History and Purpose

History
The Carolinas MED-1 project was formally initiated in 2003 as a pilot program to fill the void involving mass casualty patient care in the field when hospital resources are not available due to proximity, damage, quarantine, or surge capacity.  To date, the concept and facility infrastructure design, coupled with staff expertise, has never before been assembled. 

Comprehensive preparedness activities began in Charlotte-Mecklenburg in 1997. A result of multiple planning activities was the development of a response team called ALERT (Advanced Local Emergency Response Team).  This multi-agency team is comprised of law enforcement, fire, and emergency medical personnel.  This team continues to train on a biannual basis.  An expansion of the ALERT program included a plan to transport multiple patients to a hospital.  As planning and development continued on this project, the continuing use of emergency departments for primary care became more obvious and surge capacity was increasing.  As such, the planning shifted from mass casualty transport to creating a resource that could mobilize to an incident scene to off-load local healthcare facilities.  Further, following the Sept. 11, 2001, attack on America , the emergence of anthrax and other bio-infectious agents were proliferating, along with the increase in West Nile Virus and Severe Acute Respiratory Syndrome (SARS).  As time progressed, the emergency of H5N1 influenza occurred creating the threat of a bird flu pandemic.  These factors were used to develop a mobile hospital that could deploy not just to a mass casualty incident site, but could also serve as a shelter medical resource when isolation, quarantine shelters were opened. 

Carolinas MED-1 is a prototype project that was supported by a grant from the Department of Homeland Security, Metropolitan Medical Response System.  Construction began in 2003, with project completion in April 2004. Following multiple staff development, training, and exercise programs, the unit was demonstrated in multiple medical and disaster response conferences.  Carolinas MED-1 was officially called into action in the aftermath of Hurricane Katrina. The MED-1 unit and staff deployed with components of the North Carolina ’s State Medical Assistance Team, SMAT, to the communities of Waveland and Bay St. Louis, Miss. Over a period of seven weeks, more than 7,500 patients were treated, including approximately 15 surgeries performed on-site. 

Purpose
Terrorism
A new era exists with the threat of weapons of mass destruction playing a significant role in preparedness activities.  Hazardous materials are easily obtained and delivered to unprepared populations.  Large, mass gathering events, especially those of a high profile nature are certainly opportune targets for terrorists.  Carolinas MED-1 is a secure environment that is HEPA filtered to 0.3 microns.  This provides an environment to render individuals safe from all biological and chemical agents.  Further, the infrastructure and materials may be included and adapted in the hospital infrastructure to support decontamination procedures. 

Rural access to care
The design and equipment may be tasked to provide general access to healthcare during non-disaster times.  The operating area could support ambulatory surgical care, cancer screening in the form of colonoscopy or biopsy procedures.  General dental care may be provided using local anesthesia or conscious sedation for more comprehensive procedures.

Damaged Infrastructure
Should local facilities become incapacitated due to fire, smoke, or water damage, MED-1 could be rapidly deployed to a proximate site to the hospital to continue patient care services until critical infrastructure were repaired.  Similarly, MED-1 could be deployed to sustain patient care during periods of facility renovation.

Special Event Medical Coverage
The location of any high-profile mass gathering event or incident where dignitaries or government officials are in attendance may be an urban or rural site.  Regardless, both present unique challenges for medical response and hospital transportation.  Wherever the location, it will always be uncertain as the capabilities or level of medical care that will be provided by  any community hospital or trauma center.  MED-1 would facilitate organizing agencies by providing a single source point of contact for medical resources.  Over time, Federal agency personnel would develop relationships and understand the capabilities of the program and staff. 

National Strategic Special Events
Carolinas MED-1 could serve to support high-profile mass gathering events where certain dignitaries or government officials are in attendance.  This capability would facilitate organizing agencies by providing a single source point of contact for medical resources.  Over time, Federal agency personnel would develop relationships and understand the capabilities of the program and staff.  The location of any event or incident where dignitaries may be present may be an urban or rural site.  Regardless, both present unique challenges for medical response and hospital transportation.  Wherever the location, it will always be uncertain as the capabilities or level of medical care that will be provided by any community hospital or trauma center.  The Carolinas MED-1 staff will include a consistent cadre of experienced physicians: trauma surgeons, emergency physicians, anesthesiologists; and nurses: emergency, critical care, and operating room; all employed in a busy, urban level-1 trauma center with an annualized census of over 105,000 patients.  All paramedics on the teamwork for an urban paramedic system with call volumes exceeding 75,000 each year.