“Part of the solution:” innovation drives COVID-19 fight at Detroit’s TCF Regional Care Center

U.S. Army Spc. Anton Horton, from the 1434th Engineer Company, Michigan National Guard, sets up a patient room with supplies at the TCF Regional Care Center, Detroit, April 9, 2020. The TCF Center in Detroit, Mich. has been converted into a 970-bed alternative care facility for COVID-19 patients by the Federal Emergency Management Agency, in partnership with the U.S. Army Corps of Engineers and Michigan National Guard. (U.S. Air National Guard photo by Master Sgt. Scott Thompson)
April 14, 2020

DETROIT – “I’ve never seen 1,000 oxygen lines coming down from the roof of a convention center, and I’ve never seen walls made of portable plexiglass so they can be increased and decreased in size based on the number of patients we have – what we see here is an engineering marvel.”

U.S. Public Health Service Lieutenant Commander Myles Stone is observing the floor of the TCF Regional Care Center in Detroit, one day before the alternate care facility opens to receive patients in the ongoing fight against COVID-19.

Nine days ago, this area was a 350,000 square foot section of the TCF Center, the 17th-largest convention hall in the United States and perennial host for events like the North American International Auto Show. It is now a 970-bed hospital, augmenting Detroit’s regional health care system with tailored treatment for COVID-19 patients. This lightning-quick transformation was facilitated by a partnership between the Federal Emergency Management Agency (FEMA), The U.S. Army Corps of Engineers, and the Michigan National Guard. The Michigan Department of Health and Human Services, as well as the Michigan Department of Technology, Management and Budget have likewise played a crucial role in the leasing and acquisition of equipment to make the facility possible.

Stone, a physician with the United States Public Health Service (USPHS) Commissioned Corps, arrived on scene a few hours ago. He is part of a team of more than 60 officers deployed by the USPHS Commissioned Corps to assist with staffing as the TCF Regional Care Center becomes operational. The USPHS Commissioned Corps is one of the eight uniformed services with a history that dates back over two centuries. It is under the direction of the U.S. Department of Health and Human Services and led by the Assistant Secretary for Health; operations are overseen by the U.S. Surgeon General. The USPHS Commissioned Corps mission is focused on protecting, promoting and advancing the health and safety of the nation.

One of the first people Stone has met at TCF Regional Care Center is Lt. Col. Aaron Proffitt, an emergency physician with the Michigan Army National Guard’s medical detachment. Proffitt leads a team of five medical specialists from the Michigan National Guard who have been assigned as advisors since April 4 during the TCF Regional Care Center’s conversion and setup.

“Lt. Col. Proffitt and I met three hours ago and we’ve already revised our treatment guidelines five times because that’s how quickly the medicine is changing,” says Stone. “Both of us have been physicians for years and we’ve seen several diseases, but the management of the coronavirus disease is literally changing minute-by-minute – we have to stay innovative to make sure we have the care available to the patients that need it.”

Proffitt spent seven years as an active duty Army physician before coming to the National Guard and even after deployments to Afghanistan and Poland, he says the opportunity to be at the front lines of the COVID-19 fight is something he has spent his entire career preparing for.

“Nothing like this has ever been done before, so by definition, the whole thing is innovative,” he says. “It’s pretty exciting to see how the Southeast Michigan community is coming together to support this – not only is the Department of Defense involved, but multiple hospital systems are contributing. The Veterans Administration has supplied a pharmacy trailer, and actual medications are going to be coming from Henry Ford Health System.”

Proffitt characterizes the role of his Michigan National Guard team as a support mechanism for the civilian medical authorities staffing TCF Regional Care Center day-to-day. Overall management and operations of TCF Regional Care Center are being led by a team of experienced Detroit-area civilian professionals from Henry Ford Health System, McLaren Health Care, and Region 2 South Trauma Network.

“We’re working side-by-side with the civilian medical authorities to help develop their standard operating procedures for medical operations; we’ve helped design what the nurse’s stations are going to look like, and we give our input where we can,” Proffitt says. “Of course, as a Department of Defense asset, we’re playing a supporting role to help the civilian authorities, as they’ve requested us to do.”

Unlike alternate care facilities established recently in other parts of the U.S., TCF Regional Care Center has always been planned to provide care to COVID-19 patients exclusively. Proffitt explains how the facility’s “step down” model is designed to accept patients from regional health care systems who have mild symptoms requiring treatment they cannot receive at home.

“Hall C, which is on the second floor, has 600 rooms and will be a little higher acuity – there’s oxygen that can be delivered to each patient room there,” says Proffitt. “As patients become more stable, the plan is to move them down to Hall E, where there may not be an oxygen supply to every room; the final step down comes when patients will be discharged from that floor once they’ve improved enough to continue the final stage of their recovery at home.”

Proffitt points out that because TCF Regional Care Center is integrated with Detroit-area hospital networks, the facility’s model of care is not intended for patients to check-in or receive initial care at the site.

“The admission criteria is for patients who have gone to a hospital, been admitted for at least 72 hours, and have met other criteria that will allow them to come here,” he says. “For instance, they’re requesting that any other chronic medical conditions be controlled and not in any type of an acute status; patients also cannot have an oxygen requirement of more than six liters per minute.”

Stone says that the conversion of the TCF Regional Care Center, as well as its established model of care, has been crafted from a deep reservoir of experience, shared between multiple agency partners and combined with best practices observed from other hard-hit regions in the global COVID-19 fight.

While facilities, logistics, and staff have swiftly come together to make TCF Regional Care Center, those on the ground believe its impact will be lasting.

“There’s a huge team of very talented and dedicated people who have put this enterprise together from scratch in a very short period of time,” says Proffitt. “When this is all said and done, I believe we’ll look back and see that the TCF Regional Care Center was a big part of Detroit’s solution to this pandemic.”