Canaries in the Coal Mine: Bio-Responders in the ER

The saying “a canary in the coal mine” references the miners who carried canaries into mines knowing that if the birds died, it was a warning or indicator to leave the mine immediately. The birds were highly sensitive to adverse conditions, making them a bio-sensor to surrounding environment. When considering healthy built environments, the study of extreme conditions like those found in emergency rooms (ER) are analogous to canaries in the coal mine. These extreme scenarios are pertinent to investigate as they allow us to consider how the built environment can address and enhance our surroundings. It may do this by developing sensors and indicators to alert those at higher risk of deterioration in environmental conditions.

In considering the facets of the environmental factors that influence the built environment and how they interact to affect our experiences, it becomes clear that the built environment ultimately plays a major role in our health and well-being. The Center for Ecosystems in Architecture (CEA) is partnering with the Yale School of Medicine to question how environmental factors affect design in an extreme case: the ER of the future. When a patient has a three-minute window between life and death, it is vital that environmental conditions bolster the possibility of a positive prognosis; to this effect, the environmental systems and technologies within the space should perform and sense for optimal conditions. The challenge is that environmental requirements for patients at rest are often almost diametrically opposed to those for medical professionals who need to be extremely alert for optimal executive functioning skills. In such a scenario, how can we rethink the design of an environment to enhance the space for both the medical staff but also the patient? The ER highlights to the extreme how standard conditions such as visual stimuli, the quality of light and air, as well as the thermal and acoustical conditions can affect our physiological and cognitive functioning—in this case to a potential life or death outcome.

At CEA we research this from a systematic viewpoint. How do lighting, acoustics, air flow, and thermal conditions create the physical instantiation of the interior environment? How can each aspect of the building ecosystem be designed to meet the specific needs of an ER environment? For example, lighting on the blue spectrum has been shown to maintain alertness and enhance executive functioning, a key requirement for the physicians and operating team.¹ However, the patient may require red spectrum lighting for rest and recuperation.² Tailoring the lighting specifically to the occupant’s needs is complex and must be carefully calibrated in order to avoid chronic effects to the medical personnel’s circadian rhythms.³ In addition, the acoustical stress of an emergency room needs to be reconsidered. Emerging research is indicating that noisy environments have adverse effects on the cognitive performance of healthcare providers,⁴ particularly in hospital emergency departments.⁵ Some of the sound modulation could be achieved through the design and incorporation of new materials that maintain communication and rapid adaptability while increasing comfort and safety.⁶ The thermal requirements of the stationary patient versus the active medical staff may vary significantly,⁷ i.e. the medical staffs’ thermal comfort needs are that of a light to medium activity level,⁸ as opposed to the patient who is typically lying down with possible risk of hypothermia.⁹ This raises questions about delivering localized thermal comfort through switchable solid-state heating and cooling.¹⁰ Another aspect of the ecosystem is the air quality. While the operating team congregates around the patient, the potential for CO₂ pooling is quite high, which can ultimately affect their executive function. The ability to shape the airflow towards improved air quality conditions is another emerging area of research which is extremely relevant to the ER environment.

Linking the components of the ER environmental ecosystem is possible through data acquisition, management, and visualization. Currently the density and fidelity of environmental sensing networks needs to significantly improve in order to provide sufficient information. By sensing environmental conditions in the ER and providing real time data visualization of adequate information, the possibility exists to responsively customize environmental factors to the condition of the patients and medical personnel, and as such, from the extreme case of patients with critical conditions within the ER, we further our understanding of how banal and ordinary environmental conditions can affect health and performance outcomes in a range of work and living environments. In other words, the canary in the coal mine, or bio-responders in the ER, can become a ubiquitous framework to enhance human health and well being in our everyday built ecologies.

[1] Octavo Perez, “Effects of ‘Blue-Regulated’ Full Spectrum LED Lighting in Clinician Wellness and Performance, and Patient Safety.” In Proceedings from International Ergonomics Association 20th Conference Florence, Italy, Springer (2018)
[2] Antoine U. Viola, Lynette M. James, Luc JM Schlangen, and Derk-Jan Dijk. “Blue-Enriched White Light in the Workplace Improves Self-Reported Alertness, Performance and Sleep Quality.” Scandinavian Journal of Work, Environment & Health (2008): 297–306.
[3]  I. Acosta, R. P. Leslie, and M. G. Figueiro, “Analysis of circadian stimulus allowed by daylighting in hospital rooms,” Lighting Research & Technology (2017): 49(1), 49-61.
[4] N. Xiang, D. Sykes, W. R. Triner, and P. Dodds, “Transdisciplinary, clinical analysis of the effects of noisy environment on the cognitive performance of healthcare providers,” The Journal of the Acoustical Society of America, 137(4), (2015): 2278-2279.
[5] Ibid., 2248-2248.
[6] D. Orellana, I. J. Busch-Vishniac, and J. E. West, “Noise in the adult emergency department of Johns Hopkins Hospital,” The Journal of the Acoustical Society of America, 121(4), (2007): 1996-1999.
[7] R. Van Gaever, V. A. Jacobs, M. Diltoer, L. Peeters, and S. Vanlanduit, “Thermal comfort of the surgical staff in the operating room,” Building and Environment (2014): 81, 37-41.
[8] Y. H. Yau and B.T. Chew, “Thermal comfort study of hospital workers in Malaysia,” Indoor air, 19(6) (2009): 500-510.
[9] D.C. Scales, S. Cheskes, P.R. Verbeek, R. Pinto, D. Austin, S.C. Brooks,… and L.J. Morrison, “Prehospital cooling to improve successful targeted temperature management after cardiac arrest: A randomized controlled trial,” Resuscitation, 121, (2017): 187-194.
[10] B. Matalucci, K. Phillips, A.A. Walf, A. Dyson, and J. Draper, “An experimental design framework for the personalization of indoor microclimates through feedback loops between responsive thermal systems and occupant biometrics,” International Journal of Architectural Computing, 15(1), (2017): 54-69.