Design of a resident in-field experience for an emergency medicine residency curriculum

The importance of a resident training in emergency medical services (EMS) is emphasized by the recent development of formal curricula that attempt to prepare the graduating emergency physician for a leadership role in the EMS community. Despite the delineation of specific goals and objectives of such training, actual field exposure and experience in prehospital care have remained voluntary and often sporadic. We designed a resident experience for on-scene attendance at selected incidents and surveyed our residents for their opinion of the curriculum. We also examined field records to determine the nature of field calls and the numbers and types of procedures carried out by second- and third-year residents. During the six-month review period, 158 cardiac arrests were attended, 58 difficult intubations were carried out, 49 central or peripheral lines were started, and 24 severely injured patients were treated on-scene or en route to the hospital. The average response time by the resident to the scene was nine minutes, and the average on-scene time was 20 minutes. Residents completing the survey indicated support for the program and agreed that it has enriched their learning experience. Combined with an air (helicopter and fixed-wing) and ground critical care transport service, the EMS in-field experience has provided opportunities for residents to make rapid decisions, to appreciate the field team's perspective, to report concisely and clearly to colleagues, and to practice required advanced skills. We believe that a formal, planned, and balanced in-field curriculum can afford an opportunity for unique educational experiences that will enrich the graduate program in emergency medicine.