Improving the Air Force Medical Service's Expeditionary Medical Support System: A Simulation Approach

Analysis of Mass-Casualty Combat and Disaster Relief Scenarios

by John A. Hamm

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Research finds minor changes to the Air Force's Expeditionary Medical Support System (EMEDS) that produce significant impacts on patient outcomes in mass-casualty events.

The Air Force presently deploys a modular medical treatment facility (MTF), the EMEDS, to provide emergency care to patients around the globe. A fully developed EMEDS consists of twenty-five medical and surgical beds. The EMEDS is not designed to treat large numbers of critically wounded patients or individuals needing advanced trauma surgery. However, the Air Force has previously employed an EMEDS to assist with the emergency medical care provided in large-scale operations.

This research uses a simulation tool to answer three questions. First, how well does the EMEDS currently perform across three types of mass-casualty events: fixed-based missile strikes, earthquakes, and hurricanes? What changes can be made within an EMEDS that might allow it to better serve large numbers of patients? Finally, across the indicated changes, what are the specific impacts on overall patient outcomes (evacuations, returns-to-duty, and mortality) for different patient streams?

This research confirms that the EMEDS is not well-suited to handle patient surges. Though large-scale changes to the EMEDS structure are impractical, two small changes were found that each produce beneficial and statistically significant impacts on patient outcomes. Increasing the size of one of the EMEDS's functional areas, the Critical Care Ward, by adding two beds alleviates patient bottlenecks and improves patient throughput by 50% in some scenarios. Prioritizing certain low mortality risk patients increases evacuations by an average of 200% while increasing return-to-duty rates significantly. When combined, these two adjustments further improve the productivity of the MTF.

This research recommends that the Air Force conduct operational tests of modified EMEDS to confirm that the proposed changes have the beneficial impacts measured and thus strengthen the ability of EMEDS to respond to mass-casualty events.

Table of Contents

  • Chapter One

    Introduction

  • Chapter Two

    EMEDS Background and Existing Medical Tools and Research

  • Chapter Three

    Threat Environment

  • Chapter Four

    Model Formulation

  • Chapter Five

    Assessing Alternative EMEDS Configurations

  • Chapter Six

    EMEDS Improvements for Fixed Base Attacks

  • Chapter Seven

    EMEDS Improvements for HA/DR Events

  • Chapter Eight

    Research Limitations and Additional Considerations

  • Chapter Nine

    Conclusions and Recommendations

  • Chapter Ten

    Appendix

  • Chapter Eleven

    References

Research conducted by

This document was submitted as a dissertation in September 2018 in partial fulfillment of the requirements of the doctoral degree in public policy analysis at the Pardee RAND Graduate School. The faculty committee that supervised and approved the dissertation consisted of Brent Thomas (Chair), Bart Bennett, and Jose Sorto.

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