Emergency Centre - Gazetted

IUSS HEALTH
FACILITY GUIDES
Emergency Centres
Gazetted
17 February 2014
Task Team: A:01
Supported by:
Document tracking
Version Date Name
Draft 1.1 29 May 2012 E. Fleming(EF)
20t June 2012 E Van der Schyf
8 July 2012 E Van der Schyf
12 September 2012 E. Fleming
Draft 1.2 27 November 2012 E. Fleming
12 December 2012 T.Hardcastle/EF
21 December 2012 EF/L.Wallis/H.Tuffin/PBrysiewicz
Draft 1.3 20 February 2013 / D.Rendal/EF
N.Draper/EF
Draft 1.4 10 October 2013 E.Fleming
Version 1 25 October 2013 Approved National Health Council
Version 2 08 May 2014 Front pages updated
Version 2 12 June 2014 Formatting
Gazetted 17 February 2014 National Health Act,2003(Act
no.61 of 2003)
INFORMATION NOTES
Form: Health facility guides

Status: Gazetted 17 February 2014
Title: Emergency Centres

Original Title: Accident & emergency
Description: “Emergency Centres” contains health facility guidance in five parts covering
the infrastructure norms and standards for emergency centres for facilities
providing regional, tertiary, central and national referral services. It is to be
read in conjunction with the full norms and standards suite and covers policy
and service context (Part A); planning and design (Part B); room data (Part C);
accommodation schedules
Reference: CSIR 59C1119 A:01- 001
Authors: IUSS N and S task group A:01
Stakeholders: National Department of Health, Provincial Departments of Health and Public
Works
Acknowledgement The Australasian College for Emergency Medicine:
“Guidelines on Emergency Department Design”, March 2007
Trauma Society of South Africa (TSSA)
Emergency Medicine Society of South Africa (EMSSA)
Accessing of these guides
This publication is received by the National Department of Health (NDoH), IUSS Steering Committee
Chairman, Dr Massoud Shaker and Acting Cluster Manager: Health Facilities and Infrastructure
Management, Mr Ndinannyi Mphaphuli. Feedback is welcome.
The CSIR and the NDoH retain the moral rights conferred upon them as author by section 20(1) of the
Copyright Act, No. 98 of 1978, as amended. Use of text, figures or illustrations from this report in any
future documentation, media reports, publications, competition entries and advertising or marketing
material is solely at the discretion of the Health Infrastructure Norms Advisory Committee and should
clearly reference the source. This publication may not be altered without the express permission of the
Health Infrastructure Norms Advisory Committee. This document (or its updates) is available freely at
www.iussonline.co.za or the forthcoming Department webportal.
Application and development process
These IUSS voluntary standard/ guidance documents have been prepared as national Guidelines,
Norms and Standards by the National Department of Health for the benefit of all South Africans. They are
for use by those involved in the procurement, design, management and commissioning of public
healthcare infrastructure. It may also be useful information and reference to private sector healthcare
providers.
Use of the guidance in this documentation does not dissolve professional responsibilities of the
implementing parties, and it remains incumbent on the relevant authorities and professionals to ensure
that these are applied with due diligence, and where appropriate, deviations processes are exercised.
The development process adopted by the IUSS team was to consolidate information from a range of
sources including local and international literature, expert opinion, practice and expert group
workshop/s into a first level discussion status document. This was then released for public comment
through the project website, as well as national and provincial channels. Feedback and further
development was consolidated into a second level development status document which again was
released for comment and rigorous technical review. Further feedback was incorporated into proposal
status documents and formally submitted to the National Department of Health. Once signed off, the
documents have been gazetted, at which stage documents reach approved status.
At all development stages documents may go through various drafts and will be assigned a version
number and date. The National Department of Health will establish a Health Infrastructure Norms
Advisory Committee, which will be responsible for the periodic review and formal update of documents
and tools. Documents and tools should therefore always be retrieved from the website repository
www.iussonline.co.za or Department webportal (forthcoming) to ensure that the latest version is being
used.
The guidelines are for public reference information and for application by Provincial Departments of
Health in the planning and implementation of public sector health facilities. The approved guidelines will
be applicable to the planning, design and implementation of all new public-sector building projects
(including additions and alterations to existing facilities). Any deviations from the voluntary
standards are to be motivated during the Infrastructure Delivery Management Systems (IDMS) gateway
approval process. The guidelines should not be seen as necessitating the alteration and upgrading
of any existing healthcare facilities.
Acknowledgements
This publication has been funded by the NDoH.
IUSS Norms and Standards task team (Emergency Centres): Edwina Fleming, Etha van der Schyf, Geoff
Abbott, Magda Coetzer and Nkhensani Baloyi.
Reviewed by:
Clinical and nursing staff - Inkozi Albert Luthuli Community Hospital, Durban
Clinical and nursing staff - Edendale Hospital, Pietermaritzburg
Clinical and nursing staff - King Edward VIII Hospital, Durban
Clinical and nursing staff - King Georg V Hospital, Durban
Clinical and nursing staff - Ngwelezane Hospital, Empangeni
Clinical and nursing staff - Groote Schur Hospital, Cape Town
Clinical and nursing staff - Pelanomi Hospital, Bloemfontein
Clinical and nursing staff - Ngwelezane Hosppital
Clinical and nursing staff - Charlotte Maxeke Hospital
Staff - Worcester Hospital, Worcester
Gustav Brink - TV3 Architects
Frik Lange - OLA Architects
Rene Du Toit - Hospital Facility Planning
Mande Toubkin - Netcare 911
Tim Hardcastle -Trauma Unit - Inkozi Albert Luthuli Community Hospital
David Muckart -Trauma Unit - Inkozi Albert Luthuli Community Hospital
Kenneth Boffard - Charlotte Maxeke Hospital, Gauteng (pending)
Lee Wallis - Western Cape Emergency Medicine
David Yuill - David Yuill Architects, Bloemfontein (pending)
Petra Brysiewicz - UKZN and Emergency Nurses Society of South Africa
TABLE OF CONTENT
TABLE OF CONTENT ....................................................................................................................... 1
LIST OF FIGURES .............................................................................................................................. 4
LIST OF TABLES................................................................................................................................ 5
OVERVIEW ......................................................................................................................................... 6
PART A – POLICY AND SERVICE CONTEXT .............................................................................. 8
1. Policy context .................................................................................................................................................. 8
2. Service context ................................................................................................................................................ 8
3. Determining the size of an emergency centre ..................................................................................... 9
PART B - PLANNING AND DESIGN ......................................................................................... 10

1. Overview .........................................................................................................................................................10
2. Operational functioning of an Emergency Centre (EC) ..................................................................10
2.1. Hours of operation ............................................................................................................................................ 10
2.2. Patient escorts .................................................................................................................................................... 10
2.3. Management ........................................................................................................................................................ 11
2.4. Staff .......................................................................................................................................................................... 11
3. 10 Useful Tips for Designing an Outstanding EC ..............................................................................11
4. General Design considerations ...............................................................................................................12
4.1. Designing to reduce the spread of tuberculosis (TB) and other infectious diseases .......... 12
4.2. Design for privacy and dignity..................................................................................................................... 12
4.3. Reduction of noise levels................................................................................................................................ 12
4.4. Design for flexibility and building for surge capacity and major incidences .......................... 13
4.5. Salutogenic design ............................................................................................................................................ 13
4.6. Calming environment to help reduce aggression ............................................................................... 13
4.7. Meeting the needs of special patient types: ........................................................................................... 13
4.8. Security upon arrival at the EC: .................................................................................................................. 14
4.9. Wayfinding ........................................................................................................................................................... 14
4.10. Circulation ............................................................................................................................................................ 14
4.11. Design should provide: ................................................................................................................................... 14
4.12. Common mistakes in the design of ECs ................................................................................................... 15
5. Location and clinical departmental relationships: .........................................................................15
6. Intradepartmental relationships and functional zones ................................................................17
6.1. Patient coding ..................................................................................................................................................... 20
6.2. Resuscitation, majors and minors areas ................................................................................................. 21
7. Patient flow through the EC......................................................................................................................22
INFRASTRUCTURE UNIT SUPPORT SYSTEMS (IUSS) PROJECT 1

Health Facility Guides:
Emergency Centres [Gazetted 17 February 2014]
8. Public Spaces .................................................................................................................................................27
8.1. Site Access............................................................................................................................................................. 27
8.2. Parking ................................................................................................................................................................... 27
8.3. Signage ................................................................................................................................................................... 27
8.4. Helistop .................................................................................................................................................................. 27
8.5. Entry into the EC ................................................................................................................................................ 28
8.6. Trolley/Wheelchair Bays ............................................................................................................................... 29
8.7. Porters’ Room ..................................................................................................................................................... 29
8.8. Security and Access .......................................................................................................................................... 30
8.9. Decontamination Shower .............................................................................................................................. 30
8.10. Family and Friends Main Waiting Area ................................................................................................... 30
8.11. Reception/Info/Help Desk ............................................................................................................................ 31
8.12. Administration Area ......................................................................................................................................... 32
8.13. Administration Desk ........................................................................................................................................ 32
9. Clinical spaces (Assessment and Treatment) ....................................................................................33
9.1. Triage ...................................................................................................................................................................... 33
9.2. Resuscitation Area - Red ................................................................................................................................ 35
9.3. Majors Area: Orange and Yellow ................................................................................................................ 39
9.4. Isolation Room .................................................................................................................................................... 43
9.5. Calming room (safe room) ............................................................................................................................ 44
9.6. Respiratory Area ................................................................................................................................................ 44
9.7. Sensitive Examination Room ........................................................................................................................ 45
9.8. Minors - Code green area ............................................................................................................................... 45
10. Clinical support areas to be shared between majors, minors and paediatrics .....................47
10.1. Procedure Room ................................................................................................................................................ 47
10.2. Plaster of paris (POP) Room ......................................................................................................................... 48
11. Administrative areas ..................................................................................................................................49
11.1. Standard Administrative Rooms ................................................................................................................ 49
11.2. Non Standard Administrative Rooms ....................................................................................................... 49
12. Staff areas........................................................................................................................................................51
12.1. Standard Staff Rooms ...................................................................................................................................... 51
13. Service support areas .................................................................................................................................51
13.1. Standard Support Rooms ............................................................................................................................... 51
13.2. Non-Standard Support Rooms ..................................................................................................................... 51
14. Speciality assessment units......................................................................................................................52
14.1. Paediatric unit ..................................................................................................................................................... 52
14.2. Mental-health assessment area ................................................................................................................... 54

14.3. Clinical Forensic Unit ....................................................................................................................................... 56
14.4. Counselling/comfort room ............................................................................................................................ 57
14.5. Body viewing room ........................................................................................................................................... 58
14.6. EC Observation Ward ...................................................................................................................................... 58
15. Emergency care area in a clinic or CHC (8-hour clinic) .................................................................58
15.1. After-hour clinic patients in the EC ........................................................................................................... 59
16. Engineering requirements .......................................................................................................................59
PART C - USER ROOM REQUIREMENTS .............................................................................. 60

1. Emergency Centre – Example of user room requirements ...........................................................60
LIST OF ABBREVIATIONS............................................................................................................ 72
REFERENCES.................................................................................................................................... 73
APPENDIX......................................................................................................................................... 74

LIST OF FIGURES
Figure 1 – Project process ................................................................................................................................................................ 10
Figure 2: Departmental relationships ......................................................................................................................................... 16
Figure 3: EC - Critical departmental relationships ................................................................................................................ 17
Figure 4: Intradepartmental "spaces or zones" ...................................................................................................................... 18
Figure 5: One-way patient flow...................................................................................................................................................... 22
Figure 6: EC internal patient flow - chc ..................................................................................................................................... 23
Figure 7: EC internal patient flow - small district hospital ................................................................................................ 24
Figure 8: EC internal patient flow - regional and large district hospitals ................................................................... 25
Figure 9: EC internal patient flow - tertiary/central hospital .......................................................................................... 26
Figure 10: Patient flow - triage ...................................................................................................................................................... 34
Figure 11: Work space around the patient in resuscitation bay ..................................................................................... 38
Figure 12: Work space around patients in two adjacent resuscitation bays ............................................................. 38
Figure 13: Patient flow - Majors area .......................................................................................................................................... 40
Figure 14: Indicative layout of majors area .............................................................................................................................. 41
Figure 15: The Majors Area of the new Emergency Department at Kerry General Hospital (Irish
Association for Emergency Medicine) ........................................................................................................................................ 41
Figure 16: One way patient flow through minors area ....................................................................................................... 46
Figure 17: Procedure room .............................................................................................................................................................. 48
Figure 18: plaster of paris room (POP) ...................................................................................................................................... 49
Figure 19: Example of administration counter ....................................................................................................................... 50
Figure 20: Calming room .................................................................................................................................................................. 56
Figure 21: Patient flow - Clinical forensic unit ........................................................................................................................ 57

LIST OF TABLES
Table 1 : IUSS:GNS Reference Documents ........................................................................................................................ 7
Table 2: proposed calculations ......................................................................................................................................................... 9
Table 3: Functional zones or spaces ............................................................................................................................................ 19
Table 4: Sats priority levels and target times for patients to be seen with-in (SATS, 2012, p.7) ..................... 21
Table 5: Service panel requirements ........................................................................................................................................... 39
Table 6: EC – example list of EC room requirements ........................................................................................................... 60
Table 7: Extract from Draft Regulation Governing Emergency Centre in South Africa ........................................ 64

OVERVIEW
This document outlines the policy and service context and attempts to illustrate the desired planning principles
and design considerations of Emergency Centres (EC).
- Part A outlines the national and provincial service and policy context which are the basic
determinants of the planning and design principles;
- Part B contains planning and design guidance, design considerations, functional relationships
between hospital departments with respect to the EC, and relationships within the EC itself;
- Part C provides a list of user room requirements
- Part D provides a list of proposed equipment requirements
Examples of generic space requirements for an EC are contained in the schedules of accommodation. The
example schedules provide a basis for sizing facilities at initial planning stages but exact requirements should
be determined locally based on the category of the facility (CHC, district/regional/tertiary hospital), the level of
services to be provided, the number and case mix of patients, staff availability, specific user requirements,
policy and the location of the facility.
While this document outlines design requirements and acceptance criteria which have an impact on clinical
services, these requirements are prescribed within the framework of the entire IUSS set of guidance
documents and cannot be viewed in isolation.

Table 1 : IUSS:GNS Reference Documents
CLINICAL SUPPORT HEALTHCARE PROCUREMENT&
SERVICES SERVICES ENVIRONMENT/ OPERATION
Recommended
Recommended
Recommended
Recommended
CROSSCUTTING
Essential ISSUES
Essential
Essential
Essential
Adult Inpatient Administration x Generic Room x Integrated
Services and Related Requirements infrastructure
Services planning
Clinical General Hospital x Hospital Design x Briefing Manual
Diagnostic Support Services Principles
Laboratory
Guidelines
Mental Health Catering Services Building Engineering x Space Guidelines x
for Hospitals Services
Adult Critical Laundry and x Environment and x Cost Guidelines x
care Linen Sustainability
Department
Emergency Hospital x Materials and Finishes x Procurement
Centres Mortuary
Services
Maternity Care Nursing Future Healthcare x Commissioning Health x
Facilities Education Environments Facilities
Institutions
Adult Oncology Health Facility Healthcare x Maintenance x
Facilities Residential Technology
Outpatient Central Sterile x Inclusive x Decommissioning
Facilities Service Environments
Department
Paediatrics and Training and Infection Prevention x Capacity Development
Neonatal Resource Centre and Control
Facilities
Pharmacy Waste Disposal x Information x
Technology and
Infrastructure
Primary Health Regulations x
Care Facilities
Diagnostic x
Radiology
Adult Physical
Rehabilitation
Adult Post-acute
Services
Facilities for
Surgical
Procedures
TB Services x
Colours Legend
Consultants
Administrators
Related documents

PART A – POLICY AND SERVICE CONTEXT
1. Policy context
The Emergency Centre is The National Department of Health has adopted “Emergency Centre” as
the functional area the formal nomenclature1.
within a hospital The Emergency Centre (EC) is defined as the dedicated area in a health
designated for the facility that is organised and administered to provide a high standard of
provision of Emergency emergency care to those in the community who are in need of acute or
Medicine urgent care. It forms the direct portal of entry for patients requiring
2
emergency services .
An emergency is a condition where the patient is, or is believed to be,

suffering from an illness or injury requiring early assessment and/or management, either to save life or
limb, to relieve pain and/or suffering, or to prevent further deterioration in a treatable condition in order
to reduce morbidity or mortality2.
The core activities of an EC, as defined by Emergency Medicine Society of South Africa (EMSSA), are the
resuscitation, assessment and treatment of acute illnesses and injury in patients of all ages by
appropriately trained and experienced staff, according to national and local standards directed by
international best practice and clinical governance guidelines, and the onward referral of patients as
required. This service will be available continuously 24-hours a day and will be emergency physician-led.
The EC also provides for the reception and management of mass casualties or major incidents as part of
the hospital’s responsibility within the disaster plan of each province.
This document is to be read in conjunction with: “Draft Regulations Governing Emergency Centres in
South Africa”1
2. Service context
Hospitals are categorised according to Government Notice - R 185, National Health Act 61/2003:
Regulations: Categories of hospitals: No.35101
The hospital will provide emergency care in accordance with the service package which differs per
category of hospital:
a) District hospital -
A small or large district hospital may provide emergency care and trauma services depending on the
size of the facility.
c) Regional hospital –
A regional hospital may provide emergency care and trauma services.
d) Tertiary hospitals –
A tertiary hospital may provide specialist emergency care and trauma care.
1Draft regulations National Department of Health: Regulations Governing Emergency Centres in South Africa
2Emergency Medicine in South Africa: EMSSA 2009

e) Central hospitals -
Central referral services are provided in highly specialised units, require unique, highly skilled and
scarce personnel and at a small number of sites nationwide.
Each EC should be purpose-built to suit the level of services provided by a hospital, the category of the
hospital, the patient case-load and the catchment population.
As a minimum (proposed by the EMMSA) each EC should provide:
• 1 x resuscitation trolley per 15 000 annual attendees;
• 1 flat treatment bay (includes trolleys in majors, procedure beds, POP room bays) per 1 100
annual attendees;
• a child-friendly and child-safe environment within the EC;
An EC Observation Ward will be required at larger hospital: This is a dedicated area for patients requiring
a short stay (less than 24 hours). Here patients may be investigated to obtain a definitive diagnosis
3
and/or be observed without treatment, and/or be actively treated with a view to early discharge home.
3. Determining the size of an emergency centre

Space provision is planned in relation to the activity within the required space. In general, a combination
of activity (number of attendances), acuity (types of attendances) and the desired performance level
(waiting times and access block) determine the amount and type of space required.
The size of the emergency centre is based on the maximum number of patients expected at any given time
over a 24-hour period and should consider peak arrival rates and peak occupancy rates. Peak periods
vary. Cognisance must also be taken of current trends, triage categories, the admissions and transfer rate,
average length of stay, turnaround times for radiology and pathology, patient mix and staff availability.
Population size to generate
TABLE 2: PROPOSED CALCULATIONS

(Guidelines on Emergency Department Design: Australasian College Of Emergency Medicine)
The calculation of the number of treatment bays (resuscitation bays, majors bays, minors consultation
bays) is to be determined by the population served, the hospital category and the location of the
hospital. The existing workload and peak loads may also be utilised to establish the requirements in an
existing facility
The number of resuscitation areas should be no less than 1/15 000 yearly attendances or 1/5 000 yearly
admissions and at least 2 per facility.
The total internal area of the emergency centre, excluding the observation ward, should be at least 50
m²/1 000 yearly attendances or 145 m²/1 000 yearly admissions, whichever size is greater. The
minimum size of a functional emergency centre is 700 m²
ECs should be designed taking into account the expected increase in work load over a 10-year period looking
at the 5-10% per year increase in work-load that is seen consistently in all ECs. While a unit that is being
renovated or built now should be planned for the 10-year horizon, due to cost constraints, it may only be
possible to build a floor area for the projected 3 – 5-year increase in work load. However the planning can
include designing-in specific growth and flexible solutions for the 10-year projections.
It is not advisable to design according to the current attendance figures.
Note: Paediatrics usually contributes between 20 - 25% of the EC workload.

PART B - PLANNING AND DESIGN
1. Overview
The service and policy Part B contains planning and design guidance, functional relationships between
context should be the basic hospital departments and within the emergency centre (EC), the flow of people
determinant of planning and and services with respect to the EC.
design principles in the This document will, where required, outline differences that may occur
Emergency Centre design. regarding the provision of services in an EC with respect to categories of
hospitals.
FIGURE 1 – PROJECT PROCESS
2. Operational functioning of an Emergency Centre (EC)

An EC manages all unplanned attendances to the hospital normally considered an emergency. These
patients receive priority access to the clinical treatment areas. The EC for district hospitals is generally
less complex than those required at regional and tertiary facilities.
2.1. Hours of operation

The EC operate 24 hours per day, seven days per week.
2.2. Patient escorts

The healthcare institution determines escort policy. However, patients are more often accompanied to the
EC by a member of the family or a friend. These escorts are not allowed in the resuscitation or majors
areas unless accompanying children or incapacitated adults. Accommodating the EC patients’
families/friends must be considered without compromising the care, privacy and security of all patients.

2.3. Management
• At community health centres and small district hospitals, clinical governance oversight and
responsibility will be provided by a senior doctor (medical officer) in consultation with a family
physician in the district4;
• At larger district hospitals, emergency medicine or family medicine should lead clinical care and
governance in the EC;
• At regional Hospitals, emergency medicine should lead clinical care and governance in the EC;
• At tertiary/central hospitals, clinical care and governance in the EC will be the responsibility of
Emergency Medicine. Clear working relationships with Acute Medicine and Trauma Surgery will
guide the essential close working relationships of these key specialists.
2.4. Staff
Staff in the EC includes clinical and nursing staff who provide continuous care to patients in shifts, visiting
specialist clinical staff who call to provide periodic or specialised care to patients and persons who
provide support services (such as cleaning and maintenance). Teaching and volunteering activities may
also take place within the EC.
The number and level of staff in ECs will be defined according to size and level of the hospital:
3. 10 Useful Tips for Designing an Outstanding EC 5

A design guide can never realistically provide a “ready-made” design solution, to be simply copied
straight onto a plan for a particular hospital. There will inevitably be shifts away from the text book as
compromises are made in response to constraints such as insufficient budget, site restrictions or
conflicting demands from individual team members, and in response to developments and ideas that
follow after the publication of the guide.
Planners and designers following the guide closely will undoubtedly produce effective and efficient
departments, especially if they are not constrained by having to adapt an existing building.
However, experience has shown that close adherence to a detailed design guide alone will not necessarily
produce an outstanding design. The need or temptation to focus on detail can become overwhelming, as
there are so many specific details to be delivered.
“10 Useful Tips for Designing an Outstanding EC” is a brief summary of the strategically most important
elements in achieving an excellent design for an EC, intended to help keep the design team’s collective eye
on the bigger picture as they delve further into the detail.
These are presented in no particular order of priority:
1. Make the entrance area a focus of design effort and investment as getting this right sets up the rest of
the design
2. Pay close attention to the definition and planning of the principal flows
3. Relate the flows and zones to the shape and the size of the building with 1:200 block plans, to help
keep the plan clear and legible, and to help ensure schematic flows are replicated in the design.
4. A linear shape for the EC reduces turns for patients, aiding speed and reducing risks
5. Define how operational flexibility (e.g. altering the balance between major and minors) should be
achieved and review all plans to assess specifically how well this is delivered.
6. Plan specifically for the accommodation and management of anxious relatives and friends by
designing for a calming environment rather than a solely defensive/safe one
4 For staffing requirements: Refer to Emergency Medicine In South Africa: EMSSA.2009: Page 21-23
5 Comments by Nigel Draper: Mike Nightingale Fellowship: UK: 13/01/2013

7. Create a hierarchy of privacy for staff, including areas where they can work without interruption, as
this should help reduce errors
8. Pay close attention to the management of infected patients and particularly the potential impact on
them having been in the department before they are diagnosed
9. Use low-cost solutions to provide surge capacity, given built-in provision represents a major sunk
cost which is likely to prove uneconomic.
10. Develop a single design with capacity for the long term, but include specific provision for how it can
be built smaller (in accordance with short-term capacity needs) and subsequently expanded with
minimum disruption to the working department.
4. General Design considerations

Refer to IUSS document: “General Design Guidelines” and “Inclusive Environments”
4.1. Designing to reduce the spread of tuberculosis (TB) and other infectious
diseases
ECs need to be designed in such a way as to minimise TB spread to staff and fellow patients. High-risk
environments for TB transmission include areas where symptomatic, undiagnosed patients are seen, and
congregate settings. Parts of the ECs meet these criteria and can therefore be regarded as a high-risk
environment for TB transmission and designed and engineered accordingly.
• The waiting areas must be designed to reduce the risk of cross-infection through:
o Good ventilation
o Minimising overcrowding of the waiting areas by anticipating peak loads
o Provision of outside waiting areas
• Consulting and treatment areas
o Good ventilation
o Positioning of doctors or staff in relation to the patient should be such that the air flow
(where possible) does not flow from the patient to the doctor
Refer to IUSS: TB services as well as Infection Prevention and Control
4.2. Design for privacy and dignity

Cubicles need to be designed to maintain privacy for the patient both physically and auditory. While
partitioned cubicles provide greater privacy, curtained cubicles allow better visual contact with patients,
flexibility when additional space is required, optimal use of limited space and flexible space.
4.3. Reduction of noise levels6

There is a need to decrease sound transmission in the EC. It is the nature of emergency medicine that
patients will need to divulge intimate information at most points in their journey, therefore it is essential
to create the correct environment for patients to feel comfortable doing so. Walled cubicles are the
optimal choice for increased privacy however, they do not allow for visualisation of patients, flexibility for
surge capacity, optimal use of limited space, easy sanitation or UVGI, thus curtained cubicles continue to
be the best choice in ECs.
6
HBN 22:Accident and emergency facilities for adults and children: NHS Estates: UK DOH: 2006: This document has been used extensively
as a reference

High noise levels adversely affect both patients and staff and can influence staff ability to function, leading
to increased fatigue, increased perceived work pressure, stress, emotional exhaustion and error due to
distraction and poor communication.
While much of the noise in an EC is unavoidable (verbal communication, ambulance arrivals, monitors
and other equipment, etc.), some can be mitigated by paying attention to acoustic architecture: The
surfaces used (sound-absorbing rather than the typical sound-reflecting), reducing flanking, building-in
sound baffles, using sound-absorbing ceiling tiles/panels, honeycomb fabrics for curtains (increased
sound absorption), etc. These will not only advance privacy and reduce noise, but also enhance speech
intelligibility by reducing reverberation.
4.4. Design for flexibility and building for surge capacity and major
incidences
There will be times when the demand exceeds capacity, especially in the event of a major incident when a
large number of people are affected. Design needs to be flexible enough to cater for this event as
efficiently and quickly as possible.
Specific design features that support flexibility:
• Moveable partitions in resuscitation areas,
• Multiple oxygen ports per bed with curtained (as opposed to walled) majors cubicles (This will
allow 3 - 4 trolleys in 2 cubicles);
• Design of waiting areas such that they will be able to cater for surge capacity (including a small
sub-waiting areas that can also be utilised);
• Cubicles in the minors area can be fitted with services that will accommodate majors patients;
• Corridors, where wide enough, can have services running the length of the corridor to
accommodate additional patients in an emergency;
• An external concreted area that can be used for everyday parking but, in the event of a major
incident where additional services are required, a tent can be set up. A service hub would be
required
• A large covered ambulance bay may be utilised for additional services in the event of a disaster.
4.5. Salutogenic design

Design should support salutogenic planning principles to ensure a holistic healing environment that
promotes health and wellbeing. This includes consideration with regard to good lighting; clear external
views; as much morning sun or light as possible; positive interior distractions; access to nature, art,
symbolic objects where possible; individual control of noise, lighting, indoor temperature and social
interaction spaces. Consideration should focus on a healing environment to suit both the patient and staff.
4.6. Calming environment to help reduce aggression

As aggressive patients can be affected by their surrounding environment, EC design consider design
elements that promote a calming effect through the design choice in colour, lighting, temperature control,
noise reduction and the seating arrangements in public and patient areas.
4.7. Meeting the needs of special patient types:

This includes meeting the needs of
• Children,
• Mentally-ill patients,
• The elderly and confused patients.

4.8. Security upon arrival at the EC:
Security is a major concern especially in those areas where violence and gangsterism are prevalent. As
the patients’ and visitors’ route into the EC begins at one of the two entrances, it is essential that this is
strictly controlled by security. This is often accomplished by the provision of a lobby upon entry where
security can control arrivals, remove weapons and deny access where required. In the case of weapons, a
gun safe should be provided in the security office upon entry. Better still; guns should be confiscated upon
entry onto the hospital site.
Security should also have a view into the EC as they may be required to assist when patients are
exhibiting violent or criminal behaviour.
4.9. Wayfinding
To reduce the difficulty of patients and visitors finding their way around the EC, the layout of the EC
should enable patients and visitors to naturally find where they need to go and the route they will be
required to follow. This should be supported by clear signage at key locations such as the entrance,
reception and treatment areas.
4.10. Circulation
The design of circulation space and the relationship of key areas should minimise the time spent by staff
walking between different key locations to help minimise the distances they have to walk on each shift.
4.11. Design should provide:

• Design that takes into consideration the needs of patients, staff and visitors;
• Design that maximises patient safety and reduces the risk of errors and accident;
• Appropriate space norms and room design;
• Recognised infection control policies (refer to the IUSS document on Infection Prevention Control);
• Compliance with quality assurance principles;
• Communication and information systems that will support patient management and
administration;
• Design that balances requirements for clinical need and capital and recurrent budget
considerations;
• Access to and within the facilities for physically and sensory impaired people including:
o - Mobility impairment
o - Visual impairment
o - Hearing impairment
• Appropriate equipment and infrastructure to be provided to facilitate the required service;
• Appropriate and comprehensive signposting shall be provided for all hospitals. Signposting shall
clearly identify staff, patient and visitor areas, and draw attention to restricted areas.
• Way finding and signage must be considered from the inception of the design process;
• Ergonomic design - all facilities shall be designed and built in such a way that patients, staff and
maintenance personnel are not exposed to avoidable risks. Designers are to consider the
optimum comfort of all situations for staff, patients and visitors
There are three major particular considerations when designing individual spaces within the health
environment:
a. Human resources– Patient type and the number of people at any given time in a specific place
to perform a specific task or procedure;
b. Activities– What procedures are to be performed in the spaces to be provided;
c. Equipment – What equipment is required that will occupy the space.

The relationships of one space to another and the flow of patient, public, staff and services between
spaces are another important consideration:
4.12. Common mistakes in the design of ECs

• Treatment areas that are used as thoroughfares, compromising patient privacy and dignity;
• Key related areas not positioned correctly in relation to one another thus compromising flow and
travel distances, complicating patient way finding.
5. Location and clinical departmental relationships:

Access to the EC entrances is either via the main site entrance or may, in larger busy facilities, have direct
access off the public road through to the EC.
Position of the EC on site:
• Access to the EC should be close to the site entrance and as such, the EC should be situated to
allow easy access from the road to EC entrances.
• The EC should preferably be on the ground floor of the building,
• The EC should have adjacent parking for ambulances as well as for those vehicles belonging to EC
patients and their escorts.
• The drop-off point for cars should be able to accommodate at least 3 cars at any given time;
• The helicopter stop should have close, direct access through to the EC.
The clinical profile of the unit requires an efficient functional relationship between clinical departments.
Critical departmental adjacencies include:
• The EC in all categories of hospitals should have a close relationship to general Radiology.
Regional and tertiary hospital ECs’ should have a close relationship to the CT scanner;
• Access to laboratory services is desirable for laboratory tests;
• Access to a blood bank facility;
• Point of care access for electrolyte/blood gas analysis, pregnancy and urine testing, coagulation
testing should be provided within the EC;
• A close relationship to the operating theatres is essential in all categories of hospitals. Preferably
the theatres should be with the EC on the ground floor. Tertiary hospitals may have dedicated
theatres within the EC;
• Smooth access and proximity to the intensive care units is desirable to minimise transfer times of
critically ill patients.
Important relationships include:
• Clear access to inpatient units;
• 24-hour access to the hospital pharmacy;
• Access to the mortuary.
The relationship of these departments to the EC could be horizontal or vertical with the emphasis on
rapid access.

FIGURE 2: DEPARTMENTAL RELATIONSHIPS

FIGURE 3: EC - CRITICAL DEPARTMENTAL RELATIONSHIPS
6. Intradepartmental relationships and f unctional zones

The EC can be clearly separated into functional zones or specific spaces that should be arranged to
support the five main flow patterns at the EC, namely:
• Public spaces - site access, parking, main waiting areas;
• Patient (Clinical) spaces - triage, majors, minors and resuscitation areas;
• Shared clinical support spaces - procedure room, POP room and X-ray;
• Administration spaces - offices and teaching spaces;
• Staff spaces- staff room, ablutions and overnight accommodation;
• Service support spaces- utilities, stores and hospital services.
The relationships are indicated in FIGURE 4

FIGURE 4: INTRADEPARTMENTAL "SPACES OR ZONES"

Table 3: Functional zones or spaces
Facility CHC District Regional Tertiary Central
1.0 PUBLIC SPACES
Site access/Entrance to the site x x x x
Parking and drop off x x x x
Entrances to EC:
o Emergency ambulance entrance x x x x
(resuscitation and majors)
o Walk-in entrance (minors) x x x x
Security station x x x
Porter stations x x x
Decontamination shower; x x x
Waiting area for escorts x x x x
Public toilets- male, female, paraplegic, baby change x x x x
Entrance/Reception desk x x x x
Sub waiting area for administration x x x
Administration desk /Medical records x x x
2.0 PATIENT SPACES (CLINICAL SPACES)
TRIAGE
Triage sub waiting for patients x x x x
Triage curtained cubicles x x x x
RESUSCITATION
Resuscitation treatment bays x x x x
Small laboratory area x x x
Blood fridge x x x
Workstation x x
MAJORS
Patient treatment bays x x
Combined majors treatment area x x x x
Respiratory area x x x
Isolation room x x x
Central workstation x x x
Private treatment bay x x x
MINORS
Sub waiting minor assessment x x x x
Assessment rooms for minors x x x x
PAEDIATTRICS
Sub waiting for paediatric assessment x x
Paediatric assessment rooms x x
Rehydration area x x
Paediatric treatment room x x x
Central workstation x x
SPECIALITY AREAS
Calming room for acute, behaviourally disturbed x x x
patients
Distressed relatives/counselling room; x x x
EC observation ward. x x x

FFACILITY CHC District Regional Tertiary
SHARED CLINICAL SUPPORT AREAS:
Resuscitation/Majors/Minors/Paediatric areas
Procedure room x x x x
Plaster of paris room x x x x
X-ray - Full body scanner x x
X-ray - Portable x x x
3.0 ADMINISTRATION SPACES
Offices x x x
Meeting/Seminar room x x
4.0 STAFF SPACES
Staff room x x x x
Staff ablutions x x x x
Clinical overnight accommodation x x x
5.0 SUPPORT SPACES
Body room x x x
Clean utility x x x x
Dirty utility x x x x
Sluice x x x x
Stores:
o Disaster x x x
o Consumables x x x x
o Pharmaceutical x x x x
o Clean linen x x x x
o Equipment x x x x
o Surgical supplies x x x x
o Stationery x x x x
Mobile equipment bay x x x
Mobile X-ray bay x x x
Cleaners’ room x x x x
Body room/Dead on arrival (DOA) room x x x
Patient ablutions x x x x
Each functional zone is described in detail and follows the patient flow through the EC commencing with
access onto the site and entry into the EC. The patient flow through the EC is described from triage,
through to assessment, treatment and finally either discharge, admission to a ward or referral to another
facility.
6.1. Patient coding7

ECs should lead the management of flow of acute and emergency patients through the healthcare system,
8
ensuring that the patients who are the most sick are rapidly and appropriately prioritised and treated .
The emergency centre should provide care in an integrated system of services. The goal is to match
correctly the patient’s healthcare needs to the services available. An important element of the assessment
concerns initial prioritisation on the basis of urgency, or “triage”. Patients with immediate needs are
identified and receive help immediately.
7
Emergency Medicine Society of South Africa (EMSSA), 2010. Practice guideline EM014: Implementation of the South African triage scale.
South Africa: EMSSA.

Patients are categorised in terms of their clinical acuity profile in accordance with the South African
Triage Scale (SATS):
• Green patients are regarded as non-emergencies;
• Yellow patients are seriously ill and in need of urgent attention;
• Orange patients are seriously ill, traumatised and in need of very urgent intervention;
• Red patients are critically ill or severely traumatised and might have a life threatening or
debilitating outcome if not regarded as a priority requiring immediate intervention;
• Blue patients are deceased or dead on arrival.
9
SATS priority levels and target times for patients to be seen
TABLE 4: SATS PRIORITY LEVELS AND TARGET TIMES FOR PATIENTS TO BE SEEN WITH-IN (SATS, 2012, P.7)
Priority Colour Target time Management/ Streaming

Red Immediate Take to resuscitation room for emergency management
Orange <10 min Refer to majors for very urgent management
Yellow <1 hour Refer to majors for urgent management
Green <4 hour Refer to designated minors area for non-urgent cases
Blue < 2 hour Refer to doctor for certification
Benefits of implementing SATS (SATS Training Manual 2012)
1. Expedites the delivery of time -critical treatment for patients with life threatening conditions;
2. Ensures that all patients are appropriately prioritized according to their medical urgency;
3. Improves patient flow;
4. Improves patient satisfaction;
5. Decreases the patients overall length of stay;
6. Facilitates streaming of less urgent patients;
7. Provides a user-friendly tool for all levels of health care professionals.
Emergency Medical Services (EMS)
There is a close relationship between the Emergency Medical Services (EMS) and hospitals where
emergency services are provided. The EMS will use the SATS to assess the acuity of the patient at the
source of the emergency and, in some cases, use specific diagnostic guidelines, to inform their choice of
facility to access.
6.2. Resuscitation, majors and minors areas

There are three main areas within the EC to which patients are directed from triage according to the
SATS:
• Resuscitation area to which the “Red” patients are directed immediately upon arrival;
• Majors area to which both “yellow” and “orange” patients are directed i.e. urgent and very
urgent attention required;
• Minors area to which all “green” patients are directed and occasionally some of the “yellow”
patients.
9 The South African Triage Scale (SATS), 2012. Training manual. [pdf] Cape Town South Africa: Department of Health. Available at
http://emssa.org.za/wp-content/uploads/2011/04/SATS-Manual-A5-LR-spreads.pdf [Accessed 15 February 2014].

7. Patient flow through the EC
To understand the relationships of the areas within the EC, it is important to understand the patient flow
through the EC. The category of patient determines the separate patient flow within the EC. The
infrastructure should reflect these separate flows. Patients and escorts should be separated at the
entrance to the unit. Both wait in dedicated separate waiting rooms. Patients admitted to the EC are
classified and triaged according to the acuity code system and are clinically managed accordingly.
There are five separate patient clinical flows through the EC:
• Resuscitation: Red patients in need of immediate, life-saving intervention. These are usually
stretcher cases which shall have priority entrance, past security and medical records into the
resuscitation or procedure room;
• Majors: Orange and yellow patients who are unstable, require very urgent or urgent attention and
who will likely need complex treatment and/or admission;
• Minors: Green patients and certain yellow patients who are stable, walk-in patients;
• Paediatrics: It is important to protect children, separating the paediatric patients from adult
emergencies after triage and allow for an appropriately fitted area to treat children. A parent or
guardian will accompany children into the unit, unless otherwise indicated by the staff;
• Clinical forensic patients and victims of violence: Rape victims or victims of violence that enter the
EC will be sent directly to the Clinical Forensic Unit where they will wait in a separate waiting
area prior to assessment and treatment in separate consulting rooms. Adequate facilities for
children are to be provided. The Clinical Forensic Unit is separate but close to the EC.
Patient flow through the EC should be one way with each flow path kept separate but close, with minimal
cross traffic between them (Figure 2).
FIGURE 5: ONE-WAY PATIENT FLOW
Behaviourally disturbed patients who arrive at the hospital need to be assessed for medical causes of
their behaviour. They are triaged as Orange and will be assessed in the majors area. Patients who are
violent or in need of containment, will go to the “calming room” (a secure environment separate to the
other patients) in order to be removed from potentially harming themselves or others. Once sedated or
calmed, they will be assessed in the majors area. Once medical causes have been ruled out, they will be
referred to the inpatient psychiatric ward or transferred to a psychiatric facility in keeping with local
referral guidelines.
Respiratory patients: The status of the patient with respiratory ailments will define the risk level.
Patients with severe respiratory distress will be taken to the nebulisation area for immediate attention.
Mildly distressed patients will be managed as walk-in patients
As these hospitals are sub-specialist hospitals, the ECs differ. This is an indicative example only and will
vary depending on the facility and services it provides.

FIGURE 6: EC INTERNAL PATIENT FLOW - CHC
The EC in a CHC is dependent on the size of the CHC and whether the CHC provides 24-hour or 8-hour
services

FIGURE 7: EC INTERNAL PATIENT FLOW - SMALL DISTRICT HOSPITAL

FIGURE 8: EC INTERNAL PATIENT FLOW - REGIONAL AND LARGE DISTRICT HOSPITALS

FIGURE 9: EC INTERNAL PATIENT FLOW - TERTIARY/CENTRAL HOSPITAL
Clinical resources such as X-ray, procedure rooms and the POP room are shared by resuscitation,
paediatrics, Majors and Minors areas and, as such, should be positioned so that they are accessible to all
three areas without compromising the flow of any one path.
Paediatric patients who are attended to in the adult areas, should preferable be in separate cubicle areas.

8. Public Spaces
The public spaces begin the process of movement through the EC, starting with arrival and ‘entry’ onto
the site.
8.1. Site Access

• The entrance to the EC should be clearly visible from the entrance to the hospital site;
• Ambulance approach and pedestrian walkways should not conflict;
• Vehicle access should be close to the entrance to the EC;
• Emergency vehicles should have direct access to the EC entrance. There should be separate access
and egress routes for ambulances and private vehicles, both one-way flow past the two entrances,
ambulance and Walk-in, respectively.
8.2. Parking
• Emergency parking should be provided, adjacent to the EC entrances, for ambulances, emergency
busses and members of the public who drop off a patient at the EC. This parking should be close
to the entrance, available to patients, their relatives and staff.
8.3. Signage
• The EC should be clearly identified from all approaches.
• Signposting that is illuminated is desirable to allow visibility at night. The use of graphic and
character displays such as a white cross on a red background with the word emergency is
encouraged.
8.4. Helistop
• This should be close to the entrance to the EC
• The helistop must have a concrete walkway through to EC entrance.
• The centre of the helicopter landing area is to be 50 m away from any building, vegetation or
parking area.
• The area is to preferable be positioned on the ground however, in dense urban areas, lack of
space may necessitate a helipad to be stationed on the roof of the hospital with direct access by
lift to the EC, theatres and ICU.
• Landing area - 15 ton minimum stress.
• Slope to be maximum 1/25.
• Refer to DOH requirements.
• Direction of runway to be ascertained from local airport (direction of prevailing winds).Consult
AMS.
• An area for the helicopter team may be required containing a store for equipment and a
shower/changing room.
A helipad has more stringent requirements and has to be designed in accordance with Civil Aviation
requirements.

8.5. Entry into the EC
• This is where the “care” process commences for the patient and as such should be welcoming.
• Access into the EC must be controlled. This will require security at the entrance and a controlled
lobby area prior to entering the EC.
• The EC should be accessible by two separate entrances: one for ambulance (stretcher) patients
and the other for ambulant patients (walk-in patients).
• The two entrances to the EC must be at ground-level, clearly demarcated, and covered.
• It is recommended that each entrance area contains a separate foyer that can be sealed by
remotely activating the security doors.
• Both entrances should direct patient flow towards the Reception/Triage area.
• There should space for 4 ambulances to park adjacent to the ambulance entrance, under cover.
• Entry into the EC should be direct and straight with reduced travel distances from the site
entrance.
• The internal entrance from the main hospital linking with the EC must be considered, especially
the security control with regard to access at this point
Ambulance Entrance
This is a dedicated entrance from the ambulance drop-off area and is separate to the walk-in entrance. All
patients arriving by ambulance are immediately off-loaded and must report to the Triage officer who will
record their details in a register. For resuscitation patients, the administration officer will attend to the
patient in the resuscitation room as these patients will be taken straight to resuscitation. Patients are
streamed according to their level of acuity ie. Red, Orange, Yellow or Green patients.
There are several types of patients who are brought through the ambulance drop off entrance:
• Unstable stretcher patients who are critical and are taken straight to the resuscitation area;
• Unstable stretcher patients that are taken immediately to the Majors area where they will be
classified following triage;
• Stable patients brought in by ambulance will be taken to the triage area;
• Violent/psychotic patients will be taken to the calming room.
The ambulance entrance must be close to the resuscitation area (immediately adjacent) and should flow
into the Majors section. The isolation room should be close to this entrance. The decontamination room
should be adjacent to this entrance.
Requirements include:
• The entrance should open into a wind lobby with two doors spaced 3 m apart, one closing before
the other opens, in order to minimise air movement;
• Access is to be controlled by security guards to emergency and clinical areas;
• Ambulance drop-off to be under cover such that the patient is removed from the ambulance and
taken to the EC without getting wet;
• Automated doors are recommended into the EC entrance from ambulance drop-off;
• The entrance to the EC shall be paved to allow patients to get out from cars and ambulances;
• The ambulance entrance should be screened as much as possible for sight and sound from the
ambulant patient entrance;
• Storage of wheelchairs and trolleys should be adjacent to this area.
• Facilities to decontaminate the ambulance and wash the vehicles (inside and outside) should be
adjacent to the ambulance entrance.
• Space should be adequate for the ambulances to reverse or drive straight through the entrance
drop-off point for ambulances.

• To avoid patients walking through this ambulance entrance, the entrances should be situated
such that the walk-in patients first encounter the walk-in entrance on their route from the main
site entrance.
Walk-in Entrance to EC
The walk-in entrance is for ambulant patients and their relatives to enter the EC. The entrance should
open into a wind lobby with two doors spaced 3 m apart, one closing before the other opens, in order to
minimise air movement. All patients entering the EC report to the Triage officer and are recorded in a
register. Obvious resuscitation patients bypass the triage area and are taken straight through. Their
details will be entered into the register at a later stage.
The entrance needs to be separate from the ambulance entrance, preferably on a different side of EC away
from the clinical areas of the EC;
The walk-in entrance should allow for flow into Majors or Resuscitation areas, bypassing Triage Area (for
patients who are obviously unconscious/arrested/extremely ill);
The entrance should open into the main waiting area of the EC reception area;
The porters’ room should be adjacent to this entrance with a clear view of both entrances.
• Parking for private vehicles close to this entrance;
• Attempt one-way flow of vehicles past this entrance;
• The entrance should be covered;
• Storage space for wheelchairs adjacent to this entrance;
• Doors into the EC to be glass sliding with access control supervised by security.
8.6. Trolley/Wheelchair Bays

This is an area for the storage of sufficient wheelchairs and trolleys for patient transport, controlled by
the porters.
This should be located at the entrances to the EC, next to the Porters’ Room.
A trolley wash bay for cleaning and decontamination of wheelchairs and trolleys must be provided near
to but outside the ambulance entrance.
8.7. Porters’ Room

This is a base for the porters to wait to be called to assist.
The porters room to be located at the walk-in entrance and be adjacent to a wheelchair storage area.
• Windows to outside allowing visibility of the whole entrance area from inside the room. It must
have a view to the ambulance and walk-in arrivals (priority to be given to viewing the walk-in
entrance);
• The room is to contain chairs and a table and a kitchenette;
• A call system through to the admissions desk, resuscitation and trauma care areas, theatre
(casualty) holding areas is to be installed;
• At least two telephone lines;
• Size depends on amount of porters who will be using the area;
• Lockers to be provided for equipment and uniforms:
• Workspace for kettle, tea and coffee - preferably not in view from outside or waiting room.

8.8. Security and Access
All patients, escorts and visitors must pass through a security check point at the EC entrance.
The security area should be positioned so that it allows security staff a clear view of the waiting room,
triage and reception areas. Remote monitoring of other areas in the department by CCTV and of staff
duress/personal alarms should occur from this area.
• Counters of sufficient height and depth to minimise the possibility of them being jumped over or
reached over.
• Relatively secluded or isolated areas should be monitored electronically, by CCTV, with monitors
in easily visible and continuously staffed areas
8.9. Decontamination Shower

A decontamination shower is required immediately outside the EC for washing down and
decontaminating patients that may be contaminated with a hazardous substance (chemical, biological or
other contamination).
Any contaminant must be removed before the patient enters the EC, so the decontamination shower room
must be at the ambulance entrance, with access from the outside as well as from inside of the EC.
• The shower must be large enough to contain a trolley, stretcher or wheelchair with adequate
space for staff movement without being in contact with trolley/patient;
• Flexible hand-held shower to be attached to the wall with a 1.5 m-long flexible cord;
• Hot and cold water supply with a mixer control;
• High-volume, low-pressure water system with multiple (at least 4)hand–held shower heads;
• Floor slope to be 1/50 to drain toward a stainless steel ‘Rofo’ floor drain;
• Walls to be tiled, floor to ceiling;
• Floor to have porcelain floor tiles that are chemically resistant and non-slip;
• Solid ceiling panel;
• Provide patient privacy;
• Raised area for staff so as to avoid standing in contaminant;
• Hairdressers sink (to wash the hair of patients with lice);
• Toilet;
• Clinical wash hand basin;
• Ante chamber to be attached for staff to gown in protective gear with cupboard for towels.
8.10. Family and Friends Main Waiting Area10

It is essential that all waiting areas are non-threatening and that patients and the public, especially
children, are made to feel welcome.
The main EC waiting area is the EC public waiting space for patient escorts to wait while the patient is
being attended to.
It is located at the front of the EC with direct access from the Walk-in Entrance lobby.
10
Refer to : Improving the patient experience Friendly healthcare environments for children and young people:
NHS Estates: UK DOH:2006

From this waiting area there must be access to:
• Triage sub-waiting area via security doors
• Reception areas
• Toilets
• Baby change room
• Light refreshment facilities which may include automatic beverage dispensing machines
• Telephone and health literature
• The waiting area should be monitored to safeguard security and patient wellbeing and identify
any inappropriate or criminal behaviour;
• Provision must be made for people to sit. Seating should be comfortable and adequate. Number of
seats to be calculated:
o 4.4 m2 per 1 000 yearly attendants: minimum 10 m2
o Seating 1 per 1 000 yearly attendants;
• The main waiting area is for escorts and visitors and must be outside the secured clinical area.
Public toilet facilities must be adjacent to the main waiting area;
• The waiting area for the escorts and visitors shall be so situated as to be close at hand but not
part of or contained within the secured area of the EC and should provide sufficient space for
waiting patients as well as relatives/escorts. The area should be open and easily observed from
the triage and reception areas;
• Space should be allowed for wheelchairs, prams, walking aids and patients being assisted. There
should be an area where children may play;
• Support facilities, such as a television, should also be available;
• Fittings must not provide the opportunity for self-harm or harm towards staff.
• Waiting areas must be negatively pressured. Good ventilation and outside views are essential.
• Clear signage for areas in EC as well as signage directing patients to other departments within the
hospital;
• Signage giving general information such as waiting times, the triage system, hospital phone
numbers etc;
• Children’s play area: An area attached to the main public EC waiting area which provides for
children to play is required with a chalkboard on the wall at a low height. Provide table and
chairs for small children as well as equipment suitable for safe play activities, including a
television. The play area must be visible from the triage area
• Public ablutions off the waiting area: Ablution facilities for the visitors and escorts should be
separate to the rest of the EC. The ablutions shall include for separate male, female, paraplegic
and baby change facilities (in family toilet facility). Wheelchair patients must be provided for. The
number will depend on size and load on the EC.
8.11. Reception/Info/Help Desk

The reception should be viewed directly visible and accessible upon entry into the EC. Upon arrival
through the “walk-in” patients’ entrance, patients will be directed to the triage sub waiting area , or
immediately to the resuscitation area should their condition be critical, by staff at the reception/info help
desk. Escorts will be directed to wait in the main waiting area.
This area is immediately visible upon entry into the EC and contains a desk/counter, chair and telephone
with communication through to the porters area.
Reception and triage shall be located so that staff can observe and control access to treatment areas,
pedestrian entrance, and public waiting areas.

8.12. Administration Area
Administration sub-waiting
After triage, stabilised patients (or escorts on their behalf) proceed to the administration waiting area
where they will wait to be attended to by a clerk at the administration counter. Here patients will obtain
their folders or have a new folder opened before proceeding to the Minors or Paediatric areas for
assessment and treatment. Escorts of ill patients sent straight through to Majors or Resuscitation need to
open or collect folders as well. Resuscitation patients must be prioritised.
The area should be accessible from Triage Rooms, Paediatric area, Majors and Minors areas.
8.13. Administration Desk

The administration desk is where patients come to register, collect their files and their attendance
recorded electronically on the hospital information system.
The administration area is required to accommodate:
• Reception of patients and visitors;
• Registration interviews of patients;
• Collation of clinical records;
• Printing of identification labels.
This area should be adjacent to the administration sub-waiting area and should be accessible from the
triage area. Access from the administration desk through to the majors and resuscitation areas should be
directly linked. A close link to medical records and admissions is preferable.
• The administration desk should be an open plan area with a counter top divided into cubicles
that are partitioned separately for privacy:
o Seating is to be provided on both sides of the counter – one for the clerk on the inside
and two for patients (patient and escort) on the outside (facing the queue). The number
of cubicles will depend on the size of the EC and patient load;
o Cubicle should be set up to allow patients to move easily into and out of seats and
wheelchairs to enter, turn, wait and exit;
o Provision on the counter space for patients to write on;
o Provision for patients in wheelchairs is essential. The counter should have at least one
reduced height counter to enable wheelchair patients to be attended to comfortable.
• The ideal set-up would entail a few kiosks/cubicles serving a single queue of patients (working
for the most part on a first come first served basis), as opposed to individual queues forming in
front of each kiosk.
• The administration area should be designed with due consideration for the safety of staff and
requires a duress alarm;
Services required per cubicle:
• Computer per cubicle, linked to hospital information system
• Telephone.

9. Clinical spaces (Assessment and Treatment)
9.1. Triage
Triage is an essential first step in efficient and effective emergency care - whether at the roadside or in
the public or private hospital area to help save lives and reduce morbidity.
Triage means “to sort” in French. The aim is to bring the greatest good to the greatest number of people -
achieved through prioritising limited resources to achieve the greatest possible benefit. Patients are
sorted with a scientific triage scale in order of urgency (SATS) - the patient with the greatest need is
helped first.11
Though triage is a process and not a place - an area for patients is required for those patients not sent
directly through to resuscitation or majors. It is an area to allow for privacy and should be set up in order
to observe the vital signs for the Triage Early Warning Score(TEWS), other investigations and tasks.
The triage provider could be a medical officer, a registered nurse, enrolled nurse or an enrolled nursing
assistant.
The rooms should allow for one way flow of patients from the entrance, into the triage sub-waiting area
then to the triage area from where they are directed according to their acuity level (SATS).
Triage sub-waiting area
Patients not sent directly through to resuscitation room or majors area are directed to the triage sub
waiting area upon arrival at the EC. Escorts must remain in the main EC waiting area unless the patient
requires assistance, is in a wheelchair, is infirm or is a paediatric patient.
• Security doors from main waiting area
• Clear signage
• Triage waiting area would flow into triage rooms, preferably with one-directional flow through
triage rooms into the administration area
• Seating should accommodate approximately 12 seats as well as adequate space for at least 2
wheelchairs.
Triage area
The triage area is the focus of initial presentation, where patients are sorted in terms of their clinical
severity on arrival12. All patients should undergo triage as soon as possible upon entering the EC.
The triage area should be placed adjacent to the sub waiting area, close to the entrance and accessible
from both the ambulance and walk-in entrance.
Patients are rapidly assessed by an emergency nurse in the triage area and then are sent to one of the
following areas:
• Resuscitation- Red Treatment Area;
• Majors - Yellow/Orange Area - Acute Treatment ;
• Minors - Green Area for assessment;
• Clinic forensic unit for victims of violence;
• Paediatric area.
11 SATS Training Manual 2012

12
Emergency Medicine Society of South Africa (EMSSA), 2010. Practice guideline EM014: Implementation of the South African triage scale.
South Africa: EMSSA.

FIGURE 10: PATIENT FLOW - TRIAGE
• A dedicated triage space that is well signed;
• The provision of 2-4 triage bays, depending on patient load and size of the unit;
• Entrance to a triage area should be controlled by security doors from the main waiting area
• Flow should be towards the administration sub-waiting ;
• There should be easy access to resuscitation, Majors area and the Paediatric area from the triage
room without going through the reception area;
• Assessments must be completed with due regard to privacy;
• Each triage cubicle should preferable be in a walled room to enable privacy both visually and
acoustically;
• Appropriate seating for escorts that may need to accompany the patient;
• Allow for easy wheelchair entry, turning and exit;
• Space for desk, two chairs plus wheelchair;
• Large enough to accommodate pushchairs, wheelchairs and stretchers.
Services to include:
• A dedicated toilet adjacent to triage for specimens collection;
• Hand wash basin with elbow taps and gooseneck outlet in the room with tiles above, mirror, soap
dispenser and paper towel dispenser;
• Service panel to be provided with an examination light;Services to be provided on the wall;
• In all cases the service panel shall be at a height to provide unobstructed access to the patient;
• Emergency call facility;
• Telephone;
• Good examination lighting is required at each service point.
Equipment to include:
• Waste bins and sharps containers;
• Ophthalmoscope/otoscope;
• Foot stool;
• Access to gloves, face masks and other barrier-protective equipment;
• Wall clock with a second hand;

• Low reading electronic/mercury thermometer
• Vital signs monitor or baumanometer and one with paediatric cuffs
• Pulse oximeter including one with paediatric probes
• ECG
• Finger prick machine, haemoglobin and glucometer measurement
• Urine collection containers, urine dipsticks and urine pregnancy tests
• Stethoscope
• Low reading thermometer
• Dry dressings and bandage
• Sphygmomanometer (manual, digital or electronic)- preferable wall-mounted;
• A measuring tape;
• 2 x different SATS posters prominently displayed in the triage area;
• SATS manual readily available;
• SATS patient info leaflets in waiting area;
• Triage register (manual/computer);
• White board to track and communicate to other staff acuity of those triaged.
Space allocation per triage bay:
A minimum of 10 m² to accommodate a triage provider, an examination couch, space for a patient in a
wheelchair with a relative or carer in attendance.
The space should accommodate a desk for the triage provider, two chairs for patients and a clinical wash
hand basin.
9.2. Resuscitation Area - Red

The Resuscitation Area is used for the resuscitation, stabilisation, initial investigation and treatment of
critically ill or injured patients. Investigation may include blood tests, mobile X-rays, ultrasound scanning,
surgical interventions. Activity around the patient usually involves large teams (with trolleys and medical
equipment) performing time critical interventions on the patient.
Resuscitation bays to be calculated at 1 per 15 000 yearly attendants with a minimum of 2 resuscitation
bays to be provided in any emergency unit.
The resuscitation area is to be directly off the ambulance entrance lobby or close to it with easy access to
all treatment areas, X-Ray, full body scanner, majors area and theatre whether within or outside the EC.
The resuscitation area should be directly adjacent to the majors area with free flow between the two.
The route from the EC to the mortuary must not pass any waiting areas.
General Requirements
• Computer linked X-Ray system with X-Ray viewing box / X-Ray viewing station (for digital X-
Rays)
• 1 hands-free clinical basin, with elbow taps, per 2 beds
• Air-conditioning –
o designed to deliver 10 air changes per hour;
o Fresh air introduced from outside at 30 litre per second;
o Suction temperature of unit should not exceed 26°C;
o Temperature in the room should not exceed 26°C more that 14 days during a normal
year.
• Fire alarm system: smoke detection, audible (check noise level). Accessible visible extinguisher
(no sprinklers)
• 22-24 °C optimum temperature
• Air pressure within the area shall be positive in relation to other areas.

The following equipment to be provided for the resuscitation area:
• Small fridge for medication;
• Computer with flat-screen monitor;
• Syringe pumps;
• Blood warmer;
• Digital electronic imaging system and computer access;
• A clock with an elapsed time control should be clearly visible from each bed space;
• Blood fridge;
• Patient warming devices;
• Portable monitor/defibrillator for each resuscitation bay;
• Resuscitation trolley (with airway, drugs and other items) per bay.
The following should be immediately accessible to the resuscitation bays but can be shared between bays:
• Intravenous access trolleys,
• Thoracotomy tray
• Intercostal catheter
• Urinary catheterisation tray
• Airway management tray
• Invasive vascular access insertion tray
• Ultrasound machine
• Procedures trolley
• Paediatric resuscitation trolley, age and weight colour-coded
• Ultrasound machine: along with operator, would be situated on the patient’s right
• Portable X-ray - can approach from either side of the bed and needs a lot of space to manoeuvre.
Imaging facilities should include:
• X-Ray gantry with full access to all resuscitation beds - Radiation protection as per SABS
standards
• Portable ultrasound
• Full body scanner for regional, tertiary or central hospitals.
Requirements Per Resuscitation Bay
SERVICES PER BAY

• Computer linked X-Ray system with X-Ray viewing box/station (for digital X-Rays).
• Services to be provided on the wall, on a pedestal, or from an articulated arm from the wall or
ceiling.
• In all cases the service panel shall be at a height to provide unobstructed access to the patient.
• Physiological monitor with facility for ECG, printing, NIBP, SpO2, temperature probe, invasive
pressure, C02 monitor.
• Lighting should be a high standard focused examination light with a power output of 30 000 lux
to illuminate a field of at least 150 mm and be of robust construction.
• Data points - one of which should be networked to the hospital’s patient record system.
• Provide an uninterruptable power supply (UPS) to an agreed number of electrical outlets.
• IPS and UPS sockets should be colour-coded to differentiate them from one another.
• Additional switched and shuttered sockets, connected to ring circuits, may be provided at the
bedhead for portable non-medical equipment.
• Gas and vacuum supply (refer to table).
• Nurse call.

• Emergency alarm (for emergency assistance from staff members).
• Wall power outlet (“dirty”) for mobile X-Ray equipment (clearly marked).
• The pendant should be connected to an isolated power supply.
GENERAL REQUIREMENTS PER BAY

Each resuscitation bay to include:
• Space to ensure 360 degree access to all parts of the patient for uninterrupted procedures. Clear
access to patient all around is essential with adequate space between the patient stations for at
least 6 people around the trolley.
• Curtains to separate each cubicle with a curtain at least 1.5 m from edge of the foot of the bed.
Curtains should be 3 separate drop with stops and overlap to allow access as well as maintain
privacy.
• Overhead IV track.
• Operations carried out in resuscitation area in an emergency therefore theatre quality lighting to
be provided.
• Provide mobile work stations. These are to be a clear 600-wide clear working space, be post
formed, formica with an easily cleanable surface.
• Waste bins and sharps containers.
• Radiolucent emergency trolley suitable for the full-body scan area.
• Mounting space for infusion - and syringe pumps, for suction units and oxygen flow meters.
• Mounting space/platform for ventilator (if not on mobile trolley), for vital sign monitor.
The following equipment to be provided per resuscitation bay:
• Equipment monitors at each bed space,
• A full range of physiological monitoring and resuscitation equipment,
• Wall-mounted sphygmomanometer, diagnostic set (ophthalmoscope/otoscope);
• A full range of airway management equipment;
• Cardiac arrest/resuscitation drug and equipment trolley;
• Physiological monitor with facility for ECG printing, NIBP,SpO2, temperature, invasive pressures,
CO2,
• Defibrillator;
• Resus trolley: This is always on wheels and can move sides. Usually a waist high equipment
trolley;
• Vital signs monitor (including NIBP, Saturations, Cardiac monitor) would be mounted on the
pendant;
• Ventilator: will be whichever side the pendant is, at the head;
• Infusion pump: Normally at the patient’s shoulder on the side of the drip site: attaches to a drip
stand, needs a plug point.
Resuscitation Area –Spacing Per Bay
The space per bay should be a minimum of 20.5 m² in order to accommodate the equipment/furniture.
Space for 4 100 mm minimum wall length at bed head with 2.4 m clear floor space between beds
This will also allow:
• staff access to the patient from all sides of the bed;
• staff to manoeuvre the patient, themselves and equipment safely;
• five members of staff to attend to the patient in an emergency situation;

FIGURE 11: WORK SPACE AROUND THE PATIENT IN RESUSCITATION BAY
FIGURE 12: WORK SPACE AROUND PATIENTS IN TWO ADJACENT RESUSCITATION BAYS

TABLE 5: SERVICE PANEL REQUIREMENTS
Area Unswitched Oxygen 4-bar air 7-bar air Medical Anaestheti Emergency call system with Data
socket outlets outlets outlets vacuum c gas separate switch for crash call point
outlets for where outlets scavenging
isolated surgical points
supply equipment is
used
Red 14 3-4 2 1 2-4 1 y 4

Resuscitation
Yellow/Orange 8 2 1 2 1 y 1
Acute treatment
Procedure room 8 2 1 1 1 y 1
POP room 8 2 1 1 1 y 1
Consultation room 4 1 1 y 1
Central workstation in the Resuscitation area

• A workstation, central to the Red resuscitation area with a clear view of all patients and the
entrance;
• To have telephone, computer and network connectivity and space where nurses and doctors can
write up patient files;
• A wall storage space for forms must be provided near the workstation;
• Provision for viewing digital X-Rays by doctors;
• White boards and notice boards mounted on the wall are essential.
PAEDIATRIC RESUSCITATION WITHIN THE ADULT RESUSCITATION AREA

It is imperative that there is paediatric equipment available within the resuscitation area.
A FULL-BODY SCANNING UNIT

This is to be located within the resuscitation area or adjacent to and immediately accessible from the
resuscitation area. This should be provided in regional, tertiary and central hospitals. However, a CT
scanner in both Tertiary and Central hospital ECs is preferred.
9.3. Majors Area: Orange and Yellow

The majors area of the EC is where higher priority, Yellow and Orange patients receive initial assessment
and care. Within 6 hours these patients are moved to either the EC observation ward, a ward in the
hospital, or they are discharged home.
These patients are not considered in need of immediate resuscitation but require urgent attention (refer
to the Triage Score, Page 19 of this document). Patients are treated in their beds or on a trolley in an open
area with the beds so arranged that the clinical and nursing staff in attendance can, at all times. Observe
the patients either at the bedside or from the nurses’ station.

FIGURE 13: PATIENT FLOW - MAJORS AREA
Procedures such as insertion of intercostal drains or suturing, or investigations such as bed-side

ultrasound scanning, may be performed in this area.
The majors area is adjacent to the ambulance entrance and is accessible from both the triage and
resuscitation areas.
Access is required to:
• Procedure room;
• X-Ray facilities;
• A patient toilet and shower;
• Storage for stock and equipment;
• Sluice room;
• A clean utility room;
• Accessible from the staff tea room.
Layout
The majors area is usually a large area with curtained cubicles arranged on the outer walls of the room
with the patients on trolleys lying perpendicular to the wall.
All beds are observable from the nurses’ station which should be central to the beds.

FIGURE 14: INDICATIVE LAYOUT OF MAJORS AREA
Where paediatrics are placed with adults in the majors area, a separate area for paediatrics should be
provided.
FIGURE 15: THE MAJORS AREA OF THE NEW EMERGENCY DEPARTMENT AT KERRY GENERAL HOSPITAL (IRISH
ASSOCIATION FOR EMERGENCY MEDICINE)

General requirements
• 1 hands-free clinical basin, with elbow taps, per 4 beds;
• Air pressure within the ward area shall be positive in relation to other areas;
• Air-conditioning – designed to deliver 10 air changes per hour;
• 22-24 °C optimum temperature;
• Not to be visible from waiting areas;
• Access restricted;
• Patient shower and toilet to be provided;
• Space for equipment monitors at each bed space;
• Lighting
o – 400 lux at working plane
o – 10 000 lux for local examination luminaire
• Enough space to house equipment trolleys, drip stands, wall mounted IV stands, patients’
belongings etc.;
• Lockup cupboards, open shelves and worktops are required throughout;
• General waste and biological waste bins need to be in place.
Requirements per cubicle
REQUIREMENTS
• Space provision per cubicle
o Minimum 14,145 m2
o Minimum wall width 3.450m
o Minimum length 4,150 m
o Minimum space between beds is 2.4 m
• Clear access to patient all around essential - adequate space between the patient stations for at
least 5 people around the trolley;
• Curtains to surround each bed but be at least 1.5 m from edge of the foot of the bed. Curtain
anchor away from the bed. Curtains must be in 3 separate lengths with stops in order to be able
to access the opening between curtains, and slight overlap, so as to ensure patient privacy;
• Ceiling hung drip rails;
• Gabler rail for mounting of future equipment or containers;
• Mounting space for infusion- and syringe pumps; Mounting space/platform for vital sign monitor;
• Mounting space/platform for ventilator (if not on mobile trolley);
• Mounting space for suction units and oxygen flow meters;
• Storing of patients property to be considered.
SERVICES PER CUBICLE

• Services to be provided horizontally on the wall;
• In all cases the service panel shall be at a height to provide unobstructed access to the patient;
• Wall-mounted diagnostic set (ophthalmoscope/otoscope);
• 2 x data points - data outlets, one of which should be networked to the hospital’s patient record
system;
• Isolated power supply and provide an uninterruptable power supply (UPS) to an agreed number
of electrical outlets (at least 4 per cubicle);
• IPS and UPS sockets should be colour-coded to differentiate them from one another;

• Additional switched and shuttered sockets, connected to ring circuits, may be provided at the
bedhead for portable non-medical equipment;
• Gas and vacuum supply (refer to table 3: service panels);Nurse call;
• Emergency alarm (for emergency assistance from staff members);
• Wall mounted monitors (NO PENDANTS);
• Wall-mounted ENT set for each cubicle;
• Vital signs monitor at each bed, linked to central telemetry station.
The following equipment to be provided in the majors area:
• A clock with an elapsed time control should be clearly visible from each bed space;
• Fire alarm system: smoke detection - audible (check noise level). Accessible visible extinguisher
(no sprinklers);
• Provide fluid warmer;
• Fridge and fridge for bloods;
• Blood pressure monitors;
• Intravenous hooks;
• Computer linked X-Ray system with X-Ray viewing box/ station (for digital X-Rays);
• Wall power outlet (“dirty”) for mobile X-Ray equipment (clearly marked);
• Wall mounted lin bins.
Central workstation
This is a work station that is located central to the majors area with a clear view of all patients. It is the
central hub for all communication and monitoring devices. Doctors and nurses sit or stand and write up
patient notes, fill in forms, phone or discuss patients.
REQUIREMENTS
• The work station is to face patients and have a view of the entrance;
• Station to have at least 2 x telephone, computer and network connectivity and space where
doctors and nurses can write up patient files;
• Emergency trolleys, ECG machine and files can be stored in the central workstation;
• A wall storage space for forms must be provided near the staff station;
• Provision for viewing digital X-Ray by staff;
• Hand wash basin with elbow taps and gooseneck outlet with tiles above, mirror, soap dispenser,
waste bin and paper towel dispenser - 1 per 4 bays;
• Adequate lighting for selection of medication;
• Alarm panel linked to all EC areas;
• Patient staff call system to be monitored here;
• Radio communications station for two-way communication with EMS;
• Incoming call - only speed dial direct line from EMS control centre;
• Medications for use in the EC are stored here. This is also the central hub for all communication
and monitoring devices;
• Patient staff call system to be monitored from here;
• Minimum 2 phones in every majors area (more depending on size): 1 linked to switchboard, 1
independent line;
• It is recommended that the unit be built with a pneumatic tube system linked to lab, medical
records, pharmacy and wards (if not already present in hospital).
9.4. Isolation Room

The isolation room in the EC is for potentially infectious patients suspected to have an infection
associated with high mortality rate (such as Ebola Virus or XDR TB).

This room must be close to the entrance so as to avoid contact with other patients and should be within
view of the Majors central workstation.
There should be a minimum of 1 isolation room in the EC.
Refer to the IUSS standard room dictionary for specific requirements.
The services are to be as per the Majors cubicles and allow for monitoring of patient from central working
station.
9.5. Calming room (safe room)

The calming room is specifically for patients who are behavioural disturbed: either intoxicated, delirious
or psychotic. They are assessed and stabilised within the calming room to avoid disrupting or
endangering other patients and staff. The patients receive initial assessment and, where necessary,
sedation here before being moved to the appropriate treatment space.
This room should be situated close to the entrance and should be within view of the Majors central
workstation.
REQUIREMENTS
• Size:
o At least 7 m2 and 3 m high ceiling. Preferable a solid, concrete slab over this room.
• Door
o The door into the room must be visible from Central Station
o At least 1 m wide, not exceeding 2 m. Should be enough space to move resuscitation
equipment in and out
o Solid, hard wood
o Should be hanged on 3 hinges
o Door needs to be able to open both ways to avoid staff member being trapped
o Lockable from the outside only. Preferably secured at top, middle and bottom to
safeguard against repetitive abuse by patient
o Door needs to have a polycarbonate observation window, not exceeding 0.3 m2, but of
sufficient size in order to see entire room from outside
o Door needs to be sound proof.
• An empty room except for one, fire-proof (or non-toxic if set alight) mattress on the floor;
• No fixtures, sharp corners, hardware or protrusions;
• Roof to be reinforced with concrete/steel mesh/sturdy wood covering;
• Fire-retardant, washable paint on walls;
• Floor should be reinforced. Non-slip poly-screed floor. No skirting floor should cut in under wall;
• No toilet in the room;
• A floor drain is imperative;
• Access to daylight not important as this is temporary holding area. Recessed lighting: patient
should not be able to reach or break;
• Fresh air supply;
• All service points to be outside including light controls, electrical points, oxygen points;
• Monitoring and emergency equipment can be brought in.
9.6. Respiratory Area

The respiratory area is a short-term treatment area for patients who present with respiratory conditions
that can be treated in the EC and who are likely to be discharged after a few hours of treatment. The size

of the area depends on the size of the facility and patient load. In small EC, this area may be combined
with the oral rehydration area.
This area is located adjacent to the majors area within sight of the central nurses station.
REQUIREMENTS
• Comfortable reclining chairs (not trolleys);
• Each chair area to have immediate access to:
o Piped oxygen
o Medical gas
o Suction
o At least 4 power points.
• Equipment: Basic observations and oxygen saturation monitor;
• Shelving/Cupboards: For stationery, nebulisation medications and stock;
• Air conditioning: Should have windows that can be opened, natural light and TB lights.
9.7. Sensitive Examination Room

This room is specifically for enhanced privacy where any sensitive examination can be performed.
Examples of cases include gynaecological examinations, perianal abscess and, depending on size of EC,
forensic cases needing emergency care.
• The Sensitive Examination room is located in the Majors area;
• Consideration should be given to position and orientation of the cubicle to allow for maximum
patient privacy;
• Cubicle should be near to the waiting room in order that friends or family can enter without
crossing majors Treatment area, but also set up in such a way as to block visual access from the
waiting room if the door is open;
• Preferable to have bathroom with toilet adjacent;
• Ceiling or wall-mounted lamp on extra length arm;
• Services as per majors cubicle areas.
9.8. Minors - Code green area

The Minors (GREEN CODE area) attends to patients that do not require immediate attention but have to
be seen within 240 minutes. The assessment/consultation area is for the examination and treatment of
ambulant patients who are not experiencing a major or serious illness requiring resuscitation or
monitoring.
The facilities for the Minors area are adjacent to the triage area, majors and the resuscitation as the
medical staff need to move quickly between the four areas.
The following facilities are to be provided in the Minors area:
• A sub-waiting area,
• A specimen room for urine samples,
• A nurses station,
• Assessment area with assessment/consulting rooms - the number depends on the size of the EC.

FIGURE 16: ONE WAY PATIENT FLOW THROUGH MINORS AREA
Minors sub-waiting area

The subwaiting area for minors is for patients who have been triaged and have collected their files from
the administration desk and have to wait for assessment by the clinician or nurse. They may be
accompanied by escorts. This area is located adjacent to the EC administration area with a one-way flow
from administration through the minors area to finally the pharmacy and/home. The waiting area must
have access to public toilets.
Provide at least 4.4 m² per 1 000 yearly attendants and 1 seat per 1 000 yearly attendants. Allow
additional space for patients in wheelchairs to move around as well as wait in the waiting area.
The waiting area must be visible from the minors assessment area.
Minors assessment area (Consulting rooms)
This is an area where low acuity patients, patients with simple pathology or patients who, at triage, are
deemed likely for discharge, are examined and assessed. By definition their assessment and work-up is
simple and patients should thus spend no more than 4 hours total in the EC, ±30 minutes in all with the
doctor or CNP.
Patients may be assessed in the assessment room before being sent to the pharmacy and/or home at this
point. Alternatively they may be referred for X-Ray, treatment in the procedure room or the POP room
after which they may return to the minors sub-waiting for further assistance from the clinician in the
assessment room before being referred to the pharmacy and/or home.
This area must be adjacent to the minors sub-waiting with free flow access to the X-Ray area, procedure
rooms and POP rooms.
The assessment rooms are similar to consulting rooms (refer to the IUSS standard room dictionary for
consulting rooms details). The layout and equipment are common to all the consulting rooms - the only
difference in the EC minors area is the configuration of the rooms:
The size of each consulting room is 12 m². Quantity required depends on the size of the EC and patient
case load. The quota here will be part of the overall 1 treatment space for every 1 100 patient visits per
year for the EC.
Each area to have:
• Service panel each with:
o 1 oxygen outlet
o 1 Suction point
o 2 Plug points
• An examination couch;
• A desk and three chairs (one for doctor, one for patient and one for an escort);
• Computer outlet and terminal;
• Telephone;
• Wall storage for dressing materials and a dressings trolley;
• X-Ray viewing box (one panel);
• Wall-mounted lin-bins;
• Adequate space for wheelchairs;

• One clinical hand wash basin with elbow taps;
• Sharps’ container;
• Cupboards/shelves for stationary;
• Mobile equipment trolley (waist high) for stock, the top of which will act as small work surface
and 2 or 3 equipment drawers for stock;
• Space for wheelchair to enter, turn and exit;
• Cubicles would be separated by curtains or dry-walling at the sides with curtains covering front
entrance, as per local preference.
10. Clinical support areas to be shared between majors, minors and

paediatrics
10.1. Procedure Room

This is a room in which procedures may take place, specifically those requiring a form of conscious
sedation or local or regional anaesthesia. It is fully equipped with surgical lighting, monitors, some
medications (others will be in scheduled drugs cupboard in resuscitation or elsewhere) and equipment
for common procedures. Patients may receive post-procedural observations for some hours here.
The procedure room should be located such that it is easily be accessible to majors and minors, preferably
somewhere between them.
The number of procedure rooms depends on the size of the EC.
REQUIREMENTS
• Service panel (per trolley accommodated within the unit)
o 1 x Oxygen outlet
o 1 x Medical air outlet
o 1 x Suction outlet
o 4 Plug points
o Staff Emergency Call
• Theatre quality lighting is required over each trolley
• Equipment
o Full monitoring equipment
o Ceiling-mounted surgical lamps
• Cupboards/Shelving for procedure packs, stationery, stock
• Emergency trolley
• Hands free scrub sink with elbow taps or foot operated taps.

FIGURE 17: PROCEDURE ROOM
10.2. Plaster of paris (POP) Room

Dedicated room for applying Plaster of paris to fractured limbs of patients seen in the EC. The POP room
should be accessible to Majors and Minors, preferably somewhere between them. A minimum of one POP
room is required in the EC. The room size should be a minimum of 16 m².
REQUIREMENTS
o 1 x Oxygen outlet
o 4 Plug points
• High quality lighting is required over each trolley
• Equipment
o Large X-Ray viewing board - at least 3 panels
• Large storage areas with cupboards/shelving for procedure for POP, equipment, crutches, packs
• Hands-free wash hand basin with elbow taps, waste bin
• Large SS sink for POP

FIGURE 18: PLASTER OF PARIS ROOM (POP)
11. Administrative areas

The administrative spaces are common to all areas within the EC.
11.1. Standard Administrative Rooms

(Refer to the IUSS Standard Room Document )
• Office for:
o Nurse manager;
o Unit manager;
o Clinical manager;
• Clinical Administration space for digital radiology screens;
• Meeting/Seminar room;
• Management of mass casualties and major trauma patients (this depends on the size and location
of the EC and is not included in all facilities);
• Undergraduate and postgraduate teaching (this is dependent on the category of hospital).
11.2. Non Standard Administrative Rooms

Administration cubicles
DESCRIPTION
Patients, upon entering the EC, are required to register at a dedicated EC reception. This requires either
collection of their existing records from Medical Records or a new registration (electronically) has to be
initiated (for new patients). Either way, privacy is required when discussing details and admission
cubicles off reception are required.

The ideal set-up would entail a few kiosks/cubicles serving a single queue of patients (working for the
most part on a first come first served basis), as opposed to individual queues forming in front of each
kiosk.
LOCATION
The administration cubicles are required adjacent to the triage waiting area, accessible from Triage
Rooms, Paediatric area, Majors and Minors via the Administration sub-waiting area.
This area should be linked to the main records of the hospital.
SERVICES
Data points at each cubicle;
Power outlets for computer at each cubicle;
Fax and printer power outlets;
Nurse call linked to the clinical and staff areas;
Telephone outlet.
REQUIREMENTS
• An open plan area with counter top ( wheelchair friendly) with individual cubicles created for
privacy;
• Counter worktop for patients to write;
• Glass separation between patients and staff assisting;
• Area behind the staff at the counter for the fax and printing machines.
FIGURE 19: EXAMPLE OF ADMINISTRATION COUNTER

12. Staff areas
Staff must have access to all areas within the EC apart from identified stores with limited access.
12.1. Standard Staff Rooms

• Staff room
• Staff ablutions
• Overnight accommodation for doctors
• Library
It is important that the staff areas are separate from the public and clinical areas. However, there must be
direct access for the clinical and nursing staff from the rest areas into all the treatment areas including the
code Red, Orange, Yellow and Green areas.
13. Service support areas
13.1. Standard Support Rooms

• Clean utility;
• Dirty utility (waste disposal);
• Sluice;
• Stores:
o Surgical supplies
o Clean linen
o Disaster supplies or equipment
o Consumables
o Equipment
o Medical
• Cleaners room;
• Patient shower and toilet;
• Mobile equipment bay;
• Mobile X-Ray bay.
13.2. Non-Standard Support Rooms

Laboratory area with blood analyser
A small laboratory for tests where results are required immediately off the resuscitation area.
Approximate size is 6 m².
LOCATION
Directly off the resuscitation area or provide a surface within the resuscitation area

SERVICE
• A double bowl, stainless steel sink;
• Hand wash clinical basin with elbow taps and splash back;
• Power points in the wall above the counter top for the blood gas analyser and other blood-testing
machines and printer as required;
• Power outlet for a small fridge.
REQUIREMENTS
• Counter top with cupboards underneath;
• Waste bin.
14. Speciality assessment units

A number of speciality areas are not always included in EC. These are to be determined at the planning
stage.
14.1. Paediatric unit

National policy states that ECs should have dedicated paediatric areas, where children can wait, be seen
and assessed in a child-friendly environment, separate from the adult areas. Paediatric patients coming
by ambulance would be taken directly to this area, while paediatric patients brought in by private
transport would first be triaged and then streamed to this area. The only paediatric patients not seen in
this area would be resuscitation patients.
Areas include:
a. Public space
i. Main paediatric waiting and ablutions
ii. Reception
b. Clinical spaces
i. Assessment rooms
ii. Sub-waiting
iii. Consulting rooms
iv. Treatment area
v. Counselling rooms
vi. Rehydration area
vii. Observation area
c. Administration spaces
d. Staff spaces
e. Service support spaces.
LOCATION
• Close to the EC and should share the EC entrances
• Clear pathway to procedure rooms and POP room in EC.
The paediatric unit should have
• Free-flow access from Triage, Administrative area as well as from ambulance entrance.
• Free-flow to resuscitation.

PAEDIATRIC PATIENT FLOW
• All walk-in patients will be triaged and forwarded to the paediatric area where they will first
collect their folders before proceeding to the paediatric main waiting area;
• Patients requiring resuscitation (code Red) will be directed immediately to the resuscitation area
• Patients arriving by ambulance that do not require code Red service attention will be taken
straight to the paediatric main waiting area;
• From the main paediatric waiting area, patients will go to the assessment cubicles
Paediatric sub-waiting
The sub-waiting area should flow from the Triage, Administrative area and Ambulance entrance.
All walk-in patients will be triaged first (except for those obviously extremely ill, who will be streamed
straight from the walk-in entrance to resuscitation). Some will need to be sent straight to the Paediatric
area (needing urgent attention) while others will wait for a folder before proceeding to paediatric sub-
waiting area.
Patients arriving by ambulance will go straight to the paediatric sub-waiting area (folder will be
requisitioned by ambulance staff).The sub-waiting should be adjacent to a toilet area (preferably not
shared with another area) and nappy-change facility.
There must be an adequately-sized play area within the paediatric sub-waiting.
Paediatric assessment area (consulting rooms)
This area is adjacent to the paediatric sub-waiting and flows from that area.
These could be separate assessment rooms or an open-plan area with curtained cubicles. Each cubicle
would house an examination trolley. Although paediatric resuscitation will occur in the main
resuscitation area, it is advisable to have a paediatric resuscitation trolley close at hand.
In larger hospitals, one high specification bed (for more intense monitoring) may be feasible.
The minimum size is 12 m² for a contained room and 10 m² if the assessment areas are curtained.
Minimum wall length per area is 3 m. The quantity depends on the size of the unit and patient case load.
The quota here will be part of the overall 1 treatment space for every 1 100 patient visits per year for the
EC. Consideration should be given to the proportion of patients seen in this stream, the amount of staff
manning this stream and turnover rate of this stream.
REQUIREMENTS
o 1 x Oxygen outlet
o 4 Plug points
• High quality lighting is required
• Equipment
o X-Ray viewing board, one panel
• Cupboards with cupboards/shelving
• Hands-free wash hand basin with elbow taps and waste bin
• One examination trolley
• One desk, chair for the doctor and two chairs for the patients (mother and child) per cubicle
• Wall-mounted vital signs monitor

• Wall-mounted Lin-bins
• Sharps’ container
• Computer terminal per cubicle if “paperless” hospital.
FOR THE AREA GENERALLY

• One resuscitation trolley
• Workstation with 2 chairs (doctor and nurse), computer and telephone
• A second telephone (on desk or elsewhere)
• Cupboards/shelves for stationary
• Mobile equipment trolley (waist high) for stock, top of which can act as small work surface
SEPARATION OF CUBICLES
If these are curtained, not walled cubicles:
• Curtains must be in 3 separate lengths with stops in order to be able to access the opening
between curtains, and slight overlap, so as to ensure patient privacy
• Preferably honeycomb fabrics to be used for curtains
• As much as possible, acoustic architectural techniques need to be employed to reduce
reverberation and transmission of sound.
Rehydration Area
An area to house gastro patients who are being assessed to ascertain whether or not they can keep fluids
down (and thus go home). These patients would only be kept for about 4 hours, after which time they
would be discharged or admitted. As these are not ill patients, they do not need to occupy beds, rather can
sit on mothers’ laps.
This is a room near to, and accessible from, the paediatric area, but not necessarily in the paediatric area
or even in the EC.
The patients would need to be easily visible from the nurses’ station.
This area should contain, or be directly adjacent to, a nappy change area and, if load necessitates, a
separate sluice.
REQUIREMENTS
• Comfortable seats for mothers: children to sit on laps
• Sink and work-surface for nurses to mix up oral rehydration solution. Adjacent kitchen area may
be an option depending on layout and local preferences
• Separate hands-free wash hand basin
• Storage for cups, sachets
• Nappy change area
14.2. Mental-health assessment area

The patient who is suffering from an acute psychological or psychiatric crisis has unique and often
complex requirements. The EC should have adequate facilities for the reception, assessment, stabilisation
and initial treatment of patients presenting with acute mental-health problems.
It is not to be used for prolonged observation of uncontrolled patients. The main purpose of such an area
is to provide a safe and appropriate space to interview and stabilise patients. Acute mental-health
presentations have the potential to disrupt the normal operation of an EC. Conversely, the busy
environment of an EC may not be conductive to the care of patients with acute mental-health crises

LOCATION
The Acute Mental-Health Assessment Facility should be separate enough from adjacent patient care areas
to allow privacy for the mental-health patient as well as protection of other patients from potential
disturbance or violence.
There should be both acoustic and visual separation from adjacent clinical areas, but ready access for staff
in the event of an urgent need for intervention. The incorporation of sound-insulating material is
recommended. Patient flows should be separated where possible to maximise privacy and to minimise
disruption. A separate secure entrance for use by community emergency mental-health teams and the
police is desirable. Patients should be continuously observable by staff either directly or via closed circuit
television
Ideally the facility should contain at least two separate but adjacent areas:
Calming room
• The calming room should be within close proximity of other continuously staffed areas of the
department, with ready access to assistance when required.
• As far as possible, the facility should not contain objects that could be thrown at staff.
• There should be two separate exists to allow the exit of staff if one exit is blocked.
• The exit doors should open outwards, and should be lockable from the outside but not from the
inside. One door should be large enough to allow a patient to be carried through it.
• If a window is incorporated, any drapes or blinds shading the window should be operable from
outside.
• All areas should have easily accessible duress alarms.
• As far as possible, the area should be free of heavy or breakable furniture, sharp or hard surfaces
which could injure an uncontrolled patient, and should incorporate tamper-resistant electrical
fittings.
• It should also incorporate interior design features that promote calmness, such as muted colours
and soft furnishings and appropriate lighting.
• Designed in such a way that observation of the patient by staff outside the room is possible at all
times; this may be backed up with CCTV for the safety of staff.
• Arranged to ensure that patients have no access to air vents or hanging points.
• Fitted with a smoke detector.
• Fitted with duress alarm at each exit.
• Have an epoxy floor finish that is easily cleanable.

MATTRESS
FIGURE 20: CALMING ROOM
Examination/Treatment Room
• The Examination/Treatment Room should be immediately adjacent to the seclusion room;
• It should contain adequate facilities for physical examination of the patient, however the
inclusion of unnecessary and easily dislodged equipment should be avoided;
• It should contain the appropriate facilities and monitoring equipment, mounted out of reach of a
potentially violent patient;
• It should contain the minimum of additional fittings or hard furnishings that could be used to
harm an uncontrolled patient or staff;
• It should be of sufficient size to allow a restraint team of five people to surround a patient on a
standard Emergency Unit bed and should be at least 12 m2 in floor area;
• 2 x Comfortable chairs to be used during psychiatric assessment.
14.3. Clinical Forensic Unit

A Clinical Forensic Unit is an independent unit, separate from the EC with separate staffing. However,
each EC should have an area that can house patients who have been victims of violent assault and are
suffering from injuries necessitating acute care, including sexual assault, domestic violence, and
paediatric patients suspected or known to have been abused. Alleged perpetrators (if seen at the same
time as victim) should to be seen in a completely different part of the EC or, preferably, different part of
hospital.
Patients will be sent from the triage area straight to the Crisis Centre and will not have to wait in the main
waiting area. Victims of rape and violence are seen at the unit. Most of the patients will require police
intervention combined with the clinical intervention. The unit should provide a homely environment with
the emphasis on developing a therapeutic environment and a safe space.
The unit should be placed close to the resuscitation area as the unit is regarded as a Red Zone.
Patients attended to at the unit will revisit the unit for the first follow up visit before being seen at the
outpatients department .

Provide:
• A waiting area for the family or escorts should be provided with separate waiting areas for adults
and adolescent/child victims. These waiting spaces should be private and if possible should be
positioned close to the consulting/counselling rooms
• A kitchenette
• Two offices
• One counselling room for adults
• Counselling for children with a one-way mirror
• The number of consulting rooms will depend on the environment, provide a large consulting
room with facilities to suture, an examination light and medication cupboard, clean linen
cupboard and patient pack storage space
• Provide patient shower and toilet off the consulting room
• Children should be provided with a therapeutic play area
• Provide a toilet and a child bath.
FIGURE 21: PATIENT FLOW - CLINICAL FORENSIC UNIT
14.4. Counselling/comfort room

An area for relatives to sit before, during and after they receive news of their loved-one’s death, or
pending death. This may also function as a room for counselling.
• A counselling room must be provided within the EC unit;
• The room should be able to accommodate at least 5 people comfortably;
• Soothing décor should be considered;
• Couches and or comfortable chairs to be provided as well as tables;
• Soft lighting should be installed;
• Telephone with outside line;
• Refreshments available close by;
• Some play things for children.

14.5. Body viewing room
This is a room where newly deceased patient can be cleaned and readied for relatives to view or a body
held until collected.
• The room should be outside of the EC but in close proximity;
• The room should be approximately 16m2 to accommodate a bed and family members;
• Lighting should be dimmable to soften the quality of light when viewing a body;
• Air conditioning is necessary to keep the body cool;
• A clinical wash hand basin with elbow taps is required;
• Two chairs;
• Cupboard for clean linen and cleaning materials.
14.6. EC Observation Ward

Refer to IUSS inpatient accommodation for general requirements.
The EC Observation Ward is required at larger hospitals (Regional and Tertiary/Central Hospitals), larger
district hospitals and is a dedicated ward for patients requiring a short stay (<24 hrs), or those patients
who need to be observed before a decision can be made as to whether to discharge or admit the patient.
The object of this ward is to improve the quality of care for patients through extended evaluation and
treatment while reducing inappropriate admissions.
The ward should be located adjacent to the EC and be accessible from Majors, Minors and Paediatric
areas.
The ward should have:
• Dedicated observation beds (number to be determined by the annual patient census in EC, at a
suggested rate of 2.5 - 5 beds per 10 000 attendees);
• Available nursing staff (on rotation through the ward from the EC) and support staff.
15. Emergency care area in a clinic or CHC (8-hour clinic)

This room is necessary for the assessment, stabilisation and initial treatment of emergency patients
attending a clinic or CHC (8 hour clinic). While the frequency of use is low (as low as 2-3 times a week in
smaller clinics), it is still necessary that these rooms are set up to treat these patients effectively up to the
point that they can be transported to the nearest, appropriate facility.
• This room may need to accommodate more than one patient at a time, eg asthma patients.;
• This room should be close to the ambulance access which is separate to the main entrance to the
clinic;
• The room should be at least 18 m²;
• Basic equipment required:
o Mobile oxygen;
o Telephones;
o Wall-mounted vital signs monitor;
o Fully stocked resuscitation cart ;
o Defibrillator;
o Suction;
o Resuscitation trolley x 2;
o Suction.

15.1. After-hour clinic patients in the EC
Stable, unscheduled patients can be seen as part of the Minors stream, as, by definition, they are Minors
patients. It is up to individual facilities as to whether this stream is seen within the EC or continues to be
seen in the Minors area after hours. This decision is largely based on manning and distance of Majors
from Minors area. No extra area is needed for this group.
Note: Triage area is NOT a consultation area and is not equipped as such, thus should not be used to
assess these patients.
16. Engineering requirements

Refer to the IUSS document:Building Engineering Services

PART C - USER ROOM REQUIREMENTS
1. Emergency Centre – Example of user room requirements

TABLE 6: EC – EXAMPLE LIST OF EC ROOM REQUIREMENTS
ROOM Standard Non-standard Area Each

Component Component m²
AREA 1
EXTERNAL AREA
Ambulance Drop Off X
Helipad X
ENTRANCE
Decontamination Shower x 6
Reception/Info/Help Desk x 12
Public Ablutions - Male x 4
Public Ablutions - Female x 4

Toilet for the Disabled x 5
Baby Change Area x 6
Family and Friends Waiting Area x 52
Casualty Admissions Desk and Cubicle x 21
Children’s Play Area x 12
Porters Room with Kitchenette x 20
Security x 6
Trolley Bay (15) x 1.5
Wheelchair Bay (15) x 0.6
Store – Disaster equipment x 20
Bay - Handwashing x 1
DOA Room x 15
Patient Bay - Triage x 10
Lodox x 14
AREA 2
TRIAGE/Assessment
Sub-waiting Area x
Patient Bay - Triage x 10
Workstation x
AREA 3
RESUSCITATION - RED CODE AREA
Resuscitation Area Bays X 20
Paediatric Resuscitation Bays x 12
Bay - X-Ray Equipment x 4
Bay - Handwashing 1

AREA 4
MAJORS -ORANGE/YELLOW CODE AREA
Trauma Beds x 10
Non-Trauma Beds x 10
Central Nurses Station 1 x 15
En Suite bathroom x 5
Toilet - Patient x 4
Isolation Room 15
Shower - Patient x 4
Bay – Resuscitation Trolley x 2
AREA 5
MINOR TREATMENT CONSULTATION - CODE GREEN AREA
Sub-waiting Area x 16
Nurses’ Station x 10
Public Ablutions x 4
Consulting Rooms (6) x 15
Counselling Room x 9
SHARED SUPPORT
Blood Store/Fridge X 24
Laboratory x 12
Clean Utility x 12
Cleaners’ Room x 4
Dirty Utility x 9
Procedure/Treatment Room x 12
Laying-out Room x 16
Store – Pharmaceutical x 6
Store - Equipment x 20
Store – Surgical x 10
Store - General x 9
Store - Clean Linen x 9
Ventilator Cleaning Room/Store x 9
Seclusion Room x 15
Plaster Room x 16
Procedure Room x 40
Patient Bay – Holding x 9
Patient Bay – Recovery x 9
Waste Disposal x 8

ADMINISTRATION FACILITIES – SHARED
Medical Head of EC x 24
Doctors’ Office (Open plan for 3) x 21
Meeting Room - Large x 45
Office – Unit Manager x 16
Sisters’ Office x 12
Staff Facilities – Shared
Overnight Stay with en suite- Doctors x 9
(Min 3 per unit)
Staff Shower x 2
Staff Toilet x 2
Staff Restroom x 20
Staff Change x 12
IT Room x 4
SPECIALITY UNITS
ACUTE MENTAL HEALTH
Seclusion Room x 15
Examination Room x 15
CRISIS CENTRE
Entrance x 5
Waiting Adult x 10
Waiting Children x 10
Waiting Perpetrator x 9
Reception -Adult and Children x 8
Counselling Adult x 9
Counselling – Children x 9
Consulting/Examination – Adult x 15
Consulting/Examination - Children x 21
En suite to Examination Rooms x 5
Examination – Perpetrator x 15
SAPS Office x 9
Sobriety Room- Perpetrator x 9
OBSERVATION/REHYDRATION WARD (Short Stay)
Male Bed Unit x 10
Female Bed Unit x 10
Nurses’ Station x 10
Isolation Room x 15
Toilet-Male x 4
Toilet-Female x 4
Assisted Shower x 5
Clean Utility x 12
Dirty Utility x 9
Bay – Resuscitation Trolley x 1
Store - Linen x 9
Store- General x 9
Store - IV Fluids x 6
Store - Sterile Packs x 6

SOCIAL WORKERS
Waiting x 10
Office x 12
PAEDIATRIC UNIT
Main Paediatric Waiting x 16
Reception/Nurses’ Station x 14
Sub-waiting 12
Consulting Room x 12
Treatment Room x 15
Rehydration Area x
Observation Area x
Staff Room x 16
Staff Ablution x 4
Office Sister x 12
Office Doctor x 12
Sluice x 9
Dirty Utility x 8
Clean Utility x 9
Store – Consumables x 9
Store - General x 9
Store - Linen x 6

TABLE 7: EXTRACT FROM DRAFT REGULATION GOVERNING EMERGENCY CENTRE IN SOUTH AFRICA
EMERGENCY CENTRE REQUIREMENTS13

MAJOR
MAJOR SPACE DETERMINANTS (Tertiary) REGIONAL DISTRICT PRIMARY
(Balfour document: Draft 2009) EC EC EC EC
Major functional areas
Acute treatment area (non-ambulant patients) x x x x
Consultation area (ambulant patients)
2
minimum 6 m access to hand basins x x x
Consultation area for paediatric patients and gynecological
examination x x
General reception and administrative area x x x x
Plaster of paris room x x x
Resuscitation area - Depends
2
minimum 12 m on the
minimum wall length 3 000 mm x x x facility
Staff work stations x x x
Triage/Waiting area x x x x
Specialty areas
Distressed relatives/Interview room x x x
Isolation room/Treatment area minimum back wall length 300
mm x x x
Procedure room -
2
minimum 12 m x x x
Teaching areas
Tutorial room/area may not be attached to the emergency centre x x
Support services
Ablution facilities for patients x x x x
Access to wheelchair toilet x x x x
Cleaner’ room x x x x
Dirty utility room x x x x
Emergency department short-stay ward x x
Equipment storage area x x x
Hazmat shower x x
Office and administrative area/doctor and nurses x x x
Public toilet facility with hand basins x x x x
Rest room with ablution and shower facility for doctor x x
Shower/Bathroom/Toilets for staff x x
Staff rest room x x x x
Storage area for disposable stock as well as sterilised packs x x x x
Total size
2
Excluding observation area not less than 50 m per 1 000 yearly
attendants x x
2
Minimum size allowed - 700 m x x
Total number resuscitation areas not less
than 1 per 15 000 yearly attendants x x x
Total number of treatment areas
1 per 1 100 yearly attendants x x x
13Draft Regulation Governing Emergency Centres in South Africa

MAJOR
(Balfour document: draft 2009) EC EC EC EC
Functional relationship
Direct access to
24 hour X-Ray facilities on premises x x
Intensive care unit x x
Operating theatre x x x
Overhead gantry in resuscitation service/or portable
X-Ray facility in the department x x
Ready access to
Blood bank x x
Cat scan x x
Coronary care unit x x
Medical records x x x x
Pathology x x x x
X-Ray department x x x
Access to
Inpatient wards x x x
Mortuary x x x x
Outpatients x x x
Pharmacy x x x x
Short-stay ward x x x x
Design
Minimal cross traffic x x x
Close proximity between acute treatment area and resuscitation
area x x x
Protection of visual/auditory and olfactory privacy x x x x
Visitor access should not traverse clinical areas x x x x
Doors
Doors can be easily removed or opened for patient access in case
of emergency x x x x
Doors giving access to rooms for patient treatment at least 1.2 m
wide x x x
Floors
Easy to clean x x x x
Floors with concrete finish to a smooth washable finish or covered
with washable material x x x x
Non-slip surface x x x x
Ceilings
Comply with requirements of NBR x x x x
Walls
All wall surfaces to be covered with smooth finish and must be
painted with a durable, washable paint or covered with a similar
washable impervious material x x x x
Wall behind wash basins
Washable impervious covering up to height of at least 450 mm
above and a distance of at least 150 mm on each side of such fitting x x x x

MAJOR
Access and car parking

Adequately sign-posted x x x x
Car-parking close to main entrance x x x x
Located on ground floor x x x x
Pick-up and drop-off area for patients x x x x
Protected parking for on-call staff x x
Ramp to be provided if level of ground outside not the same as
inside x x x x
Undercover parking for ambulance and emergency vehicles x x x
Bed space
2.4 m clear floor space between beds x x x
Minimum length 3 m x x x
Lighting
Exposure to daylight x x x x
Lighting must conform to South African standards R158
400 lux at working place x x x
10 000 lux for local examination luminaries x x x
Electrical installations
The complete installation must conform to any special, local or
district requirements x x x x
Consumer code for the wiring of premises
South African Bureau Standards specification 0142 NBR x x x x
Occupational Health Safety Act of 1993 x x x x
Telkom regulations x x x x
The local authority fire regulations x x x x
Emergency power
Emergency generator in the hospital or uninterrupted power
supply which is of sufficient capacity to supply all critical areas x x x
Critical supply points include
All switched socket outlets used for patient life-support x x x
Gas alarm systems x x x
Medical air compressors x x x
Strategic lighting in resuscitation service
Switched socket outlets
Must be on earth-monitoring system x x x
Double-pole miniature circuit breakers must be used for critical
supply points x x x
Uninterrupted power supply
Must conform to SABS 1474 of 1998: Uninterrupted Power
Systems x x

MAJOR
Gases
May be provided by bottled or piped systems x x x x
Oxygen x x x x
Safety gases
A gas alarm system to monitor gases, excluding scavenging x x
Back-up system for medical gas x x
Oxygen supply for each patient unit x x x x
SABS 0224: Non-flammable medical gas pipeline systems x x
SABS 051 Part III: Handling and storage of medical gases and the
instillation of medical gas, compressed air and vacuum pipeline
systems x x
SABS 1409: The outlet sockets and probes for gas and vacuum
systems x x
The medical gas alarm must be connected to the emergency
power supply x x
Vacuum
May be piped or mobile. x x x x
Safety vacuum
The vacuum instillation shall comply with
Back-up system for vacuum x x
Emergency suction facilities x x x x
SABS 051 Part III: Vacuum liquid bottle traps must be installed to
collect blood/fluids etc. that may be drawn into the pipeline. One
bottle trap per patient-unit must be supplied x x
Suction units for each patient-unit
Nurse call systems
Each bed shall have a nurse call system x x x
Emergency call system in patient toilet facilities x x x x
Service panels minimal requirements:
Resuscitation bed
2 oxygen outlets x x x
1 medical air outlet x x x
2 suction outlets x x x
Switched socket outlets minimum 4 per bed x x x
Majors/Acute treatment bed
1 oxygen outlet x x x x
1 suction outlet x x x x
5 plug points x x x
Procedure/suture/plaster rooms
1 oxygen outlet per bed x x x
1 suction outlet per bed x x x
3 plug points per bed x x x
Consultation room x x x
1 oxygen outlet x x x
1 suction outlet x x x
2 plug points x x x

MAJOR
Storage around bed

Modular plastic or similar system x x x x
Storage for disposable and non-disposable supplies x x x x
Provision of adequate cabling to ensure availability of plug points,

telephone patient call, emergency call systems and computers
All clinical areas x x x
All non-clinical areas x x x
Corridor width
Adequate width to allow for passage of hospital bed without
difficulty x x x
Air conditioning
Resuscitation room
Designed to deliver 10 air changes per hour x x
Filter may be washable x x
Filter design to filter air down to 5 microns at 20% efficiency x x
2
Filter to have a minimum area of 0.35 m x x
Fresh air introduced from outside at 30 litre per second x x
Suction temperature of unit should not go below 3 degrees x x
Temperature in the room should not exceed 26 degrees
more than 14 days during a normal year x x
Other treatment areas
Air-conditioning not essential x x
If installed should meet resuscitation room requirements x x
Communication support
Telephone in acute treatment area x x x x
Telephone in clerical area x x x x
Telephone in department independent of switch board x x
Telephone in resuscitation unit x x x
Emergency call facilities
Emergency bell audible in all areas of the department x x x x
Identified and accessible to staff in all areas x x x x
Hand washing facilities
Available in each treatment area x x x x
Ratio of 1 for every 4 beds x x x x
Wall clocks
Visible in all clinical areas x x x x

MAJOR
Resuscitation room
Accessible from acute treatment areas x x x
Accessible from staff station x x x
Appropriate lighting as per SABS minimum 1 000 lux luminaire x x x
Circulation space to allow for staff movement x x x
Direct access to helipad day and night x x
Direct covered ambulance access x x x
Disposal dirty utility room x x x
2
Minimum floor space of 12 m and minimum wall length 3 000
2
me x x
Minimum two dedicated resuscitation beds x x x
Radiation protection as per SABS standard x x
Service panel per bed x x x
Shelving/lin bin system for bed space stock x x x
Space for equipment monitors at each bed space x x x
Space to ensure 360 degree access to patient x x x
Storage cupboards x x x
Wash-up facilities and scrub trough x x
Work benches x x
X-Ray gantry with full access to all resuscitation beds x x
Majors/Acute treatment areas
Access to disposal dirty utility room x x x
Accessible from reception and resuscitation area x x x x
Access to X-Ray facilities x x x x
Accessible from staff station x x x x
Appropriate lighting as per SABS minimum 1 000 lux luminaries x x x
Each area separated by solid partitions from floor to ceiling x x x
2
Each treatment area must be at least 10 m in area x x
Entrance to area must be able to be closed by partitions, curtains
or doors x x x x
Minimum space between beds must be 2.4 m x X x
Patient shower and toilet x X x
Separate gynecological examination area x X x
Separate pediatric area for children x x
Shelving/lin bin system for bed space stock x x x x
Space for equipment monitors at each bed space x x x x
Storage cupboards x x x x
Work benches x x x

MAJOR
Isolation room
Accessible from acute treatment areas x x x
Accessible from staff station x x x
Appropriate lighting as per SABS minimum 1 000 lux luminaries x x x
Disposal dirty utility dedicated to isolation area x x x
Shelving/lin bin system for bed space stock x x x
Space for equipment monitors at each bed space x x
Hand basin dedicated to isolation area x x x
Completely enclosed from floor to ceiling x x x
Solid door x x x
1 room per 10 000 annual attendants x x x
Consultation area
2
At least 10 m in area x x x x
Accessible to toilet facilities x x x x
Adequate space allocated for wheelchairs x x x x
Area for children to play x x x x
Open and easily observed from reception area x x x x
Seating 1 per 1 000 yearly attendants x x x x
Sufficient space for waiting patients x x x x
2
Total size of at least 4.4 m per 1 000 yearly attendants x x x x
Waiting room comfortable seating x x x x
Reception/triage area
Sufficient space for processing of admission access to computer
telephone and fax facilities x x x x
1 for ambulance and stretcher patients x x
1 for ambulant patients x x
Access to area controlled by security doors x x x
Access to treatment area restricted x x x x
Access to treatment from reception area controlled by security
doors x x x x
2
At least 0.8 m per 1 000 attendants per year x x x
Department accessed by 2 doors x x x
Waiting area for family and friends/enough space to prevent
congestion x x x
Security
Location of security staff in close proximity to the unit x x x
Call system for security to respond to unit x x x x

MAJOR
Doctors’ rest room and ablution facility
Adequate space for bed and night stand x x
Adequate space for work station x x x x
Close proximity to resuscitation and acute treatment area x x
En suite ablution and shower facility x x
Telephone x x
Staff tea room
Audible emergency call system x x x x
Immediate access to resuscitation and acute treatment area x x x x
In close proximity to unit so staff do not have to leave unit x x x x
Not visible to patients and family from waiting or treatment
areas/one-sided glass can be used. x x x x
Telephone x x
Cleaners’ room
Adequate storage space for cleaning materials x x x x
Wash basin x x x x
Patient ablution facilities
Accessible toilets within close proximity to acute treatment area x x x x
Accessible to wheelchair patients x x x x
Male and female toilets x x x
Minimum 1 toilet per 15 000 attendees per year x x x x
Not used as staff toilets x x x x
One hand basin per two toilets x x x x
Storage space for medical equipment x x x x
Hazmat shower
Able to control water temperature x
Hand-held shower x
In close proximity to ambulance entrance x
Must provide for patient privacy x
Raised area for staff so as to avoid standing in contaminant x
Spacious enough to allow for stretcher access and staff assistance x
Water flow run-off brisk x
Distressed relatives/interview room
Not in close proximity to treatment areas x x x
Private area for family and friends x x
Telephone
Observation short-stay area
Minimum 4 bed unit x x
Patients admitted for up to 48 hours x x
Service panel per bed space x x
Ward in close proximity to acute treatment area x x
Clean utility area
Ability to lock area x x x x
Sufficient size for the storage of clean and sterile supplies x x x x

LIST OF ABBREVIATIONS
EC Emergency Centre
ENT Ear, nose and throat
EMSSA Emergency Medicine Society of South Africa
HIG Hospital Infrastructure Grant
HRG Hospital Revitalisation Grant
IUSS Infrastructure Unit Systems Support
NDoH National Department of Health
OoM Order of Magnitude
PMIS Project Management Information System
PMSU Project Management Support Unit
RC Recommendation Committee
SS Stainless steel
TSSA Trauma Society of South Africa

REFERENCES
Health Projects International, Department of Human Services, 2004. Design guidelines for hospitals and day
procedure centers: Standard components room data sheets (2 November 2004 Issue 1). Victoria: DHS.
NHS Estates, executive agency of the Department of Health, 2006. Health Building Note (HBN) 22: Accident and
emergency facilities for adults and children. London: TSO (The Stationary Office).
The Council for Health Services Accreditation of Southern Africa: Emergency Centre Standards: Post Pilot:
November 2007
Health Department of Western Australia, Facilities Unit, 1995. Emergency unit design guidelines. Western
Australia: Health Department of Western Australia.
Emergency Medicine Society of South Africa (EMSSA), 2009. Practice guidelines. [online] Available at:
http://emssa.org.za/index.php?s=practice+guidelines [Accessed 15 February 2014].
The Australasian College for Emergency Medicine (ACEM), 2007. Guidelines on emergency department design
(version 2). West Melbourne Victoria: ACEM.
Draft regulations National Department of Health: Regulations Governing Emergency Centres in South Africa
Emergency Medicine Society of South Africa (EMSSA), 2010. Practice guideline EM014: Implementation of the
South African triage scale. South Africa: EMSSA.
NHS Estates, executive agency of the Department of Health, 2006. Improving the patient experience: Friendly
healthcare environments for children and young people. London: TSO (The Stationary Office).
The South African Triage Group (SATG)

- Paediatric Triage Working Group (PTWG) of the Western Cape Government (WCG) of South Africa (SA)
World Health Organisation (WHO), 2005. Emergency Triage Assessment and Treatment (ETAT): Manual for
participants. Switzerland: WHO.

APPENDIX
THE SOUTH AFRICAN TRIAGE SCALE (SATS)


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IUSS HEALTH

Task Team: A:01

Form: Health facility guides

Title: Emergency Centres

PART B - PLANNING AND DESIGN ......................................................................................... 10

INFRASTRUCTURE UNIT SUPPORT SYSTEMS (IUSS) PROJECT 1

INFRASTRUCTURE UNIT SUPPORT SYSTEMS (IUSS) PROJECT 2

PART C - USER ROOM REQUIREMENTS .............................................................................. 60

INFRASTRUCTURE UNIT SUPPORT SYSTEMS (IUSS) PROJECT 3

INFRASTRUCTURE UNIT SUPPORT SYSTEMS (IUSS) PROJECT 4

INFRASTRUCTURE UNIT SUPPORT SYSTEMS (IUSS) PROJECT 5

- Part C provides a list of user room requirements

- Part D provides a list of proposed equipment requirements

INFRASTRUCTURE UNIT SUPPORT SYSTEMS (IUSS) PROJECT 6

INFRASTRUCTURE UNIT SUPPORT SYSTEMS (IUSS) PROJECT 7

An emergency is a condition where the patient is, or is believed to be,

A regional hospital may provide emergency care and trauma services.

INFRASTRUCTURE UNIT SUPPORT SYSTEMS (IUSS) PROJECT 8

3. Determining the size of an emergency centre

TABLE 2: PROPOSED CALCULATIONS

3Emergency Medicine in South Africa: EMSSA 2009

INFRASTRUCTURE UNIT SUPPORT SYSTEMS (IUSS) PROJECT 9

2. Operational functioning of an Emergency Centre (EC)

2.1. Hours of operation

2.2. Patient escorts

INFRASTRUCTURE UNIT SUPPORT SYSTEMS (IUSS) PROJECT 10

3. 10 Useful Tips for Designing an Outstanding EC 5

INFRASTRUCTURE UNIT SUPPORT SYSTEMS (IUSS) PROJECT 11

4. General Design considerations

4.2. Design for privacy and dignity

4.3. Reduction of noise levels6

INFRASTRUCTURE UNIT SUPPORT SYSTEMS (IUSS) PROJECT 12

4.5. Salutogenic design

4.6. Calming environment to help reduce aggression

4.7. Meeting the needs of special patient types:

INFRASTRUCTURE UNIT SUPPORT SYSTEMS (IUSS) PROJECT 13

4.11. Design should provide:

INFRASTRUCTURE UNIT SUPPORT SYSTEMS (IUSS) PROJECT 14

4.12. Common mistakes in the design of ECs

5. Location and clinical departmental relationships:

INFRASTRUCTURE UNIT SUPPORT SYSTEMS (IUSS) PROJECT 15

INFRASTRUCTURE UNIT SUPPORT SYSTEMS (IUSS) PROJECT 16

6. Intradepartmental relationships and f unctional zones

INFRASTRUCTURE UNIT SUPPORT SYSTEMS (IUSS) PROJECT 17

INFRASTRUCTURE UNIT SUPPORT SYSTEMS (IUSS) PROJECT 18

INFRASTRUCTURE UNIT SUPPORT SYSTEMS (IUSS) PROJECT 19

6.1. Patient coding7

INFRASTRUCTURE UNIT SUPPORT SYSTEMS (IUSS) PROJECT 20

Priority Colour Target time Management/ Streaming

6.2. Resuscitation, majors and minors areas

INFRASTRUCTURE UNIT SUPPORT SYSTEMS (IUSS) PROJECT 21

FIGURE 5: ONE-WAY PATIENT FLOW

INFRASTRUCTURE UNIT SUPPORT SYSTEMS (IUSS) PROJECT 22

INFRASTRUCTURE UNIT SUPPORT SYSTEMS (IUSS) PROJECT 23

INFRASTRUCTURE UNIT SUPPORT SYSTEMS (IUSS) PROJECT 24

INFRASTRUCTURE UNIT SUPPORT SYSTEMS (IUSS) PROJECT 25

INFRASTRUCTURE UNIT SUPPORT SYSTEMS (IUSS) PROJECT 26

8.1. Site Access

INFRASTRUCTURE UNIT SUPPORT SYSTEMS (IUSS) PROJECT 27