Mobile hospital provides care when disaster strikes: when disaster strikes, a well-thought-out plan goes a long way in a successful deployment of emergency services

Healthcare Financial Management, Feb, 2006 by Carole J. Bolster

"When the convoy rolled in, it was like the cavalry had arrived. It would make the hair on the back of your neck stand up," said Tom Blackwell, MD, an emergency medicine physician at Carolinas Medical Center, Charlotte, N.C. Blackwell headed up the mobile unit, Carolinas MED-1, which was deployed to Mississippi to help victims of Hurricane Katrina.

MED-1's convoy consisted of 20 vehicles, including two tractor trailers that comprised the mobile hospital and its support apparatus. The remaining vehicles were buses, police cars, and emergency vehicles carrying some 100 medical and security personnel. The convoy pulled into a debris-strewn Kmart parking lot in Waveland, Miss., in the late afternoon of Sept. 3, 2005. Although its arrival had been unannounced, more than 70 people, who had been camping out in the lot, stood and applauded.

Hurricane Katrina devastated Waveland, a town of about 7,100 people some 50 miles from New Orleans on the Gulf Coast. Most of the town's buildings were literally swept away by winds and storm surge. Most residents were left homeless. Hancock Medical Center, which was heavily damaged by Katrina, had to close for several weeks.

Soon after arriving, MED-1's staff drafted two men with front-end loaders from the Federal Emergency Management Agency to clear the lot of cars, trucks, and boats, which were then pushed into a perimeter to form a security barrier around the compound. Then, the staff cleaned up debris and set up shop. They set up 14 beds--12 regular beds and two operating room beds--in about 45 minutes. The rest of the equipment took six to eight hours to set up. They saw their first patient that night. During their seven-week stay, they treated a gamut of medical problems, including rashes, abscesses, infections, heat-related illnesses, orthopedic injuries, heart attacks, and traumas. In all, between Sept. 4 and Oct. 14, they provided on-site ambulatory and emergency medical care to more than 7,200 patients.

MED-1 was deployed at the request of the state of Mississippi through the North Carolina Office of Emergency Management and the North Carolina Office of Emergency Medical Services. The deployment to Mississippi was MED-1's first response to a natural disaster.

"With the local hospital inoperable because of storm damage, the people of this area were in desperate need of health care," Blackwell said. "Those of us privileged to serve their medical needs are humbled by the gratitude and inner strength of the thousands we met. None of us will ever forget them, their personal stories, and the devastation of this area, which was ground-zero for Katrina."

He added, "There is no doubt about the need for and the success of this deployment. Our role was to receive and stabilize the patients with the most serious conditions, and then move them by ambulance or helicopter to undamaged hospitals elsewhere in Mississippi that were equipped to provide inpatient care."

How It Works

A level one trauma center, MED-1 was built in 1983 with $1.85 million in grant funds from the Metropolitan Medical Response System, which is part of the U.S. Department of Homeland Security. MED-1 was designed and developed by a team of emergency physicians and nurses, led by Blackwell, at the Carolinas Medical Center. MED-1 was envisioned as a unit capable of augmenting a damaged hospital or adding capacity to a functioning hospital, following a natural disaster or act of terrorism.

Blackwell worked with Kevin Staley, medical services director for the Mecklenburg EMS Agency, to design MED-1, whose components are housed in two 53-foot trucks. One truck contains an operating room, intensive care unit, emergency department, and general hospital. It has pharmacy, laboratory, radiology, and ultrasound capabilities as well as telemedicine uplinks. The other truck contains enough supplies to keep the unit self-sustaining for at least 48 hours, although the Mississippi deployment stretched this capacity considerably. MED-1 can add 1,000 square feet of additional covered treatment space, using an environmentally controlled tent system that can accommodate up to 100 exterior beds if necessary. The unit was delivered in April 2004.

"We have filed a patent on it," Blackwell said.

MED-1 is designed and equipped to provide a wide range of healthcare services, including emergency surgery, orthopedic stabilization, wound repair, burn treatment, cardiovascular and pulmonary care, invasive and noninvasive advanced life support for cardiac arrest, comprehensive asthma care, and dental procedures.

Because victims of a disaster are not billed for their care, MED-1 staff used a standard triage system to register, treat, and discharge patients. Operating the inside of MED-1 alone costs about $25,000 per day. The Waveland deployment came under the aegis of the FEMA and the Department of Health and Human Services, so all of MED-l's expenses will be reimbursed by the federal government.

A Team Effort

"Staffing and assistance for MED-1 came from all across North Carolina," Blackwell said. "We at Carolinas Medical Center were a major player, because we had the hospital. But this response was a component of the State Medical Assistance Team program."