Lauri D. Bolton, MD Emergency Medical Services Fellow Education: Rensselaer Polytechnic Institute, 01 BS   University of Massachusetts School of Medicine, 05 MD     Residency: Emergency Medicine, University of Connecticut, 05     Interests: Disaster medicine, aeromedical administration, medical student / resident education

James C. Suozzi, DO, NREMT-P Emergency Medical Services Fellow Education: University of Colorado, 99 BA   Nova Southeastern University, 05 DO     Residency: Emergency Medicine, University of Connecticut, 05     Interests: Simulation medicine, airway management, wilderness medicine, international medicine, air / ground EMS, urban search and rescue

Introduction:
The Department of Traumatology and Emergency Medicine, LIFE STAR, and the Department of EMS Education have combined to offer an EMS fellowship.  This program, open to graduates of accredited emergency medicine residencies, seeks to train the future leaders in EMS.  Participants will learn the principles of medical direction in multiple, diverse and challenging settings.  Upon successful completion of the Fellowship, participants will be prepared to be a leader in the EMS field.  In addition, those participants who are so inclined will have the option to participate in international emergency medicine programs, disaster planning, simulation medicine and EMS Law.

The Faculty:
The faculty consists of recognized leaders in each of these fields; including the leadership of the Department of EMS/Trauma, the Department of EMS Education and LIFE STAR.  Close mentoring will be employed to maximize the learning opportunities for all fellows.

Objectives:

1. To become familiar with design, implementation and operation of ground EMS systems.
2. To become familiar with design, implementation and operation of an air medical transport service.
3. To gain experience in the daily operations of ground EMS and air medical transport.
4. To participate in the training and education of ground EMS providers and air medical transport flight crews.
5. To participate in the continuing quality management for the ground EMS systems who obtain medical oversight through Hartford Hospital and John Dempsey Hospital and the LIFE STAR air medical transport program.
6. To actively participate in the administrative, legislative and financial aspects of the ground EMS system and the air medical transport system on a local, regional, state and national level.
7. To actively participate in EMS and transport medicine research.
8. To gain knowledge of the legal issues related to EMS and critical care transport medicine.
9. To become familiar with the interaction of Homeland Security issues and EMS.
10. To become familiar with disaster planning and EMS resource management.
11. To hone clinical and teaching skills essential to the practice of academic emergency medicine.
12. To be fully prepared upon completion of the fellowship, to be a leader in the EMS environment.
13. To secure a position as a medical director or assistant medical director of a ground or air transport system/program.

The System:

1. Department of EMS/Trauma at Hartford Hospital - The only Level 1 Trauma Center in Hartford, CT. The emergency department has an annual volume of approximately 82,000 visits. 
2. The Northern Tier Center for Excellence in Bioterrorism and the assistant to the Medical Director of Homeland Security will provide exposure to those areas.
3. Department of EMS Education at Hartford Hospital - This department is the main source of initial training and recurrent education for all levels of prehospital care providers in the metropolitan Hartford area.  Medical oversight for many local ground EMS providers is provided through this department.
4. LIFE STAR Helicopter Program – LIFE STAR has a primary base at Hartford Hospital and a satellite base at Backus Hospital in Norwich Connecticut.  The program operates two BK-117 helicopters 24 hours a day and completes approximately 1200 patient flights annually.
5. John Dempsey Hospital Emergency Department - the emergency department has an annual volume of approximately 31,000 visits.  John Dempsey serves as the sponsor hospital for multiple EMS agencies and medical direction occurs out of the emergency department.  The fellows will serve as associate medical directors under Dr. Kamin who provides medical oversight for the EMS services sponsored by the hospital.
6. Integrated Residency in Emergency Medicine. Opportunities to teach and mentor the 36 University of Connecticut emergency medicine residents that use Hartford Hospital as their main clinical site while working in the emergency department clinically and by providing didactics.
7. State level Medical Direction.  Experience with medical direction of a state system is gained via collaboration with Dr. Richard Kamin, EMS Fellowship Director and Medical Director, State of Connecticut Department of Public Health.
8. International Emergency Medicine.  There are various opportunities to participate in International Emergency Medicine via Dr. Cynthia Price [Africa, Haiti], Dr. Mark Bisanzo [Africa], and Dr. Robert Fuller [Ecuador, Saint Lucia].
9. Experience with medical simulation will be available through the Medical Simulation Center at Hartford Hospital and John Dempsey Hospital under the direction of Dr. Thomas Nowicki, Director of Simulation, University of CT School of Medicine.
10. Disaster planning experience will be available through collaboration with the Department of Public Health, Connecticut DMAT and USAR, the various disaster-planning committees for Hartford Hospital and the Rhode Island Disaster Initiative at Rhode Island Hospital.
11. EMS law.  Exposure to many aspects of EMS Law is available via Abigail Williams, Esq.

Fellowship Overview:

1. The Fellowship will be a one or two year appointment.
2. Fellows may obtain an MPH or MBA during their fellowship.
3. Clinical time at Hartford Hospital will be required to maintain clinical skills.
4. Moonlighting opportunities will be afforded to all Fellows at Hartford Hospital and John Dempsey Hospital (University of Connecticut). 
5. Participation in local ground EMS and LIFE STAR Medical Direction/Administration.
6. Participation in local ground EMS and LIFE STAR Quality Improvement projects.
7. Participation in local ground EMS and LIFE STAR research projects with the expectation that all fellows will develop original EMS research with the anticipation of publication of their research.
8. Participation in Department of EMS Education teaching programs.
9. Participation in local ground EMS and LIFE STAR continuing education.
10. Participation in local ground EMS, LIFE STAR, hospital, local, regional and statewide committees.
11. Membership and active participation in NAEMSP and AMPA.
12. Participation in Bioterrorism/Homeland Security programs.
13. Participation in local and regional disaster planning and simulation.

Body of Knowledge to Be Mastered:

1. Advanced working knowledge of EMS systems and their function.
2. Knowledge of Public Health in relation to EMS systems and provision.
3. Familiarity with quality improvement processes as applicable to EMS systems.
4. Knowledge and experience with medical oversight for pre-hospital critical care transport.
5. The political skills/knowledge required of an EMS medical director.
6. The ability to identify, plan and complete meaningful EMS research.
7. Teaching ability to address diverse EMS audiences.
8. Skill and familiarity in functioning in an academic emergency department.
9. Understanding the unique environment of disaster medicine.
10. Understanding of the interaction between Homeland Security and transport medicine systems.
11. Familiarity with the basic issues concerning EMS Law.

Minimal Qualifications:

1. Graduate of an accredited Emergency Medicine Residency.
2. Skill and familiarity with use of computers
3. Passing of the Board Examination in Emergency Medicine during the Fellowship will be expected.

Curriculum

Ground EMS

1. Knowledge of EMS systems and their organization, management and oversight.
2. Demonstrating competence in developing policies and procedures for smooth operation of the EMS system.
3. Knowledge of on-line and off-line Medical Direction.
4. Demonstrated competence in developing and managing a Quality Improvement Program to enhance the functioning of the EMS system.
5. Working knowledge of the various communications equipment and systems used in the day-to-day functioning of an EMS system.
6. Developing meaningful EMS research projects to improve the quality of prehospital medical care.  This will include identifying such items for study, determining the best means of studying the question, organizing a study and completing such studies to publication.
7. Understanding the importance of faculty development in an academic environment.  Participation in hospital committees and projects will be mandatory.
8. Participation in local, regional and statewide committees.
9. Providing Medical Direction for local EMS agencies, with the assistance of the EMS Fellowship faculty.
10. Participation in varying levels of EMS education.
11. Participation in EMS education for the University of Connecticut Emergency Medicine residents.
12. Membership and active participation in the National Association of Emergency Medical Service Physicians (NAEMSP).
13. Demonstrated awareness of body of knowledge/literature pertaining to EMS systems.
14. Regular participation in EMS activities outside of the hospital.
15. Participation in “on-call” Medical Director responsibilities.
16. Knowledge and familiarity with changing State and Federal rules and regulations governing EMS operations.
17. Knowledge and familiarity with the economics involved in EMS operations.

Air Medical Transport

1. Knowledge and understanding of air medical services, their management, organization and oversight.
2. Knowledge and understanding of critical care transport services, their management, organization and oversight.
3. Demonstrating competence in developing policies and procedures for smooth LIFE STAR operations.
4. Demonstrated competence in developing and managing a Quality Improvement Program to enhance the functioning of the LIFE STAR program.
5. Working knowledge of the various communications equipment and systems used in the day-to-day operation of LIFE STAR.
6. Developing meaningful air medical/ critical care transport research projects to improve the quality of each.  This will include identifying such items for study, determining the best means of studying the question, organizing a study and completing such studies to publication.
7. Understanding the importance of “internal hospital” promotion, information.
8. Participation in hospital, local, regional, statewide and national committees and organizations.
9. Participation in LIFE STAR educational activities.
10. Participation in LIFE STAR education for University of Connecticut Emergency Medicine residents.
11. Demonstrated familiarity with the body of knowledge/literature pertaining to air medicine/ critical care transport
12. Participation in LIFE STAR Medical Director “on-call’ responsibilities.
13. Participate as moderator of LIFE STAR CQI meetings.
14. Regular shifts as the LIFE STAR “Flight Physician”.
15. Knowledge and familiarity with changing State and Federal rules and regulations governing LIFE STAR/air medical/critical care operations.
16. Knowledge and familiarity with the economics involved in LIFE STAR/critical care patient transportation.

EMS Education:

1. Knowledge of the differing levels of education and capabilities of the various EMS Providers.
2. Participates in Department of EMS Education and LIFE STAR continuing education offerings.
3. Develops lectures, workshops, training scenarios and other such educational initiatives as may be deemed useful by the Section of EMS at Hartford Hospital.
4. Understands the requirements at the local, regional and state level in obtaining accreditation for training courses and curricula.
5. Participation in “outreach” programs to enhance the public’s, other health professionals, and Public Safety providers knowledge and awareness of local ground EMS operations, LIFE STAR operations, and Critical Care Transport.

Transport Medicine Research:

1. Identifies at least one subject/item of relevant research.  This may be pertaining to ground EMS, air medical services, critical care transport or any other area of research felt to be applicable by the Fellowship faculty.
2. Designs at least one clinical/research trial during their Fellowship.
3. Works with the Fellowship faculty to implement their research project(s)
4. Publishes/presents their research project and results in one of the following:
1. Peer reviewed journal
2. Abstract/Poster/Presentation at a national Emergency Medicine/EMS/Air Medical Conference.

Quality Improvement:

• Demonstrates competence and understanding of the need for and the mechanics of implementing a Quality Improvement Process for ground EMS/ air medical transport programs.
  1. Identifies at least one subject/item of relevant study.  This may be pertaining to ground EMS, LIFE STAR, and air medical services in general, critical care transport or any other area of study felt to be applicable by the Fellowship faculty.

EMS Law:

1. Demonstrated knowledge of EMTALA laws.
2. Demonstrates knowledge of HIPAA and its application to EMS and transport medicine.
3. Gains experience with risk management issues related to EMS and transport medicine.

Demonstration of Competency:

In the absence of a certifying board in EMS or Transport Medicine, competency will be determined based on the successful completion of the objectives of the fellowship stated above.  Monthly meetings with one of the Fellowship faculty will be used to evaluate the fellow’s progress. The criteria used to determine competence may include, but are not limited to, the following;

• Presentation at a national or international Emergency Medicine/EMS/Transport Medicine conference 
• Publication of a peer reviewed paper
• Successful and effective participation in the LIFE STAR Administrator-On-Call role
• Successful and effective participation as a CQI Moderator
• Successful and effective participation on the LIFE STAR Management Team
• Active and effective role in local ground EMS medical direction
• Active and effective education of all levels of prehospital care providers
• Expectation of employment as the medical director or assistant medical director of an EMS/Transport Medicine program upon completion of the Fellowship.