CURRICULUM ROTATION GUIDE

ROTATION: EMS

LOCATION(S): Omaha Fire Department

Bellevue Fire Department

Air Methods Lifenet

Cass County Emergency Management Agency

Douglas County Dispatch

Sarpy County Dispatch

Creighton EMS Education

Medics at Home-Omaha Ambulance Transport

DURATION: 4-week blocks during the PGY 1 year

INTRODUCTION:

  • The purpose of the required PGY-1 EMS rotation is to expose residents to the subspecialty of prehospital medicine. We aim to provide each resident with a solid understanding of the uniqueness and complexities of caring for patients in the field. This experience will provide residents with the knowledge that they will need to interact with prehospital providers in their future role as emergency medicine physicians. This rotation will also lay the foundation for residents who wish to pursue more advanced training in prehospital medicine. Each resident will have the opportunity to work clinical shifts with our EMS agencies and EMS physicians. We will also schedule shifts in local public safety answering points (PSAP’s) and Medical Resource Control Center-East (MRCC). Residents will also spend time teaching EMS providers.

UNIFORM:

  • Residents will be required to wear the issued UNMC Emergency Medicine polo shirt, tucked in. Pants will be either blue or kaki. A brown or black belt must be worn. Boots are preferred over tennis shoes.

GOALS OF ROTATION

The purpose of the EMS rotation is to give residents a broad exposure to EMS on a level that reflects typical EM physician interaction with EMS. The goals of the rotation are as follows:

  • Introduce residents to EMS systems and EMS providers
  • Introduce residents to EMS dispatch
  • Introduce residents to EMS education
  • Introduce residents to EMS QA/QI
  • Introduce residents to the growing body of EMS research and position statements
  • Introduce the resident to community paramedicine/mobile integrated health
  • Produce a work product at the end of the rotation (EMS presentation, mini journal club, EMS protocol review)

FACULTY AND RESPONSIBLE INDIVIDUALS

  • Supervision will be by EMS faculty and select pre-hospital providers. The individual with overall responsibility for this rotation is Dr. Eric Ernest or his designee.

DESCRIPTION OF CLINICAL EXPERIENCE AND RESIDENT RESPONSBILITIES

  • PGY-1 resident will complete ride-alongs within the Omaha metro and surrounding area ambulance services for which the University of Nebraska Medical Center currently provides medical direction. Residents will meet the goals of the rotation through interaction with the Rotation Director during didactics and protocol review, direct observation and instruction of prehospital care providers, interaction with the EMS QA/QI officers of respective agencies, observation of Douglas and Sarpy County Dispatch centers, and completion of a course of independent study.
  • The resident will complete FEMA courses IS-100.HC: Introduction to Incident Command System, for Healthcare/Hospitals and IS-700.a: National Incident Management System (NIMS), an Introduction. Courses are web-based and can be completed at the intern’s leisure. Certificate of completion should be submitted to Rotation Director.
  • The faculty supervising the PGY1 residents are members of the Department of Emergency Medicine. Senior level residents (PGY 2 or 3) also take an active role in clinical teaching.
  • The PGY-1 resident will also be responsible for instructing EMS providers during training seminars and didactics.
  • Residents will complete a review of an article in the EMS literature that is pertinent to the practice of an Emergency Medicine physician and present it in a journal-club style format.

LEVELS OF SUPERVISION

  • The resident will have on-going interaction with the Rotation Director during the rotation
  • In the pre-hospital setting, experienced pre-hospital personnel will provide supervision when the Rotation Director is not present

EVALUATION OF THE RESIDENT

  • Written end of rotation examination that tests the resident’s knowledge gained from select EMS readings
  • Rotation evaluation completed by EMS attending (New Innovations) at completion of the rotation and informal ongoing verbal feedback
  • Prehospital providers may be asked to provide written and/or verbal feedback to evaluate the resident’s ability to operate in the prehospital setting

PROGRAM EVALUATION

  • Each resident will complete an anonymous end of rotation evaluation through the New Innovations system. These evaluations will be pooled and assessed every 6 months to protect the identify of the resident

TEACHING METHODS

  • Didactics given by the Rotation Director
  • Clinical teaching given by the Rotation Director or other Ems faculty during mass gathering events
  • Role modeling by the Rotation Director and other EMS faculty
  • Self-directed learning by completion of on-line modules covering NIMS and Hazardous Materials
  • Individual projects that include EMS protocol review

EDUCATIONAL RESOURCES

  • Didactic lectures
  • Lectures/teaching conferences
  • Computer-based referencing programs (Up-to-Date)
  • Emergency Medical Services Clinical Practice and Systems Oversight textbooks
  • Standard EM textbooks, (both online and in print) including:
  • Rosen et al. Emergency Medicine: Concepts and Clinical Practice
  • Tintinalli et al. Emergency Medicine: a comprehensive study guide
  • Roberts and Hedges, Clinical Procedures in Emergency Medicine

GOALS AND OBJECTIVES FOR EMERGENCY MEDICINE RESIDENCY

EMS ROTATION
PGY-1
OBJECTIVES
At the end of the EMS rotation, the PGY-1 resident will be able to: / Medical Knowledge / Patient Care / Practice-Based Learning & Improvement / Interpersonal & Communication Skills / Professionalism / Systems-Based Practice
Provide both on-line and off-line medical direction to prehospital care providers, including time critical diagnosis such as trauma, stroke, STEMI. / X / X / X / X / X
List and describe the indications, contraindications, and risks of invasive procedures performed by prehospital care providers. / X / X
Utilize appropriate method of interfacility transportation (air versus ground) and appropriate level of care (advanced life support versus basic life support) / X / X
Gather accurate information about patients, including a history and physical examination appropriate for the pre-hospital setting. / X / X
Demonstrate skills relevant to multi-casualty incidents and primary and secondary triage / X / X / X
Identify life threatening presentations in the pre-hospital setting and give on-line medical direction for pre-hospital providers treating patients experiencing one of these presentations. Examples of these presentations include chest pain, abdominal pain in a female of child bearing age, abdominal pain in a older patient, weakness, hypotension in a trauma patient, respiratory distress / X / X
Explain circumstances and necessary skills for mass gather medicine / X / X / X
Research EMS protocols and based on the evidence found make one of the following recommendations: (1) literature supports changing the protocol; (2) literature supports no change in the protocol; or (3) not enough evidence to make a recommendation. If the literature supports changing the protocol, update the protocol, citing the available evidence. / X / X
Create a protocol on a topic if one does not exist based upon the existing supporting scientific evidence. / X
Systematically analyze pre-hospital practice, using quality improvement methods, and implement changes with the goal of pre-hospital practice improvement. / X
EMS ROTATION
PGY-1
OBJECTIVES
At the end of the EMS rotation, the PGY-1 resident will be able to: / Medical Knowledge / Patient Care / Practice-Based Learning & Improvement / Interpersonal & Communication Skills / Professionalism / Systems-Based Practice
Describe performance improvement in the pre-hospital setting / X
Explain how and why pre-hospital care does nto operate independent of traditional medical systems as demonstrated by pre-hosptial systems developed for the care of trauma, stroke, STEMI, and pediatric patients. / X
Explain the process of triaging of 911 calls received at a public safety answering point (PSAP) and how callers can be referred to other community services such as Poison Control, social services, federally funded clinics, etc. / X
Explain the structure, administration, and operation of an Emergency Medical Service. / X
Explain the concept of direct medical command / X
Demonstrate professional interaction with pre-hosptial personnel that recognizes EMS provider skill levels and emphasizes collegial behavior. / X
Demonstrate compassion, integrity and respect for others. / X / X

Emergency Medicine Residency Program, EMS Rotation, PGY1,Page. 1

Reviewed March, 2016