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Central Medical Emergency Direction

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  1. 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


  3. Overview • 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

  4. 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

  5. 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

  6. 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

  7. Definitions 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??

  8. Definitions 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

  9. Definitions 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

  10. Definitions Surge • 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

  11. Definitions CHEMPAK • 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

  12. The CMED System

  13. Everyday and Not So Everyday Use of CMED

  14. 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”

  15. 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 Age Sex Chief Complaint (CC) History of Present Illness (HPI) Past Medical History (PMH) Meds Allergies Assessment- Include pertinent negatives Treatment provided ETA Routine Radio Reports to the Emergency Department

  16. 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

  17. 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

  18. 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*

  19. Questions

  20. 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

  21. Practical Evolutions • Routine CMED Communications practical • MCI CMED Communications practical

  22. Post Assessment