Concept Of Operations (CONOPS) Basis Of Design
Tent Camp to Healthcare Concept TC2HCCONOPS & Basis of DesignARMY FACILITIES COMPONENTS SYSTEM (AFCS)Program Management OfficeTent Camp to Healthcare Concept TC2HCConcept of Operations (CONOPS)&Basis of DesignUS ARMY CORPS OF ENGINEERSENGINEER RESEARCH AND DEVELOPMENT CENTER, CORPS OF ENGINEERSCONSTRUCTION ENGINEERING RESEARCH LABORATORYP.O. BOX 9005CHAMPAIGN, ILLINOIS 61826-9005Digitally signed byJUNG.MARTIN.CHRISTOPHER.1086211927Date: 2020.06.15 11:07:42 -05'00'MARTIN C. JUNG, P.E., PMPAFCS Program ManagerUpdated: 15-Jun-20DateUNCLASSIFIEDPage 1 of 35
Tent Camp to Healthcare Concept TC2HCCONOPS & Basis of DesignTable of Contents1EXECUTIVE SUMMARY. 42CONCEPT OF OPERATIONS. 62.1 PURPOSE .62.2 SCOPE .62.2.1 Patient Flow .62.2.2 Care-Giver/House Support Work Flow .82.3 ADD-ONS/ WRAP-AROUND SERVICES.93BASIS OF DESIGN . 93.1 LAND-USE PLANNING/SPACE ALLOCATION.93.1.1 Patient Housing Area .103.1.2 Central Support Area .113.1.3 General Support Area .123.2 SITE .123.3 SECURITY .133.4 FACILITIES/ARCHITECTURAL .133.5 MECHANICAL.153.6 ELECTRICAL .153.7 PLUMBING .163.8 FIRE PROTECTION .173.8.1 Structures and Camp Layout .173.8.2 Egress .173.8.3 Equipment and Furnishings.183.9 COMMUNICATIONS.184NATIONAL INVENTORIES . 184.14.24.35COST . 205.16CONTRACT SERVICES .20SCHEDULE. 216.16.26.37TENTS: .18POWER GENERATION: .19MEDICAL FURNISHINGS: .19250-BED MODULE .21500-BED MODULE .211000-BED MODULE .21APPENDICES . 227.1 DESIGN REFERENCES .227.2 DRAWING FILES .237.3 COMMERCIAL POWER/HVAC RENTAL MATERIAL LIST .247.4 TENT INVENTORY .257.4.1 DLA Warstopper Inventory.25Page 2 of 35UNCLASSIFIEDUpdated: 15-Jun-20
Tent Camp to Healthcare Concept TC2HCCONOPS & Basis of Design7.4.2 DLA Ordering Information.257.4.3 Commercial Tent Providers .267.5 MATERIAL POCS .307.6 BILL OF MATERIALS (BOM) .317.7 SCHEDULE .327.8 MEDICAL FURNISHINGS .337.9 POINTS OF CONTACT .347.10 ABBREVIATIONS .35Updated: 15-Jun-20UNCLASSIFIEDPage 3 of 35
Tent Camp to Healthcare Concept TC2HCCONOPS & Basis of Design1Executive SummaryThe Army Facilities Components System (AFCS) Program Management Office (under direction of theOffice of the Chief of Engineers – Pentagon) produces the Joint Construction Management System(JCMS) and maintains all construction data (designs, bills of materials, material costs, laborestimates, equipment estimates and schedules) for over 600 Standardized and UFC compliant troopbuildable expeditionary and temporary facilities supporting the warfighter.The AFCS Program Management Office (PMO) utilized the site-selection and master planning tools inthe JCMS 5.0 Prototype Software to custom-design 250-, 500-, and 1000-bed COVID-19 Medical TentCamps based on the Federal Medical Station (FMS) 250-bed kit. These designs assume low-acuitypatient care, which includes patients that may need oxygen (less than or equal to 2L/min), who donot require extensive nursing care, and who can generally move about on their own, or for patientswho are currently hospitalized but can be discharged to a lower level of care. These standarddesigns match current Defense Logistics Agency (DLA) War stopper 1 tent inventory for immediateavailability. JCMS Software houses these designs for site adaptability and makes them availablethrough the USACE Reachback Operations Center (UROC) to the Department of Defense (DOD),International Partners, and Federal and State Agencies.Notable characteristics of this design include the following. Primary concept is a 250-bed Medical Tent Camp that can expand to 500 and 1000 bedswith centralized (banked) utilities and common support services (thereby separatingmaintenance and supply activities away from any COVID-19 exposure). The 125-bed patientmodule can also separately augment existing fixed medical facilities providing the commonsupport services. Based on existing inventory of CONUS available tentage (DLA Warstopper and regularinventory stock).o Each 250-bed camp includes all 18-spacial requirements of the FMS system.o Current DLA inventory supports 60 such camps (approximately 15,000 beds).o Current DLA Commercial-Off-The-Shelf (COTS) solutions project another 20 camps(5,000 beds) availability. Utilizing automated ‘rules-based optimization’ software a 250-bed Medical Tent Camp fitson 7.1-acres and a 500-bed Medical Tent Camp on less than 13-acres (approximately 1/3 thesize of a traditional military Role 3 hospital model). Full consideration is included for both military equipment/troop labor capabilities andcommercial/contracted resources.o Use of utility power with on-site generator backup or completely powered bygenerators with full redundancy.The DLA Warstopper program provides a mechanism for industrial preparedness investments and is designed toestablish and maintain an industrial base sufficient to meet additive demand during wartime and contingencyoperations.1Page 4 of 35UNCLASSIFIEDUpdated: 15-Jun-20
Tent Camp to Healthcare Concept TC2HCCONOPS & Basis of DesignCommon military electrical generation, distribution, heating, air condition and fuelstorage equipment for all services at the Medical Camp (this option gives state-agenciesthe ability to use military equipment if available.)o Private-sector supplier/national rental company common electrical generation,distribution, heating, air condition and fuel storage equipment for all services at theMedical Camp (this is outside of normal military equipment but provides SLTT agenciesthe requirements to utilize local and readily available equipment.)Project Folder includes:o CONOPS/Basis of Designo Complete Drawings (.pdf & AutoCAD .dwg)o Bills of Material (by Facility/Component)o Sample Construction Scheduleo Material (NSN) Cut-sheetso Ordering Points of Contacto Overview Briefing SlidesOptional designs are available through reachback support to add:o Laundryo Food Serviceo Ice Making/Storageo Complete Mortuary Affairs (30 cases per day, 5-day storage)o Life Support Area for Staff and support personnel staying full-time at locationo Helipado Alternate configurations of various tent-types within government sourceso Updated: 15-Jun-20UNCLASSIFIEDPage 5 of 35
Tent Camp to Healthcare Concept TC2HCCONOPS & Basis of Design2Concept of Operations2.1PurposeLike the other alternate care site concepts developed by USACE, this Medical Tent Camp designserves to compliment the Federal Healthcare Resilience Task Force Alternate Care Site (ACS) Toolkit.The team designed this layout in compliance with the Health and Human Services (HHS) FederalMedical Station (FMS) Concept of Operations and other relevant health and safety code criterialisted in Appendix 7.1. The intent is to provide technical assistance to State, Local, Tribal, andTerritorial (SLTT) entities in establishing and operationalizing alternate care sites. The Medical TentCamps are constructible by Military units and/or commercial contractors.2.2ScopeThis product provides a blueprint for a 250-, 500-, or 1000-bed Medical Tent Camp including alldetailed designs and associated construction material estimates (bills of material) for each layout.Each Medical Tent Camp provides general (non-acute), low-level care. This includes mild tomoderate symptomatic COVID‐19 patients, or patients that may need oxygen (less than or equal to2L/min), who do not require extensive nursing care, and who can generally move about on theirown (1).Each camp design includes 125-bed patient modules, each of which is designated either completelyCOVID ( ) or COVID (-). While the primary intent is to place these designs within ten (10) miles of ahospital able to provide acute care, they are designed to operate for up to 1-year with sufficientwrap-around services. The patient tent layouts are employable individually or in small numbers asoverflow for existing medical facilities. The Medical Tent Camp should be located in areas requiringminimal site work (e.g. hospital parking lots, shopping center parking lots, city parks, etc.). Theemplacing or managing agency can construct Medical Tent Camps in unimproved fields but mayrequire gravel and compaction, and can modify the layouts of camps to fit the area available.This effort includes a Basic and Enhanced plan, differing primarily in the level of site developmentand construction materials used.This document does not address roles and responsibilities of staff. The emplacing agency should usethe FMS CONOPS and the ACS Toolkit to determine the various roles and responsibilities of thenecessary personnel, and the development, operation and demobilization of the ACS.2.2.1Patient Flow1Arrival Patients arrive at the drive-in (drop-off) or parking area but can only enter first treatmentarea through the guarded personnel-gate/entry control point. Separate patients to observe social distancing protocols prior to triage.2Triage AreaPage 6 of 35UNCLASSIFIEDUpdated: 15-Jun-20
Tent Camp to Healthcare Concept TC2HCCONOPS & Basis of DesignTriage space may not be required if this complex is located as part of an existinghospital/care system where patient triage is pre-determined. In cases where this complex is a stand-alone facility, then triage is necessary for separatingpatients. The executing agency will need to develop procedures to address proper triageflow. Patients enter into waiting area tents Patients await a number for assessment Nurses in PPE provide assessment and give an assignment to:o Treat and Release (low-acuity not requiring admission).o Treat and/or refer to traditional Hospital (acute care required due to either COVID orother ailment/injury).o COVID (-) and low-acuity hospitalization required.o COVID ( ) and low-acuity hospitalization required. Patients enter treatment tents in central area, treated for minor conditions and may returnthough Triage area for release. Some patients may be initially treated but referred to higher-level care.o Medical personnel send these patients back through Triage and transport them to ahigher-level care facility. Some patients will be initially treated and require low-acuity hospitalization.o Medical personnel give these patients assignment for COVID (-) or COVID ( ) and admitthem to the holding area.Holding Area Admitted Patients await a number for assignment/admission into either a COVID (-) orCOVID ( ) module. Patients receive a tent and bed number. Patients given site orientation information and escorted to their tent/bed. 34Patient Care Medical personnel/staff escort patients into the 125-bed fenced module through anotherguarded personnel gate. Patients not routed through the PPE Don/Doff tent. Patients report to their bed and, if mobile, have unlimited access to latrines, showers andpatient common area. Once inside the 125-bed fenced module patients will remain in this area until released bytheir treating nurse or doctor.5Discharge The attending Nurse (or other designated staff) will escort releasable patients back throughthe guarded personnel gate when ready. Patients not routed through the PPE Don/Dofftent. Patients will bypass holding and treatment areas; medical personnel will release themthrough the Triage tent.Transfer6Updated: 15-Jun-20UNCLASSIFIEDPage 7 of 35
Tent Camp to Healthcare Concept TC2HCCONOPS & Basis of Design 2.2.2Patients requiring transport to higher care facilities will be moved by contract ambulanceservice. Medical staff will dictate best practices for transferring patients from theirrespective patient area to the ambulance.Care-Giver/House Support Work Flow1Arrival Caregiver/House support parking is on opposite end of complex from patient parking.2Check-in Staff (Caregivers or Contract housekeeping/support personnel) report through a guardedpersonnel entry gate (for staff only). Staff report to office tent for reporting/clock-in. Staff given work assignments.3Donning/Entry Staff working in one of the 125-Bed modules will enter through the Donning/Doffing/Deconarea.To prevent cross-contamination, executing agency shall use the designated donning/doffingtents as 1-way traffic.Each tent shall be “All donning” or “All doffing” into and out of each 125-bed module.If 1-way traffic is not preferred or feasible, then interior barrier is required at "Clean/Dirty"Division line and Tent side-exit is required on doffing side.4Work Shift Caregiver shift changes conducted in the Nurse Operations Tent. Caregivers assigned to each patient tent:o Either seven (7) or 15 low-acuity patients per tent, depending on configuration.o Approximately 220 SF Nurse’s Station in each tent. Housekeeping/support operations work from the designated House Support Tent toprovide:o Cleaning/changing patient beds/latrines/showers as needed.o Resupply field sink reservoirs, hand-sanitizer stations and bathrooms.o Trash collection and disposal to outside dumpsters at transportation off-load yard.5Donning/Doffing/Decon Exit Upon completion of shift, Staff will exit the 125-Bed modules through theDonning/Doffing/Decon area.6Rest/Return or Duty Exit Support area includes Staff rest area but donning/doffing/decon procedures are requiredwhen entering or exiting each 125-bed module. All staff completing their shift will report through the Admin/Office tent for reporting/clockout and exit through staff personnel gate.Page 8 of 35UNCLASSIFIEDUpdated: 15-Jun-20
Tent Camp to Healthcare Concept TC2HCCONOPS & Basis of Design2.3Add-ons/ Wrap-around ServicesAlthough not included in the base design, there are several add-on or wrap-around services that canbe “plugged into” the Medical Tent Camp Layout. Wrap around services may be critical for this ACFto function. Those services require contract support but can be co-located on site. Services include:1 Laundry2Ice Making/Storage3Food Service4Mortuary Affairs (in addition to basic morgue functions already in this plan).5Life Support Area (for 80-120 Staff and Support Personnel staying full-time at location).6Alternate configurations of various tent-types within government sources.7Helipad8Ambulance service provided 24-hrs for patient transfer9Communications: 3Establish wireless communications for the site.Install wireless nurse call systems.Basis of Design3.1Land-Use Planning/Space AllocationThis hospital camp includes common configurations for three main functional groups of services:Patient Housing Area(s), Central Support Area and General Support Area for a 250-bed systemsimilar to the Federal Medical Station (FMS) functions.1 Utilizing automated ‘rules-based optimization’ software and segregating each 125-bed moduleas COVID ( ) or COVID (-) treatment areas, a 250-bed Medical Tent Camp fits on 7.1-acres and a500-bed Medical Tent Camp on less than 13-acres (approximately 1/3 the size of a traditionalmilitary Role 3 hospital model).2 Space allocation (functional relationship analysis) accommodates all 18 functions shown in theFMS CONOPS (March 2014), Appendix B3 (2).3In most cases, the respective functional areas depicted by FMS Appendix B3 require largerspaces when using tents outdoors instead of open floor plan, large indoor assembly areas.Functional AreaPatient Beds and Nurses StationsArea (SF)Tents17,85033,04816 (18X108), 2 (18X54)2,9161 (18X108)1 (18X54)8309721 (18X54)1,1702,5922 (18X72)Administration and Admission1,614Offices1,291WaitingCommon AreaUpdated: 15-Jun-20Number & Size of TentsFMSUNCLASSIFIEDPage 9 of 35
Tent Camp to Healthcare Concept TC2HCCONOPS & Basis of DesignArea (SF)Functional AreaNumber & Size of TentsFMSTentsHouse Support7601,9442 (18X54)Medical Support (Nurse Operations)7752,5922 (18X72)Pharmacy2803241 (18X18)Treatment Area1,6751,9442 (18X54)Holding Area1,4251,9442 (18X54)Bio-Med3903241 (18X18)Morgue*1396482 (18X18)Storage/Staging Area9259721 (18X54)8,756-6006481 (18X36)PPE Don/Doff & DECON*-2,5924 (18X36)Reception/Triage*-9721 (18X54)Showers & Toilets*--Walkways/AislesStaff Rest AreaAccounted for in designated Walkways12 Rented Trailers*FMS does not give a designated area requirement for Don/Doff/Decon, Reception/Triage,restrooms, showers or refrigerated storage for a morgue.3.1.1Patient Housing Area1Patient Care Tents: Detailed design drawings in this document show the patient tents, both thepredominant 15-patient (18 X 108) and the 7-patient (18 X 54) configurations, which all includenurse station areas. The net areas of these tents is 33,048 SF, using tents with the (18 X 108)floor plan and two (18 X 54) tents. The generic FMS concept for an enclosed space requires17,850 SF dedicated for this function. If 125-bed module is determined to be COVID ( ), thenadditional bed-spacing may be required. If additional spacing is required, recommend removingbeds to achieve 8' spacing between beds within tent area. COVID ( ) acute care can also beaddressed through containerized acute-care solutions. Possibly replace smaller tent with acontainerized solution (for acute or transitional care).2Patient Common Area: Each patient housing module has one (18 X 72) tent providing 2,592 SFtotal patient common space in the 250-bed camp, significantly great than the FMS CONOPSrequirement of 1,170 SF. This larger area provides a greater space for able patients to spendtime away from their beds.3House Support: One (18 X 54) tent provides 1,944 SF for House Support in each of the twopatient housing modules. Effectively servicing the patient modules requires separate tents,resulting in an area exceeding the required FMS 760 SF.4Nurse Operations: One (18 X 72) tent in each of the two patient housing modules provides 2,592SF for Nurse Operations in the overall camp compared to a requirement of 775 SF in the typicalPage 10 of 35UNCLASSIFIEDUpdated: 15-Jun-20
Tent Camp to Healthcare Concept TC2HCCONOPS & Basis of DesignFMS layout. The larger area provided for collaboration addresses the relative isolation of thenurse stations in the patient tents.5PPE Don/Doff: Four (18 X 36) tents provide a combined 2,592 SF in the 250-bed camp for PPEDon/Doff and personnel decontamination. These tents serve as the entry control points for therespective patient housing modules (two tents per module). Detailed interior layouts areincluded in the drawings since they are not typical medical facilities.6Each 125-bed module is separately fenced to be considered a COVID ( ) or COVID (-)environment with common support functions outside the medical care areas between the two125-bed modules in order to eliminate exposure of operations and maintenance personnel.3.1.2Central Support Area1Reception, Triage, and Pre-Admission Waiting Area: Two (18 X 54) tents connected by avestibule support the Reception, Triage, and Pre-Admission FMS functions. This tent assemblyhas total area of 1,944 SF as compared with 830 SF provided in the FMS for a waiting area. Itcontains all three of the above functions and serves as the primary entry control for the camp.The Authority Having Jurisdiction (AHJ) is able to configure this space per their operationalconcepts.2Administration: One (18 X 54) tent provides 972 SF for Administration/Office functions in theCentral Support Area. This is in addition to two other Administration Tents in the GeneralSupport Area adjacent to staff parking. This provides additional administrative space closer toreception, triage, and outpatient treatment functions. This tent has clear space for the AHJ touse as needed.3Outpatient Treatment Area: The central support area includes two (18 X 54) tents connected bya vestibule, which serve as the treatment area for non-admitted (out) patients. Thisconfiguration provides 1,944 SF for the function (FMS site plan allocates 1,675 SF) and providesclear space configurable by the organization providing the health care.4Patient Holding Area: Two (18 X 54) tents connected by a vestibule serve as the holding spacefor patients awaiting bed assignment. This configuration provides 1,944 SF for the function, towhich the FMS site plan allocates 1,425 SF. The waiting area is a clear space configurable by theorganization administering the camp.5Bio-Med: One (18 X 18) tent supports Bio-Med functions, providing a 324 SF tent space with nopre-defined partitions or furnishings. This is slightly smaller than the 390 SF Bio-Medrequirement for FMS.6Storage Area: One (18 X 54) tent provides primary storage for supplies. The 972 SF area iscomparable to the corresponding 925 SF storage requirement for FMS. The clear tent space isavailable to be set up as needed. Additional storage space may be found in the following areasdue to excess sizing as compared to the FMS requirements: The Nurse Operations Tent within each 125-patient housing module has significantly morespace than the FMS layout requirement of 775 SF, so could hold additional supplies.Updated: 15-Jun-20UNCLASSIFIEDPage 11 of 35
Tent Camp to Healthcare Concept TC2HCCONOPS & Basis of Design 73.1.3The patient Common Area tent offers significantly more area than the FMS requirement forthis function, so additional bottled water/supplies can be stored here for patient use andefficient distribution to the patient tents.The House Support Tent provides usable space well beyond the FMS requirement for itsrequired function.Medical gases should be stored separately from other items. Contract services supplyingmedical gases should provide racks for central storage of tanks.Pharmacy: One (18 X 18) tent provides 324 SF for pharmacy distribution. Two refrigeratedcontainers (one 8 X 20 and one 8 X 40) provide 480 SF for pharmaceutical storage. Thecombined 804 SF pharmacy accommodates longer resupply times (up to 7-days) compared tothe 280 SF FMS pharmacy.General Support Area1Administration/General Office: One (18 X 108) tent provide 2,916 SF for Administration andGeneral Office functions that require 2,905 SF in the FMS construct. This plan does not provideimprovements or furnishings for this tent.2Staff Rest: One (18 X 36) tent provides 648 SF for Staff Rest, which is comparable to the 600 SFrequired in the generic FMS layout. This plan does not provide improvements or furnishings forthis tent.3Morgue: Two (18 X 18) tents provide 648 SF of space for morgue operations, storage, andadministration. Together with a 320 SF refrigerated container, this facility is substantially largerthan the 139 SF identified for this function in a typical FMS. The additional capacity, provided ina separate fenced enclosure, enables appropriate level of service even if the site must operatein isolation for several days. A separate stand-alone “Add-on Service” for Mortuary Affairs isavailable for processing 25-30 cases per day and 5-day storage capacity.4Restroom/Shower: Trailer-mounted, self-contained shower and toilet facilities address personalhygiene. Two sets of trailers are in each patient housing module and in the central supportarea. An additional latrine trailer is near the staff rest area. The trailers configured for the 250Bed Camp include: 3.21Each patient module provides eight (8) standard restrooms, two (2) ADA restrooms, four (4)ADA shower/restroom combinations, and four (4) standard showers.The central support area provides sixteen (16) standard restrooms and four (4) ADArestrooms.The general support area provides one (1) standard shower and two (2) standard restroomsadjacent to the staff rest area.SiteLocate site preferably within ten (10) miles of a traditional, acute-care hospital to expediteambulatory transportation to/from that location.Page 12 of 35UNCLASSIFIEDUpdated: 15-Jun-20
Tent Camp to Healthcare Concept TC2HCCONOPS & Basis of Design2The optimal expedient site will be a large shopping mall, box-store, or existing hospital parkinglot. If utilizing a parking lot, established storm drainage and site lighting
Jun 15, 2020 · CONOPS & Basis of Design . Page 6 of 35 UNCLASSIFIED Updated: 15-Jun-20 . 2 Concept of Operations 2.1 Purpose Like the other alternate care site concepts developed by USACE, this Medical Tent Camp design serves to compliment the Federal Healthcare
CONCEPT OF OPERATIONS (CONOPS) . 5.3.1 Transition timeline . 35 5.4 MISSION OPERATIONS SUPPORT TEAM . 36. Effective Date: June 16, 2020 410-R-CONOPS-0008 Expiration Date: Five years from date of last change Version 3.0 Responsible Organization: GOES-R Program/Code 410 Check .
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