Modular Emergency Medical System: Concepts for Building Surge Capacity

Michael Richards, MD, MPA, FACEP

Version 3 SummaryJuly 2006

New Mexico MEMSNew Mexico MEMS

Overview Background of MEMS

The MEMS Model

Patient Flow

Components

Philosophy of Care

Application of MEMS to New Mexico

MEMS Components

NEHC – Neighborhood Help Center

ACC – Acute Care Center

BACKBONE MODULES

MCC – Medical Command and Control

CTS – Casualty Transport System

CO – Community Outreach

MP – Mass Prophylaxis

KEY MODULES

PI - Public Information

Fatality Management

ADDITIONAL ELEMENTS

MEMS components provide the general framework on

which we will “hammer out” the details.

Original MEMS Assumption/Parameters Non-communicable BW

Civilian population

Hundreds to hundreds of thousands of patients and worried well

Overwhelmed health infrastructure with limited surge capacity

Federal resources not immediately available

New Mexico MEMS will be adapted for an All Hazards Approach

MEMS Assumption/Parameters NEHC & ACC are scaled to care for

1000 patients a day each

Most persons seeking care will be ambulatory

Community based outpatient centers are the most efficient manner to provide care

Adjusted “standard of care”

MEMS Flow Map

Community Outreach

HOME

Physician Office

NEHC

ACC

Hospital

FatalityManagement

MEMSComponent

CasualtyTransportSystem

RegularTransportation

System

MEMS Flow Map

HOME

Physician Office

Hospital

Regular patients (non-event) and all critical patients are transported directly to the hospital.

NEHC – Neighborhood Help Center

“Green Book”

• Primary triage and evaluation site designed for “high volume” (1000/24hr)

• Services:

• Outpatient/Ambulatory Care

• Limited treatment scope

• Prophylaxis

• Self help information

• Patients arrive by their own means

• Referrals to hospital or ACC with transport by CTS

NEHC – DMAT Example

NEHC – Adaptation

“Alternate Outpatient Care Area”

May be located within the hospital

Serves as alternate point of presentation and care

Can be scaled to needPMAC – Hurricane Katrina 2005

ACC – Acute Care Center• Expansion of inpatient/hospital ward for

patients requiring admission

• Located near hospital

• “Level of Care Philosophy”

• Limited to BW patients

• Agent specific & supportive care

• No advanced life support

• Limited triage function (admissions)“Blue Book”

ACC – Acute Care Center• Staff intensive

• Per 50 bed unit/per shift:

• 1 – Physician

• 1- Mid Level

• 6 – Nurses

• 4 – Nursing Aids/Techs

• 2 – Clerks

• 1 – Respiratory Therapist

• 1 – Case Manager

• 1 – Social Worker

• 2 – House Keepers

• 2 – Patient Transporters

ACC – Katrina Example

UMB – Unified Medical BranchMCC – Medical Command and Control UMB

Equivalent to ICS Medical Branch (Operations)

Ultimate MEMS command and control

Composed of the MCC MCC

The MCC is the hospital sector (and supporting modules) IC element

A single hospital can have its own MCC

The module IC structures report to the MCC

New Mexico MEMS will be integration into our existing ICS structure.

CTS – Casualty Transport System• External to the jurisdictional EMS

• Hospital inter-facility transfers

• Primary MEMS causality transport

• Stationed at NEHC

• Designated routes

• Not necessarily “medical”

• Initial CTS configuration: one ambulance, one bus, two wheelchair vans.

CO – Community Outreach

MP – Mass Prophylaxis Mass Prophylaxis Program

NEHC should be integrated into mass prophylaxis program

CO can/should augment effort Community Outreach

Disseminate information Assessment of community/area Conduct mass prophylaxis if

indicated

New Mexico MEMS will be adapted to accommodate the work done in this area.

MEMS in New Mexico Conceptual framework has face validity Can be applied using an All Hazards approach. Scaleable and Modular

Not an “all or none” issue Adopt and modify the individual components

Opportunity for improved integration into the existing hospital and health infrastructure.