Caring for Patients at a COVID-19 Field Hospital

During the initial peak of coronavirus disease 2019 (COVID-19) cases, US models suggested hospital bed shortages, hinting at the dire possibility of an overwhelmed healthcare system.^1,2 Such projections invoked widespread uncertainty and fear of massive loss of life secondary to an undersupply of treatment resources. This led many state governments to rush into a series of historically unprecedented interventions, including the rapid deployment of field hospitals. US state governments, in partnership with the Army Corps of Engineers, invested more than $660 million to transform convention halls, university campus buildings, and even abandoned industrial warehouses, into overflow hospitals for the care of COVID-19 patients.¹ Such a national scale of field hospital construction is truly historic, never before having occurred at this speed and on this scale. The only other time field hospitals were deployed nearly as widely in the United States was during the Civil War.³

The use of COVID-19 field hospital resources has been variable, with patient volumes ranging from 0 at many to more than 1,000 at the Javits Center field hospital in New York City.¹ In fact, most field hospitals did not treat any patients because early public health measures, such as stay-at-home orders, helped contain the virus in most states.¹ As of this writing, the United States has seen a dramatic surge in COVID-19 transmission and hospitalizations. This has led many states to re-introduce field hospitals into their COVID emergency response.

Our site, the Baltimore Convention Center Field Hospital (BCCFH), is one of few sites that is still operational and, to our knowledge, is the longest-running US COVID-19 field hospital. We have cared for 543 patients since opening and have had no cardiac arrests or on-site deaths. To safely offload lower-acuity COVID-19 patients from Maryland hospitals, we designed admission criteria and care processes to provide medical care on site until patients are ready for discharge. However, we anticipated that some patients would decompensate and need to return to a higher level of care. Here, we share our experience with identifying, assessing, resuscitating, and transporting unstable patients. We believe that this process has allowed us to treat about 80% of our patients in place with successful discharge to outpatient care. We have safely transferred about 20% to a higher level of care, having learned from our early cases to refine and improve our rapid response process.