My place is a level 2 because we don't have heart/lung bypass, we also don't have ECMO, or CVVH for that matter... but we still take GSW and SW to the OR ALL THE TIME. We also are placing thoracostomy tubes and even doing ED thoracotomies. But I'm also a Surgery resident, the EM peeps get to place Thoracostomy tubes when our residents don't need them, but we are the ones doing the thoracotomies and the emergency cric's.
I agree with you regarding the lack of real world difference in training at a level 1 or level 2. I will say that you might have a misconception about the procedures EM does when you aren't present, which is common among non EM residents, and perhaps attendings as well.
One of my colleagues recently opened a chest on a trauma patient as soon as the patient hit the door. Trauma had not yet arrived as we had not received any advanced noticed. It's rare for this to happen, but it's not like we just throw our hands in the air and give up simply because the trauma doc isn't there to do it.
The vast majority of our patients are medical, not trauma.
For instance, we put chest tubes in spotaneous pneumos who need them urgently. I only call surgery if I'm busy, the tube can wait, and I don't think it needs done right now.
Emergent Crics... This is rare overall as most of us can secure even difficult airways one way or another. But we intubate patients routinely in the ED. What happens on those extremely rare occasions when we can't secure the airway and can't bag the patient to buy time? We cric. The patient would be dead if we waited until a consultant arrived. If I anticipate a possible need for a cric or difficult airway, I may call ENT or anesthesia to the ED. But if you think surgery does the majority of emergency crics in the ED, you either don't work at a typical hospital or, more likely, don't realize what ED physicians do with the majority of our patients, who medical. Many are only mildly sick, but many show up very sick.
Heck, this may blow your mind, but when I was a 4th year student I watched an ED attending do a perimortem C-section. Did you know we are trained to do that? To really top this off... The OB resident was present at bedside... But the procedure was still done by the ED doc.
Think sepsis, out of hospital cardiac arrest, CVA, Chf, cold, and so on.
Here is my take on the original post.
If a medical student wants a good trauma experience, the best hands on training will be found at a trauma center without general surgery residencies. This means no surgery residents to compete with for procedures. All the procedures will be done be the ED residents who may let students do many of them too. I rotated at a level 2 trauma ED without surgery residents and did 2 chest tubes that month. I thought it was awesome.
In residency I worked at multiple hospitals, and one was s a level 1 trauma center without any general surgery residents. These are the places you should look for in my opinion.
The trauma level designation is rarely important to the education of students or EM residents.
That being said, trauma should not be a big factor or priority for someone choosing EM. Trauma is such a tiny part of our job that you will be very disappointed in the long run. If you enjoy seeing a mix of all types of medical patients, most not sick, some very sick, with trauma patients sprinkled in here or there, then choose EM.
Heck, even the surgery residents at my hospital dislike their trauma rotations. The vast majority of trauma patients are elderly people who fell down. There are a fair amount of MVCs. There is some penetrating trauma, but it is typically nothing like you see on TV.
Choose EM because you like getting an undifferentiated chief complaint and trying to make the correct diagnosis. Choose EM because you like making quick interventions that help people feel better. Choose EM because you like to see a variety of stuff. There are many reasons to choose or not choose EM. But I strongly advise you to not choose EM for trauma.
