 billion – a major DoD investment for military personnel healthcare around the world.
“The number of hours troops average at those hospitals, including surgery, has been the lowest ever,” Caldwell said, adding that USACE worked with nongovernmental organizations, such as Project Hope, on the host-nation facilities. “We sized those clinics based on the population we expected them to serve, but we found once the Iraqis were able to staff them with doctors and nurses, the volume of business they got exceeded our expectations, so there was a real need.
“One of the other hospitals in Iraq was the state-of-the-art Basra Children’s Hospital, which was a U.S. initiative to address a high rate of a particular disease. The Corps, along with USAID [U.S. Agency for International Development], managed the core facility itself, while others provided the equipment.”
Soldiers will benefit from a variety of outpatient services at the new $10.1 million North Troop Medical Clinic at Fort Stewart, Ga., completed by the U.S. Army Corps of Engineers Savannah District. Along with physical therapy, the clinic includes primary care physicians, pharmacy, radiology, behavioral health, optometry, and dental care. U.S. Army Corps of Engineers photo by Rashida Banks
As Premo noted, the long-running war in Southwest Asia – with its signature injuries, including traumatic brain injury (TBI) and facial burns and trauma and loss of limbs from improvised explosive devices (IEDs) – and rapid advances in medical technology have combined to dramatically change facility requirements.
“All of the hospitals we have designed and built since 2007 were required to meet what is called a world-class medical facility concept, which really pertains to the level of service provided. Medicine in recent years has used what they call evidence-based treatment, and there is a corollary evidence-based design requirement for medical facilities to ensure they have state-of-the-art equipment, but also can bring comfort to the patients,” he said. “Infection control in hospitals also has become increasingly important.”
“All of the hospitals we have designed and built since 2007 were required to meet what is called a world-class medical facility concept, which really pertains to the level of service provided. Medicine in recent years has used what they call evidence-based treatment, and there is a corollary evidence-based design requirement for medical facilities to ensure they have state-of-the-art equipment, but also can bring comfort to the patients.”
A major part of raising both new and upgraded facilities to that world-class concept is the Corps of Engineers Medical Facilities Mandatory Center of Expertise and Standardization (MX) in Alexandria, Va. MX Chief David Marquardt said it was chartered by Congress in 1978 to set standards for and bring consistency to the different services’ myriad medical facilities, with a mandate to participate in all MILCON design for which USACE is responsible.
“In the last five years, the ‘new typical’ has been much different than it was for a long time. From the early ’80s through mid-’90s, a lot of hospitals were built and remodeled, then we went into a lull for about 15 years,” he said. “But then the new hospital at Fort Belvoir was built, and replacements at forts Benning, Hood, Irwin, and Riley, and a major addition at Wright-Patterson Air Force Base [Ohio].”