Programming planning, and design services for this challenging project was to address 10 year volumes and included master planning for 20 year volume projections. Spaces include central registration, specimen collection, triage, exams, procedures, trauma, support spaces, ambulance garage. Key challenges include solutions for use of a maxed out site to accommodate 20 year volume analysis. Experience with codes and those specific to healthcare proved to be invaluable for this project to make work with the design program given the multitude of existing facility infrastructure issues.