Aug 6, 2025
Navigating complexities of Level 1 trauma hospital infrastructure
By: Kristi Vilminot
Level 1 trauma hospitals deliver life-saving care to patients who require immediate, complex medical attention. Because these hospitals operate 24/7, their infrastructure, particularly power and mechanical systems, is crucially important. From the moment patients arrive, every second counts; maintaining the continuous flow of critical services is imperative. Even a small failure in any part of the system can result in significant harm.
Ensuring this level of resiliency — without compromising patient care — presents hospital administrators and facilities managers with a complex challenge. The key to maintaining uninterrupted operations lies in a blend of meticulous planning, technological innovation and adaptive strategies.
Challenges of resiliency in trauma hospitals
The most difficult aspect of ensuring resiliency in Level 1 trauma hospitals is the upgrading of critical systems, including electrical and mechanical infrastructures, while maintaining continuous service. Unlike other facilities, Level 1 trauma hospitals can’t afford planned outages for facility upgrades, because even brief interruptions in services can have devastating consequences. A manufacturing company, for example, can afford to schedule a two-week outage during the holiday season to retool production lines or implement system upgrades. But for a Level 1 trauma hospital, any downtime — especially in life-supporting systems — jeopardizes patient care.
Phased implementation is the solution to this problem. Upgrades to electrical and mechanical systems, including new power plants, backup generators or water systems, must be executed in stages to ensure critical functions are maintained at all times. Since these systems often reside in mechanical rooms or rooftops separate from patient care areas, hospital infrastructure work can be done without directly interfering with patient care. However, ensuring no disruptions occur while upgrading these systems requires careful planning and precision.
Incorporating modern technology + sustainability in power systems
An additional layer of complexity in modern healthcare facilities is the increasing emphasis on sustainability and energy resiliency. The University of Michigan, for example, has its own power plant, which supplies electricity to its various hospitals, including its women’s center, cancer center and research facility. In these facilities, power continuity is important not only to maintain patient care but also to prevent the loss of years of research data — underscoring the need for resilient, fail-safe power systems.
Hospitals now also must comply with new regulations around renewable energy. In Michigan, for example, hospitals are required to incorporate carbon capture technologies, renewable energy systems like solar power, and backup battery systems into their infrastructure. Within the next decade, these facilities must significantly reduce their reliance on the conventional power grid, opting instead for more sustainable, in-house power solutions. This includes designing systems that can operate independently of the grid, with the use of small natural-gas generators, solar panels and battery backups.
The incorporation of renewable energy sources, such as solar and geothermal power, alongside battery backups, ensures hospitals can continue operating even during power outages. By planning for future energy needs, hospitals can avoid infrastructure overload and ensure the longevity of their power systems.
Importance of continuous maintenance + system upgrades
Maintenance and upgrades to existing systems are just as crucial as new builds. One commonly overlooked area in hospitals is underground distribution systems, which often include tunnel piping and electrical conduits. Tunnels and pipes deteriorate over time and need regular maintenance. Unfortunately, these areas are often overlooked, and hospitals may choose not to spend money on them because newer, more visible projects seem more important, like new medical equipment.\
But when these old systems aren’t maintained, they can fail and cause major disruptions. For this reason, these maintenance projects — such as updating mechanical systems, ensuring power continuity and replacing deteriorated piping — should be prioritized to avoid failures.
Managing long-term planning + budgeting
Effective planning for long-term facility upgrades and maintenance requires a strategic approach. Given the complexities of hospital infrastructure, decisions on which systems to upgrade first often depend on available resources and the long-term financial outlook.
Many hospitals lack comprehensive, up-to-date drawings or schematics of their existing systems. In these cases, tools such as Lidar scanning or visiting the site in person to gather pictures and videos of critical areas, can help provide the necessary information for accurate planning.
It’s not unusual for hospitals to struggle with allocating enough funding for upgrades. They often prioritize equipment that directly helps patients, like diagnostic machines, because these improvements have an immediate impact. But updating aging infrastructure is just as critical to keeping the hospital running smoothly. By conducting thorough assessments, healthcare facilities can determine which systems require immediate attention, prioritize repairs and spread the financial burden across annual budgets.
The process of developing a long-term financial plan involves prioritizing critical upgrades, establishing a realistic timeline for project completion and planning for potential future growth. This proactive approach ensures hospitals maintain operational continuity, while keeping their systems aligned with evolving sustainability and resiliency goals.
Addressing staff limitations + efficiency
Staffing is another big challenge hospitals face. Many healthcare facilities struggle to maintain an adequate number of skilled workers to handle the ever-increasing demands of maintaining complex systems. When staff are stretched thin, operations can become inefficient, particularly when manual processes are still in place to manage systems that could otherwise be automated.
One way to address staffing shortages is to implement more advanced automation and control systems. Automated monitoring tools can help hospital staff to quickly identify inefficiencies and to allocate resources where they are most needed. Additionally, the use of instruments, platforms and additional controls can significantly reduce staff workload while improving system performance and minimizing downtime.
Some facilities repeatedly face the same maintenance issues, like a faulty valve or a pipe that wears out too quickly. Instead of just fixing these problems temporarily, facilities managers can work with hospital administrators to identify root causes and implement sustainable long-term solutions. For example, if a pipe is wearing out because of the way it’s routed, it may be more efficient to replace it with a straighter pipe to reduce turbulence and wear. Identifying these kinds of solutions can both prevent future problems and make systems run more smoothly.
Future-proofing systems + managing growth
Hospitals are ever-evolving environments, with new buildings, departments and technologies regularly being introduced. To prepare for future growth, hospital systems must be designed to accommodate that growth without needing expensive retrofits. For example, if a hospital is planning to install solar power, it will be more cost-effective in the long run to install an oversized system that can handle future expansion, so that additional units can be added down the line without major structural changes.
Hospitals also face challenges in understanding supply-chain limitations, especially with long lead times for critical equipment. For instance, large power generators may not be available for years, so hospitals may need to consider temporary solutions or adjust their plans to account for these delays.
Understanding the limitations of suppliers and construction schedules is critical to ensuring projects remain on track. By forecasting future needs and accounting for potential delays in the availability of critical components, facilities managers can minimize project timelines and avoid costly hold-ups.
Building resiliency through planning
Ensuring resiliency in a Level 1 trauma hospital is about more than just keeping the lights on. It requires careful planning, strategic upgrades and a focus on long-term sustainability. By implementing systems that can evolve over time, using renewable energy and backup power solutions, and maintaining existing infrastructure, hospitals can reduce the risk of disruptions and continue to provide care without interruptions.
Additionally, addressing staffing limitations and ensuring systems are automated and efficient will reduce the operational burden and help ensure smooth day-to-day operations. With the right planning, hospitals can prepare for future growth, manage budgets effectively and implement long-term strategies that protect both patients and critical data. Ensuring these systems work in harmony helps hospitals continue to provide life-saving care when needed most.
Kristi A. Vilminot, P.E., is director of engineering – Power Generation & Energy, Commonwealth Associates.
Originally posted in Medical Construction & Design: Resiliency Without Outages | Medical Construction and Design
Photo courtesy of University of Michigan
Contact us today to learn how we can power change together.
Back to All Insights