Division of Emergency Medical Services UCSD Emergency Medical Services Disaster Medicine Fellowship Program

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1 Division of Emergency Medical Services UCSD Emergency Medical Services Disaster Medicine Fellowship Program Directors: Colleen Buono, M.D. Gary M. Vilke, M.D. UCSD Medical Center 200 W. Arbor Dr. #8676 San Diego, CA (619)

2 EMS Faculty Dr. Daniel Davis completed his medical school and emergency medicine residency here at UCSD. As a third year resident, he was recognized as the "UCSD Medical Center Resident of the Year," the first for our department. During his senior year, he served as one of our two chiefs and was named "Outstanding EM Resident." He was also recognized nationally as the recipient of the "Cord Resident Academic Achievement Award." As a faculty member, Dr. Davis has accepted the duties of basic hospital medical director and is the regional medical director for Mercy Air Medical Services. His research interests are in traumatic brain injury, prehospital care, and airway management, and Dr. Davis is currently editor for the "Difficult Airways" section of the Journal of Emergency Medicine. In , Dr. Davis was the recipient of the SAEM Scholarly Sabbatical Grant, and he now has NIH funding in both basic science and clinical research. Dr. James Dunford is the Medical Director of the City of San Diego and oversees the City s EMS system. Jim graduated from Columbia University College of Physicians and Surgeons in 1976 and is board certified in both Emergency Medicine and Internal Medicine. He joined the UCSD emergency medicine faculty in 1980, serving as a crew member and later Medical Director of the San Diego Life Flight helicopter program. Jim directed the UCSD paramedic base hospital for thirteen years and has been the Medical Director of the San Diego Fire-Rescue Department since In 1990, he founded the UCSD Emergency Medicine Residency Training Program and served as its director until In 1996, he won the American College of Emergency Physicians faculty CPC competition. He has been selected twice as the outstanding faculty teacher by the graduating UCSD residents. He is a coinvestigator on three NIH-funded trials involving acute stroke, wireless disaster systems, trauma resuscitation and cardiac arrest. He has received numerous awards for community service and is the President of the Board of Directors of the Greater San Diego chapter of the American Heart Association. Dr. Irving (Jake) Jacoby completed a medical internship and residency at Boston City Hospital and the Peter Bent Brigham Hospital and an Infectious Disease fellowship at the Brigham as well. He is board certified in Emergency Medicine and Internal Medicine with a subspecialty in Infectious Diseases. He was employed at the University of Massachusetts Medical Center in the Departments of Emergency Medicine and Infectious Diseases, and was a flight physician for New England Life Flight based in Worcester. Dr. Jacoby joined the DEM in 1984, and is the Associate Medical Director of the Hyperbaric Medicine Center. He

3 is the Disaster Control Officer for UCSD Medical Center, and in 2003 was named Hospital Director for Emergency Preparedness and Response. He founded DMAT-San Diego (CA-4) in 1991, and has been its Commander ever since. The Disaster Medical Assistance Team is a Level 1 deployable response team affiliated with the National Disaster Medical System (NDMS), cosponsored by UCSD Medical Center. He has led the team to over a dozen Federally -declared disasters since 1994, including the Northridge earthquake [January 1994]; the Olympic Games in Atlanta [1996]; the Grand Forks, North Dakota flood [April 1997]; Hurricane Georges to Shreveport, LA and St. Croix, USVI [1998]; Ground Zero in NYC following the terrorist attacks on America [2001]; the Winter Olympics in Salt Lake City, and Super Typhoon Pongsona in Guam [2002]. He is the Disaster Medicine section editor for the Journal of Emergency Medicine, and is on the National Training Working Group for NDMS. He is a member of the Hyperbaric Therapy Committee of the Undersea and Hyperbaric Medical Society. He received the Teaching Award from the Graduating Class of Emergency Medicine Residents in Dr. Gary Vilke completed his General Surgery Internship and Emergency Medicine Residency at UCSD Medical Center, where he also served as chief resident. Dr. Vilke joined the faculty in July 1996 and currently serves as Director of Custody Services for the department. Additionally Dr. Vilke is the former Medical Director of the County of San Diego Emergency Medical Services (EMS). He had served as medical director for the UCSD Paramedic base hospital, the Mercy Air transport program and two paramedic training colleges. He is active in prehospital policy and procedure and served on multiple local, state and national EMS committees and is on the Editorial Board for Prehospital Emergency Care. Dr. Vilke also works as one of the Medical Directors for the San Diego County Metropolitan Medical Strike Team (MMST) that is prepared for deployment if there is an act of terrorism implementing a chemical or radiological agent. Dr. Vilke is interested and active in research, particularly involving prehospital care and restraint position physiology. Dr. Colleen Buono completed her Emergency Medicine Residency and was chief resident at UCSD Medical Center, also serving as a crew member for Mercy Air. Dr. Buono developed and completed the UCSD Emergency Medical Services and Disaster Medicine Fellowship. She joined the faculty in July 2006 and currently serves as Director of the EMS-Disaster Fellowship and co- Base Hospital Director for the Department. Additionally, Dr. Buono serves as the Medical Director of the Palomar College Paramedic Program and is active in pre-hospital policy and procedure, serving on multiple EMS and Disaster Preparedness Committees. Dr. Buono is the Medical Director for the San Diego County Metropolitan Medical Strike Team (MMST) for response to terrorist acts in San Diego. Dr. Buono is the Medical Officer for the San Diego Disaster Medical Assistance Team (DMAT CA-4) and is part of the San Diego Urban Search and Rescue (CA TF-8). Dr. Buono is interested and active in disaster preparation, response, and education, as well as EMS and Disaster research. Her specific research interest lies in information technology in disaster response utilizing the Wireless Internet Information System for medical

4 Response to Disasters (WIISARD) to improve the quality, quantity, and utility of the data in a mass casualty scenario. She has traveled to the Ukraine and Mississippi with DMAT, New Orleans with USAR, and co-directed the medical response at Qualcomm Stadium during the 2007 San Diego Wildfires. She also coordinates the Women in Emergency Medicine group, which she has expanded to include members from across San Diego County.

5 UCSD EMS Fellowship Program The UCSD EMS Fellowship is designed to provide emergency medicine physicians licensed in the US the opportunity to be educated and trained in the administrative, medical oversight and field aspects of EMS systems. Individuals successfully completing the two-year fellowship should obtain sufficient didactic and practical knowledge to work efficiently and competently as a medical director of a paramedic base hospital or prehospital agency, in addition to gaining additional graduate level education with associated research exposure. Program Curriculum Goals At the completion of the fellowship, the EMS fellow will: Develop the knowledge base and skills necessary to be an active participant in the EMS community. Develop a knowledge base in disaster medicine. Possess the administrative skills needed to provide medical direction for a: o Prehospital provider agency o EMT or paramedic training institute o Local EMS agency Develop requisite academic skills to be an effective researcher and teacher in EMS. Fellow Characteristics/Requirements Graduate of an approved emergency medicine residency (PG 2-4 or 1-4, or graduate of a PG 1-3 format with at least 1-2 years as a practicing EM physician) Qualified to be half time faculty in the DEM. Fellowship Experiences The EMS fellowship will provide the following experiences to achieve curriculum goals: Didactic curriculum and EMS core lecture series. Development of EMS lectures for core curriculum, paramedic college training programs and paramedic continuing education Monthly EMS journal club Required EMS research project to be completed within the one year term Participation in NAEMSP Submission of research for presentation at the annual NAEMSP meeting Participation in the San Diego County Prehospital Audit Committee and Base Station s Physicians Committee Participation on the CA-4 Disaster Medical Assistance Team (DMAT). Participation in the San Diego County Metropolitan Medical Response System (MMRS)

6 Participation with the Mercy Air Helicopter Transport Service Participation with the San Diego Medical Services Enterprise (SDMSE) Participation with San Diego County EMS Administration Participation in medical direction of the UCSD Paramedic Base Station Participation in medical direction of the Palomar Paramedic College Instructional Objectives for Fellowship Training Didactic Exposure: EMS clinical care protocols. EMS ground and aeromedical system planning, design, and logistics. EMS finance and management. Disaster preparedness and response. Weapons of mass destruction. Hazardous materials. Injury prevention and control. Telemedicine. Basic methodology, data acquisition and management, and ethics of research. Clinical and Administrative Experience: Participation in institutional, community, and governmental work groups that influence or govern EMS-related activities. Participation in on- and offline protocol development, modification and direction for ground and aeromedical systems. Participation in disaster, weapons of mass destruction, and hazardous materials (hazmat) preparedness. Participation in departmental, institutional, paramedic training, and community teaching programs. Project Experience: Developed proposal timeline and budget together with documented supervision by fellowship director/research advisor. Completion and submission of an abstract for competitive review for presentation at a national scientific meeting. Completion and submission of a publishable paper, as judged by fellowship director/research advisor, to a peer-reviewed journal.

7 I. Didactic Exposure A. EMS clinical care protocols a. On-line vs. off-line medical direction b. State regulations c. Local scope of practice a. Lecture b. Reading c. NAEMSP Base Station Course d. NAEMSP Medical Directors Course e. NAEMSP Tactical EMS for Medical Directors Course 3. Evaluation a. Include in fellow orientation lecture to junior trainees b. Medical Director Course practica B. EMS ground & air medical system planning, design, & logistics a. System Design i. Level of response First Responders BLS ALS Air medical response ii. Single vs. multi-tiered responses a. Discussion with faculty b. Reading i. Prehospital Systems and Medical Oversight, edited by A. Kuehl c. Lecture 3. Evaluation a. Include in fellow orientation lecture to junior trainees C. EMS finance & management a. Funding for state & local agencies b. Legislation a. Discussions with faculty b. Reading c. NAEMSP Database of Rules & Laws

8 3. Evaluation a. Include in fellow orientation lecture to junior trainees D. Disaster preparedness & response a. Mass Casualty Management b. Incident Command c. Search & Rescue d. Triage e. Evacuation f. Medical response to terrorism i. Special operations ii. Biological agents iii. Chemical agents iv. Radioactive agents g. Psychological response to disasters h. Care of the dead & their families i. Public health response to disasters i. RAN ii. Surveillance iii. Reporting a. Reading Advanced Disaster Medical Response: Manual for Providers (NDMS, Harvard) b. Attend Incident Command seminar c. Discussion with faculty d. Disaster drills e. NDMS Team Training Program (website) f. DMAT Rough & Ready Exercise 3. Evaluation a. Include in fellow orientation lecture to junior trainees E. Weapons of mass destruction a. Ionizing Radiation i. Principles ii. Scenarios iii. Management b. Blast injuries i. Devices ii. Blast injuries iii. Prognostic factors c. Chemical Agents i Agents ii. Identification iii. Management

9 d. Biological Agents i. Agents (viral, bacterial, fungal, toxins) ii. Identification iii. Management a. Reading i. Advanced Disaster Medical Response: Manual for Providers (NDMS, Harvard) ii. Dept. of Homeland Security Working Group on Radiological Dispersal Device Preparedness c. Disaster drills 3. Evaluation a. Include in fellow orientation lecture to junior trainees F. Hazardous materials a. Decontamination b. Chemical Warfare Agents vs. Hazardous Materials c. Identification of HazMat d. Personal Protective Equipment a. Reading Advanced Disaster Medical Response: Manual for Providers (NDMS, Harvard) c. Disaster drills 3. Evaluation a. Include in fellow orientation lecture to junior trainees G. Injury prevention & control a. General overview b. Specific County programs a. Lectures from SDSU faculty 3. Evaluation a. Discussion with faculty H. Basic methodology, data acquisition & management, & ethics of research a. Didactic (formal classroom CREST) b. Research project(s) c. Discussion with faculty

10 3. Evaluation a. Exams, projects b. Include in fellow orientation lecture to junior trainees c. Discussion with faculty

11 II. Clinical & Administrative Experience A. Participation in institutional, community, & governmental work groups that influence or govern EMS-related activities 1. Institutional: a. Hospital Disaster Committee b. Base Hospital Committee 2. Local a. SDMSE EMS Committee b. City Council meetings c. Emergency Medical Care Committee d. SDMSE Quarterly Education Committee e. SDMSE Quality Improvement Committee f. Committee on Pediatric Emergency Medicine (COPEM) g. Emergency Medical Services for Children (EMS-C) 3. Regional a. State EMS Commission B. Participation in on- & off-line protocol development, modification, & direction for ground & air medical systems 1.Institutional a. Base Hospital Physician Committee 2. Local a. City i. EMS Staff meeting ii. SDMSE Quality Council iii. Medical Dispatch Review Committee b. County i. San Diego County Prehospital Audit Committee (PAC) ii. San Diego County Base Station Physicians Committee (BSPC) iii. San Diego County Medical Audit Committee (MAC) iv. Paramedic Quality Field Care Audit v. San Diego County Adult Protocol Revision Task Force vi. San Diego County Pediatric Protocol Revision Task Force vii. San Diego County Air Medical Protocol Revision Task Force 3. Regional a. State-wide meetings i. Emergency Medical Director s Association of California (EMDAC) C. Participation in disaster, weapons of mass destruction, hazmat preparedness 1. Institutional: a. Emergency Preparedness Advisory Committee (EPAC) b. Hospital wide Disaster Drills & Table top exercises

12 2. Local a. Area 3,4,5,6 Disaster Meeting b. Metropolitan Medical Strike Team (MMST) Operations Meetings c. MMST disaster exercises 3. Regional a. Disaster Medical Assistance Team (DMAT) Rough & Ready drill b. DMAT monthly meetings c. State-wide DMAT meetings d. CDF medical response D. Participation in departmental, institutional, paramedic training, & community teaching programs 1. Institutional a. UCSD EMS resident lectures b. UCSD EMS medical student lectures c. UCSD hospital (emergency preparedness staff) lectures 2. Local a. Palomar Paramedic College i. lectures ii. medical direction b. Mercy Air i. training lectures

13 Overall EMS Fellowship Evaluation Procedures Core faculty will complete bi-monthly evaluations of performance with regard to how well the fellow has met instructional objectives Fellowship directors will meet informally as well as formally on a quarterly basis. Written evaluations will be completed on a semi annual basis The fellow will be evaluated on the quality of research completed and on formal research presentations Successful completion of the fellowship will be ultimately determined by the fellowship directors and core EMS faculty The EMS fellow will evaluate all components of the fellowship as well as core faculty