The Next L.A. / Reinventing Our Future : HEALTH CARE : Medical Central

Researched by SHERYL STOLBERG and IRENE WIELAWSKI / Los Angeles Times

Health care in the Southern California of the future would, in the vision of experts, be delivered in an entirely different manner than today. A highly coordinated network would replace the current fragmented system. The network would function as well in times of disaster as it would in meeting people’s day-to-day medical needs.

The Network

Health care would be organized around geographic sectors, each with a hub. Such a system would ensure that ambulances are where they need to be, that supplies are stockpiled and that patient load is distributed most effectively.

1. Acute-Care Hospital

These super hospitals would act as the hub of each geographic network. They would provide basic emergency services, general surgery and intensive care and would have some transitional beds for patients prior to discharge home or to outlying facilities. Most would have about 150 beds, but a few would be designated as major trauma centers with as many as 500 beds.


2. The “Sub-Acutes”

The next level down in this system would be “sub-acute” hospitals. Functioning much like today’s community hospitals, they would be spaced around the main hospital and would take patients for short recuperative stays.

3. The Satellites

Physician groups would be based in medical office satellites. Such facilities would be equipped to treat minor injuries and dispense medication. Each facility would have on-site storage or generation capacity for electricity, fuel, water and medical gases for at least a week. Ambulances would be based at the medical office satellites.

The Super Hospital

Some of the acute-care hospitals would be larger, with up to 500 beds, and specially equipped to handle major disasters.

* Special procedures: Trauma center backup, extra beds

* Surgery: Full-capability operating rooms

* Sterile supplies: Protected storage

* Imaging center: X-rays, MRIs, EKGs, etc.

* Trauma center: Emergency room and communications center

Helipad: Ambulance helicopter would be stationed at acute-care hub hospital, with a triage area nearby

The Lifeboat Concept

Traditional hospitals are sitting ducks in a disaster. In the health care network of the future, all medical facilities--the super hospital, the sub-acutes and the satellites--would be constructed to remain fully functional after a magnitude 8 earthquake. Each would act as a “lifeboat” for the community in times of disaster, with backup generating capacity for electricity, fuel, water and medical gases for at least a week. Ambulances would be based at satellite medical centers, while an ambulance helicopter would be based at each hub hospital. The medical facilities would be directly linked to the police, fire and civil defense communications networks. Among the features:

* Security safeguards, including limited entry points, a minimum number of windows and metal detectors


* Expansion joints to keep entire building from collapsing if one section gives out

* Microwave dishes placed on top for communication with the city’s emergency command bunker and other hospitals

* Independent ventilation and exhaust system

Sources: Stephen Gamble of the Hospital Council of Southern California; Erich A. Burkhart of Lee, Burkhart, Lin Inc.