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Re: The SDN Bunker Revisted

Posted: 2013-02-23 11:47am
by Broomstick
OK, a couple of new photos, this time of the inpatient medical unit:

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From top left of the pure overhead view you have the main storage area (including locked/secure storage and an autoclave area), staff breakroom, storage closet, staff/visitor toilets, a patient room, nurses stations, auxiliary storage, a bunch more patient rooms, more auxiliary storage, more patient rooms, a general use/therapy room, and conference/classroom. In the center is a visitor/sitting/waiting area with plants and artificial sunlight.

The is a 10 patient facility. I'm not sure if it is sufficient for a colony of our planned size but of course additional units can be added. In comparison, the ER has 6 bays but then I assume some people who will be seen in ER will be "treat and release", and effectively the ER will also be the outpatient clinic.

Re: The SDN Bunker Revisted

Posted: 2013-02-23 11:54am
by Mr Bean
From personal experience in working in the medical field those rooms are set up inefficiently. Number one and this is a big one in in long term case there are not fixed beds they are all mobile. And all are designed to be center placed. Room sizes are designed to be extra large because you need to wheel equipment in and out as patent requirements change. One patent may required an EKG and a drip. One may require an ekg, three drips and restraints. This is much less a hospital setup then it is a pure outpatient family doctor setup.

A true inpatient medical unit would totally re-jigger things. Number 1 the first thing you do when you walk into Inpatent VS outpatent is run right into the nurses desk, 90% of hospitals I have worked in or with divide things in half. Let me come back with a longer post and a low quality sketchup.

Re: The SDN Bunker Revisted

Posted: 2013-02-23 11:56am
by Broomstick
Here is a proposed fitting together of the two units to form one "mini-hospital"

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Under the theory that we love redundancy I'm supposing we'll have more than one of these.

Re: The SDN Bunker Revisted

Posted: 2013-02-23 11:57am
by Broomstick
Mr Bean wrote: Let me come back with a longer post and a low quality sketchup.
OK, you're on. :)

Re: The SDN Bunker Revisted

Posted: 2013-02-23 12:25pm
by Broomstick
Crossroads Inc. wrote:I think it would be interestign to get a list together of the more "menial" work and jobs for such a place. I really agree with you that such simple things are needed to keep everyoen sane as well as rotating the jobs so no one is doing any one job for too long.
OK, here's the rough draft of

MENIAL BUNKER JOBS

[*]Dorm housekeeping - keeping the living units clean. This is something everyone has to do for themselves. If you live in a "family" unit you care for that. If you live in a multi-person "dorm pod" the residents will have to take turns.
[*]General cleaning - sweeping, mopping, dusting, vacuuming, bagging of trash in public areas
[*]Sanitizing - toilets, exercise, kitchen/food areas, and medical units. I'm thinking the big laundry for the medical needs will fall under this.
[*]Routine maintenance - fixing lights, changing filters on ventilation ducts, busted door handles, all the little things that go wrong in a complex this size. It would also include supply delivery and moving things from long term storage to short term.
[*]Agricultural maintenance - all those hydroponics units will need tending. Fortunately, not every one will need it on a daily basis but they should be checked regularly and problems fixed early. Also, if we have any sort of livestock they'll need feeding and clean up as well. This includes the aquaponic fish. The park area will need looking after.
[*]Food prep - the real grunt work of harvesting and initial processing, plus kitchen work like chopping and and prep there. Could include taking a turn serving as well.
[*]Garbage and recycling - picking up bagged trash from dorm areas and from the general cleaning teams, recycling whatever can be re-used or processed into something else, and disposal of what can't be used, probably in another section of the big salt mine "outside"

That's seven different areas. The first you'll probably have to do on an on-going basis, or on a separate rotation schedule, but the other six people can rotate through. For some people they'll have minimal hours on this - people doing critical work of some sort, as an example. For others this might be their main job. Either way, if there's a maximum time assigned to each unit no one has to do the same scut work forever. For instance, if you're assigned to a unit for a maximum of two weeks it will be three months before your assignment repeats. Or we might want to use some other interval.

I do feel everybody should have to take their turn, no exceptions, even if some people are doing more of this kind of work than others. All of this stuff is just as vital as anything else in this bunker.

Re: The SDN Bunker Revisted

Posted: 2013-02-23 01:10pm
by Mr Bean
I promised low quality and I deliver
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Sleep are the nurse/doctor sleeping pods, typically it's two to four beds (bunk), a small center desk and cabinets for personal effects. Normally it's a single bed in one for the doctor and four bunk beds for the nurses in the other room. The Break room is what you'd expect, two or three tables a TV on a hanging stand, cabinets and a refrigerator. Plus the medical refrigerator which to avoid hijinks is typically a different color and either keypad locked or key opened along with being labeled.
Isolation are isolation rooms with doors and sometimes an internal door to suit up in.
Patients are patient rooms, in a normal hospital there will be a small desk and someplace to hook up a laptop, in a children hospital there will be a twin bed with an even smaller desk to hook up a laptop. Some places every patent room contains a bathroom and shower others only a bathroom with a common shower room elsewhere.
Modular is hospital to hospital to some it's just more patent rooms. Others it's larger doc offices, some it's some combination of patient rooms, a personal exam room, or playrooms in children's hospitals.

First off explanation, hospitals in different countries are built in different ways with room orgs set up differently so I've see it done about eight different ways but there are common elements. Isolation rooms are typically within line of sight of the nurses desk. The entrance to the drug room in each ward has a door within visual contact of the main nurses desks. Doctors offices are tucked away in the back behind all the patients. Equipment rooms are typically paired with drug rooms, and equipment rooms are typically stuffed with spare medical machines, computers, cleaning supplies but NOT medical supplies. You'll find spare EKG's, extra rolling bag stands, spare chairs and wheel chairs, bleach normally a small sink but not a single bandage or bit of Aspirin.

Next rooms are typically door free, unless it's an isolation room you get a curtain and that's it. This is to facilitate the beds being able to be rolled directly into the room from surgery or out of the room for some new surgery. As well as from the emergency room after being given triage.

Last rules of thumb. Hospitals break down into the children, the general, the specialty and the teaching/research hospitals. Childrens hospitals have rooms with bathrooms, showers, the parent bed and parent desk. Modular areas are set aside for a playroom, a personal exam room and depending on the type of ward (Disease VS Long-term VS General) will contain something related to that condition.

General hospitals by contrast will contain a bathroom with just a toilet no shower with the modular area containing one shower room per hallway and the rest being just more patent rooms with everything kept locally in a children hospital moved elsewhere for centralization. Bethesda for example keeps physical therapy in a separate wing from most of the patient rooms in a bit of irony. Last Teaching/Research hospitals are typically set up along the same lines as children hospitals except everything is ward centralised, you almost never need to leave your ward to go do therapy with only stuff like CT scans or MRI's requiring a trip down the hall.

Normally these types of setups are grouped around a common waiting room rather than containing a waiting room in the ward.

Re: The SDN Bunker Revisted

Posted: 2013-02-23 11:37pm
by Zaune
Definitely liking the central "garden" room, though; it seems like it'd have major psychological benefits.

Also, it might be worth making provision to set up extra wards as and when they're needed; some modular partitions and mobile beds could be stored next to the tennis/basketball courts in the event of a major incident, and a permanent unit of maybe thirty beds could be reserved for post-surgical recovery or other critical cases.

EDIT: As an afterthought, Mr Bean, what's your professional opinion on the idea of simply assigning two RNs to each block of n residence units to administer medication and take obs for anyone who'd normally be treated as a low-priority inpatient? We could also tack on a basic examination room and dispensary and have a doctor hold a weekly clinic or something.

Re: The SDN Bunker Revisted

Posted: 2013-02-24 12:09am
by Mr Bean
Zaune wrote: EDIT: As an afterthought, Mr Bean, what's your professional opinion on the idea of simply assigning two RNs to each block of n residence units to administer medication and take obs for anyone who'd normally be treated as a low-priority inpatient? We could also tack on a basic examination room and dispensary and have a doctor hold a weekly clinic or something.
Nurses have to live someplace but Nurse work long hours to begin with and while year 1 might have nurses working eight hour days every other day, by year 5 we might have nurses working fourteen hour days every day and sleeping in the ward to avoid wasting time walking back to their room.

Better to create a "wellness coordinator" who's job it is to keep up on other residents fitness, heath and other sundry concerns.

Re: The SDN Bunker Revisted

Posted: 2013-02-24 02:36am
by Zaune
True. Maybe being assigned to carry out home visits could be something qualified personnel are assigned to on a rota; four days on the ward, one day doing home visits to administer meds or something?
And it's worth keeping in mind that aside from whatever refugees turn up on the doorstep, we're going to have a relatively young and healthy population; the median age here on SDN is what, somewhere just short of thirty? And a majority are also middle class and college-educated, with all the health benefits that implies.

Re: The SDN Bunker Revisted

Posted: 2013-02-24 03:08am
by spaceviking
Zaune wrote:True. Maybe being assigned to carry out home visits could be something qualified personnel are assigned to on a rota; four days on the ward, one day doing home visits to administer meds or something?
And it's worth keeping in mind that aside from whatever refugees turn up on the doorstep, we're going to have a relatively young and healthy population; the median age here on SDN is what, somewhere just short of thirty? And a majority are also middle class and college-educated, with all the health benefits that implies.
Are you sure? I am assuming many of us are overweight.

Re: The SDN Bunker Revisted

Posted: 2013-02-24 07:27am
by Crossroads Inc.
Broomstick wrote:You'd almost want an airlock between sections or pods.
That is an idea that I would imagine should be fairly easy to implament into the Pod systems

Re: The SDN Bunker Revisted

Posted: 2013-02-24 07:34am
by Broomstick
Today's long nursing shifts have more to do with modern staffing practices than actual medical need.

Given that this will be a relatively small population, one that is relatively youthful, it is conceivable there will be times the ER and inpatient unit will be completely empty.

I do think reconfiguring the set up is worthwhile, but I won't have time to work on the drawing until my next "weekend".

Re: The SDN Bunker Revisted

Posted: 2013-02-25 12:16am
by Sea Skimmer
Speaking of which, the bunker will need a crematorium for body disposal, I assume the surface will be far too contaminated with radioactive feces for burials. Some kind of composting area for garbage is also needed, and a place to burn trash. I assume this isn't meant to be completely closed at all times, so that sewage can just be dumped and fumes exhausted except when actually buttoned up during attack; wells can provide water and cooling can based on a large water tank, those features are of no great concern.

Re: The SDN Bunker Revisted

Posted: 2013-02-25 12:36am
by Knife
Broomstick wrote:Today's long nursing shifts have more to do with modern staffing practices than actual medical need.
*snort* Sure for acute care needs, you could have personnel on call as needed. But it's not like all of medicine or nursing is acute care. Today's long shifts have more to do with staffing related to payment, it's a business model, not a medical or nursing one. PPD's and acuity staffing is horrendous because of profit motive, not need for less staff to do more with less.
Given that this will be a relatively small population, one that is relatively youthful, it is conceivable there will be times the ER and inpatient unit will be completely empty.
Good, would be nice to catch up on follow ups on people sent back into the population, do surveillance on disease and injuries, and figure out some protocols for a large number of people living together with some infrastructure and not all the modern stuff, and what the hell to do if some nasty pathogen starts hopping around.