On the MD side, there is no such thing as a “pure” disaster medicine career trajectory. It will always intertwined with Emergency Medicine Services. EMS is pre-hospital management of patients.
All EM physicians do rotations with the EMS service during residency, including ride alongs.
Emergency Medical Services is a subspecialty within emergency medicine and requires a fellowship after the completion of an emergency medicine residency. Because of the additional training EMS fellows do and because EM physicians have significant exposure to EMS field service during residency, prior experience as a paramedic/emt isn’t necessary or expected.
An EMS physician is the de facto director of all emt/paramedic services within a service region (county, city, etc). During a disaster, all emt teams report to him. He will dispatch pre-hospital teams to the site and direct the disposition of patients to various emergency departments within the region–or outside of it if the disaster is large enough .He will also direct what types of safety precautions that pre-hospital teams take (e.g. radioactive contamination, toxic chemicals, airborne poisons or bioweapons, etc) and what special treatment patients may need to receive during transport. The EMS physician will be involved in disaster planning, but only as one member of a larger committee. (All disaster planning is done by a committee because there are a variety of agencies involved and a breadth of expertise is required beyond the purview of single individual.)
An EMS physician would always be onsite to observe and take notes during an disaster simulation/disaster readiness drill. During an actual disaster, he would be in the hospital directing his team remotely and treating the injured.
The thing is disaster medicine is just a minor part of what an EMS physician does. Disaster medicine is never a full time position. 98% of the time an EMS physician will work the ED just like any other EM doc, but will have the added responsibility of being on radio duty–which means s/he must be available to direct the EMTs in patient management while the patient is enroute. Some municipalities require a EMS physician to ride along and be present onsite whenever the SWAT or hostage negotiation team is called. The physician doesn’t participate in the police action, but is on hand to provide medical advice (like on a perpetrator’s or victim’s mental or physical condition) and in the event of a injury to provide immediate medical care.
All the EM docs out in the field during mass casualty events that you see on TV—basically that never happens in real life.
Specifically speaking about UNM SOM-- 4th year med students student can elect to do a 4 week EMS rotation. (D1 did. She got to ride along on call outs in the EMS Suburban with the big a** medical field kits in the back and had her very own flak vest and helmet. She did not carry a gun, but the EMS physician on duty is required to be firearms certified and carry a handgun on call outs. She also got to sit in on one really long meeting down at city hall while a disaster readiness drill was being planned. BTW, drill planning takes many months… Had it been football or basketball season, she would have gotten to sit on the team bench with the EM physician on duty to provide emergency medical care to an injured player–or to the fan who has heart attack in the stands.)
A MPH disaster planner is more concerned with identifying what are the potential sources of a disaster and how to minimize the effects on the local population. (What industries store toxic chemicals on site. What chemicals are they. What are the heath dangers. What neighborhoods are in danger should a toxic chemical container rupture given various different wind patterns. How can we get the word out to evacuate neighborhood Z without causing panic. etc) They would not be hands-on during disaster readiness drill. But they would participate in the after-analysis of the success/failure.
My S has a stubborn streak, and he just plain wants those certifications. In fact, the price of talking him out of the BS in EMS was “Fine, but I’m still doing paramedic.”