WMed plays an integral role in disaster medicine, healthcare preparedness, and emergency medical services in Southwest Michigan and statewide through our physician response vehicle program, administrative and leadership roles in multiple prehospital oversight agencies, regional and state level committee participation (our division chief is also the EMS Medical Director for the State of Michigan), national disaster life support foundation course coordination, EMS Fellowship Program offering post-residency specialized training, and much more. We believe that emergency physicians should have a solid foundation in prehospital and disaster medicine and be leaders within these important disciplines. Our residents receive outstanding training throughout their residency and those with a particular interest in these disciplines are afforded numerous opportunities for additional professional development.
Our EMS faculty, fellow, and prehospital resident responded to numerous scenes created by a destructive tornado in 2024.
The Kalamazoo County Medical Control Authority (KCMCA) is a pseudo-governmental agency tasked in state statute with oversight of the county’s EMS system. KCMCA is physically housed within WMed’s Department of Emergency Medicine, and has served as a lead agency for the coordination of healthcare preparedness and disaster response for the nine counties in Southwest Michigan (Michigan Region 5) for numerous years. Several examples include: responding to large senior citizen apartment complex fires and providing support at the reception centers, assisting with patient care at major highway pile ups during winter snow storms, setting up and staffing a call center during the early period of the covid-19 pandemic, and organizing/staffing a low acuity covid-19 isolation hotel operation for patient without sufficient means to isolate during their infectious window. Our faculty, residents, and fellows are also members of the Region 5 Technical Rescue Team and respond out to various scenes to provide medical support to the team and patients.
MI-TESA is staffed by healthcare professionals from throughout the region but relies heavily upon our residents, faculty, and staff. The Michigan Transportable Emergency Surge Assistance (MI-TESA) Medical Unit is housed within southeast Michigan and supported by WMed through personnel to staff the unit. This 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 - our residents and fellows can participate. 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.
Our residents and fellows learn about HazMat decontamination in a practical sense. They get to don PPE and take a manikin through the decon line, learning about the steps and challenges in this process. 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, tribes, law enforcement, and other stakeholders. These entities meet together regularly to better prepare the region for natural and manmade disasters, and acts of terrorism. The Centers for Disease Control and Prevention designated the 5DMRC as a “2008 Model Community” for disaster preparedness, one of the few in the nation.
As part of the PGY2 and EMS Fellowship curricula, residents and fellows take our Advanced Disaster Life Support Course. 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 and fellows receive training in both BDLS and ADLS. Interested residents and fellows can become certified NDLS instructors during residency.
Interested residents and fellows 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.
During a lake effect snow event, a chain reaction crash occurred on one of our interstates and led to a 195-vehicle pileup. In addition to assisting with patient care, our faculty and prehospital resident had to navigate leaking chemicals and a truck carrying fireworks which had ignited. The resident-staffed Medical Support Unit (MSU-1) is a prehospital resource intended to rapidly forward deploy a senior Emergency Medicine resident physician and/or EMS Fellow to major EMS incidents. It carries Advanced Life Support supplies and various specialized equipment, including chemical and radiological monitoring devices, multi-port oxygen manifolds, trauma packs, and chemical antidotes. The residents and fellows 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 24/7/365 to respond to multi-casualty and major EMS incidents in selected counties in Southwest Michigan.
William Fales, MD, serves as EMS Medical Director for Kalamazoo County, a core faculty member (past program director) of the EMS Fellowship program, and as core faculty within the residency. Dr. Fales served as the past Regional Medical Director for Healthcare Preparedness, continues to serve as 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 EMS 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.. 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.
Joshua Mastenbrook, MD, serves as the EMS Medical Director for Allegan County and Associate EMS Medical Director for Kalamazoo County. He is the EMS Fellowship Program Director, Associate Program Director for the residency, EMS elective director, and EMIG faculty advisor. Dr. Mastenbrook has served on a number of regional and national committees, including the EMS Milestones 2.0 writing committee, the State of Michigan Trauma Advisory Committee, MI-TESA Operations Group, the Michigan SaveMiHeart Conference planning committee, Region 5 Medical Control Authority Network (chairperson), Region 5 Trauma Professional Standards and Review Organization (chairperson), and the Kalamazoo Community Research Symposium planning committee (co-chairperson). As a current paramedic and firefighter, he still actively serves his community responding to calls for service in addition to responding to calls within the county as an EMS physician.
John Hoyle Jr, MD, serves as the Associate EMS Medical Director for Pediatrics for Kalamazoo County, the current David Overton Endowed Chair of the Department of Emergency Medicine, and core faculty for both the residency and fellowship programs. Dr. Hoyle is quadrupled boarded – EM, PEM, Peds, EMS. He is an accomplished researcher with >1 million dollars in grant funding, with a focus on prehospital pediatric management. Dr. Hoyle continues to maintain his prehospital skills by responding to scenes within the county with our residents and fellows.
William Selde, MD, serves as the EMS Medical Director for Yellowstone National Park and is one of our core faculty for the fellowship program. He has earned his paramedic and firefighter certificates and was serving his community via a local fire department prior to being deployed overseas as a reserve in the US Navy. Dr. Selde has served as the chairperson of the air medical committee within the NAEMSP organization and occasionally writes articles for JEMS.
Stephanie Van Alsten, MD, serves as the EMS Medical Director for Calhoun County and Indiana Dunes National Park, Associate EMS Medical Director for Kalamazoo County, the Associate Program Director for the fellowship program, and core faculty for the residency program. She is a graduate of our EMS Fellowship program and still responds to prehospital scenes as an EMS physician to maintain her skillset.
Michael Bentley, MPA, serves as the Director of the Division of EMS and Disaster Medicine. He is one of our fellowship core non-physician faculty members. Michael is a former paramedic and hold an EMS Instructor-Coordinator license.
Judy Wheeler, MPM, serves as the Director for the NDLSF program within the state of Michigan, Coordinator for our American Heart Association courses, and Director of our M1 Medical First Responder course. She is one of our fellowship core non-physician faculty members. Judy is a former paramedic, QA manager, and holds an EMS Instructor-Coordinator license.
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, two-tier Advanced Life Support system with robust countywide Basic Life Support first responders. With a population of approximately 260,000, the county is served by two ALS 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.
Pictured above are our two EMS Physician response vehicles along with the Region 5 Major Incident Support Unit. As noted above, the Medical Support Unit is a unique partnership between WMed and KCMCA. Staffed 24/7/365 by a senior (PGY-2 or PGY-3) Emergency Medicine resident, MSU-1 is available to respond to a variety of EMS incidents. MSU-2 is staffed by our fellow(s). 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 phone or 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, tech rescues, multi-casualty incidents, major hazardous materials incidents, multi-alarm fires and other similar high-profile incidents. Additionally, they handle medical control consultation calls from paramedics with Kalamazoo County, Yellowstone National Park, and Great Smokey Mountains National Park. Residents may take MSU-1 home at night. While faculty physician consultation is always a radio click/phone call away, this program affords residents tremendous autonomy and responsibility. Few residency programs in the nation provide this degree of EMS field experience.
Our EMS Fellow discusses cardiac arrest management with a group of paramedic students at our local community college. 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/fellows 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/fellows. Residents/fellows also have opportunities to teach at the Kalamazoo Valley Community College's EMT-B and Paramedic Programs.
Ample opportunities exist for residents/fellows to participate in EMS research projects. Some 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 prehospital 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/fellows presenting papers, that is in addition to their standard conference funding.
Resident/Fellow Response Vehicles
Overview
The medical support unit (MSU-1 & 2) Resident & Fellow Physician Response Program is a unique partnership between WMed Emergency Medicine, the Kalamazoo County Medical Control Authority, and our two hospital system, Beacon Kalamazoo and Bronson Methodist. The program places a senior (PGY-2 or PGY-3) EM resident physician and/or EMS Fellow in a dedicated response vehicle for a 24-hour shift. MSU-1 is staffed 24/7/365 whereas MSU-2 is staffed based on 48 hours of EMS Fellow home call per week. The physician response units are directly dispatched by the Kalamazoo County Consolidated Dispatch Authority (911 Center) for responses to multi-casualty incidents, cardiac arrests, significant traumas, tech rescues, and other major EMS incidents. In this way, residents/fellows learn first-hand how EMS operates. Residents/fellows develop the face-to-face relationships with our responders that allow them to more effectively interact during high stress incidents. Residents/fellows are considered field medical control physicians and are authorized by KCMCA to direct all aspects of prehospital care.
A MSU-1 resident physician (blue helmet) assists with extrication at a highway crash.
800 MHz mobile radio on Michigan Public Safety Communications System
VHF mobile radio
800 MHz portable radio
VHF fire pager
iPhone with FirstNet cellular data service
iPad with FirstNet cellular data service
Active911 app provides dispatch information, GPS routing, and real-time tracking of MSU-1 and county first responders
Crewforce app is a two-communication app that interfaces with the 911 center, providing scene/dispatch details, live GPS tracking, and routing information
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.
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" calls. 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.
While MSU-1 residents are encouraged to make autonomous decisions, attending-level advice is never more than a radio click or phone-call away. There is an on-call EMS faculty member each day.
We realize how important sleep is to residents. Between 2300 and 0800 HRS, residents do not Kalamazoo County medical control radio consult calls, although they may still get an occasional National Park consult. Residents are still on call to respond to major EMS incidents, but overnight 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 are considered to be medical control physicians and operate as representatives of the Kalamazoo County Medical Control Authority.
Annual EMS Day
Our annual EMS Day is held each fall and affords our residents/fellows a great opportunity to experience first-hand many of the challenges of EMS and rescue operations. Squads are created so that there is a mix of PGY level EM residents and rotating residents/students. Each squad rotates through all stations:
Vehicle Rescue and Extrication Techniques
Kendrick Traction and In-Car Airway Management
Prehospital Traumatic Arrest Management
Adult Cardiac Arrest Management
MSU-1 Review
First On-Scene Scenarios
Ambulance Patient Compartment Orientation
High-Rise Repelling and In-Air Intubation
The purpose of EMS Day is to expose residents/fellows 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 processes that occur before patients arrive in the emergency department. Additionally, EMS Day helps to better prepare our residents/fellows to work effectively as part of the EMS Team while staffing our physician response vehicles. Finally, EMS Day is a fun team-building experience that is a welcome break from the normal clinical and educational routine.
For many, this is the most popular station. 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 extrication techniques during simulated rescue operations. Safety is stressed and an injury-free day is always our primary goal.
Stabilizing a closed mid-shaft femur fracture is an important prehospital skill and part of a multi-modal analgesic plan. Managing a patient's airway when they are pinned inside the wreckage of a car offers its own challenges aside of the procedure itself. 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 our faculty, including the tomahawk intubation technique.
This station covers the prehospital management of blunt traumatic arrest patients including hemorrhage control, oxygenation/ventilation, needle/finger thoracostomy, and disposition decision making in accordance with the associated state EMS protocol for traumatic arrests.
In this station, squads get the opportunity to manage an out-of-hospital cardiac arrest with a high-fidelity simulator utilizing equipment that would typically be available from first responder and advanced life support units.
At this station, residents and students discuss our prehospital physician response program that is part of our longitudinal EMS curriculum. Medical and protective equipment, communication and dispatch related technologies, and scene response logistics are reviewed.
Given that our emergency medicine residents and EMS fellows respond to prehospital scenes as part of the longitudinal EMS curriculum, we use this teaching station to cover what to do in the first 5-10 minutes when the EMS physician is first on-scene. Scenarios include a respiratory distress tracheostomy case, an opioid overdose, and a scene safety situation.
Life EMS is the advanced life support ambulance agency that serves the majority of Kalamazoo County. For EMS Day they bring an ambulance to orient our residents and fellows to the patient compartment, giving squads the opportunity to load and unload a power stretcher, review the location of patient care equipment, and gain insight into the available working space. Our senior residents and EMS fellows typically accompany critical patients into the hospital from scenes to which they responded, hence the importance of being familiar with the patient compartment of the ambulance.
Who wants to be treated by a physician in the emergency department who has not repelled from the fifth story of a building and intubated a manikin 30 feet off of the ground? Our colleagues from Comstock Fire Department provide our residents, fellows, and students with the opportunity to safely repel down the side of the county fire training tower. We also position a stokes basket with a manikin in midair as a fun challenge to intubate via direct laryngoscopy.
For many, this is the most popular station. 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 extrication techniques during simulated rescue operations. Safety is stressed and an injury-free day is always our primary goal.
Stabilizing a closed mid-shaft femur fracture is an important prehospital skill and part of a multi-modal analgesic plan. Managing a patient's airway when they are pinned inside the wreckage of a car offers its own challenges aside of the procedure itself. 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 our faculty, including the tomahawk intubation technique.
This station covers the prehospital management of blunt traumatic arrest patients including hemorrhage control, oxygenation/ventilation, needle/finger thoracostomy, and disposition decision making in accordance with the associated state EMS protocol for traumatic arrests.
In this station, squads get the opportunity to manage an out-of-hospital cardiac arrest with a high-fidelity simulator utilizing equipment that would typically be available from first responder and advanced life support units.
At this station, residents and students discuss our prehospital physician response program that is part of our longitudinal EMS curriculum. Medical and protective equipment, communication and dispatch related technologies, and scene response logistics are reviewed.
Given that our emergency medicine residents and EMS fellows respond to prehospital scenes as part of the longitudinal EMS curriculum, we use this teaching station to cover what to do in the first 5-10 minutes when the EMS physician is first on-scene. Scenarios include a respiratory distress tracheostomy case, an opioid overdose, and a scene safety situation.
Life EMS is the advanced life support ambulance agency that serves the majority of Kalamazoo County. For EMS Day they bring an ambulance to orient our residents and fellows to the patient compartment, giving squads the opportunity to load and unload a power stretcher, review the location of patient care equipment, and gain insight into the available working space. Our senior residents and EMS fellows typically accompany critical patients into the hospital from scenes to which they responded, hence the importance of being familiar with the patient compartment of the ambulance.
Who wants to be treated by a physician in the emergency department who has not repelled from the fifth story of a building and intubated a manikin 30 feet off of the ground? Our colleagues from Comstock Fire Department provide our residents, fellows, and students with the opportunity to safely repel down the side of the county fire training tower. We also position a stokes basket with a manikin in midair as a fun challenge to intubate via direct laryngoscopy.
