PG 18-3 – DESIGN AND CONSTRUCTION PROCEDURESDecember 1, 2020TOPIC 18 – TRANSPORTATION,MATERIALS AND SOLID WASTE MANAGEMENT,AND AUTOMATED DELIVERY SYSTEMS1. SCOPEA. This Program Guide applies to the design of transportation and logistical requirementsfor materials and waste management, transportation equipment, methodologiesrequired for efficient, cost-effective, and timely movement of people, equipment,related materials and waste management functions. This guide provides direction todesigners and helps to coordinate transportation activities detailed in other ProgramGuides (PG) and Design Manuasl (DM). This Guide applies to all applicable facilitieswhether new or existing. Addition and alteration projects shall meet these guidelines tothe extent practical.B. There shall be no deviations from these requirements except when permitted by adetailed and specific waiver granted to the Architecture/Engineering (A/E) and to theMedical Transport Logistics Consultants (MTLC) by the VA in a hardcopyauthorization/waiver format.C. This Program Guide does not prescribe when specific systems are required or wherethey should be employed. Table 18-1 prescribes when different technical analyses arerequired based on a facility’s size. It is the responsibility of the designer of record todevelop a holistic and efficient design incorporating the campus and individual facility’stransportation needs.D. Design, specifications and installations of all systems shall be based on providing acomplete “turnkey” operation. All components, subsystems, devices, and controlsrequired for a complete and useable transportation system shall be provided in the finalconstruction documents. This includes equipment and devices such as integrating cartwashers, carts and elevators into the designs and specifications of Automatic Guidedvehicles (AGV) and Automated Mobile Robots (AMR) systems, carriers and inserts forPneumatic Tube System (PTS) systems, Trash and Linen bags for Pneumatic Trash andLinen Systems (PTLS).E. This Program Guide provides guidance for the study, selection, and design oftransportation and logistics systems in support of the design and construction of VAfacilities and provides guidance for the completion of the feasibility study requirementslisted in PG-18-15.2. MEDICAL TRANSPORTATION LOGISTICS CONSULTANT (MTLC)A. The A/E will submit the qualifications of their preferred MTLC to the VA for review andapproval. A qualified MTLC shall have successfully provided for a period of not less thanfive years comprehensive study, design, and Construction Administration services in theTRANSPORTATION AND LOGISTICS DELIVERY18-1

PG 18-3 – DESIGN AND CONSTRUCTION PROCEDURESDecember 1, 2020areas of materials management, food and nutrition receiving and distribution, solidwaste management, horizontal and vertical transport of people, materials andequipment, sterile supply processing and distribution, automated and manual materialshandling. The MTLC shall provide resumes for all System Design staff associated with theproject for approval by the VA. The MTLC must demonstrate prior experience on aminimum of three (3) successful, completed and fully operational healthcare facilitieswith similar scope. Previous project experience must include designs and specificationsfor the equipment and systems being incorporated into the VA project. For example: ifthe VA project in question is to have a PTS the MTLC must show experience with three(3) completed projects that contained a successful PTS that was fully designed andspecified by the MTLC.B. The designs of the Food and Nutrition Services (FNS) functions and associateddepartments is a specialized discipline and may be provided by a Consultant thatspecializes in that area. The MTLC shall provide the studies and recommendation forfunctions and areas that support FNS such as the receiving docks, waste management,internal transportation service to both in-patient and non-patient areas to ensureconsistency and uniformity of those functions with all other logistics functions anddepartments.C. The VA recognizes that the studies and designs of certain automated materialstransportation systems such as AGV, AMR, PTS, and Pneumatic Trash/Linen Systems(PTLS) are not considered standard in VA facilities. Where these systems are included ina project and the MTLC does not have the required three (3) project experience thenthe A/E team shall assign that element of design to an approved Specialist MedicalTransportation Logistics Consultant Subcontractor (SMTLCS) that meets all therequirements stated above. The qualifications for the SMTLCS shall be submitted to theVA for approval. The SMTLCS shall work as an integral part of the MTLC’s team and willbe assigned the design responsibilities associated with the special systems. Where thisdocument refers to the MTLC those conditions and requirements shall also apply to theSMTLCS if one is assigned.D. The MTLC shall use the VA specifications where available and develop newspecifications where VA specifications are not available. Copies of these basespecifications shall be submitted to the VA for approval during design review. The MTLCshall provide examples of the design considerations, utilities, interfaces, etc. that will berequired as the project moves forwardE. Vendors or their employees shall not be used as a MTLC. A/E’s shall not act as theMTLC unless they can demonstrate that they provide these services as a regular part oftheir business and meet all the requirements for a MTLC.1) The Transport Consultant/MTLC may contact vendors as necessary for specificproduct information required by the MTLC designer to provide proper competitivespecifications and designs.TRANSPORTATION AND LOGISTICS DELIVERY18-2

PG 18-3 – DESIGN AND CONSTRUCTION PROCEDURESDecember 1, 2020F. Recommendations and designs shall be non-proprietary as to promote competitivebidding. Where desirable system/equipment features are protected by patents thesefeatures shall be functionally described in detail in the bidding documents to allowcompetitors to provide those functions using their standard technologies. Designs shallnot eliminate any qualified competitor by a failure to provide adequate and reasonableutilities, spaces and clearances.G. Table 18-1 prescribes the level of technical analyses needed based on a facility’s size anddifferent transportation systems that may be required. It is the responsibility of thedesigner of record to develop a holistic and efficient design incorporating the facility’soperational and functional needs based upon observations and staff interviews.AnalysisTable 18-1 Analysis RequirementsFacility CharacteristicTransportationLogistics Analysis (TLA)Any facility or contiguous medical campus 200,000 BGSFRenovations and new construction of Ambulatory Care andHospitalsElevator Traffic Study& Analysis (ETSA)All facilities 1 storyMaterial ManagementAnalysis (MMA)All facilities or contiguous medical campus 100,000 BGSFAll Warehouse facilities 20,000 BGSFWaste ManagementAnalysis (WMA)All facilities or contiguous medical campus 50,000 BGSFAll dedicated Food Service facilities 10,000 BGSFNotes Table 18-1: Medical Campus Facilities include Outpatient Clinics, Health Care Clinics,Ambulatory Care Centers, Hospitals, Medical Centers, and Research/Laboratory buildings.BGSF – Building Gross Square Feet3. TRANSPORTATION SYSTEMS EVALUATIONA. For all projects requiring a Logistics Analysis (TLA, ETSA, MMA, WMA) the A/E shallensure the services of a qualified MTLC is included in the request for planning andarchitectural services. The A/E shall utilize the services of the consultant as notedherein.B. The MTLC shall be an integral part of the design team and shall be the primary plannerin every aspect of the project as it relates to transportation, materials management,waste management, central sterile processing, and logistics. This includes, but notlimited to: vertical and horizontal circulationfacility logisticsdesigns and specifications for vertical transportation and materials handling systemsmaterials managementcentral sterile processingTRANSPORTATION AND LOGISTICS DELIVERY18-3

PG 18-3 – DESIGN AND CONSTRUCTION PROCEDURES December 1, 2020food and nutrition serviceswaste managementC. The A/E and the MTLC shall ensure all transportation and material handling systemsselected are designed in accordance with design documents and applicable codes andstandards. The MTLC shall be responsible to coordinate with and provide the A/E therequired design criteria to ensure the designs incorporate the necessary spaces,adjacencies, utilities, and other appropriate building elements for the equipment to beinstalled.D. In any study all human activities, such as walking speeds, pushing, pulling, and lifting,etc. shall be studied and designed to meet all applicable codes and standards includingVA, Occupational Safety and Health Administration (OSHA), and National Institute ofOccupational Safety and Health (NIOSH).1) Circulation studies dealing with walking and pushing speeds must recognize thatmovement through straight and uncrowded pathways is the maximum attainablespeed and through crowded pathways with turns will be slower. It is understoodthat these speeds will vary by many factors but for the purposes of VA studies thoseshown in Table 18-2 shall be used for corridor widths of approximately eight (8) feet.Where designs encourage high volumes of movements wider corridors shall bestudied and used as required.Table 18-2 Travel SpeedsAverage Movement Speedsfor Studies (Note thatweights noted assumelarger sizes contribute toslower speeds)Feet PerMinute StraightUnobstructedPathwayFeet Per Minute Straight CrowdedPath (speedconsiders patientsand wheelchairs inthe corridors)Feet Per Minute - %of straight speedthrough 90 Degreeturns with speed for3 feet going into andafter the turn.Purposeful Walking withoutpushing or carrying a load.275175At 80%Purposeful Walking whilecarrying a 15 25-poundload.235175At 80%Purposeful Walking whilecarrying a 25-pound load.215150At 80%150125At 85%140115At 80%Pushing Cart or wheelchair 500 Pounds Gross Weight 150 feet distance.Pushing Cart or wheelchair 500 Pounds Gross Weight 150 feet distance.TRANSPORTATION AND LOGISTICS DELIVERY18-4

PG 18-3 – DESIGN AND CONSTRUCTION PROCEDURESDecember 1, 2020Pushing Cart or wheelchair 500 Pounds Gross Weight140115At 90% 150 feet distance.Pushing Cart or wheelchair 500 Pounds Gross Weight125100At 75% 150 feet distance.Notes Table 18-2: Assumed Travel Speeds Through eight (8) foot wide main corridors. Usewider corridors when required.Travel speeds shown may be lower than non-VA medical facilities due to the higher number ofpatients (walking, in wheelchairs, etc.) in the corridors. Different speeds may be considered ifthey are verified in on-site observations/evaluations.4. TRANSPORTATION AND LOGISTICS ANALYSIS (TLA) REQUIREMENTS.A. Different transportation and logistics analyses are required for facility designs asindicated in Table 18-1. These analyses must address the transportation, logistics, SPS,materials and waste management requirements of the project as required by thisdocument. When required by Table 18-1 the MTLC will be the lead planner in thedevelopment of concepts identifying the general transportation and logisticsrequirements for the project.1) All studies and designs for bulk/cart automated transport systems such as AGV/AMRshall recognize that pathways for those systems must be dedicated, for properoperation of the system and per code, and any use of that pathway for manualtransport where allowed by code is to be limited to occasional very low volumeusage. Should a high transport volume department such as Food and NutritionServices or Waste Management not be included on the automated cart systemanother route must be provided.2) Calculations shall clearly show the input and output values and provide briefdiscussions and examples of the “math” formulas used to demonstrate themethodologies used in reaching results. Recommendations shall not be acceptedthat are not adequately supported.B. The TLA studies and narratives shall provide a complete and detailed recap of theactivities performed and the study and design status of the various systems andequipment studied and/or recommended.1) Where an Option or System has not been accepted or recommended and notincluded in a Project the rational for that decision shall be identified in the ongoingTLA reports, for future reference, and further studies or analysis of that Option shallnot be required. This will help eliminate repetitive studies.2) The TLA studies shall include everything that needs to move in the facility: people,clean and soiled materials/supplies, equipment, medications, specimens, etc. withrecommendations for the mode of transport including elevators, stairway, manualand/or AGV/AMR, gravity chutes, PTS, etc. to be used for each material category.TRANSPORTATION AND LOGISTICS DELIVERY18-5

PG 18-3 – DESIGN AND CONSTRUCTION PROCEDURESDecember 1, 2020a) Studies to include the movement from the point of entry into the facility, themode(s) of transport through the facility, and the mode of transport for exitingsoiled and/or salvage materials.b) Materials and Equipment studies and systems planning shall be comprehensiveand shall include the following materials categories as applicable to the project: General WastesInfectious WasteLab WastesSharpsHazardous WastesChemical WastesRadioactive WastesFood WastesRecyclingCardboardConfidential PapersSalvage MaterialsConstruction WastesSoiled LinensSoiled SurgicalInstrumentsClean LinensClean UniformsClean Supplies Standard and Special PalletsOthers applicable to the projectClean Medical SuppliesClean Surgical SuppliesSterile Surgical InstrumentsMedical gasesBulk and Unit PharmaceuticalsPatient MedicationsLab SuppliesLab SpecimensFood SuppliesPatient FoodKitchen MaterialsCafeteria FoodCrash CartsSurgical SuppliesClean Medical EquipmentEmpty Carts3) The TLA shall include all aspects of the Elevator Traffic Study and Analysis (ETSA),Material Management Analysis (MMA), and Waste Management Analysis (WMA)studies and designs provided as a single unified and totally holistic, coordinatedlogistics, transportation system study, design, and shall be accomplished in that highlevel of integration by the MTLC.4) The TLA studies for the various Materials Handling, ETSA, MMA, WMA systemoptions shall include and discuss the space impacts of these systems on the project.Many AGV/AMR installations have saved space in the target project and thispotential needs to be documented in the TLA Studies. This would be the same wherea system might require more space than the other options.5) Many automated and semi-automated systems such as an AGV/AMR, PTLS, andGravity Chutes almost always require different spaces and adjacencies than requiredfor a manual system.a) Adjacency revisions to VA Standards to accommodate the proper design,installation and operation of a system or equipment item shall be specificallyidentified in detail and included in the submittals.TRANSPORTATION AND LOGISTICS DELIVERY18-6

PG 18-3 – DESIGN AND CONSTRUCTION PROCEDURESDecember 1, 2020b) Any space or adjacency irregularities shall be identified immediately to theProject Manager for resolution.C. Material Management Analysis (MMA) to include a comparison of automatic to manualmaterial handling systems. Automatic systems include Automatic Guided Vehicles(AGV), Automated Mobile Robots (AMR), Pneumatic Tube Systems (PTS), and Pneumaticor Gravity Chutes in addition to other or newer technologies.D. Life Cycle Cost Analysis (LCCA) shall be used to evaluate the alternatives and todetermine the appropriate system. The LCCA shall include all costs of “Ownership”including elements listed below and as applicable to the system studied from day zero(0) through the first 30 years of operation. installed equipment costscosts of space usedrelated construction costsutility costsoperational labor costs maintenance parts and laborexpendablesperiodic upgradesoverhaulsreplacement1) Provide charts and five (5) year recap showing Cumulative Life Cycle Costs of theoptions considered and a second chart showing the annual cash flows for theoptions.a) The LCCA shall be based on traffic matrices developed and maintained by theMTLC for the various systems in question.E. The MTLC shall sign the transportation logistics analysis and report certifying theinformation contained therein is accurate, vendor neutral, and based on empirical data.F. Recommendations shall be provided on replacements, upgrades, or modernizationsrequired to meet the needs of the project and the current standards and criteria. Newconstruction shall, where applicable and practical augment any shortfalls in the existingbuildings or utilize any excess capacities offered by existing structures that will remain inservice.G. The TLA shall describe in detail and contain scaled drawings of the MTLCrecommendations to maximize the transportation and logistics efficiencies and how therecommendations are implemented into the design. The MTLC shall coordinate with andprovide the A/E Design Team with the design details applicable to the space, flow,adjacency, machine rooms, maintenance area, and other building elements necessary toinstall, operate and maintain the systems and equipment for the project in question.H. The TLA shall focus on optimizing adjacencies, efficiencies and safety and minimizeoverall patient, staff, and material movement costs in the project design.I. The TLA shall be based on empirical data provided by the using facility. When such datais not available the MTLC shall work with the using facility to reach final estimates thatare acceptable to the affected facility user departments.TRANSPORTATION AND LOGISTICS DELIVERY18-7

PG 18-3 – DESIGN AND CONSTRUCTION PROCEDURESDecember 1, 20201) Site visits shall be made to the existing facility, by the MTLC or ETSA/MMA/WMAConsultant as applicable to inspect and observe conditions and operations and togather relevant operational and equipment information. The MTLC orETSA/MMA/WMA Consultant as applicable shall conduct detailed interviews of thevarious departments that represent the Users (including nursing and surgical staff)and Providers of the various Support Services. Complete notes for these interviewsshall be transmitted to the facility for verification of the information contained.These interview notes shall be used as an important part of the data base used forthe project and shall be included in the TLA. The MTLC shall make detailed nontechnical inspections of all applicable departments and equipment, including theelevators, SPS processing equipment, and materials handling systems to estimatetheir potential life expectancy, need for more detailed inspections and potential usefor the project. Facility and departmental tours shall be arranged as requested bythe VA if required to complete the data collection process. The following functionsshall be included in the interview/data collection process as applicable. AdministrationHuman ResourcesIn-Patient Care Services/ NursingOutpatient Patient Care Servicesand Nursing ServicesSurgical ServicesEmergency DepartmentSterile Processing ServicesInfection ControlLogistics/Materials Management Food and Nutrition ServiceEnvironmental ServicesLinen Services/LaundryPatient Transport ServicePharmacy ServicesLaboratory ServicesImaging ServicesFacility Management Engineering & ShopsMail RoomOther departments as requiredJ. Data including site constraints: Design Concept of Operations for the logisticaldepartments like food service, linen and waste management, materials management,housekeeping, pharmacy, sterile processing, distribution, and projected workload forthe new facility will be noted and documented.K. Elevator loading density and the load/unload time shall be bas