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General
The Center for Prehospital Medicine's EMS Fellowship Program at Carolinas Medical Center began in 1991 and is affiliated with the Mecklenburg EMS Agency (Medic) in the City of Charlotte and Mecklenburg County. The first fellow graduated in 1996; as of 2009, 17 fellows have successfully completed the program. While the Fellowship is typically a one-year program, a two-year option exists that includes a Master's Degree in Public Health from the University of North Carolina-Charlotte or Chapel Hill. One position is offered each year to qualified candidates who must be residency-trained and board certified/eligible in Emergency Medicine from an ACGME accredited program.
Reference materials
Experience and Opportunities
The EMS Fellow serves as Assistant Medical Director for Medic and the affiliated first responder agencies, and will be responsible for performing all duties required by the Medical Director. In addition, the Fellow will serve as Emergency Medicine faculty in the Department of Emergency Medicine. Participation in all activities conducted by the Center for Prehospital Medicine is expected, including EMT-Basic refresher and EMT-Paramedic courses, special events medical coverage and hospital disaster preparedness.
The unique design of this program and the EMS system affords complete medical control of all prehospital medical components within the community, including all BLS first responders and ALS transport. The opportunity exists to nourish any special interest that a fellow may have regarding a future in prehospital medicine.
EMS Education
The Center for Prehospital Medicine provides instruction for courses including an EMT-Basic refresher, EMT-Paramedic and numerous adjunct courses and inservice modules for Medic. Based on the academic programs offered, the Center was first to be approved as a primary teaching site by the North Carolina Office of EMS. Full-time and adjunct faculty provide the curriculum development, course content, didactic lectures, clinical rotations, and lab sessions. The EMS fellow is involved with program administration and all levels of teaching. 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. A Medical Education and Simulation Center developed several years ago is also available for hands-on instruction. This state-of-the-art facility incorporates simulated, controlled environments, high-fidelity mannequins (including a human patient simulator), ambulance simulator, and human cadaver anatomy lab.
Tactical EMS
Medic has developed a tactical medical support unit that provides medical coverage for the Charlotte-Mecklenburg Police SWAT (Special Weapons and Tactics Team) 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 SUV has been integrated and 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.
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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 and supplies. 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.
Administrative Duties
Fellows are 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 Patient Care Protocols are evidence-based and 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 are constantly being reviewed and implemented if selected. The medical director and EMS fellow review all priority transports as part of the quality improvement process. Deficiencies are handled in a due process review format, with the fellow becoming involved in all clinical incident reviews. The fellow will work closely with three Quality Improvement and Education Analysts to review specific data, evaluate trends in system performance, develop simulation scenario-based training, and to identify opportunities for system expansion and process improvement.
Mass Gathering Medical Support
The Center for Prehospital Medicine faculty are responsible for medical oversight for all special events coverage at multiple sites including the Bank of America Stadium (Carolina Panthers NFL), the Charlotte Motor Speedway (NASCAR racing), the zMax Dragway (NHRA racing), Knights Stadium (Charlotte Knights AAA baseball), the Quail Hollow Championship (PGA tournament), the Charlotte Convention Center, and other venues as requested. The fellow will assist in coverage at all Bank of America Stadium and Charlotte Motor Speedway events and may choose to participate in others if interested. The fellow always has a full access pass and credentials at all venues.
Air Medical Services
The MedCenter Air Flight Service at Carolinas Medical Center operates air and ground critical care transport resources. Helicopters include four American Eurocopter EC135 P2+. Each is stationed at one of three operational bases across the referral region. In addition, two Beechcraft King Air 200 turboprop fixed wing aircraft and two Cessna Citation 560 series jets are also part of the service. Helicopter EMS 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.
Disaster 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 and Emergency Preparedness Coordinator is on faculty at the Center for Prehospital Medicine. The fellow assists in disaster preparedness for the hospital and the regional facilities as well. Creating a coordinated system response and identification of resources for incapacitated facilities or for those experiencing surge capacity is the ultimate goal. 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, including the development of a Hospital Disaster Response Team.
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 b 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.
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Carolinas 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 and Medic 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 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.
EMS Administration
The EMS fellow has the opportunity to participate in all components of the EMS system including operations, communications, fleet maintenance, ambulance design and purchasing, materials management, human resources, budget preparation and auditing, and systems status management. The fellow also interacts with all affiliated first responder and law enforcement agencies.
Compensation
Salary is at the PGY-4 level which is $51,158 for the 2009-10 year. All fellows and their dependents are provided medical, prescription drug, and dental coverage. Professional liability, life, and disability insurance, along with 3 weeks of paid vacation and $1,900 for continuing medical education are also provided for the 2010 academic year. Offices are provided on the hospital campus and at the Medic Headquarters building so that the fellow is integrated into the entire system. To facilitate field response, an emergency response vehicle is assigned to the fellow as indicated above. For communication purposes, a hospital pager, EMS pager, 800 mHz radio, and laptop computer are issued.
 Mecklenburg EMS Agency (Medic)
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 Healthcare 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 Medic and all personnel are under the aegis of medical control, functioning at the EMT-Basic 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 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.
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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 Medic. Two full-time quality improvement analysts oversee all Medic 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 supervisors also assist with the educational programs. 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 (Public-Safety Answering Point) 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.
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Carolinas Medical Center
Carolinas Medical Center is a 874-bed, community-based, tertiary care teaching hospital that serves as the only regional level-I trauma center, the State Poison Control Center, and is a tertiary referral center for Mecklenburg County and 16 surrounding counties in North and South Carolina. It is the flagship facility for the network that includes acute care facilities, subacute facilities, and clinics in North and South Carolina. As part of the hospital campus, a newly constructed, 234-bed Levine Children's Hospital opened in November, 2007. Residency programs exist in all specialties including Emergency Medicine. The Emergency Medicine Residency is a PGY 1-3 program that includes 42 residents. Fellowship positions are offered in EMS, Toxicology, Ultrasound, Pediatric Emergency Medicine, and Research. There are 38 academic faculty in the Department of Emergency Medicine.
Emergency Department
The Emergency Department at Carolinas Medical Center manages over 115,000 patients each year, or about 300 to 320 patients per day. The department features an unusually diverse mix of patient care opportunities including 30% medical, 27% surgical/traumatic, 25% pediatric, 15% obstetrical-gynecological, and 3% psychiatric and toxicological. Further, the socioeconomic diversity of our patient population sets us apart from other institutions. There four treatment areas: Major Treatment, Diagnostic Center, Ambulatory Emergency Center, and a 12-bed Children's ED. Patients are triaged to one of these four areas based on the acuity of illness. The Children's ED is first in the region that offers 24-hour emergency care for children in a family-centered environment.
Two to four board-certified emergency medicine faculty are present in the open areas 24-hours a day. Within the department are a satellite radiology suite and an observation unit which constitutes the Emergency Department's Chest Pain Evaluation Center. Additional features include digital X-ray, computerized labs and transcriptions, point-of-care testing, and wireless networking. In 2004, Carolinas Medical Center achieved Chest Pain Center accreditation from the Society of Chest Pain Centers, as well as Primary Stroke Certification through The Joint Commission.
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 two operating rooms and a small animal lab. Support personnel include two research scientists at the Ph.D. level, two clinical research nurses, and four lab technicians.
The Center for Prehospital Medicine incorporates a full-time PhD Director of Prehospital Research. All resident and fellow research projects are coordinated by the Director. Bi-weekly research meetings are conducted with selected hospital and EMS staff to identify opportunities for potential studies.
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Charlotte and the Surrounding Area
Charlotte is located in the southern Piedmont region of North Carolina. Two large lakes, Lake Norman and Lake Wylie, 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 552 square miles, with the city limits of Charlotte comprising about 285. The population is around 875,000, with an additional commuter influx of about 250,000.
Charlotte is a city of both traditional and modern tastes. The city's architecture blends historical homes and new developments. It is home to many corporate headquarters and major industrial employers. The city offers more than 700 different houses of worship in all denominations. This area of North Carolina is famous for its family atmosphere and southern charm. There is a huge variety of clubs, pubs, sports bars, restaurants, gallery crawls and coffee houses. Fine arts include the Charlotte Symphony Orchestra, Discovery Place, Levine Museum of the New South, Mint Museum of Art, Blumenthal Performing Arts Center, North Carolina Dance Theater, and Opera Carolina. Sporting events include the Carolina Panthers NFL team, the Charlotte Bobcats NBA team, Charlotte Motorspeedway for NASCAR events, The Quail Hollow PGA Championship Golf Tournament, the Charlotte Checkers minor league hockey team, the Charlotte Knights minor league baseball team, and various NCAA sporting events at UNC-Charlotte and Davidson College.
Weather in Charlotte
January: average low 30º - average high 49º
June: average low 70º - average high 89º
Sunny days: 214/ year
Average precipitation: 43.1 in./year
Average snowfall: 5 to 6 in./year
For More Information about Charlotte, visit the Charlotte Chamber of Commerce.
Interested Applicants
Interested applicants should 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 our Program Coordinator, Elizabeth Shelton, MLIS at 704-355-8660 or elizabeth.shelton@carolinashealthcare.org.
Fellows Past and Present
Our current fellow and all fellowship alumni are invited to join our Google Group, CMC EMS Fellowship. This group has been set up to encourage networking and the sharing of ideas and accomplishments. Visit us at http://groups.google.com/group/cmc-ems-fellow.
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