The UCSF Department of Emergency Medicine offers one and two year fellowship in EMS/Disaster for emergency medicine residency trained physicians.  The program provides training and education in all aspects of EMS/Disaster including administration, medical oversight, research, teaching, and clinical components.  Duties of this EMS/Disaster fellow will include attending physician responsibilities at San Francisco General Hospital, a Level 1 Trauma Center with a new emergency medicine residency as well as the management of specific urban disaster projects through the San Francisco EMS Agency. 

Emergency Medical Services/Disaster is embedded in the Department of Emergency Medicine with medical student electives in EMS/Disaster, EM residents with an Area of Distinction in EMS as well as several areas of active clinical research.  The faculty is involved in the oversight and administration of the EMS system for the City and County of San Francisco.  Our fellowship is ACGME accreditation in EMS Medicine.

Program  

The Department of Emergency Medicine at UCSF in collaboration with the San Francisco EMS Agency is hosting a fellowship in Emergency Medical Services/Disaster for emergency medicine physicians.  Two year fellows would be expected to pursue an advanced degree: Masters of Public Health (UC Berkeley), Masters of Public Administration (University of San Francisco), Masters of Science in Clinical Research (UCSF), or Advanced Training in Clinical Research Certificate program (UCSF).  This program will provide training and education in all aspects of EMS, including administration, research, medical oversight, teaching, and prehospital clinical care.  This fellowship is tailored toward academic and operational EMS and a graduate will be uniquely prepared for a career in academic EMS and/or medical direction for a regional EMS system.

• One year or two year fellowship
• Masters degree or equivalent required for two year fellowship
• Educational Fees paid for by the fellowship
• Attending duties at San Francisco General Hospital ED, level 1 Trauma Center and the San Francisco Veteran's Administration Medical Center Federal Coordinating Center for disasters in the Bay Area
• Disaster planning experience with SF Emergency Medical Services Agency
• Compensation based on PGY V salary

Applicants must be residency trained in an ACGME approved Emergency Medicine program and be board eligible or board certified in EM. They must have a California Medical License and DEA before starting fellowship. 

Goals

• Understand and master the public administration of EMS Systems at the local, regional, state, national, and international level
• Perform curriculum development, instruction, and evaluation of EMS provider education at all levels.
• Lead the medical preparation for, and if appropriate, response to major disasters.
• Master EMS research methodology and evaluation.
• Perform competent EMS quality improvement.
• Be eligible to sit for the EMS Medicine board exam at the conclusion of the fellowship program.

Interim EMS Fellowship Director

John Brown, MD,MPA, FACEP
Associate Clinical Professor of Medicine
San Francisco EMS Agency Medical Director

EMS Fellowship Co-Directors

Prasanthi Govindarajan, MD, MAS
Assistant Clinical Professor
Department of Emergency Medicine
University of California, San Francisco

Mary Mercer, MD
Assistant Clinical Professor
Deparment of Emergency Meidicine
University of California, San Francisco

Clement Yeh, MD, MS
Associate Clinical Professor
Department of Emergency Medicine
Medical Director of the SF Department of Emergency Management
University of California, San Francisco

Facilities

Local

The San Francisco EMS System comprises the geographic area of the City and County of San Francisco with a daytime population of 1.2 million and an annual volume of 70,000 EMS calls. The City has one base hospital (San Francisco General Hospital) and a highly professionalized work force of approximately 400 paramedics and 1,800 EMT-1’s. Prehospital oversight and emergency medical disaster planning is provided by the San Francisco EMS Agency, housed in the Department of Emergency Management. The SF EMS Agency is responsible for EMS program development including Public Access Defibrillation, EMS plans for mass gatherings, trauma, stroke and ST Segment Elevation Myocardial Infarction systems, and triage and care of patients with mental health and substance abuse multiple diagnoses with the Mission Street Sobering Center and Psychiatric Urgent Care Center. Close collaboration is achieved with regional EMS agencies and the State EMS Authority on many levels and with many projects.

Our faculty has unique positions of authority in almost all aspects of prehospital care in our community.  This program will be directly partnering with the San Francisco EMS Agency bringing a practical real world level of experience for our fellows.  The Department of Emergency Management provides Police, Fire, and EMS dispatch for all of San Francisco.  This system utilizes the Medical Priority Dispatch System for EMS call dispatch.  The San Francisco Fire Department provides service to approximately 70% of EMS calls are transported by the SF Fire Department.  Both of these entities allow for a unique centralized function for one jurisdiction allowing excellent system analysis.  San Francisco General Hospital is the sole Base Hospital in our community.

Dedicated office space for the EMS Fellowship is provided at the San Francisco EMS Agency with a prehospital library along with university library access.  The Emergency Department has in house statistical and research design support as well as intramural assistance for grant applications.

The UCSF Section of Emergency Medicine was involved in one of the first NIH sponsored prehospital trials, The Prehospital Status Epilepticus trial (A comparison of lorazepam, diazepam, and placebo for the treatment of out-of-hospital status epilepticus. N Engl J Med. 2001 Aug 30;345(9):631-7.)  This study was also instrumental in informing the Federal Rule for waiver of consent research.  We are currently a site for the San Francisco Node of the Neurological Emergencies Treatment Trials (NETT), an NIH funded multi-city research consortium.  We recently completed enrollment in a multi center prehospital waiver of consent study comparing intramuscular versus intravenous benzodiazepam.

The San Francisco Department of Public Health is responsible for the planning and implementation of programs to mitigate the impact of disasters on the health of San Franciscans. The fellows will be involved in this phase of public health, including providing medical direction and oversight to the City’s Field Care Clinic system, local pharmaceutical cache for homeland security and disasters, and can participate in the Metropolitan Medical Response System for terrorist attack response.

State

San Franicsico EMS Agencies has a long history of collaboration with regional EMS agencies and the State EMS Authority on many levels and with many projects.  There will be an opportunity to participate in the EMS Medical Director Association of California meetings as well as the state wide Scope of Practice Committee.  These organizations are important in setting the pace and direction of EMS practice in our state.  There will be an opportunity to take part as a member of the regional CA-6 Bay Area Disaster Medical Assistant Team, a national resource that is dispatched to nationally declared disasters.

International

EMS physicians may function as consultants on how to provide prehospital care in other nations maximizing resource utilization while providing competent care in a culturally appropriate manner. Recent projects have involved Haiti, Ukraine, Lithuania, Vietnam, and Tanzania.

Clinical and Research Components

Medical Direction:

Medical control - Learn the scope of medical oversight and the responsibilities for providing direct on-line as well as indirect/off-line medical control.

Provider medical direction – Opportunity to assist the medical directors for private and public EMS entities, including dispatch centers and ambulance providers.

Communications:

The Fellow should come to understand the principles of emergency medical dispatch, communications and 911 systems. The Fellow will learn about how these systems work by spending time in communications and by working with communications staff on continuing education for call takers, guide card revision and quality improvement.

Administrative:

Participation in Local / Regional / State EMS related functions – The fellow should gain an understanding of the interplay of local, regional and national regulatory processes on EMS administration. Attending local, regional, state and national administrative meetings (EMSAC, EMDAC, Scope of Practice Committee, EMS Commission) is encouraged.

Quality improvement - The Fellow should gain insight into the on-going function of continuous performance improvement program. The Fellow will develop a QI project and present the results to the appropriate organization.  Specific Risk Management cases will be presented for discussion and to inform process improvement and training.

The Fellow is encouraged to gain experience in researching new procedures / devices / medications and fostering service acceptance and / or state acceptance.

Field experience/ride along:

Ride along with ALS and BLS – Ride alongs are required and will enable the fellow to appreciate pre-hospital logistics and inter-service collaboration, directly observe EMT’s and paramedics and build rapport with field personnel. Field experience will involve direct patient care, EMS personnel supervision and training.

Teaching: 

Education of Residents, Medical Students, and Paramedics in a variety of teaching environments will be encountered including Lectures, bedside education, and high fidelity human simulation.

Mass gathering/mass casualty medicine:

• Participation in planning process and provision of care in mass gatherings (involvement in Bay to Breakers Road Race, Halloween Celebration, etc.). The experience can provide the fellow with a better understanding of political and logistical issues involved in the implementation of optimal medical care for mass gatherings. 
• Participation on mass casualty medicine - Involvement in small and large-scale drills, table top exercises and multi-agency drills (ie: Golden Guardian) The goal is to familiarize the fellow with the difficulties encountered in coordinating an optimal medical response with different services and jurisdictions.
• The Fellow is encouraged to join DMAT CA-6 for further mass casualty / disaster medical experience.
• Two EMS/Disaster Fellowship faculty members are medical officers for CA-6.

Clinical Research:

The Fellow will participate in the development and implementation of a specific EMS related research project.  The areas of research could range from system analysis, efficacy of specific prehospital interventions, EMD process, disaster preparedness to medical education.

Supervisory and patient care responsibilities 

Due to the unique funding from the EMS Agencies, the EMS Fellows will be involved in specific administrative tasks that will be complementary to their education.  The following are some examples of possible roles.

• Field Care Clinic Medical Director. There are 6 Field Care Clinics, which are mobile medical facilities the City has purchased to provide medical care in time of disaster. These clinics will be staffed by the San Francisco Department of Public Health (DPH) and other voluntary medical personnel and are designed to have medical supplies sufficient to care for 50 to 200 patients per hour.
• Public Access Defibrillation Program Medical Director. There are over 400 PAD programs registered with the EMS Agency; each program has one or more sites where an automatic external defibrillator is placed and personnel who are designated to respond to a cardiac arrest. The EMS Fellows would provide medical direction of this program, visiting sites, doing outreach to potential future sites, and promoting the program and providing education of the general public on this program.
• EMS Plans for Mass Gatherings Medical Director. The EMS Agency receives approximately 60 EMS plans per year for mass gatherings which need to be reviewed and modified. Some City agencies and private event organizers are providing complete plans, others less complete ones. The EMS Fellows will provide detailed plan review, follow up and the potential for site inspections for these plans and events.
• Assistance to the EMS Agency Quality Improvement Program.
• EMS Provider training assistance, including instructor for the City College of San Francisco CoAEMSP accredited paramedic training program, and instructor for the San Francisco Paramedic Association American Heart Association accredited regional training center.
• Performance Improvement project.
• Clinical Research project

The EMS Fellows will also be required to provide 12 hours of clinical coverage as a Clinical Instructor/Attending Physician per week in the Emergency Department at San Francisco General Hospital.

Progression of responsibility by PGY level

Initial year (PGY-5):

• Serves as attending physician at SFGH Emergency Department, providing on-line medical control and teaching UCSF medical students and UCSF, St. Mary's and CPMC Residents
• Teaches prehospital providers
• Initiates masters degree
• Completes didactics in EMS systems and research, initiates research project
• Initiated disaster didactics and membership in DMAT
• Provides medical direction for DPH administrative projects with oversight from fellowship directors

Second year (PGY-6): .

• Serves as attending physician at SFGH Emergency Department, providing on-line medical control and teaching UCSF medical students and UCSF, St. Mary's and CPMC Residents
• Teaches prehospital providers and develops curricula and systems improvements locally, state-wide, nationally or internationally according to interest.
• Completes masters degree
• Completes research project
• Continues membership in DMAT and teaches disaster medicine to all levels of providers
• Provides medical direction for DPH administrative projects with minimal oversight from fellowship directors
• Provides mentorship for UCSF EM Residents in EMS/Disaster Area of Distinction.

Teaching responsibilities of clinical fellow

• During their function as an attending physician at SFGH, the fellows will be supervising the clinical care of UCSF residents and medical students. They will be providing them with real time feedback and education.
• Participate in the lectures for the UCSF EMS/Disaster Medicine rotation.
• One to two paramedic education lectures per year.
• Aid in the curriculum development for ongoing paramedic training.

Application Procedure

• A cover letter explaining your interest in EMS and Disaster Medicine and any previous experience you have
• Curriculum Vitae
• Three letters of recommendation (one of which must be from your program director and another from your residency's EMS and Disaster Medicine Director if you have one at your institution)
• Deadline for application: September 1st
• Please submit the material via email to Eve Phongsasavithes, the fellowship coordinator. If you have any questions, please feel free to contact, Dr. John Brown, Fellowship Director.

Fellow Characteristics/Requirements

• Graduate of an ACGME approved U.S. Emergency Medicine residency
• Board eligible or board certified in Emergency Medicine
• Qualified to work as an attending at SFGH
• Must have a California Medical License and DEA before starting fellowship