Since 2001, more than 23,000 U.S. troops have been wounded in Iraq and Afghanistan. Of those injured, more than 10,000 have received injuries too severe to allow them to return to active duty. More than 800 service personnel have lost at least one limb. The most severely injured suffer from double and triple amputations, severe burns, head and body trauma, blindness, deafness, and partial or full paralysis.
Advances in battlefield medicine have made injuries that would have killed a soldier in earlier conflicts no longer fatal, but still debilitating. To meet this urgent need, philanthropists, physicians, researchers, construction workers, and 600,000 donors (checks ranged from $1 to $1 million, primed by Don Imus pitches and Avon sales of donor pins) took on a mission to create the world’s most technologically advanced physical rehabilitation and research facility to offer partial or full care for wounded military personnel. As many as 400 troops will go through an arduous rehabilitation process annually at the Center for the Intrepid, a part of Brooke Army Medical Center at Fort Sam Houston in San Antonio, Texas.
The four-story, 65,000-sf, $50 million center accommodates sophisticated amputee rehabilitation technology through the use of advanced prosthetics, computer and video monitoring for biochemical studies, virtual reality, robotics, and simulation, all to provide military patients with severe extremity injuries, amputations, and burns the best opportunity to regain their pre-injury abilities in a supportive environment.
“From the beginning, everyone involved in this project was 100% devoted to getting it done quickly and right for the soldiers who needed it,” said William Kline, VP and project manager for architect SmithGroup, Detroit, Mich. “All of the little challenges you have on a project of this magnitude and complexity were nonexistent. The work, from the architects to the construction manager to the subs, was a complete team effort that everyone was committed to, because we all knew who this building was for.”
Building a team on the run
That team included the Washington, D.C., office of SmithGroup; the San Diego office of MEP engineer Syska Hennessy Group; structural engineer Cagley & Associates, Rockville, Md.; civil engineer Garcia & Wright Consulting Engineers, San Antonio; and construction manager Skanska USA Building, Parsippany, N.J. The developer was the Intrepid Fallen Heroes Fund, one of several nonprofit organizations founded by the late Zachary Fisher, a leader in New York real estate and a benefactor of the armed forces. Named after the U.S.S. Intrepid aircraft carrier, which Zachary Fisher saved in the 1970s and turned into a floating military museum, the fund had provided financial support to the families of soldiers killed during both Iraqi wars. Congress later took over that role, leaving the IFHF flush with cash. The nonprofit offered to provide funds to build an amputee center at Walter Reed Army Medical Center in Washington, D.C., but the Defense Department refused due to rules prohibiting the mingling of private and public funds. However, the DoD could accept a donation of a completed project. Arnold Fisher, Zachary’s nephew, offered to build such a center and donate it back to the Pentagon.
“Arnold Fisher came to Washington and talked with the Secretary of Defense and the Chairman of the Joint Chiefs of Staff and said, 'I want only two things from you: I want the government to approve this project and then we want you to get out of our way,’” recalled Philip Tobey, FAIA, SVP of SmithGroup and principal-in-charge on the Intrepid project. Because SmithGroup had worked on the original proposal for a facility at Walter Reed, Fisher wanted the firm to work on the new project.
Within two days of his Washington meeting, Arnold Fisher met with Tobey, SmithGroup medical planner Lora Schwartz, and designer William Hendrix. Within a week of the initial meeting the Pentagon provided a 5.5-acre site directly adjacent to Brooke Army Medical Center and close to two existing Fisher Houses. (Fisher Houses are homes away from home for the families of wounded service members recovering at U.S. military facilities; there are 33 in the U.S. and two overseas.) By the time the design team landed in San Antonio, they’d developed the program and concept design.
Commitment to the mission
The Center for the Intrepid is organized in a "village" concept around a common courtyard shared by two Fisher Houses on the five-acre site. Families and patients can follow granite pavers, engraved with the donor names and words of encouragement, that line the path to the center. Photo: Tim Hursley
During site visits to the Walter Reed and Brooke Army Medical Centers, Building Team members met with medical staff and patients to better understand the challenges wounded service personnel faced during recovery. Some of these discussions led to the addition of new equipment and programs in activities that the men and women enjoyed most, such as rock climbing and surfing. They also partnered with Brooke Army Medical Center’s staff to identify medical technologies that were not available due to lack of funds or R&D. The 18-month construction schedule meant the team had to work completely in parallel to meet a tight deadline, even as the project grew by 5,000 sf for future expansion of equipment and programs.
“We actually went through parallel processes of building a cost model and value engineering the structure similar to a government project,” said Tobey, who is also a member of BD+C’s editorial advisory board. “One of the constraints we did not have was money. The Fishers continued to come up with ideas they felt were important, and they would then find more money to increase the budget. They realized there were things that the Army wanted and needed that were just not in the budget.” In the end, the fund raised an additional $10 million beyond the original budget.
The final program included a prosthetics fabrication lab, a natatorium with a wave pool and a flowrider system that teaches balance through the movements of surfing, an after-hours fitness area, extensive physical rehabilitation areas, clinical space, occupational therapy, clinical prosthetics, a gait lab, virtual reality simulators, and outpatient rehabilitation needs for the Department of Veterans Affairs. All of it had to fit into a limited, four-story footprint.
One of the facility’s most important areas, the rehabilitation training and exercise center, is a two-story light-filled space at the heart of the complex. Spanning the entire front of the building on the two top floors, the rehabilitation center borrows light from the building’s central atrium. It features a cantilevered running track, a treadwall and 21-foot climbing tower, elevating parallel bars, and other equipment to promote strength, balance, agility, and aerobic conditioning. Because of the building’s elliptical form, multiple rehabilitation activities can be conducted concurrently within and adjacent to it.
The state-of-the-art gait lab, located on the ground floor, is visible from the main lobby through full-height glass walls. It is fitted with 24 cameras on an automated truss that use infrared light to analyze human motion, with particular emphasis on amputee gait. Force plates in the floor, parallel bars, and treadmills measure ground reaction forces in three directions to determine the torque that muscles or prosthetic components produce. Electromyography (EMG) assesses the electrical activity given off during muscular contraction, detecting both the timing and intensity of muscle contractions. The gait lab contains a 50-foot running lane, terrain paths with gravel and foam, and a 1.5-ton inclining, dual-belted treadmill.
Adjacent to the gait lab is the Computer Assisted Rehabilitation Environment, a 21-foot simulator dome with a 300-degree screen upon which virtual realities are displayed. The CAREN immerses a patient in a fully reactive virtual and physical environment, using sensors placed on the body, high-speed infrared cameras, and a moving platform that reacts to movement. Members of the SmithGroup design team traveled to Israel, where the technology was still in development, to learn how to best integrate the $1.5 million dome into the design. This simulator is the first of its kind in the U.S. and holds tremendous rehabilitation promise.
Rehabilitation plus research
Schwartz, director of SmithGroup’s healthcare division, has already planned trips back to San Antonio to talk with patients and see how they are responding to the programs at the Intrepid Center, in hopes of incorporating those ideas into future designs. One key area of research is the prosthetics and fitting factory, where prostheticists and technicians provide state-of-the-art, on-site fabrication of artificial limbs using computer-assisted technology for design, milling, production, and fitting of prosthetic devices, including unique specialty limbs for sports and other activities. The designers expect specialized limbs to not only allow amputees to regain lost abilities, but even to allow servicemen to return to active duty if they choose.
In awarding the project Silver honors, the judges, including David P. Callan, VP and director of sustainable design with Syska Hennessy (who did not work on the center), were impressed with both the project’s mission and execution. “Aside from the service it provides, this is a state-of-the-art rehabilitation facility that would be an amazing building even if it were not serving the purpose it is serving,” said Callan.