# Surge equipment & vehicle



## NomadicMedic (Mar 25, 2019)

Curious if your department has a Surge vehicle and what you carry. 

Working on a project and need some details.


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## DesertMedic66 (Mar 25, 2019)

Surge vehicle as in an extra rig when all others are on calls or something else?


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## NPO (Mar 25, 2019)

We have a modular 60-bed mobile hospital.

It's core unit is a trailer that functions has a command post, and also has a patient triage/treatment area in the back for 4 patients.

We also have 2 MCI trailers with bulk casually supplies. One small, one larger.

For day to day demand flexes, we have up to 6 fly cars.


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## NomadicMedic (Mar 25, 2019)

DesertMedic66 said:


> Surge vehicle as in an extra rig when all others are on calls or something else?



No, an MCI/special operations truck.


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## DrParasite (Mar 26, 2019)

NJ's EMS task force has a large mass care vehicle and small mass care vehicle: https://www.nj.gov/health/ems/documents/special_services/njemstf_overview.pdf 

Wake EMS has Major Operations Support vehicle Truck 1, as well as their medical ambulance bus EVAC-1

Most MCI vehicles are better suited as county wide resources, vs individual agency vehicles, simply because most small agencies can't justify an MCI truck just for them.

I've seen two types of MCI vehicles: trailers that are pulled by a pickup truck, and MCI vehicles.  The biggest advantage with vehicles is you have power and can charge equipment (and you don't need another vehicle to pull it), but they are substantially more expensive.

If I were specing out a MCI truck, I would make a list what I would need to handle the following incidents:
1) highrise fire with 20 patients with smoke inhalation
2) fully loaded bus vs another another bus traffic accident
3) music festival /  school sporting event with either OD or weather related MCI

Things to make sure you have:
collapsible cots
chairs  & tables
fire rehab equipment
shelter from the rain
extra water and gatoraid
Triage supplies (red/yellow/green signs and colored tape to identify boundries)
traffic cones
FEMA paperwork and container to store it all
back boards (to move people from point A to B, not to strap them down and torture them)

The real answer is, you can spend a whole lot of money on something that might get used maybe a dozen times a year.  Look at your area, and determine your needs.


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## Bullets (Mar 26, 2019)

NomadicMedic said:


> Curious if your department has a Surge vehicle and what you carry.
> 
> Working on a project and need some details.


As @DrParasite said, NJ has the EMS Task Force. My agency has a portion of the field hospital, it is 3 19x35ft western shelter tents as well as a one of those SOVs in the slide show that hold 2 20x20 Western Shelter tents. These units come with HVAC, hot and cold running water, showers, sinks, chemical toilets, generators and everything we need to support the tents, all kinds of tools and other logistics equipment. If you have any questions PM me. 

We also have a hospital in my town and we support their surge trailer. It has Westcot folding beds and two DRASH tents for setting up in the parking lot. We would use a combination of the two if the hospital needed it


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## Tigger (Mar 27, 2019)

To me it seems like an MCI vehicle should be able to provide treatment to moderately ill/injured patients on scene with the goal of releasing them. I don't get the "trailer of spinal" model, those patients all get transported (in theory) and every ambulance should have no issue providing care for two to three patients. 

A large apartment building fire is probably the most resource intensive MCI that most agencies will face, especially in the winter. Excluding actual thermal injuries, most "patients" probably just need out of the cold and maybe some oxygen. Most won't need transport, unlike a commercial transportation incident where people will either be able to self care with minimal assessment required or need an ambulance. The latter tests your system's actual transport capacity, a large fire is a way different animal.


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## DrParasite (Mar 27, 2019)

Tigger said:


> A large apartment building fire is probably the most resource intensive MCI that most agencies will face, especially in the winter.


Fire in an assisted living facility or senior housing? even a smoke condition that fills up a wing or two, necessitating partial or complete evacuations?

I always think that most MCI vehicles are able to bring a whole lot of resources to the scene for I can get a huge amount of ambulances for transport.  So if I have a commercial bus that hits an immovable object, or a train accident, or multiple unconscious patients at a mass gathering, I need some way to treat them before those 30 ambulances arrive.

If I just need to house non-injured out of the elements, I can request a transit bus from the bus company.  When I think MCI, I am thinking I have more patients than ambulances, and need equipment at the scene before all of my mutual aid ambulances arrive (so I need to be able to set up triage and treatment zones, when M/A arrive, transport can just give them a patient and send them on their way).


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## NPO (Mar 27, 2019)

DrParasite said:


> Fire in an assisted living facility or senior housing? even a smoke condition that fills up a wing or two, necessitating partial or complete evacuations?
> 
> I always think that most MCI vehicles are able to bring a whole lot of resources to the scene for I can get a huge amount of ambulances for transport. So if I have a commercial bus that hits an immovable object, or a train accident, or multiple unconscious patients at a mass gathering, I need some way to treat them before those 30 ambulances arrive.
> 
> If I just need to house non-injured out of the elements, I can request a transit bus from the bus company. When I think MCI, I am thinking I have more patients than ambulances, and need equipment at the scene before all of my mutual aid ambulances arrive (so I need to be able to set up triage and treatment zones, when M/A arrive, transport can just give them a patient and send them on their way).


Agreed.

To me, the need is taking care of those patients you can't transport right away. What happens when a commercial airliner slides off the end of the runway with 137 people on board? My county has 6 ambulances during peak hours. County west has 3. East has one, and north has 4. 

Even with everyone coming, it's going to be a long day. We do not have an "AmBus" so we are going to need to treat and stabilize on scene of any large MCI where people are going to be expected to remain on scene for a while.

That mobile hospital I posted about has only been deployed once (although we use the trailer command/triage module at least once a year). It was for an F5 tornado that took out a hospital elsewhere in the state. The mobile hospital was in continuous operation for about 2 years if I recall. But that's different than what I think the point of this thread was.


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## johnrsemt (Mar 28, 2019)

Worse case where I work PT, is a commercial or school bus MVC or fire at hotel/casino.  We have 3 ambulances staffed on a good day, closest backup is 110 miles.  closest helicopter is the same, along with a fixed wing;  then the next closest ground ambulances (4)  and helicopter is 125 miles; then multiple ambulances 130-150 miles, and helicopters (7) 130-175. 
So if something big happens we are screwed for approx 2 hours.
And we don't have a hospital in our town/s so the closest hospital is 110 miles, 125 and then 130-140 for level III, II and I's.  So that will even be worse.


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## Chimpie (Mar 30, 2019)

NomadicMedic said:


> No, an MCI/special operations truck.


Also keep in mind what gap you're trying to fill and something often overlooked, what timeframe-gap are you trying to fill?

Having inflatable rooms with generators and a/c/heater units is awesome, but if it's going to take 45 minutes to arrive on site, and realistically an hour or more to set up (tying up both time, people and *space*), can you effectively and efficiently move those greens and light yellows someplace else for treatment before either releasing or sending them someplace? 

Just trying to make sure you're seeing from every angle.


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