By Jake Katzenberger, Mark Chrisman, and Russ Murdock
Our healthcare system has been pushed beyond capacity by the ever-growing number of COVID-19 patients. The need for hospital beds, ventilators, PPE, and isolation rooms has vastly outstripped the available supply, and the country is looking for spaces to repurpose into healthcare service. Our team of healthcare experts, along with design experts across diverse building types and engineering disciplines, can help convert existing buildings such as hotels, convention centers, and arenas into temporary healthcare facilities. We understand not only the infection-control requirements needed to convert these spaces, but also the existing infrastructure and functional layout of them. Having knowledge of both is crucial for success when making modifications to repurpose these environments to care for the sick among us.
Many of these building types are not an obvious fit for a healthcare space. As we mentioned in our previous article on negative isolation rooms, there are specific airflow requirements in place to minimize the chances of cross-contamination to caregivers and other patients when designing infrastructure serving an infectious patient. Supporting patients suffering from COVID-19 requires even further design consideration since many patients may need ventilators. Ventilators require oxygen piped from a medical gas system and must have electrical systems provided by emergency power circuits to ensure they will continue to operate in the event of a power failure. The typical requirements for negative isolation rooms, medical gas, and emergency power are not always easy to implement in alternative building sites, but it is possible.
Below we will discuss convention centers being converted into temporary hospital spaces and address some of the challenges and opportunities that exist. In all situations, discussions with the owner-operator and design/construction team will be critical to understand the patients who will be in a convention center/arena/auditorium conversion and their needed level of care.
Convention centers and similar high-occupancy venues (enclosed arenas and auditoriums) are well-suited to convert to temporary healthcare facilities or command/control centers. Convention centers by nature are flexible, convertible spaces, and the architectural and systems infrastructure decisions made during design and construction are typically done to provide adaptability for the needs of a yet undefined clientele. There are several components of an urban convention center that might be re-purposed in various ways to suit the needs of the temporary facility.
Entry/Lobby/Pre-Function: An urban or community focused convention center is most often provided with multiple points of entry at varying corners of the same city block, or perhaps across several city blocks. The entries may be adjacent to bus drop offs, or mass transit, allowing for convenient ambulatory access. If repurposed to a temporary healthcare facility, entries could be zoned or tiered to focus on a particular patient need, relying on signage at the city corners and building exterior to direct the public or emergency personnel to various entry points. One entry point might be family access/registration, another may be emergency responder/staff/private access, and a third could be more medically focused and be configured as a screening/triage station. These spaces are typically open, provided with generous power provisions, and connected to all other portions of the center in such a way that an organized “traffic” pattern could be created from the point of entry to the next stop needed for a particular occupant.
Restrooms: Convention centers are generally designed (in the large public spaces noted herein) at nominally 7-10 square feet per person, so the accompanying infrastructure must be able to accommodate that density. Large banks of public restrooms are typically accessible from both the public side (lobbies/pre-function) and the event side (exhibit halls) of the facility. While these restrooms aren’t personal or isolated, they do offer needed capacity if isolation is not required.
Exhibit Halls: The centerpiece of most convention centers, exhibit halls can be expansive open areas with soaring ceilings, flat floors, and a flexibility that is not available in most other commercial/public spaces. Exhibit halls come in varying sizes and shapes, but as an example, might be a large, 200,000 SF open space that is sub-dividable with air walls into four smaller 50,000 SF spaces. In a conversion to a temporary healthcare facility, each of those sub-dividable spaces could be assigned a different level of acuity. Schematic layout of HVAC to infectious patient pods
Exhibit halls are typically provided with access to a loading dock, configured with ramp access for direct drive in, or perhaps accessible via oversized freight elevator. Most access is maintained, even when the halls are sub-divided. Exhibit halls are often provided with an electrical infrastructure that can adapt to whatever need may be present — a common configuration provides utility floor boxes at 30-60 feet on center across the open floor of the exhibit hall. The utility boxes are highly customizable, but often are provided with 100A of power at 208Y/120V — 3 phase. Utility boxes may be provided with water service (though it is generally classified as non-potable), drains, compressed air, and low-voltage (copper/fiber) connectivity. In addition, utility boxes may be provided with a “bail-out” system of empty conduits (perhaps 4-6″) that provide connectivity to each box and out to the loading dock.
Configured as a temporary healthcare facility, the utility boxes would be the “hub” for the electrical needs, with a capacity to serve significant numbers of patient stations, or bed line-ups depending on the configuration. Similarly, the fiber/copper connectivity in each box can be used to create local monitoring and networking capability, as could the presence of Wi-Fi and DAS systems throughout the facility. If a bail-out system is available, it could be used to pull temporary medical gas hoses or water lines from infrastructure located at the loading dock. There is the possibility that if the water connections were all extended above the flood rim of the utility box that the water could be classified as potable and used for local handwashing and sanitation. The HVAC systems are often zoned by divisible space as well, providing some measure of isolation between adjoining rooms, and the occupant density of the spaces typically introduces the need for the HVAC to accommodate significant outside air volumes. In a conversion scenario, the electrical distribution is well-suited to accommodate local exhaust or filtration units as needed to create isolation or necessary pressure relationships, even if the mechanical infrastructure itself may need to be provided.
In some cases, exhibit halls are also outfitted with catwalk systems and “mega columns” that can deliver the same flexibility of services afforded by the utility boxes, perhaps even more so as “bail-out” services could be strung along the cat-walks and dropped down to the areas of the floor where they are needed below.
Meeting Rooms/Ballrooms: The desired flow of convention centers typically pushes/pulls event attendees from the exhibit halls to smaller breakout or plenary sessions in blocks of meeting rooms or a larger ballroom/multipurpose space. Though smaller in square footage and volume than the exhibit halls, the meeting rooms and ballrooms are designed with the same flexibility and sub-divisibility in mind. Power is generously provided in a combination of floor and wall outlets. Though not typically provided with the same power capacity as the exhibit halls, meeting rooms and ballrooms still generally have permanent power provisions (and temporary power provisions via company switches) to support a multitude of functions in a temporary conversion. Meeting rooms could be dedicated to high- or low-acuity patients, used as command and control space, or perhaps even as a respite zone for staff and emergency personnel. These spaces do not generally have the same ease of access to a loading dock and are typically connected to the dock through the vertical transportation systems. These spaces are often provided with carpet or similar sound absorbing materials on the floor, so provisions might be needed to temporarily remove those materials during a conversion.
Kitchen/Commissary: Given the frequency of banquet events in convention centers, many are provided with full cooking kitchens and commissaries. The benefit being they are well-suited to provide nutrition and meals to patients, families, and staff/caregivers as needed. Most kitchens/commissaries are connected via back of house service corridors and vertical transportation to the exhibit halls and meeting rooms/ballrooms, allowing for efficient and isolated delivery lanes to all parts of the facility.
Emergency Power: Convention centers are typically provided with emergency power in the form of diesel generator systems, and most are designed in accordance with Articles 700, 701, and 702 of the National Electrical Code (NEC). However, they generally are designed to support only emergency egress from the facility, not ongoing support of operations, especially for the HVAC systems, and most often only have enough diesel fuel on-site for nominally eight hours of operation or less. The loading docks do afford the opportunity to place mobile/temporary generators at the dock and provide temporary connections to the existing normal services as a means of ensuring continued operations on-site in the event of utility power failure.
Jake Katzenberger is Healthcare Technical Leader, Mark Chrisman is Healthcare Practice Director/Vice President, and Russ Murdock is Convention Center Practice Director/Vice President for Henderson Engineers.