key: cord-0846101-iqeajobk authors: Luo, Hanbin; Liu, Jiajing; Li, Chengqian; Chen, Ke; Zhang, Ming title: Ultra-rapid delivery of specialty field hospitals to combat COVID-19: Lessons learned from the Leishenshan Hospital project in Wuhan date: 2020-07-04 journal: Autom Constr DOI: 10.1016/j.autcon.2020.103345 sha: ef17f33bbdbe5b6ba517f066befe5b399744b47d doc_id: 846101 cord_uid: iqeajobk With the outbreak of the 2019 novel coronavirus (COVID-19) epidemic in Wuhan, China, in January 2020, the escalating number of confirmed and suspected cases overwhelmed the admission capacity of the designated hospitals. Two specialty field hospitals—Huoshenshan and Leishenshan—were designed, built and commissioned in record time (9–12 days) to address the outbreak. This study documents the design and construction of Leishenshan Hospital. Based on data collected from various sources such as the semi-structured interviews of key stakeholders from Leishenshan Hospital, this study found that adhering to a product, organization, and process (POP) modeling approach combined with building information modeling (BIM) allowed for the ultra-rapid creation, management, and communication of project-related information, resulting in the successful development of this fully functional, state-of-the-art infectious disease specialty hospital. With the unfortunate ongoing international COVID-19 outbreak, many countries and regions face similar hospital capacity problems. It is thus expected that the lessons learned from the design, construction and commissioning of Leishenshan Hospital can provide a valuable reference to the development of specialty field hospitals in other countries and regions. J o u r n a l P r e -p r o o f 3 fully functioning field hospitals outfitted with all the medical equipment necessary to treat patients with severe symptoms. More surprisingly, the construction of Huoshenshan Hospital and Leishenshan Hospital took only 9 and 12 days, respectively. Many people witnessed their construction processes, which were livestreamed by state media [11] . Hospital should be praised from both managerial and technological perspectives. For instance, key stakeholders, including the designer, main contractor, and relevant governmental departments, seamlessly collaborated with each other and allocated sufficient resources within a short timeframe; over ten thousand construction workers worked in shifts to accelerate the construction process. Regarding the technologies that facilitated the project delivery, both Huoshenshan Hospital and Leishenshan Hospital adopted prefabrication technology to avoid time-consuming in situ construction work. Moreover, the implementation of digital technologies such as building information modeling (BIM) cannot be overlooked. BIM starts with an object-based digital model that provides a digital representation of the project [12] [13] . Following the product, organization, and process (POP) modeling approach, BIM incorporated organization and process information to become a shared platform for information creation, management, and communication during the development of Huoshenshan Hospital and Leishenshan Hospital. J o u r n a l P r e -p r o o f 4 The remainder of this paper is organized as follows. The next section reviews BIM implementation in hospital projects and the necessity of integrating BIM with the POP modeling approach. The third section provides details of the case study. The fourth section introduces the typical BIM applications during the development of Leishenshan Hospital. The fifth section discusses the lessons learned from the development of Leishenshan Hospital. The last section summarizes this study. As a construction project, a hospital generally has complex design requirements that are influenced by many uncertainties, and its technical requirements can be much more complicated than other types of projects with similar scopes [15] . Previous studies have explored the use of BIM to help fulfill these technical requirements and improve the development of hospitals. Given its 3D presentation and virtual reality simulation capability, BIM can act as a technical tool that can be applied to improve design quality and productivity in a number of areas, including construction plan rehearsal and optimization, and construction site management [16] . [17] reported that the application of BIM during the conceptual design stage of healthcare projects could provide instant 3D visualization and save time for quantity takeoffs. [18] developed an integrated design system to improve the efficiency of BIM-based collaborative design among project participants in a hospital project. They suggested that, because of its information interoperability, BIM can address several collaboration problems such as unnecessary repetitive work, and data errors and losses. For the on-site application of BIM during the construction stage, [19] explored the use of "Site BIM" system that allowed site workers to use mobile tablet personal computers to access design information to assure progress and quality control. [20] noted that BIM can J o u r n a l P r e -p r o o f 5 With the wide spread of BIM adoption and the complexity of healthcare facilities, researchers and practitioners have realized that BIM provides less help to the project delivery if the model contains only physical and functional product information [21] . Therefore, Product, organization, and process (POP) modeling which complements the product model with process and organization information becomes particularly effective in conjunction with BIM applications [22] . A POP model consists of three sub-models, namely: (1) a product model that contains both the geometric and non-geometric attributes of physical objects and allows for quantity takeoff, ventilation simulations, and other necessary analyses; (2) a product-process model that integrates the product model with the construction progress for seamless construction coordination and schedule management; and (3) an organization-process model that associates the specific project delivery tasks with organizational responsibilities at different project stages [23] . Through POP modeling, comprehensive data interrelationships in BIM can be constructed to establish a more interactive model for improved project planning, coordination, and visualization [24] . All these benefits contributed to the successful delivery of Leishenshan Hospital. Leishenshan Hospital is located at an abandoned parking lot of the Wuhan Military Games Athletes' Village in Jiangxia District, with a site area of approximately 220,000 m 2 and a total construction area of nearly 80,000 m 2 . Leishenshan Hospital consists of three main areas, including the medical staff living area (marked in purple in Figure 1 ), the logistics area (e.g., supply warehouse, wastewater treatment station, trash incineration station, and ambulance decontamination area; marked in red in Figure 1 ), and the medical treatment area (marked in blue in Figure 1 ). The design of the medical treatment area of Leishenshan Hospital adopted a fishbone layout, complying with the "three zones and two passages" principle and the national design code for an infectious disease hospital (see Figure 2 ). The three zones include a clean zone, a semi-contaminated zone, and a contaminated zone; The two passages include a passage for medical personnel and a passage for the patients. Similar to other fully functioning infectious disease hospitals, the medial treatment area of the Leishenshan Hospital includes isolation wards, a medical technology facility, consultation rooms, intensive care stations, liquid oxygen stations, and other essential facilities to protect both patients and medical staff members. Leishenshan Hospital adopted the modular design that divided the whole hospital into individual prefabricated units. The medical treatment area consisted of over three thousand container-type prefabricated units; each unit has its own functions with a standard size of 6 m × 3 m × 2.6 m or 6 m × 2 m × 2.6 m (see Figure 3 ). The units were produced in factories and then transported to the construction site and installed at the designated location by a mobile crane. The isolation ward was equipped with a double-sided cabinet that linked the ward to the passage; the cabinet allowed the medical personnel to deliver daily necessities or medicine to the patients without the need to enter the ward, which prevented cross-infection. In addition, the isolation wards had air conditioners, cables, televisions, and electric lights, which were installed after the prefabricated units were assembled on the construction site. The living area for the medical personnel was adapted from the original canteen of the Athletes' Village. A total of ten buildings were newly built; among them, eight were two-story buildings with a height of 7.5 m, and two were one-story buildings. These ten buildings provided nearly 400 rooms and over 2300 beds for the medical staff of Leishenshan Hospital, and their construction also consisted of container-type prefabricated units. These prefabricated units were placed on a truss, which mitigated the need to develop a structural foundation and renovate the drainage system. Each room was equipped with a wardrobe, air conditioner, and other furnishings and appliances, as well as a private bathroom. In this case study of Leishenshan Hospital, both first-and second-hand data were collected from multiple sources. The first-hand data were gathered through semi-structured interviews with three of the designer's staff members (one project manager, one design director, and one BIM coordinator) and two of the main contractor's staff members (one technical manager and one BIM manager). All the interviewees oversaw and used BIM during the project delivery. Due to the physical constraints resulting from the epidemic, semi-structured interviews were conducted J o u r n a l P r e -p r o o f 9 through telephone and online video calls, each lasting for 15 to 25 minutes. The interview questions were separated into parts. The first part focused on the challenges of project delivery; the second focused on how BIM was used to address these challenges. The interviewees were asked to answer questions following the designated sequences but were also allowed to discuss their BIM experience freely. In addition to the first-hand data, second-hand data were collected from media outlets, public reports, and internal project documents from the designer, which mainly Third, communicating information among project stakeholders can be challenging due to the large number of stakeholders involved and the inherent organizational fragmentation. Parts of the design and construction of Leishenshan Hospital were conducted in parallel, and the construction work contained more than ten cross-disciplinary processes such as site leveling, foundation engineering, pipeline embedding, anti-seepage membranes, prefabricated component assembly, and interior finishing. On the busiest construction day, there were over fifteen thousand workers and more than eight hundred construction machines working at the construction site. The main contractor had to coordinate subcontractors from different disciplines to maximize their productivity and maintain progress in accordance with the schedule. To address these challenges, the designer (Central-South Architectural Design J o u r n a l P r e -p r o o f 12 A strict separation of pathways for patients and medical personnel was an essential requirement for Leishenshan Hospital. To satisfy this requirement, the pathways for patients and medical personnel were visualized in the BIM model (see Figure 5 ). Utilizing a fishbone-shaped layout, patients entered the isolation wards through branches of the fishbone and could access bathrooms through the patient pathway. The patient pathway was also used for waste disposal at a temporary storage facility. The long middle area was a dedicated pathway for medical staff members who entered and exited the isolation ward from the buffer area by using a one-sided door. Through a route simulation of patients and medical personnel, clean supplies and waste flows were separated, and buffer areas were accurately allocated within the medical treatment area. Therefore, the chance of cross-infection to medical personnel was minimized. Leishenshan Hospital has complex building service systems that incorporate nearly ten subsystems, including a heating, ventilation and air conditioning (HVAC) system, a water supply and drainage system, a lighting system, a weak current system, and Considering that COVID-19 is an infectious disease that can spread through breath and remain viable for several hours in the air [26] , the ventilation systems of the Leishenshan Hospital followed the principle of negative pressure to isolate pathogenic microorganisms. The air pressure in the isolation ward was lower than the air pressure outside the ward. In this way, outside air flowed into the ward, and the air contaminated by patients in the ward was discharged only after special treatment; the concentration of pathogenic microorganisms in the ward was diluted by ventilation, and the area outside the ward was not contaminated. This organization of air circulation within the hospital was critically important and was carefully designed to meet relevant standards and requirements. Based on the characteristics of Leishenshan Hospital, the designer generated four air supply and exhaust solutions, as shown in Figure 6 Additionally, the size of the air outlet port was 0.4 m × 0.4 m, and the volume of its exhausted-air was set at 700 m 3 /h (in the horizontal direction). Temperatures of the inner wall and outer wall were set according to the room temperature and ambient temperature, following the equal wall boundary condition. With these defined parameters, Solution A formed a U-shaped airflow inside the isolation ward. As shown in Figure 7 , the air flows out from the air inlet port, changes its direction after arriving at the opposite wall, and flows through the position of the two patient beds to the lower area. The pressure difference between the buffer room and the ward can effectively prevent the contaminated air from spreading to the buffer room; the contaminants can be filtered and discharged through the outlet port. Leishenshan Hospital rose from the ground in 12 days, stunning the world with its construction speed. J o u r n a l P r e -p r o o f 24 It is worth noting that some of the reflected benefits and challenges have been reported in previous studies examining the process and context of BIM implementation [31] [32] [33] [34] [35] [36] . Nevertheless, this study documents the first case study of the use of BIM in the rapid design, construction and delivery of a specialty field hospital. The experience of Leishenshan Hospital outlined here could enrich the body of knowledge concerning BIM applications in the development of healthcare facilities [17] [18] [19] [20] 37 ]. 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