NM MEMS Framework

The New Mexico Modular Emergency Medical System (NM MEMS) Framework

Summary: Providing care during a catastrophic incident accompanied by a surge of patients may exceed available resources and require adjustments in normal resource management and triage.

Description: In the event of a widespread public health emergency or other catastrophic incident, there could be a surge of patients that would overwhelm the health care system, specifically, the normal response capabilities of emergency medical services (EMS), hospitals, primary care clinics, and other health care providers. Response to a patient surge resulting from a mass casualty incident that would become a public health emergency (i.e. infectious disease pandemic, act of biological terrorism or a natural disaster) will require the health care system to manage large numbers of victims with very limited health care resources, including personnel, equipment, hospital beds, and pharmaceuticals.

Under conditions of overwhelming patient surge, a goal of response will be to optimize the use of available resources in relation to demands in order to provide a reasonable level of healthcare to those affected by the incident. Legally and ethically, an acceptable “standard of care” requires that a health care provider (or health care system) exercise the education, training, skills and diligence that is reasonably expected of a health care provider (or health care system) practicing under the same or similar circumstances. This standard essentially means that a prudent health care provider should provide a reasonable diagnostic and treatment process for the care of a certain type of patient, with a certain type of illness, under certain clinical circumstances, which include available resources. Exemptions regarding scopes of practice during emergencies may exist in State statutes for professional licensing boards.

These “standards of care” will be applied in each functional area of medical response and will be in effect for as long as it is reasonably necessary to accommodate the health care system’s response during overwhelming patient surge. When a catastrophic incident occurs causing an overwhelming number of patients to seek care, a public health emergency may be declared through the New Mexico Public Health Emergency Response Act* (PHERA). The New Mexico PHERA allows the Governor and state executive agencies to exercise extraordinary powers in response to a public health emergency, such as the rationing of health care supplies and the utilization of health facilities.

During overwhelming patient surge conditions and or limited and insufficient resources, the following types of decisions are typical of those that will be required:

• Identification of essential clinical services, including elements of critical care delivery and prophylactic treatment that will continue during medical surge;
  
  
• Determine use of pharmaceuticals and equipment that have been stockpiled.
  
  
• Criteria determining the prioritization of patients to receive the limited and available medical resources (i.e. how to choose between two medically equal individuals when there is only enough resources for one);
  
  
• Criteria for care of patients who qualify for essential clinical services but who are not exposed or infected with the particular agent responsible for patient surge;
  
  
• Criteria for patients who are terminally ill or mortally injured and may require palliative care;
  
  
• Procedures to ensure that planning for resources needed to provide palliative care receives equal importance as efforts to provide medical care; and,
  
  
• Policies and procedures for documentation of financial expenditures and other costs resulting from response to patient surge are developed.
  
  

Discussions should be held about the environment influencing the need for these “hard” decisions prior to the incident by every institution, its response partners, individual providers and community leaders. Elected officials at all levels of government should be included in order to maximize available personnel and other resources and to assist the community in recovery after the incident.

Planning Assumptions:

a. Delivery of Care During Overwhelming Patient Surge is distinguished from typical emergency department overcrowding and the crises that arise in handling daily patient flow or surge.

b. The term “overwhelming medical or patient surge” has been used to distinguish the sudden, insidious, unexpected and overwhelming increases in demand for medical services that would occur during a major public health incident.

c. The concept of “standard of care” allows for the practice of different standards of medical care in unusual circumstances (i.e. in the face of exigent circumstances such as would occur during “overwhelming medical or patient surge”).

d. When the demands for health care services exceed existing health care resources (i.e., lack of availability of hospital, ICU or specialty care beds, need for alternate care sites; inadequate medical equipment, medicine and supplies; lack of sufficiently trained or qualified medical personnel to provide medical care, etc.), the “standards of care” will be met if such resources are utilized in a reasonable manner in an effort to achieve the greatest benefit (i.e. the best chance of survival and recovery within the limits of available resources).

e. It is necessary to develop evidence-based “standards of care” that will be applicable to the health care system’s response to “overwhelming medical or patient surge” and to recognize that practicing within such “standards of care” will be appropriate under the circumstances in an effort to optimize patient outcomes and to save the most lives possible.

f. Communities must have discussions pre-incident regarding “standard of care” and the realities of limited resources and community impact.


*Public Health Emergency Response Act (PHERA), Sections 12-10A-1, et seq., NMSA 1978, now part of the New Mexico Emergency Powers Code created by the 2006 New Mexico Legislature (Laws 2005, Chapter 22)

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