In America, mass shootings have increased at an alarming rate since 2015, reshaping the landscape of emergency medicine. In 2022 alone, more than 600 lives were lost, and over 2,700 individuals were wounded in mass shooting incidents. These tragic numbers underscore a stark reality: trauma centers must be equipped, both structurally and operationally, to respond swiftly and effectively to large-scale emergencies. As mass-casualty events' frequency and scale grow, so must our preparedness. The redesign of Orlando Health's Level One Trauma Center is a powerful example of innovation born from necessity.
The Catalyst
In the early morning hours of June 12, 2016, Central Florida was shaken by one of the deadliest mass shootings in U.S. history. A gunman opened fire inside Pulse, a popular Orlando nightclub, killing 49 individuals and injuring 53 others. Just three blocks away, the Orlando Regional Medical Center (ORMC), home to the region's only Level One Trauma Center, became ground zero for emergency response.
Within 36 minutes, 36 critically wounded victims had surged into the trauma bays. At the peak of the crisis, more than 90 patients crowded the emergency department, some unrelated to the incident, while 44 victims were triaged and 28 trauma surgeries were performed in just 24 hours. The operating rooms functioned continuously, and every patient who reached surgery survived. This unprecedented mass casualty event not only tested the limits of medical staff and infrastructure but also highlighted a systemic need for long-term improvements in trauma care.
The History
Originally built more than 30 years ago, ORMC's trauma center resembled a relic of the past, often compared to an outdated MASH unit. Designed to accommodate 1,000 trauma patients annually, the center now handles over 5,100 cases yearly due to Central Florida's explosive population growth. By 2019, it was clear that the trauma unit needed a transformation in space, efficiency, adaptability, and readiness.
Designing for the Future
The challenge was daunting: renovate a 24/7 operational Level One Trauma Center without disrupting patient care. The design team faced limitations due to space, regulations, and the COVID-19 pandemic, which strained healthcare workers' availability to participate in planning. To overcome these obstacles, the design team turned to an innovative solution—integrating three-dimensional Virtual Reality (VR) technology in the early programming stage. While VR is not new to design simulation, its application at this phase and in a high-stakes trauma renovation project was virtually unprecedented.
Using immersive VR walkthroughs, physicians and nurses could interact with and critique the proposed layouts in real-time, identifying inefficiencies and guiding immediate refinements. As Dr. Joseph Ibrahim, a trauma surgeon who treated Pulse victims, recalled: "Anything that [RLF] set up, they could put the virtual reality headsets on and say, 'No, we can't have that cart there; the person who's going to do that procedure is over here.'" This level of direct clinical input ensured that every square foot was optimized for real-world trauma care. The process led to consensus-based solutions, such as the strategic placement of equipment and improved patient flow and enabled a phased construction plan that maintained full operational capacity throughout the build.
Aesthetic Meets Function
Renovating a trauma center is akin to changing a tire on a moving car. The redesign had to enhance functionality, safety, and efficiency without sacrificing the human aspect of care. Drawing inspiration from Central Florida's urban grid and lake-dotted landscape, the design team developed a layout based on logical pathways ("streets") that linked exam rooms, trauma bays, and nurse stations. These intersections improved visibility, communication, and access ensuring that patient care was at the forefront of our design.
Designers embedded organic forms representing lakes in floor patterns and nurse station designs to counterbalance the sterile grid. These natural elements introduced a sense of calm, supporting emotional well-being for patients and staff alike. Materials such as antibacterial wall finishes and resilient, slip-resistant flooring prioritized infection control, safety, and durability.
The Transformation
The renovation included 20 new and 10 reimagined patient exam rooms, upgraded headwalls and casework, and redesigned nurse stations to improve visibility and workflow. The redesign also adjusted trauma bay walls to allow for more medical equipment and installed new headwalls to modernize the space.
Significantly, the expansion more than doubled the size of the trauma center, enhancing surge capacity with 12 additional treatment bays for future mass casualty scenarios. The redesign also added four new EMS transfer bays, a larger ambulance entrance, and upgraded communications systems.
Construction and Modular Innovation
Phased construction was essential to keeping the trauma center fully operational during renovations. An enabling phase allowed strategic utility changes to keep future systems online. A new electrical room was added to feed the future renovation areas, and new medical gas main shutoff valves and alarm stations were added. Existing mechanical systems required detailed pre-testing to confirm the reuse of existing central air handling systems.
Strategic mechanical connections allow the central systems to continue operation while the future phases occur at the same time. In addition, the older controls were upgraded during each phase.
While analyzing project risks and staffing disruption patterns, it became apparent that using a modular wall system in lieu of traditional stick-built design would significantly reduce phasing time by allowing for off-site pre-fabrication. This approach cut temporary moves from 11 to just 7 and shortened the construction schedule from 33 to 19 months, preserving operations while saving time and costs.
To deliver long-term value, the design team considered occupant well-being, construction efficiency, and ease of maintenance. They selected Falkbuilt prefabricated wall systems with super studs that extend from floor to deck, providing greater resilience, improved acoustics for patient privacy, and minimal dust during installation. Their panelized design also allows easy access to behind-the-wall systems, streamlining future maintenance.
The team incorporated BIOS Lighting, a NASA spinoff technology used on the International Space Station and submarines to support staff performance. Designed to regulate circadian rhythms, this system helps trauma staff stay alert and mentally sharp in environments with limited natural light.
The thoughtful integration of modular systems and real-time collaboration with clinical staff enabled faster, cleaner construction and a smarter long-term solution, completing the project 14 months ahead of schedule while ensuring high-quality, uninterrupted trauma care.
The Impact
Orlando Health's Level One Trauma Center has come a long way since its original construction in 1983. It now represents a beacon of preparedness and resilience, shaped by tragedy but built for the future. As Dr. Michael Cheatham, Chief Surgical Officer and a 20-year trauma team veteran put it: "It is not a question of if you will be faced with an event like this. It's a question of when."
Every decision made, every innovation, design iteration, and construction method was grounded in one driving truth: trauma care must evolve. It must not only heal the wounded but stand ready for the unthinkable. Thanks to a $5 million donation, technological enhancements, and the dedication of a multidisciplinary medical team working collaboratively with the RLF design team, Orlando Health now operates a state-of-the-art trauma center capable of saving lives under even the most extreme circumstances.
With this transformation, Orlando Health has not only honored the lives affected by the Pulse tragedy but also set a national benchmark for trauma care in the face of modern challenges.
