Emergency Medicine Service Fellowship Curriculum

The fellow will work closely with the fellowship director and other EMS faculty to learn the principles of both military and civilian EMS system design, operations, training, equipment, receiving facilities and communications. The fellow will have the opportunity to participate in a wide variety of EMS educational and administrative activities under the direction of the faculty. Future opportunities hope to combine the fellowship experience with degree or diploma programs in clinical research, health policy, epidemiology, informatics or business administration. In addition, the fellow will participate in EMS scholarly and research activities under the guidance of the EMS faculty. Furthermore the fellow will rotate through the Department of Combat Medic Training (DCMT) and serve as an instructor for DCMT. Finally, the fellow will rotate through a variety of local and state agencies as described below:

  1. The Department of Combat Medic Training:

    1. The Military EMS fellow will participate as an instructor in the training conducted by the Department of Combat Medic Training (DCMT). DCMT is the proponent for the 91W MOS and Army EMS. As the largest EMT-B certification program in the country, DCMT trains over 6,500 Soldier Medics annually. During his/her time at DCMT, the Military EMS fellow will instruct classes throughout the 16 week footprint of training. This is possible because at any given moment at DCMT, there at six classes of at least 400 students in various phases of the training calendar. As part of preparation for this instruction, the fellow will attend the U. S. Army Medical Department Center and School's Instructor Training Course (ITC) 5K-F3/520-F3 conducted by the Staff and Faculty Development Branch. ITC is a two-week (80 hour) course that provides basic instruction on the duties, skills and competencies required of an instructor. For Soldiers in the 16 weeks of training at DCMT, the fellow will have the opportunity to lecture, provide hands-on-instruction, and serve as Subject Matter Expert for all classes conducted by the Initial Entry Training Branch, the 91W Field Craft Branch and the Advanced Training Branch. In addition to the duties mentioned previously, the fellow will also have a seat on DCMT's Curriculum Review Committee and will be responsible for reviewing and revising the 91W course Program of Instruction (POI) based on input and observation from instructors, students, the NREMT, and lessons learned from the operational Army. Other opportunities afforded the Military EMS fellow by DCMT include representing the Army with the Director of DCMT at the NREMT's National Board Meeting, speaking at the National 91W Conference held every May in San Antonio, serve as a military representative on one of the NREMT's Item Writing Committees, and participate in the one the many projects conducted by DCMT's Research and Development Branch.
    2. The Military EMS fellow will participate as an assistant Medical Director for US Army EMS. This Agency is responsible for the oversight of 59,000 EMTs globally, Army EMT training programs, and the training at the 16 Medical Simulation Training Centers around the world.
  2. Travis County EMS:

    The Austin/Travis County EMS Program is an enhanced 911 system responsible for the care and safety of the citizens of Travis County. There are over 80,000 annual EMS runs in this community that covers approximately 1200 square miles and one million people. A full-time EMS physician, employed by the City and County, provides medical oversight. The EMS System transports patients at a Level Two Trauma Center and all major medical facilities within city limits. It is a single-tiered transport system that is a Municipal 3rd Service. Several facilities provide adequate space for the administration, supervision, and training of EMS personnel. Mannequins, patient models and audiovisual modules are available for the training and testing of EMS personnel. Text periodicals and computer-assisted instruction are also available.
  3. Bexar County EMS:

    The San Antonio Fire Department and Leon Valley EMS Programs utilize enhanced 911 system responsive for the care and safety of the citizens of the City of San Antonio and of the City of Leon Valley; Medical Director Responsibilities also include most First Response Activities within Bexar County via the Bexar County First Responders Network. There are over 125,000 annual EMS runs in this region that provides coverage over approximately 1250 square miles and one and one-half million people. A full-time EMS physician, employed by the University of Texas Health Science Center operating under a contract with the City of San Antonio, City of Leon Valley, and the University Hospital District, provides medical oversight. The EMS System transports patients to three Level One Trauma Centers, two Level 3 Trauma Centers and 17 other major medical facilities within Bexar County, Texas. It is a single-tiered transport system that is Fire Department Based. Administration, supervision, and training of EMS personnel takes place in a variety of settings including offices and classrooms at the University of Texas Health Science Center and training facilities throughout the system. Mannequins, patient models and audiovisual modules are available for the training and testing of EMS personnel. Text periodicals and computer-assisted instruction are also available.
  4. US Army Institute of Surgical Research/trauma Institute of San Antonio:

    The Trauma Institute of San Antonio Texas is the first congressionally funded, joint military-civilian trauma institute in the United States. TRISAT coordinates academic, community and military resources to most effectively serve trauma victims and their families. The Institute is ensuring the preparedness of the community and country when trauma strikes, both in peacetime and wartime TRISAT combines the expertise of surgeons, nurses and other trauma team members from the University of Texas Health Science Center at San Antonio, University Health System, Brooke Army Medical Center, Wilford Hall Medical Center and the U.S. Army Institute of Surgical Research, which operates the nation's only military burn center. The establishment of TRISAT puts an exclamation point on the strong partnerships already present in these San Antonio trauma institutions. The city is the only one in the country with the distinction of having three Level 1 trauma centers working together with a Congressional mandate. TRISAT member centers see 8,000 trauma patients per year from a 22-county trauma service area and beyond. TRISAT manages a consolidated electronic database of the region's hospital trauma registries and 70 EMS agencies throughout the trauma service area, resulting in greater opportunities for clinical research and injury prevention.
  5. AirLife:

    San Antonio AirLife is an aero-medical transport service dedicated to safety, rapid transport, and superior medical care of patients requiring critical care 24 hours a day within a 150-mile radius of San Antonio. AirLife is committed to community service through activities which promote safety, illness and injury prevention, and awareness of community medical resources. San Antonio AirLife is a regional air medical transport provider licensed by the Texas Department of Health. Helicopter transport of the critically ill and injured is available 24 hours a day/365 days a year in a 150 mile radius around San Antonio. Three Bell 412/SP/IFR helicopters and a spare Bell 206 helicopter are used to perform both inter-hospital transfers and emergency scene transports in conjunction with local EMS agencies. The crew transports over 2500 patients per year. The AirLife medical crew consists of a Registered Nurse/Paramedic team for every patient mission. The medical flight crew provides advanced life support for a wide variety of patients from adult to pediatric age suffering from varied medical diagnosis. The AirLife medical crew accompanies specialty teams from University Hospital, Methodist Hospital, and Santa Rosa Hospital on neonatal transports and a pediatric nurse accompanies the air medical crew on inter-hospital transfers for Methodist Hospital PICU. The medical crew performs assessments and intervenes with advanced skills when required by written protocols or with the direction of medical control physician. San Antonio AirLife also provides transport for organ retrieval teams when aircraft are available. Both AirLife medical crew members accompany these flights as safety officers.
  6. American Medical Response:

    American Medical Response: Provides EMS service for all of Bexar County, several small municipalities within Bexar County, the City of San Antonio, three area military installations and two counties in South Texas. Annual EMS volume is over 13000 per year. In addition to EMS work AMR provides non-emergent transports for the majority of the hospital systems in the areas. This non-emergent work accounts for an additional 26000 transports per year. On the education side AMR provides PAL, ACLS, EMT, PARAMEDIC, First Aid and CPR classes in the community.
  7. San Antonio Public Health and 911 facilities:
  8. Overview of Didactic Activities:
    1. History of EMS: The fellow will gain an understanding of the history of EMS through directed readings and meetings with the EMS faculty. The fellow will familiarize him/herself with articles of historic significance in the establishment of the national and state EMS systems.
    2. Legislation / Legal issues: The fellow will work closely with the State EMS director to learn about state regulation and legislation involving the EMS system. He/she will attend work and formal meetings of the State EMS committee. The fellow will review the state administrative rules delineating the legal roles and responsibilities of EMS providers and medical directors. The fellow also will meet with members of the state American College of Emergency Physician's board to discuss current legislation related to EMS.
    3. System design: The fellow will gain an overview of general system design through directed readings and didactic sessions. An exposure to the Portland regional system will be gained through interactions with EMS providers, administrators and medical directors. The fellow will attend meetings of the Bexar and Travis County's EMS Strategic Planning Group. The fellow will meet with the State EMS director, the Travis and Bexar County medical directors, and with the medical director from American Medical Response to learn about unique aspects of each system.
    4. Air medical transport: The fellow will learn the components of a fixed wing and rotor medical transport service through direct experience with the AirLife program. The fellow will complete an orientation to AirLife under the direction of the clinical manager. The fellow will attend the AirLife clinical conferences and CQI conferences to gain further understanding of operations, including safety, dispatching, medical staffing, and other aviation issues. The fellow will understand the responsibilities of the AirLife medical director through attending meetings and conferences with the medical director. Furthermore, the fellow will rotate through the Army MEDEVAC Proponency Division on Fort Sam Houston, Texas. The fellow will gain insight and understanding of military evacuation assets and capabilities.
    5. Personnel / Human Resources: The fellow will be able to describe the levels of EMS providers and their training and certification through meeting with the director DCMT program. The fellow will participate in a state certification examination to understand the testing process. Knowledge regarding issues such as hiring, discipline, occupational exposures, and critical incident stress debriefing of EMS personnel will be acquired through meetings with the county and agency medical directors, as well as administrators.
    6. Finance: The fellow will review state EMS revenue sources and expenditures with the state budget manager. The Bexar County EMS administrator, as well as the financial manager for AMR will provide an introduction to local EMS revenue and expenditures. The fellow will review annual budgets and project future needs.
    7. Equipment: The fellow will review the federal standards and state administrative rules that govern ambulances. The fellow will meet with EMS officers from the first responder fire agencies, as well as personnel from the transporting agency (AMR) to learn about EMS apparatus, as well as medical and communications equipment. The fellow will also review and understand the military equipment used for combat casualty care.
    8. Education / Training: The fellow will meet with the director DCMT training program to familiarize himself / herself with all aspects of the program, including admission requirements, curriculum, and testing. The fellow will have the opportunity attend lectures within the 91W training program, as well as to observe other teaching activities of the EMS faculty. Attendance at monthly Department of Emergency Medicine morbidity and mortality conferences, trauma conferences, and monthly journal club meetings will be expected. (12 hr / month) The fellow will obtain instructor certification in ATLS, ACLS and PALS.
    9. Operations Management: The fellow will meet with the operations managers for local EMS agencies to learn about the daily operations of EMS agencies, including personnel and equipment issues. Labor relations and union issues will be addressed by both fire and private agencies.
    10. Community Education: The AMR community outreach coordinator will meet with the fellow to discuss current efforts at community education, such as promotion of CPR. Fire agency officers will review injury prevention programs, as well as fire safety and prevention methods. The EMS faculty will orient the fellow regarding the availability of Pre hospital Automatic Defibrillators.
    11. Communications: The fellow will visit the Bexar and Travis County's Emergency Communications Centers. The fellow also will observe the computer aided dispatch system at AMR. The fellow will spend several hours at each dispatch center with a call-taker listening to 911 calls and familiarizing himself / herself with the local triage guidelines and procedures. The fellow will attend meetings of the Travis County EMS dispatch committee.
    12. Disaster Management: The fellow will attend planning sessions for local mass casualty and disaster drills, and become familiar with area-wide and hospital plans. The fellow will participate in a departmental lecture series on bio-terrorism and mass casualty incidents. The fellow will complete one or more courses to learn the Incident Command System. The fellow will participate in all Mass Casualty Incident drills on post as well as serve on the disaster committee.
    13. Prevention: The fellow will meet with the research director and with the medical directors of agencies involved in prevention activities to learn about prevention in EMS. Fire prevention will be taught through the fire prevention offices of the local fire agencies.
    14. Medical Direction: The fellow will receive education in direct and indirect medical direction. An introduction to direct medical control will be obtained through the 8-hour base station course as outlined below. The fellow will then provide on-line medical control while on duty in the emergency department. Experience in indirect medical supervision will be developed through participation in EMS activities with the fellowship director and the local medical directors. The fellow will spend 1-2 months each with the three major EMS providers: San Antonio Fire Department, Travis County Fire Department, and American Medical Response. These rotations will allow the fellow to gain experience with fire and private agencies, first responder and transporting agencies, and urban versus rural response. Furthermore, the fellow will serve as the assistant medical director for Fort Sam Houston Fire Department. In addition, the fellow will attend the NAEMSP medical directors' course.
    15. EMS Research: The fellow will learn research theory and techniques through seminars, course work, and participation in research projects. The fellow will attend the monthly departmental research seminars on applied research methodology, which includes study design, statistical analysis, and data presentation. The fellow will develop his/her research proposals with the help of members of the research team. The fellow will also attend all research meetings held at the US Army Institute of Surgical Research as well as all San Antonio Trauma research meetings. The fellow will rotate through the US Army Institute of Surgical Research and learn about trauma database collection as well as combat casualty research.
    16. Clinical Activities: The fellow will attend the American Medical Response field training officer program at the level of a new-hire paramedic for a period of two weeks. The fellow will function in the field at the paramedic level and will be required to complete the training objectives for a new paramedic. After completion of training, the fellow will complete ride alongs monthly with fire and private EMS agencies as an observer and educator. The ride-alongs will be performed with the agency where the fellow is currently on rotation. While on fire agency rotations, the fellow will also ride with the fire agency battalion chiefs to provide direct medical oversight and observe the incident command system.
    17. EMS Educator: The fellow will meet with the directors of the DCMT and the EMT/paramedic training program at UTHSCSA to familiarize himself / herself with all aspects of the programs, including admission requirements, curriculum, and testing. The fellow will prepare and deliver lectures for both training programs and assist with one laboratory session teaching procedural skills. The fellow will give two lectures for the emergency department staff and medical students regarding out-of hospital emergency care and disaster management. The fellow also will assist with quarterly EMS morbidity and mortality conferences. The fellow will have the opportunity to observe EMS presentations by local medical directors and in-services held by the training departments of the local private and public (fire) agencies. The fellow will give case reviews and didactic sessions for both private and fire agency EMTs and paramedics at rotating locations throughout the tri-county area. The fellow will also work as a teaching faculty and staff physician in the Department of Emergency Medicine, Brooke Army Medical Center.
    18. Quality Improvement Activities: The fellow will attend monthly meetings of the quality assurance subcommittee for the system he is rotating through. The fellow will participate in the quality improvement processes of the fire agencies and AMR during rotations, including chart audits and incident review.
    19. Emergency Vehicle Operation: The fellow will complete the AMR emergency vehicle driving course (EVOC) to learn safe driving techniques. The course is conducted each year by AMR.
    20. Vehicle and technical rescue: The fellow will also participate in the training sessions of the fire agencies for vehicle extrication and technical rescue.
    21. Participation in disaster drills: The fellow shall help organize and participate in all local EMS disaster drills. The fellow will also review the disaster plan for the base and surrounding county as well as serve on the disaster committee.
    22. EMS coverage for mass gatherings: The fellow will participate in medical coverage for local events such as the "Fiesta" and other large sporting or spectator events.
    23. EMS base station operations: The fellow will assist with a base station course for EM residents. The course consists of an introduction to online medical control, review of ALS protocols, case presentation, orientation and practice sessions with the radio and telephone, and an examination based on ALS protocols. The fellow will function as online medical control for ambulances with destination hospitals within Bexar County, when he /she is on duty in the emergency department. The fellow will give quarterly tape review sessions of EMS calls as part of Emergency Medicine conference activities.
    24. Participation in local, state and national EMS organizations:

      The fellow will be a member of the EMS section in the Department of Emergency Medicine, which meets quarterly. The fellow will be a physician member of the Fort Sam Houston EMS committee. The committee meets monthly and develops and revises ALS and BLS protocols for paramedics and EMTs on post. The fellow may participate in state EMS activities through the state EMS office and TCEP. The fellow shall be a member of NAEMSP.
    25. Air medical services: The fellow will be oriented to the local air medical system by the AirLife clinical manager. At the end of the orientation the fellow will function at the level of a flight physician and participate in rotor and fixed wing transports. The fellow will fly with the team approximately 2 shifts per month while rotating through, and possibly participating in interfacility transfers by fixed and rotor wing, and responding to scene calls by helicopter.
    26. Participation in variance investigation: The fellow will work with the medical directors from the EMS agencies to participate in the management of problems and complaints. The fellow will learn the procedures of the individual EMS agencies for the management of these issues.
    27. Public health: The fellow will rotate through the local department of public health and learn about reporting and disease surveillance. Particularly, the fellow will concentrate on EMS activities that enhance the role of public health response and reporting.
    28. Activities with fellowship director: The fellowship director will meet regularly with the fellows to review progress and educational objectives. The fellows will attend educational activities, organizational meetings, and other EMS activities with the fellowship director.
  9. Rotation Schedule:
    • Department of Combat Medic Training (3 blocks)
    • Travis County EMS (1 block)
    • San Antonio Fire Department (2 blocks)
    • San Antonio 911/Public Health (1 Block)
    • AirLife (1 Block)
    • US Army Institute of Surgical Research (2 Blocks)
    • American Medical Response (1 Block)
    • Elective (1 block)