Medical Design Consulting Procedures

A team of small businesses is adding value to a multi-year design-build project at Nellis AFB through comprehensive review and analysis of design documents and processes.
By Brad Carne, P.E., M.SAME
The Mike O’Callaghan Federal Hospital at Nellis AFB was renamed the Mike O’Callaghan Federal Medical Center under the 2011 National Defense Authorization Act. The change accompanied an increase in the size and scope of its patient care mission. A multi-year design-build construction project is ongoing to expand the facility. U.S. AIR FORCE PHOTO BY SENIOR AIRMAN BRETT CLASHMAN

When a U.S. Air Force medical clinic or hospital undergoes a renovation, a protocol is in place for the project from cradle to grave. Private firms are integrated into this in three different ways, enabling companies the opportunity to provide their expertise to deliver successful projects.

The Air Force Medical Support Agency/Health Facilities Division (AFMSA/HFD) is responsible for the programming, planning, design, construction and initial outfitting of medical treatment facilities worldwide. They are chartered with modernizing hospitals, clinics, medical office buildings, warehouses, vet clinics and wellness centers. To meet the demands of healthcare design and construction projects, AFMSA/HFD requires technical support services from experienced healthcare architects-engineers who are able to rapidly respond to multiple requirements, meet constrained schedules, and provide a variety of technical support services.


These services generally come in three separate phases: AE1, AE2 and AE3. “AE1” describes the architect-engineer who assists the owner in developing design/bid documents for design-bid-build or the request for proposal/statement of work (RFP/SOW) supporting documents on a design-build project. “AE2” describes the design-build team charged with the design and construction of the facility, meeting all the requirements set forth by AFMSA/HFD. “AE3” represents the interest of the government owner as well as provides design and construction support services.

AE1. The AE1 team is defined as the team that takes the project from the government after a task order had been given. The government relies on these teams because of their experience in medical buildings, and expertise in assessing a building and its infrastructure. The goal of the AE1 team is provide a strong RFP to the AE2 team that minimizes any changes in construction. In the past, the government has provided this service in-house, but has recently realized the added value a private firm brings to the table. It is the AE1’s job to create all the requirements for the AE2 team to design and build the project.

The project starts with a Pre-design Teleconference and a Pre-design Review Conference. The AE1 team then travels to the site to attend and facilitate the Design Charrette. Each of the team disciplines creates value by bringing their expertise to the assessment and running to ground any outstanding issues. By doing this, the surprises are limited during the construction.

After the Design Charrette, a Charrette Report (Submittal #1) is created. This contains the project description and engineering parameters regarding all codes and design guidelines for architecture, interiors, civil, structural, seismic, energy and water conscious design, HVAC, plumbing and med gas, electrical, communications, accessibility, fire projection, physical security, medical and dental equipment, transportation and material handling, waste management, anti-terrorism/force protection, way finding, and building information modeling requirements. It is the intent of the submittal to report on all existing conditions, and provide a realistic design that will meet the budget and schedule.

A Pre-Final Design Conference (Submittal #2) is the next task where the team travels to the site and attends and facilitates a review of the draft RFP. During the Pre-Final Design Conference, the team addresses all of the user comments and provides elevations and sections as well as a refined budget and schedule. There is a great chance to add value here and provide expertise to alleviate any user concerns.

The last task of this contract is a Corrected Final Telecom (Submittal #3). The AE1 team responds to all comments and incorporates the comments into the final document and submits.

AE2. The AE2 team is defined as the Prime Construction Contractor responsible for design and/or construction of the new or newly renovated facility.

The AE2 team takes the project from the RFP and creates the design documents including all drawings, specs, cutsheets, calculations, and design narrative. The team then constructs the building, following all of the codes and guidelines set out in the RFP.

AE3. The AE3 team is the team that represents the interest of the government and provides design and construction support services. The team provides cradle-to-grave technical reviews of design and construction submittals/shop drawings, helps identify costly conflicts/omissions in the plans and specifications, and assists in developing solutions to unforeseen conditions that arise during construction. The AE3 team provides its value by having an intimate working knowledge of the project requirements, design, and construction issues. The AE3 team starts with the Kick-off Teleconference with all parties detailing out the project and the expectations.

The team’s first task is to attend the Design Charrette meeting to ensure a thorough understanding of the facility’s current design, layout and construction as well as ensure requirements for the pending renovation are achieved. The meeting is facilitated by the AE2 team.

The AE3 team reviews each AE2 design submittal (four total), then is responsible for eliminating conflicts, errors and omissions, and for ensuring all technical requirements are met. The AE3 team must ensure the general contractor complies with the RFP/SOW, codes, criteria and standards. It should be noted, the AE3 team is the primary, and sometimes the only reviewer, of the documents. During the course of design and construction, the AE3 team attends a weekly Design and Construction Progress Meeting.

During construction, the team reviews selected construction submittals and is responsible for on-site support in coordination with the project engineer, including quality review, inspection, field supervision and coordination of trades. Depending on the timeline, this can include weekly to monthly visits.

The AE3 team then completed a review of the four design submittals, providing comments relating to the design intent, eliminating conflicts, errors and omissions, and ensuring all technical requirements were met.

The Mike O’Callaghan Federal Medical Center is a 374,528-ft² facility located at Nellis AFB in Las Vegas. Opened in 1994, it is run by the Air Force’s 99th Medical Group, and was authorized for expansion in 2010. The ongoing design-build project, scheduled for completion 2016, is executing a functional reconfiguration of the spaces, necessitated in part by one of its tenants, the Department of Veterans Affairs, vacating the building as part of its own relocation to a new facility in the area.

By utilizing an existing five-year indefinite delivery contract for A-E services in support of the Healthcare Facilities Modernization Program with the U.S. Army Corps of Engineers (USACE) Little Rock District, Specialized Engineering Solutions (SES), along with the prime contract holder, Altus Architectural Studios—and subcontractors Kenneth Hahn Architects; VW International; Thompson, Dreessen & Dorner; Protection Engineering Consultants; and Code Consultants—are providing AE3 services to the government. SES is providing mechanical, electrical, and data communications review.

The project is large and complex. A thorough understanding of the current Unified Facilities Criteria and Facility Guidelines Institute guidelines is critical. The AE3 team of consultants is contracted by the government and is representing the government’s interests. However, the team also is viewed as an asset to the design-build team to ensure costly mistakes and change orders are avoided and potential issues are addressed proactively. Their combined specialties bring a unique and comprehensive skillset to the project that otherwise might not be possible.

The AE3 team began the project by attending the two-week Design Charrette on site. SES attended the user group meetings and toured the facility with the AE2 team and users. The firm became familiar with each section of the building, and each type of system serving it. The AE3 team also worked with the AE2 team to find solutions so each user group was satisfied with their new space. For example, the program called for one Caesarian Section room in the suite, while the users asked for two. By working with the AE2 team, two Caesarian Section rooms were able to be created while still meeting the program space requirements.

The AE3 team then completed a review of the four design submittals, providing comments relating to the design intent, eliminating conflicts, errors and omissions, and ensuring all technical requirements were met. Each comment was discussed and resolved between the AE2 and AE3 team. In instances where further discussion was needed, the teams worked to find a solution suitable to all parties. For instance, 5000-K lamps are required in certain sections of the hospital. SES worked closely with the AE2 team to find T5 lamps that met this demand and help with the Energy Policy Act of 2005 energy savings requirements.


SES and the entire AE3 team has provided an added value, giving both AFMSA/HFD and USACE beneficial feedback through a thorough review of the design documents.

As a small business, it is essential to understand the high commitment to excellence required by the government—and be able to respond with significant flexibility and agility to meet and exceed the project requirements through inspired, innovative solutions. The AE3 team for the Mike O’Callaghan Federal Medical Center project is comprised entirely of small businesses. By understanding the perspective of all occupants, from the patient to the nurse to the building engineer, these firms provide a level of detail that is exceedingly valued. Adding value doesn’t mean adding cost to the project; it means adding quality to the solution.

Brad Carne, P.E., M.SAME, is Director of Government and International Operations, Specialized Engineering Solutions; 402-991-5520, or This email address is being protected from spambots. You need JavaScript enabled to view it..