As good As Advertised: Mobile Hospital Shines in Katrina Response

     Lots of our shiny new resources, in this age of terrorism and major-disaster readiness, look good on paper or in the garage. As yet, few have been tested with real-world deployments. Who can say whether they'll really function as advertised?

     But Carolinas MED-1 did. The mobile hospital, designed and developed by physicians and EMSers in the Charlotte area, spent six weeks assisting the injured and ill in storm-devastated areas of Mississippi following Hurricane Katrina in 2005. Its caregivers helped an estimated 7,400 patients.

     In an online article describing the deployment for the Annals of Emergency Medicine, MED-1 medical director Thomas Blackwell, MD, and colleague Michael Bosse, MD, an orthopedic trauma surgeon, concluded that MED-1 "proved to be a unique, comprehensive medical resource that sustained quality patient care activities until the local system was restored."

     Just what its architects had in mind.

     Carolinas MED-1 was conceived in 2000 as a mass-casualty transport vehicle. But its early advocates-including Blackwell, medical director of prehospital medicine at Carolinas Medical Center in Charlotte-soon recognized (thanks in no small part to 9/11) that in a major incident, an on-scene treatment facility would be more useful than a mere patient-hauling asset. With $1.5 million in funding from the Department of Homeland Security's Metropolitan Medical Response System, they shaped MED-1 into a mobile medical resource capable of providing everything from basic-level care to surgical interventions.

     Today it consists of two 53-foot tractor trailers, one for patient care and one for support and storage. It is staffed by physicians, nurses and associated personnel from Carolinas Medical Center, a Level 1 trauma center, and paramedics from the Mecklenburg EMS Agency, assisted by tactically trained and federally deputized law enforcement personnel.

     The patient-care trailer features three slide-out pods: One provides a two-bed shock-resuscitation and surgical unit, and the others a 12-bed critical- and emergency-care unit, both with a full complement of monitors, equipment and tools. An attached awning system can shelter up to 130 more beds outside.

     MED-1 also boasts diagnostic and laboratory resources, enough medications for 72 hours, a complete communications infrastructure and its own power source.

     It was among resources deployed to the Waveland/Bay St. Louis area under an EMAC request following Katrina. By September 4, it was set up and providing care in a parking lot near Bay St. Louis' incapacitated Hancock Medical Center. It did so until October 14.

     Early on, its staff dealt largely with little things: infections, abscesses, rashes, prescriptions. Then there were bigger issues: myocardial infarctions, cerebrovascular accidents, diabetic emergencies, asthma.

     "Local ambulance providers became knowledgable about our services," Blackwell and Bosse wrote, "and soon began transporting significant trauma cases and critically ill patients to MED-1 because of the capabilities offered." This spared them 70-mile round trips to the next-closest facility that could treat critical patients.

     Traumatic injuries were largely orthopedic, the authors said, but they also saw blunt head and torso injuries and significant burns. Around 10 were operated on. In all, the crew saw anywhere from 25-300 patients a day.

     Their outcomes could not be tracked, of course, but anecdotal evidence found no adverse outcomes and plenty of positive feedback.

     The question now becomes "Can this model be replicated?" Blackwell and Bosse think so.

     "Future interest," they concluded, "should focus on widespread strategic distribution of mobile medical facilities, development of early notification and deployment protocols when a disaster is imminent, and sustainment funding for equipment, training and quality improvement processes."

     For more on Carolinas MED-1, visit www.carolinasmed-1.org.