::::::::: Overview  ::::
A reliable member of the local and international community, the Section of Prehospital and Disaster Medicine is committed to the improvement of public health. The Section's active involvement in the oversight and continuing education of Emergency Medical Services (EMS) operations, disaster planning, and leadership in public health innovation acknowledges our value as an EMS resource both at home and overseas. The Section of Prehospital and Disaster Medicine is comprised of academic Emergency Medicine faculty with clinical, educational, administrative, and investigative duties.

::::::::: Services  ::::
The Section of Prehospital and Disaster Medicine provides the following services to the community:

Medical Direction of Grady EMS
In continuous operation since 1892, Grady EMS is one of the oldest ambulance services in the United States. Presently, the service responds to approximately 95,000 calls per year making Grady EMS the largest hospital-based ambulance service in the country. Grady EMS has a service area of 142 square miles and is the designated 911 ambulance provider for the city of Atlanta.

Medical Direction of Rural Metro Ambulance Service (Fulton and Forsyth Counties)
Rural Metro Corporation is the exclusive 911 ambulance provider for north and south Fulton County and Forsyth County. With a fleet of 24 ambulances staffed at the ALS level, Rural Metro runs approximately 40,000 calls a year. Dr. Ian Greenwald and Dr. Scott Sasser oversee all aspects of the Clinical Services Department including QA/QI, education, and training.

Medical Direction of Fulton County Fire Department
The Fulton County Fire Department provides medical First Response to the citizens of unincorporated Fulton County. Through 10 ALS rescue units and 13 BLS engines, the Fulton County Fire Department makes more than 10,000 rescue responses a year.

Medical Direction of Fulton County 911 Emergency Communications Center
The Fulton County 911 Emergency Communications Center manages all the EMS calls for the city of Atlanta and Fulton County in addition to Fire and Police emergency calls for the County. Call taking and prearrival instructions are organized through Medical Priority Dispatch Protocols and all ambulances responding to emergency calls in the city and county are currently dispatched by Fulton County 911.

Medical Direction of Fulton County Office of EMS
The Office of EMS resides within the Fulton County Department of Health and Wellness. This office serves as the contract manager for prehospital emergency medical response in the County and has been actively involved in the establishment of medical guidelines for mass gatherings in the County.

Medical Direction of Emory EMS
Emory EMS is a student-run, volunteer Intermediate Life Support provider that serves Emory University and the surrounding Emory community. The Unit began in 1992 in an effort to assist the local 911provider by delivering initial stabilization and treatment in the event of life-threatening illness or injury to those on campus. The Unit responds to over 600 calls per year, provides standby coverage to major University events, and teaches CPR courses on campus to students, faculty, and staff. Emory EMS recently held the largest CPR Training event in the country in the fall of 2007.

Medical Direction of Emory Flight
Emory Flight is a critical care air transport program which serves north and central Georgia including the Atlanta metro area. With its four A-star 350 helicopters - staffed with a pilot, critical care flight nurse, and flight paramedic - the program assists at scene calls at the request of a responding EMS agency and provides inter-facility critical care transport at the request of a referring medical facility. This service responds to approximately 100 calls per month.

Medical Direction of Emory EMT Curriculum
The Department provides EMT training on the Emory University campus to meet the needs of Emory EMS (EEMS). In order to ensure a cadre of qualified candidates to staff the Unit, Emory University hosts an EMT-I course. Approximately 25 Emory University students are trained per year.

Interagency Personnel Agreements with the Centers for Disease Control and Prevention (CDC)
Collaborative relationships exist with the National Pharmaceutical Stockpile, the National Center for Injury Prevention and Control, and the National Center for Environmental Health.

::::::::: Teaching  ::::
Teaching is an important component of the Section's activities. Each year, approximately 120 medical students and 18 new Emergency Medicine interns are trained in the Emory Emergency Medicine residency Emergency Medical Services (EMS) rotation. In collaboration with Emory Flight/Rocky Mountain Helicopters, the Emory Emergency Medicine residents will participate in a didactic and experiential aeromedical program as an optional component of their EMS rotation.

The EMS rotation provides the didactic presentations on EMS for the Emergency Medicine residency. In the wake of the 9/11/01 terrorist attacks, members of the group were instrumental in the rapid development of a didactic presentation on disaster mitigation provided for the Emergency Medicine Residency and open to Emory University and the public health and public safety community.

Faculty of the Section of Prehospital and Disaster Medicine also coordinate the Resuscitation Sciences course for all third-year Emory University medical students. This course brings together nationally recognized Emergency Medicine faculty to present the latest research on cardiac arrest and resuscitation science..

::::::::: Research  ::::
Research will become an increasingly important focus for the Section of Prehospital and Disaster Medicine in coming years. Members of our faculty are involved in developing an innovative program to enhance the prehospital care and ultimate outcome of patients sustaining an acute ST-segment myocardial infarction. Our faculty members are also playing a key role in support of the department's NIH-funded clinical trial of a promising treatment for traumatic brain injury and are interested in developing and evaluating strategies to involve Emergency Medical Services (EMS) in injury prevention and public health.

The Section of Prehospital and Disaster Medicine is also working with the Centers for Disease Control and Prevention (CDC) on a new research initiative called Cardiac Arrest Registry to Enhance Survival (CARES). Through the CARES program, we hope to develop a national registry system that would track when and where cardiac arrest occurs and how well the local EMS system dealt with the cases, with the goal of increasing cardiac arrest survival rates.

The Institute of Medicine (IOM) released The Future of Emergency Care report, which included a summary of the CARES program. The following is an excerpt from the IOM report.

"A new 18-month initiative funded by the Centers for Disease Control and Prevention (CDC) is under way in Fulton County, Georgia. Cardiac Arrest Registry to Enhance Survival (CARES) is intended to develop a prototype national registry to help local EMS administrators and medical directors identify when and where cardiac arrest occurs, which elements of their EMS system are functioning properly in dealing with these cases, and what changes can be made to improve outcomes. The initiative is engaging Atlanta-area 9-1-1, EMS, and first-responder services and EDs in systematically collecting minimum data essential to improving survival in cases of cardiac arrest and submitting these data to the registry. Area hospitals log on to a simple Health Insurance Portability and Accountability Act (HIPAA)-compliant website to report each patient's outcome. Data compilation and analysis are being conducted by researchers at Emory University. Using information gathered from the CARES registry, a community consortium organized by the American Heart Association (AHA) will orchestrate various community interventions to reduce disparities and improve outcomes among victims of cardiac arrest. CARES is designed to enable cities across the country to collect similar data quickly and easily, and use these data to improve cardiac arrest treatment and outcomes."

Sudden cardiac arrest results from an abrupt loss of heart function and is the leading cause of death among adults in the Unites States. Its onset is unexpected, and death occurs minutes after symptoms develop (AHA, 2005). Survival rates in the event of sudden cardiac arrest are low, but vary as much as 10-fold across communities. Victims' chances of survival increase with early activation of 9-1-1 and prompt handling of the call, early provision of bystander cardiopulmonary resuscitation (CPR), and rapid defibrillation, and early access to definitive care. CARES is designed to allow communities to measure each link in their "chain of survival" quickly and easily and use this information to save more lives.

::::::::: Leadership  ::::
The Section of Prehospital and Disaster Medicine faculty members are also leaders in professional service. Regionally, the Section's faculty members are active within the Atlanta-Fulton County Emergency Management Agency and the Metropolitan Medical Response System, helping the community prepare for the mitigation of catastrophic events.

The Section's faculty members have also been active at the state and national levels, serving as consultants to the Centers for Disease Control and Prevention (CDC) and serving on the following state committees:

• Georgia State EMS Medical Advisory Board
• Georgia State Region Three EMS Advisory Council
• Georgia State Trauma Committee
• Georgia Air Transport Committee