Division of Out of Hospital Care, IU Department of Emergency Medicine

Out of Hospital Care Fellowship
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Resident Opportunities
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The Division of Out of Hospital Care provides Emergency Medicine Residents with opportunities to experience all facets of out-of-hospital emergency medical care. It provides Tactical EMS support to the SWAT Teams of the Indianapolis Police Department, Marion County Sheriffs Department, Indiana State Police, and the FBI Region 5. It is very involved in Mass Gathering Medicine and provides spectator emergency medical coverage for all events held at the RCA Dome and Indianapolis Convention Center (including Colts games and rock concerts), all events held at the Indianapolis Motor Speedway (including the Indianapolis 500, the Brickyard 400 (NASCAR), the United States Grand Prix (Formula 1) and the PGA Seniors Tournament), the largest ½ marathon in the country with over 25,000 runners, and the 2001 World Police and Fire Games. There are opportunities for those interested in Motor Sports Medicine through the events held at the Indianapolis Motor Speedway and Indianapolis Raceway Park. Many residents have been active in the USAR Task Force and have gone on deployments to Hurricane Floyd, the Atlanta Olympic Games, a grain elevator explosion in Kansas, and to New York City after the 911 tragedy. And of course, there are ample opportunities to gain experience in traditional Urban EMA, Suburban EMS, and Rural EMS systems.

Residents participate in the formal didactic and clinical teaching of prehospital providers and provide in-service lectures to the many prehospital agencies that we sponsor. All emergency medicine residents participate in a required four-week rotation in EMS. During this month they ride as observers on IEMS ambulances and fire apparatus; spend time at the 911 dispatch center; and attend administrative, operational, and quality improvement meetings with the medical director. The goal is to develop an appreciation and understanding of how EMS systems operate. All residents are encouraged to participate in the hospital's helicopter program as flight-physicians. In this capacity they often make scene runs to major trauma incidents and have the opportunity to practice emergency medicine in the out of hospital setting. Both Methodist and Wishard Hospitals are certified by the state as ALS teaching facilities and each has regularly scheduled paramedic, EMT-basic, and first responder classes. (Top)

The residency faculty have long had a strong commitment to Out of Hospital Care and EMS.

The Department of Emergency Medicine Chair, Dr. Rolly McGrath served as the Medical Director of Wishard Ambulance Service for over ten years prior to being promoted to Chair.

The Director of the Division of Out of Hospital Care, Dr. Michael L. Olinger, is involved at a national, state, and local level. At the national level he is actively involved with the Federal Emergency Management Agency's (FEMA) Urban Search and Rescue Program (USAR) and has been deployed to such events as the Oklahoma City bombing, Hurricane Marilyn, and the Atlanta Olympic Games. He is a member of the USAR Medical Working Group and is on call every third month to respond as the Chief Medical Officer for the USAR Incident Support Team. He is also an instructor for FEMA's Confined Space Medicine Course. He received a gubernatorial appointment to the Indiana's EMS Commission in 1992 and has served as a medical investigator for the Indiana State Police and as a member of the governor's Anti-Terrorism Task Force. He is the Medical Director for Indianapolis EMS (Wishard Ambulance Service/ Indianapolis Fire Department) and Wayne Township Fire Department. He is also a Deputy Medical Director for both the Indianapolis Motor Speedway and the Indy Racing League, and Co-Chair of the Medical Division of the 2001 World Police and Fire Games.

Dr. Ed Bartkus is the EMS Medical Director for Methodist Hospital and provides medical direction for all events held at the RCA Dome and Indianapolis Convention Center. He is also Medical Director for a number of suburban and rural EMS agencies including Putnam County Operation Life, City of Lawrence Fire Department, Rural Metro Ambulance in Tipton, Muncie, and Anderson IN, and the Indianapolis International Airport Fire Department. He is the Director of the Out of Hospital Emergency Medicine (EMS) Fellowship to be offered beginning in July of 2002.

Dr. Henry Bock also has a strong background in out-of-hospital emergency medical care. He was the original medical director of Methodist's aeromedical program (LifeLine), and was a medical advisor to the National Highway and Traffic Safety Administration (NHTSA) in the development of the new EMT-Basic Curriculum. Dr. Bock is a leading authority on Motor-Sports Medicine, and is the medical director for the Indianapolis Motor Speedway, the Indy Racing League, and United States Auto Club (USAC).

Dr. Geoff Billows is the Medical Director for LifeLine helicopter aeromedical program and a Deputy Medical Director for the Indianapolis Motor Speedway and the IRL. (Top)

Adopt-a-Medic

For those residents with a deeper interest in out of hospital care, an elective program in medical direction is available. Those who participate in this program become the assistant medical director, under the preceptorial guidance of the medical director, of one of the many EMS agencies that we sponsor. They participate in the quality improvement, education, and operational activities of the agency.

Aeromedical (Top)

Flying since July, 1979, the Life Line helicopter service annually transports over 1,200 critically ill or injured patients from the scene of accidents or from other community hospitals in the referral area. The Emergency Medicine residents with the full-time flight nurses are responsible for patient management on helicopter runs. With advice from faculty always available by radio, this program gives the residents tremendous independent experience in the initial management of high-acuity patients. The program uses two twin-engine Bolkow helicopters (BK117). The BK-117 is equipped with the latest weather scope technology. Safety is the number one priority and the decision to fly is left to the final, total discretion of the pilot who is blinded to the nature of the run.
Geoffrey Billows, M.D., FACEP is the Medical Director of Life Line.
Kathy Beretta, R.N. is the Chief Flight Nurse of the Life Line Program.
Michael Murphy MD is the chair of the Life Line Committee

About 20% of the flights are scene flights.

A second aircraft, staffed by a nurse-paramedic crew, is available from noon-midnight as well.

Safety is our major concern, and residents are not required to fly. Any member of the flight crew may request to abort a flight at any time.

Residents begin flying orientation flights as a R1 (minimum of 10 before being allowed to fly solo as an R2), and may begin flying solo as an R2.

Residents are provided with Nomex flight suites and helmets.

	2001 Life Line Stats: • Total LifeLine requests = 2133 • Total Flights = 1299 • Medical = 51% • Trauma = 49% • Adults = 1055 • Peds = 244 • Neonatal = 9 • Double Transports = 9 • Scene = 17%

Mass-Gathering (Top)

The Indianapolis 500-Mile Race and the Brickyard 400, and the United States Grand Prix

Methodist Hospital is the support hospital for the Indianapolis 500, the largest single-day sporting event in the world (an estimated 400,000+ spectators). The EMTC provides physician and nursing support through the 20 bed free standing ED on site (the Clarian Emergency Medical Center) for the Race and the two preceding weeks of events, including the two days of Qualifications and the nation's largest mini-marathon (over 25,000 runners). They also assist with the disaster planning for all major events, as well as for the Indianapolis Airport.

Since August 1994, the NASCAR Brickyard 400 race brings four days of activities to the Indianapolis Motor Speedway (IMS). New in 2000, the United States Grand Prix Formula One race has been added to the calendar.

Methodist Hospital EM Physicians, nurses and paramedics, support these activities. Henry C. Bock, M.D., F.A.C.E.P., the Indianapolis Motor Speedway Medical Director, has been involved emergency medical care at the Race since 1966. Michael L. Olinger, M.D., F.A.C.E.P., serves as the Associate Medical Director.

Motor Sport (Top)

Rural EMS (Top)

Tactical EMS (Top)

The Tactical Emergency Medical Services (TEMS) program was founded in 1999 with the cooperation of Wishard EMS, the Indianapolis Police Department, and the Indianapolis Fire Department. The program consists of three Wishard Paramedics and three IFD Paramedics. The TEMS unit falls under the command of Lt. Dale True, SWAT Commander, of the IPD SWAT Team. The Wishard Paramedics report to Tom Arkins and the IFD Paramedics report to the Special Operations Chief.

There was a need for medical access in the hot zone. That need was fulfilled with the TEMS program. Each of these paramedics trains monthly with the SWAT team. All have been trained with every weapon that a team member might use but they are not armed because their mission is medical and not tactical. Team members work a rotating schedule to respond to high-risk warrants or full team call outs. Recently the TEMS units have begun working with the IPD K-9 unit and the IPD Bomb Squad. Each of the medics is equipped with ballistic gear, radio, gas mask, and medical equipment.

In order to become a team member each individual must pass an oral interview with the current TEMS members, a physical agility test, and a final interview with the SWAT commander before being added to the team. Every year the TEMS medics must complete the same mandatory physical that the team members complete and held to all of the same standards.

In 2001 another TEMS unit was created to respond with the Marion County Sheriffs Department SWAT team. This program consists of four Wishard Paramedics.

Paramedics and physicians from Methodist Hospital support a TEMS unit that is attached to the local FBI and the Indiana State Police.

Urban EMS (Top)

EMS System Structure

The entire metropolitan area has an enhanced 911 system. At the Public Safety Answering Point (PSAP), fire and EMS calls are transferred to emergency medical dispatchers trained in priority emergency medical dispatch. EMS communications within the metropolitan area are over a countywide, 800-megahertz, multiplex communications system.

Within the Indianapolis metropolitan area EMS Services are provided by geopolitical entities called townships. Center Township, the largest of these entities, includes downtown and the surrounding urban neighborhoods. Its EMS Services are provided by Indianapolis EMS (IEMS) composed of Wishard Ambulance Service (WAS) and IFD. This is a two-tiered system with first response provided by IFD and ambulance transport provided by WAS. All 750 firefighters are trained to at least the level of EMT-Basic and there are approximately 70 IFD paramedics in the system. Every fire apparatus is equipped with a SAED and has BLS capabilities. In addition there are several ALS engines and squads in the system. Wishard Ambulance Service is the largest EMS provider in the state and responds to over 60,000 calls per year. They provide ALS transport for the intercalated city of Speedway, Wayne Township, Franklin Township, and Decator Township, in addition to Center Township. All Wishard Ambulances are ALS with a crew consisting of a paramedic and either an EMT or a second paramedic.

The surrounding townships and intercalated cities each have ALS systems, mostly fire department based. The five medical directors of the numerous agencies within the greater Indianapolis area have formed an EMS Task Force under the auspices of the county medical society and have developed unified, countywide, prehospital protocols.

Urban Search & Rescue (Top)
Chris Strachan and Chris Evers, Methodist faculty and IUEM resident respectively, hard at work with the USAR team in NYC just after the horrible attack on America.

"Rescue workers preare their backpacks before heading the trade center site. They are (from left) Stephanee Evers, a doctor from Methodist Hosptial; Larry Byerly, a Lawrence Township paramedic; and Chris Strachen, a doctor at Methodist. (Staff Photo / Mpozi Mshale Tolbert)"
THE INDIANAPOLIS STAR

If you are not familiar with FEMA or USAR and their roles and involvement in disasters or if you are interested in rescue progress, please visit their sites.