Meuschke says project team members have taken a seven-year project and compressed it to three-and-a-half. Dallas-based project designer HKS Architects Inc. is on site weekly, and all subs have been co-located in an office to further expedite plans. "We hired the majority of them late 2011 and early 2012 so they could be on hand to consult with the design team as they completed drawings," says Meuschke.

Though hectic, he says work is far more orderly than in the weeks following the tornado, when he found himself working alongside members of the National Guard to stabilize hospital operations.

Since then, Mercy has rebuilt and rebuilt again: First came an interlocking set of portable metal enclosures that saw it through winter; then, in spring 2012, a $52-million, 150,000-sq-ft interim component facility constructed of 224 steel-framed units. In all, two-thirds of the facility—which Mercy will occupy until the replacement hospital is complete—was prefabricated off site.

The component facility proved to be a major undertaking of its own. Before approving the component-structure concept, Mercy dispatched Farnen and other representatives to California to tour Sierra Kings District Hospital in Reedley, which adopted a similar plan to execute a 20,000-sq-ft expansion. After also touring the operations of Mentone, Calif.-based supplier Walden Structures, "We realized this was the quickest way to get us back up and running," says Farnen.

"The real savings is time," says Dave Hitchcock, principal with Angels Camp, Calif.-based Aspen Street Architects (ASA), the project's designer. "You can either pay out $50 million over a four-year period or pay out early and begin receiving income sooner." Walden Structures CEO Charles Walden says that unlike many modular facilities, component structures fabricated by his firm are intended for permanent or semi-permanent use. "One of the key differences is our units are constructed of structural steel," he indicated in a statement. Once units are framed, they proceed along an assembly line, where they receive insulation, drywall, ceiling grids and a coat of paint.

"Units typically arrive on site 80% finished," says Farnen. The interim hospital, the largest code-compliant component facility of its kind in the nation, was completed in just eight-and-a-half months, its 40,000-lb, 14-ft by 60-ft sections shipped from Southern California to Joplin by rail and semi-trailer. Due to a limited number of vehicles capable of transporting them, units shipped at a rate of 20 to 24 per week from November 2011 through February 2012. While awaiting units, crews in Joplin laid the facility's foundation, which includes spread footings and a perimeter wall, an arrangement common to residential structures.

"We literally lifted the units off trucks with cranes, set them on the foundation and welded them to embed plates." says Meuschke. As crews assembled the facility jigsaw-puzzle style, welding together corner columns among adjacent units, ASA and Walden performed design tweaks and approvals on site to maintain the project's schedule.

Some units were fitted out in the field rather than in Mentone. "We first fabricated highly replicable units, such as those for patient rooms, which arrived finished on site," says Hitchcock. Units dedicated to the facility's radiology department proved more problematic. "Those units were subject to change, once imaging equipment was selected," says Hitchcock. "Some equipment is so heavy, it requires a pedestal-like foundation of its own."

Those pours proceeded on site. During peak periods, some 500 workers converged on the site to complete ductwork, electrical, utilities and flooring. Less than a year after the tornado, Mercy was fully operational.

In addition to a two-story, 100-bed inpatient wing, the facility houses 20 emergency department exam rooms, four operating rooms, two cath labs, a 10-room LDPR unit, a pharmacy and a radiology department housing X-ray, CT, MR, ultrasound, EP/PV and nuclear medicine equipment.