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Introduction: There is a minimal amount of published data regarding to Emergency Medical Services (EMS) fellowship programs. The purpose of this study was to obtain program characteristics and diversity data regarding EMS fellowship programs. Methods: A survey was sent to program directors at all EMS fellowship programs accredited by the Accreditation Council of Graduate Medical Education (ACGME). Data collected included: year program started, year program accredited, unfilled fellow positions, number of EMS faculty, gender, and race/ethnicity. Gender and race/ethnicity data from EMS fellowships were compared to emergency medicine (EM) residencies using data from the American Association of Medical Colleges. Data were analyzed using IBM SPSS with descriptive statistics, and Chi-square tests. Results: The response rate for the survey was 88% (45/51) of all EMS fellowship programs that were accredited at the time of this survey. Most programs (71%) offer a one-year EMS fellowship, with the remaining offering an optional second year. The median number of physician response vehicles per program was 1.0 (IQR 0.0-2.0), with 24% (11/45) not having a dedicated physician response vehicle. This survey identified that 118 EMS fellows have graduated since inception of the accreditation process, while 34 positions went unfilled. The median number of EMS fellow positions per program was 2.0 (IQR 1.0-2.0), with a range of 1 to 4. It was noted that 31% of programs had no female EMS faculty, and 48% of programs had no under-represented minority EMS faculty. There was a significantly larger proportion of female faculty in EM residency programs (30.5%; 949/3,107) compared to EMS fellowships (19%; 53/274), OR = 1.8, 95% CI:1.3-2.5, p < 0.0001. There was a significantly larger proportion of female fellows in EMS (56%; 66/118) vs. female residents in EM (38%; 2,193/5,777), OR" = 2.1, 95% CI:1.4-3.0, p < 0.0001. There was a significantly larger proportion of under-represented minority faculty in EM residency programs (19.7%; 786/3,978) vs. EMS fellowships (12.0%, 33/274), OR = 1.8, 95% CI:1.2-2.6, p < 0.002. Conclusion: A significant number of EMS fellowship positions have remained unfilled since implementation of an accreditation process for EMS fellowships. The percentage of females and under-represented minority faculty in EMS programs was much lower than for EM residency programs.

Introduction. Survival from cardiac arrest is associated with having a shockable presenting rhythm (VF/pulseless VT) upon EMS arrival. A concern is that several studies have reported a decline in the incidence of VF/PVT over the past few decades. One plausible explanation is that contemporary cardiovascular therapies, such as increased use of statin and beta blocker drugs, may shorten the duration of VF/PVT after arrest. As a result, EMS response time would become an increasingly important factor in the likelihood of a shockable presenting rhythm, and consequently, cardiac arrest survival. Objective. To develop a model describing the likelihood of shockable presenting rhythm as a function of EMS response time. Methods. We conducted a retrospective observational study of cardiac arrest using the North Carolina Prehospital Care Reporting System (PreMIS). Inclusionary criteria consisted of adult patients suffering nontraumatic cardiac arrests witnessed by a layperson between January 1 and June 30, 2012. Patients defibrillated prior to EMS arrival were excluded. Chi-square and t-tests were used to analyze the relationship between shockable presenting rhythm and patient age, gender, and race; response time measured as elapsed minutes between 9-1-1 call receipt and scene arrival; and bystander CPR. Logistic regression was used to calculate the adjusted odds ratio (OR) of shockable presenting rhythm as a function of response time while controlling for statistically significant covariates. Results. A total of 599 patients met inclusion criteria. Overall, VF/PVT was observed in 159 patients (26.5%). VF/PVT was less likely with increasing EMS response time (OR 0.92, 95% CI = 0.87-0.97, p < 0.01) and age (OR 0.98, 95% CI = 0.97-0.99, p < 0.01), while males (OR 1.98, 95% CI = 1.29-3.03, p < 0.01) and Caucasians (OR 1.86, 95% CI = 1.17-2.95, p < 0.01) were more likely to have shockable presenting rhythm. Bystander CPR was not associated with shockable presenting rhythm, although EMS response time was longer among patients with bystander CPR compared to those without (9.83 vs. 8.83 minutes, p < 0.01). Conclusions. We found that for every one minute of added ambulance response time, the odds of shockable presenting rhythm declined by 8%. This information could prove useful for EMS managers tasked with developing EMS system response strategies for cardiac arrest management. Key words: cardiac arrest; paramedic; emergency medical services; response time; shockable rhythm; ventricular fibrillation [ABSTRACT FROM AUTHOR]