EMS Elective Materials (click here)

By Dr D

This page is intended for Emergency Medicine Residents and Students at Michigan State University (or other affiliated sites) who are on their EMS rotation at Sparrow Hospital

–> DONT FORGET TO COMPLETE THE QUIZ AT THE END OF THIS PAGE *

Welcome to your EMS Rotation!

My name is John Dery and I will be your rotation director for this fun and exciting 1 – 2 week experience in Pre-Hospital Emergency Medicine.

Classification: Required

Instructor(s): John Dery, D.O., FACEP, FACOEP, FAWM; Emergency medicine agency site directors.  Emergency medicine teaching staff at Sparrow Hospital and Ingham Regional Medical Center

Length: 1 – 2 week(s)

Level of Training: PGY-2, PGY-3, or  PGY-4

Rotation Goals:

  1. To provide Emergency Medicine Residents with exposure to the Tri-County EMS System via
  2. Participating with paramedics and EMT’s in ambulance run
  3. Observation and participation at EMS base station.
  4. To develop an appreciation for field conditions, time, personnel and equipment constraints on paramedic personnel.
  5. To share our expertise in Emergency Medicine with pre-hospital personnel.
  6. To facilitate a “team relationship” with paramedic personnel.
  7. To participate in training of EMS personnel and health care providers in pre-hospital care of those requiring immediate medical care.
  8. To understand the challenges and pitfalls of “On-Line” medical direction.

 

Resident Responsibilities:

The requirements of the EMS rotation during the one week EMS rotation are divided into (5) major categories:

(1) EMS Ride-Alongs: Participating in a total of 3 (three) full 8-hour days during the course of the week directly observing and, when appropriate, participating in the care of patient’s as they are assessed and transported by EMS personnel. Your responsibilities will be dictated by the EMS personnel you rotate with but will generally included:

    1. a. Observation of EMS personnel and assisting when requested
    2. b. Keeping patient logs and turning these in to Dr Dery and Renee Day at the Emergency Medicine Residency office.

Scheduling your EMS Ride-A-Long Shifts: YOU will be responsible to contact the agencies listed below at LEAST (1) week (seven days) in advance to make sure that there is a crew available on that day to have you as a ride-a-long. Please contact one of the agencies below to schedule your EMS Day:

  • Lansing Fire Department – please call Ms. Alexis Pierce (the LFD EMS Secretary) at 517-483-5087(Please note that there are several different stations around the Lansing area; make sure you know the address and cross road for the station so you arrive at the correct site)
  • Mercy Ambulance – Dennis Palmer, 482-1245
  • East Lansing Fire Department – Jody Kimball 351-4220 (between 8am – 5pm)
  • Delta Fire Department  – please speak with “Cindy” 321.6622 x415
  • Helicopter (HEMS) LifeNet of Saginaw – please call the Saginaw Base at Covenant Hospital at 989.583.7100 to schedule

Dress code: Casual dress is fine (Khaki and polo’s) or you can wear hospital issued scrubs but blue jeans and T shirts are NEVER acceptable nor do they represent the professional impression that we try to maintain. We are guests of the Fire Departments and we are representing their department while we are there.

Meals: The on-duty crews will typically ask you at the beginning of the shift of you brought your own food or if you are planning to eat with them. If you plan to eat with the crews, make sure to bring approx $5 for lunch and $7 for dinners. There is a lot of planning that goes into cooking (and they typically make some GREAT food too!) so make sure to tell them in advance you are planning to eat with them. There is typically a pop machine available for some small snacks as well so bring a few $1 bills or coins in case you get the munchies.

Duties: Discuss with your assigned crew what they want you to do on scene. Remember, your safety always comes first!

Evaluations: please bring a Shift Evaluation form with you to your EMS Day. Click here for the Ride-A-Long Form or you can find it below in the “required forms” section below. You will need to have a member of your crew sign your evaluation form in order to get credit for your (8) hour shift. This form will need to be turned in the rest of your materials at the end of the rotation.

 

(2) Base Station Observation at Sparrow Hospital Emergency Department to gain a better understanding of the overall function of the city wide EMS system and radio communication as the “On-Line” Medical Control.  In addition, during this time the resident with complete and turn in the TCEMCA Protocols Test (which will be completed online at the checkthelead.com website; or click here).  This is an open book test that covers the Tri-County EMS protocols.  These protocol books may be found at IRMC  Radio Desk or the Ground Transport Radio at Sparrow.

(3) NIMS Training modules.  This a FEDERAL requirement for all EM trained residents to complete. This is an introduction course in the Federal Incident Command Structure. At times of a mass casualty incident or chaos, there must be a simplistic and universal system to know “who is in charge” and who to report to within the Emergency Department and our surrounding community. At completion of this on-line training program, a certificate of completion will be mailed to you and should be turned into the EMS faculty advisor for placement in your permanent file.   This information can be found by clicking on this link right here. 

  • Click here for the FEMA NIMS ICS 100 course (look on the right side of the page; FIRST, locate the heading on the right under TAKE THIS COURSE and click on the link immediately below; after you are done taking the coursework, you can look just underneath to the next heading entitled TAKE FINAL EXAM; click the link to take the test online)
  • Click here for the FEMA NIMS ICS 200 course (look on the right side of the page; FIRST, locate the heading on the right under TAKE THIS COURSE and click on the link immediately below; after you are done taking the coursework, you can look just underneath to the next heading entitled TAKE FINAL EXAM; click the link to take the test online)
  • Click here for the FEMA NIMS ICS 700 course (look on the right side of the page; FIRST, locate the heading on the right under TAKE THIS COURSE and click on the link immediately below; after you are done taking the coursework, you can look just underneath to the next heading entitled TAKE FINAL EXAM; click the link to take the test online)

(4) MCI & Triage Exercise: click here to link to the page (contact Dr Dery by email at drdery@gmaill.com for the password to this page)

  • GOALS: The resident will review and re-create a “real-time” mass casualty disaster utilizing radio communications from both the EMS and police radio transmissions from a recent disaster.
  • OBJECTIVES: Identify positive and negative aspects of a mass-casualty incident (MCI); Discuss the real-time implementation and use of the incident-command system (ICS); Identify failure in communication between the EMS and Police response; Identify how best to use the resources “on-scene”
  • TIME: The anticipated time to complete this assignment is 45 mins.
  •  INSTRUCTION: Make sure to log in to the CHECK THE LEADS website.; Find the “CATEGORIES” tab in the LEFT column; Highlight the “EMS ROTATION” option; Scroll up and down until you find the AURORA, CO SHOOTING post. Please note that this is a password protected page due to security; Please contact Dr Dery for the password to access this page; Follow the instructions on the screen and answer the questions as well; You will not get credit for completing this exercise unless you complete all the questions

(5) Assigned Readings: You will need to look at several different articles and journals during the course of this rotation. I am basing these reading on the Core Content of an EMS Fellowship published by the Journal of Prehospital Care (you can read this information by clicking here).

The required readings are listed below. You will be able to access these files from either this website directly, by clicking on weblinks that will open in a different page, or be available in the department for you to review on your own time.

  • Handbook for EMS Directors (published from FEMA): click here
  • Legal Aspects of CPR (from LegalAspects of EM): LegalAspects – CPR
  • Legal Aspects of C-Spine (from LegalAspects): CLICK HERE
  • Legal Aspects of Trauma article (from LegalAspects): click here
  • HEMS vs Ground Transport article (from JAMA, 2012): click here
  • Disaster Medicine Core Content article (from Annals of EM, 2012): click here
  • Terminating CPR (from NAEMSP Position Statement): click here
  • Safe Handoff’s between Ground & Air Teams (from AMPA, 2012): click here
  • EMTALA article from The Sullivan Group: Click here to download the PDF
  • Pre-Hospital Refusals (from Prehospital Emergency Care): click here
  • Resident Involvement in Civillian TEMSResident Involvement in Civilian TEMS Tactical Emergency Medicine (printer-friendly)
  • Tintinalli JE, Kelen GD, Stapczynski JS (eds).  Emergency Medicine: A Comprehensive Study Guide, 6 th ed. New York, McGraw-Hill, 2004Chapters       1      Emergency Medical Services2      Pre-hospital Equipment and Adjuncts3      Air Medical Transport4      Neonatal and Pediatric Transport5      Mass Gathering6      Disaster Medical Services12     Cardiopulmonary Resuscitation in Adults13     Neonatal Resuscitation in Emergencies14     Pediatric Cardiopulmonary Resuscitation16     Resuscitation Issues in Pregnancy24  Newer Resuscitative Techniques29  Pharmacology of Antidysrhythmic and Vasoactive Medications 251   Initial Approach to Trauma
  • Review the disaster medicine resources available from ACEP (click here to link to the private page)

(6) EMS lecture.  During the EMS week, the resident will prepare a lecture or interactive discussion that will be provided to the EMS personnel with whom you are interacting with during your week long rotation.  Alternatively, select individuals may be asked to prepare a lecture that will be provided as part of the biannual ED-EMS city-wide symposium or develop material to be added to the checktheleads.com website.

  • Talks given to EMS should be at an appropriate level for EMS personnel with the ultimate goal to share an Emergency Medicine perspective on typical presenting complaints and management techniques that will be encountered in the pre-hospital setting.
  • All materials MUST be reviewed and approved by Dr Dery prior to distribution.
  • THE ONLY OTHER ALTERNATIVE IS TO SPEAK WITH DR DERY AND ARRANGE A LECTURE OR WEBSITE DEVELOPMENT PROJECT such as making an instructional video like this: click here

(7) Post an answer to some of the discussion questions – 

(8) EMS Medical Director Course – from Ohio Emergency Medical Association

(9) Administration Meetings with Dr Dery. You will be expected to assist and attend any EMS and Team meetings during your one week rotation. These can include:

  • Tri-County Agency Director Meetings
  • Physician Advisory Board Meetings
  • Lansing Fire Department Education Meetings
  • Lansing Police Department Special Tactics and Rescue Team Meeting/Training
  • Clinton County Special Operations Team Meeting/Training
  • Ingham Regional Special Response Team Meeting/Training
  • Capital Area Dive Team Meeting/Training

–> here is the remainder of the EMS information that is listed on the New Innovations site (click here if you want to go to New Innovations

REQUIRED FORMS – you should print these off and keep them with you

EMS Selective Rotation Schedule:

You will need to discuss any major changes to this rotation schedule with the EMS faculty liaison (Dr. Dery) PRIOR to the beginning of the rotation. Here is a typical 1-week’s schedule:

Monday: (8 hours total)

    1. Base Station Observation – Sparrow ED EMS Desk  (you are also assigned to the Critical Care Transports and runs that day)
    2. Completion of Tri-County EMS Protocol Test

Tuesday: (8 hours total)

    1. Emergency Medicine Resident Lectures (4hrs)
    2. EMS Ride-a-long (4 hrs)

Wednesday: (8 hours)

    1. Preparation for EMS lecture/discussion
    2. NIMS Training modules (ICS 100, 200, 700 – print off the certification forms please)
    3. Mass Casualty Incident (MCI) and Triage Exercise (see #4 above)

Thursday: (8 hours)

    1. EMS Ride-A-Long (8 hrs)

Friday: (8 hours)

    1. EMS ride-along or Helicopter ride-a-long
    2. Give the EMS lecture/discussion (#5 above) to the on-duty crew

Immediate responsibilities:

    1. The week before the start of the rotation, the resident is to contact the Emergency Medical Service contact individual at one of the above facilities to arrange the time and the place where you will be doing your Ride-Alongs and EMS education
    2. At the conclusion of the rotation, the resident will give a CD copy of the presentation provided to the EMS personell to the EMS faculty liaison (Dr. John Dery) who will be in charge of the resident’s final rotation evaluation.
    3. It is strongly recommended that you review all assigned reading material prior to      starting the rotation, especially Tintinalli Chapters 1-6.
    4. Should there be any difficulties in starting the rotation, the resident must contact the training site’s Emergency Medicine leadership office (Renee Day 364-2583).
    5. The resident is responsible for completing the Emergency Medical Services Work Sheet found below and turning this into the Emergency Medicine Residency administrative offices within 10 day from the end of the rotation.
    6. The resident will be responsible for completing an electronically generated evaluation form that will be sent via email during their final week of a rotation. This will be used to provide the Emergency Medicine leadership with feedback on the value of this rotation.

 

Emergency Medical Services Goals and Objectives

Goals

  1. Learn the organizational structures of various emergency medical services (EMS)
  2. Learn the educational requirements and skill levels of various EMS providers.
  3. Learn principles of EMS system operations.
  4. Learn basic principles of disaster management.
  5. Learn principles of prehospital triage and emergency medical care.
  6. Learn medicolegal principles relating to EMS.

Objectives

  1.  Demonstrate effective communication with patients, their families, and professional associates (*ICS).
  2. Demonstrate respect, compassion, and integrity (*PR).
  3. Demonstrate the ability to perform an appropriate history and physical exam in the EMS patient (*PC)
  4. Demonstrate the ability to develop an appropriate differential diagnosis and treatment plan (*MK).
  5. Demonstrate appropriate clinical decision making skills (*PC).
  6. Understand the pathophysiology of typical injuries and diseases as encountered in the prehospital setting (*MK)
  7. Learn the principles of adult and pediatric resuscitation in the prehospital setting (*PC).
  8. Demonstrate procedural skills that are technically proficient with level of training (*PC)
  9. Learn the basic resources available for the care of the EMS personnel used on an ambulance (*SBP).
  10. Learn the appropriate information resources (i.e., textbooks, handbooks, online resources, etc.) available for care of patients that may be utilized by EMS personnel. (*PBL).
  11. Actively participate in prehospital care (*PC).
  12. Actively participate in EMS systems administration (*SBP)
  13. Demonstrate an ability to use the EMS communication system (*SBP).
  14. Provide initial and continuing education to all levels of EMS personnel (*ICS, PBL).
  15. Demonstrate an understanding of medicolegal liability issues relating to EMS (*CBP).
  16. Participate in EMS continuous quality improvement (*ICS,PBL).
  17. Demonstrate understanding of appropriate use for ground and air medical services (*SBP)
  18. Review local EMS prehospital care protocols (*SBP)
  19. Demonstrate an understanding of basic concepts of disaster management
  20. Demonstrate an understanding of the importance of- and methods for medical  control in EMS systems (*SBP).
  21. Discuss the differences in education and skill level of various EMS providers (*SBP,MK).
  22. Describe common environmental, toxicologic, and biological hazards encountered in the prehospital care setting (*MK).
  23. Discuss injury control strategies (*MK).

(* Denotes core competency area: PC-patient care, MK-medical knowledge, ICS-interpersonal and communication skills, PR-professionalism, SBP-systems based practice, PBL-practiced based learning and improvement)

You must complete this brief to quiz to verify that you have read all of the requirements completed the EMS Rotation Orientation

I have read all the information above.




Ride-A-Long Form I understand that i need to bring a copy of the Ride-A-Long form with me and get signatures from the crew members that i ride with (ps - i have attached it here in case you did not know where to find it)



i understand that i have a lot of reading to complete on this rotation and i know where to find the readings in Tintinalli and I have access to the articles that i am expected to read through this website




click here: Worksheet i understand that i have to complete the worksheet as well and answer all the questions associated with it in order to complete this rotation.



I understand that i must contact Dr Dery directly as soon as possible if i have any questions or concerns about this rotation.