EMERGENCY MEDICAL SERVICES SECTION
San Antonio EMS Fellowships: A Unique Partnership Craig Cooley, MD MPH EMT-P FACEP FAAEM FAEMS,* Bryan Everitt, MD NRP FAAEM,† Rachel Ely, DO MHA MPH NRP FAAEM FAEMS,‡ and Ryan Newberry, DO MPH NRP FAAEM FAEMS§
UTHSA Program
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ntroduction
Many advances in civilian trauma and prehospital care have stemmed from the evolution of military combat casualty care. However, translating these directly into the civilian world can be challenging and often needs to be adapted to the civilian environment for effectiveness. The approach to emergent prehospital care taken from the combat environment also often depends on the available system. For example, the United Kingdom (UK) military has developed a physician-led prehospital advanced trauma team that has published evidence of improved outcomes compared to current U.S. military medevac platforms. This UK physician-led prehospital team shares its roots with the physician-led teams of London’s Air Ambulance (LAA), thus creating a natural exchange of innovations between military and civilian prehospital physicians. In contrast, the current U.S. civilian and military prehospital models are built around a paramedic and the assumption that the transport time to definitive care will be less than one hour. As violent and traumatic injuries continue to evolve across the U.S., the current EMS system will unlikely have the capabilities to improve upon present day patient outcomes without significant innovation. To address these concerns, one solution to consider is to enhance the ability of EMS systems to bring the capabilities of the emergency department and critical care to the patient. The next advances in trauma care that will improve survivability will come from finding the balance between maximizing the capabilities of a first responder and optimizing the niche of the prehospital physician who can deliver critical care at the point of injury. However, recognizing that physicians are rarely utilized in the U.S. prehospital system, we do not currently have a model in place to improve upon. Given this long relationship between the practice of prehospital care in times of peace and under threat, a partnership between training platforms for aspiring EMS physicians is a relevant and worthwhile result. For 12 years the EMS fellowships at the University of Texas Health San Antonio (UTHSA) and San Antonio Uniformed Services Health Education Consortium (SAUSHEC) have partnered to train fellows as EMS experts. This partnership has served to promote physician presence in the field, as well as foster the exchange of information and innovation between the military and civilian community.
The EMS Fellowship at the University of Texas Health Science Center at San Antonio was established in 2012 in parallel with the military program. The one-year ACGME accredited program provides the educational foundation and practical experience for physicians wanting to advance their career in prehospital medicine. Currently, the program accepts up to three fellows per year, and funds the response vehicles for both programs’ fellows, allowing physicians to contribute critical decision-making skills at the scene of patient care, as well as to facilitate advanced physician-only procedures to be performed in the prehospital setting. SAUSHEC Program
The Military EMS and Disaster Medicine Fellowship was established in 2012 to train physicians who would subsequently influence battlefield care and reduce preventable deaths. This tri-service program, housed within the San Antonio Uniformed Services Health Education Consortium (SAUSHEC) at Brooke Army Medical Center (BAMC), is two years in length and trains two to four fellows per academic year. The first year is an ACGME-accredited EMS fellowship focusing on the fundamentals of prehospital care and takes place predominantly in the civilian setting in parallel with UTHSA fellows and faculty. In the second year of training, fellows shift focus to military EMS systems as well as disaster response. Fellows complete a Master of Public Health over the course of the two years of training. Graduates go on to serve in various roles within their respective branch of service, to include leadership in installation EMS, clinical roles such as forward resuscitation teams or critical care air transport, trauma system development, and medical direction for training platforms for military medics and the special operations pipeline. Benefits of the Partnership
Strength in Numbers One of the significant benefits of the relationship between the UTHSA and SAUSHEC programs is our numbers. The two programs have a complement of eleven EMS physician faculty, a Ph.D. researcher and prehospital practitioner, and nine fellows currently. The depth of the faculty roster allows for a structured weekly didactic curriculum and input >>
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COMMON SENSE MAY/JUNE 2024