Modular Emergency Medical System: Concepts for Building Surge Capacity

1. New Mexico MEMS Michael Richards, MD, MPA, FACEP Modular Emergency Medical System: Concepts for Building Surge Capacity Version 3 SummaryJuly 2006

2. Overview • Background of MEMS • The MEMS Model • Patient Flow • Components • Philosophy of Care • Application of MEMS to New Mexico

3. PI - Public Information Fatality Management ADDITIONAL ELEMENTS 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 MEMS components provide the general framework on which we will “hammer out” the details.

4. 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

5. 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”

6. MEMS Flow Map

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

8. NEHC – Neighborhood Help Center • 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 “Green Book”

9. NEHC – DMAT Example

10. NEHC – Adaptation • “Alternate Outpatient Care Area” • May be located within the hospital • Serves as alternate point of presentation and care • Can be scaled to need PMAC – Hurricane Katrina 2005

11. 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”

12. 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

13. ACC – Katrina Example

14. 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.

15. 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.

16. CO – Community OutreachMP – 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.

17. 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.