Krasnozhon T. Principles of Architectural and Planning Organization of Medical-Rehabilitation Centers of Polytrauma

Pathologies of the locomotor system are one of the main causes of incapacity and disability, which today occupy leading positions in the global structure of the general morbidity of the population. Of particular importance are combined and multiple injuries, which include the simultaneous occurrence and development of several pathological conditions. Simultaneously with the beginning of the escalation of the operational situation in the East of the country and the beginning of a full-scale invasion as a result of the negative impact of the factors of combat activity, about 90% of servicemen and civilians who suffered injuries, contusions or mutilations or were held in places of imprisonment, people who received disabilities due to stress and hiding from shelling, need complex medical rehabilitation. The lack of modern approaches to the architectural and planning organization of medical and rehabilitation centers of polytrauma in the conditions of the development of the health care structure makes it expedient to generalize the experience of designing and building institutions of the above type and to develop recommendations for the architectural and planning organization of medical-rehabilitation centers of polytrauma for the further possibility of providing comprehensive high-quality assistance, because in the conditions of wartime, this direction of research acquires special importance. During the research an in-depth analysis of the evolution of the formation of medical-rehabilitation centers was carried out, a chronological systematization was established, and the main historical periods of the development of the architectural and spatial organization of patient care facilities were identified and characterized. The domestic and foreign experience in the design and construction of health care facilities is analyzed. The main directions of modern trends in the development of medical-rehabilitation centers have been identified. The inconsistency of the existing polytrauma medical-rehabilitation centers of Ukraine with modern requirements and trends in the development of the architecture of the health care industry was established. Based on the improved classification of medical-rehabilitation centers on the example of polytrauma three possible typological models of the functioning of institutions of this type have been proposed. General scientific and special methods of architectural analysis were systematized and a methodological apparatus was formed, which considers theoretical and empirical levels of knowledge and consists of systemic and complex approaches. Based on the system analysis, a structural model of the study of the general structure of the internal space of medical-rehabilitation centers of polytrauma was developed. A methodical assessment of the factors influencing the architectural and planning organization is given. The main urban planning issues regarding the placement of institutions of the above type in the structure of the city have been studied. Spatial-territorial organization of plots and basic compositional solutions for the location of functional blocks were proposed. Тhe functional and technological structure was investigated and models of the functional organization of small, medium and large medical-rehabilitation centers of polytrauma were developed. On the basis of typological models of functioning, characteristic types of the building system and expedient composition schemes that consider the main types of architectural and planning organization are determined. The expediency of implementing open prefabricated architectural and structural systems and progressive engineering and technical solutions is substantiated. The formation of additional structural modules of medical-rehabilitation centers of polytrauma in wartime on the basis of existing institutions was considered. It was proposed to introduce pneumatic structural systems as auxiliary or temporary volumes during emergencies. Based on the system analysis, a structural model of the study of the general structure of the internal space of medical-rehabilitation centers of polytrauma was developed. The regularities and peculiarities of the manifestation of geometric means of artistic-spatial expressiveness from the point of view of the object's impact on the patient have been revealed. Proposals regarding the methodology has been developed, the principles and methods of architectural and planning organization and the issues of forming additional centers of the medical and rehabilitation space has been formulated.