The Medical Emergency Response Facility (MERF) Protocol

• 2008 May 1

Having solved the equipment-deployment and force-multiplication aspects of the paradox, Darling authored the Medical Emergency Response Facility (MERF) protocol. This protocol is a highly functional disaster management and major incident response concept designed to maximize results with the resources available at the time they’re needed, with reasonable expectations of success. 

How does this concept compare to the traditional disaster deployment? Let’s look at a representation of today’s typical response to a major disaster.

Large deployed health care facilities (HCF), although effective once they become operational, routinely don’t arrive at the disaster region in the first critical 72 hours after an incident (see Figure 1). 

In addition, in a worst-case scenario, should a chemical, biological, radiological or nuclear event (CBRNE) occur that contaminates this HCF, 100% of the deployed health-care support offered by the facility will be rendered useless (see Figure 2).

In contrast to the large, single HCF used by many federal agencies and regions, the use of multiple, locally housed, rapidly deployed, scalable, highly mobile MERFs offers multiple advantages and back-up capabilities. This is the primary focus of the MERF protocol. 

The MERF protocol for deployment involves multiple, rapidly deployed, scalable, highly mobile MERF systems. As illustrated in Figure 3, the deployment of multiple MERFs, distributed strategically throughout an affected community(s), enables first responders to offer medical and critical services just one hour after an incident occurs. 

Each of the 10 or more of these 10-bed facilities can become operational in less than one hour when an available building or other location is used and in three hours if shelters are required. The facilities offer medical assessments, BLS/ALS treatment, surgery, radiology and ICU capabilities on scene. This means that MERFs will arrive earlier—well within the critical 72-hour window—than federal DMAT teams, hospital ships and other large medical-response resources.

Each of the MERFs is independent, but linked via common communication frequencies or WAN/LAN. Some MERFs can be customized or physically connected together if scene needs dictate. In addition, regions that have existing shelters and mass-care equipment can add components of the MERF, as well as Charlie’s Horse canisters, patient platforms and transfer carts, to their existing system. 

The versatility of this system allows parts of the facility normally deployed as a radiology branch or ICU area, for example, to easily be converted into an additional treatment or surgical area using the same Charlie’s Horse beds/platforms that came with the MERF. The Charlie’s Horse transport and litter platforms are all designed to be adaptable and compatible with the other specialty-area equipment and equipment used by the military. For example, the Charlie’s Horse litter platform is compatible with NATO spec litters/stretchers.

In contrast to the earlier example of a CBRNE incursion occurring at an incident due to a secondary explosion and wiping out a single, large-footprint, portable medical facility, because of the relatively small footprint of each MERF and the purposeful distribution of several MERFs, a CBRNE event in the area of a MERF facility will result in only a 10% loss of health-care delivery due to the stand-alone and semi-isolated nature of each 10-bed facility (see Figure 4).

As a situation stabilizes and other large facilities are erected, if the deployed MERFs are still required, they can consolidate into large bed-count facilities (see Figure 5).  

In addition, if long-term health care is needed at the scene of a disaster, or should indigenous health-care facilities be rendered inoperable as occurred after the flooding of New Orleans, the larger facilities and consolidated MERFs can remain and function as 100-bed or larger facilities providing continuous surgery, radiology, ICU and post-operative or general medical capabilities.

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