Programs with less trauma

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To my memory, all EM programs are located in level 1 trauma centers. Out of curiosity, can anyone think of a program that is not?

The volume that any individual center sees, as well as the types of trauma will vary from center to center.

Are you asking about the Level of the trauma center, or are you speaking more about the actual volume/type of truama?
 
Newark-Beth Israel, Maimonides (Lutheran is Level I, two miles away - one block, and 2 blocks at ShockTrauma), Methodist in Brooklyn, I think NYMC-Metropolitan, Mt. Sinai is not (but Elmhurst, their largest affiliate, is), Morristown in NJ (I think) - those are the first round that I come up with.
 
The "level", whether Level 1 or Level 2, of the trauma center doesn't necessarily speak to the volume nor type of trauma that they see. Achieving Level 1 trauma center status is as much a matter of paperwork and politics as anything else. I'm not sure how much (if at all) it matter on the volume of the trauma they get.
 
How about programs that get less volume trauma then?
 
York, Pa is a level 2
 
In general the programs with the least trauma will also be the programs with the least volume. In that respect, you should be asking around which are the programs known to be "cushier." Pretty much all programs will provide a pretty high level of training, but the county hospital-type facilities will have a much higher patient load as well as a higher trauma volume, as the county facilities are generally the regional trauma centers.

Were you thinking of a particular region of the country?
 
I believe Baystate in Springfield, MA is a Level II now. They used to be level I but downgraded since they do not have a neurosurg on call 24/7 (if anyone knows different please correct me). However, they still get loads of trauma. They are the main trauma center for the area. You really can't dase the volume of trauma on whether or not the center is Level I or II.
 
Sessamoid said:
In general the programs with the least trauma will also be the programs with the least volume. In that respect, you should be asking around which are the programs known to be "cushier." Pretty much all programs will provide a pretty high level of training, but the county hospital-type facilities will have a much higher patient load as well as a higher trauma volume, as the county facilities are generally the regional trauma centers.

Were you thinking of a particular region of the country?
Click to expand...
Less volume doesn't always translate to a cush program. A program with high volume might have more residents (I know of one program that has 18 residents), whereas a low volume program might only have 7 or 8 residents.
 
southerndoc said:
Less volume doesn't always translate to a cush program. A program with high volume might have more residents (I know of one program that has 18 residents), whereas a low volume program might only have 7 or 8 residents.
Click to expand...
Of course, the cushier residencies are that way for a number of other different factors, including physician staffing. Faculty staffing comes into play, and probably nursing and ancillary services staffing is even more important in the workload of the residents. Fast, efficient hospitals are going to make for a much easier residency. This usually means rich, private or uni hospitals in relatively well-to-do neighborhoods. UC Irvine comes to mind, since it's close to me now.
 
Our program has only 6 a year but that has more to do with the available spots USF had to us... not necessarily correlated with amount of workload. We have absolutely NO scut whatsoever (besides helping the RNs with an EJ if they can't find access). We see ~60-75k a year (combined with Ped ER). I dont' have our #s for trauma, though, but we see quite a bit.

Wasn't a trauma, but last week we had a guy who fell into a septic tank and wasn't found until 40 minutes later, came in a medical code. He really stunk up the ED... and it even made the local news the next day (although they didn't know he died in the ED). I'm just glad I wasn't in the ED that day, as apparently there was feces flinging with each compression.

Q, DO
 
QuinnNSU said:
ith Ped ER). I dont' have our #s for trauma, though, but we see quite a bit.

Wasn't a trauma, but last week we had a guy who fell into a septic tank and wasn't found until 40 minutes later, came in a medical code. He really stunk up the ED... and it even made the local news the next day (although they didn't know he died in the ED). I'm just glad I wasn't in the ED that day, as apparently there was feces flinging with each compression.

Q, DO
Click to expand...


Really! no puns intended, but shouldn't this victim been treatd as a hazmat and decontaminated in the field before being brought into the ED?
 
There's now only one trauma center in Rochester, so there's alot more trauma at URMC now. The other trauma center, Rochester General, was de-certified after UR took out all their ortho residents last year. RGH was in a bad neighborhood, so they used to get lots of visits from the knife and gun club...now they all go to URMC.
 
After last night's shift I'm starting to wonder if looking for a program with less trauma isn't such a bad idea. I saw about 15 patients during my shift last night, and about 10 of them were trauma-related. Trauma patients are so time consuming sometimes. I was there 3.5 hours after I stopped picking up patients! I hate that. Our program is really good about sign-outs, but sometimes it just doesn't work out very well.
 
I would say that there were times at my program when the heavy trauma volume was a hinderance to learning. Discuss a long differential or treatments when you are just getting clobbered all the time.
 
For the ED doc trauma gets routine pretty quickly. Stabilization procedures for trauma are all fairly standardized, and there isn't a whole lot of intellectual stimulation. The really interesting part of trauma is handled by surgery, IMHO. The procedures can be fun though.

Intellectually, the medical side is much more interesting.
 
I might be wrong but from what I have seen at NYC EDs, Cornell is pretty low stress and probably an easy residency. They have the burn unit and the hospital for special surgery, so then all kinds of exotic fractures and burns come in. But for the most part, from what I observed there, mostly elderly rich people coming in because they fell out of bed.

And with the awseome inhouse specialists, it might not be so hard on a resident. Looked pretty smooth to me.

Anyone else know more? I am going to be a first year and so I don't mind admitting I have alot to learn.
 
Texas A&M University Health Science Center--Scott & White Hospital, Temple, TX.

This is a trauma center, but is located in a rural area. All the trauma in the surrounding towns comes in here, but there are other trauma centers in larger cities 30-60 miles north and south of Temple on the interstate, so more goes to the other hospitals.

The trauma that does come in is minimal, and all of the personnel have to share these few cases.

The residents are given the opportunity to rotate through a trauma center in Austin, TX or Denver, CO for just a month per residency year.

This is one of only 4 civilian EM residencies in Texas. The others are in large cities (El Paso, Houston, Dallas.)
 
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