Affiliated with The Mecklenburg Emergency Medical Services Agency

The EMS Fellowship Program under the Center for Prehospital Medicine, Department of Emergency Medicine at Carolinas Medical Center began in 1991 and is affiliated with the Mecklenburg EMS Agency (Medic) in Charlotte-Mecklenburg County. The Program has been a Society for Academic Emergency Medicine-Medtronic/PhysioControl approved EMS training site since inception. The first fellow graduated in 1996 and to date, 12 fellows have successfully completed the Program. The Fellowship is typically a one-year program. A two-year program is optional which affords a Masters Degree in Public Health Administration form the University of North Carolina-Charlotte if desired. Up to two positions are offered to qualified candidates who must be residency trained and board certified/eligible in Emergency Medicine.

The EMS fellow will serve as the Assistant Medical Director for Medic and the affiliated provider agencies, and will be responsible for performing all duties required by the Medical Director. A 2004 Chevrolet Tahoe with appropriate warning lights, siren, radio, and markings is assigned to the fellow for permanent use 24-hours a day. This vehicle is a fully equipped with the necessary equipment and supplies to respond on any call. The fellow will also be issued a hospital pager, EMS pager, and 800 mHz radio. Participation in all activities conducted by the Center for Prehospital Medicine, including the paramedic program and special event medical coverage will be expected. The EMS fellow will also provide clinical duties as an Emergency Medicine Attending approximately every 6th weekend.

The unique design of this Program and the EMS system affords complete medical control of all prehospital medical components within the community. The opportunity exists to nourish any special interest that a fellow may have regarding a future in prehospital care.

Fellowship Opportunities

1. EMS Education - At Carolinas Medical Center, the Carolinas College of Health Sciences and The Center for Prehospital Medicine administers an 9-month (full-time) and 15-month (part-time) Paramedic Training Program, a Nurse to Paramedic Bridge Course, and a two-year Associates Degree in Emergency Medical Science Program. Five full-time prehospital faculty and additional adjunct faculty provide the curriculum development, course content, didactic lectures, clinical rotations, and lab sessions. EMS fellows become involved with program administration and teaching at all levels. There are multiple opportunities to provide inservice education to emergency medicine residents, Medic staff, and first responder personnel, including quarterly prehospital Morbidity and Mortality conferences at Medic.
2. Tactical EMS - Medic developed a tactical medical support unit that provides medical coverage for the Charlotte-Mecklenburg Police SWAT and the Charlotte FBI SWAT teams. The tactical medics and medical director participate in all drills and training exercises and respond with the team whenever a deployment occurs. A dedicated tactical EMS ambulance has been developed that contains all equipment and supplies necessary for tactical deployments. Additional opportunities for the tactical paramedics include deployments with the Charlotte-Mecklenburg Police Field Force and the Aviation Unit where short hauls, rescues, and rappelling are all incorporated into the scope of practice.
3. Field Response - The EMS fellow has a dedicated 4-wheel drive SUV adapted for emergency response with warning lights and siren. While there is not a mandate to respond, the medical director and EMS fellow are paged on particular calls and response is encouraged. All medical care equipment is provided including personal protective equipment, cardiac monitor/defibrillator, and laryngoscope with assorted fiberoptic blades, and prehospital medications. The EMS fellow plays an integral role in providing stand-by medical coverage for working fires, hazardous materials incidents, and any incident resulting in mass casualties.
4. Off-Line Medical Control - The EMS fellow is required to assist in all off-line duties provided by the medical director. Assessment Centers for new hires include a battery of interviewing and testing, and the new employee Orientation Program offers a unique opportunity to participate in training all providers in basic and advanced skills. The Patient Care Protocols are fluid in nature, constantly changing to meet the needs for the changing community and healthcare advancement. The fellow will be required to draft new protocols and to reengineer existing ones. Similarly, new equipment and medications will also be reviewed and implemented if selected. The fellow will become involved in all clinical incident review processes. The medical director and EMS fellow all review priority transports as part of the quality improvement process. Deficiencies are handled in a due process review format. The fellow will work closely with the two Quality Improvement Analysts to review specific data, evaluate trends in system performance, and to identify opportunities for improvement.
5. Mass Gathering Medical Support - The Center for Prehospital Medicine faculty are responsible for medical oversight for all special events coverage at multiple sites including Bank of America, Lowes Motorspeedway (NASCAR racing), Knight's Stadium (Charlotte Knights AAA baseball team), Wachovia PGA Tournament, Charlotte Convention Center, and other venues as requested. The fellow will assist in coverage at all Bank of America and Lowes Motorspeedway events and may choose to participate in others if interested. The fellow always has a full access pass and credentials at all venues.
6. Air Medical Services - The MedCenter Air Flight Service at Carolinas Medical Center operates two Bell 230 helicopters, three King Air fixed wing aircraft, and one Citation jet. The helicopter responds to approximately 1200 flights each year, 30% of which are scene responses. EMS fellows have the option of participating on the flight team and with inservice education and quality improvement processes.
7. Disaster Medicine and Terrorism Preparedness - Carolinas Medical Center serves as the central facility for all disaster and preparedness activities for the Metrolina region. A full-time Disaster Preparedness Planner is on faculty at the Center for Prehospital Medicine. The fellow will assist in disaster preparedness for the hospital and the regional facilities as well. Creating a coordinated system response and identification of resources for incapacitated facilities of those experiencing surge capacity is the ultimate goal.
   Since 1997, tremendous effort has been dedicated toward the preparedness of Mecklenburg County against the threat of biological and chemical terrorism. Our considerable success to date has been predicated upon a strong coalition among the participating agencies and organizations. Other critical ingredients have included substantive Federal grant support and the leadership qualities and enthusiasm of each interagency chief and director.
   The primary focus of all incident response activities involves the Advanced Local Emergency Response Team (ALERT). This team concept builds on and supports existing emergency resources that may be called on to respond to a mass casualty incident. It functions as an interagency cadre of experts, highly skilled and cross-trained to alternative disciplines such that terrorist incidents may be expeditiously and appropriately mitigated. ALERT is designed to ensure that victims of a terrorist incident are properly cared for and that the community infrastructure is kept safe and is functionally maintained.
   ALERT members were selected from the Charlotte-Mecklenburg Police Department, Mecklenburg County Sheriff's Department, Federal Bureau of Investigation, United States Marshal's Service, Transportation Security Agency, Charlotte Fire Department, Mecklenburg EMS Agency, Mecklenburg County Medical Examiner's Office, and Carolinas Medical Center. All team members have been trained on the unique special characteristics of a biological or chemical incident, and training initiatives have centered on mass decontamination of ambulatory and nonambulatory patients. Each member understands issues related to scene security, crowd and traffic control, evidence preservation, hazardous materials, decontamination procedures, and all issues related to patient care (triage, treatment, and transportation).
   As the only Level-1 Trauma Center in the region, Carolinas Medical Center has undergone extensive renovation and prepared personnel for responding to a chemical or biological attack. A system of barrier canvas tarps designed to restrict facility access have been designed and constructed. These are easily deployed by staff using a manual roller system. Using this system, two points of entry are possible; one for ambulatory and one for nonambulatory patients. Additional barriers are located between the ambulatory and nonambulatory sections for confidentiality purposes.
8. Med-1 - It is understood that hospital surge capacity and vulnerability increases with disasters resulting in mass casualties; therefore, the decision was made to create an alternative treatment facility to augment existing resources or to support the capabilities of local healthcare systems.
   The staff at Carolinas Medical Center developed Carolinas MED-1 over a three-year period to include the necessary and anticipated level of care required when disasters or mass casualty incidents occur. This one-of-a-kind mobile treatment facility will also serve as a prototype for other communities looking to expand existing mobile healthcare programs.
   Carolinas MED-1 is designed and equipped to address a wide range of emergency medical conditions. Emergent operative surgery, orthopedic stabilization, wound repair, burn treatment, and management of multiple medical problems are all possible.
9. Other Activities - The EMS fellow will have the opportunity to participate in all components of the EMS system including fleet maintenance, ambulance design and purchasing, materials management, human resources, budget preparation and auditing, and systems status management. The fellow will interact with all affiliated first responder and law enforcement agencies.

Mecklenburg Emergency Medical Services Agency
Mecklenburg EMS Agency (Medic) was established in 1978 as a third-service/municipal system endorsed and supported by the Mecklenburg Board of County Commissioners. The system has progressed over the years through all levels of provider certification, and currently is described as a single-tier, all advanced life support paramedic service.

In an effort to improve service delivery, the two hospital systems in Charlotte (Carolinas HealthCare System and Presbyterian Health Care System) introduced a proposal to the Board of Commissioners to administer and operate the EMS system as a joint agency. The proposal was accepted, and on October 8, 1996, the Mecklenburg EMS Agency was initiated. Since that time, multiple improvements in all components of the EMS system have been realized. Medic reaches all emergency, life-threatening calls in less than 9 minutes 59 seconds for at least 90% of the calls received.

Medic is the single provider of all 9-1-1 and prescheduled transports in Mecklenburg County. An Ambulance Franchise Ordinance exists which prohibits 9-1-1 competition. First responder services are provided by the Charlotte Fire Department within the city limits of Charlotte and by 15 volunteer fire and rescue squads in the incorporated and unincorporated areas of the county. All first responder services are under contractual agreements with the Agency and all personnel are under the aegis of medical control, functioning at the EMT-D level of care. The annual Medic call volume exceeds 75,000 call responses, approximately 60,000 of which result in hospital transport. 15% of these calls are considered critical or life-threatening.

Medic moved into their new headquarters location in September, 1998. This new 88,000 square foot central operations facility incorporates all components of the system including Administration, Clinical Affairs, Operations, Human Resources, Materials Management and warehouse, Communications, fleet services, and building maintenance.

Administration
The Administrative Division coordinates all human resource efforts which include all employee benefits, safety and risk management, and occupational safety. An Occupational Health Nurse is on-site full time to assist with routine and preventative health and wellness. Assessment centers for new hires and new employee orientation programs are supervised by the Human Resources staff. The Quality Improvement staff and all office support staff are also components of the Administrative functions of the Agency. Two full-time Quality Improvement Analysts oversee all Agency databases and assist in multiple clinical and operational projects.

Medical Services
The Medical Services Division provides oversight to all clinical patient care components of the system. The Medical Services Director and a nurse educator oversee all continuing education programs for Medic personnel and the first responders. Inservice education programs are conducted year round and include didactic and skill sessions, evaluation, and testing to ensure employee competence. All instructional programs are approved by the Medical Control Board and the North Carolina Office of EMS. Ten Field Supervisors provide oversight to all operational and clinical field activities, responding to calls, observing continuing care of transported patients while in the emergency department, and reviewing Patient Care Reports. All assist with the educational programs as well. An Education Coordinator ensures that all certifications are current and that all employees are attending the inservice programs.

Operations
The Director of Operations and Operations Manager oversee the day to day activities of the system. Shift Supervisors are present 24-hours a day ensuring that staffing levels are appropriate and that the system is running appropriately. Medic incorporates it's own Communications Center, logistics staff and warehouse, and fleet services department.

The Charlotte-Mecklenburg Police Department serves as the primary PSAP for incoming 9-1-1 calls. Medical calls are immediately forwarded to the Central Medical Emergency Dispatch Center. This communications center is under the direction and control of Medic. All telecommunicators are certified at the Emergency Medical Dispatcher level. The Medical Priority Dispatch System is used for call screening and prioritization. Communications Supervisors serve as system status controllers, with each ambulance incorporates a GPS and mobile mapping system. A $1.2 million upgrade in the computer-aided dispatch system was recently installed to improve overall system performance and response times.

Carolinas Medical Center
Carolinas Medical Center is a 861-bed, tertiary care hospital that serves as the only regional level-I trauma center and the State Poison Control Center. Approximately 110,000 patients are seen each year in the newly renovated ($3 million) emergency department. Residency programs exist in all specialties including Emergency Medicine. The Emergency Medicine Residency is a PGY 1-3 program that includes 30 residents. Fellowship positions are offered in EMS, Toxicology, and Research. There are 17 academic and 5 clinical faculty in the Department of Emergency Medicine.

Research
The Cannon Research facility was completed in 1991 and serves as a small and large animal lab for all clinical departments in the medical center. The Department of Emergency Medicine has dedicated lab space, including 2 operating rooms and small animal lab. Support personnel include 2 research scientists at the Ph.D. level, 2 clinical research nurses, and 4 lab technicians.

Research in Progress
Multiple prehospital projects are currently in progress, including the following:

1. Virtual Simulation - A project involving the development of a "Hollywood Soundstage" that would serve as a virtual simulation lab for paramedic competency education. This project is supported by a Grant from the National Highway Traffic and Safety Administration.
2. Carbon Monoxide - This study involves a descriptive cross sectional survey of exhaled carbon monoxide levels amongst firefighters at a training fire to compare differences in smokers and nonsmokers and those who don an SCBA during suppression and overhaul activities.
3. Ambulance reassignment using the Medical Priority Dispatch System - The purpose of this project is to evaluate the clinical impact on patients when responding ambulances are reassigned to higher priority calls.
4. Impact of the Medical Priority Dispatch System and emergency medical dispatchers to provide pre-arrival instructions for administering CPR.
   This multisystem study will evaluate the time it takes callers to determine if CPR is needed, the percentage of callers who are willing to perform CPR, and the time to initiate the procedure, and outcome.
5. Development and evaluation of a prehospital protocol for paramedic - determined triage of behavioral emergency patients directly to a psychiatric hospital emergency service without a medical clearance examination.
   This is a three-phase development study that will evaluate the following:
   1. Identifying prehospital clinical predictors in psychiatric patients which correlate the need for a comprehensive medical clearance examination prior to transfer to a psychiatric emergency service.
   2. Using an observational model, determining the ability of paramedics to safely and accurately utilize a transport tool for the on-scene triage of suspected behavioral emergency patients directly to a psychiatric hospital.
   3. To prospective measure of the safety and accuracy of a protocol allowing paramedics to triage suspected behavioral emergency patients directly to a psychiatric hospital.

Abstract Presentations by Faculty and Former EMS Fellows
View abstract presentations...

Location (Charlotte and Vicinity)
Charlotte is located in the southern piedmont region of North Carolina. Two large lakes are situated at the northwest and southwest corridors of the county. Driving time to the Great Smoky Mountains is approximately 3 hours, and approximately 4 hours to North and South Carolina beaches, including the Outer banks, Myrtle Beach, Charleston, and Hilton Head. The summers are hot and winters mild with occasional snow falls and ice storms. Mecklenburg County is approximately 550 square miles, with the city limits of Charlotte comprising about 250. The population is around 400,000, with an additional commuter influx of about 200,000. The city hosts a ballet, symphony, and multiple theaters. Professional sports teams include the Carolina Panthers NFL, Charlotte Bobcats NBA and NASCAR. Baseball, soccer, and ice hockey are at the semi-professional level.

Should you be interested in our program, please download and complete the electronic application and forward along with your curriculum vitae. If we can provide additional information concerning our program or your decision, please do not hesitate to contact us.