Just my two cents.. when I was originally compiling my ROL's, I placed a heavy emphasis on EM supervised trauma admissions. I viewed this policy as emblematic of emergnecy medicine's strength as a department within a particular institution. Though I don't have studies to corroborate this opinion, I believe seamless integration between the emergency and surgical specialties is of prime importance. Trauma is a surgical disease, and our efforts as EPs are focused on the rapid rule out and stabilization of immediate life/limb threats. There's little question that we can manage airways with the best of them, crack an ocassional chest, and pop in a chest tube with the confidence of a general surgeon. When patients are have blood in their belly, however, they will often require operative management- something EP's are not immediately capable of providing. Consequently, it makes little sense to judge a program on the basis of the supervision of immediate trauma care. Emergency medicine physicians need to achieve procedural competence in all phases of ATLS, but our practice embraces much more than the primary and secondary surveys described in that course. While running a trauma, we're also responsible for the sore throat in triage, the decompensating CHF'er in the resus bay, and the disposition of patients in urgent care.
My point is rather simple: I would very humbly suggest that the supervision of trauma resuscitation is not indicative of a program's strength. Consider our experience at Shock Trauma, for example. There's little question about hierarchy within the resus bays- trauma surgery supervises ALL traumas with anesthesia managing the emergent airways. An aspiring EM resident might view this as entirely problematic, as I did in my initial survey of the U Maryland program. Interestingly enough, this apparent exclusion of emergency medicine couldn't be farther from the truth... Shock Trauma admits over 7000 patients per year. Three trauma teams, comprised of a trauma surgery attending, trauma critical care fellow, GS and EM residents, special forces medics, and some students assume responsibility for admissions. The team's residents take turns as the "admitting physician".. this policy affords "supervisory" and "leadership" time for both GS and EM trainees. Currently, UMaryland EM residents spend four months with the trauma surgery service. This practice results in procedural numbers that far exceed RRC-EM minimums. Finally, emergency medicine residents spend a dedicated month functioning as a trauma anesthetist. During this junior year rotation, the EM resident manages all trauma airways and semi-elective procedures performed in the trauma operating rooms. There's little to no intra-operative time; the emergency medicine resident literally runs from trauma bay to trauma bay to provide any necessary acute airway interventions. During this month alone, it is not uncommon to secure 60-80 emergent intubations.
So....there's a little more complexity intrinsic to the question of, "who runs the traumas?" Most any program will provide EM residents with the requisite number of tubes and procedures. When doing your research, be sure to ask about the trauma experience as a WHOLE. The question of supervision occasionally boils down to inter-department politics and rivalry. Provided that a good working relationship between the two services is in existence, the EM resident will be provided with ample opportunity for ATLS oriented practice.
