Mission

To develop a tri-service cadre of specially trained, operationally experienced, physician-leaders shaping peacetime and battlefield prehospital care through a shared vision, determined leadership, and translational research.

Vision

Experienced prehospital and battlefield medicine specialists leading the way to save lives, and to serve warriors.

Aims

• The EMS fellowship seeks to produce graduates that are ready to deploy anywhere, at any time, and care for any patient with limited resources while potentially in a hostile environment.
• Our graduates will be the military’s subject matter experts on prehospital medical systems. Our graduates will be leaders in the future development of executive level prehospital policy and research in the DOD and will be instrumental in advancing the practice of prehospital medicine on the battlefield.
• Our graduates will be educators and advocates for EMS, sharing their knowledge with medics, physicians, and commanders across the spectrum of the military.
• Through the completion of a Master’s in Public Health Degree with an emphasis on emergency management, our graduates will have a fundamental understanding of public health and disaster management, and how it intersects with prehospital medicine.
• Our graduates will save lives through direct action in the field, as well as through creation of an advanced military EMS system that provides excellent care from point of injury and at all points of casualty transport until the wounded are home.

• Grand Rounds is traditionally held on Tuesday mornings. This block of time is protected from clinical shifts or other responsibilities. These didactic sessions are lecture and discussion based and focused on the core content areas relevant for preparation for the American Board of Emergency Medicine (ABEM) EMS qualifying exam.
• Monthly Journal Clubs are held every third Wednesday evening and cover important and evolving topics in prehospital medicine.
• Fellows are welcome to attend weekly Emergency Medicine Residency Grand Rounds as their schedule allows.

• The SAUSHEC Military EMS & Disaster Medicine Fellowship Program is two years (24 months) in length. The first year follows the training requirements outlined by the American Board of Emergency Medicine (ABEM) and the Accreditation Council for Graduate Medical Education (ACGME). The second year is built upon the unique military mission and incorporates training in disaster response and military systems.
• The first year of fellowship is performed 100% with civilian partners to ensure a strong foundation of medical direction fundamentals that can be applied to any setting. The second year of fellowship includes 60% civilian partner rotations and 40% military rotations at various sites within Joint Base San Antonio.
• In the second year of fellowship, fellows are invited to take part in various relevant courses and training opportunities to broaden their experience in medical mission planning, patient movement courses, global health engagement, and humanitarian operations.

Military Emergency Medical Services (EMS) and Disaster Medicine fellowship rotation schedule per year.

1st Year	2nd Year
EMS Orientation UT Health San Antonio Office of the Medical Director Austin-Travis County EMS North Channel EMS Acadian Ambulance Service	UT Health San Antonio Office of the Medical Director North Channel EMS U.S. Army Medical Center of Excellence (MEDCoE) Department of Operational Medicine Southwest Texas Regional Advisory Council Joint Trauma System Institute of Surgical Research Joint Base San Antonio Fire & Emergency Services

• While there are no designated elective rotations, fellows are encouraged to seek out 1-2 weeklong opportunities in the second year of training to refine their interests and expertise.
• Humanitarian aid/disaster response rotation assignments can be added in an ad hoc fashion to facilitate short-notice crisis response.

• Fellows take approximately 96 hours of phone/radio call monthly while assigned to University of Texas Health San Antonio Office of the Medical Director, typically in 12-hour shifts spread across weekdays, weekends, and nights.
• Fellows work four clinical shifts monthly in the BAMC Emergency Department while assigned to local rotations.

The second-year curriculum, in addition to its disaster medicine focus, is designed to prepare fellows specifically for military prehospital and en route care.

Lectures, courses, trainings, and exercises seek to develop fellows who are subject matter experts in:

• Military health system structure for all services, including roles of care, en route care assets, and patient tracking systems.
• Initial and continuing training and career progression for medics of all services
• Medical operational planning
• Combat injuries and management
• Principles of medical readiness
• The military role in domestic and international disaster response
• Structure/administration of installation EMS for all services

First Year Fellows

• National Association of EMS Physicians (NAEMSP) Medical Directors course in January.
• Counter Narcotics and Terrorism Operational Medical Support (CONTOMS) Emergency Medical Technicians (EMT)-Tactical Course

Second Year Fellows

• Joint En Route Care Course (JECC)
• Public Health and Medical Services in Defense Support of Civil Authorities Course

Advanced Prehospital Procedure Lab

Fellows participate quarterly in procedure refinement using human cadaver models, to include thoracostomy, amputation, fasciotomy, cricothyrotomy, thoracotomy, resuscitative hysterotomy. Labs progress skill practice to scenario-based implementation in a simulated field/scene environment.

Call Lab

Fellows are exposed to simulated phone and radio call cases during orientation to prepare them for online medical direction.

EMS medical directors lead complex systems of care in their community, teams of prehospital providers within their agencies, and multidisciplinary teams within the Emergency Department.

The Military EMS & Disaster Medicine Fellowship develops leaders by:

• Progressively increasing leadership and autonomy in online medical direction and field response.
• Creating opportunities to provide supervision, leadership, and mentorship to junior fellows, residents, enlisted medical professionals, and other team members during the second year of training.
• Coordinating deputy medical director roles in the 2nd year with experienced EMS medical directors in smaller agencies to allow better integration into the system with additional opportunities for project leadership, process improvement, protocol development, etc…

• Completing two research projects is a requirement for graduation from the fellowship program.
• Each fellow must be an investigator with a significant contribution (primary or co-investigator) on an original research project, as well as a contributor to a secondary project that may include a literature review or case study.
• Opportunities for original research are plentiful and varied; current topics of investigation currently include whole blood administration, mobile integrated health initiatives, efficacy of needle thoracostomy devices, adult education strategies, and more.

Fellows routinely engage in quality improvement processes in the prehospital setting, as well as in the hospital and as it pertains to their own training. Fellows are required to participate in prehospital case reviews, Morbidity and Mortality (M&M) of low-frequency/high-impact procedures, regional committees focused on system process improvement, and take advantage of SAUSHEC-led training such as the Health Safety Review Course.

EMS and Disaster Medicine Fellows are encouraged to take on leadership opportunities beyond the local and regional level. Fellows are encouraged to present their scholarly activity at professional conferences and take advantage of the networking and educational opportunities at those meetings. Program faculty and fellows alike serve on many national committees that influence policy and practice of prehospital medicine, such as American Academy of Emergency Medicine (AAEM), American College of Emergency Physicians (ACEP), National Association of EMS Physicians (NAEMSP), Society for Academic Emergency Medicine (SAEM), Special Operations Medical Association (SOMA), as well as state and uniformed chapters of those and other organizations.

• University of Texas Health San Antonio
• Austin-Travis County Emergency Medical Services
• North Channel Emergency Medical Services
• Acadian Ambulance Service
• Southwest Texas Regional Advisory Council
• Joint Base San Antonio Fire & Emergency Services
• Lackland Emergency Medical Services
• US Army Medical Center of Excellence (MEDCoE) Department of Operational Medicine
• Institute of Surgical Research
• Joint Trauma System

Our program offers rotations to fourth-year medical students on a space available basis. Rotations are typically from two to four weeks long and include ride-along shifts with various local EMS agencies, prehospital physician response, didactic opportunities, a cadaver skills lab, and other exciting opportunities that come up such as confined space training, vehicle extrications, mass casualty exercises, event medicine, and more. Students interested in rotating with our program should contact dha.jbsa.brooke-amc.list.saushec-ems@health.mil and follow guidance through SAUSHEC Graduate Medical Education regarding rotation logistics.

If you would like to schedule an interview with our program, please contact dha.jbsa.brooke-amc.list.saushec-ems@health.mil.

Program graduates take the American Board of Emergency Medicine (ABEM) qualifying examination in Emergency Medical Services. These exams are offered every two years, in odd-numbered years. To become fully board certified, applicants are eligible to take board certification exam upon completion of their Accreditation Council for Graduate Medical Education (ACGME) Post Graduate Year (PGY4). Fellows completing their first year of fellowship training in an odd-numbered year are expected to take the ABEM subspecialty qualifying exam in October of their PGY5 year. To be eligible to take subspecialty board exams, graduates must complete their fellowship training by the date of the examination. Board eligibility is described on the ABEM website. Graduates remain board eligible for up to seven years after board eligibility start date or through four administrations of the subspecialty initial certification examination, whichever is longer.

Fellows are expected to assume increasing levels of responsibility as teachers to prehospital professionals, emergency medicine residents, junior fellows, and junior Emergency Medicine faculty. Starting in the first year of training, fellows share responsibility with their classmates to provide weekly didactic and skills training to the Emergency Medical Technicians and Paramedics of San Antonio Fire Department. Opportunities to lead resident lectures, journal clubs, staff faculty development, and EMS or preparedness projects are frequent.

Fellows have various opportunities for teaching prehospital care, austere medicine, en route care, mass casualty care, and various combat medicine-related topics. Many of the opportunities occur across the globe in coordination with the Defense Institute for Medical Operations, the US State Department, and various partner forces. Fellows and faculty have participated in multi-national instruction and exercises in countries around the globe.

Our faculty have subspecialty training in: 

• Emergency Medical Services
• Disaster Medicine
• Public Health
• Research
• Administration

Fellows are encouraged to engage faculty with similar interests or career experiences to serve as mentor during their time in training. Opportunity for more formal arrangement occur in the second training year, in which fellows serve as deputy medical directors in agencies/organizations of their choice for a more personalized course of study. Fellows are also encouraged to serve as mentors themselves to emergency medicine residents or prehospital professionals, and opportunities for formal training in mentorship are provided periodically by SAUSHEC.

• Wellness: The fellowship program and its curriculum have been designed to maximize off time without reducing opportunities for training. Fellow orientation includes a didactics session on physician wellness. Required evening/weekend activities are limited and can be self-scheduled to honor personal time. Journal clubs are held off site monthly and offer an opportunity to get to know other fellows and faculty in a casual atmosphere. A fellowship graduation dinner is held in celebration of the SAUSHEC graduates in early June, where graduates and their immediate families are honored.
• Fellows are encouraged to participate in the SAUSHEC Wellness Committee geared at optimizing program wellness and involvement with hospital-wide peer wellness and support groups.