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

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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

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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

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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

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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

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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??

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DefinitionsAmbulance 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

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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

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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

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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

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DowntownBoston

DNCG

CMED

SSH

Waltham

Scituate

UNIVERSITY

UNIVERSITY

Other Agencies

The CMED System

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Everyday and Not So Everyday Use of CMED

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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”

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Routine Radio Reports to the Emergency Department

• 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

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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

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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

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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*

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Questions

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Further Information

Western Massachusetts EMS Council (EMS Region I)168 Industrial Park DriveNorthampton, MA 01060

(413) 586-6065Central Massachusetts EMS Council (EMS Region II)

361 Holden StreetHolden, MA 01520

(508) 854-0111NorthEast EMS Council (EMS Region III)

20A Delcarmine StreetWakefield, MA 01880

(781) 224-3344Metropolitan Boston EMS Council (EMS Region IV)

25 B Street, Suite ABurlington, MA 01803

(781) 505-4367Southeastern Massachusetts EMS Council (EMS Region V)

10 Center Street Middleborough, MA 02346

(508) 946-3960

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Practical Evolutions

• Routine CMED Communications practical

• MCI CMED Communications practical

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Post Assessment