How do you build a field hospital?

Hamilton’s new mobile health unit will soon be ready to receive patients. Even with cases falling, experts say, the facility plays an important part in the fight against COVID-19
By Justin Chandler - Published on May 27, 2021
Hamilton Health Sciences’ mobile health unit will be ready to accept patients as of May 31. (Courtesy of Hamilton Health Sciences)

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HAMILTON — Several boxy, military-green tents stand clustered together in a parking lot near Hamilton General Hospital. From the outside, this setup may not look much like a health-care facility, but the structures constitute Hamilton Health Sciences’ latest effort in the battle against COVID-19: an 80-bed mobile-health unit.

“This was an addition to our existing bricks-and-mortar hospital-bed capacity to serve the region — and the province — if we needed it,” says Kelly Campbell, HHS’s vice-president of corporate services and capital development.

The new 1,580-square-metre facility is the second such mobile-health unit provided to the province by the federal government. With intensive-care units in southern Ontario hospitals under strain from the pandemic’s third wave, the province’s first mobile unit opened on April 30 in the parking lot of the Bayview Campus of Toronto’s Sunnybrook Health Sciences Centre. 

Sunnybrook’s field hospital tells TVO.org that it stopped admitting patients on May 25, as hospitalizations have recently declined, but that “the facility will be maintained for the foreseeable future and MHU teams will be mobilized should the need arise.” Hamilton’s, too, may remain on standby, although it will be ready to accept patients on May 31. But health-care experts say these facilities are still an important part of Ontario’s pandemic response. “I think it’s comforting to have this up and ready to go until such time as the Ministry of Health feels it can be demobilized,” says Robert Burgess, Sunnybrook’s senior director of emergency preparedness. 

rows of green tents
Mobile health unit in the parking lot of Sunnybrook hospital's Bayview Campus. (Courtesy of Sunnybrook Health Sciences Centre)

When HHS began planning for its mobile health unit this past winter, the team benefitted from being able to follow Sunnybrook’s lead and seek advice, Campbell says: “It’s good to be second sometimes.” She and Burgess agree that any hospital team working to build an MHU should understand the importance of communicating with contractors and sharing information between hospitals.

In Toronto and Hamilton, Burgess and Campbell say, a lot of advance planning was needed. Prior to building, hospital staff worked with contractors to identify each site’s needs — for example, which layout would best enable the movement of staff and patients. In Hamilton, contractors spent two weeks levelling the lot, removing curbs, and checking to make sure drainage would be adequate before beginning construction last month.

workmen in a large tent
 Electrical work underway at Hamilton's mobile health unit. (Courtesy of Hamilton Health Sciences)

Preparing staff to work in a different environment is another important pre-opening consideration, and this was expected to take place this week in Hamilton. Health-care workers need to get familiar with site-specific emergency procedures, such as new evacuation plans. They also need to learn where certain items are stored and how to operate a different model of bed. “They’re a little bit different than the ones we have in the hospital,” Campbell explains. “They need to understand how the facility operates, and if it’s too hot or too cold, what do they do?” 

The biggest difference between an MHU and a standard hospital is that the walls are made not of brick and drywall but of fire-retardant fabric on aluminum frames, Campbell says: “There’s mostly similarities, not differences. [Patients are] in a hospital bed just like they would be in the hospital.” In addition to the washrooms, medical-support systems, HVAC, and filtration and fire-alarm systems you’d find in a normal hospital unit, the MHUs will be equipped with round-the-clock support for repairs and security.

It was the difference in appearance that made some inbound patients to Sunnybrook’s 84-bed MHU nervous initially: “From the outside, it’s almost like an army tent,” Burgess says. But once patients got inside the bright, climate-controlled MHU, he adds, their apprehension faded: “These are not the kinds of tents I think people would imagine. For the most part, the history of these does relate to the military, but inside, it’s very impressive, very sophisticated.” 

a hospital bed inside a tent
Bed in a patient ward at Hamilton's mobile health unit. (Courtesy of Hamilton Health Sciences)

Unlike triage tents set up near a battlefield, Burgess says, Ontario’s MHUs are fully functional hospitals. “You can certainly provide care in this environment, if you do it in a careful fashion,” he says. Before pausing operations, the MHU treated more than 30 patients.

Despite the similarities, MHUs are not a replacement for traditional hospital beds, Burgess says: only specific types of patients were admitted to the Toronto unit — those who had COVID-19 or who’d had it and were nearing the end of their hospital stay. It’s also important to understand, he adds, that these field hospitals have been created for the overall Ontario health system, not exclusively for Sunnybrook or HHS: “We recognize that doing patient care in a semi-austere environment like the mobile health unit is not preferable if you have beds available in a bricks-and-mortar hospital. We have a primary principle of using this when there’s a surge.” 

He notes that, while the ratio of care providers to patients in the MHU is similar to that in a typical Ontario hospital, if all MHU beds were ever to be full, Sunnybrook would work with health-care leaders to determine appropriate staffing levels and the type of patients who would be best served there. That’s the plan for Hamilton, too, Campbell says — though that could change based on provincial need.

masked woman with dolly in a large tent
Workers at Sunnybrook's mobile health unit. (Courtesy of Sunnybrook Health Sciences Centre)

A spokesperson for the Ministry of Health tells TVO.org via email that no decision has been made as to how long the MHUs will remain in operation: “The ministry, in discussion with Ontario Health, hospitals, public health officials and other levels of government, will determine the appropriate amount of time the Mobile Health Units should remain available to support Ontario hospitals throughout the COVID-19 crisis.”

While COVID-19 cases in Ontario hospitals are declining, Campbell and Burgess say these MHUs didn’t arrive too late. “It’s always better to be in a position where things aren’t quite as dire; it takes some of the pressure off,” says Campbell. Burgess adds that, although capacity is manageable right now, with non-urgent surgeries resuming, new pressures could mount and then further worsen if COVID-19 numbers were to rise again. 

And, Campbell notes, there’s always the chance of another wave. “A lot of people didn’t expect we’d have a third wave; we could still have a fourth wave,” she says. “We’ll work with the province and the region, and if they need us, we’ll be there.” 

Ontario Hubs are made possible by the Barry and Laurie Green Family Charitable Trust & Goldie Feldman.

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