In October 2012, David S. Burson stood in the former Charlestown Navy Yard, at the site of the new Spaulding Rehabilitation Hospital, at high tide during Hurricane Sandy. The water rose to two feet from breaching the site. “It was as high as I’ve ever seen it, but it didn’t come onto our site,” says Burson, a senior project manager at Partners HealthCare, an affiliate of the Spaulding Rehabilitation Network. “However, if Sandy had hit at a different hour, we probably would have seen some water.”

According to a Boston Harbor Association study, had Hurricane Sandy’s storm surge corresponded with high tide in Boston, instead of hitting after it, about 6 percent of the city would have been under water, including the former navy yard. That experience meant that Burson and other planners of Spaulding’s new 132-bed rehabilitation hospital could be immensely relieved that they’d designed a building capable of withstanding the rising sea levels projected over the next century. The 262,000-square-foot hospital, which opened in April 2013, includes a panoply of strategies that fall under the umbrella term of “resilience architecture”—in this case strategies specifically designed to thwart rising sea levels.

While Hurricane Sandy was confirmation that the approach was not only a smart one, but an essential one, the original impetus behind designing Spaulding as a resilient hospital was Hurricane Katrina in 2005 in New Orleans. “The failure of hospitals in Katrina led Partners HealthCare to develop a ‘top 10’ list for resilience features, beginning with setting the base elevation of the building above the current 500-year floodplain,” says Robin Guenther, the global sustainable healthcare leader for Perkins + Will, the architecture firm that designed Spaulding.

The 500-year floodplain maps the hypothetical inundation of Boston during a flooding event of such magnitude that it might hit the city once every 500 years. The ground floor of the Spaulding tower was raised about 2.5 feet above the current 500-year floodplain elevation. “It’s probably fair to expect that someday water will get to the building, given sea level rise projections over the life of the building, and that’s what we tried to prepare for in the design,” Burson says.

Spaulding, which has eight stories and a two-level penthouse, also has an underground parking garage, an obvious candidate for flooding. However, it was designed so that the ramp goes up to grade before descending to parking areas, and unless water breaches the ground floor of the hospital, the parking garage should stay dry, Guenther says.

On the hospital site, planners designed berms made of granite seawall blocks and some of the old oak timbers, which were uncovered in preparing the site for construction, Burson says. (Most of the timbers were donated to the restoration of a 19th-century whaling ship at the Mystic Seaport Museum in Connecticut.) The manmade berms create a reef of sorts to help protect the hospital from the sea if it floods. “Those stone walls, in addition to providing a landscape amenity, provide some measure of protection against a storm surge,” Burson says.

Besides strategies to thwart seawater from breaching the building, Spaulding’s designers also devised myriad measures to keep the building operational should it flood. Anything critical to the continued operation of the hospital is on higher floors, while the ground floor was made largely open to the public, which was also a condition of the Boston Redevelopment Authority for building on the site, Guenther says. Thus, the hospital’s ground floor has a public cafeteria-restaurant, a swimming pool used by rehab patients during the day and the community in the evenings, public bathrooms, and conference rooms that can be reserved by members of the public.

The 132 beds start at the fourth floor, and are typically 30 beds to a floor, except the eighth floor, which has 12 pediatric beds with the balance of the floor built out as administrative and support space, Burson says. “The eighth floor also provides some expansion capability in the future, should we ever need to expand the capacity.”

In another unconventional move, the building’s critical mechanical and electrical gear has been placed in the penthouse. That required a lengthy negotiation with the electrical utility provider (NSTAR) to allow their utility lines to run through concrete-encased walls up to the roof as well, Burson says. “Their traditional practice has been to locate their primary switchgear down at street level…in a separate vault where they have ready access or in the basement,” he says. “We didn’t think that was a prudent approach to this site.”

NSTAR’s primary switchgear vault is now up in the penthouse, and the utility controls access to the vault, sending its workers to the roof with a key. The only remaining vulnerability is flooding at the utility itself. In that case, the hospital, which has a cogeneration plant, can also function for four to five days on natural gas, which is stored in a double-walled 15,000-gallon tank. “The one thing you can’t do is elevate your fuel tank for your emergency generators—fire departments don’t let you do that,” Guenther says. “So the hospital has an underground fuel tank, and then the pump has to be located near it, so they put the pump in a floodproof vault.”

The vault is a submarine vault that’s completely watertight, so the pump should in theory continue to function despite flooding. “Our emergency generators would still be operational,” Burson says. While the chances of losing heating and cooling capabilities are minimized by the redundant systems, the hospital’s planners continued to worry about ventilation. “They were really moved by the images and reports from hospitals in New Orleans that people threw furniture through the sealed windows of patient rooms, because the buildings overheated once they lost their ventilation systems, and indoor temperatures in some of those hospitals went well above 100 degrees,” Guenther says.

Thus, planners decided the hospital would have screened operable windows in all the patient rooms, as well as operable windows in the various gyms for maximized natural ventilation. Windows that open for cross-ventilation turn patient lounges into screened-in porches. “Large portions of the building are fully naturally ventilated,” Guenther says. “This is actually one of the first hospitals in the U.S. that’s tried this much natural ventilation.”

Like many features of the hospital, the natural ventilation serves multiple purposes. Besides providing an energy benefit, it enables patients to experience rehabilitation in an environment full of the sounds and sights of the sea and natural environment, she says.

Many of the resilience features also met requirements for environmental sustainability in the hospital building, which received a Leadership in Energy and Environmental Design (LEED) Gold certification. They also helped to enhance the patient experience. For instance, the large amounts of space used for green roofs and terraces moderates stormwater runoff, which can cause flooding, but it also provides some measure of insulation, along with a popular patient amenity. One green roof is used by patients for therapeutic gardening, Burson says.

Because many features would have been incorporated even without concerns about resilience, the actual cost of those features providing only resilience benefits was quite reasonable, Burson says. The hospital’s construction cost was $140 million and about half a percent of that, or about $700,000, went to strictly resilience features. “That’s largely due to the cost of elevating that electrical switchgear and that concrete-encased service cabling up through the building, which was around $600,000,” Burson says.

Despite the reasonable cost, there are those who’ve pointed out that the hospital could have simplified things by building on higher ground. Hospital administrators, however, such as Spaulding Rehabilitation Hospital’s president David Storto, have said the waterfront location serves to provide patients with access to the outdoors for adaptive sports, such as kayaking. As well, the location is a prominent one.

“For far too long, rehabilitative care was an afterthought to many, relegated to the basements of hospitals and out of sight,” Storto says. “This hospital makes a bold statement that a new era of rehabilitative medicine is here.” As a leader on a par with the major centers of healing in the world, administrators say Spaulding’s waterfront location reinforces that role.

“I think it’s important to emphasize that a hospital above all is a social institution and must play a leading role in its community,” says Hubert Murray, the director of sustainability initiatives for Partners HealthCare. “The new hospital in the Charlestown Navy Yard represents a commitment to the city and the neighborhood.”

While Spaulding’s administrators took on the challenge of working with a waterfront development site willingly, they said they hope the lessons learned from the design of the hospital enable other organizations to work together to combat rising sea levels.

“One building and one institution cannot do it alone,” Murray says. “As thoughtful as the design has been of the hospital’s building itself, the dependency on support infrastructure requires a similar commitment from government agencies and utility companies to broaden and deepen a truly resilient strategy.”

One of those organizations may even be the U.S. Green Building Council, which could incorporate resilience strategies into its LEED certification program, Guenther says. “I think having a site credit around demonstrating resilience to climate impacts—demonstrating that someone’s really looked at the potential climate hazards and risks and then has addressed those, either through site measures or energy measures or resource measures—would be really great actually,” she says.

Design Resilience Measures

Key design enhancements included:

• A high performance envelope, including triple-glazed windows and exterior shading, to improve thermal performance and prevent low interior temperatures/freezing if conditioning is lost in winter months.
• Daylight harvesting maximizes the use of “free” daylighting in resident rooms, gymnasia, and public/circulation spaces. Reduced dependence on artificial lighting supports sheltering in place during power loss and longer operation on a given supply of emergency generator fuel.
• Incorporation of key-operated operable windows in resident rooms, so that if the building cooling or ventilation system is inoperable, indoor overheating can be avoided in summer months and patients can shelter-in-place. (After Katrina, indoor temperatures in sealed hospitals exceeded 100 degrees F, which caused staff to break windows with furniture items).
• The gymnasia and social spaces are naturally ventilated. When outside weather conditions permit, windows can be opened via remote operation and the building management system automatically shuts off delivery of tempered air in these areas. This system, which can be overridden manually if necessary, not only saves energy that might otherwise be spent on mechanical cooling, it helps residents build stamina through exercising in ambient conditions. Like the resident room windows, operability improves the ability of the space to maintain habitable temperatures if conditioning systems fail. And it allows patients and staff to hear boats, seabirds, and other harbor activity, providing a meaningful connection to the outside world.

• The placement of all critical mechanical/electrical/communications infrastructure on the roof to minimize possibility of interruption. All required program space is likewise above flood elevation.
• Implementation of gas-fired onsite co-generation (CHP), to offer additional redundancy for power generation in the event of grid loss or diesel generator issues. CHP infrastructure is on the roof, as are emergency diesel generators. Onsite power generation is more efficient than utility power, as transmission losses are minimized.
• The building systems are energy efficient. With an Energy Use Intensity of approximately 150 kBtu/sf/yr, Spaulding is close to 50 percent below the industry average energy intensity of hospital buildings. This, coupled with the implementation of onsite CHP, translates into dramatically lower carbon emissions.
• Despite the importance of universal access for rehabilitation patients, the ground floor elevation has been raised more than 30” above the 500-year floodplain level, to account for future projected sea level rise. The site is bermed with landscape elements and gently slopes to achieve this elevation gain.
• Extensive green roofs mitigate stormwater discharge during heavy rainfalls. The green roofs also include a universally accessible vegetable garden (accessible to wheelchair residents) that provides some local food, a Boston tradition.

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