Fellowship

Our Out-of-Hospital Care (EMS) Fellowship is a one-year opportunity for immersion training in a busy, progressive EMS system.

Indianapolis has 1.3 million people in the metropolitan region, making it the 12th largest city in the US. The various agencies providing EMS make more than 125,000 responses each year.  Under the leadership of a consortium of EMS Medical Directors, rapid BLS first response and competent, efficient ALS response/transport is provided to the community.  The program faculty and the Fellow work at two of the busiest Emergency Departments in the city (and the only two adult Level 1 trauma centers in Indiana).  Clarian Methodist Hospital and Wishard Hospital are state-certified as Sponsoring Hospitals for ALS agencies and provide on-line medical direction.  More than 100 ambulances arrive each day.

The “core” activities of the fellowship are experience with the Wishard Ambulance Service, the Indianapolis Fire Department Ambulance Service, the Marion County Emergency Management Agency, a didactic “book club”, participation in the NAEMSP EMS Medical Director Course and Practicum, participation in the ACEP Emergency Medicine Basic Research Skills (EMBRS) course, EMS education to various levels of providers, and scholarly activities.

The fellow is quickly integrated into the leadership of Wishard Ambulance Service (WAS), the second-largest hospital-based EMS system in the U.S. This agency makes more than 60,000 responses in the urban and suburban region. As a result of the close, daily interactions with the WAS leadership, the Fellow will become knowledgeable about:

• Ambulance service operations

• Continuous quality improvement (CQI) processes

• Derivation and utility of various EMS metrics

• Budgeting – expenses and revenue (billing)

• Human resources issues (hiring, counseling, union representation)

• Medical equipment selection

• On-line and off-line medical direction

• SOP/protocol development

• ED diversion

Regular meetings are scheduled to review didactic material.  Using the newest edition of the NAEMSP’sPrehospital Systems and Medical Oversight text, the salient aspects of each chapter are reinforced and the faculty provide real-world examples and insights.  Selected chapters from the JEMS Prehospital Care Administration book supplement the readings. The Fellow will attend NAEMSP’s Annual Meeting and participate in the EMS Medical Director’s Course and Practicum as well as the “Gathering of Eagles” – an annual conference of the EMS Medical Directors from of the 50 largest US cities.

Integral to the program is “trickle down” teaching and mentoring.  The Fellow will share his/her knowledge, experience, and newly acquired capabilities through education of EMT, EMT-P, and Critical Care Paramedic students as well as the EM and EM/Peds residents during their EMS Base station course, case reviews, and the Assistant EMS Medical Director program.  Training will also be provided to the county’s Fire/EMS dispatchers.  In addition, the Fellow will participate as an instructor in regional ACLS, ACLS-EP, PALS, and PHTLS courses.

Opportunities for scholarly activity abound.  Program faculty are involved in a number of projects, including recently serving as co-investigators for the multicenter Poyheme® study.  Virtually any project can be undertaken, from basic science bench research to physiological or pharmacologic work with non-primate animal models to epidemiologic studies in the community or critical evaluation of prehospital medication or procedure outcomes.

In addition to the core EMS activities listed above, the Fellow may choose to participate in any or all of the following areas as dictated by his/her interests:

• Serve as the Associate EMS Medical Director for one of the fire-based or private EMS agencies sponsored by Clarian Methodist Hospital or Wishard Hospital.  These are in metropolitan suburban areas as well as rural outlying counties.

• EMS Communications is provided by the Metropolitan Emergency Communications Agency (MECA).  The EMD program is overseen by the program faculty, and audit/review of cases is conducted regularly.  Changes in resource allocation and the pre-arrival instructions are made as dictated by changing demographics and review of evidence-based literature.

• Urban Search and Rescue (USAR). The IN-TF1 has been deployed to a wide variety of situations across the US, including the World Trade Center disaster.

• Tactical Emergency Medical Support (TEMS) for the Indianapolis Metropolitan Police Department, Indiana State Police, and Indianapolis FBI Office’s SWAT teams.

• Motor sports medicine at the Indianapolis 500 (IRL), Brickyard 400 (NASCAR), and Moto-GP race.  Dr. Michael Olinger, who heads the Division of Out of Hospital Care, is the medical director of the Indy Racing League (IRL).  Dr. Geoff Billows, also part of the Division, serves as the medical director for the Indianapolis Motor Speedway.

• Clarian’s LifeLine Critical Care Transport Service provides an opportunity to become familiar with the unique aspects of air medical care.  LifeLine makes more than 1,200 flights each year – both scene responses and critical care interfacility transfers.  The Fellow has an opportunity to become familiar with flight operations, CQI, RFPs for service expansion, budgeting, aircraft selection and maintenance, and expanded-scope mid-level provider practice.

• Organization and implementation of mass gathering medicine for the Indy 500 (the largest single sports event in the country), the 500 Mini-Marathon (with 35,000 runners), the Indiana State Fair, and at the city’s Lucas Oil Stadium and Convention Center with several hundred clients for music shows, sports events, and large meetings.

• Specialized rescue and tactical services of the Indianapolis Fire Department (e.g., heavy extrication, high-angle rescue, confined space/trench rescue, dive rescue, hazardous materials identification and mitigation) and at the Indianapolis International Airport’s Fire/Rescue operation.

• Emergency Preparedness/Disaster management, including chemical, biological, and nuclear weapons of mass destruction.  Work with the City and County’s Emergency Management Agency will allow familiarization with large urban planning and multi-agency disaster management workgroups.

• EMS certification to enhance the sense of camaraderie with prehospital personnel is available to interested Fellows. Participation in the skills sessions of the EMT, EMT-P, and Primary Instructor classes allow formal challenge of the written and practical certification exams.

• Work with Indiana Department of Homeland Security, IDHS, (governing agency for EMS in Indiana). Fellows will have the opportunity to work with state officials with grant management, novel program design, and emergency preparedness.  Also, the state’s aggregate EMS database is available to the Fellow for scholarly activities.  The Fellowship program provides critically-appraised topics (CATs) to the State EMS Commission as requested to clarify prehospital medical topics.

• The National Registry of EMTs allows our Fellows to participate in their test development meetings, bringing exam theory and psychometrics to life.

• There is an opportunity to explore and develop an EMS/Public health interface utilizing beta materials being designed by the CDC/APHA consortium.

Like other progressive EMS systems, ours is always changing. Upcoming, anticipated changes include:

• System consolidation (11 fire departments providing first-response BLS and AL with the hospital-based ambulance service integrated into a single agency)

• County-wide implementation of an EMS electronic patient care record.  The resulting database can be “mined” for epidemiologic, clinical, and educational data, and an investigator can create supplemental, context-specific screens to answer specific research questions.

• An updated, digital 800 MHz radio system for the entire region with automatic vehicle location (AVL) for EMS apparatus

Potential “deliverables” made available by this 12 month immersion:

• EMS certifications (EMT, EMT-P)

• NIMS certifications (100HC, 200HC, 300, 400, 700, and 800)

• Hazmat Response at the Operations Level

• Instructor certifications (ACLS-EP, START Triage)

• Completion of the ACEP Emergency Medicine Basic Research Skills (EMBRS) course

• NAEMSP EMS Medical Director Course and Practicum completion

 

For additional information, please contact either Charles Miramonti, MD at Wishard Memorial Hospital cmiramon@iupui.edu  (317) 695-2042, or Ed Bartkus, EMT-P, MD, FACEP, at the Clarian Methodist Hospital, (317) 962-3003