RAMS EMS Roadmap

EMS The implementation of hospital based Emergency Medicine into the setting of the Pre-Hospital setting including but not limited to the management of Fire-Rescue, Ground and Air Evacuation.

MED STUDENT (MS3/4)

JUNIOR RESIDENT

background

Senior RESIDENT

Resources

AUTHOR: Amanda L. Ventura, MD Welcome to the Emergency Medical Services (EMS) Roadmap, your definitive step-by-step guide on how to succeed in EMS at every training level. Don’t know where to start? Click on “Background” or select your training level above. A full list of fellowships, conferences, and podcasts can be found in “Resources.”

For pearls of wisdom from faculty and residents in the trenches, click on “Insider Advice.”

insider Advice

1 - SENIOR MEDICAL STUDENT

M3/M4 Focus on getting the most from each clerkship and preparing for your career in EM in general. Explore opportunities to ride along with local fire departments. Use your home institution’s EMS relationships or pick a department close to home.

Many have programs that allow other medical providers to ride along and learn about how they practice. You should also investigate any emergency medical opportunities within your institution. Some have volunteer rescue squads that can be staffed by medical students.

2 - JUNIOR RESIDENT PGY 1 First and foremost, focus on your new role as doctor! Determine who in your department makes up the EMS division and inquire about mentorship within the department. Some EMS heavy programs will have the opportunity to serve as resident assistant medical director for a local department – make sure you are aware of when and how you should express interest in this opportunity.

PGY 2 Now that you are starting to feel more comfortable in the role of physician, its time to get involved in some more EMS specific activities. Try to spend some time in EMS education, find out when and where they are opportunities to teach EMTs and paramedics. This is also a good time to consider some EMS focused research – but remember, research takes time and if you want it to be a part of your CV for your fellowship application you should start early.

The field of prehospital medicine is broad with a career as an EMS physician taking on many different appearances. It is imperative that the junior resident interested in EMS seek mentorship in the field so that they can learn about the different aspects of the field and gain a realistic view of what their career may entail. Seek mentorship in and out of your home institution as different programs have different emphasis and it will be important to find your niche in the field.

3 - SENIOR RESIDENT

R3/R4 EMS fellowships do not have a universal application date. Applications are typically due in early fall of the academic year preceding the year in which you would be a fellow, though this varies pretty broadly so make sure you do your homework.

There is not a standardized ERAS or ERAS-like application system, you will typically be applying directly to programs and hearing back directly from programs after an interview.

5 - BACKGROUND Overview and History:

EMS physicians bridge the gap between the hospital world and the prehospital world. An EMS fellowship is typically a one year fellowship following residency that focuses on prehospital medicine. EMS fellows have extensive interaction with fire departments, and are typically responsible for both EMT and paramedic education, as well as the administration aspect which consists of reviewing fire department patient care and providing feedback to team members. EMS fellowship is also a jumping-off point for many other types of community involvement. EMS divisions typically house event medicine, disaster medicine, and may be involved in other types of prehospital medicine such as aeromedical transport (HEMS). Event medicine allows the fellow to learn about and participate in planning and delivery of medical care for large gatherings such as sporting events and concerts. Disaster medicine focuses on planning for worst case scenarios, and aeromedical transport allows the fellow to see prehospital and intra-facility transport from a whole new perspective, often with more critically ill and injured patients.

The EMS fellowship is relatively new with ACGME accreditation offered only since 2013. However, many programs were in place with “unofficial” fellowships for many years prior.

As EMS fellowships are now ABEM accredited, there is a board certification exam and a set of standard curricula that all EMS fellowships must cover.

Current and Future:

Current hot topics in EMS include EMS provider safety, and advances in technology and care provided by EMS personnel prehospital.

Be prepared to discuss these topics during interviews or other interactions with EMS physicians. There is also a trend in EMS toward simulation. You are likely to see a heavy emphasis on simulation both with manikins, as well as live “mock” patients.

Challenges

The biggest challenge to finding your way in EMS is finding your niche because EMS is such a broad field. It is important to have some idea of what your niche might be prior to fellowship because different fellowship programs have different emphasis. Engage in a broad range of electives during residency to help narrow down your interests.

Mentorship

Seek out mentorship not only among EMS physicians, but get to know the leaders in your affiliated fire departments and other EMS agencies as well. After all, these are people that you will be working with day in and day out, and they will have invaluable knowledge about the in’s and out’s of EMS.

6 - RESOURCES Conferences: • S AEM Annual Meeting • N AEMSP – Annual Meeting in January, rotating location

Clubs and Memberships: • Society for Academic Emergency Medicine (SAEM) saem.org • N ational Association of EMS Physicians (NAEMSP) www.NAEMSP.org • A ir Medical Physician Association (AMPA) www.AMPA.org

Journals and Publications: • A cademic Emergency Medicine • P rehospital Emergency Care - the Journal of the NAEMSP • E mergency Medical Services - Clinical Practices and Systems Oversight, David Cone, editor

7 - INSIDER ADVICE Dr. Jeff Nusbaum, Chief Resident, Mount Sinai in New York When applying to the EMS Fellowship, “...most did require my in-service scores which kinda caught me off guard.” “...from what I could tell...” the component of the application weighted the most heavily was “the in person interview was far and away the most important part of the process. Most places had multiple hours of interviews with many interviewers.”

Any specific advice for applicants?

“Find out where program alumni are now. It’s important to think a few steps ahead and to see where you might end up when you finish fellowship.”

“Despite being ACGME accredited, there is TREMENDOUS variability between programs, be sure to see what each specializes in.”

“Some fellowships offer second years to obtain MPH or MHP degrees, be sure to know who offers this if you are interested.”

Dr. Christine Brent, Assistant Director of Survival Flight, University of Michigan “You need to have a niche within EMS since it is such a broad field, and your application should reflect that niche.”

“Find elective rotations that apply to what you want to do so that your cover letter and CV will reflect your niche.

I knew that I wanted to do critical care transport so I did EMS, HEMS (helicopter EMS) and a lot of critical care rotations.”

“I used the SAEM and NAEMSP lists of fellowships, found those that focused on flight, and took that list to mentors to help determine where I should apply.”