POINTS OF CONTACTS

Nicholas McManus, DO

Medical Director

1903 Marquette Ave, Suite J

Muskegon, MI 49442

(231) 728-1967 (ext. 1030)

nmcmanus@mcmca.org

Alayna Prest, MD

EMS rotation faculty

1903 Marquette Ave, Suite J

Muskegon, MI 49442

(231) 728-1967 (ext. 1030)

aprest@mcmca.org

Chad Lawton

EMS Administrator

1903 Marquette Ave, Suite J

Muskegon, MI 49442

(231) 728-1967 (ext. 1040)

clawton@wmrmc.org

Scott Wilkinson

EMS Coordinator

1903 Marquette Ave, Suite J

Muskegon, MI 49442

(231) 728-1967 (ext. 1050)

swilkinson@mcmca.org

ROTATION OVERVIEW

You will be expected to complete 17 "shifts" during your month. A portion of this time will be spent rotating with various fire departments, EMS and first response support services around our community. This is an incredible opportunity to gain first hand experience and insight into what the entire echelon of prehospital care goes through before a patient presents to the Emergency Department. Further, you will spend time in the regional medical control office at the Muskegon County Medical Control Authority (MCA). Here you will gain some insight into how a Medical Control Authority (MCA) operates both in aspects of daily medical and logistical support, as well as in regards to regional disaster preparedness. As future emergency physicians and leaders, you may serve as an MCA director at some point in your career, especially if you plan to practice rural medicine. Even if this isn’t the case, you will communicate with EMS personnel for your whole career in emergency medicine either with online medical direction or upon patient handoff at the hospital.

It is important to note that 3 of these "shifts" will be spent as asynchronous learning modules for independent study as well as time to complete specialty projects with the Medical Control Authority (MCA). You cannot expect to obtain sufficient EMS knowledge from a few required EMS ride-alongs. This EMS curriculum is designed to give you some insight into federal and state specific medical control, an overview of what it takes to be an EMS medical director as well as some aspects in emergency preparedness/disaster medicine.

ORIENTATION MODULES

Resident duties in the emergency department and in the prehospital setting are very different. To EMS providers, residents/doctors are outsiders. These two qualities can create a substantial barrier during EMS shifts or ride-alongs. Accept and express that you know very little about how to be an EMT or paramedic (even if you were an EMT in a previous life). Even though you may have more years of formal medical training, translating your knowledge to the prehospital setting is challenging and takes time.

The orientation module series will need to be completed prior to your first ride along. Your first day on the rotation is set aside to complete them. These briefly discuss the approach to patient evaluation in the field as well as scene and equipment safety. In each module, answer the content knowledge questions and submit the module upon completion for credit.

SHIFT BREAKDOWN

- 1 - Orientation modules

- 1 - Central dispatch shift

- 2 - Ambulance shifts

- 5 – Fly car shifts

- 2 - Fire department shifts (1 at Dalton, 1 at Muskegon Heights)

- 3 - MCA Office days (Wednesday afternoons after conference)

- 3 – Asynchronous learning shifts

RIDE-ALONG SHIFTS

EMS is a niche within EM that draws considerable interest from residents, but finding time for EMS experience in residency can be difficult. Many EM residents acquire some EMS experience prior to residency, but for those without prior experience, residency is a great time to get to know EMS providers and better understand what they experience. EM residencies are required to provide a basic EMS education, which offers only a glimpse into the world of EMS. We want residents to be more involved in prehospital care, develop a better understanding of the system, and learn from our EMS colleagues.

Dress Code

While in the field, you will likely get dirty. Please dress respectfully, as you represent not only your fellow residents, but also the EMS organization that you are embedded with that day. Acceptable dress includes EMT pants or Khakis with a polo shirt while in the field. Keep in mind that anything you do wear could potentially be damaged. If you need pants for your rotation, and are not able to purchase them, please ask your Chiefs, and attempts to borrow them from other residents will be made. Please do not wear scrubs while in the field. A high-visibility reflective vest is also required when on an ambulance.

tips for success

TIP # 1: KNOW YOUR ROLE

Know the role of the on-scene physician within the EMS command structure – prehospital care is a delicate balancing act of politics and medicine. During your month, you will spend time completing the introductory NIMS online courses (100, 700). For now, understand that you are not the boss. All positions carry very different responsibilities, and if you really want to understand and be accepted within EMS, you need to understand this culture. Residents lack EMS skills and experience, and there’s no substitution for time on the job. The fact is spending time with EMS crews enhances your understanding, builds stronger relationships, and improves your skills

TIP # 2: KNOW HOW TO READ A PROTOCOL

It is unlikely that you will know the protocols in just a month, but you should at least where to find them and reference them frequently. Each EMS agency had a set of protocols that guide patient care and you should know how to access them. Chances are, they aren’t much different than what you would do in the ED. A quick way to lose respect and trust from an EMS provider is to suggest patient care that drastically deviates from established protocols. If you don’t know the protocol, just ask and be open to some teaching!

Muskegon County EMS protocols can be found at www.wmrmcc.org --> Protocols --> Muskegon

One Dose App

TIP # 3: Appreciate those willing to teach you

Be humble, courteous, and leave your ego at home.
Ask to be treated like a new paramedic or FTO student and dress the part.
Remember you are there primarily to learn.
Ask questions and look for opportunities to improve your skills but never steal procedures.
Offer to help by carrying equipment, pushing the stretcher, taking vitals, starting an IV, or cleaning up after a run.
If you are spending the day in a firehouse station, pitch in money for lunch or dinner
Take time to get to know your colleagues.
Ask about the frustrations and rewards of the job and see how you can work to reduce those frustrations.
Ask what EMS providers like that physicians do when they bring a patient to the ED (it might surprise you).

SPECIALTY PROJECTS

You will have days scheduled with an EMS faculty member in the MCA office. During this time, you will be assigned to work on 1 of 2 specialty projects pertinent to medical direction and the medical control authority. These projects are a small taste of tasks expected of an EMS medical director. The EMS track residents may have ongoing projects that need assistance. Don't forget to document these activities for residency based scholarly activity...it counts!

Develop a CME lecture for the state database

One of the primary roles of an EMS medical director is involvement in education and training activities. TRAIN is a national learning network that provides thousands of quality training opportunities to more than 2 million professionals who protect and improve the public's health. Powered by the Public Health Foundation (PHF), the TRAIN Learning Network brings together agencies and organizations in the public health, healthcare, and preparedness sectors to disseminate, track, and share trainings for the health workforce on a centralized training platform. MI-TRAIN is the affiliate branch of TRAIN for the state of Michigan, managed by the Michigan Department of Health and Human Services; Bureau of EMS, Trauma, and Preparedness; and Michigan State Police.

The Bureau of EMS, Trauma, and Preparedness has agreed to use lectures resorded by our residents as potential CME opportunities for EMS personnel across the state. Please design and organize a 30 minute lecture on a topic of your choosing pertinent to pre-hospital medicine. You may look through the catelog of lectures on MI-TRAIN for examples of the types of lectures they are looking for. After you design your lecture, you will give your lecture at one of the EMS track didactics sessions and this will be recorded and submitted to MI-TRAIN by the EMS faculty. If you are not comfortable recording your voice for this project, please let the EMS faculty know.

Protocol test bank questions

One of the primary duties of a Medical Control Authority is to establish written protocols for the practice of life support agencies and EMS personnel and uphold accountability for adherence to these protocols. That means, we need to have adequate education and confirmation of knowledge before these protocols are adopted in the field.

For this project, watch this 30 minute NREMT Test Writing and Validation video from MI-Train. If you have not already done so, you will need to create an account to watch this video. This is a state platform for CME used by the state of Michigan for EMS providers and if you have any interest in pursuing a career as an EMS medical director in the state, you should be familiar with this platform. This video covers the information necessary for validation and writing of test items at an NREMT level. Print your certificate of completion and turn it into the EMS Faculty drop box in the EMS office for credit.

After watching the video, please write 10 well designed NREMT level test questions for EMS provider continuing education. Please email Chad Lawton or Dr. McManus to determine the protocols of interest for these test questions.

ASYNCHRONOUS LEARNING MODULES

You will have 3 days blocked off on your schedule for Asynchronous learning exercises. Each day will have a series of online/independent learning modules or readings to complete. You do not have to complete them on the scheduled day, although these days are specifically set aside to allow you ample time to accomplish these modules during your rotation.

A.L. Module Set # 1

Intro to Medical Directorship and the Medical Control Authority

The purpose of this module is to lay a foundation for the general overview of the EMS System

A.L. Module Set # 2

EMS Medical Legal Modules

In this module, you will learn the protocols that pertain to the medical legal aspect of EMS as this is extremely important for any EM physician to understand, particularly when providing medical oversight to an EMS system.

A.L. Module Set # 3

Emergency/Disaster Preparedness

The purpose of this module is to introduce the resident to the incident command structure through the FEMA modules and an introduction to the emergency preparedness in the state of Michigan.

A.L. Module Set # 4

Virtual Ride-Along

In this module, you will watch 15 short videos, each ranging 2 to 10 minutes in length. These videos are of various EMS providers interacting in patient contact scenarios. Following each video, you will see a number of open ended prompts to deepen your knowledge and understanding of prehospital protocols and medical direction. Please answer the prompts and submit your answers. These answers will be discussed at your faculty meeting on the 4th Wednesday session.

ADMINISTRATIVE DAYS

ROTATION ADDRESSES