Fellowship Training

Disaster and Emergency Medical Services

A Two Year Curriculum

Introduction | Clinical Core Content | Implementation: Yearly Summaries | Contact

I. Introduction and Overall Goal of the Fellowship
The Department of Emergency Medicine at Brown Medical School offers a fellowship in Disaster and Emergency Medical Services (DEMS). Two fellows will be trained in a two-year curriculum, with one fellow in each year. Successful applicants will have excelled in a three or four year accredited residency in emergency medicine and will have the requisite capabilities and desire to participate in vigorous DEMS training and practice, including a demanding schedule and a variety of practice settings. Applicants will also be willing to travel for training, education, patient care and deployment at mass events and disasters, and be willing to board various vehicles such as boats, helicopters, jets, and ambulances to provide patient care and transport. The curriculum requires completion of a Masters in Public Health or equivalent training unless previously achieved, and training in research design and statistics. This requirement provides the fellow with a broadened experience and a substantial background for research and administration efforts.

The overall goal of the fellowship is production of graduates who are clinically proficient in prehospital care, including critical care transport and emergency ambulance response, mass event and disaster medicine, and are prepared to serve as medical directors for ambulance services, as EMS administrators, as researchers in disaster and EMS, and as competent EMS faculty in residency training programs. The successful fellow will attain these general disaster and EMS educational objectives, will achieve a basic understanding of EMS economics, injury prevention, EMS regulation, various types of disaster and relief medicine, issues related to terrorism and mass effect weapons and other topics, and will also attain special knowledge and expertise in a chosen focus area.

Fellows will accomplish these goals over a period of 24 months. Time will be spent in clinical care of patients in a variety of settings, including emergency departments affiliated with Brown University, ambulance services, critical care transport programs, and disaster response organizations. Lifeguard, a critical care transport and training program with a disaster support and research role, will be a major fellowship focus. Lifeguard is tasked not only with critical care transport, but also with implementation of training and other dissemination activities developed during the Rhode Island Disaster Initiative, a multi-year federally funded disaster response research project. The fellows will also participate with the pediatric non-trauma transport program based at Hasbro Children’s Hospital. Additional time will include attendance at conferences, lectures and meetings, research, quality assurance activities, in high-fidelity simulation training affiliated with the Rhode Island Hospital Medical Simulation Center, in activities with the Injury Prevention Center, and in other activities. Fellows will also attend research design and statistical analysis training, and will be expected to attend core curriculum courses offered by the Air Medical Physician Association.

Rhode Island has 89 licensed ambulance services, covering a wide range from busy fire-based urban services to rural volunteer-staffed ambulances. Several levels of emergency medical technician (EMT)training exist, providing both basic life support (BLS) and advanced life support (ALS). EMT curricula are substantially similar to the national Department of Transportation model. There are over 110,000 annual transports in Rhode Island, with statewide data collected using an electronic and computer-based system. Affiliations exist with area helicopter transport programs, the RI-1 Disaster Medical Assistance Team (RI-1 DMAT), the United States Coast Guard Station Castle Hill, the Rhode Island Department of Health, the Emergency Management Agency, the Rhode Island Red Cross, the Injury Prevention Center, and the Rhode Island E-911 Center. Brown-affiliated emergency departments include one of the busiest facilities in the nation, a specialty pediatric facility, and several other emergency departments. Together, over 200,000 patients are treated in Brown-affiliated emergency departments annually.

II. Clinical Core Content
1. Core Content Objectives
The fellow will learn and practice principles of disaster and emergency medical services care. These include the following:

1. Patients are found in a variety of environments, including hazardous situations, uncontrolled, austere, damaged, wilderness, rural and hostile settings. System design, personal protection, scene safety and management, and patient care must account for these situations.
2. Patients may present in any number or condition, with problems ranging from critical life-threatening emergencies and challenging rescue circumstances to relief needs, social difficulties and transportation challenges.
3. The practice of prehospital care is driven by public health methodologies and goals, with training, physician-directed protocol-driven practice, and quality assurance activities designed to care for populations, not specific individuals. Similarly, public health focus on prevention and mitigation can be applied to DEMS practice.
4. In almost all situations, disaster and EMS care involves both care of the patient and transportation of the patient, using a variety of vehicles such as ambulances, helicopters, jets, boats, or wilderness vehicles.
5. Prehospital care always involves time as a critical element. The patient may be hours or days from definitive care. Response to time-critical conditions involves a chain of time-consuming actions, from the initial call for help to accessing the patient once EMTs arrive at the scene. System design includes standards for response time, resource distribution, communication, and turnaround.
6. Good medical practice, including diagnostic and therapeutic efforts, must be adapted or adjusted from the hospital setting during disaster and EMS care. Not everything that can be done in a hospital can or should be done in the prehosptial environment.
7. EMS professionals (EMTs and others) work in cooperation with physicians as system leaders and consultants, and with other health care professionals to achieve optimal patient care.

2. Core Cognitive Skills
Disaster and EMS fellows should learn to recognize, rescue, treat and transport patients with a broad spectrum of clinical conditions encompassing problems typical to disaster situations and emergency departments. In addition, they should understand disaster response and EMS system design and components, injury prevention, training, supervision and practice of EMTs, EMS vehicle design, management and operation, EMS safety, communications systems, disaster prevention, readiness, response and mitigation, and related research.

III. Implementation: Yearly Summaries
1. Year One
The Disaster and EMS Fellow will serve in a clinical role commensurate with residency training and experience and in cooperation with the Brown Emergency Medicine Residency to avoid supervisory conflict. During a typical work week, the fellow will provide:

• 16 hours of clinical emergency department care,
• 24 hours of on-call (may be simultaneous with other activities except clinical care) transport and medical consultation coverage for Lifeguard (RIDI critical care transport/training system),
• 8 hours of administrative, research, or training activity, including EMS protocol review and development, quality assurance activity, and EMT course lectures,
• 8 hours devoted to a disaster / EMS focus area (such as DMAT, tactical EMS, air medical care, USCG medical staffing, injury prevention, or medical direction of an ambulance service), and
• 8 hours dedicated to education, including lectures, reading, conferences, and courses leading to a Masters in Public Health if not previously attained. The fellow will be expected to attend the Air Medical Physician Core Curriculum program.

The fellow will attain familiarity with prehospital and disaster/mass event care as well as emergency department care in a variety of settings. Rotations and experiences will provide a foundation and background in these system designs and patient presentations. If not previously attained, the fellow will begin a two-year program leading to a Masters in Public Health. Stress will be placed on clinical competence, safe management of prehospital environments, administrative, medical direction, training, and research skills. Participation in a research project, with submission of results for presentation or publication, is a desired goal for the first year.

2.Year Two
During the second year, the fellow will serve as a junior attending in Brown-affiliated emergency departments for an average of 16 hours per week. Focus will be on development of research capability, administrative and leadership skills, along with training of residents, allied health and EMT students and education in EMS principles for other trainees. Additional time will be apportioned as follows:

• 24 hours of on-call transport and 24 hours of medical direction coverage for Lifeguard. This time may be concurrent with other activities except clinical care.
• 16 hours devoted to an agreed-upon focus area or project related to disaster and/or EMS care. A research project, closely supervised by a mentor within the department and funded if possible from outside sources, will be completed and submitted for publication or presentation as a requirement for fellowship completion.
• 8 hours devoted to education, including lectures, reading, conferences, and courses leading to completion of a Master’s Degree in Public Health if not previously attained. The fellow will be expected to attend at least one national conference (NAEMSP, NASEMSD, DMAT, AMPA, or other related EMS physician organization) related to their focus area in addition to attending the AMPA Air Medical Physician Core Curriculum Program (two courses annually).

Contact
Kenneth A. Williams, MD
Brown University/Rhode Island Hospital
Coro West Suite 106
1 Hoppin Street
Providence, RI 02903
Phone: (401) 444-6237 Fax: (401) 444-5456
Email: kwilliams@lifespan.org
Length: 2 years
Salary: $70,000 plus benefits and tuition reimbursement
No. of Positions: 1 per year
Deadline: April