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