“DELIVERING POINT-OF-NEED CRITICAL CARE WHEN NOTHING ELSE CAN”

1. “DELIVERING POINT-OF-NEED CRITICAL CARE WHEN NOTHING ELSE CAN”

2. CAPABILITIES Force Multiplier 10 Bed Capacity / 72 Hrs. 500 Cubic Feet / 5000 Lbs. Modular / Expandable Operational 1 Hr. Deployable Worldwide 24 Hrs. Critical Care Casualty Collection Casualty Treatment Casualty Evacuation Oxygen X-Ray Water Purification Power Generation Tent / Trailer / Room of Opportunity

3. VISION • Deployable worldwide 24 hours by all available platforms. • Fully operational within one hour of touchdown. • Provide a force multiplier/productivity enhancer to military and emergency response personnel. • System must be “Mission Adaptable, Not Mission Specific.” • System must provide medical care from triage through staged resuscitative surgical interventions.

4. WHY? Hurricanes Earthquakes Tsunamis Military Casualty Care Pandemic Influenza Terrorism Large Public Gatherings

5. CURRENT SHORTCOMINGS VS. FUTURE REQUIREMENTS • Current Medical Response Systems require an intact infrastructure to respond. • Current systems are greatly hampered due to size, configuration and logistical footprint thus making them manpower dependent. • Future systems must be deliverable under the most extreme conditions without the need for heavy lift capability and large manpower requirements. • Future systems must be independent for 72 hours before re-supply is required.

6. SOLUTION • Based on a highly compressed footprint, MERF provides optimal patient management from triage through staged resuscitative surgical interventions. • MERF is deployable worldwide within 24 hours by all currently available platforms • MERF is fully operational within 1 hour of touchdown. • MERF is operationally independent for 72 hours before re-supply is required. • MERF is a “Force Multiplier” designed to be “Mission Adaptable, Not Mission Specific.”

7. ADVANTAGES • Modular and expandable to mission requirements. • All modules are of a plug and play design. • All components have been designed with muti-task capability thus maximizing utility while reducing weight and cube. • Deployment canisters are single man portable. They can be delivered by all available platforms(truck, trailer, planes, parachute, helicopters, walked in, etc.)

8. DEPLOYMENT MERF is deployed within the CH661 SERIES of the Charlie’s Horse Deployment System.

9. PATIENT MOVEMENT / TREATMENT MODULE Properly accessorized, the SR701RT is a Mobile Medical Facility within itself.

10. PATIENT MOVEMENT / TREATMENT MODULE • Each SR701RT can be configured as Casualty Collection apparatus; Treatment apparatus; Casualty Evacuation apparatus; ICU Beds. • Trendelenberg capability. • Compatible with all NATO spec Litters/Stretchers. • Quick attachment and release of Litters/Stretchers. • Each SR701RT is capable of moving 20 cubic feet / 500lbs. of medical supplies by a single individual. • Nine SR701RT Wheeled Litter/Stretcher Stands with Adjustable Back Rests, Medical Accessory Towers and Cargo Haulers (SR 731). make up the Patient / Treatment Module. • Five Accessory Kit A's (10 Adjustable Arm Boards; 10 IV Poles; 5 Adjustable Mayo Trays; 10 Medical Accessory Clamps). • Five Accessory Kit C's (10 Welch-Allyn 150 Watt halogen Examination / Treatment lights with 10 Medical Accessory Clamps). • Disposable Fluid Captures with 6 liter absorption capability available as accessory if stipulated by end user. • Final capabilities, configurations and equipment / supplies determined by end user.

11. CRITICAL CARE MODULE

12. CRITICAL CARE MODULE

13. CRITICAL CARE MODULE • Operational within one hour of touchdown in any shelter of opportunity. • Compatible with all NATO spec Litters/Stretchers. • One SR901RT Multi-Purpose Utility Table, fully adjustable to specific requirements within minutes. 6” inches of height adjustment; 1” Macro adjustments; 1” Micro adjustment. • Trendelenberg capability. • All Medical Accessories designed to adjust/attach/detach quickly as necessary. • Disposable Fluid Capture (6 liter absorption capability). • PAX LED lighting, rugged, lightweight, compact and durable. Dual light spectrum. • Equipment to run 1 O/R and 3 ICU Stations; 4 Impact Ventilators, 4 Impact Aspirators; 4 Welch Allyn Propaq LT Monitors and 2 Halogen Head Lamps; Magellan Anesthesia. • Storage for 55 cubic feet / 1,500lbs. of medical supplies, within 6 drawers, 5 trays with clear poly-carbonate lids for easy identification of stored supplies (see Supply Module) and one large piggyback canister. • Final capabilities, configurations and equipment/supplies determined by end user.

14. SUPPLY MODULES

15. SUPPLY MODULES • Modules can be configured to specific requirements of end user. • Adjustable legs can be added to all lids when space allows providing additional tables or administrative desk space. • Five Supply Modules are standard within MERF • Modules consists of 5 Lids (CH661-18L) with 6 Drawers each (CH661-DRAW); 5 Bottoms (CH661-BM4) with 5 Trays each (CH661-TRAY-5); 4 Piggyback Bottoms (CH661-PB12) with 6 Trays (Two sets of CH661-TRAY-3); 4 Piggyback Lids (CH661-L4) with Adjustable Legs (CH661-LGS); 16 PB Hold Down Straps. • All Drawers and Trays have clear poly-carbonate lids for easy identification of stored supplies. • Five Supply Modules provide 200 cubic feet / 5,000lbs. of deployable storage space deployed within 5 Charlie's Horse Carts (CH401M4) by 5 individuals. • CH401M4's can be utilized for Casualty Collection/Treatment when properly accessorized with CH411 Accessory Clamps. • Final capabilities, configurations and equipment/supplies determined by end user.

16. OXYGEN CONCENTRATOR MODULE

17. OXYGEN CONCENTRATOR MODULE • Increased flexibility and safety - PVOCS HF affords a safe low-pressure point-of-use approach for production and delivery of respiratory gases. • Availability of Medical Grade Air and Oxygen afford the medical practitioner unparalleled flexibility for respiratory treatment in the field. • Significant reduction in the deployment footprint (weight and cube). One PVOCS HF supplying 30 liters per minute of oxygen and medical grade air for 72 hrs. can replace 37 H-size cylinders and provide a 5,000 lb. weight savings. • Continuous performance monitoring - PVOCS HF continuously monitors critical performance related functions: inlet air temperature and pressure; oxygen product concentration and pressure; and medical grade air delivery pressure; dew point; and carbon monixide levels. • Interface with deployed systems --PVOCS HF has been fully validated and is compatible with ventilators and anesthesia machines in the current inventory. • Ruggedized for field deployment - tested to U S Military (MIL-STD-810E and MIL-STD-461E) and International (IEC 60601-1) requirements. • PVOCS HF is a new standard in point of use oxygen and medical grade air generation; rugged, lightweight, portable, and safe.

18. OXYGEN STORAGE MODULE

19. OXYGEN STORAGE MODULE • 25,000 Litter Oxygen Delivery/Storage System • Five lightweight, high strength, high pressure, composite wound, brass lined cylinders mounted within the Charlie’s Horse CH661 canister make this capability possible. • Composite carbon fiber wound brass-lined cylinders prevent combustion and do not fragment or explode on ballistic impact (.50 caliber ballistic tested). • System has been designed to be deployed by a single individual without the need for heavy lift equipment. • Used by both military and civilian disaster response teams to quickly supply oxygen when and where needed. • Deployed with three LSI Mass Casualty Oxygen Manifold Systems (optional), 24 patients can be ventilated at 15 LPM simultaneously within 10 minutes of arrival at scene. • Refillable from any high pressure oxygen supply. • Stored oxygen as compressed gas without loss. • Complete with all hoses and regulators for 10 bed distribution.

20. X-RAY MODULE

21. X-RAY MODULE • Mobile Computer Radiography • Complete Digital Radiography Department designed for field use. • Provides a simple plug-and-play CR solution for integrating x-ray studies into PACS, Mini-PACS, Tele-Radiology, Centralized Reading, Image Distribution, and Archives. • System lets user acquire, process, and send images to DICOM destinations on a Local or Wide Area Network (LAN/WAN). • High quality radiographs produced without film, wet chemistry or darkroom. • Reusable phosphor plate takes the place of the x-ray film in the x-ray cassettes. Plates can be reused for 7,000 exposures. • System is designed to reduce costs, size, weight and environmental hazards, while improving the quality of patient care. • Processing time is efficient at one minute per image. Digital images can then be burned onto CD's or transmitted over a network for diagnosis. • Installation and training require less than one day. • System weighs 750 lbs. and is deployable by one individual without the need for heavy lift equipment.

22. WATER PURIFICATION MODULE

23. WATER PURIFICATION MODULE • Comprehensive one-touch total automation. Micro-processor controlled electronics provides state-of-the-art technology and reliability with manual override. A Simple-to-use touch screen displays pictorial images of all operating conditions. Digital and bar graph readout of all system conditions in US Standard or Metric. Computer interface ready. • Self adjusts to any feed water condition. Automatic shut down, either time duration or product quantity. Hour meter for keeping accurate logs & scheduling of preventative maintenance. • 316 stainless steel pressure transducers for accurate measurement of system functions. New solidstate electronic flow meters for visual monitoring of the product water and feed water flow used to calculate production rates of the system. A fail-safe product water diversion valve. Digital and bar graph salinity meter shows actual product water quality; an essential tool for product water monitoring. • Dedicated heavy duty latching relays for each motor integrated in the system. Unique low voltage control circuitry, shielded terminals, and covered high voltage components for end-user safety • High efficiency 316 stainless steel booster pump for extended pre-filter life. Patented high pressure quintiplex axial plunger pump is water lubricated, does not require oil changes and is rated to operate 8,000 hrs. between required maintenance. • High rejection/high yield membrane element that produces higher quality product water. Clear viewable sea strainer with cleanable monel mesh screen filter. • Fully self-contained when deployed within the Charlie’s Horse CH661 canister and cart; 1,800 gals. per day/18,000 gals without refueling. Spares and hoses included in piggyback container. Set-up in less than 45 minutes. • Low emission, high efficiency electric start Kubota diesel engine.

24. POWER GENERATIONMODULE

25. POWER GENERATIONMODULE • 2-Pole & Single Phase with 11kW Output. • Generator and engine are direct-coupled to ensure a more reliable power supply with minimum power loss. Eliminates the cog-belt, therefore, no need to replace or adjust. • Waveform distortion is kept to a minimum by the skewed rotor, while the damper winding protects the generator during short circuits, regulates voltage fluctuations during condensive loads, and withstands load fluctuations during condensive and non-linear loads. • 50A receptacle providing up to 42A from a single socket, and 83A in total from multiple sockets. • One-side maintenance realized, reducing the operator's work load. ( Maintenance checkups on oil, fuel, battery and cooling water levels.) Large-capacity oil pan to stretch oil change intervals up to 200 operating hours. • Double circuit protectors. In addition to the overall circuit protector, each receptacle has a circuit protector that will shut the engine down to prevent it from overcurrent damages. • Automatic shut down should water temperature rise excessively or oil pressure drop below safety levels. Starter safety relay to prevent the starter from engaging again after engine starts. • Large capacity dual fuel tanks (36.5 gals.) enables longer continuous operation. Fuel consumption at full load 1.08 gals. per hour.( 33+ hrs. of operation before refueling is required). • Double element air cleaners for heavy duty applications. • Low Sound levels (68dB) at 23 feet.

26. MERF TRAILERS Trailers can be set up to end user’s final MERF configuration requirements. The standard MERF trailer is 40 feet long with sleeping accommodations for 6, showering, and lavatory facilities. Available command & control center at the front of the trailer can replace sleeping accommodations. Other uses/configurations available based on customer requirements.

27. MODULES IN DEVELOPMENT FUELING MODULE REFRIGERATION MODULE COMMUNICATIONS MODULE ENVIRONMENTAL CONTROL MODULES

28. MERF PROTOCOL vs CURRENT PROTOCOL ISSUES Surge Capacity Staffing Deployment Casualty Collection Casualty Treatment Casualty Evacuation Chemical/Biological Impact Major disaster – Existing HCF’s overwhelmed by walk-in patients.

29. Current protocol – Bring in large deployable (Fleet-type) health care facility (100 bed). Cost of approximately $8,000,000 / $10,000,000 per facility with appropriate capabilities. Surge Capacity has been addressed other issues remain open.

30. CHEM/BIO impact on deployed facility. Probable loss of 100% of Mobile Response.

31. Deployment of 10 MERF’s @ $750,000 / $950,000 each; 10 beds per MERF with full Surgical and ICU capabilities in each, total 100 beds. All are linked to each other and externally to, for example, NORTHCOM. Total cost of $7,500,000 / $9,500,000. All issues are resolved.

32. CHEM/BIO impact as suggested above, only 10% of capability is impacted.

33. As situation stabilizes (72 hrs.) MERF units are re-supplied and relocated to treat additional casualties or consolidated to establish a more permanent 100 bed facility.

34. SUMMARY • Response resources are dispersed to pre-determined locations based on a demographic study prior to disaster assuring survivability. • Response times of personnel to each location have been reduced. • Casualty collection and treatment times have been accelerated. • Medical treatment is being dispersed simultaneously to hundreds. • CHEM/BIO impact on response resources has been greatly reduced. • Response resource will be operational under all scenarios with what is available at time of need.