Abstract
To the Editor:
Emergency medical services (EMS) and prehospital medicine are required areas of competency for graduation from Emergency Medicine residency programs. 1 Most programs use a traditional ride-along model in which residents spend time in EMS vehicles, participating in prehospital care, and assisting providers in the field.2,3 Although the standard model has primarily involved participation in urban 911 calls along with exposure to EMS agency administration, unconventional methods for achieving and meeting the core requirements have arisen to meet the challenge of innovating education to meet changing resident expectations. 4 In addition, the growth of Accreditation Council for Graduate Medical Education (ACGME)–approved EMS fellowships has added to the learner pool, necessitating the exploration of new avenues and methodologies to achieve prehospital requirements.
Race medicine is a relatively modern subset of medicine, encompassing event and mass-gathering medicine, wilderness medicine, expeditions medicine, sports medicine, EMS medicine, primary care, and emergency medicine. In many cases, races are held in remote and geographically interesting places over the course of several days. These events may involve large numbers of participants who de facto have been separated from the reach of emergency services infrastructure. Race physicians frequently encounter injury and illness related to both routine medical care and specific medical threats as a result of environment and activity. 5 Furthermore, much of the medical equipment and processes used in an emergency department are unavailable, and physicians must use a heightened clinical acumen and field-expedient tools to provide care.
The Grand to Grand Ultra is a 7-day, 6-stage, self-supported foot race held in September and covering 169 miles from the Grand Canyon in Arizona to the Grand Staircase Monument in Utah. The State University of New York Upstate Medical University, through its Wilderness and Expedition Medicine program within the Department of Emergency Medicine, provides primary medical support to the race. Before the event, a planning group is convened to build a practical curriculum and assemble the necessary medical and staff resources to provide coverage to the race, using the opportunity to implement a new curriculum. We hypothesized that our curriculum would both be practical and efficacious in the field, providing a novel educational experience for program participants.
In preparation for the race, it was determined that staffing would consist of 5 physicians, including the EMS Medicine fellow, the Wilderness and Expedition Medicine fellow, 2 licensed emergency medicine residents (postgraduate year 2 and 4), 1 paramedic, and a department faculty member (J.J.) who also served as the race medical director, yielding a total of 4 learners who underwent the entirety of the educational experience. One-hour-long didactic sessions were held before the event to review core topics in race and prehospital medicine, including heat illness, dehydration, foot care, and exercise-induced hyponatremia, for a total of 4 hours.
Using this information, fellows assisted in the development of the race supply list and medical operations plan, which included coordination with local EMS, law enforcement, and search and rescue teams. The residents assisted the fellows in all duties and in the implementation of the medical action plan as determined during the prerace informational meetings. After the race, postevent debriefing meetings occurred, during which an assessment of the course’s overall efficacy and satisfaction was undertaken.
A total of 4 learners underwent the educational experience in 2013. The total duration of the curriculum including the race was 8 days. The participating physicians universally stated that their educational experience was a positive one, and all surveyed stated that they would repeat the event if given the opportunity. Patient encounter numbers were not tallied because traditional visits were replaced by continuous contact time with participants. Physician learners were expected to provide medical checks at every checkpoint and then again in the evening rest hours. A centrally located medical tent became a hub of social gathering, regular foot and skin care, and education. The hands-on medical care was positively received by the participating medical providers as well as by the individuals participating in the race. A few medical emergencies arose on the racecourse, which were met by the physician team and managed successfully without evacuation. Each physician carried a small bag termed an ALS (advanced life support) bag, which contained minimal emergency equipment and supplies for a small subset of race-related medical threats.
Prehospital medicine is an integral part of an emergency medical education at both the resident and fellow level. Our utilization of a remote ultramarathon event to fulfill the requirements of the ACGME core competencies is unique in both its implementation and innovation. We were able to deliver a multifaceted curriculum that allowed not only for the acquisition of technical knowledge through the didactic curriculum and planning meetings but also the translational knowledge derived from the hands-on care administered on-site.
Although there were 2 subdivisions of learner (resident and fellow), the curriculum and experience was broad enough to adequately meet the educational needs of each participant. Fellows assumed a greater leadership role during the event as reflected by their autonomous provision of care to race participants at various checkpoints, whereas residents operated under the auspices of the medical director. Each group rated their educational experience positively, allowing us to set this curriculum to be further used in the coming years for future events.