Programs heavy in ortho/trauma

[bad virus]

High guys,

I know most of you hate these kinds of questions, but you can'nt blame aguy for trying to find out. Do you know of any programs that are big on ortho and trauma? If you trained or work at such a program, let me know . Thanks in advance.

Take care.

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[KiloAxe]

Every level 1 trauma center is going to see a heck of a lot of trauma and with that comes ortho injuries. Maybe more important questions are what is EM residents role in the trauma (ie. airway, procedures, who runs it).

 

[Hamhock]

High guys,

I know most of you hate these kinds of questions, but you can'nt blame aguy for trying to find out. Do you know of any programs that are big on ortho and trauma? If you trained or work at such a program, let me know . Thanks in advance.

Take care.

Yeah, I don't think you are going to get the list you are looking for...even though I think it is a legit question.

...the usual suspects will pop up, if enough people respond.

However, like the prior posted started to imply: What you really want to know is EM's role in trauma and ortho at any of the Level I/II spots. (I have never worked in a Level II, but I have heard about a fair number that EM does nearly everything).

I think among the many things that separate the quality of EM residencies (and I think there are many -- see my many prior comments about this), the EM role in ortho is a big one...there are some places that consult EVERY fracture or dislocation that isn't N/V threatened...and there are some places that reduce, splint, and OTD nearly every fracture (and develop the knowledge of which can't be sent OTD).

Sadly - although I think I got great training and believe my program to be one of the best - my residency saw plenty (way too much trauma) and ortho, but ortho remains one of my weakness at less than one year out of residency.

I applaud your careful discrimination between programs...just ask your questions even more carefully.

HH

 

[pinipig523]

My program has a standalone Trauma ER where you rotate through as a PGY2, a PGY3, and as a PGY4. You rotate in for a total of 14 weeks. You get graded responsibility and you become trauma chief as a PGY4 (which is coooool) and you get all airways that no one else gets (so you get the last try before the cric hammer comes crashing down). You also get to man the entire place while the attending sleeps and the only time he/she wakes up is for 1 of 3 things:

1. To sign the charts on patients you've seen, managed, and dispositioned.
2. To help you out because the poop has hit the fan on a friday night and there are 4 GSW victims, 4 MVC victims, 4 BHT victims, 2 stab wounds, and 1 peds case who was thrown out the car... all coming in within 4 hours of each other and all are in your trauma resus area.
3. Or if you suck and you can't handle the heat and you can't run the trauma room without the attending present.

I think this is great... being immersed in a trauma rotation really gets you to understand what and how to do things. I prefer this over a year-round minor trauma here and there, a major trauma here and there type thing. When I'm in trauma - I don't want the little stuff... I want to get COMPLETELY ANNIHILATED!!!!! When I was trauma chief... I would come to call that day and I pray to God that I get completely DESTROYED that night. I love it when I'm up to my neck in crap and that I feel like 1 more patient will break the team... but it doesn't and you feel fantastic the next day. I wanted to see how many it would take before my team would be stretched to its limits and where I would begin to bend.

Was it going to be 2 shock traumas that night? Maybe 3 intubations? Maybe 2 chest tubes? Am I going to have to stick my finger in someones leg again to tamponade an arterial bleeder? Is this going to be another 20 GSW victim that somehow survives since every vital organ was missed by the perp? Will there be a code blue in the Trauma ICU that night? Do I get to tube that one too? Will I get to reduce a b/l anterior shoulder dislocation in a patient coming off a motorcycle accident - just so I could get him to fit into a CT scanner?

Also, my program is strong with ortho. We do a dedicated ortho month where you splint/reduce/help manage approximately 200 fractures over that month. You do it with the orthopods so you get to see how they do things. We try not to consult ortho for any fracture that needs reduction - I usually put it back myself. I splint everything myself... I don't have some fancy tech do it.

 

[la gringa]

My program has a standalone Trauma ER where you rotate through as a PGY2, a PGY3, and as a PGY4. You rotate in for a total of 14 weeks. You get graded responsibility and you become trauma chief as a PGY4 (which is coooool) and you get all airways that no one else gets (so you get the last try before the cric hammer comes crashing down). You also get to man the entire place while the attending sleeps and the only time he/she wakes up is for 1 of 3 things:

1. To sign the charts on patients you've seen, managed, and dispositioned.
2. To help you out because the poop has hit the fan on a friday night and there are 4 GSW victims, 4 MVC victims, 4 BHT victims, 2 stab wounds, and 1 peds case who was thrown out the car... all coming in within 4 hours of each other and all are in your trauma resus area.
3. Or if you suck and you can't handle the heat and you can't run the trauma room without the attending present.

I think this is great... being immersed in a trauma rotation really gets you to understand what and how to do things. I prefer this over a year-round minor trauma here and there, a major trauma here and there type thing. When I'm in trauma - I don't want the little stuff... I want to get COMPLETELY ANNIHILATED!!!!! When I was trauma chief... I would come to call that day and I pray to God that I get completely DESTROYED that night. I love it when I'm up to my neck in crap and that I feel like 1 more patient will break the team... but it doesn't and you feel fantastic the next day. I wanted to see how many it would take before my team would be stretched to its limits and where I would begin to bend.

Was it going to be 2 shock traumas that night? Maybe 3 intubations? Maybe 2 chest tubes? Am I going to have to stick my finger in someones leg again to tamponade an arterial bleeder? Is this going to be another 20 GSW victim that somehow survives since every vital organ was missed by the perp? Will there be a code blue in the Trauma ICU that night? Do I get to tube that one too? Will I get to reduce a b/l anterior shoulder dislocation in a patient coming off a motorcycle accident - just so I could get him to fit into a CT scanner?

Also, my program is strong with ortho. We do a dedicated ortho month where you splint/reduce/help manage approximately 200 fractures over that month. You do it with the orthopods so you get to see how they do things. We try not to consult ortho for any fracture that needs reduction - I usually put it back myself. I splint everything myself... I don't have some fancy tech do it.

i trained at the same place.... spot on.

 

[codegrey]

^ would you mind telling me which program you are are talking about? PM if you like...

I'm looking at away rotations this very minute.

 

[yossarian444]

^ would you mind telling me which program you are are talking about? PM if you like...

I'm looking at away rotations this very minute.

A thing to keep in mind: A program heavy on trauma for residents may or may not be the same thing for students rotating at that place. Example: Cook county - plenty of trauma for residents, but rotating EM students (by design) see a grand total of zero traumas during the rotation. It's not good or bad, it's just something to be aware of if your goal is to see traumas as a student.

 

[b-real]

^ would you mind telling me which program you are are talking about? PM if you like...

I'm looking at away rotations this very minute.

I believe it's Cook County...tremendous program.

Edit: yossarian beat me to it.

 

[dotcb]

I personally liked seeing trauma steadily throughout residency, rather than have it segregated out. Most of the county or level 1 trauma centers will give you adequate exposure to trauma & ortho to be good at it.

 

[Danbo1957]

Look for Emergency Medicine programs that are a Division of the Department of Surgery-- there you will receive direct instruction and evaluations from Trauma surgeons.

UTSW has a big, good Burn/Trauma/Critical Care program:

http://www.utsouthwestern.edu/educa...ivisions/burn-trauma-critical-care/index.html

 

[codegrey]

Look for Emergency Medicine programs that are a Division of the Department of Surgery-- there you will receive direct instruction and evaluations from Trauma surgeons.

UTSW has a big, good Burn/Trauma/Critical Care program:

http://www.utsouthwestern.edu/educa...ivisions/burn-trauma-critical-care/index.html

parkland is definitely on my list! will apply for an away there as soon as my VSAS is ready.

 

[Bojack Horseman]

Parkland has a trauma team that handles all the major stuff. The ER docs don't really do trauma. The only reason the ER is a division of the surgery department is so that they can receive more funding.

 

[Danbo1957]

... The only reason the ER is a division of the surgery department is so that they can receive more funding.

UTSW does not need any additional funding.

It's more complicated than that. Most Texas academic programs don't want an EM that's independent of IM or Surgery.

 

[b-real]

UTSW does not need any additional funding.

It's more complicated than that. Most Texas academic programs don't want an EM that's independent of IM or Surgery.

Care to elaborate?

 

[Cerberus]

Look for Emergency Medicine programs that are a Division of the Department of Surgery-- there you will receive direct instruction and evaluations from Trauma surgeons.

UTSW has a big, good Burn/Trauma/Critical Care program:

http://www.utsouthwestern.edu/educa...ivisions/burn-trauma-critical-care/index.html

I totally disagree with this. EM is a distinct entity from Surgery and there is no reason for an EM program to be under the division of anything other than emergency medicine. As someone at a program that does it's trauma months at a big name trauma place that is run by surgeons, I can say that the management of a trauma patient is a hell of a lot different when run by EM trained people versus surgeons (Surgeons tend to be of the "scan the hell out of everyone" mentality), whereas, at least at my program, we try to throw some rational behind who we scan. As someone else stated, if you want an Ortho/trauma heavy experience, the most important thing to look at is the role of EM at that institution, if your role in an ortho case is "call ortho and let them sort it out", it doesn't matter how much ortho you see, you won't be good at it.

 

[Bojack Horseman]

UTSW does not need any additional funding.

It's more complicated than that. Most Texas academic programs don't want an EM that's independent of IM or Surgery.

The emergency medicine division gets more funding from the surgery department than they would if they were a division of medicine. There was an article posted that explicitly stated this whenever the residency program began.

Trauma team handles trauma at parkland. Not ER docs.

 

[Danbo1957]

The emergency medicine division gets more funding from the surgery department than they would if they were a division of medicine.

This is correct, most non-independent EM programs are a division of the Department of Surgery.

EM is a distinct entity from Surgery and there is no reason for an EM program to be under the division of anything other than emergency medicine. .

The hard answer is that there are still bigtime turf wars (especially at Parkland and San Antonio), and there are "Powers That Be" at many big US Level I-Trauma hospitals who mistrust and sneer at the current educational/residencies and clinical operations of Department of Emergency models that have developed over the last thirty years.

 

[pinipig523]

This is why you need to go to a program who not only has the numbers but that they actually allow you to participate in their care. Cook County EM has a great relationship with the Trauma department and the EM residents do the entire trauma work up short of the OR.

 

[Old_Mil]

High guys,

I know most of you hate these kinds of questions, but you can'nt blame aguy for trying to find out. Do you know of any programs that are big on ortho and trauma? If you trained or work at such a program, let me know . Thanks in advance.

Take care.

If you want a program that's heavy in ortho and trauma, go somewhere there is neither a surgery residency nor an orthopedic residency. It isn't so much what rolls through the door, it's what you are allowed to do to it. In general, for most trauma surgeons ER = family medicine and for most ER guys surgeons = barbers.

 

[la gringa]

This is why you need to go to a program who not only has the numbers but that they actually allow you to participate in their care. Cook County EM has a great relationship with the Trauma department and the EM residents do the entire trauma work up short of the OR.

i've been out almost 3 yrs now and feel more than adequately trained in ortho/trauma. i shake my head at a few of my colleagues from time to time...

it's definitely nice to know that you can run a trauma alone - b/c that's exactly what you'll do in the community if you aren't at a major trauma center. ambulances will still show up w/ the wrong patient for your hospital and patients don't know the difference! i do miss having a trauma "team" though -- nothing sucks your time or resources (and ergo backs up your department) like a sick trauma patient!

i will caveat the above by saying that i also have a lot of pre-medical school as well as personal experience in ortho/sports med that helps me out when my EM training fails me -- especially with back pain!

 

[shookwell]

If you are interested in seeing trauma as a medical student you can do the critical care/trauma elective at King's County. I did it as an MS4 and it was pretty trauma and ortho heavy, although there was a lot of really sick medical patients as well. How involved Surgery is on the trauma patients is very attending dependent. Some atendings only call the trauma team in if they think the patient needs it and some will call them down as soon as the trauma phone rings.

http://www.downstate.edu/emergency_medicine/emed-4034.html

 

[docvino]

cook county = 4 year long program :/

 

[bad virus]

Thanks for the replies guys.

Yeah, Cook and King's county are both high on my list right now. I am just working to save aa little bit of money so i can try to do an away rotation at one of those two.

I also heard great things about Cincinnati .

So as one of the posters told me to do, I will ask my question more carefully.

Could you guys provide me with the names of a few of the programs that do the majority of their own fractures and reductions and only consult or ortho on surgical cases?

Also, could you provide me with the names of programs where the EM team does the trauma evaluation and work up and only consults surgery if needed?

Thank you all in advance. I am not asking these questions to put any programs down, I just have an interest in these two things and would like to make sure that the program i go to will be very strong in those aspects.

Take care.

 

[Hamhock]

Thanks for the replies guys.

Yeah, Cook and King's county are both high on my list right now. I am just working to save aa little bit of money so i can try to do an away rotation at one of those two.

I also heard great things about Cincinnati .

So as one of the posters told me to do, I will ask my question more carefully.

Could you guys provide me with the names of a few of the programs that do the majority of their own fractures and reductions and only consult or ortho on surgical cases?

Also, could you provide me with the names of programs where the EM team does the trauma evaluation and work up and only consults surgery if needed?

Thank you all in advance. I am not asking these questions to put any programs down, I just have an interest in these two things and would like to make sure that the program i go to will be very strong in those aspects.

Take care.

I think you have a pretty good start with parts of Cook County and Kings County.

IIRC, Cook County handles nearly all their own ortho, but trauma is handled in a different part of the ED, more under the supervision of surgery.

...and I think King's County runs/manages nearly all their own trauma, but a lot of ortho procedures are consulted.

I have no idea about Cincinnati; just rumors that is a great place for EM in general.

HH