1. Accelerating Scalable Community Emergency Network Demonstration Ascend links regional healthcare facilities with private and public assets under a unified vision that results in an integrated, scalable medical evacuation solution during a regional emergency .

5. Epicenter – The area of an emergency which is unsafe or uninhabitable External Emergencies Have an Epicenter Epicenter

6. Epicenter Scale EMAC Federal Local Regional Statewide Border States Interstate State Interstate Measures of Emergencies - Scale

7. Scale EMAC Federal Local Regional Statewide Border States Interstate General Population Transportation Disadvantaged Population Assisted Living Long Term Care Medical Long Term Care Medical General Medical ALS / ICU Medical Special Needs Scope Medical Nonmedical State Interstate Epicenter Measures of Emergencies – Scope

8. Our Products - HELP Scale EMAC Federal Local Regional Statewide Border States Interstate General Population Transportation Disadvantaged Population Assisted Living Long Term Care Medical Long Term Care Medical General Medical ALS / ICU Medical Special Needs Scope Medical Nonmedical State Interstate HELP

9. HELP Provides Additional Resources for Large Scale Disaster HELP provides access to transportation assets and receiving hospitals outside the Region Second Tier Providers Mobilized for Hospital Hospital Network Outside of Emergency Zone

10. Our Products - SPEAR Special Patients Emergency Ambulance Response Scale EMAC Federal Local Regional Statewide Border States Interstate General Population Transportation Disadvantaged Population Assisted Living Long Term Care Medical Long Term Care Medical General Medical ALS / ICU Medical Special Needs Scope Medical Nonmedical State Interstate SPEAR HELP

11. SPEAR Program Many special needs patients cases cannot be transferred at the regional level. For instance, a large burn incident may require coordinating the transfer of multiple patients throughout the United States to verified burn centers. Special Patient Emergency Ambulance Response Program Verified Burn Center Patients Dispersed From a Major Burn Incident to Verified Burn Centers

12. Our Products - ASCEND Accelerating Scalable Community Emergency Network Demonstration Scale EMAC Federal Local Regional Statewide Border States Interstate General Population Transportation Disadvantaged Population Assisted Living Long Term Care Medical Long Term Care Medical General Medical ALS / ICU Medical Special Needs Scope Medical Nonmedical State Interstate SPEAR HELP ASCEND

15. 1993 Midwest Floods 2005 Hurricane Katrina 1994 Northridge Earthquake Natural Disasters Have Accelerated During Last Four Decades

16. Terrorism Against Americans 1961 – First U.S. Aircraft Hijacking 1974 – Patty Hearst Kidnapping 1979 – Iran, U.S. Embassy Hostages 1983 – Lebanon and Kuwait U.S. Embassy Bombings 1988 – Pan Am Flight 103 1993 – World Trade Center Bombing 1995 - Oklahoma City Bombing 1996 – Saudi Khobar Towers Bombing 1996 – Centennial Olympic Park Bombing 1998 - Unabomber 1998 - Kenya and Tanzania U.S. Embassy Bombing 2000 - U.S.S. Cole Bombing 2001 – 9/11 Coordinated Attacks World Trade Center and Pentagon 2001 – Anthrax Attacks 2002 – Beltway Sniper Attacks 2009 – Fort Hood Shootings Terrorism Against Americans Has Escalated Probability of Dirty Bomb Attack in Next Decade – 40 percent Iran 1979 Oklahoma City 1979 U.S.S. Cole 2000 New York 2001

21. Two Dimensions of an Emergency – Speed and Scale SPEED vs. SCALE Static Time Response Velocity Time Response Acceleration Time Response

22. Effective Medical Response Must Integrate Six Functions To maximize emergency medical response capability, regions must integrate six functions into a Community Emergency Network (CEN) that acts as one seamless unit Emergency Management Emergency Medical Service Health Care Facilities Inter-facility Transport Special Needs Transport Emergency Support CEN

23. Interdependent Medical Response Chain Pre-hospital Ambulances Frontline Hospital ER Inpatient Hospital Admissions Inter-facility Transport Regional Hospitals Regional Hospitals Inventory Interstate Transport Interstate Receiving Hospitals Interstate Special Needs Transport Patient Flow Evacuation Expansion Emergency Acceleration

24. Pre-hospital Ambulances Epicenter – The area of an emergency which is unsafe or uninhabitable Link 1 – Pre-hospital Ambulance Network Epicenter

25. Front Line Hospitals – Functioning Hospitals nearest the Epicenter Link 2 – Front Line Hospital Emergency Rooms During a community emergency, front line hospitals’ primary emergency function is to provide stabilization and first definitive medical care to persons coming from the epicenter that require medical treatment. Pre-hospital Ambulances Frontline Hospital ER

26. Emergency Room Hospital Admission Self Present Discharge Ambulance Net Patient In-Flow Accelerates In a large scale emergency, the pace of patient arrival to front line hospitals will accelerate, potentially overwhelming ERs and creating the need to initiate ER surge capability

27. CEN Responds Early To Shared Info As the front line hospital’s ER becomes inundated with self presenters, first respond ambulances react by diverting. In addition, before a hospital in-patient levels reach divert status, inter-facility ambulances respond to relieve front line hospital of stable patients. Pre-hospital Ambulances Frontline Hospital ER Inpatient Hospital Admissions ABC Hospital ER Hospital Wait Time hrs: 2.4 Capacity: 92% Capacity %: 122 Net Admit RPH: 17 Net Arrival RPH: 21 At Capacity: 3.4 Hrs Acceleration %: 82 Bed Divert: Burn Critical ER Capacity 85% Inter-facility Requirement: 20 ALS 11 BLS ER Hospital

28. Pre-hospital Ambulances Frontline Hospital ER Inter-facility Transport Regional Hospitals Regional Hospitals Inventory Inpatient Hospital Admissions Links 4-6 Interfacility Transport and Regional Hospitals

30. Management Software ASCEND Software Component

32. Command Center ASCEND Seamless Operations Center

33. SEOC Assists Local EOC Epicenter Stabilized Patients Surge Resources Shared Information And Coordination of assets Hospital Hospital Hospital Hospital Local Emergency Operations Center Front Line Regional Front Line The SEOC provides the Local EOC invaluable real-time information to make critical decisions and assists the EOC with real-time analysis. Some hospitals may find themselves inside the epicenter and require full evacuation of their hospitals. Shared Information, Analysis, and Coordination of Resources Seamless Emergency Operations Center

34. Regional Response Integrates with Federal Response Pre-hospital Ambulances Frontline Hospital ER Inpatient Hospital Admissions Inter-facility Transport Regional Hospitals Regional Hospitals Inventory Interstate Transport Interstate Receiving Hospitals

36. SEOC Manages National Special Needs Transfers Many special needs patients cases cannot be transferred at the regional level. For instance, a large burn incident may require coordinating the transfer of multiple patients throughout the United States to verified burn centers. Pre-hospital Ambulances Frontline Hospital ER Inpatient Hospital Admissions Inter-facility Transport Regional Hospitals Regional Hospitals Inventory Interstate Transport Interstate Receiving Hospitals Interstate Special Needs Transport Verified Burn Center Patients Dispersed From a Major Burn Incident to Verified Burn Centers