Equine Hospital Design
Whether you are planning a large hospital or a one-room, haul-in clinic, our advice is to think big. Creating rooms that are large enough is half the battle in designing a well-functioning equine veterinary facility.
Stalls
Most horse people are familiar with 12-foot-by-12-foot stalls, as this is the basic module in the United States. Many products are manufactured to create stalls to this standard. However, 12-foot-by-12-foot stalls are too small for larger breeds of horses (drafts and warmbloods), for a mare and foal, and for ICU or neurological stalls, where having more space to work around the horse is very important. Our advice is to use 14-foot-by-14-foot modules for specialized medical stalls and large breeds, and to use at minimum 12-foot-by-18-foot or 14-foot-by-18-foot stalls for foaling or mare and foal. One of the easiest way to accommodate a foaling stall is to remove a partition to create a double-wide stall.
Barn Aisles
Most barn aisles are either 10 feet or 12 feet wide. The latter is the width that works best for cross-tied horses. For medical barns, we prefer 14 feet in width because it helps reduce accidental transmission of disease, and it is less stressful to walk a frightened horse through a slightly wider space.
If your horses have the ability to extend their heads from their stall doors, a wider aisle will also help prevent accidental contact between the horse in its stall and one being led through. If you plan to do workups in the medical barn, enlarge the aisle space to 16 feet in width, but remember that cross-ties are dangerous in a wide aisle.
Examination Spaces
The building block for the equine medical facility is an examination space. The minimum size for a safe examination space is a 16-foot-by-16-foot clear space. If you have a wall of cabinets, enlarge the space by two feet in that direction to maintain the full 16-by-16 clear space. An exam space can be used for a basic exam, taking vitals, ultrasound, mobile X-ray, etc.
In busy hospitals, it might be necessary to accommodate more than one horse in the same examination space. Each examination area will need its 16-foot-by-16-foot module, plus you will need 8 feet of additional clear circulation space to prevent interference between horses that are being walked through and examinations being performed. For example, a room that contains three examination spaces would likely be (16 feet plus 8 feet) x (3(16)), or 24 feet by 48 feet in size, to be used comfortably for three horses simultaneously.
Examination/Treatment Space with Stocks
The minimal size for a treatment space that includes stocks is 18 feet by 24 feet. This assumes the horse can be walked straight through the room via a separate entry and exit. This size module is efficient for rooms such as standing surgery and dental.
If the room is planned with only one exit, then it must be enlarged to be safe enough to turn the horse and exit the room from the same door. With a room that is 24 feet by 24 feet or larger, increasing it to 24 feet by 30 feet will feel safer if the room only has one entry/exit.
Induction and Recovery Stalls
When we design induction stalls, we begin by speaking directly with the surgeon, as he or she likely has been trained a specific way for inducing and recovering horses, and this will influence the size of the space.
In the case of recovery, the stall size is critical to maintaining the safety of the horse. For horses recovering unassisted, most people agree that the stall should be a standard 12-foot-by-12-foot module (padding will slightly reduce the room size) to prevent the horse from crashing around while recovering.
However, if the veterinarian prefers assisted induction with a squeeze gate or assisted recovery with ropes, the stall might need to be enlarged to allow room for this assistance. Spaces that are 14 feet by 14 feet or 12 feet by 16 feet are typical sizes for enlarged induction/ recovery stalls.
Combination Induction and Procedure Areas
In the smallest hospitals, a veterinarian might create a padded knockdown stall where procedures are done in the stall. This is not optimal, but it can be done when there are no other possibilities.
A typical 12-foot-by-12-foot induction/ recovery stall will be too small for this purpose, and a larger 14-foot-by-14- foot or 16-foot-by-16-foot stall might be used. As a reminder, this stall will not be an ideal size for unassisted induction or recovery, and it will be a little small for working in, so the space is compromised for both of its functions.
Surgery Rooms
If a hospital is large enough to have a dedicated surgery room, it should put its resources toward sizing this space for well-run surgeries. Our rule of thumb for the smallest efficient general surgery room is 20 feet by 25 feet from wall to wall, with the table placed in the center parallel to the long dimension.
For a more generously-sized general surgery room, enlarge the room slightly to 20 feet by 30 feet, as the long dimension can be confining in the smallest module. While this room might sound big, it’s actually too small for large orthopedic surgeries. Orthopedic and other specialty surgery rooms need even more space. For example, 25 feet by 30 feet is common in larger hospitals and 30 feet by 30 feet in referral and teaching settings where more people might be present, in addition to tools and carts and anesthesia equipment.
Specialty Imaging
Do not proceed with designing specialty equipment rooms without aligning the exact sizing of the room with the equipment to be installed. For example, scintigraphy and overhead X-ray typically have gantries supported by steel structures that are specific to the equipment. Clearly, the room needs to be sized to at least accommodate the steel structure, and to provide some space in front of the equipment for staging either the standing sedated or anesthetized horse.
For those few hospitals incorporating human medical equipment such as human CT machines or human models of hi-field MRI, the sizing of a room becomes more complicated. It must be upsized for a horse, rather than planned around a typical human model. Hospitals planning for this type of expensive equipment should visit other university and referral hospitals to understand what works and what does not before proceeding.
Central Supply and Pharmacy
As hospitals grow over time, supply needs grow. Supply and pharmacy rooms can get cluttered, and cluttered supply spaces can make inventory control more challenging.
When sizing your pharmacy and central supply areas, consider all the items you need to store, and estimate their spatial requirements. We often articulate needs in terms of “linear feet of shelving.” This will help you anticipate the true need for the room size. It is typical for a full-service busy hospital to need at least 12 feet by 16 feet for stocked materials.
Central supply rooms get much larger if planned to allow ambulatory trucks to pull in for stocking. In this scenario, the supply room will become a garage-like space with large oversized bays. For example, 15 feet in width in each bay and 30 feet in depth will allow for shelving on both sides of the truck and at one end.
We also have observed larger stocking areas in facilities serving rural areas and in practices with a large ambulatory service, where central supply might need to serve many farms or farms in a wide region.
Laboratory It is easy to size a laboratory space, as it is nothing more than an equipment coordination exercise. Make a list of all of the lab equipment that your lab needs to contain (now and in the near future), and work with your designer to provide the counter space to accommodate the equipment, along with some seating stations.
Ask your designer to “walk you through” the laboratory area by looking at all the cabinets and equipment properly placed and the outlets located. This will help you get a lab that is just right in size.
Lobbies and Client Spaces
Last but not least, put some thought into the client spaces of your hospital. Because these spaces don’t make money (at least not directly), they tend to receive little focus. A small sitting area sized to accommodate a few comfortable chairs, a television and a coffee station is sufficient for small- and medium-sized hospitals. This space might be dimensioned like a generous office—or 10 feet by 12 feet or 10 feet by 14 feet in size.
Large hospitals might need or want more generous client areas for gathering groups or to accommodate a greater flow of clients.
Fear-Free Design for Equine Veterinary Practices
Here are design and management tips to help your facility become less traumatic for your equine patients.
The natural light at the Tryon Equine Hospital allows horses to be more comfortable because they can see better.
Fear Free is a movement started by small animal practitioner Dr. Marty Becker (fearfreepets.com) to reduce the fear and anxiety animals can feel when they visit veterinarians. Eliminating negative experiences is not only better for the animals, it is good for business.
Fear Free has become a major movement in small animal veterinary practices. While Fear Free standards have not yet been developed for equine veterinary practices, equine veterinarians are already benefitting from a more engaging conversation about the benefits of a Fear Free approach for equine patients.
As architects who design spaces for animals, we care about how the spaces themselves will support successful veterinary experiences. In general, horses are prey animals, so they are very motivated to look for danger in their surrounding environments. Therefore, it is important to design from a horse’s perspective.
When considering Fear Free spaces for horses, start with traffic flow concepts.
Traffic Flow
Create a quiet area for unloading. Horses arrive stressed and should be unloaded in a quiet area away from other activities and excessive traffic flow.
Separate equine exam and treatment spaces from human circulation spaces. In older hospitals, it is not uncommon to come across situations where staff members must walk through an equine treatment area to get from one area of the hospital to another. Horses experience heightened stress levels every time a door swings open or a new person strides through. It is optimal to develop separate circulation paths outside of rooms so the patient exam and treatment areas can remain quiet and undisturbed.
Separate horses from vehicles. Throughout your hospital site, separating vehicular traffic from patient traffic can cut down on stress and create a safer workplace. For example, if vehicles circle around the perimeter of your site, horses should circulate through the center.
Reduce Social Stressors
Horses like the reassuring presence of other horses, and they do not like braving scary things on their own. However, in hospital environments where every horse is surrounded by unfamiliar horses, interactions between horses can also be stressful. For example, if an arriving horse sees a horse running around a paddock in a panic, he also might feel like running and panicking.
The hospital design can set equine patients up for better success by eliminating fear-inducing social cues and reinforcing positive ones as much as possible. Below are some examples of strategies we use:
Design horse housing so healthy horses can see each other for reassurance.
Create wide barn aisles (14 feet or greater) to reduce the “gauntlet of horses” feeling that develops when walking down a narrow aisle.
In larger facilities, separate medical barns by sex. House stallions away from other horses.
Keep serious work-up spaces (such as arenas and exam rooms) out of view of areas where horses might be out of control, such as the unloading yard. This will prevent horses from being scared by other, frightened horses.
Keep a calm “ambassador” horse within sight of newly arriving horses for reassurance.
Create flexible, partially open treatment and exam areas (when weather allows) to avoid the feeling of fear that develops in horses from physical isolation. This open area can look out to calm areas on your site, such as turn-out pastures.
Work with the Horse’s Sense of Sight
Horses don’t have strong binocular vision or depth perception like people do, but they can see almost all the way around their bodies. They also have a keen sense and understanding of movement, light and shadow, etc. Create solutions designed for the way your equine patients see.
Light work spaces evenly. In barns, deep shadows and bright rays of light can be beautiful and comfortable, like standing in the dappled shade under a tree. But in spaces where horses are working or are under stress, such as arenas or veterinary spaces, uneven lighting can create anxiety.
Design equine work spaces with regularly placed, unobstructed lighting. If possible, use lighting that has a spectrum like natural sunlight. The best technology is LED lighting.
Allow horses to see what is coming. Anyone who has worked with horses knows they prefer not to be surprised. In arenas and work areas, it is better to locate visible doors at the ends of the space rather than the sides. This gives the horse a better chance of seeing an object or person arriving with both of its eyes. Horses can be especially terrified of unexpected sights at the ground level, such as moving garden hoses, plastic bags and the like.
Soften and filter natural light. Fabric-roofed arenas make for very comfortable indoor riding spaces because they filter natural light. The effect is a space that is bathed in soft, bright light. The idea of filtering natural light can also apply to traditionally constructed structures. High windows and skylights can be designed with translucent materials to evenly distribute the light in the space, thereby minimizing shadows and glare.
Safe Flooring Is Critical
Design a floor surface that looks solid and even. Horses are spooked by drains, grates, changes of materials and other features in the floor surface that are difficult to see and visually comprehend. Therefore, walking surfaces should be designed to be even, unobstructed and uniform. Drains can be placed to the sides or carefully obscured to reassure the horse that the floor is safe.
Slipping is dangerous as well as scary. Horses hate to slip, and they will be especially anxious if they feel unsafe on the flooring. Inside the hospital, create non-slip flooring solutions such as:
rubber matting designed for horses
poured, soft floor solutions specifically designed for horses
some textures of concrete.
Refer to the previously published EquiManagement articles on flooring for more information about appropriate flooring solutions. You can find the first article here Solid Foundation and the second article here Design from the Floor Up.
Consider Odors and Ventilation
Horses will also use their superior sense of smell to test their surroundings for safety. In addition to good basic ventilation to create adequate indoor air quality in medical barns and equine treatment areas, consider other sources of odors in the indoor environment and use ventilation strategies to prevent odors from spreading.
Separate surgery and procedure room air flow from the exam and work-up areas of the hospital. This strategy helps prevent the smell of blood and other potentially scary odors from becoming pervasive in the rest of the hospital.
Separate all dirty/utility spaces and do not recirculate air from them into exam/treatment spaces. For example, a necropsy room or a dirty laundry room likely smells terrifying to horses coming in for treatment.
Use gentle disinfectants such as accelerated hydrogen peroxide. Accelerated hydrogen peroxide leaves only a slight odor rather than the strong antiseptic, caustic smell left by older disinfection technologies.
Use natural ventilation in barns and treatment areas when possible to reduce odors and to capitalize on natural scents from the outdoors.
Place manure and trash away from the main buildings and downwind.
Create Comfort
Do anything you can to help your patients be comfortable, particularly when they’re sick or injured. Keep barns above freezing in winter and free from drafts. In summer, temper the inside of barns by moving air, creating shade and utilizing occasional supplemental cooling depending on your location. But don’t overdo it. It is hard on horses metabolically to go from extreme heat into a chilly, over-air conditioned space. The medical barn indoor temperature range should be between 50 and 85 degrees.
Use appropriate, deep bedding or forgiving, rubberized flooring in hospitalized areas so the horses can lie down or stand comfortably.
With the guidance of the veterinarian overseeing care, provide many frequent, small meals, or if appropriate, free access to hay throughout the day, rather than two large meals. Horses are intended to forage continuously, and eating can relieve anxiety.
Provide horses with access to fresh, clean water. If using automatic watering devices, ensure they are fully disinfected, cleaned, dried and refilled between patients for the health of the next horse.
When medically appropriate, provide safe turnout for horses. Use easy-to-see fencing to keep horses from crashing into unfamiliar paddock or pasture fencing.
Take-Home Message
Good equine facility design already contains all the elements of low-stress, Fear Free spaces. The fundamental difference is the approach. Fear Free challenges us as designers and you as veterinary professionals to prioritize the perception of animals, and to eliminate fearful experiences from veterinary visits. As we do this within the realm of equine medicine, the spaces where horses are treated and cared for will change fundamentally for the better.
