Fellowship

Division of Operational and Disaster Medicine at Carolinas Medical Center

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Fellowship Eligibility

• Completion of an emergency medicine residency

Duration of Training

• 12 to 24 months

Compensation

• PGY-4: $61,587 + Benefits

General

The Carolinas Medical Center, Operational and Disaster Medicine Fellowship is an SAEM-approved Disaster Medicine Fellowship.

Operational Medicine

Operational medicine is an increasingly important sub-specialty in emergency medicine that was borne from the complex military environment. At its core, operational medicine began as all medical components required for successful international military deployments. This includes preventive medicine, occupational medicine, infectious disease and tropical medicine, trauma care, humanitarian medicine, disaster response, medical intelligence and medical diplomacy.

During the past decade, it has become increasingly apparent that the lessons learned in conflict apply in the civilian setting. Civilian operational medicine evolved to meet a growing need for medical providers who can provide critical problem-solving skills in austere and often dynamic situations. Operational medicine demands integrity, intelligence, humility, resilience and a willingness to sacrifice comfort for success. Operational medicine is an “outcomes-based” specialty where mission success trumps individual ego.

The Operational and Disaster Medicine program at Carolinas Medical Center (CMC) in Charlotte, NC, offers both breadth and depth of experience. The fellow will participate in:

• Self-directed learning
• Focused didactics
• Intense simulation
• Experiential learning
• Operational on-the-job training

Upon completion of this fellowship, graduates will be skilled in all aspects of the disaster cycle and have the ability to assume a leadership role on the local, regional, federal or international level in the area of disaster medicine, operational medicine and emergency management. The program prepares fellows to be active in research and academics, leading to their emergence as internationally noted experts in these fields.

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Disaster Medicine and Terrorism Preparedness

All hazards disaster preparedness is a critical concept in modern disaster medicine. Carolinas Medical Center’s unique role as the central facility for all disaster and preparedness activities for the Charlotte metropolitan area and as the flagship facility within the regional Atrium Health offers the ODM fellow unparalleled opportunities in complex system management. 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 coalition among the participating agencies and organizations. Institutional, local and regional opportunities exist for chemical, biological, radiological, nuclear and explosives (CBRNE), active shooter and high-threat response training. The Metrolina HealthCare Preparedness Coalition (MHPC) employs a full-time disaster and emergency preparedness coordinator who can work with the fellow on local preparedness and emergency management issues. The fellow will work with the emergency management committee at CMC and assist in disaster preparedness for the main campus and all Atrium Health facilities, including regional affiliates.

Fellows will:

• Participate in a wide variety of experiences to develop expertise in domestic disaster response at the tactical, operational and strategic level

Operational and strategic level training will include participating in local, regional and national preparedness conferences. The fellow is expected to complete basic and advanced online courses in incident command structure (ICS) as well as provide ICS training for residents and staff. The fellow is also expected to participate as needed in real-world emergency operations center (EOC) and field operations during hurricanes, floods and other natural disasters.

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Carolinas MED-1

Natural and man-made disasters stress hospital surge capacity and increase community health vulnerability. Carolinas MED-1, located in Charlotte, NC, was created to strengthen community resilience, expedite high-quality disaster medical response and provide an all hazards response asset to the regional communities. 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. The ODM fellow will serve as assistant medical director for MED-1 and gain exposure at all levels of strategic and operational planning.

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Tactical EMS (Elective)

The ODM fellowship has particularly strong ties to the national and international tactical emergency medical services (TEMS) communities with faculty representation on the committee for tactical emergency casualty care (C-TECC), the committee on tactical combat casualty care (CoTCCC), the National TEMS Council and the Defense Health Board Subcommittee on Trauma and Injury. Fellows have the opportunity to become TECC and TCCC instructors and support local TEMS operations.

MEDIC has developed a tactical medical support unit that provides medical coverage for the Charlotte-Mecklenburg police special weapons and tactics team (SWAT) 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 in which short hauls, rescues and rappelling are all incorporated into the scope of practice. Upon approval from MEDIC, the ODM fellow may provide educational and occasional operational support to the CMPD TEMS team.

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Humanitarian Medicine

The ODM fellowship at Carolinas Medical Center offers a uniquely flexible experience. The faculty at CMC boasts a diverse background in civilian and military humanitarian medicine. Their global work resulted in significant collaborations and partnerships.

Fellows may have the opportunity to attend:

• The Harvard Humanitarian Initiative (HHI) field simulation exercise in Boston, MA
• The Joint Humanitarian Operations Course (JHOC) at Fort Bragg, NC
• The Health Emergencies in Large Populations (HELP) course
• And other selected courses on global health, humanitarian operations and international disaster management. In addition, the fellow may have the opportunity to work with the UNC Department of Global Health on a project by project basis.

Fellows will also have the opportunity to participate in real-world operations, planning and training overseas as well as participate in courses and seminars related to international disaster assistance in collaboration with The Operational Medicine Institute. Cooperative relationships with Uniformed Services University of the Health Science’s Center for Disaster and Humanitarian Assistance Medicine (CDHAM) program, The Operational Medicine Institute (OMI) at Harvard Medical Faculty Physicians and the Harvard Humanitarian Initiative are being developed to support this phase of fellow training.

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Other

The ODM fellow will have the opportunity to tailor their elective time. Additional opportunities exist in wilderness medicine (AWLS instructor courses), public health, and global emergency medicine

Carolinas Medical Center – Department of Emergency Medicine

Carolinas Medical Center, part of Atrium Health, in Charlotte, NC, is a 874-bed, community-based, tertiary care teaching hospital that serves as the only regional Level 1 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. CMC is the largest research hospital in the region and one of five teaching hospitals in North Carolina. As part of the hospital campus, the 234-bed Levine Children's Hospital opened in October 2007.

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 percent medical, 27 percent surgical/traumatic, 25 percent pediatric, 15 percent obstetrical-gynecological and 3 percent psychiatric and toxicological. Further, the socioeconomic diversity of our patient population sets us apart from other institutions. There are 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 the first in the region to offer 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. 

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.

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Training Structure

The fellow will be involved in the following basic areas of training: didactic lectures and readings, participation in hospital-based, local and regional leadership committees, research, fieldwork and thesis development.

1. Didactic Education

The didactic component of the training occurs throughout the duration of the fellowship and consists of textbook readings, small group lessons, courses and lecture series.

• Primary Text: Disaster Medicine. Ciottone. Mosby. First Edition (2008)
• Secondary Text: Disaster Medicine. David E. Hogan and Jonathan L. Burstein. Lippincott Williams & Wilkins; Second Edition (March 1, 2007)
• Secondary Text: Advanced Disaster Medical Response Manual for Providers. Susan Briggs and Kathryn H. Brinsfield Harvard Medical International; 1st edition (July 2003)
• Secondary Text: Sphere Handbook, 2011

The fellow will also be asked to give two presentations to the emergency medicine residents from the Carolinas Medical Center emergency medicine residency and two community preparedness lectures during his/her fellowship.

2. Committee Participation

Throughout the fellowship the fellow will participate in both Atrium Health, Carolinas Medical Center and Charlotte/Mecklenburg disaster-related committees/activities, including both Atrium Health and Carolinas Medical Center emergency management committees and the Mecklenburg County emergency management committee.

3. Research

The research and thesis development portion of the training will span the entire fellowship period. The fellow will be asked early on to define a research goal and to begin designing his/her thesis. The research and subsequent thesis will focus on a specific area of operational, disaster or tactical medicine and will be approved by the fellowship director. The goal of the thesis is for it to be published in the specialty literature.

4. Fieldwork

The fieldwork phase will be in conducted throughout the fellowship program. The fellow will perform fieldwork in disaster preparedness and response through deployment with local and regional agencies and organizations, including:

• Carolinas MED-1
• North Carolina SMAT-2 Team
• Charlotte-Mecklenburg Police Department (CMPD) Tactical EMS Support Team
• Charlotte MEDIC Special Operations
• CMC Special Events Medicine
• MedCenter Air
• Center for Prehospital Medicine (CPM) disaster and tactical medical response

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Core Knowledge

The fellowship will focus on the following areas:

1. Introduction to disaster medicine and emergency management:

a. Common definitions and disaster cycle
b. Role of hospitals, EMS and public health in disasters
c. Psychological impact of disasters
d. “All hazards” emergency operation plans in healthcare facilities
e. Conducting a hazard vulnerability analysis

2. Training and programs evaluations:

a. Overview of governmental resources

3. Medical management in specific events:

a. Natural disasters
b. Blasts/collapse/shooting/crashes/terrorism
c. Chemical/hazmat events
d. Biological events (Bacterial/viral/toxin disease recognition, infection control, vaccination, prophylaxis etc.)
e. Mass gatherings
f. Humanitarian crises and displaced populations
g. Nuclear/radiological events

4. Operational principles:

a. Incident command system
b. Mass casualty triage and response
c. Surveillance
d. Communications
e. Search and rescue
f. Decontamination and personal protective equipment (PPE)
g. Evacuation
h. Surge capacity
i. Media
j. Legal and ethical issues in disasters
k. Integration of prehospital, hospital and public health services

Courses

1. Incident command system (100, 200, 300, 400, 700, 800)
2. Hospital incident command system (HICS)
3. Hazardous material training (Level B and C)
4. Basic/advanced disaster life support (BDLS/ADLS)
5. Homeland security exercise and evaluation program (HSEEP)
6. Other online courses offered through FEMA website
7. Harvard Humanitarian Initiative (HHI) field simulation exercise in Boston
8. The Joint Humanitarian Operations Course (JHOC) at Fort Bragg
9. The Health Emergencies in Large Populations (HELP)

Recommended Conference Attendance

1. American College of Emergency Physicians (ACEP) Scientific Assembly
2. World Congress on Disaster and Emergency Medicine

Evaluation

1. Fellow Evaluation: The fellow will have ongoing contact with the fellowship director and faculty. He/she will be evaluated formally at the midpoint and at the end of the fellowship period. Evaluations will consist of assessment of thesis and research progress and ongoing assessment of knowledge base. Multiple evaluators will be used (e.g., faculty, peers and other professional staff). Successful completion of the fellowship will be accomplished by achieving unanimous approval of the faculty and fellowship director and passing grade on the thesis.
2. Faculty Evaluation: At least once a year, the program will evaluate faculty performance including a review of the faculty’s teaching abilities, commitment to the fellowship program, DM knowledge, professionalism and scholarly activities.
3. Thesis Evaluation: The fellow will write a thesis during the course of the 12-month fellowship. The thesis will be based on an accepted subject and data will be collected during the fieldwork portion of the program. The thesis will be evaluated based on originality of subject, data collection and analysis, writing and impact on current Disaster Medicine theories and practices.
4. Program Evaluation and Improvement: The program will document formal, systematic evaluation of the curriculum at least annually. The program will monitor and track fellow and faculty performance. If deficiencies are found, the program will prepare a written plan of action to document initiatives to improve performance in the areas identified.

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