Located in the San Antonio suburb of Live Oak, HCA Northeast Methodist Hospital’s emergency room serves south Texas residents 24 hours a day, seven days a week. When the hospital decided to renovate and expand its emergency department to better serve the growing community, they called on Gresham Smith to commission the mechanical equipment in the space. Working closely with HCA and Northeast Methodist Hospital staff, our team of commissioning agents tested and certified that the systems in the 12,000-square-foot space were constructed and operated for peak performance, giving staff the space they need to deliver the highest level of care as quickly as possible.


Hospital Corporation of America


Live Oak, TX

Project Type



square-foot mechanical room


square-foot ED


air terminal units

Limiting Airborne Illness

Limiting Airborne Illness

The 6,000-square-foot addition added 17 treatment rooms to the emergency department, including one isolation room for patients with airborne diseases. With an emphasis on controlling air flow to keep germs from spreading, we had to make sure the room’s ventilation was properly designed and the equipment was properly installed. Additionally, we confirmed that the room’s pressurization worked correctly to limit contact with contaminants.
A Mechanical Room on the Roof

A Mechanical Room on the Roof

The hospital added a 1,300-square-foot penthouse—a mechanical room on the roof. The space is now home to the emergency department’s large mechanical equipment, including an air handling unit and 16 air terminal units that serve both the main emergency department and isolation room. The equipment is controlled by a building automation system, which nearly eliminates trips to the roof. We tested and confirmed that the system was installed and operating correctly, allowing the maintenance staff to control the units from their office.
True Teamwork

True Teamwork

During our functional performance testing we identified a handful of mechanical issues that needed to be addressed. We worked closely with HCA and hospital maintenance staff to resolve the problems quickly and correctly prior to the emergency department re-opening its doors.

Project Contact

Our team is committed to improving the places we call home.

Bring genuine ingenuity to your community.

Johnathan Woodside, P.E., C.E.M., LEED AP (O+M)
Johnathan Woodside, P.E., C.E.M., LEED AP (O+M)
Senior Mechanical Engineer