Inclusion of Confined Space Rescue in EMS Physician Fellowship Programs

Introduction:  In July 2021, the ACGME updated the Program Requirements for Graduate Medical Education in Emergency Medical Services to include participation in special operations trainings as a required key index procedure during an EMS fellowship. These requirements now include documentation of “participation in confined space, technical rescue, or collapse/trench training”.  EMS fellowships may have limited opportunities for fellows to actively participate in these complex events. Background:  Federal or State Urban Search and Rescue (USAR) teams present a unique opportunity to meet this training requirement. USAR teams perform search and rescue operations in collapsed structures and provide emergency medical care for entrapped survivors, task force personnel, and search canines. The physician is integrated into the Incident Command Structure of the USAR teams under the Medical Branch as the “Medical Team Manager”. This provides a defined team role in training and promotes physician level knowledge and skills in rescue operations. Methods:  The University of Chicago EMS Fellowship partnered with Illinois Task Force-1 USAR team to meet the new training requirements and participate as a Medical Team Manager on the team. Results: During the 12-month fellowship period, the EMS fellow participated in monthly USAR training that included both single day and multi-day exercises. The exercises included scenarios with complex hazardous materials, confined space rescue, high angle rescue, collapsed structure and trench rescue. With a dedicated physician role on the USAR team, the EMS fellow integrates into the response structure as a Medical Team Manager and can learn how to deliver high quality patient care in an austere environment.  USAR training fulfilled several of the new ACGME key index procedure for an EMS fellow in the special operations environment including participation in hazardous materials response training, participation in confined space, technical rescue, or collapse/trench training, and participation in vehicle rescue/extrication training.  Conclusions:  EMS fellowship programs can collaborate with Urban Search and Rescue teams to provide training opportunities in confined space rescue to meet ACGME requirements for key index procedures and integrate qualified EMS physicians into USAR responses. Collaboration between EMS fellowship programs and USAR teams can be mutually beneficial.