Division of EMS and Disaster Medicine

Welcome from the Division Chief

WMed plays an integral role in disaster medicine and healthcare preparedness in Southwest Michigan and statewide. We believe that emergency physicians should have a solid foundation in disaster medicine and be leaders within this important and emerging discipline. Our residents receive outstanding training in disaster management throughout their residency and those with a particular interest in the discipline are afforded numerous opportunities for additional professional development.

Program Features

• Regional Healthcare Preparedness and Disaster Response 
  The Kalamazoo County Medical Control Authority (KCMCA) has been designated by the state of Michigan as the lead agency for the coordination of healthcare preparedness and disaster response for the nine counties in Southwest Michigan (Michigan Region 5). KCMCA is physically housed within WMed’s Department of Emergency Medicine and the EMS Division administrator provides support to the Regional Healthcare Preparedness Coordinator. Acting on behalf of the region, KCMCA coordinates resources, distributes state and federal grant funds to regional hospitals and EMS agencies, monitors the operational status of healthcare agencies on a continuous basis, and serves as a Regional Medical Coordination Center during major incidents. 
• MI-TESA
  The Michigan Transportable Emergency Surge Assistance (MI-TESA) Medical Unit is housed within Region 5, coordinated by KCMCA, and supported by WMed. The unit is a fully self-sufficient “field hospital” designed to operate in an austere environment and is deployed when local critical medical infrastructure is compromised. MI-TESA capabilities include full medical and trauma resuscitation resources; digital portable X-ray, ultrasound, and laboratory functions. MI-TESA is staffed by healthcare professionals from throughout the region but relies heavily upon our residents, faculty, and staff. The unit conducts  a variety of exercises each year. Emergency Medicine residents played a major role in staffing MI-TESA during Operation Vigilant Guard, a five-day major Department of Defense exercise in 2010, and also during a full scale deployment in the Spring of 2014. Experience in working with MI-TESA provides an excellent foundation for graduates interested in serving on federal Disaster Medical Assistance Teams (DMAT) or other specialized disaster response units.
• 5th District Medical Response Coalition
  Partners within the  nine counties of Southwest Michigan's 5th District form the 5th District Medical Response Coalition (5DMRC). This unique regional effort provides multi-disciplinary, cross-jurisdictional planning, training, exercising, and response.  The 5DRMC includes, the region's hospitals, major EMS agencies, public health departments, emergency management programs, long term and specialty care facilities, law enforcement, and other stakeholders. These entities meet together monthly to better prepare the region for natural and manmade disasters, and acts of terrorism. The Centers for Disease Control and Prevention has designated the 5DMRC as a 2008 Model Community for disaster preparedness, one of the few in the nation.
• National Disaster Life Support
  WMed has been designated as the coordinating agency for Michigan's National Disaster Life Support (NDLS) Program. Basic and Advanced Disaster Life Support (BDLS and ADLS) courses are conducted locally and program staff assist other regions in offering such programs. All of our residents receive training in both BDLS and ADLS. Senior residents frequently assist by instructing during the ADLS high-fidelity simulation components of the training.. Interested residents can become certified NDLS instructors during residency.
• Center for Domestic Preparedness
  Interested residents are encouraged to attend the weeklong Healthcare Leadership Course at the Center for Domestic Preparedness in Anniston, Alabama. Operated by the FEMA, this advanced-level course provides an opportunity for healthcare professionals from various disciplines to train together.  Attendees interact with other professionals from around the nation during highly challenging exercises. All course and travel costs are paid for by FEMA.
• MSU-1
  The resident-staffed Medical Support Unit (MSU-1) is an emergency management resource intended to rapidly forward deploy a senior Emergency Medicine resident physician to major EMS incidents. It carries various specialized equipment, including chemical and radiological monitoring devices, multi-port oxygen manifolds, trauma packs, and chemical antidotes. The residents that staff MSU-1 are required to complete training in Basic and Advanced Disaster Life Support, incident command and the National Incident Management System (NIMS). MSU-1 is available 24/7 to respond to multi-casualty and major EMS incidents in selected counties in Southwest Michigan.
• Faculty and Staff
  William Fales, MD serves as EMS Medical Director for Kalamazoo County, Program Director of the EMS Fellowship program and as core faculty within the residency. Dr. Fales also serves as the Regional Medical Director for Healthcare Preparedness, Medical Advisor to the Michigan State Police Emergency Support (Tactical) Team, Bomb Squad, and Emergency Management and Homeland Security Division, and is the State of Michigan Medical Director, Bureau of EMS, Trauma and Preparedness. Active at both the state and national levels, he serves as faculty for the National EMS Medical Directors Course. Dr. Fales has extensive experience in healthcare preparedness, homeland security, and disaster response. In addition, numerous WMed professional staff members are responsible for various aspects of healthcare preparedness and emergency management. Residents with a high level of interest in EMS use Dr. Fales as a mentor during residency and as a resource after graduation. A former paramedic and firefighter, Dr. Fales frequently responds to EMS incidents throughout the county.

Emergency Medical Services

At WMed, our residents are exposed regularly to a variety of EMS activities, ranging from the resident-staffed medical support unit (MSU-1) to plenty of hands-on training in a wide range of EMS and rescue practices. Emergency physicians must have a solid understanding of EMS and this is best achieved through a longitudinal experience throughout residency, rather than via an isolated rotation. We also believe that EMS is best mastered by being an active participant and our diverse set of experiences challenge our residents and instill an appreciation for the many facets of EMS that will stay with them throughout their careers.

The Kalamazoo County EMS system is a high-performance, single-tier Advanced Life Support system with robust countywide Basic Life Support first responders. Serving a population of approximately 250,000, the countyis served by five ambulance services covering designated areas of the county and 16 first-responder agencies provided through fire and public safety agencies. The Kalamazoo County Medical Control Authority coordinates and oversees the EMS system and is physically housed within WMed’s Department of Emergency Medicine. This partnership allows for close interaction between residents, faculty, and the EMS system's staff. Through the hard work and dedication of our EMS personnel and an effective EMS system design, cardiac arrest survival in Kalamazoo County is among the highest in the nation.

Key Features of our EMS Program

• MSU-1
  As noted above, the Medical Support Unit is a unique partnership between WMed, and KCMCA. Staffed 24/7 by a senior (PGY-2 or PGY-3) Emergency Medicine resident, MSU-1 is available to respond to a variety of EMS incidents. MSU-1's mission includes response to multi-casualty and other major EMS incidents, offering on scene medical control at EMS scenes, and providing medical control to paramedics via radio. Residents are typically on-call for a 24-hour block, during which time they are expected to respond to a minimum of four EMS scenes of any type. They are dispatched to all cardiac arrests, vehicle crashes with entrapment, multi-casualty incidents, major hazardous materials incidents, multi-alarm fires and other similar high-profile incidents. Additionally, they handle radio medical control consultation calls fromparamedics. Residents may take MSU-1 home at night. While faculty physician consultation is always a radio click away, this program affords residents tremendous autonomy and responsibility. Few residency programs in the nation provide this degree of EMS field experience. 
• Teaching Paramedics
  Ample opportunities exist for residents to teach medical first responder, EMT-B, and paramedic students and provide continuing education to practicing paramedics. First year WMed medical students take a medical first responder course at the start of their degree program and our residents assist with teaching. Several times per year, Kalamazoo County paramedics  engage in training in WMed’s Simulation Center and these sessions may be taught by residents. Residents also have opportunities to teach at the Kalamazoo Valley Community College's EMT-B and Paramedic Programs.
• EMS Research
  Ample opportunities exist for residents to participate in EMS research projects. Some residents develop research projects on their own with assistance from faculty where others join in on existing research projects. MSU-1 provides a unique opportunity to conduct field research and has been involved in NIH-funded pre-hospital resuscitation research. Students, residents, and fellows frequently present their EMS research findings at a variety of regional, State and national conferences. WMed is pleased to provide supplemental funding to residents presenting papers that is in addition to their standard conference funding.

Resident Response Vehicle

Overview

The medical support unit (MSU-1) Resident Physician Response Program is a unique partnership between WMed Emergency Medicine, the Kalamazoo County Medical Control Authority, and the Kalamazoo County Sheriff's Department Office of Emergency Management.  The program places a senior (PGY-2 or PGY-3) EM resident physician in a dedicated response vehicle on a 24/7 basis. MSU-1 is on call to respond to multi-casualty incidents, cardiac arrests, major trauma cases, and other major EMS incidents.  In this way, residents learn first hand how EMS operates. Residents develop the face-to-face relationships with our responders that allow them to more effectively interact during high stress incidents. Residents are considered field medical control physicians and are authorized by KCMCA to direct all aspects of pre-hospital care.

MSU-1 Equipment/Systems

• Communications and Navigation
  • 800 MHz mobile radio on Michigan Public Safety Communications System
  • VHF mobile radio
  • 800 MHz portable radio
  • iPhone
  • iPad with cellular data service
  • Active911 app provides dispatch information, GPS routing, and real-time tracking of MSU-1 and county first responders
• Mass Casualty and Special Response
  • MCI Trauma Pack
  • Multi-port oxygen manifold
  • Chemical Antidote Kit (includes nerve agent and cyanide antidotes)
  • Radiation and volatile organics detectors
  • Carboxyhemaglobin oximeter
• Personal Protective Equipment
  • Nomex fire resistant turn out coats
  • Helmets with eye protection
  • Gloves
  • ANSI high visibility vests (required for  use at roadway incidents)

   
• Medical Equipment
  • First in bags with standard BLS and ALS equipment
  • Advanced procedure bag includes:
    • EZ-IO intraosseous access device
    • RSI intubation meds
    • Cricothyrotomy kit
    • Chest tube set
  • ALS drug bag
  • Philips MRX monitor / defibrillator
  • Portable ultrasound
  • GlideScope

Medical Support Unit-1 (MSU-1) FAQs

• I don't have an EMS background; will that be a problem when working on MSU-1?
  No. Most of our residents don't have previous EMS experience. Residents receive extensive hands-on training before hitting the street in MSU-1.
• How do the paramedics feel about having residents responding in the field?
  Our EMS community has been very receptive to MSU-1. Frequently paramedics request MSU-1 respond to scenes that they believe to be particularly educational. Many paramedics realize that this is a wonderful opportunity for them to directly influence how emergency physicians view EMS.
• Don’t ride-alongs in EMS units achieve the same thing as MSU-1?
  Doing EMS ride-alongs is a good way to expose residents to EMS. However, in most ride-along programs, residents are passive observers, not active participants. Also, the unit the resident is assigned to may not be catching "the good" runs. MSU-1 is an integral part of our EMS system, serving as on-scene medical control. The unit is available, and expected, to respond to all of the major EMS incidents in the county.
• What if the MSU-1 resident has a complicated case where they need advice?
  While MSU-1 residents are encouraged to make autonomous decisions, attending-level advice is never more than a radio click or phone-call away.
• Is there a chance to sleep during a 24-hour MSU-1 shift?
  We realize how important sleep is to residents. Between 2300 and 0800 HRS, residents do not field medical control radio consult calls. While still on call to respond to major EMS incidents, these occur relatively infrequently. Generally, if MSU-1 is asked to respond during the night, it is well worth losing a few hours of sleep. Thus, during evening hours, MSU-1 is essentially “home call.” Residents do need to live within Kalamazoo County in order to ensure a timely response time.
• What authority do MSU-1 residents have on scene?
  Residents are considered to be medical control physicians and operate as representatives of the Kalamazoo County Medical Control Authority.

Annual EMS Day

The annual EMS Day event each fall affords our residents a great opportunity to experience first hand many of the challenges of EMS and rescue operations. We hold EMS Day each fall. Four teams are created, consisting of even numbers of first-, second-, and third-year residents, rotating residents and medical students. Each team rotates through four stations. Each station has a particular focus: 

• Vehicle Rescue and Extrication Techniques
• KED Boarding and In-Car Airway Management
• EMS Trauma Skills and MSU-1 Review
• Chemical Protective Clothing and HazMat/Decon

The purpose of EMS Day is to expose residents to some of the many challenges our colleagues in EMS and fire/rescue face every day.  As emergency physicians, we typically receive trauma patients after they have been extricated, packaged and, in some cases, decontaminated in the field. EMS Day allows us to better appreciate the process that has occurred before patients arrive in our emergency departments. Additionally, EMS Day helps to better prepare our residents to work effectively as part of the EMS Team on MSU-1. Finally, EMS Day is a fun, team-building experience that is a welcome break from the normal clinical and educational routine.

• Vehicle Rescue and Extrication Techniques
  For many, this is the most popular of the four stations. Residents don bunker gear, helmets, and gloves and, with the assistance of skilled firefighters serving as instructors, use standard highway rescue power tools to dissect a car. Cribbing is used to stabilize the vehicles. Windows are shattered and windshields removed. Powered hydraulic spreaders (AKA "Jaws of Life") are used to pry open doors. Hydraulic cutters and electric reciprocating saws are used to sever roof posts allowing for total roof removal. Pneumatic lifting bags are used to lift the entire vehicle in a matter of seconds.  This is a rare chance for residents to experience first hand the physical and mental challenges of performing highway rescue operations. Safety is stressed and an injury-free day is always our primary goal.
• KED Boarding and In-Car Airway Management
  Stabilization of a patient’s cervical spine using a KED Board can be a challenging skill. So, too, can managing a patient's airway when they are pinned inside the wreckage of a car. This station provides hands-on training in these two skills that are required of effective EMS personnel. Residents learn a number of tricks of the trade from some of the best EMS providers in the business.
• EMS Trauma Skills and MSU-1 Review
  This station covers the use of the long spine board, traction splinting, and other vital EMS skills. Additionally, residents review MSU-1 equipment and operations. For first-year residents, this is usually their first exposure to MSU-1. For senior residents, it's a good opportunity to become reacquainted with some of the important specialized equipment.
• Chemical Protective Clothing
  While not an everyday EMS skill, the use of chemical protective clothing is a vital form of EMS personal protection. Residents dress out in chemical suits and don powered air purifying respirators. This is the same type of equipment used by hospital decontamination teams.
• Taking Residents to New Heights
  A popular – but optional -- confidence builder involves climbing the aerial fire truck to the top. You can't beat the view!
• The Grand Finale!
  The final event of EMS Day is a group photo while burning one of the cars. While arguably not a "Green" event, residents learn how quickly a vehicle fire can progress. From a safe distance, they can also appreciate the tremendous heat released from such a fire. Some things you just can't get out of a book.

Division Team Members

William D Fales, MD