AGC MEMBERS HEAR A CRY FOR HELP AND JUMP INTO ACTION
BY STEVEN H. MILLER
COVID-19 caught the world off guard. But in a way, it’s as if the construction industry has been training for this moment. Rising trends like Lean, increased collaboration between design and construction, and modular pre-fabrication all apply well to the demands of this unusual moment. The industry had a number of the key tools and skills already in service and, just as important, had the will and the strength to stand up and make things happen. The need arose, and AGC members jumped in.
NAPKIN SKETCH HOSPITAL
As Boston began to approach the surge of COVID-19 patients, a plan evolved between the state of Massachusetts and the city of Boston to create a field hospital to treat non-acute patients and prevent existing hospitals from being overwhelmed. They tapped Partners Healthcare (a prominent local healthcare network that includes Brigham and Women’s Hospital and Massachusetts General Hospital) to be the medical partner, and Suffolk Construction, a member of multiple AGC chapters, as construction manager, and built a 1,000-bed facility in just four days inside the Boston Convention Center. They named it Boston Hope.
The plan was a dual-purpose facility, featuring 500 single rooms for sub-acute patients who do not need ICU care, and 500 rooms for unsheltered patients whose illness is not bad enough to require acute care, but who still need to be sheltered and treated, as well as isolated, to prevent their spreading the virus.
“The design was already under way by the city of Boston,” recalls Jim Grossmann, COO of Suffolk, “and their public works folks reached out to me, asking dimensionally what should a field hospital look like. They created an 8’x8’ bed area module that you could replicate 500 times. Within a 24-hour time frame, all the parties converged, met at the Boston Convention Center, and a day later we started construction, truly based on napkin sketches.”
They wanted to build something more substantial than the fabric walls being used in New York’s temporary facilities and other early field hospitals. “We knew we wanted to do something with drywall, whether it was a packaged product that you could buy from a medical supplier, or if it was a hand-built. Ultimately, because we needed to mobilize in 24 hours, we hand built them.”
Suffolk rented two warehouses near their drywall contractor New England Finish Systems, in New Hampshire, and deployed a team of 150 carpenters and others there. They framed individual modules, dry-walled both sides and applied anti-bacterial paint. Working around-the-clock shifts, they framed, dry-walled and painted 1,000 rooms in 36 hours.
“We could ship the modules in a box,” explains Grossmann, “and literally stand them up and screw them together once they showed up on-site.”
Meanwhile at the convention center, the Suffolk team and others were preparing the site. Working with the center’s facilities managers (whom Grossmann calls “one of the nicest and one of the most sophisticated groups I’ve ever worked with”), they learned about the convention-style construction. “Their concrete floors are very precious,” explains Grossmann, “so they don’t let you attach to anything. They use double stick and velcro to adhere convention walls to the floors. So we did that.”
With introductions made by the convention center management, Suffolk connected to the teamsters who usually handle booth assembly for conventions. “We brought the teamsters on board and connected them with our carpenters and laborers. So, while we were building the panels (in New Hampshire), we did all of our layout. We taped our lines out because using chalk lines would stain the floors.”
They laid out long aisles of bedrooms, with plumbing at the ends for wash stations and nurses’ stations. They tapped into the subfloor electrical grid to be able to hook up the rooms. Framed modules started arriving on the afternoon of the second day.
In addition to the two 500-room patient sections and associated nurses’ stations, they built six so-called crash rooms — for patients who suddenly became acute and needed intubation and ventilation — complete with four walls and a ceiling so they could be held at negative air pressure. They also built an X-ray room, a mental health/therapeutic room, two chapels, a movie theater, and a physical rehabilitation area. “We found out that when folks are recovering from COVID-19, their bodies are really beat up; their physical condition needs to be built up again.”
All of it was completed in four unrelenting days on-site. In addition to the teamsters, union leadership from Greater Boston Building Trades and the New England Carpenters helped mobilize their members. Others in the team included Select Demolition Services, an Alabama AGC member, New England Finish Systems, Select Paint, Liberty Construction, McDonald Electric, and JC Cannistraro (HVAC and oxygen).
“It was about 300 people per shift,” recalls Grossmann. “On day three, about 11 p.m., I was with the construction management team, and we all were wearing Apple watches, and someone said, ‘Look at how many miles you walked.’ We hadn’t thought about it, but people were walking 15, 16, 19 miles in a day.”
Suffolk also answered the call on another front. They searched their warehouses in Boston, New York, Florida and California and collected 2,500 N95 masks that they donated to Partner’s Healthcare to help Boston’s response to the virus.
“Everyone working toward one goal. In my 21 years at Suffolk, in my 25 years in the industry having worked my way up from a carpenter to where I am now, it was the best job I’ve ever been on.”
In Florissant, Missouri, near St. Louis, Tarlton Corporation, a member of multiple AGC chapters, stepped up for another whirlwind project with the U.S. Army Corps of Engineers (USACE): the conversion of an existing 130-room Quality Inn into a 100-patient non-acute care facility. Starting with a five-hour design charrette on the afternoon of Wednesday, April 8, they mobilized about 40 workers and entered the building that same evening at 6 p.m.
“We put together a three-page scope narrative with the USACE,” recalls Tarlton VP Joe Scarfino, “and basically built it from a three-page Word document that kept evolving.”
The entire hotel was repurposed.
The building has a T-shaped plan, so one suite at the crux of the T on each of the four floors was converted into a nurses’ station. It was completely emptied and set up with office furniture, room for temporary storage of medical equipment, etc. The hotel telephone system was converted into a nurse call system.
The remaining rooms were stripped of excess furniture (most of it bolted down) leaving only one bed, a nightstand and a credenza. Hotel-style locks on room doors and bathroom doors were removed or disabled.
The rooms were all deep-cleaned. “The fourth floor turned out to be a smoking floor,” recalls Scarfino. “We basically had to redo everything, taking it down to the drywall and the floor.” They created 100 patient rooms in all.
“The biggest challenge,” according to Scarfino, “was to take a hotel HVAC system and turn it into a light hospital/medical office system. Starting up on the roof, we had to relocate clustered exhaust fans and plumbing vents that were too close to air intakes, to ensure the system was not recycling restroom air right back into the rooftop air handling units. Then we thought about how to clean the airstream, and came up with a design solution where we put UV light filtering in all of the returns.” All HVAC units were inspected and cleaned, and approximately 10 percent of the room PTAC units were replaced.
In addition, isolation doors were installed in the corridors between the nurse areas and the patient areas on each floor.
It took them less than 100 hours from April 8-11 to transform the building.
The project had particular meaning for the Tarlton team. Robert Elsperman, who led Tarlton from 1972 to 1999, had succumbed to COVID-19 just hours before the assignment arrived.
His son, Dirk Elsperman, current Tarlton COO and former AGC of America president, observed, “It turned into a therapeutic project for the entire Tarlton family. Our design-build partners, subcontractors and consultants were critical to the project’s success. Everyone brought ideas and the will to succeed — a strong commitment to the 12:01 a.m. Sunday turnover. The Big Guy loved how the toughest projects brought people together,” Elsperman added in reference to his father. “The Corps chose Tarlton for a reason, and we were not going to let them down.”
ICUS ON WHEELS
Meanwhile, The Boldt Company, a member of multiple AGC chapters, was looking further down the road, at the demand for increased isolating ICU space as the pandemic continues and hospitals need to treat all their usual patients in addition to COVID-19 patients.
Boldt had already been working on a modular clinic solution for about five months for another customer, and had built a full-scale mockup. On March 13, Executive Vice President and General Manager Ben Bruns had returned from road-testing the mockup to see how it withstood shipping on a semi bed.
“I walked back into the office, and around that time the world was going to heck in a handcart,” remembers Bruns, “and it struck me, what if we used this modular construction we’re developing to help fight coronavirus?” Over the weekend, he reached out to HGA, the Minneapolis-based architecture firm, in the person of Kurt Spiering, principal and healthcare market sector leader. “My question,” says Bruns, “was, ‘What would be the most useful adaptation for this module size?’ And Spiering immediately thought of airborne isolation ICU rooms.”
“We called it ‘inside the box’ thinking,” quips Spiering.
The modular ICU, called a STAAT-Mod (Strategic, Temporary, Acuity-Adaptable Treatment Module), was a much more advanced concept than the field hospitals that United States Army Corps of Engineers started to work on a week later, “more like Phase 3 of a United States Army Corps of Engineers plan,” Bruns comments. An airborne isolation ICU serves acute patients with infections that spread by air, and the rooms are held at negative air pressure so that when a door is opened air flows into the room but not out. The STAAT-Mods include HEPA filtering for both intake and exhaust air.
“By end of the first week, we had a concept plan, a cost, and a schedule that we could believe in and show to prospective customers,” relates Bruns. That schedule was to produce a module a day, and a 16-bed unit in 11 days.
HGA brought healthcare professionals who consulted with them on a regular basis. They were also well-versed in using digital design tools and virtual reality, so they brought in nurses who had infectious disease expertise using VR, and held a meeting inside the virtual model of the STAAT-Mod. “The nurse tried to wheel the bed into the room,” relates Spiering, “and she said, ‘There’s no way I can get it in with this configuration.’ So we moved the bed to the other wall, 90 degrees.” The nurses also suggested installing a pass-thru window so they could get supplies without leaving the room and having to waste a complete set of PPE.
By the end of the first week, Boldt redesigned its pre-fabrication facility for appropriate social distancing and started construction on March 30. Just one day later, the company presented its first proposal to the state of Maryland. On April 8, Maryland ordered 64 beds, modules that were to be distributed to several different locations in the state.
The modules are the biggest size that can ship anywhere in the country, 12.5’ W x 40’ L x 10’ H. Metal-stud framing is built on a heavy steel chassis that even has a built-in axel for transport. Each module includes two patient rooms, plus an externally accessed donning room for putting on PPE before entering the patient room. The walls include fixed electrical hookups and medical gas. The roof is shipped separately and attached on-site when the modules are joined together to form an ICU building. The first 12 modules (16 beds plus support space) were installed at Adventist Fort Washington Hospital and ready for patients in late May, with more to go elsewhere in Maryland. Meanwhile, STAAT-Mod 2.0 is in design, fully code compliant and informed by customer feedback from STAAT-Mod 1.