Multidisciplinary health centre over four storeys

The length and the regularity of the two main facades make it possible to consider repeating bays. That repetition may concern the studs, the facade panels, the windows, certain joists and several connection details.

It does not mean that all the panels are identical. The doors, the risers, the fixed equipment, the radiation shielding, the openings and the bracing requirements produce specific components.

Repetition must be sought within a controlled structural grid. The genuinely recurring zones are prepared as such; the singular ones are studied separately rather than forced into a module that would not match their function.

Where a programme comprises several comparable centres, a common base can be developed for certain panels, consultation rooms, layouts or facade details. Each building nevertheless remains recalculated according to its site, its equipment, its dimensions and the applicable climatic or seismic actions.

In a multi-storey building, the loads of the upper levels accumulate progressively down to the foundations. The load-bearing walls, beams, lintels and supports must be organised so as to form continuous load paths.

Aligning the main load-bearing lines vertically generally limits complex transfers. Where a level calls for a wider room, a different corridor or an opening that interrupts that alignment, a transfer component may become necessary. That decision affects the floor depth, the connections and the technical passages.

The long circulation routes and the number of doors reduce the portions of wall available for bracing. Horizontal stability must be distributed between solid panels, cross walls, the floor and roof diaphragms, their connections and the anchors.

The partly occupied top level introduces a change of geometry. Any setbacks, roof areas, upstands and changes of facade must be coordinated with the transfer of the forces and the continuity of the envelope.

A floor intended for a health centre is not defined by its distributed load alone. Some machines apply concentrated loads, produce vibration or call for great stability of their support.

A lightweight solution on joists may suit certain zones where the spans, the loads, the deflection, the vibration, the acoustics and fire allow it. A reinforced dry build-up or a steel-concrete composite slab may be studied where more mass, stiffness or continuity is needed.

The choice may vary from one level or one zone to another. It would not be coherent to size a meeting room, an equipped laboratory and a room intended for heavy medical equipment in the same way.

Placing the imaging equipment on the ground floor may limit its interaction with the upper floors. It does not remove the study of the slab, the foundations, the vibration, the anchors or the route allowing these machines to be brought in and replaced.

An imaging room is designed from the characteristics of the machine actually chosen. Its dimensions, its mass, its clearances, its supply, its cooling, its associated rooms and its installation route must be known early enough.

Equipment producing X-rays calls for a radiation protection study. The walls, doors, glazing, floors and ceilings concerned must receive the shielding determined by the competent specialist. A later change to the machine, to its orientation, to its workload or to the use of the neighbouring rooms may require a reassessment.

An MRI room raises different questions. It must not be treated as a simple radiology room. Control of the magnetic field, protection against radiofrequency interference, controlled access, technical penetrations and any emergency provisions are developed from the requirements of the equipment.

The presence of a steel structure does not, by itself, allow the conclusion that an MRI room is compatible or incompatible. The position and the nature of the steel components, the shielding, the services and the other equipment must be coordinated with the MRI specialist and with the data of the chosen manufacturer.

The openings, reinforcement and interfaces are built in before manufacture. An opening made afterwards in a wall or a floor may simultaneously affect the structure, the shielding, the air tightness and the fire protection.

The plans distinguish several families of laboratory. Their presence on the same floor may make it easier to share certain services and support spaces, but their needs are not automatically identical.

The level of containment, the movement of samples, the separation between clean and exposed zones, staff access, safety equipment and waste management must be determined from the real activities.

Ventilation may call for specific flow rates, filtration, extraction or pressure relationships. The ducts required occupy part of the ceilings and pass through the floors. Their route must be reserved without cutting the joists, the bracing or the connections.

The benches and machines may call for water, drainage, electricity, data, gases, cooling or local extraction. These supplies must reach risers that are accessible and maintainable.

Moving a laboratory later does not therefore mean moving a partition. It may change the services, the loads, the ventilation, the treatment of effluent, the fire protection and the conditions under which samples and waste circulate.

A vertical building makes it possible to group certain risers between the levels. This arrangement becomes efficient where the wet rooms, the sanitary facilities, the technical equipment and the distribution points are coordinated within a single grid.

Drainage calls for falls and penetrations that cannot always be moved freely. The main pipes, ventilation ducts, cable trays and data networks must cross the floors in prepared zones.

Concentrating laboratories on one level and imaging equipment on the ground floor may lead to significant needs in electricity, air conditioning, data and continuity of service. The plant rooms and the capacity of the services are sized from the equipment chosen, not from the floor area of the building alone.

The schematic plans do not show all this infrastructure. They therefore do not allow the conclusion that the risers, plant rooms or capacities required are already provided for.

The longitudinal layout makes the levels easy to read, but it produces significant distances between certain functions. The routes of patients, staff, visitors, samples, consumables, cleaning and waste must be studied separately.

The stairs and the lift shown give an intention for vertical circulation. They do not demonstrate that their number, their dimensions, their capacity or their position answer the final brief.

The choice of lift depends on the people and the equipment to be carried. A car intended mainly for visitors does not have the same dimensions or the same loads as one that must take a stretcher, technical equipment or certain medical devices.

The exits, escape routes, compartments and waiting areas must be verified according to the occupancy, the uses, the mobility of the occupants and the applicable rules. Adding rooms or occupying a zone that carries no brief today may change that strategy.

Repeating the windows may simplify part of the facade, but the requirements vary from room to room. A waiting room, a laboratory, a consultation room and an imaging room do not necessarily call for the same daylight, the same privacy or the same acoustic separation.

The build-up of the envelope is studied according to the climate, the exposure, the thermal needs, the management of water and air, the acoustics and the fire protection. It remains distinct from the load-bearing structure.

Between the levels, the floor must be considered as a whole: frame, slab or substrate, insulation, ceiling, any resilient layers, penetrations and fire-stopping. The performance sought depends on the complete build-up.

The risers, cables, pipes and equipment that cross a separation must not interrupt the acoustic or fire functions foreseen. The treatment of these passages is prepared at the same time as the services.