Dissertation Improving the Air Force Medical Service’s Expeditionary Medical Support System: A Simulation Approach Analysis of Mass-Casualty Combat and Disaster Relief Scenarios John A. Hamm 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. PARDEE RAND GRADUATE SCHOOL For more information on this publication, visit http://www.rand.org/pubs/rgs_dissertations/RGSDA343-1.html Published 2020 by the RAND Corporation, Santa Monica, Calif. R® is a registered trademark Limited Print and Electronic Distribution Rights This document and trademark(s) contained herein are protected by law. This representation of RAND intellectual property is provided for noncommercial use only. 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Support RAND Make a tax-deductible charitable contribution at www.rand.org/giving/contribute www.rand.org Abstract 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. iii Table of Contents Abstract .......................................................................................................................................... iii Figures............................................................................................................................................ ix Tables ........................................................................................................................................... xiii Contact Information .................................................................................................................... xvii Acknowledgments ........................................................................................................................ xix Abbreviations ............................................................................................................................... xxi 1. Introduction ............................................................................................................................... 1 Policy Objective ....................................................................................................................................... 1 What is an Expeditionary Medical Support System? ............................................................................... 1 Research Questions ................................................................................................................................... 2 Policy Relevance ...................................................................................................................................... 3 Organization ............................................................................................................................................. 4 2. EMEDS Background and Existing Medical Tools and Research ............................................. 5 Roles oF Medical Care .............................................................................................................................. 5 Role 1 Medical Care ............................................................................................................................. 5 Role 2 Medical Care ............................................................................................................................. 6 Role 3 Medical Care ............................................................................................................................. 6 Role 4 Medical Care ............................................................................................................................. 6 Patient Prioritization and Movement ........................................................................................................ 7 Patient Prioritization ............................................................................................................................. 7 Patient Movement ................................................................................................................................. 9 Historic EMEDS System ........................................................................................................................ 10 When Was the EMEDS System Designed? ....................................................................................... 10 When Are EMEDS Used? .................................................................................................................. 10 Combat Operations ............................................................................................................................. 11 Current Deployable Medical Assets ....................................................................................................... 13 EMEDS Health Response Team ........................................................................................................ 13 EMEDS+10 ........................................................................................................................................ 14 EMEDS+25 ........................................................................................................................................ 14 58 Bed Air Force Theater Hospital .................................................................................................... 14 Existing Analytic Tools .......................................................................................................................... 15 Medical Planner’s Toolkit (MPTk) .................................................................................................... 15 Joint Medical Planning Tool (JMPT) ................................................................................................. 16 Theater Air Base Models .................................................................................................................... 17 Existing Literature .................................................................................................................................. 17 Expeditionary Medical Support (EMEDS) and Air Force Theater Hospital (ATFH) ....................... 17 How Should Air Force Expeditionary Medical Capabilities Be Expressed? ..................................... 18 v Timelines For Reaching Injured Personnel in Africa .......................................................................... 19 A Chance in Hell: Evaluating the EfFicacy oF US Military Health Systems in Foreign Disaster RelieF ...................................................................................................................................................... 19 Conclusion .............................................................................................................................................