Treatment on the fly: Mobile units help hospitals boost surge capacity
By Rochelle Nataloni
Emergency physician Roy Alson, MD, vividly remembers getting the call to mobilize his team in the aftermath of Hurricane Katrina. As the commander of a federal disaster medical assistance team (DMAT) in North Carolina, Dr. Alson was anxious to offer assistance to the hurricane’s victims, and his team was well equipped to do so with a portable hospital unit designed to handle overflow during emergencies.
“My unit was deployed to Gulfport, Miss., to deal with massive overflow in the ER of Gulfport Memorial Hospital,” said Dr. Alson, who is now the medical director of North Carolina’s Emergency Medical Response System. Prior to this post, he spent 18 years leading DMATs as a participant in the National Disaster Medical System (NDMS), the federally coordinated group that helps states and localities deal with the impact of major peacetime disasters.
Members of North Carolina’s Emergency Medical Response System participate in a regional training exercise in Surry County in March 2009.
“Gulfport Memorial normally saw between 100 and 150 patients a day, and during the aftermath of Katrina they were dealing with an excess of 500 patients a day,” Dr. Alson explained. “We were able to decompress the ER so that its staff could concentrate on urgent and critical patients, while we took the less urgent patients outside to our mobile hospital.” The portable unit used by Dr. Alson’s team was assembled outside of the ER within a couple of hours.
Inflatable versus assembly required
Portable “MASH-like” hospital units are helping communities across the country improve their ability to respond to disasters and other events requiring extra capacity. Depending on the design, the units either inflate within minutes or can be assembled manually over several hours.
Portable medical treatment facilities typically are deployed through DMATs, local offshoots of the Department of Health and Human Services’ NDMS. DMATs are staffed by volunteer medical professionals, including hospitalists, as well as paraprofessionals and administrative crews, which provide emergency medical care and triage in their own state and neighboring areas.
The main benefit of inflatable hospitals, in contrast to units requiring assembly, is rapid deployment, said Tom Grace, RN, PhD, president of the Delaware Valley Healthcare Council. “With the inflatable tent you can get into service faster, and our mission is to support hospitals between the time when an event occurs and when federal response is able to acknowledge the event,” he explained. The Southeastern Pennsylvania Specialized Medical Response, which Dr. Grace manages, recently inflated its portable hospital tent in a record 14 minutes during an exercise at the Valley Forge Convention Center in King of Prussia, Pa.
However, rigid, assembly-required modular hospital systems also have benefits, according to Christopher Lake, former director of emergency preparedness for the Nevada Hospital Association.
“Lightweight (inflatable) tent-like structures are designed to set up quickly and stay up for about three days,” said Mr. Lake. “They can be set up inside a facility such as a convention center. If they’re set up outside, they don’t do well in rain or sleet or snow.”
Today, Mr. Lake manages California’s disaster response efforts as an employee of BLU-MED, a mobile hospital distributor. During his stint with the Nevada Hospital Association, Mr. Lake took a 200-bed field hospital to Gulfport, Miss., after Hurricane Katrina. The field hospital, which was functional for 69 days, replaced a local hospital that was temporarily shut down because of mold problems. “We had 72 hours from the time we got called to the time the field hospital had to be transported, set, up, stocked and functional,” explained Mr. Lake.
In addition to disasters and potential pandemics, mobile units also make it easier for hospitals to help during large public events. For instance, Louisville, Ky., used a mobile unit at the Ironman Games in summer 2007. Louisville’s unit can be set up in less than seven minutes and can accommodate 20 patients at a time. It cost $256,000 and was funded by the Kentucky Department for Public Health and the Kentucky Hospital Association, according to Louisville EMS director Neal Richmond, MD. Dr. Richmond said that his team typically gets help very quickly to the injured or sick but that the portable hospital “makes it possible to rapidly stabilize and initiate treatment of large numbers of patients on site without flooding the 911 system or area hospitals.”
Other states that have portable units up and running include the following
- North Carolina has eight mobile units that are owned by the state’s eight trauma centers (funded by a federal Health Resources Services Administration grant) and manned by State Medical Assistance Team (SMAT) volunteers. If deployed simultaneously in the same location, the eight units can be configured into a 400-bed field hospital. “So far, we haven’t had the need to do that,” said Dr. Alson. “The beauty of this system is that it’s scalable. Components can be pulled off for small events or added for larger ones. For instance, when we responded to a tornado in eastern North Carolina, we didn’t need to set up all 50 beds; we didn’t even need to hold patients. We just used the mobile unit as a triage area.”
- South Carolina’s six mobile medical facilities represent a fairly typical configuration. Each has two showers, two toilets, and a sink with three basins. Each unit has a 2,000-gallon potable water system and a 40-gallon water heater. A portable generator helps power heating, air conditioning, the water heater and lighting. Each unit houses 50 cots complete with an intravenous line pole, foam mattress and bed linens. “Mostly, we expect to use these units for triage and minor care in the event that an emergency room is damaged in a disaster,” said Jim Beasley, public information director for the South Carolina Department of Health and Environmental Control.
Rochelle Nataloni is a freelance writer in Sewell, N.J.
Are you involved in hospital medicine? Then you should be getting ACP Hospitalist and ACP HospitalistWeekly. Subscribe now.
ACP Hospitalist Weekly
From the February 15, 2017 edition
- Vancomycin may have mortality benefit over metronidazole for patients with severe C. difficile, study finds
- Severe sepsis patients getting earlier antibiotics were less likely to develop shock
ACP Career Connection
Looking for a new hospitalist position?
ACP Career Connection can help you find your next job in hospital medicine. Search hospitalist positions nationwide that suit your criteria and preferences. Jobs are posted about two weeks before print publication of Annals of Internal Medicine, ACP Internist, and ACP Hospitalist. Exclusive “Online Direct” opportunities are updated weekly. Check us out online.
ABIM Maintenance of Certification for Hospitalists
Hospital-based internists have the option of maintaining their certification in either Internal Medicine or Internal Medicine with a Focused Practice in Hospital Medicine. Learn more about resources from ACP to complete both MOC programs.
- ACP MOC Resources - ACP offers a variety of recertification resources to help you earn both MOC points and CME credits through the same educational program.
Not an ACP Member?
Join today and discover the benefits waiting for you.
ACP offers different categories of membership depending on your career stage and professional status. View options, pricing and benefits.
A New Way to Ace the Boards!
Ensure you're board-exam ready with ACP's Board Prep Ace - a multifaceted, self-study program that prepares you to pass the ABIM Certification Exam in internal medicine. Learn more.