- Email: [email protected]
Model curriculum in emergency medical services for emergency medicine residencies
SPECIAL CONTRIBUTION education, resident; emergency medical services, resident education
Model Curriculum in Emergency Medical Services for Emergency Medicine Residencies [Swor R, Chisholm C, Krohmer L EMS Educators Committee, Society of Teachers of Emergency Medicine~University Association for Emergency Medicine: Model curriculum in emergency medical services for emergency medicine residencies. Ann Emerg Med April 1989; 18:418-421.]
Robert A Swor, DO, FACEP Carey Chisholm, MD, FACEP John Krohmer, MD Royal Oak, Michigan
PURPOSE
From the EMS Educators Committee, STEM/UAEM.
As the emergency department is the logical interface between the hospital and the emergency medical services (EMS) system, our purpose is to prepare the emergency medicine residency graduate for a career of interaction with the EMS community. As emergency medicine has taken a leadership role as the caretakers of EMS, all residents should be well educated in this field. The curriculum should, at minimum, assure competency in providing off-line and on-line medical controlJ -4 This requires an understanding of the structure and function of an EMS system and the capabilities of its components. The curriculum also should serve as a foundation for further training of the resident interested in becoming actively involved in the EMS community.
Received for publication December 5, 1988. Accepted for publication December 27, 1988. Address for reprints: Robert A Swor, DO, FACER Department of Emergency Medicine, William Beaumont Hospital, 3601 W 13 Mile Road, Royal Oak, Michigan 48072.
GOALS The goals of an EMS curriculum should be to train the resident in emergency medicine in accordance with the following goal s as modified from the American College of Emergency Physicians position paper on qualifications of medical control physicians: 5 familiarity with the design and operation of prehospital EMS systems; experience in prehospital emergency care; routine participation in base station radio control; active involvement in the training of basic and advanced life support prehospital personnel; active involvement in the medical audit, review, and critique of basic and advanced life support prehospital personnel; and education regarding the administrative and legislative process affecting the regional and/or state prehospital EMS system.
EMS GOALS FOR THE EMERGENCY MEDICINE RESIDENT The following represent s an overview of topics that require didactic presentation as part of an emergency medicine residency curriculum. It makes no attempt to be exhaustive, with a total of 22 hours allotted for didactics. Both didactics and active participation are extremely variable in emergency medicine residencies at this time. Number of hours and level of participation are dependent on the opportunities and needs of each program. 1. Overview 1.1. History of EMS - Describe the impact of the following on the development of EMS systems. 1.1.1. Post-World War II military activities 1.1.2. Accidenta] Death and Disability 1.1.3, White House EMS demonstration projects 1.1.4. Emergency Medical Services Systems Act of 1973 1.1.5. Preventative health services block grants, 1981 1.1.6. State enabling legislation .
18:4 April 1989
Annals of Emergency Medicine
418/131
MODEL CURRICULUM Swor et al
T i m e spent - 1 hour Selected readings - Boyd DR, 6 p 1-30; Rockwood CA, 7 p 299-308 2. EMS structure and c o m p o n e n t s 2.1. EMS systems design - List the necessary compon e n t s of an EMS system; describe the structure of the local EMS system. 2.1.1. Generic - The 15 c o m p o n e n t s as outlined by the 1973 Emergency Medical Services Systems Act 2.1.2. Local system - Regional, county, local 2.1.2.1. Operational 2.1.2.2. Political 2.1.2.3. A d m i n i s t r a t i v e 2.1.3. T r a u m a care systems T i m e spent - 1 hour Selected readings - Boyd DR, 6 p 30-51; ACEP, 8 Lilja GPr 9 Tsai A 1° 2.2
2.3.
Personnel 2.2.1. Training - Compare and contrast levels of training for first responder, dispatcher, basic emergency medical technician (EMT), intermediate EMT, advanced EMT. 2.2.2. Licensure - Identify requirements for licensure and c o n t i n u i n g education of EMTs. 2.2.3. Protocols - List types of medical conditions for which EMT protocols exist. Explain the role of protocols i n prehospital care. T i m e spent - 1 hour Selected readings - D e p a r t m e n t of Transportation 11 Local EMS protocols State and local legislation Equipment 2.3.1. A m b u l a n c e s - Define general criteria used in a m b u l a n c e design and role of regulation. List key e q u i p m e n t for basic life s u p p o r t (BLS) and advanced life support (ALS) ambulances. 2.3.2. Drugs - List drugs available on local ALS units. Identify drugs appropriate for prehospital use and explain rationale for use. 2.3.3. Radios - N a m e types of c o m m u n i c a t i o n e q u i p m e n t available. 2.3.4. Adjunctive e q u i p m e n t - Explain process by w h i c h n e w e q u i p m e n t is added to a m b u lances. 2.3.5. Rescue and extrication e q u i p m e n t T i m e spent - 1 hour Selected readings - A m e r i c a n College of Surgeons 12
2.4.
Agencies - Identify the role that each of the following agencies play i n prehospital care locally. 2.4.1. Municipal - Fire, public health 2.4.2. Private 2.4.3. Volunteer T i m e spent - 15 m i n u t e s Selected readings - N o n e
2.5.
Receiving facilities 2.5.1. Hospitals - Contrast vertical and horizontal
132/419
categorization. Trauma centers - Discuss procedure for designation of the trauma center. 2.5.3. Pediatric centers - Discuss the local role of t e r t i a r y care c e n t e r s for e m e r g e n c y pediatrics. 2.5.4. Other - Identify role of nonhospital receiving facilities. T i m e spent - 1 hour Selected readings - Cales RH, 13 Boyd DR, 6 West JC 14 2.5.2.
3. 3.1.
3.2.
3.3.
Communications Access 3.1.1. 911 - List advantages of 911 system. Identify m e a n s of accessing EMS in local community. Dispatch - Identify m e c h a n i s m by w h i c h a m b u lances are dispatched in your c o m m u n i t y . Explain the degree of training dispatchers receive locally and what other types of training are available. Hardware 3.3.1. Radios - List types of radios in use. Compare and contrast advantages of each. List other types of c o m m u n i c a t i o n s e q u i p m e n t that m a y be used (eg, cellular telephone). T i m e spent - 1 hour Selected readings - Clawson jj, ls Mhyre N 16
4.
Medical direction - Concepts and practice Explain the difference between on-line and off-line medical control/direction.
4.1.
O n - l i n e medical radio operator training 4.1.1. Equipment - Explain how to use telemetry equipment. 4.1.2. Etiquette - Recite c o m m o n appropriate radio jargon and explain meanings. 4.1.3. Protocols - G i v e n a clinical scenario, recite the local EMT protocol. 4.1.4. Other training aids 4.1.4.1. Case reviews - Review tapes of c o m m o n radio and p r o b l e m radio calls. 4.1.4.2. S i m u l a t i o n s - D e m o n s t r a t e competence in m a n a g e m e n t of simulated radio calls. T i m e spent - 6 hours Selected readings - Crowell, 17 Pointer 18
4.2.
Off-line medical direction 4.2.1. Base station role -- Explain the role of the base station in directing and evaluating care. 4.2.2. .Quality assurance - List four m e t h o d s of evaluating adequacy of care. Identify advantages of each. 4.2.3. P e r f o r m a n c e r e v i e w - E x p l a i n h o w EMS care is reviewed locally and identify the limitations of this approach. T i m e spent - 1 hour Selected readings - Pepe PE, 19 Holroyd BR, 2o Stewart RD 21
5.
Disaster p l a n n i n g and mass gathering p l a n n i n g
Annals of Emergency Medicine
18:4 April 1989
5.1. Principles of m a n a g e m e n t - O u t l i n e at least eight major c o m p o n e n t s of a disaster plan. 5.2. Involved agencies - List the agencies involved in planning a disaster response. Identify the role of EMS in a disaster. 5.3. Hazardous materials - Discuss special considerations that m u s t be m a d e w h e n responding to a hazardous materials disaster. Discuss need for separate c u r r i c u l u m as part of residency. Time spent - 1 hour Selected readings - F e l d s t e i n BD, 22 D e M a r s ML, 23 M a h o n e y LE 24 Legal aspects of prehospital care 6.1. Roles and responsibilities - Define the role and legal responsibilities of each of the following in rendering prehospital emergency care: 6.1.1. EMS agencies 6.i.2. EMTs 6.1.3. Physicians 6.2. M e d i c o l e g a l p r o b l e m s - O u t l i n e the unique problems that each of the following situations create for EMS personnel and describe a m e t h o d for m a n a g e m e n t . 6.2.1. Refusal of care 6.2.2. I n c o m p e t e n t patient 6.2.31 Pediatric patients 6.2.4. T e r m i n a l l y ill patients 6.2.5. Physician on scene T i m e spent - 4 hours Selected readings - G o l d s t e i n AS, 25 Holroyd BR 26 7. Emergency aeromedical care 7.1. List c o m m o n indications for aeromedical transport of the emergency patient. 7.2. Identify c o m m o n problems encountered in preparation for aeromedical transport. 7.3. D e s c r i b e p h y s i o l o g i c a l c o n s i d e r a t i o n s i n v o l v e d in aeromedical transport. Discuss need for separate c u r r i c u l u m as part of residency. T i m e spent - 1 hour Selected readings - Carter G , 27 Carter G, 2s Baxt 29
8.
Rural EMS 8.1. Describe u n i q u e considerations required for dev e l o p m e n t and provision of prehospital care in rural c o m m u n i t i e s w i t h respect to each of the following: 8.1.1. Cost 8.1.2. Skills m a i n t e n a n c e 8.1.3. Response and transport t i m e 8~1.4. Training T i m e spent - 1 hour Selected readings - Vukov LF,3° A l l i s o n EJ, 31 Will i a m s o n JE32
t r a u m a patient. Cardiac arrest - C o m p a r e the different levels of care available and the advantages of each. 9.3. A i r w a y m a n a g e m e n t - Discuss the types of prehospital airway control measures available and list indications for each. T i m e spent - 1 hour S e l e c t e d r e a d i n g s - Pepe PE, 33 C u m m i n s RO, 34 G o l d , 35 C h a m p i o n , 36 C l e m mer 37 9.2.
9.
Active Participation 1.
On-scene experience - Critical link 1.!. Observation 1.2. Participation Selected readings - Stewart RD 38 T i m e spent - Variable
2.
Training 2.1. Participate in classroom training of basic, intermediate, and advanced EMTs. 2.2. Participate in clinical training of EMTs in training and practicing EMTs. Selected readings - N o n e T i m e spent - 2 h o u r s / y e a r / r e s i d e n t
3.
Medical direction 3.1. O n line 3.1.1. M e d i c a l r a d i o o p e r a t i o n - P r e c e p t e d calls 3.1.2. Medical radio operation - A t PGYII/III level Participate in regular direction of prehospital care as medical control physician. 3.2. Off line 3.2.1. Participate in regular review of prehospital runs. 3.2.2. Participate in individual incident investigation.
4.
Disaster planning 4.1. S i m u l a t i o n participation
For the Resident With a Special Interest in EMS 1.
.
Patient care 9.1. T r a u m a care - Contrast the advantages of ALS versus BLS for the t r a u m a patient. 9.1.1. Patient triage - Describe triage instrum e n t s and their role in the Care of the
18:4 April 1989
P o l i t i c a l / a d m i n i s t r a t i v e - D e s c r i b e the i m p a c t t h a t each of the following has on the provision of prehospital care and give examples for each: 9.1. G o v e r n m e n t a l agencies 9.2. State and federal legislature 9.3. C o m m u n i t y i n v o l v e m e n t and public education T i m e spent - 1 hour Selected readings - N o n e
In-field experience 1.1. Liaison e x p e r i e n c e to i n c l u d e regular c o n t a c t w i t h an agency to identify problems, issues, local needs 1.2. Expanded on-scene activity to develop first-hand knowledge of field care
Annals of Emergency Medicine
420/133
MODEL CURRICULUM Swor et al
2.
3.
4.
Training 2.1. I n v o l v e m e n t w i t h n e w E M T t r a i n i n g a n d t e s t i n g 2.2. P e r i o d i c r u n r e v i e w w i t h u n i t s
14. West ]C, Tmnkey DD, Lim RC, et ah Systems of trauma care. Arch Surg 1979;114:455-460.
Administrative/political 4.1. Assignment to local EMS board for project and
18. Pointer JE: The emergency physician and medical control in advanced life support. JEM 1985;3:31-35.
committee activity Observation of process level EMS organizations
at regional
and
state
15. Clawson JJ: Regulations and standards for emergency medical dispatchers: A model for state or region. Emerg Med Serv 1984;13;4:25-29. 16. Mhyre N: The enhanced 911 program. Emerg Med Serv 1984;13:32-37. 17. Crowel,l R, Baraff LJ, Jergens ME: Pre-hospital care: A syllabus for emergency physicians base station physician (unpublished paper).
19. Pepe PE, Stewart RD: The role of the physician in the prehospital setting. Ann Emerg Med 1986;15:1480-1484. 20. Holroyd BR, Knopp R, Kallsen G: Medical control: Quality assurance in prehospital care. JAMA 1986;256:1027-1031.
Research
5.1.
6.
13. Cales RH: Trauma mortality in Orange County - The effect of implementation of a regional trauma system. Ann Emerg Med 1984;13:1-10.
Medical direction 3.1. Off line 3.1.1. Regular interaction with local/regional medical director 3.1.2. Active role in quality assurance 3.1.3. On-scene EMT performance review
4.2.
5.
12. Committee on Trauma: Essential equipment for ambulances. Bull Am Col1 Surg 1983;68:36-38.
Development of a project suitable for publication on EMS-related topic
Systems elective 6.1. R o t a t i o n t o E M S s y s t e m s i n d i f f e r e n t l o c a l e s , t y p e s of s y s t e m s (eg, r u r a l , s u b u r b a n , u r b a n )
21. Stewart RD, Burgman J, Cannon GM, et ah A computer-assisted qual, ity assurance system for an emergency medical service. Ann Emerg Med 1985;14:25-29. 22. Feldstein BD: Disaster training for emergency medicine in the US: A system approach. Ann Emerg Med 1985;14:36-40. 23. DeMars ML: Disaster planning, in Tintinalli JE, Rothstein RJ, Krome R L (eds): Emergency Medicine, A Comprehensive Study Guide. New York, McGraw-Hill, 1985, p 976-982. 24. Mahoney LE, Reutershan TP: Catastrophe disasters and the design of disaster medical care systems. Ann Emerg Med 1987;16:1085-1091.
T h e a u t h o r s t h a n k Jerris Hedges, MD, FACEE a n d G e n e Kallsen, MD, FACEP, for t h e i r a s s i s t a n c e in t h e p r e p a r a t i o n of t h i s m a n u script.
REFERENCES 1. Kallsen G, Merritt-Lindgren: An emergency medical services curricul u m for e m e r g e n c y m e d i c i n e r e s i d e n c i e s . A n n Emerg M e d 1984;13:912-915. 2. Cooper MA, Omato JP: Involving and educating base station physicians in paramedic programs. Ann Emerg Med 1980:9:524-526.
25. Goldstein AS: EMS and the Law." A Legal Handbook for EMS Personnel. Bowie, Maryland, Robert J Brady Co, 1983, p 44-93. 26. Holroyd BR, Shalit M, Kallsen G, et ah Prehospital patients refusing care. Ann Emerg Med 1988;17:957-963. 27. Carter G, O'Brien DJ: The impact of aeromedical helicopter programs on emergency medicine resident training: Resident attitudes, perceived risks and benefits. J Emerg Med 1986;4:471-476. 28. Carter G, Dolan MC, Couch RH, et ah Safety and helicopter-based programs (letter). Ann Emerg Med 1986; 15:1117-1118.
3. Lowry JW, ,Lauro AJ: A general EMS curriculum for residency training. Ann Emerg Med 1980;9:250-252.
29. Baxt WG, Cleveland HC, Fischer RP, et ah Hospital-based rotorcraft aeromedical emergency care services and trauma mortality: A multicenter study. Ann Emerg Med 1985;14:859-864.
4. Paris PM, Stewart RD, Benson N: Survey of requirements for EMS experience in emergency medicine residencies (unpublished paper).
30. Vukov LF, White RD, Bachman JW, et al: New perspectives on rural EMT defibrillation. Ann Emerg Med 1988;17:318-322.
5. Emergency Medical Services Committee: Medical Control of Emergency Medical Services: An Overview for Emergency Physicians. American College of Emergency Physicians, Dallas, 1984.
31. Allison EJ: Meeting the medical care needs of the geographically underserved: Emergency care. N Carolina Med J 1983;44:665-667.
6. Boyd DR: The history of emergency medical services sYstems in the United States of America, in Boyd DR, Edlich RF, Micik SH (eds): Systems Approach to Emergency Medical Care. Norwalk, Connecticut, AppletonCentury-Crofts, 1983, p 1-51. 7. Rockwood CA, Mann CM, Farrington JD, et al: History of emergency medical services in the United States. J Trauma 1986;16:299-308. 8. American College of Emergency Physicians: Guidelines for trauma care systems. Ann Emerg Med 1987;16:459-463. 9.. Lilja GP, Swor R: Emergency medical services, in Tintinalli JE, Krome RL, Ruiz E (eds): Emergency Medicine, A Comprehensive Study Guide. New York, McGraw-Hill, 1988, p 171-175. 10. Tsai A, Kallsen G: Epidemiology of pediatric prehospital care. Ann Emerg Med 1987;16:284-292. 11. Department of Transportation Training Guideline. Emerg Med Serv 1986;15:163-166.
134/421
32. Williamson JE, Landis SS, Allison EJ: The evolution of a rural EMTintermediate training program. N Carolina Med J 1983;44:737-742. 33. Pepe PE, Copass MD, Joyce TH: Prehospitat endotracheal intubatfon: Rationale for training emergency medical personnel. Ann Emerg Med 1985;14:1085-1091. 34..Cummins RO, Eisenberg MS: Prehospital cardiopulmonary resuscitation: Is it effective? JAMA 1984;252:2408-2412. 35. Gold CR: Prehospital advanced life support vs "scoop and run" in trauma management. Ann Emerg Med 1987;16:797-801. 36. Champion HR: Trauma score. Crit Care Med 1981;9:672-676. 37. Clemmer TP, Orme JF, Thomas F, et ah Prospective evaluation of the CRAMS scale for triaging. J Trauma 1985;25:188-191. 38. Stewart RD, Paris PM, Heller MB: Design of a resident in-field experience for an emergency medicine residency curriculum. Ann Emerg Med 1987;16:175-179.
Annals of Emergency Medicine
18:4 April 1989
Model Curriculum in Emergency Medical Services for Emergency Medicine Residencies [Swor R, Chisholm C, Krohmer L EMS Educators Committee, Society of Teachers of Emergency Medicine~University Association for Emergency Medicine: Model curriculum in emergency medical services for emergency medicine residencies. Ann Emerg Med April 1989; 18:418-421.]
Robert A Swor, DO, FACEP Carey Chisholm, MD, FACEP John Krohmer, MD Royal Oak, Michigan
PURPOSE
From the EMS Educators Committee, STEM/UAEM.
As the emergency department is the logical interface between the hospital and the emergency medical services (EMS) system, our purpose is to prepare the emergency medicine residency graduate for a career of interaction with the EMS community. As emergency medicine has taken a leadership role as the caretakers of EMS, all residents should be well educated in this field. The curriculum should, at minimum, assure competency in providing off-line and on-line medical controlJ -4 This requires an understanding of the structure and function of an EMS system and the capabilities of its components. The curriculum also should serve as a foundation for further training of the resident interested in becoming actively involved in the EMS community.
Received for publication December 5, 1988. Accepted for publication December 27, 1988. Address for reprints: Robert A Swor, DO, FACER Department of Emergency Medicine, William Beaumont Hospital, 3601 W 13 Mile Road, Royal Oak, Michigan 48072.
GOALS The goals of an EMS curriculum should be to train the resident in emergency medicine in accordance with the following goal s as modified from the American College of Emergency Physicians position paper on qualifications of medical control physicians: 5 familiarity with the design and operation of prehospital EMS systems; experience in prehospital emergency care; routine participation in base station radio control; active involvement in the training of basic and advanced life support prehospital personnel; active involvement in the medical audit, review, and critique of basic and advanced life support prehospital personnel; and education regarding the administrative and legislative process affecting the regional and/or state prehospital EMS system.
EMS GOALS FOR THE EMERGENCY MEDICINE RESIDENT The following represent s an overview of topics that require didactic presentation as part of an emergency medicine residency curriculum. It makes no attempt to be exhaustive, with a total of 22 hours allotted for didactics. Both didactics and active participation are extremely variable in emergency medicine residencies at this time. Number of hours and level of participation are dependent on the opportunities and needs of each program. 1. Overview 1.1. History of EMS - Describe the impact of the following on the development of EMS systems. 1.1.1. Post-World War II military activities 1.1.2. Accidenta] Death and Disability 1.1.3, White House EMS demonstration projects 1.1.4. Emergency Medical Services Systems Act of 1973 1.1.5. Preventative health services block grants, 1981 1.1.6. State enabling legislation .
18:4 April 1989
Annals of Emergency Medicine
418/131
MODEL CURRICULUM Swor et al
T i m e spent - 1 hour Selected readings - Boyd DR, 6 p 1-30; Rockwood CA, 7 p 299-308 2. EMS structure and c o m p o n e n t s 2.1. EMS systems design - List the necessary compon e n t s of an EMS system; describe the structure of the local EMS system. 2.1.1. Generic - The 15 c o m p o n e n t s as outlined by the 1973 Emergency Medical Services Systems Act 2.1.2. Local system - Regional, county, local 2.1.2.1. Operational 2.1.2.2. Political 2.1.2.3. A d m i n i s t r a t i v e 2.1.3. T r a u m a care systems T i m e spent - 1 hour Selected readings - Boyd DR, 6 p 30-51; ACEP, 8 Lilja GPr 9 Tsai A 1° 2.2
2.3.
Personnel 2.2.1. Training - Compare and contrast levels of training for first responder, dispatcher, basic emergency medical technician (EMT), intermediate EMT, advanced EMT. 2.2.2. Licensure - Identify requirements for licensure and c o n t i n u i n g education of EMTs. 2.2.3. Protocols - List types of medical conditions for which EMT protocols exist. Explain the role of protocols i n prehospital care. T i m e spent - 1 hour Selected readings - D e p a r t m e n t of Transportation 11 Local EMS protocols State and local legislation Equipment 2.3.1. A m b u l a n c e s - Define general criteria used in a m b u l a n c e design and role of regulation. List key e q u i p m e n t for basic life s u p p o r t (BLS) and advanced life support (ALS) ambulances. 2.3.2. Drugs - List drugs available on local ALS units. Identify drugs appropriate for prehospital use and explain rationale for use. 2.3.3. Radios - N a m e types of c o m m u n i c a t i o n e q u i p m e n t available. 2.3.4. Adjunctive e q u i p m e n t - Explain process by w h i c h n e w e q u i p m e n t is added to a m b u lances. 2.3.5. Rescue and extrication e q u i p m e n t T i m e spent - 1 hour Selected readings - A m e r i c a n College of Surgeons 12
2.4.
Agencies - Identify the role that each of the following agencies play i n prehospital care locally. 2.4.1. Municipal - Fire, public health 2.4.2. Private 2.4.3. Volunteer T i m e spent - 15 m i n u t e s Selected readings - N o n e
2.5.
Receiving facilities 2.5.1. Hospitals - Contrast vertical and horizontal
132/419
categorization. Trauma centers - Discuss procedure for designation of the trauma center. 2.5.3. Pediatric centers - Discuss the local role of t e r t i a r y care c e n t e r s for e m e r g e n c y pediatrics. 2.5.4. Other - Identify role of nonhospital receiving facilities. T i m e spent - 1 hour Selected readings - Cales RH, 13 Boyd DR, 6 West JC 14 2.5.2.
3. 3.1.
3.2.
3.3.
Communications Access 3.1.1. 911 - List advantages of 911 system. Identify m e a n s of accessing EMS in local community. Dispatch - Identify m e c h a n i s m by w h i c h a m b u lances are dispatched in your c o m m u n i t y . Explain the degree of training dispatchers receive locally and what other types of training are available. Hardware 3.3.1. Radios - List types of radios in use. Compare and contrast advantages of each. List other types of c o m m u n i c a t i o n s e q u i p m e n t that m a y be used (eg, cellular telephone). T i m e spent - 1 hour Selected readings - Clawson jj, ls Mhyre N 16
4.
Medical direction - Concepts and practice Explain the difference between on-line and off-line medical control/direction.
4.1.
O n - l i n e medical radio operator training 4.1.1. Equipment - Explain how to use telemetry equipment. 4.1.2. Etiquette - Recite c o m m o n appropriate radio jargon and explain meanings. 4.1.3. Protocols - G i v e n a clinical scenario, recite the local EMT protocol. 4.1.4. Other training aids 4.1.4.1. Case reviews - Review tapes of c o m m o n radio and p r o b l e m radio calls. 4.1.4.2. S i m u l a t i o n s - D e m o n s t r a t e competence in m a n a g e m e n t of simulated radio calls. T i m e spent - 6 hours Selected readings - Crowell, 17 Pointer 18
4.2.
Off-line medical direction 4.2.1. Base station role -- Explain the role of the base station in directing and evaluating care. 4.2.2. .Quality assurance - List four m e t h o d s of evaluating adequacy of care. Identify advantages of each. 4.2.3. P e r f o r m a n c e r e v i e w - E x p l a i n h o w EMS care is reviewed locally and identify the limitations of this approach. T i m e spent - 1 hour Selected readings - Pepe PE, 19 Holroyd BR, 2o Stewart RD 21
5.
Disaster p l a n n i n g and mass gathering p l a n n i n g
Annals of Emergency Medicine
18:4 April 1989
5.1. Principles of m a n a g e m e n t - O u t l i n e at least eight major c o m p o n e n t s of a disaster plan. 5.2. Involved agencies - List the agencies involved in planning a disaster response. Identify the role of EMS in a disaster. 5.3. Hazardous materials - Discuss special considerations that m u s t be m a d e w h e n responding to a hazardous materials disaster. Discuss need for separate c u r r i c u l u m as part of residency. Time spent - 1 hour Selected readings - F e l d s t e i n BD, 22 D e M a r s ML, 23 M a h o n e y LE 24 Legal aspects of prehospital care 6.1. Roles and responsibilities - Define the role and legal responsibilities of each of the following in rendering prehospital emergency care: 6.1.1. EMS agencies 6.i.2. EMTs 6.1.3. Physicians 6.2. M e d i c o l e g a l p r o b l e m s - O u t l i n e the unique problems that each of the following situations create for EMS personnel and describe a m e t h o d for m a n a g e m e n t . 6.2.1. Refusal of care 6.2.2. I n c o m p e t e n t patient 6.2.31 Pediatric patients 6.2.4. T e r m i n a l l y ill patients 6.2.5. Physician on scene T i m e spent - 4 hours Selected readings - G o l d s t e i n AS, 25 Holroyd BR 26 7. Emergency aeromedical care 7.1. List c o m m o n indications for aeromedical transport of the emergency patient. 7.2. Identify c o m m o n problems encountered in preparation for aeromedical transport. 7.3. D e s c r i b e p h y s i o l o g i c a l c o n s i d e r a t i o n s i n v o l v e d in aeromedical transport. Discuss need for separate c u r r i c u l u m as part of residency. T i m e spent - 1 hour Selected readings - Carter G , 27 Carter G, 2s Baxt 29
8.
Rural EMS 8.1. Describe u n i q u e considerations required for dev e l o p m e n t and provision of prehospital care in rural c o m m u n i t i e s w i t h respect to each of the following: 8.1.1. Cost 8.1.2. Skills m a i n t e n a n c e 8.1.3. Response and transport t i m e 8~1.4. Training T i m e spent - 1 hour Selected readings - Vukov LF,3° A l l i s o n EJ, 31 Will i a m s o n JE32
t r a u m a patient. Cardiac arrest - C o m p a r e the different levels of care available and the advantages of each. 9.3. A i r w a y m a n a g e m e n t - Discuss the types of prehospital airway control measures available and list indications for each. T i m e spent - 1 hour S e l e c t e d r e a d i n g s - Pepe PE, 33 C u m m i n s RO, 34 G o l d , 35 C h a m p i o n , 36 C l e m mer 37 9.2.
9.
Active Participation 1.
On-scene experience - Critical link 1.!. Observation 1.2. Participation Selected readings - Stewart RD 38 T i m e spent - Variable
2.
Training 2.1. Participate in classroom training of basic, intermediate, and advanced EMTs. 2.2. Participate in clinical training of EMTs in training and practicing EMTs. Selected readings - N o n e T i m e spent - 2 h o u r s / y e a r / r e s i d e n t
3.
Medical direction 3.1. O n line 3.1.1. M e d i c a l r a d i o o p e r a t i o n - P r e c e p t e d calls 3.1.2. Medical radio operation - A t PGYII/III level Participate in regular direction of prehospital care as medical control physician. 3.2. Off line 3.2.1. Participate in regular review of prehospital runs. 3.2.2. Participate in individual incident investigation.
4.
Disaster planning 4.1. S i m u l a t i o n participation
For the Resident With a Special Interest in EMS 1.
.
Patient care 9.1. T r a u m a care - Contrast the advantages of ALS versus BLS for the t r a u m a patient. 9.1.1. Patient triage - Describe triage instrum e n t s and their role in the Care of the
18:4 April 1989
P o l i t i c a l / a d m i n i s t r a t i v e - D e s c r i b e the i m p a c t t h a t each of the following has on the provision of prehospital care and give examples for each: 9.1. G o v e r n m e n t a l agencies 9.2. State and federal legislature 9.3. C o m m u n i t y i n v o l v e m e n t and public education T i m e spent - 1 hour Selected readings - N o n e
In-field experience 1.1. Liaison e x p e r i e n c e to i n c l u d e regular c o n t a c t w i t h an agency to identify problems, issues, local needs 1.2. Expanded on-scene activity to develop first-hand knowledge of field care
Annals of Emergency Medicine
420/133
MODEL CURRICULUM Swor et al
2.
3.
4.
Training 2.1. I n v o l v e m e n t w i t h n e w E M T t r a i n i n g a n d t e s t i n g 2.2. P e r i o d i c r u n r e v i e w w i t h u n i t s
14. West ]C, Tmnkey DD, Lim RC, et ah Systems of trauma care. Arch Surg 1979;114:455-460.
Administrative/political 4.1. Assignment to local EMS board for project and
18. Pointer JE: The emergency physician and medical control in advanced life support. JEM 1985;3:31-35.
committee activity Observation of process level EMS organizations
at regional
and
state
15. Clawson JJ: Regulations and standards for emergency medical dispatchers: A model for state or region. Emerg Med Serv 1984;13;4:25-29. 16. Mhyre N: The enhanced 911 program. Emerg Med Serv 1984;13:32-37. 17. Crowel,l R, Baraff LJ, Jergens ME: Pre-hospital care: A syllabus for emergency physicians base station physician (unpublished paper).
19. Pepe PE, Stewart RD: The role of the physician in the prehospital setting. Ann Emerg Med 1986;15:1480-1484. 20. Holroyd BR, Knopp R, Kallsen G: Medical control: Quality assurance in prehospital care. JAMA 1986;256:1027-1031.
Research
5.1.
6.
13. Cales RH: Trauma mortality in Orange County - The effect of implementation of a regional trauma system. Ann Emerg Med 1984;13:1-10.
Medical direction 3.1. Off line 3.1.1. Regular interaction with local/regional medical director 3.1.2. Active role in quality assurance 3.1.3. On-scene EMT performance review
4.2.
5.
12. Committee on Trauma: Essential equipment for ambulances. Bull Am Col1 Surg 1983;68:36-38.
Development of a project suitable for publication on EMS-related topic
Systems elective 6.1. R o t a t i o n t o E M S s y s t e m s i n d i f f e r e n t l o c a l e s , t y p e s of s y s t e m s (eg, r u r a l , s u b u r b a n , u r b a n )
21. Stewart RD, Burgman J, Cannon GM, et ah A computer-assisted qual, ity assurance system for an emergency medical service. Ann Emerg Med 1985;14:25-29. 22. Feldstein BD: Disaster training for emergency medicine in the US: A system approach. Ann Emerg Med 1985;14:36-40. 23. DeMars ML: Disaster planning, in Tintinalli JE, Rothstein RJ, Krome R L (eds): Emergency Medicine, A Comprehensive Study Guide. New York, McGraw-Hill, 1985, p 976-982. 24. Mahoney LE, Reutershan TP: Catastrophe disasters and the design of disaster medical care systems. Ann Emerg Med 1987;16:1085-1091.
T h e a u t h o r s t h a n k Jerris Hedges, MD, FACEE a n d G e n e Kallsen, MD, FACEP, for t h e i r a s s i s t a n c e in t h e p r e p a r a t i o n of t h i s m a n u script.
REFERENCES 1. Kallsen G, Merritt-Lindgren: An emergency medical services curricul u m for e m e r g e n c y m e d i c i n e r e s i d e n c i e s . A n n Emerg M e d 1984;13:912-915. 2. Cooper MA, Omato JP: Involving and educating base station physicians in paramedic programs. Ann Emerg Med 1980:9:524-526.
25. Goldstein AS: EMS and the Law." A Legal Handbook for EMS Personnel. Bowie, Maryland, Robert J Brady Co, 1983, p 44-93. 26. Holroyd BR, Shalit M, Kallsen G, et ah Prehospital patients refusing care. Ann Emerg Med 1988;17:957-963. 27. Carter G, O'Brien DJ: The impact of aeromedical helicopter programs on emergency medicine resident training: Resident attitudes, perceived risks and benefits. J Emerg Med 1986;4:471-476. 28. Carter G, Dolan MC, Couch RH, et ah Safety and helicopter-based programs (letter). Ann Emerg Med 1986; 15:1117-1118.
3. Lowry JW, ,Lauro AJ: A general EMS curriculum for residency training. Ann Emerg Med 1980;9:250-252.
29. Baxt WG, Cleveland HC, Fischer RP, et ah Hospital-based rotorcraft aeromedical emergency care services and trauma mortality: A multicenter study. Ann Emerg Med 1985;14:859-864.
4. Paris PM, Stewart RD, Benson N: Survey of requirements for EMS experience in emergency medicine residencies (unpublished paper).
30. Vukov LF, White RD, Bachman JW, et al: New perspectives on rural EMT defibrillation. Ann Emerg Med 1988;17:318-322.
5. Emergency Medical Services Committee: Medical Control of Emergency Medical Services: An Overview for Emergency Physicians. American College of Emergency Physicians, Dallas, 1984.
31. Allison EJ: Meeting the medical care needs of the geographically underserved: Emergency care. N Carolina Med J 1983;44:665-667.
6. Boyd DR: The history of emergency medical services sYstems in the United States of America, in Boyd DR, Edlich RF, Micik SH (eds): Systems Approach to Emergency Medical Care. Norwalk, Connecticut, AppletonCentury-Crofts, 1983, p 1-51. 7. Rockwood CA, Mann CM, Farrington JD, et al: History of emergency medical services in the United States. J Trauma 1986;16:299-308. 8. American College of Emergency Physicians: Guidelines for trauma care systems. Ann Emerg Med 1987;16:459-463. 9.. Lilja GP, Swor R: Emergency medical services, in Tintinalli JE, Krome RL, Ruiz E (eds): Emergency Medicine, A Comprehensive Study Guide. New York, McGraw-Hill, 1988, p 171-175. 10. Tsai A, Kallsen G: Epidemiology of pediatric prehospital care. Ann Emerg Med 1987;16:284-292. 11. Department of Transportation Training Guideline. Emerg Med Serv 1986;15:163-166.
134/421
32. Williamson JE, Landis SS, Allison EJ: The evolution of a rural EMTintermediate training program. N Carolina Med J 1983;44:737-742. 33. Pepe PE, Copass MD, Joyce TH: Prehospitat endotracheal intubatfon: Rationale for training emergency medical personnel. Ann Emerg Med 1985;14:1085-1091. 34..Cummins RO, Eisenberg MS: Prehospital cardiopulmonary resuscitation: Is it effective? JAMA 1984;252:2408-2412. 35. Gold CR: Prehospital advanced life support vs "scoop and run" in trauma management. Ann Emerg Med 1987;16:797-801. 36. Champion HR: Trauma score. Crit Care Med 1981;9:672-676. 37. Clemmer TP, Orme JF, Thomas F, et ah Prospective evaluation of the CRAMS scale for triaging. J Trauma 1985;25:188-191. 38. Stewart RD, Paris PM, Heller MB: Design of a resident in-field experience for an emergency medicine residency curriculum. Ann Emerg Med 1987;16:175-179.
Annals of Emergency Medicine
18:4 April 1989