Adapting Residential Space for Coronavirus Care – Stat!

Syska has worked on many fast-track projects, but the conversion of residential space for nurses into ICU wings at North Central Bronx Hospital is more aptly described as an Olympic sprint.

On March 18, architect Lothrop Associates engaged Syska to design MEP and FP systems for 120 ICU beds on three floors and two partial floors. Normally a project of this scope would take approximately six months to design. But with COVID-19 spreading rapidly, the team was given a target of 30 days for design and construction combined.

Fortunately, Syska already had a team in place. A hospital replacement project had just been put on hold, so senior principal Tim Krawetz reassigned the team members to the new effort. When they learned about the tight timeframe, their first reaction was a stunned “wow,” recalls project manager Danielle Ford. But the “wow” was closely followed by “Let’s get moving!”

Who’s Who Client: NYC Health and Hospitals Corporation Architect: Lothrop Associates LLP Construction Managers: Skanska and Jacobs The Syska Team Principal in charge: Tim Krawetz Mechanical: Mike Itkin, Brandon Smith, John Michlik, Brett Kuklewicz Electrical: Danielle Ford (project manager) and Leigh Ann Vogel Plumbing/Fire Protection: Wayne Salfarlie, Dempsey Narcisse, Ryan Redican Printing/Drawings: Rodney Jones

Design Considerations

The 30-day target was not the only challenge. Because the coronavirus is so easily transmitted through droplets, the team had to design systems more complex than those of traditional ICUs, which are already complex. Furthermore, the conversion of residential space into ICU space created additional obstacles. “This is essentially a form of adaptive reuse,” says Tim.

There could be no shortcuts, either. As with any other hospital facility, the project had to meet the strict codes of the Department of Buildings, Department of Health, and Fire Department of New York.

Meanwhile, site visits had to be kept to a minimum in keeping with stay-at-home and social-distancing orders. The need for virtual collaboration quickly became evident: Following the initial meeting on site, the lead architect came down with the coronavirus. Tim, who had attended that nine-hour meeting with the architect, had to self-quarantine for 14 days. Brandon Smith, one of the lead mechanical engineers on the project, toured the site early on with a borrowed N95 mask. But since then, most of the work has taken place via Skype, calls, and email.

More recently, Syska turned to Microsoft Teams. This technology enabled one engineer to perform an on-site survey on April 9 while sharing the feed through his cellphone to other team members. As a result, everyone could collaborate in real-time and provide immediate feedback to the contractors.

Equipment Supply and Selection

Given the urgency of the project, the team chose equipment that was readily available. “Everyone reached out to manufacturers from the get-go,” says Leigh Ann Vogel, who specializes in electrical engineering design. Wayne Salfarie, the team’s senior plumbing and fire protection engineer, called up manufacturers to find out what was in stock and what could be delivered within two weeks. Brandon found vendors to be “super helpful” once they learned that the equipment would be used for COVOID-19 treatment.

But the equipment was not your everyday equipment. It had to meet special requirements of coronavirus care. On the HVAC front, for example, the team could not use the fan coil units in the existing space because they could circulate the virus. These were removed and replaced by air-handling units with two different modes of operation. “One mode is for a regular ICU; the other is intended specifically for coronavirus treatment,” says Brandon. “In the second mode, we essentially exhaust all the air for the floor so there is no recirculation of air – it doesn’t escape from the walls. Instead, it gets drawn in. We call this ‘negative pressure,’ which protects staff and other areas of the hospital from airborne droplets.”

The unique nature of the coronavirus also affected the design of medical gas equipment. According to Wayne, sizing of such equipment is normally based on the assumption that all of the medical gas outlets would not be used simultaneously. He notes: “Here we anticipated that all of the outlets would be used at once for coronavirus patients, so we allowed for extra load on the system.”

Rapid Progress

As soon as the team determined what equipment was available, it was time to create drawings. Within two weeks, the team delivered 66 drawings of specific floors to allow contractors to begin fabrication and ordering equipment. “We’re flying -- doing this in record time,” Tim states. “We’re working 18-hour days and through weekends. I’m really proud of how the team has stepped up.”

Contractors have played an important role in this process: In some instances, they are taking the preliminary plans and finalizing the details so they can get started on fabrication and construction right away. “We’re not the only ones working hard,” says Brandon. “The contractors are working 24/7.” Danielle adds: “Everyone’s been really great in adapting to new ways of learning and getting things done and sharing information.

Thanks to the speedy efforts of all parties, the wings are slated for completion in mid to late April, which will enable the hospital to treat Covid-19 patients during the peak period of the outbreak in New York City. In Danielle’s view, this result makes the stress and long hours well worthwhile: “It’s a chaotic time, but we’re all happy to be part of a team dedicated to helping during this crisis.”

Designing MEP Systems for a COVID-19 Tent Hospital

The ICU wings at North Central Bronx Hospital represent only one of several COVID-19-related projects that Syska is engineering. Another is a temporary hospital comprising two tents of 50 beds each, located in the parking lot of New Bridge Medical Center in Paramus, New Jersey.

RSC Architects, which is working with the Army Corps of Engineers on the facility, engaged Syska for mechanical, electrical, and plumbing design in late April. Other project partners include Strategic Planning Services, LLC (hospital management), Planate (construction and facilities service support), Disaster Management Group, LLC (construction management), and Holt Construction.

Although both facilities accommodate COVID-19 patients, there are significant differences between the Paramus and Bronx projects. The Paramus hospital is intended for non-acute care; patients treated here are not on ventilators. Consequently, Syska had much more flexibility in equipment choices. For example, there was no need for negative pressurization from air-handlers as within the ICU wings at North Central Bronx.

On the other hand, a tent environment presents its own set of challenges. Tom Ford, the mechanical project manager, explains that equipping a tent involves delivery of a brand-new electrical service from the local utility to the site and multiple HVAC units to ensure code compliance within the space.

A few challenges applied to both projects, however – speed, for instance. Tom recalls that in the case of Paramus: “We were approached on Monday, April 20. By Tuesday morning I was on site for a meeting with the contractors and developers. We created a team from our local New Jersey office augmented by a second team from our Boston office. We were up and running at warp speed by Wednesday.” Thanks to quick mobilization and extensive coordination with project partners, the temporary hospital opened on April 29, only 9 days after the initial call.

Another shared challenge was remote coordination. Although we did have team members visit the site (wearing protective gear), much of the work was conducted virtually. “Skype, Microsoft Teams, and WebEx were some of the tools we used,” says John Bilotta, the principal in charge.

He continues: “Thanks to quick mobilization and extensive coordination with project partners, the temporary hospital will open in early May, under a month after the initial call.”