ED Design Concepts

Issues and topics related to overall design of emergency units

The Portal Concept

Michael P. Pietrzak, MD, PAHM

People, vehicles, packages, food, water, air, and information all enter and exit medical facilities and emergency departments in large numbers every daily. Any of these modes of entry may provide a method for intrusion into or exit from the facility with undesired consequences.

The facility must always be attentive to threats posed by the access provided and at the same time rapid access to the Emergency Department essential by definition. Reviewing Emergency Department entrances around the nation one often observes make-shift security, monitoring and other features added after the original construction. It becomes apparent through this observation that there are other functions needed at entrances besides entry/exit. In designing EDs, the ‘portal concept’ implies determining all the processing that one would desire at the time of entrance or egress.

Ultimately this portal concept is more of an approach to design (considering all the factors in the process of ingress and egress) as opposed to a prescribed physical structure. In the fundamental application of the portal concept there are several basic processes to be considered.

1. Access
2. General protection and safety.
2. Identification of the individual or object
3. Screening for and detection of threats or unauthorized material
4. Detention capability
5. Neutralization or elimination threat
6. Through-put

Appropriate application of these concepts in the design process could improve operational effectiveness as well as security.

In order for the portals to be effective they must be integrated with other features in the over-all plan. Secure portals are of little use if other access points can be easily misused. Effective measures to prevent entry via any method other than designated portals will be necessary.

The monitoring and detection technologies in the portals can be connected and integrated with an overall security/monitoring system. Appropriate data collected from proposed screening systems need to be transmitted to a control site separated from the portal site for interpretation and archival. Finally, the portal concept addresses external threats but not internal threats such a patient to patient violence or workplace violence. Appropriate internal security measures are needed.

Access and security is not the only considerations for a portal to an Emergency Department. Could it be possible to collect clinical information relevant to triage and treatment? The technologies already available today suggest this will be possible soon.

Design Considerations

The specific design, appearance, configuration, number and location of portals will vary from facility to facility. However, several general principles will apply. Most threats are significantly decreased by simply placing distance or barriers between the potential threat and the protected area. This is true of blast, radiation and chemical as well as most criminal activities. Therefore designers/planners should give attempt to place portals at sufficient distances from public traffic yet close to patient drop-off areas. After establishing the proper stand-off distance, there should be some type of barrier to deter vehicles from ramming the portal. This can be achieved in a variety of methods some as simple as high curbs or stationary decorative bollards.

The exterior appearance of the portal should intuitively assist in way-finding by leading people to it. Once it is apparent where to go the access for those who need it should be convenient and universal. These issues are addressed in standard healthcare design guidelines.

Safety in the portal is paramount for the patients, visitors and staff. Standard safety items include non-slip surfaces, lack of protrusions in the floor, etc. However, additionally, designers need to consider the specific threats that face that facility such as drive by shootings. In many circumstances it will be desirable to avoid glass doors or if used to ensure that these are resistant to the identified threats.

Functional features of the portal will be determined by the client. However, a discussion of the basic functions should be discussed with the users in advance. These include:

  • Ingress and egress
  • Identification
  • Detection
  • Detention
  • Decontamination
  • Disposition

Since the users may determine in the future that new functions are necessary, flexibility to accommodate such changes are desirable. Whatever the design location or configuration, the portal should have the flexibility to accommodate newer technologies that can be inserted or removed in a modular fashion.

Ideally, the portal interiors for human use will appear pleasing, non-threatening and use technologies that are non-intrusive. The portals themselves should have surfaces that are easily cleaned and/or decontaminated. The technologies applied can be automated with little labor requirement. Rapid through-put and high reliability are requirements for technology that is being considered. In some cases the desirable technology features may not have yet achieved acceptable efficacy or reliability for inclusion into the portal design. Never the less the portal should be designed with the foresight that such technologies are rapidly developing and portals designed today should be able to accommodate technology as it develops.

Finally, the overall space utilization, materials, and maintenance expenses of the portal must be cost effective throughout the life-cycle of the building.

Relocate-able and portable approaches could be considered as well as “fixed” solutions. This would allow for scalability and adaptability in contingency situations. Fixed-site solutions could have significant blast mitigation features in the portal structure.

The architectural challenges for portal design include:

1. Identifying appropriate positions for portals in the plan that will enhance security and improve traffic management
2. Minimize manpower requirements
3. Design portals that allow the incorporation of various technologies
4. Design portals that are integrated with an overall mitigation strategy
5. Maintain the healing environment appearance
6. Maintain cost effectiveness


The ‘portal concept’ in Emergency Department design is in fact more of a design process and approach rather than a directive for a design specification. Ultimately a facility design team could determine that the only function needed in their ‘portal’ is a door that opens and closes or perhaps even an opening to let people and things pass freely with no door. However, the portal concept of design suggests that such a conclusion should be made only after a formal evaluation of the operational needs and the potential threats are fully assessed. Today’s environment would suggest more than a door.

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