Genesis of the Charlie’s Horse Deployment System & the MERF

• 2008 May 1

The idea behind both the Charlie’s Horse Deployment System and the MERF (Medical Emergency Response Facility) was born out of several years of careful research and interviews conducted with members of emergency response agencies, the disaster response community and the Armed Forces medical commands. The interviews determined whether existing protocols for prolonged incidents provided the necessary response and capabilities needed to fulfill mission requirements. The groups were also asked whether existing equipment stockpiles sufficiently supported the personnel expected to implement the response protocols. 

What was discovered during the interview process was that there was a gap between those responsible for implementing response and treatment protocols and those who conceived the protocols. It was also apparent that existing equipment was inadequate and required significant manpower to deploy and make operational. 

Redundancies also existed in both the military and the civilian sectors. Instead of developing systems and protocols that were synergistic, with commonality of equipment, egos prevailed and funds were squandered. 

It became apparent that a new approach was needed when it came to medical equipment deployment and the utilization of manpower in field medical operations at major incidents, particularly those that must be sustained for days—or weeks.

When Hurricane Katrina struck New Orleans and forced thousands of residents to seek shelter in the Superdome, vital resources, such as water purification, oxygen generation and emergency dental services, weren’t available for days until disaster medical assistance teams (DMAT) and other federal assets arrived. Considering the size and scope of today’s major incidents, be they natural or manmade, this is an “old school” approach to disaster response. Regions must be better prepared to address incident needs early on.

When the Northridge earthquakes struck Southern California in January 1994, they disrupted hospital and emergency department operations, forcing staff members to work in parking lots under the hot sun until DMAT teams and military resources arrived or other shelter facilities were located. 

A University of Delaware Research Center report on issues involving intergovernmental coordination during the Northridge earthquakes highlights the need for improvements in the way we respond to and manage large disasters. Some of the issues noted in the study include: 

• Governmental lack of coordination—Past research on emergency response has demonstrated time and time again that the major problems between governmental jurisdictions occur from a lack of coordination and communication, often caused by a lack of prior planning. 
• Lack of city/county organization—Again, we see evidence of this lack of coordination both within a city and between cities and the county. 
• Perceived inability to respond—In the Northridge aftermath, the lack of coordination appears to be related primarily to city officials’ perceptions of the county’s inability to fulfill its needs on a timely basis. The reasons for these perceptions are many, including logistical incapacity (the inability to get resources to the requesting jurisdiction quickly); lack of a consistent contact in the county emergency operations center; and inquiries concerning resource needs to other governmental entities (e.g., sister cities or the disaster field office).

These areas highlight the need for a flexible but coordinated disaster response protocol. All field medical operations have a great deal in common, whether they’re military combat operations or disaster response operations. The size and scope of instant-demand patient needs are the same in the first few hours after a major incident as they are after a military battle. It has been demonstrated that a more significant clinical impact can be realized—and more lives saved—if triage, surgery and critical care are offered soon after the incident or battle. Where field medical operations differ is in the types of injuries and illnesses that are treated in each. 

The central issues surrounding all field operations that came to light during the MERF research and interview process included: 

• Concern about the weight and space required to deploy the equipment and resources. It’s often more effective and beneficial to the community in need to station medical resources in a park or lot so people can access them when roadways are impassable and the transportation system is disrupted, rather than setting up a massive medical tent city in a football stadium miles from the disaster epicenter that people can’t access easily; 
• The need for easy deployment of all equipment and shelters. Resources that are labor-intensive to load and transport equate to delays in medical care. Fast, compact, efficient canisters that can be moved by one person on arrival are timesavers and force multipliers, enabling few to do the work of many; 
• The reliability of the equipment deployed. Scene managers must be assured that the equipment being delivered to them and used by their medical staff will operate immediately and for sustained periods without failure or the need for maintenance;
• The need for less dependency on logistical support, particularly because resources required to off-load and move heavy equipment are not always readily available. If transportation modes are disrupted and industries are shut down after a major incident, so too will be the ability to travel and obtain forklifts and carts to lift and move heavy pallets and cargo containers. Small, easy-to-transfer cargo canisters have been found to be more effective during disaster operations; 
• The need to use available manpower in a more efficient manner. There are seldom enough human resources available to meet all medical, search-and-rescue, evacuation and relocation demands. Therefore, the manpower assigned to the arrival zone to off-load medical supplies, erect shelters, assemble litters and litter platforms, and set up medical delivery components must be maximized (force multiplication) and able to assist in assembly with limited instruction or direction; and, most importantly,
• The need to standardize equipment between civilian emergency/disaster response organizations and corresponding branches of the military. Equipment purchased for deployment at incidents involving the military should be designed and constructed to be compatible with the myriad of equipment the military and other civilian forces will be utilizing. For example, it’s essential for patient platforms to not only be compatible with all NATO-approved litters, but also to hold and lock the litters securely in place.

These central issues presented an interesting paradox. How do you increase the productivity and capabilities of the individuals deployed to a protracted incident but decrease the footprint left by deployable resources? 

The solution: Design an integrated deployment system made up of interchangeable parts that can be configured into different pieces of equipment as mission requirements change. This equipment must be reliable, multi-purpose and have a force-multiplying aspect.

Further review of the research and interviews also revealed the need for an improved protocol for field medical deployments, one that could be implemented in all scenarios with the resources available at the time. This protocol would also have to address why existing major incident protocols were failing. 

• 

• Copyright © Elsevier Inc., a division of Reed Elsevier Inc. All rights reserved. Terms and Conditions Privacy Policy.

  SUBSCRIBE to JEMS NOW >>