Postgraduate Emergency Medicine

Prehospital Care / EMS Fellowship

  1. Overview of the Fellowship Program
    • The goal of the Prehospital Care Fellowship Program is to support a fully trained Emergency Physician to develop sub-specialty skills and expertise in Prehospital Care.
    • There will be 1 or 2 spots available annually

  2. Activity
    • The fellow will participate in a variety of activities including directed study, administrative meetings/projects, clinical EMS field experiences, education development and delivery, disaster preparedness and simulation, and clinical emergency medicine:
      • Emergency Department 12-20 hours/week as an emergency physician/fellow (approximately 1-2 days/week)
      • Paramedic/Physician EMS Education/Evaluation/Simulation approximately 1 day/week
      • EMS Field, EMS Communication Centre, Disaster Planning/Simulation (approximately 1 day/week
      • QA/CQI/Research Projects (approximately 1 day/week)
      • Administrative meetings, guidelines and Medical Directive preparation, reference review (approximately 1 day/week)

  3. Training Sites
    • Centre for Paramedic Education Research; shared office space with other fellows/Medical Advisors
    • 9 affiliated EMS Services
    • 3 affiliated Communication/Dispatch Centres
    • Hamilton Health Sciences Emergency Departments
  4. Fellowship Director and Faculty
    • Fellowship Director: Dr. Michelle Welsford
    • Additional Physician Faculty: CPER Medical Directors, Advisors, and Base Hospital Physicians
    • CPER Program staff - Program Director, CQI and Education Programs
    • HHS Emergency Department Staff Physicians

  5. Timeline
    • 12 month commitment
    • May be extended for an additional year with approval to complete a prehospital care Research fellowship

  6. Evaluation
    • Monthly reviews
    • Evaluation of clinical skills in the Emergency Department, field, and simulation
    • Completion of Fellowship Manual that documents all activities and objectives
    • Completion of QA, CQI, Directive/Guideline, and research projects
    • Final Written and oral Evaluations

 

Objectives

CanMEDS Competency

Clinical, Academic and Scholarly Content

Evaluation Method

1. Medical Expert

EMS Overview

  1. Describe the important past and present EMS acts and legislation (USA and Canada)
  2. Discuss the historical development of CPR/Resuscitation techniques.
  3. Describe the development of EMS training curriculum.

Medical Control
  1. Describe the medical direction and authority structure for the local system, including qualifications and responsibilities for the Medical Director.
  2. List the personnel of the base hospital and describe their roles; describe program funding and overall organization.
  3. Define and describe on-line medical direction – remote and on-scene.
  4. Define and describe off-line medical direction – prospective and retrospective; CQI and QA; specific incident complaints or problems.
  5. Know the protocols, policies and procedures for the local Base Hospital system.
  6. Define and describe the differences between the base hospital and resource hospitals.
  7. Describe the limitations and policies when a non-delegating physician assumes on-scene medical control.
  8. List the elements of a good “patch” and understand the indications for a patch.
  9. Describe the process of medical disciplinary procedures including deactivation, remediation and decertification.
  10. List the steps and describe the process to create, approve and implement a new Medical Directive.

EMS Systems Design
  1. List the 15 key components of an EMS system.
  2. List the clinical systems models as defined by the EMS/Ambulance Act.
  3. Discuss the design concepts and options for EMS system structure including the general philosophy of each system design.
  4. Describe the enabling legislation and rules and regulations that govern EMS activities in your jurisdiction.
  5. Describe the unique needs of special systems of care such as trauma, cardiac, pædiatrics, toxicology, psychiatric, neonatal/high risk OB, volunteer systems, and first responder systems.
  6. Discuss the interface and interaction between allied agencies (public health, fire, police, other) in relation to public safety.

EMS Equipment/Vehicles
  1. Describe the function and appropriate use of ambulance emergency response equipment including lights, siren, and flares; discuss the relevant and risk management issues.
  2. Describe the types and design of different vehicles including rural and urban ambulances, non-transporting vehicles, disaster, and rescue vehicles.
  3. List the extrication, transportation, and medical equipment necessary for a unit to function as a Primary or Advanced Care unit according to provincial requirements.
  4. List the medications utilized by primary, advanced and critical care paramedics.
  5. Discuss the appropriateness of different medications in the prehospital setting (including efficacy, relative risks, and medicolegal considerations), the rationale and scientific conclusion for their use.
  6. List and compare the communications equipment used eg: radios, cellular, simplex, duplex radios and UHF, VHF capabilities etc.
  7. Discuss the method of evaluation and approval of new equipment and techniques.
  8. Describe the special requirements for pædiatric equipment.

EMS Agencies
  1. Describe the structure and interrelationship of local, provincial, and national EMS agencies and governing bodies.
  2. Discuss and compare different structural/funding models for EMS systems: municipal, regional, provincial, private.

Receiving Facilities
  1. Describe the guidelines for preferred transport (including trauma triage guidelines) to the following specialty centres: trauma, ICU, pediatric, burn, psychiatric, spinal cord, neonatal/perinatal, stroke.
Air Medical
  1. Describe and discuss the indications/contraindications and advantages/limitations of the use of aeromedical transport vs land based transport.
  2. Describe the physiological changes that can occur during aeromedical transport and list the conditions for which it may be contradicted.
  3. Describe aircraft safety procedures and equipment for ground operations as well as inflight problems.
  4. Describe special considerations of air medical transport which pose problems with patient care (eg. aircraft space, noise preventing auscultation).
  5. Discuss how to prepare a proper landing zone, package a patient for transport, and load and secure that patient in the aircraft.
  6. Discuss the fundamental differences between on-scene and inter-hospital transfer and the coordination of air with land transport required for these operations.
  7. Discuss the mandates and operation of local, provincial, and private aeromedical agencies.
  8. Examine systems utilizing fixed-wing vs rotary aircraft and compare the advantages/disadvantages of each.
Mass Gathering/Disaster Management
  1. List the components of a disaster plan and review the disaster plans of institutions and hospitals, the local area or community, the region, the ambulance service, and the provincial emergency response.
  2. Describe the incident command structure.
  3. Describe the interaction between EMS and other providers and agencies during a disaster response (fire, police, public health, public utilities).
  4. Describe the local, regional, provincial, and federal resources available in a disaster. Discuss relevant Medical Aid Programs.
  5. Describe protocols for potential hazardous materials exposure to include decontamination and treatment of chemical and radiation exposure.
  6. List the potential physiologic effects on the patient and EMS provider from exposure to hazardous materials
  7. List at least 8 components of an EMS disaster response.
  8. Describe the philosophy of disaster triage.
  9. Describe the categories of disaster triage priorities using START and SALT.
  10. List the pitfalls to successful triage.
  11. List the components which must be addressed in the development of:
    1. an area wide EMS disaster plan
    2. a hospital disaster plan
  12. Describe special considerations for the planning of EMS coverage for special events such as: sporting events (eg. Major stadium events, motor vehicle races, boat races); concerts, air shows.
  13. Describe the interaction of all public safety agencies (police, fire, EMS, public utilities, governmental administrative bodies) at local, provincial and federal levels during a disaster response.
  14. Special considerations regarding Hazardous Materials:
    1. Describe a general protocol for insuring the proper response to a potential hazardous materials exposure, including proper protection of personnel.
    2. List the sources available to provide guidance in assuring proper protection, decontamination and treatment of patients exposed to hazardous materials such as:
      1. chemical exposure
      2. radiation exposure
    3. Describe physiologic effects on the patient and EMS provider for hazardous materials exposure such as:
      1. chemical exposure
      2. radiation exposure
Prehospital Clinical Care Issues
  1. Review the prehospital literature and identify the key clinical entities of proven EMS efficacy.
  2. Identify clinical entities in which EMS care is controversial.
  3. Discuss the effect of the health care system, including EMS activities, on overall patient outcome.
Practicum
  1. Participate in field activities as an observer, educator, and care-provider
  2. Train in the proper use of EMS equipment
  3. Train in appropriate rescue and extrication techniques
  4. Base hospital physician activities:
    1. train as a base hospital physician
    2. participate as a base hospital physician
  5. Participate as an emergency physician/fellow in the emergency department (12-20 hours/week). (CPSO licensed physicians only)
  6. Participate in the development of EMS hospital disaster plans.
  7. Participate in special events, multiple casualty incidents, and disaster exercises.
  8. Participate in hazardous materials training

 

Monthly Meetings to discuss completion of specific activities and objectives.

 

Complete written summary of objectives in Fellowship Manual

Oral and/or Written Evaluations

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Participate in EMS field experiences, EMS clinical Education programs, on-line Medical Direction activities, Clinical Emergency Medicine activities, Hazmat training, EMS/Hospital Disaster Preparedness Meetings, and Disaster Simulations

Evaluation of clinical skills in the ED, field and simulation

2. Communicator

Communication

  1. Describe the different EMS access procedures (eg: 911) for your area and nationally.
  2. List the differences between 911 and enhanced 911.
  3. Compare medical priority dispatch to other local dispatch priority systems.
  4. List the critical components of emergency medical dispatching.
  5. Describe post-dispatch instructions for common emergencies.
Practicum
  1. Participate in communication/dispatch centre experiences.

Monthly Meetings to discuss completion of specific activities and objectives.

Complete written summary of objectives in Fellowship Manual

 

Oral and/or Written Evaluations

Participate in periodic communication centre experiences.

3. Collaborator

Practicum
  1. Participate in activities involving the EMS system interaction with outside stakeholders, such as municipal agencies, hospitals.

Participate in meetings and interactions with EMS stakeholders

4. Manager

EMS Personnel
  1. Describe the national and relevant provincial legislation for training and continuing education for all levels of providers including dispatchers, First Responders, Primary Care, Advanced Care, Critical Care Land and Air Paramedics.
  2. Compare and contrast the patient care capabilities and responsibilities for all levels of paramedics.
  3. Discuss licensure and certification of all levels of providers.
  4. Discuss the medical-legal issues that need to be anticipated.
  5. Describe the principles of crisis intervention and stress management programs.
  6. Describe the critical components of labour relations and disciplinary procedures.
  7. Identify resources to address infectious diseases and health safety problems.
Funding
  1. Describe the budget components for your local EMS agency and identify current funding sources (local, provincial, federal).
  2. Describe necessary budget components of a base hospital.
  3. Develop and discuss a budget proposal for a new program.
Operations Management
  1. Develop a business plan incorporating a long-range strategic plan for developing or improving an aspect of the EMS service.
  2. Describe common techniques of negotiating and identify methods of effective problem solving involving diverse stakeholders.
  3. Describe the development and conduct of an effective problem solving session incorporating diverse stakeholders.
  4. Discuss the components of financial management of an EMS system to include: include budget development, cost systems, budget target tracking, income sources, and management accounting.
  5. Describe labour relations requirements in managing a professional workforce of EMS providers, to include: systems of compensation, health and safety issues, wrongful discharge, due process, evaluation and letters of recommendation.
  6. Describe the development and use of management information systems in managing EMS system operations.
Practicum
  1. Participate in the investigation and management of complaints and problem cases.
  2. Participate in system planning, budget and financial development and disciplinary activities (administrative, legislative and political committees)

Monthly Meetings to discuss completion of specific activities and objectives.

 

Complete written summary of objectives in Fellowship Manual

Develop a business plan

Oral and/or Written Evaluations

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Participate in Base Hospital Investigation Committee and Senior Team Meetings

5. Health Advocate

Community Involvement
  1. Describe a program for the development of public education issues addressing the following:
    1. EMS services – availability, level of services, access
    2. CPR and first aid training
    3. Health care issues
  2. Design a program for first responder defibrillation and public access defibrillation.
  3. Outline a program for media education and interaction during EMS events.
  4. Identify funding sources available in the community for EMS and health related activities and procedures to access those funds

 

Monthly Meetings to discuss completion of specific activities and objectives.

Complete written summary of objectives in Fellowship Manual

Oral and/or Written Evaluations

6. Scholar

Education
  1. Describe the general principles of adult education.
  2. Participate in development of a program of paramedic evaluation for EMS educational programs for First Responders and Primary, Advanced and Critical Care Paramedics.
  3. Describe maintenance of competence programs for each provider level.
  4. Discuss the National Occupational Competency Profile and how this applies to education programs for various levels of paramedics.
  5. Describe a risk management program to minimize malpractice exposure.
Research
  1. Discuss the importance of each of the following research concepts, with particular emphasis on the relationship and uniqueness to EMS:
    1. literature review
    2. research design and methodology
    3. data collection
    4. statistics
    5. Research Ethics Board (REB) submission
    6. consent issues, including deferred consent
  2. Describe techniques for effective oral and written presentations.
  3. Describe funding sources available for EMS related research.
Practicum
  1. Participate in EMS education, both initial and continuing education programs, of all levels of providers.
  2. Participate in medical directive development
  3. Conduct and complete both a quality assurance and quality improvement study.
  4. Participate in the education of physicians at all levels regarding prehospital care.
  5. Conduct prehospital related research (either two projects as contributor or one as the principal investigator).
  6. Development and submission at least one grant proposal for funding of a prehospital care project.
  7. Submission of one prehospital care related abstract for presentation at a national/international EMS conference.
  8. Submission of one prehospital care related article for publication in a peer review journal.
  9. Develop/review guidelines to manage each of the following high risk situations:
    1. intervening physician on-scene
    2. refusal of care
    3. DNR/terminally ill patients
    4. incompetent patients
    5. communicable disease exposure
    6. destination decisions
    7. transfer policies
    8. multiple patients/triage
    9. paediatric patients and consent

 

Monthly Meetings to discuss completion of specific activities and objectives.

Complete written summary of objectives in Fellowship Manual

Oral and/or Written Evaluations

 

 

 

 

 

 

 

Evaluations from providers/educators.

Completion of QA and CQI project

Completion of research project(s)

Submission of article for publication

Submission of new Medical Directives

Submission of specific situation guidelines

7. Professional

  1. Participate in local, regional, provincial and national EMS organizations and societies
  2. Discuss the concept of vicarious liability and how it applies to EMS activities.
  3. Describe the persons with legal responsibility for the actions of EMS personnel in the field.

Monthly Meetings to discuss completion of specific activities and objectives.

Participation in meetings and committees

Oral and/or Written evaluations

 

Application Process for 2017

Applicant to provide the following (including translation into English, if required):

  1. Application letter outlining interest and experience in the area of study and describing how the applicant will apply the knowledge and skills acquired in the Fellowship.
  2. Fellowship Application Form PGME (//www.fhs.mcmaster.ca/postgrad/documents/applicationform.pdf)
  3. Three Letters of Reference
  4. Curriculum Vitae
  5. Specialty certificate (Royal College of Physicians and Surgeons of Canada or equivalent)
  6. Certified Copy of Medical Degree
  7. Certified Copy of Transcripts
  8. If the applicant has already secured external funding, the applicant must provide proof of the funding source and the amount of the funding.
  9. Visa applicants must include:

 

Application Deadline: September 15, 2017
Interviews:
Selection:
Fellowship Start Date: July 1, 2018

Contact Person: Teresa Vallera, vallera@mcmaster.ca

How to Apply

International (visa) applicants with Foreign Government Sponsorship must apply through their sponsorship bureau and not directly to programs or the Postgraduate Office.

Applicants outside of the Foreign Government Sponsorship group should apply to the Postgraduate Office: McMaster University, Postgraduate Medical Education, MDCL 3101, 1200 Main Street West, Hamilton, ON  L8N 3Z5

Contacts

Foreign Government Sponsorship — Sharon Ciraolo

Other funding sources — Robyn Crozier