Elevators are the circulatory system of a multi-story hospital — they move patients on gurneys and in beds, clinical staff, visitors, supplies, pharmaceuticals, food, linen, and waste through a building that runs 24/7/365. The elevator strategy decides how many cars, of what type and size, grouped into which banks, serving which floors and flows — and it is one of the earliest, most expensive-to-reverse decisions in healthcare design. Get it wrong and you create permanent operational friction: code-bed transports waiting behind a visitor crowd, soiled carts sharing a car with meal trays, or an OR that can't receive a bed because the only stretcher car is out of service.
This Article defines the elevator strategy and the car-type taxonomy used in U.S. hospital design. The companion Articles in this Chapter cover the quantitative sizing math and clinical-flow separation (Traffic Analysis, Sizing & Clinical-Flow Separation) and the governing safety code and accessibility requirements (ASME A17.1 Code Compliance & Accessibility); life-safety functions such as firefighters' emergency operation, occupant-evacuation elevators, and emergency power/recall live in the Life-Safety & Resilience Chapter. Here the focus is the design intent: what each car type is for, how cars are organized into a coherent strategy, and the decisions an owner and design team must make early.
An elevator strategy is the building-wide plan for vertical movement of people and material. Unlike a commercial office tower — where the dominant problem is moving people up in the morning and down at night — a hospital has multiple simultaneous, conflicting flows that run all day:
The strategy answers, for each flow: which cars carry it, on which routes, and how it is kept separated from incompatible flows (clean from soiled, public from clinical, the deceased from the living). It also fixes the physical parameters that downstream disciplines depend on — shaft count and location, machine-room arrangement, structural openings, lobby sizes, and the electrical and emergency-power loads. Because shafts are structural and run the full height of the building, the count and footprint are effectively frozen at schematic design. FGI Guidelines for Design and Construction of Hospitals set the baseline expectations for patient-handling elevators, with the IBC governing occupancy/egress and fire-service interfaces, ASME A17.1/CSA B44 governing the equipment itself, and the AHJ (plus accreditors such as TJC or DNV, and CMS Conditions of Participation operationally) shaping the final result.
Hospital elevators are specified by function, which in turn drives cabin perspectives, capacity, door type and width, interior finishes, and ride characteristics. The four functional families below are the working vocabulary; a single building usually deploys all four.
Passenger elevators serve ambulatory people — outpatients, visitors, and staff who are not transporting a patient or a cart. They are the public face of vertical transport: they open onto main lobbies and public corridors, carry the building's wayfinding identity, and are sized for crowd peaks (clinic opening, shift change, end of visiting hours) rather than for a bed.
Passenger cars are not a substitute for patient-handling cars: their cabin depth cannot accept a hospital bed, and routing patient transports through public lobbies creates dignity, infection-control, and congestion problems.