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

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

3. 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.

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

8. 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

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 Branch MCC – 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 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.

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.