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Presentation by Nadine Kahlafor
EDU 653Central Michigan University
Patient Movement Items (PMI)
Dustoff 2UH-1 helicopter (Huey) workhorse of the Viet Nam era..MedEvac choppers typically referred to as "Dustoff.“Photo source: USUHSPAO, Sandra Carbajal, November 2, 2011. http://www.flickr.com/photos/48481327@N07/6305741094/in/photostream/
What is PMI and Why?• Patient Movement Items (PMI) consists of critical life-sustaining
medical equipment
• Without this equipment, casualty survivability would not be possible during transport between medical facilities
• This equipment is also very expensive, and the initial treatment team (usually a Forward Surgical Team) has very limited resources
• If the life-sustaining equipment is evacuated with the casualty, the treatment team loses this equipment and thus loses the ability to treat additional casualties
• The PMI program was implemented as a solution to this problem
• The basic concept is to provide additional “theater-owned” medical equipment that is solely used to sustain patients during transport
• Replacement PMI is exchanged one-for-one during patient evacuations
• The patient is able to remain on life support during transport, and the treatment team does not lose its capability to receive additional casualties
Key TermsTERM MEANING
CL VIII Military class of supply pertaining to Medical items
CSH Combat Support Hospital (Role III Medical facility)
CASEVAC Casualty Evacuation- This type of evacuation pertains to the use of non-medical evacuation platforms (e.g. transporting casualties in the back of a truck as opposed to an ambulance)
DUSTOFF A term used for rotary wing (helicopter) air-evacuation units
FST Forward Surgical Team (Role II+ Medical facility)
MEDEVAC Medical Evacuation- This type pertains to the transporting of casualties using standard medical evacuation platforms (e.g. ambulances or medically configured helicopters)
MEDLOG Medical Logistics
MLC Medical Logistics Company
PAD Patient Administrator
Role II Medical unit located closest to or within conflict zone able to provide resuscitative, surgical, and post-op care in order to stabilize a casualty for evacuation to a Role III facility (Ref 4)
Role III Larger medical facility located further from the conflict zone that has additional diagnostic, surgical, and specialty care capabilities. Facility is able to fully recover casualties or further stabilize injuries requiring more definitive care outside of the Theater of Operations (such as an established hospital in Germany or in the U.S.) (Ref 4)
SMEED Special Medical Emergency Evacuation Device—it is a configurable platform used to hold life-sustaining medical equipment for use in patient evacuation)
Equipment
Defibrillator, Zoll
MedSys III IV Pump 326M Suction Unit
Vital Sign Monitor
Oxygen Monitor
754M Ventilator
LTV 1000 Ventilator
PCA Pump
KCI Wound VacKendall SCD 9525
Pulse Oximeter
***Photos taken directly from the Southwest Asia (SWA) PMI Cell presentation (Ref 5)
PMI Durables
• “Package about how the 386th Expeditionary Medical Group recently stood up a new mission titled the Patient Movement Item or PMI hub in support of several area of responsibility operations. Soundbite includes SSgt. Taylor Ramos - 386 MDG PMI Manager. Produced by SSgt. Peter Ising.” Accessed from the Defense Video and Imagery Distribution Sustem (DVIDS) at http://www.dvidshub.net/video/125230/medical-supplies-quick-fast-and-hurry#.T8LkHLBfGIk.
Durables consist of reusable medical items that are not categorized as life-sustaining equipment. Examples include:
• Litters, wheeled litter carriers, litter straps• Adjustable back elevators• Litter pads
Vignette Terminology
AOR: Area of Responsibility
FOB: Forward Operating Base
PMI ProcessDEPLOYED MEDICAL UNIT REQUIRES MEDEVAC OF
CASUALTIES)
MEDEVAC REQUEST IS SENT AND INCLUDES
DETAILS OF REQUIRED PMI
DUST OFF UNIT RECEIVES REQUEST AND LOADS
REQUESTED PMI
REQUESTING MEDICAL UNIT PREPARES CASUALTIES FOR MEDEVAC
TRANSPORT USING ON-SITE PMI EQUIPMENT
DUST OFF NOTIFIES HIGHER ECHELON
MEDICAL FACILITY (ROLE III) OF PMI BEING USED
MEDEVAC ARRIVES, EXCHANGES PMI EQUIPMENT (1 for 1), AND
TAKES CASUALTIES FOR TRANSPORT TO ROLE III
ROLE III PREPARES EXCHANGE PMI
EQUIPMENT FOR EXCHANGE WITH DUST
OFF
PAD OFFICER LOGS PMI EQUIPMENT TO BE TRANSPORTED WITH CASUALTIES
DUST OFF TRANSFERS CASUALTIES AT ROLE III AND RECEIVES 1-for-1
EXCHANGE OF PMI EQUIPMENT
ROLE III REQUESTS REPLACEMENT PMI
FROM MLC -- also relays to the Theater PMI Cell
for replacement
THEATER PMI CELL PROCESSES REQUEST AND PUSHES PMI TO
MLC
PAD OFFICER INSPECTS PMI FOR SERVICEABILITY AND LOGS PMI EQUIPMENT AS
RECEIVED IN DATABASE/REPORT
PAD OFFICER THEN RESETS THE PMI INTO A TRANSPORTABLE
CONFIGURATION ENSURING EQUIPMENT IS CHARGING AND
FUNTIONAL
MLC SENDS REPLACEMENT PMI
TO ROLE III
MLC REQUESTS REPLACEMENT PMI
FROM THE THEATER PMI CELL
Components
Special Medical Emergency Evacuation Device (SMEED)
A SMEED is a platform used to secure life-sustaining medical care equipment during patient transport.
The SMEED was developed to securely attach to the litter without impeding patient care. This platform ensures
secure and stable transport of the equipment, maximizing access for patient care.
Ordering PMI
Photo contributed by co-worker
Ordering PMI
DEPARTMENT OF THE ARMY UNIT NAME
TASK FORCE NAME UNIT LOCATION/ADDRESS
31 Oct 2011 MEMORANDUM FOR AFCENT/SG SUBJECT: Patient Movement Item (PMI) Level Review FROM: Unit, Location 1. IAW USARCENT Policy Memorandum SURG-13, dated 3 May 2010, the following levels were reviewed and authorized by the medical treatment facility commander based on the minimum prepositioned levels equal to three days of expected patient flow.
EQUIPMENT LIST CURRENT LEVELS REQUESTED LEVELS4 Bay Battery Charger Single Bay Battery Charger Defibrillator, Zoll IV Controller Monitor, Propaq Oxygen Analyzer Pulse Oximeter, BCI 3303 Stryker Frame Suction Unit LTV Ventilator 1000 0 1Ventilator KCI Freedom Vac PCA Ambit Pump Sequential Compression Device Vacuum Spinal Board
2. JUSTIFICATION FOR INCREASE/DECREASE IN LEVELS: This MTF receives a high number of pediatric trauma patients. An LTV Ventilator 1000 is needed for the emergency MEDEVAC of these patients.
NAME OF OFFICER IN CHARGE RANK, AFFILIATION Duty Title
Signature
PMI is exchanged one-for-one during MEDEVAC.
If additional equipment is required than is on hand,
or special equipment is required, a justification
memo for additional equipment must be submitted
to the Theater PMI Cell.
Maintenance and Replacement Procedures
Preparing Patients for Movement, by MAJ Richard Morton, Director, Joint Enroute Care Division, OIC, Joint Enroute Care Course, Jan 2007
OPTION 1:• Each piece of equipment has a service tag• Keep track of the expiration dates• Request replacement equipment within 60 days of expiration from the
Theater PMI Cell• Once replacement is received, ship equipment requiring maintenance
to the Med Maintenance Team or PMI Cell
TWO OPTIONS:
OPTION 2:• If the Med Maintenance Team is willing and able, request a visit to
perform services and recalibrate the equipment on-site• Ensure you maintain a good working relationship with Med
Maintenance!
NEVER, NEVER, NEVER LET YOUR EQUIPMENT EXPIRE!
Configuration
“The Special Medical Emergency Evacuation Device (SMEED) provides a safe, convenient and lightweight platform with universal anchor points for mounting standard issue monitors and life support equipment to litters for use in evacuation of patients.” Photo accessed from the Combat Casualty Care Research Program (CCCRP) at the following address:https://ccc.amedd.army.mil/task-areas/advanced-capabilities-for-emergency-medical-monitoring.jspx
“The Special Medical Emergency Evacuation Device (SMEED) allows for Intensive Care Unit-level monitoring of patients while they are being flown to higher-level treatment facilities.” Accessed from the National Museum of Health and Medicine at the following address: http://nmhm.washingtondc.museum/exhibits/balad/balad5.html
Here are 2 neatly configured SMEEDs with
PMI attached. The picture on the right
shows how it attaches to a litter for patient
transport.
At the Ready
Personal photo
In this picture two SMEEDs are set up and configured with the standard PMI.
During combat operations, having the PMI ready to go and charged is imperative!
Charged O2 tanks with regulator attached and extras
Ventilator with O2 hoses
ZOLL Defibrillator with all attachments
Suction with tubing attached
Yes– it looks a mess, but it’s all plugged
in, charged, and ready to go!!!
PMI Equipment Reporting
DIGITAL PROGRAM:
The Patient Movement Item Tracking System, otherwise know as the PlexusD, is a program used to track the use, movement, location, and redistribution of PMI equipment. How PlexusD works:
• Use the digital scanner to scan the barcodes of the equipment being shipped
• Scan the equipment being received (should be a 1-for-1 swap)• Plug the scanner into the dock via USB cable• Download scanner information (automatically uploads into the
report)• Send report the Theater PMI Cell
IRAQ * FM6943 (P) 332nd CASF
BALAD
(1) A1C Cox
443-2617EQUIPMENT LEVEL On-Hand RDY QA
4 Bay Battery Charger 3 3 3 Battery Charger Single Bay
0 0 0
Defibrillator Zoll 4 5 5 IV Controller 28 23 23 Monitor Propaq 33 30 28 2Oxygen Analyzer 2 3 3 Pulse Oximeter BCI 3303 8 7 7 Stryker Frame 1 1 1 Suction Units 18 11 11 LTV Ventilator 1000 1 2 1 1Ventilator 23 25 18 7Oversized Litters 0 0 0 KCI Freedom Vac 12 1 1 PCA Ambit Pumps 14 16 14 2AWIS 0 0 0 SCD 18 1 1
VSB 2 2 2
TOTALS 167 130 118 12
Theater
PMI Equipment List
UNIT
POC
Levels: AuthorizationsOn-Hand: Bi-weekly inventoryRDY: Ready for useQA: # of pieces with deficiencies (due-cal, in need of repair....)
PMI Equipment Reporting“MANUAL” REPORTING:
If you do not have access to the automated tracking system, you can send up the report manually using the following format:
***Information taken directly from the Southwest Asia (SWA) PMI Cell presentation (Ref 5)
Best Practices
• Inventory and test PMI equipment daily• Re-configure as soon as patient transport needs are identified• Set up and attach equipment to patient/litter at least 30
minutes prior to MEDEVAC arrival • To ensure equipment works adequately with patient prior to
transport• To eliminate any delays in MEDEVAC
• Write down or scan any outgoing equipment prior to MEDEVAC arrival
• Write down and scan replacement PMI received from MEDEVAC
• Ensure replacement equipment is not expired or about to expire for maintenance services
• Check for all attachments and operability prior to MEDEVAC leaving
• DO NOT: accept expiring/expired or non-operable equipment• DO: demand immediate comparable PMI reconstitution for any
inadequate PMI refused during swap, to include any missing attachments
• Keep ALL PMI equipment plugged in and charged at all times:• In the event the PMI on the configured SMEEDs is faulty upon use• In the event of a MASCAL that exceeds 2 SMEED/PMI
configurations• Set up and configure replacement SMEEDS and PMI
immediately after MEDEVAC departure– you may have to use it again sooner than anticipated!
• Always prepare for the worst-case scenario and be ready!
1. Department of Defense U.S. Army Institute of Surgical Research, “Special Medical Emergency Evacuation Device (SMEED)," http://www.flcmidatlantic.org/pdf/publications/Special_Medical_Emergency_evacuation_device.pdf
2. Joint Publication 4-02., Health Service Support, 31 Oct 2006
3. Headquarters, Department of the Army, Field Manual (FM) 4-02.1: Army Medical Logistics, December 2009
4. NATO Logistics Handbook, Oct 1997, www.nato.int/docu/logi-en/1997/lo-1610.htm
5. United States Army Maintenance Management Center, Southwest Asia (USAMMC-SWA), “Patient Movement Item Program (PMI), 29 Aug 2011
References
Recommended