The UCSF Fresno Parkmedic Program trains resident physicians and fellows to provide high quality Emergency Medicine Services (EMS) and this includes a unique opportunity to help lead a course for National Park Service (NPS) rangers advancing the delivery of expert emergency care in harsh wilderness environments.
About 50 years ago, the UCSF Fresno Parkmedic Program was established and for nearly five decades, rangers from national parks, as close as Yosemite, Sequoia and Kings Canyon – and parks across the United States – have been coming to UCSF Fresno every other year for a rigorous six-week Parkmedic Primary Certification Training Course to improve their Emergency Medical Services (EMS) skills.
Importantly, this course provides a compelling learning opportunity for Emergency Residents covering EMS care in austere environments and has been a decidedly successful resident recruiting resource for UCSF Fresno.
This January, 19 rangers participated in the training, which is an Advanced Emergency Medicine Technician (AEMT) certification but also includes an expanded pharmacological component and scope of practice that is tailored and designed for the NPS. UCSF Fresno is the sole provider of the training.
The one-of-a-kind training takes into consideration different environments of the national parks and the varying risks for patients, such as high altitude at nearby Sequoia and Kings Canyon National Parks, the marine environment at Everglades in Florida or the desert of Death Valley National Park.
The training is provided by a team of UCSF Fresno physicians including faculty: Nicholas Black, MD; James McCue, MD; Gayle Kouklis, MD; and Geoff Stroh, MD – and a multitude of EM residents, led by Nathan Dreyfus, MD; Madeline Giegold, MD; Miles McDonough, MD; and Mathew Lippi, MD. The Wilderness Medicine fellow, this year Johnny Bauman, MD, also participates in the planning and execution of the course, in addition to an Emergency Medical Responder (EMR) course in spring.
Dr. Stroh, UCSF Fresno Parkmedic Program Co-Faculty, praised the rangers participating in this year’s training course. “They are incredibly bright and incredibly diligent and just simply work hard. “This is a very, very intense course, and we pound a lot of information into their heads and then we make them demonstrate it.”
Rangers attend lectures during mornings for four weeks and have the information reinforced in the afternoons with hands-on training, including scenarios involving volunteers who act as patients during simulation exercises. As part of the advanced certification, they are given instruction in intravenous (IV) access and insertion of airway devices to manage breathing issues, among other skills sets. They also learn proper dosage and administration of more than 30 medications. The last two weeks of training are spent in the emergency department at Community Regional Medical Center (CRMC) and ride-alongs with American Ambulance.
A Parkmedic can be with a patient for hours before and during transport to a hospital, Dr. Stroh said. “For example, sometimes you have open fractures in the back country and it's two to three hours, up to a day, maybe overnight, before you can get that person to definitive care at a hospital. So, administering IV antibiotics to reduce the chance of infection or loss of a leg is crucial.”
Cody Hays of Yosemite National Park said the Parkmedic certification training at UCSF Fresno allows him to better help people in difficult situations. “Right now, I am an EMT basic. I can provide a very basic level of care to a person in a medical or traumatic problem and this course is going to allow me to provide that advanced level of care, anywhere from intravenous therapy and additional sets of drugs and advanced airways … which will help support people in those difficult situations for longer and better quality.”
Clara Maynard an EMT from the state of Washington, echoed Hays. “This program is really important to me because there is only so much I can do as a basic EMT in a remote environment. And I care for patients in really austere environments that are very far away from definitive medical care. And I’m very excited to learn skills where I can do more for my patients and really give them a better outcome.”
Maynard was one of nine participants in the UCSF Fresno Parkmedic training course this year who received a UCSF Danny Dresher Memorial Scholarship for Parkmedic Training. In January 2019, NPS back country ranger Danny Dresher completed the Parkmedic Primary Certification Course at his own expense. He later died in a tragic mountaineering accident in Alaska. The UCSF scholarship fund was established in his memory by the Dresher family to help pay tuition costs for NPS rangers who would not otherwise be able to attend the course due to limited financial resources.
The UCSF Fresno Parkmedic Program has been in existence for almost 50 years. The training course is overseen by UCSF -Fresno faculty, including Dr. Stroh, who has been involved in the UCSF Fresno Parkmedic Program since 1993, but many of the lectures are led by Emergency Medicine residents who choose to participate in the Parkmedic Program. Residents become EMS medical directors (under faculty supervision) for the EMS providers of Sequoia and Kings Canyon National Parks. They also manage the parks’ base hospital radio at CRMC, responding to back country emergency calls. This experience is a great learning environment to help teach EMS to residents.
An exposure to wilderness medicine attracts many residents to UCSF Fresno, in addition to the Emergency Medicine residency’s strong emphasis on clinical teaching and hands-on training at the only Level 1 trauma center and burn center for Central California, Dr. Stroh said.
Miles McDonough, MD, a fourth-year UCSF Fresno Parkmedic Program resident, oversaw much of this year’s Parkmedic Training lectures and simulation exercises, and said the Parkmedic program is a big reason he came to UCSF Fresno for Emergency Medicine residency. “It’s a pretty unique program in that there is no other Emergency Medicine training program in the country that works hand-in-hand with the National Park Service like we do. We have a long history – we’ve been doing it since the mid-1970s.” Residents and rangers alike benefit from the Parkmedic Program, Dr. McDonough said.
“In the ER, we’re doing definitive medicine, we have all the bells and whistles. We have all the resources we need. But for our Parkmedics who are doing similar skill sets, they’re in the middle of nowhere, no back up and they’re often alone. So, being able to understand our definitive medicine and being able to communicate that in a limited resource setting, definitively not only helps them in the medicine they need to practice but it helps us form a richer and deeper understanding of the principles of medicine in Emergency Medicine and how they are applied.”
Hays of Yosemite National Park said the Parkmedic collaboration between the national parks and UCSF Fresno deserves recognition. “This is the only course in the nation. It’s located in Fresno, California.”
