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Central Medical Emergency Direction. CMED An Overview and Its Practical Applications Department of Public Health, Office of Emergency Medical Services, Emergency Medical Care Advisory Board Mass Casualty Sub-committee. SELF ASSESSMENT. Overview. Where CMED came from CMED Functions

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Central Medical Emergency Direction

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Central Medical Emergency Direction


An Overview and Its Practical Applications

Department of Public Health, Office of Emergency Medical Services,

Emergency Medical Care Advisory Board Mass Casualty Sub-committee



  • Where CMED came from

  • CMED Functions

  • Definitions

  • How it works Technologically

  • Everyday and not so everyday use

    • Hailing

    • Routine

    • MCI/Surge

  • Questions

  • Practical Evolutions

  • Post-Test

The Beginning of CMED

  • The Federal Emergency Medical Services System Act of 1973

    • Established the concept of a Central Medical Emergency Direction (CMED) Center.

    • Funded by both private and public agencies including Department of Public Health and private hospitals.

  • A CMED Center

    • Is an entity that provides specialized communication functions

    • Connects hospitals and field medical first responders

Functions of CMED

  • Compliance with state and appropriate regional EMS communications plans

  • Manage regional EMS channel use

  • Enable ambulance to hospital communication

  • Obtain ED care capabilities during an MCI and ED specialty capability including decontamination

  • Communicate with other public safety agencies as necessary

  • Request Regional Mass Casualty Support Units (MCI trailers)

  • Incoming out of area support

Functions of CMED, Cont.

  • Request and coordinate distribution of EMS CHEMPAK supplies

  • Coordinate patient distribution during an MCI

    • Including but not limited to assigning patient destination

  • Coordinate requests for EMS resources

    • In conjunction with fire district control centers

  • Coordinate forward movement of patients during surge events

  • Coordinate with other Regional CMED Centers as needed


Regional Mass Casualty Support Unit (RMSCU)

(MCI trailer)

  • Mobile MCI treatment and support supplies

    • 13 trailers located across Massachusetts

    • Each trailer is equipped with supplies to treat 50-75 patients

    • Unit has available minimal EMS branch support supplies

    • Staffed by two providers from host agencies

    • For additional information go to http:// Any Decision on WEBLINK??


Ambulance Task Force

  • Any combination of ambulances, within span of control, with common communications and a leader

    • There are 58 Task Forces in Massachusetts

    • Task Forces are accessed through the Fire District Control Centers

    • 5 ambulances and a Leader or Alternate Leader make up a task force

    • Can be either ALS, BLS or a combination

    • Some Task Forces have an additional non-transport paramedic units assigned them

    • There are a total of 290 ambulances

    • Task Forces utilize the DCR radio network when traveling together


ED Care Capability

  • The number of red, yellow and green patients a hospital can care for during an MCI

    • CMED continually monitors the ED capability during the duration of an incident



  • The forward movement of patients during a high patient volume event

    • Evacuation from a nursing home or hospital

    • Influx of patients from disasters in other areas of the country or parts of the world

    • A Pan-flu event



  • Federally funded program providing nerve agent antidotes for large scale events

    • Stored at select hospitals throughout the Commonwealth

    • Designed for use during very large scale nerve agent exposures or organophosphate poisonings

    • Requested through CMED

    • Transported to staging area by EMS provider

The CMED System

Everyday and Not So Everyday Use of CMED

Contacting CMED

  • All communications with CMED begin here

    • The common hailing channel in all Regions is MED 4

    • This is true for everyday patches as well as declaring an MCI

  • When hailing CMED

    • Request Medical Control

    • CMED name x 2

    • Service and unit number

    • Reason for request

    • Physical Location

      • For Example: “Boston-CMED, Boston-CMED. This is Bedford A-2 requesting a priority one patch to the Lahey from Route 62”

Make this report as clear, concise, and short as possible

Rule of thumb, no more than two minutes

When reporting a patients’ condition, the radio report should include the following



Chief Complaint (CC)

History of Present Illness (HPI)

Past Medical History (PMH)



Assessment- Include pertinent negatives

Treatment provided


Routine Radio Reports to the Emergency Department

Radio Communications with CMEDMass Casualty Incidents

  • Contact CMED where incident occurred immediately on MED 4 upon determining an MCI – (the EMS Region of an event manages the event)

  • Using the mnemonic METHANE relay the following information;

    • Major incident declared

    • Exact Location - The precise location of the incident, staging area, if applicable

    • Type - The nature of the incident, including how many vehicles, buildings etc. are involved

    • Hazards - Both present and potential

    • Access - Best route for emergency services to access the site, or obstructions and bottlenecks to avoid

    • Numbers - Numbers of casualties, dead and uninjured on scene

    • Emergency Services - Which services are already on scene, and which others are required(MCI Trailer, Regional Staff, Task Force…)

  • Request that the surrounding hospitals be advised of incident

    • Request CMED to acquire the ED Care Capabilities

Radio Communications with CMEDMass Casualty Incidents

  • Request a channel assignment

    • Assigned channel is used by EMS to request additional resources per the ICS protocol

      • MCI Trailers, CHEMPACK, Task Force, Regional Support, etc.

    • Assigned channel is used by the Transport/Loading Supervisor

      • Transport/Loading coordinates distribution of patients through CMED

  • CMED Provides patient destination to Transport/Loading Supervisor for distribution of patients

    • CMED and the Transport/Loading Supervisor maintain a record of patient distribution to hospitals to include;

      • Patients tag numbers, priority, ambulance service and unit number, and hospital destination

      • EMS Branch, CMED, and Hospitals will reconcile records after incident is over

Radio Communications with CMEDMass Casualty Incidents

*Ambulances transporting patients from an MCI shall not contact CMED unless the patients conditions changes so that it is immediately life-threatening and needs to be redirected by CMED to a closer hospital*


Further Information

Western Massachusetts EMS Council (EMS Region I)

168 Industrial Park Drive

Northampton, MA 01060

(413) 586-6065

Central Massachusetts EMS Council (EMS Region II)

361 Holden Street

Holden, MA 01520

(508) 854-0111

NorthEast EMS Council (EMS Region III)

20A Delcarmine Street

Wakefield, MA 01880

(781) 224-3344

Metropolitan Boston EMS Council (EMS Region IV)

25 B Street, Suite A

Burlington, MA 01803

(781) 505-4367

Southeastern Massachusetts EMS Council (EMS Region V)

10 Center Street

Middleborough, MA 02346

(508) 946-3960

Practical Evolutions

  • Routine CMED Communications practical

  • MCI CMED Communications practical

Post Assessment

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