EMS Heavy EM Residency

[JRaae]

So let me just start out by saying sorry if this is the wrong place to post this or there have already been discussions on this (which I couldn't find, but hey). I was in EMS quite a while before med school, so pretty naturally I'd like to stay involved with it through residency and at any subsequent job. I'm just wondering if anyone has some insight into which EM residencies have the most EMS experience/involvement/etc? So far as I can tell Indiana has the EMS track which is about as involved as you can be and KZoo also has a lot of great experiences with EMS / strongly encourages involvement. Any others would be nice to know about, especially in the West Coast / Mountain region.
I feel like I should also mention that I'm aware of the several EMS fellowships that exist and while I'm interested in perhaps pursuing them after residency, they're not what I'm currently asking about. Thanks in advance for the help though!

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[hoot504]

Look into UT Houston. Tons of EMS exposure. Busiest non-military helipad in the United States, as Life Flight is the only air medical transport unit in the city.

 

[namethatsmell]

UPMC.

I worked on rigs for 5 years before med school, so let me offer a little unsolicited advice: residency time spent on EMS is time not spent learning the type of skills/medicine you will want as much exposure to as possible during residency. Now that EMS fellowships are an official thing your time in residency is probably better spent learning how to handle a surge of patients hitting your department rather than learning to triage them in the field. Pick a program you'll be happiest at and where you'll learn the most. EMS and the fellowship will be there when your done.

 

[DeadCactus]

As an outsider, Cincinnati seems to do it well.

 

[engineeredout]

UPMC, allegheny general, Geisinger

 

[racerwad]

-Buffalo has a resident response vehicle like Western MI.
-UIC/Peoria has a EMS track w/ NAEMSP cert

 

[quickfeet]

Curious - what does one do these on EMS rotations? Forgive me ignorance, just curious.

 

[arkdoc]

I rotated at IU and they are heavy into EMS. Wake has really good involvement as well.

 

[Mighty Mouse]

Mercy St Vincents in Toledo -- very active flight system; adopt a firehouse; EMS ride alongs; EMS fellowship

 

[docdragon]

Cincinnati.
CMC in Charlotte?
Fresno -- first responder with park service, regular EMS oversight.
I believe Madison also allows you to fly with the HEMS team, though Cinci is the only program that requires it.
UPMC -- rapid response/fire chief vehicle

Also look at mass gatherings. Cinci, IU, and I believe Albuquerque for example.

 

[JRaae]

Awesome! Thanks for all the input!

 

[JRaae]

UPMC.

I worked on rigs for 5 years before med school, so let me offer a little unsolicited advice: residency time spent on EMS is time not spent learning the type of skills/medicine you will want as much exposure to as possible during residency. Now that EMS fellowships are an official thing your time in residency is probably better spent learning how to handle a surge of patients hitting your department rather than learning to triage them in the field. Pick a program you'll be happiest at and where you'll learn the most. EMS and the fellowship will be there when your done.

I totally get what you're saying. I'm not looking at this for experience in the field or understanding the EMS system - I did it for 6 years in rural and urban settings before school. It's more that I figured it would be time well spent. Rather than say rotating through many different medicine floors, these programs might offer something a little more tailored to me / let me network, etc. Plus, I'd love to get involved with education (like training paramedics at school or for renewals) and I've seen that at many of the same places that emphasize EMS.

 

[southerndoc]

UPMC, Orlando, Yale, Carolinas, Emory -- all have pretty heavy EMS involvement.

Pretty much any place that has an accredited EMS fellowship will have heavy EMS involvement.

 

[racerwad]

I totally get what you're saying. I'm not looking at this for experience in the field or understanding the EMS system - I did it for 6 years in rural and urban settings before school. It's more that I figured it would be time well spent. Rather than say rotating through many different medicine floors, these programs might offer something a little more tailored to me / let me network, etc. Plus, I'd love to get involved with education (like training paramedics at school or for renewals) and I've seen that at many of the same places that emphasize EMS.

You couldn't do EMS stuff in lieu of core rotations but most places nowadays are pretty good about minimizing wasted floor months. It sounds like what you're looking for is a place that has an ems track that allows you to focus your electives and extracurricular time on prehospital medicine.

TBH, as others have said before, your time is really best spent learning how to be a doctor. You are already an EMT or paramedic so try not to think of things like floor months as a waste.

When you are interviewing, ask about their ems rotations because a lot of places often just have you riding third turd rather than as a provider (hems or ground) and you probably don't want that. Places with fellowships tend to have better infrastructures for getting involved in paramedic/EMT training and continuing ed.

Curious - what does one do these on EMS rotations? Forgive me ignorance, just curious.

It depends on the program. Some just have you spending a month observing ems crews on ride alongs. Others have you providing real care. A few places (UMPC, Buffalo, Kalamazoo, etc) have residents staff quick response units longitudinally after intern year. Mainly, the goal is to expose residents to prehospital medicine if they don't have any prior experience. For those of us that used to be medics or EMTs, it lets us continue our obsession during training.

 

[DrDrummer]

I would say Harborview was the biggest during-residency in terms of EMS focus. UW Madison also has a heavy program in terms of flight if that's your thing. Hennepin also runs their own EMS agency, and while I don't know that you do any more field work than at any other residency (though I'm sure you could if you wanted) they have a strong presence.

 

[Dartmein]

UPMC does "Jeep shifts" (starting 2nd year--you get to ride in a ford explorer with lights and sirens) where you respond to scenes, guide EMS, etc. Also do helicopter flight shifts, but not as many as say....cincy. EMS fellowship that is ACGME accredited as well with a fair amount of "big name" EMS faculty.

 

[ihearttriangles]

When I applied this last cycle I too thought EMS would be one of the deciding factors for me. But, when I interviewed there were only a couple of places that actually let you play in the field. The rest had you observe and I thought that sounded horrible. I can't stand being placed in the corner. Nobody puts ihearttriangles in the corner, nobody! I had more than my fair share of that in med school and don't want anymore.

Plus, when I think back on what I enjoyed most about being a medic it was the camaraderie with my coworkers, the sense of community, the lack of fear of financial/legal repercussions, being young and single, etc... Now all that stuff is gone and I've just accepted that I'm old and married and have a sh@# ton of debt that I need to pay back as fast as possible. While I would certainly have enjoyed training someplace that let me play in the field I ultimately ranked based off of location/money (3 yrs)/availability of work for my wife. While all the bells and whistles seem important in the beginning I found that in the end location/family/money were really the only criteria I considered. Good luck!

 

[JRaae]

Plus, when I think back on what I enjoyed most about being a medic it was the camaraderie with my coworkers, the sense of community, the lack of fear of financial/legal repercussions, being young and single, etc... Now all that stuff is gone and I've just accepted that I'm old and married and have a sh@# ton of debt that I need to pay back as fast as possible. While I would certainly have enjoyed training someplace that let me play in the field I ultimately ranked based off of location/money (3 yrs)/availability of work for my wife. While all the bells and whistles seem important in the beginning I found that in the end location/family/money were really the only criteria I considered. Good luck!

It's funny - I was thinking something similar. My husband's generally not in for the east coast, or "anywhere with tornadoes". . . so with all the names folks are throwing out being in the Midwest or East, I get the feeling I may follow suit. Plus it probably helps that I've given up caring how much debt we have - it's just soul-crushing otherwise.

 

[JRaae]

You couldn't do EMS stuff in lieu of core rotations but most places nowadays are pretty good about minimizing wasted floor months. It sounds like what you're looking for is a place that has an ems track that allows you to focus your electives and extracurricular time on prehospital medicine.
TBH, as others have said before, your time is really best spent learning how to be a doctor. You are already an EMT or paramedic so try not to think of things like floor months as a waste.
When you are interviewing, ask about their ems rotations because a lot of places often just have you riding third turd rather than as a provider (hems or ground) and you probably don't want that. Places with fellowships tend to have better infrastructures for getting involved in paramedic/EMT training and continuing ed.

Right. I've looked into a few of those definitely - and they look pretty neat, especially with with assistant med director experience, etc. But hey, like everyone's mentioned - at the end of the day any residency will do the job. It's true. I'm just trying to narrow down the ones that peak my interest most, I suppose.

 

[CajunMedic]

OP, sounds like you are looking for the same things I am. Check out UA Birmingham- they used to require taking the Alabama EMS Medical Directors course along with involvement with Birmingham Fire/Rescue or the AL DMAT. Vanderbilt has a lot with Nashville FD IIRC.

LSU-Baton Rouge does a month in the PGY-3 Year. You spend a couple of shifts in communications, the rest are on the road as a 3rd rider with a crew (I was one of the medics they rode with). Typically, they want you to be involved with patient care and acting as on-scene med control as needed. They also teach a limited amount if it's during their inservice or mini-conference times. They have a new medical director as well as a community paramedic program, so it may be changing.

I don't know much about LSU-New Orleans other than one of them was on "Nightwatch", intubating a patient. Some of the medics I've worked with have said they also carry a radio and act as med control for the entire system for that shift.

I'd love to go to UPMC, maybe I'll be the lucky DO that can pull that off.

 

[deleted109597]

Every residency does an "EMS" month, as it's part of the RRC requirements.
Some just do a bit more than required.

 

[JRaae]

Right - that's true. Isn't it true too that a lot of them couple the EMS rotation with things like Toxicology or Admin (or just cut them down to 2 weeks) so you don't get a lot of practical experience as med control, etc? They're usually awesome at lots of other stuff - just EMS isn't their focus. Which is fair. It's not a huge community. That kind of lets me know I probably don't want to spend the next 3-4 years there though (I think - who knows how I'll change my mind in the next year).

 

[racerwad]

Right - that's true. Isn't it true too that a lot of them couple the EMS rotation with things like Toxicology or Admin (or just cut them down to 2 weeks) so you don't get a lot of practical experience as med control, etc? They're usually awesome at lots of other stuff - just EMS isn't their focus. Which is fair. It's not a huge community. That kind of lets me know I probably don't want to spend the next 3-4 years there though (I think - who knows how I'll change my mind in the next year).

Apart from the programs that folks have listed here, you'll want to ask at resiency interviews if their EMS experiences are longitudinal. some of the places that only had an EMS month were more than willing to let me make it a residency long thing, mainly through additional teaching, medical direction, etc.

 

[deuist]

Curious - what does one do these on EMS rotations? Forgive me ignorance, just curious.

At my program, we spent 2 weeks riding in the back of the ambulance while inhaling diesel fumes. I once got to help move a cardiac arrest patient out of her house. That was the highlight of the rotation.