1. Grade-level well-marked, illuminated, and covered entrance with direct access from public roads for ambulance and vehicle traffic. Entrance and driveway shall be clearly marked. If a raised platform is used for ambulance discharge, a ramp shall be provided for pedestrian and wheelchair access. The emergency vehicle entry cover shall provide shelter for both the patient and the emergency medical crew during transfer from an emergency vehicle into the building.

2. Paved emergency access to permit discharge of patients from automobiles and ambulances, and temporary parking convenient to the entrance.

3. Reception, triage, and nurses' station shall be located to permit staff observation and control of access to treatment area, pedestrian and ambulance entrances, and public waiting area. The triage area requires special consideration. As the point of entry and assessment for patients with undiagnosed and untreated airborne infections, the triage area shall be designed and ventilated to reduce exposure of staff, patients and families to airborne infectious diseases. If determined by the infection prevention and control risk assessment, one or more separate, enclosed spaces designed and ventilated as airborne infection isolation rooms shall be required.

4. Wheelchair and stretcher storage shall be provided for arriving patients. This shall be out of traffic with convenient access from emergency entrances.

5. Public waiting area with toilet facilities, drinking fountains, and telephones shall be provided. The hospital shall conduct infection prevention and control risk assessment to determine if the emergency department waiting area shall require special measures to reduce the risk of airborne infection transmission. These measures may include enhanced general ventilation and air disinfection similar to inpatient requirements for airborne infection isolation rooms.

6. Communication center shall be convenient to nurses' station and have radio, telephone, and intercommunication systems.

7. Examination and Treatment Room(s). Examination and treatment room(s) shall have minimum floor area of 120 square feet. The room shall contain work counter(s); cabinets; handwashing stations; supply storage facilities; examination lights; a desk, counter, or shelf space for writing; and a vision panel adjacent to and/or in the door. When treatment cubicles are in open multiple-bed areas, each cubicle shall have a minimum of 80square feet of clear floor space and shall be separated from adjoining cubicles by curtains. Handwashing stations shall be provided for each four treatment cubicles or major fraction thereof in multiple-bed areas. For oxygen and vacuum requirements, see Table 4 of the Appendix. Treatment/exam rooms used for pelvic exams should allow for the foot of the examination table to face away from the door.

8. Trauma/cardiac rooms for emergency procedures, including emergency surgery, shall have at least 250 square feet of clear floor space. Each room shall have cabinets and emergency supply shelves, X-ray film illuminators, examination lights, and counter space for writing. Additional space with cubicle curtains for privacy may be provided to accommodate more than one patient at a time in the trauma room. Provisions shall be made for monitoring the patient. There shall be storage provided for immediate access to attire used for universal precautions. Doorways leading from the ambulance entrance to the cardiac trauma room shall be a minimum of five feet wide to simultaneously accommodate stretchers, equipment, and personnel. In renovation projects, every effort shall be made to have existing cardiac/trauma rooms meet the above minimum standards.

9. Orthopedic and cast work. These may be in separate room(s) or in the trauma room. They shall include storage for splints and other orthopedic supplies, traction hooks, X-ray film illuminators, and examination lights. If a sink is used for the disposal of plaster of paris, a plaster trap shall be provided. The clear floor space for this area shall depend on the functions program and the procedures and equipment accommodated here.

10. Scrub stations located in or adjacent and convenient to each trauma and/or orthopedic room.

11. Convenient access to radiology and laboratory services.

12. Poison Control Center and EMS Communications Center may be part of the work and charting area.

13. Provisions for disposal of solid and liquid waste. This may be a clinical sink with bedpan flushing device within the soiled workroom.

14. Storage area out of line of traffic for stretchers, wheelchairs and emergency equipment;

15. A toilet room for patients. Where there are more than eight treatment areas, a minimum of two toilet facilities, with handwashing stations(s) in each toilet room, will be required.;

16. Soiled workroom for the exclusive use of the emergency suite. This room shall be separate from the clean workroom. The soiled workroom shall contain a clinical sink or equivalent flushing type fixture, work counter, sink equipped for handwashing, waste receptacle and linen receptacle. This room shall be separate from the clean workroom and shall have separate access doors.

17. Clean workroom or clean supply room. A clean work room is required if clean materials are assembled within the emergency suite prior to use. It shall contain a work counter, a handwashing fixture, and storage facilities for clean and sterile supplies. If the room is used only for storage and holding as part of a system for distribution of clean and sterile supply materials, the work counter and handwashing fixtures may be omitted. Soiled and clean workrooms or holding rooms shall be separated and have no direct connection.

18. Nurses' Station(s). Facilities for charting, clinical records, work counter, communication system, space for supplies and convenient access to handwashing stations shall be provided. Visual observation of all traffic into the suite, where feasible.

19. Securable closets or cabinet compartments for personnel.

20. Staff lounge. Convenient and private access to staff toilets, lounge, and lockers shall be provided.

21. Housekeeping room. A housekeeping room shall be directly accessible from the unit and shall contain a service sink or floor receptor and provisions for storage of supplies and housekeeping equipment.

22. Security station. A security system should be located near the emergency entrances and triage/reception area. The non-selective 24-hour accessibility of the emergency dictates that a security system reflecting local community needs be provided.

23. At least one airborne infection isolation room shall be provided. The need for additional airborne infection isolation rooms or for protective environment room shall be as determined by the Infection Prevention and Control Risk Assessment. See Section 44.C for requirements.

24. Bereavement Room shall be located within or adjacent to the emergency suite. A telephone shall be provided.

25. Secured holding room in accordance with the functional program. At least one holding/seclusion room of 80 square feet shall be provided. This room shall allow for security, patient and staff safety, patient observations, and soundproofing.

26. Decontamination area. A decontamination area shall be provided. The functional program shall define the location of the area and the types of exposure (i.e., nuclear, biological, chemical) to be considered. The location of the area shall be permitted to be on the exterior perimeter of the facility adjacent to the ambulance entrance or built within the walls of the facility.