READY FOR ANY SCENARIO

When the coronavirus pandemic reached Europe in March 2020, the Berlin Senate set an ambitious target: to build a hospital in an exhibition hall in just four weeks. Up to 1,000

beds are available at short notice – although ideally they will never be needed.

TEXT OLIVER DRIESEN   PHOTOS PATRICK OHLIGSCHLÄGER

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AS FAR AS THE EYE CAN SEE

Almost 500 beds stand in rows in the 165-meter-

long Hall 26, ready to take the pressure off Berlin’s

hospitals, if necessary PH

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LIQUID OXYGEN is suppliedby a 50,000-liter tank located outside. A network of pipes distributes it to the respective hospital beds

Pale sunlight falls in diagonal stripes through the sky-lights in Hall 26 on this late summer’s day. It is quiet in here, even quieter than outside on Berlin’s almost deserted exhi-bition grounds beneath the radio tower built in 1926, one of the city’s landmarks. With increasing distance, the deepen-ing shadows being cast appear to play tricks on the eyes – one hospital bed after another is lined up along the aisles marked with green and blue linoleum flooring. There are almost 500 beds here, extending across a hall with a length of 165 meters. All are identical, standing in front of mobile wall supply units*, which supply ventilators with oxygen and compressed medi-cal air. Every single bed is empty. An auxiliary hospital now stands on the same 12,000 square meters of space where thoroughbred horses were exhibited at the start of 2020 as part of International Green Week.

BERLIN WANTED TO BE WELL PREPARED“I am very much hoping that it remains empty,” says Albrecht Broemme. The 67-year-old should know. After all, in his role as general project manager, he oversaw the construction of the auxiliary hospital in record time. When the former chief of Ber-

lin’s Fire Department – who later became president of Germa-ny’s Federal Agency for Technical Relief (commonly known as THW) and is now its honorary president – retired last Decem-ber, little did he know that Berlin’s Health Senate Director Dilek Kalayci would call him out of retirement just a few months lat-er as a disaster management expert. His mission: to construct the Jafféstraße Coronavirus Treatment Center, to give it its offi-cial name. Now, in late summer 2020, the treatment center has been built and is currently in standby mode.

“Jafféstraße is a so-called overflow hospital,” explains the architect Bettina Hufe, who is usually the project mana-ger overseeing the construction of new hospitals for Ger-many’s umbrella association of accident insurance institu-tions for the industrial and public sectors (German Social Accident Insurance or DGUV). Patients are only admitted to overflow hospitals when the regular hospitals are literal-ly overflowing – in this case due to the ongoing coronavi-rus pandemic – and can no longer accommodate the influx of sick patients. And this is precisely what the state of Berlin wanted to be prepared for. Within Broemme’s team, Hufe was responsible for coordinating those involved in the on-site

planning and construction due to her experience in managing hospital development projects.

Nobody had experience of building an improvised pan-demic hospital, however, when those in charge of the project met on March 19, 2020 for the first planning meeting, imme-diately after the start of the nationwide lockdown. There were no regional or national action plans that anyone could consult. And given the pressure caused by the fact that nobody knew how the pandemic would progress, everything had to be orga-nized very quickly, particularly since China had already shown the world how a specialized pandemic hospital could be built within a matter of weeks. Could they pull off a similar feat in Berlin – despite the completely different starting situation and approval procedures (with almost 100 licensing units)?

First of all, planning permission was required, because con-verting an exhibition hall into an auxiliary hospital is clearly clas-sified as a change in use. A neat and clever solution was found, which also complied with building regulations. It still brings a smile to Broemme’s face: “We declared it a civil protection facil-ity, for which there is a special paragraph in most state building codes. This paragraph allowed us to complete the fastest build-ing application in Berlin’s history – I simply had to draft a build-ing notice and then approve the application myself!” Necessity is the mother of invention.

COMPLETED WITHIN WEEKSThe Senate specified, however, that it had to be ready four weeks after construction work began – which necessitated a firm plan in the beginning. “On March 20, we called the plan-ners and asked them whether they wanted to get involved,” recalls architect Hufe. “Just a few days later, the draft was on the table.” The Lübeck-based company Dräger was also on hand from the very start. Not just as the manufacturer of the 111 ventilators for patients who would need mechanical venti-lation, but also as the supplier of the technical infrastructure behind it all – the units that supplied oxygen and compressed medical air for the ventilators. In the fastest time possible, a complex network of pipes and cables was created to supply the

THE SHEER DIMENSIONS SEEM TO

PLAY TRICKS ON THE EYES

MASTERMINDS behind the coronavirus treatment center project, which was built within a matter of weeks: ex-THW President Albrecht Broemme and architect Bettina Hufe

hospital with the different media it needed: gases, water, elec-tricity, data. At the heart of the innovative solution was oxygen, a vital gas for patients infected with Covid-19. “In terms of oxy-gen supply, a conscious decision was made to install one cen-tral tank rather than use individual cylinders,” explains Patrick Bading, key account manager at Dräger. “With 111 ventilators, it would have been necessary to employ an entire team just to regularly replace the oxygen cylinders.” The concept adopted by Dräger involves one 50,000-liter tank filled with liquid oxy-gen and compressors for compressed medical air, all located outside the hall. The gases flow from here along a 6-kilometer- long network of copper pipes to the hospital beds, where they are fed into the supply units. The supply of such medical gases is one of the areas in which the Dräger ANSY busi-ness unit specializes. The planners’ main concern was how they were going to get heavy copper pipes, 110 kilometers of

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KEEPING TRACK OF THE PRESSURE

The gas management system from Dräger monitors the pres-

sure of two important media: oxygen and compressed air for medical applications. Both are supplied to the bedside via a system of pipes installed be-

neath the hall ceiling (top photo)

70

electric cables, and 20 kilometers of network cable to where they were needed in an exhibition hall that was not designed for such infrastructure (no load-bearing interior walls). For hygienic and structural reasons, laying the pipes and cables underground was not an option. The solution came from on high. The cluster of pipes and cables was attached to steel ropes hung on transverse beams, which can be lowered from the ceiling and raised up again. “We rented some of the trans-verse beams from the stage show of a comedian,” says project manager Hufe. “He doesn’t need them at the moment, because of the lockdown.”

A SECOND HALL IS BEING PREPARED“We built the hospital from the top down,” says project man-ager Broemme, “because it was statically possible to construct the network of pipes and cables in a quick and neat way using maneuverable transverse beams.” Almost simultaneously, the problem of the hall floor had to be solved. Ultimately, clearly laid-out paths for beds on wheels had to be created on rough concrete. The solution came in the form of green linoleum for the normal care area and blue for the intensive care area. “All of this was only possible,” says Broemme, praising the effort, “because the entire team worked from morning till night with-out thinking about taking time off!” This is confirmed by Toralf Meier, divisional manager at Dräger ANSY GmbH: “Thanks to the hard work of everyone involved, we were able to reach the milestone and keep to the ambitious timetable. On our side, too, all employees from different departments pulled together.” Construction work on the entire treatment center in Hall 26 was completed on May 11, as the first wave of the pandemic had begun to significantly subside. It was officially recognized as a hospital one week later. Yet since the hall could only accommo-date half of the roughly 1,000 beds planned by the Berlin Senate and it remained uncertain how the pandemic would progress, the neighboring Hall 25 is also being prepared as an additional treatment area, initially with another approximately 320 beds. Around 200 beds remain in reserve at Vivantes, the Berlin- based healthcare company that is operating the treatment center. “The infrastructure for Hall 25 will be built with all

If you have any questions about Dräger Medical ANSY GmbH or require further information, simply scan the QR code and send us an e-mail.

MAKING IT ALL POSSIBLE The fact that Dräger Medical ANSY GmbH was involved in the construction of the coronavirus treatment center in Berlin is no coincidence: The Lübeck-based company specializes in medical engineering and construction services in hos-pitals. The main areas of focus lie in installing central gas supply lines and designing medical workspaces together with supply units. The division of the sales operation within four regions of Germany and the decentralized personnel structure guarantee fast reaction times and cus-tomer-oriented service – not only with its own products, but also other systems. A 3D planning tool developed together with the Dräger Work-place Infrastructure Projects (WPI) business unit and the use of Building Information Modeling (BIM) are among the highly developed technolo-gies used to assist hospital planners with design and construction tasks. In addition, there are (currently virtual) customer workshops on work-space design, held at the Dräger Design Center in Lübeck, where all spaces relevant to hospital processes are set up. Equally interesting is the range of services covering risk management in the supply of medical gases. ANSY helps its customers meet their obligations as operators in this field, especially when it comes to complying with the provisions of Germany’s Critical Infra-structure Directive that governs the functional safety of critical infrastructure facilities. Yet the company has also demonstrated its efficiency and flexibility beyond predictable situations and standard projects. When called upon in emer-gencies during floods and other disasters, the company has often helped hospitals avert the threat of having to evacuate patients. Here the crisis management teams benefit from the fact that the Lübeck-based company also keeps key components and compact systems fully prepared and on standby.

THE SOLUTION CAME FROM ON HIGH:

TRANSVERSE BEAMS SECURE THE

CLUSTER OF PIPES AND CABLES

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the required connections, although the final phase of the project using public funds will only be implemented if the sit-uation requires it,” explains Broemme. The same goes for the delivery of most of the planned ventilators. “Our company’s strategy has always been to ensure that the hospitals with an acute need for the machines are primarily the ones that get them,” says Dräger key account manager Bading. “Given the current global situation, it would be irresponsible to send even more machines to Berlin when they are needed much more urgently elsewhere.”

Numerous lessons have been learned by everyone involved in the project that was completed in record time. It has become clear, for example, that the highly flexible Berlin model can be reproduced in an extremely flexible approach for future pan-demic scenarios around the world. “There is already a great deal of interest,” says Hufe, “whether from the German Armed Forces Medical Academy, ambassadors, politicians, the trade press, or medical professionals who want to find out more about the auxiliary hospital project.”

CONSIDERABLE FEEDBACKRegardless of the situation, planners can rely on Dräger’s cross-functional experience. Prof. Peter Schmiedtchen, pro-fessor of hazard prevention at Magdeburg-Stendal University of Applied Sciences and head of safety and emergency manage-ment at Dräger, sums up the available package of services in a nutshell: “As a supplier of critical care medical equipment and supply units, infrastructure design, protective equipment such as masks, and medical and safety advisory services, Dräger is uniquely positioned to prepare hospitals for future pandemics.”

WELL PREPARED FOR AN EMERGENCYWhat is the point of a backup hospital if every-thing stalls in the event of an emergency? To prevent this from happening, the Berlin-based healthcare company Vivantes trained for an emergency under real conditions: Actors playing Covid-19 patients were driven to the hospital, registered in reception, and handed over to the clinical staff. Then the doctors, nursing staff, and more than 80 previously trained extras playing patients practiced the initial diagnostic process; among other things, the use of mobile X-ray machines was tested at the bedside. This was followed by routine tasks, such as preparing and serving food. Special situations were also simulated, such as alarm management or the reactions of staff members to problem cases and complications. One of the “patients,” for example, feigned a sudden loss of consciousness. In keeping with the scenario, others turned out to be under 18 or dialysis patients – two patient groups that cannot be treated at Berlin’s Jafféstraße Treat-ment Center and would have to be transferred to other hospitals in the event of an emergency. The outcome of the simulation exercise was that clinicians practiced taking care of patients and the logistics chain was tested. It also proved advantageous for the treatment center to have the clinical staff committed to a con-tract. In the field of healthcare in particular, it would otherwise be difficult to guarantee suffi-cient staffing levels during a pandemic. There was room for improvement in the sanitary con-tainers, for example, which proved not to be wheelchair-accessible, and this was rectified.

Albrecht Broemme, the veteran of disaster management, hopes a sudden ramping up of activities at Jafféstraße won’t be nec-essary. Yet the considerable feedback received has convinced him of the positive effect the mere existence of such a facility can have. “Most people I speak to express how happy they are that the ‘coronavirus hospital’ exists – because we now have a buffer in Berlin that has been sorely missed in places such as New York, Madrid, and Rome.”

FULLY EQUIPPED: This ICU space is already prepared for demonstration purposes (“Berlin model”). A total of 111 of these ventilation units are ready to use in the event of an emergency

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