Programs with trauma

[Beer drinker]

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I did a search, but found limited, out of date info on this. I'm planning on going into EM and really enjoy the adreniline rush of the trauma codes.

Was wondering which EM residency programs have

1) lots of penetrating trauma?

2) the EM residents running it all and doing the procedures?

Thanks for the info in advance.

 

[southerndoc]

I believe this was just discussed last year, so it's not that out of date.

 

[EM2BE]

I did a search, but found limited, out of date info on this. I'm planning on going into EM and really enjoy the adreniline rush of the trauma codes.

Was wondering which EM residency programs have

1) lots of penetrating trauma?

2) the EM residents running it all and doing the procedures?

Thanks for the info in advance.

You might think about trauma surgery instead.

Uh oh, I need to not do this. :troll:

 

[Beer drinker]

You might think about trauma surgery instead.

This may be a :troll:

There are many factors that go into specialty decision, I don't feel that I need to list the numerous benifits of a career in EM over surgery here. I simply find the acute presentation of serious trauma exhilarating.

Interestingly, when I did a search of the topic initially, the one recent thread that was relevant to my question, had the same helpful post from southerndoc as he provided on this thread.

The reason for the post is to narrow down the 140 odd programs that are available to apply to, to be able to focus on programs that cater to my interests. Not to start an argument or be a problem.

 

[EM2BE]

There are many factors that go into specialty decision, I don't feel that I need to list the numerous benifits of a career in EM over surgery here. I simply find the acute presentation of serious trauma exhilarating.

Interestingly, when I did a search of the topic initially, the one recent thread that was relevant to my question, had the same helpful post from southerndoc as he provided on this thread.

The reason for the post is to narrow down the 140 odd programs that are available to apply to, to be able to focus on programs that cater to my interests. Not to start an argument or be a problem.

I view trauma as more of a surgery thing unless/until you get a job at a smaller, non-community hospital (no residents/very few). That's what I've seen in my limited experience. There are several places the EPs do not even touch traumas because there is a designated team. If trauma interests you that much, I would look into going in the direction of trauma surgery if I were you. I guess that's all I have to say about the matter. (just my limited 2 cents)

 

[sleepymed]

You might think about trauma surgery instead.

Uh oh, I need to not do this. :troll:

it doesn't sound like he's being a troll by posting what he posted... i think lots of people can be interested in trauma without wanting to be surgeons...

i know a bunch of the philly programs see a lot of trauma, cook county sees a lot of trauma, a bunch of programs in detroit see a lot of trauma... i particularly liked temple... i felt like they see a lot of trauma and were very adept at managing it... what you want to do is look for places with a high crime rate and apply for programs there 😉

 

[domer621]

Yeah, I would think that the inner-city programs would have the most penetrating trauma experience for you. UChicago, Cook County, UMaryland (the first shock trauma center), Highland, etc.

Nothing wrong with liking trauma and wanting to do EM.

what you want to do is look for places with a high crime rate and apply for programs there 😉

Exactly!

 

[AmoryBlaine]

Sounds fairly non-trollish to me as well. But several points bear repeating.

1. Management of trauma is not THAT complex. It is VERY algorhythmic (sp?) as opposed to managed sick medical patients. Even for people that seem to have all sorts of injuries about all that an EM doc is going to do is establish an airway, establish access, rarely do a direct intervention on the inury (ie thoracotomy), and then get the patient into a CT scanner and into the hands of the doctors who can really save their lives -- the surgeons!!

2. The lifelong practice of EM is highly unlikely to involve a significant amount of penetrating trauma. Many trauma centers are academic institutions with surgical trauma teams. Community emerg med is very trauma poor excepting minor blunt trauma.

3. This whole concept of "EM running the traumas" is kind of silly in my humble opinion, though I would welcome discussion on the topic. The only thing this is good for is sparing our surgical colleagues from coming down to see the BS low-speed MVCs. I've seen programs where EM "runs" trauma and here's how it works: penetrating trauma gets immediate surgical trauma team activation, bad blunt trauma gets immediate trauma activation. So alot of teams the EM resident would "run" the trauma by calling the surgery residents.

4. I fully recognize how relatively exciting trauma is compared to vaginal bleeding or abdominal pain. I know that it's a large part of the appeal for medical students looking at EM. I just think it's very instructive to look at the discrepancy between how med students view trauma (super exciting!) and how residents, both EM/Surg, tend to view it (painful).

 

[EM2BE]

Sounds fairly non-trollish to me as well. But several points bear repeating.

1. Management of trauma is not THAT complex. It is VERY algorhythmic (sp?) as opposed to managed sick medical patients. Even for people that seem to have all sorts of injuries about all that an EM doc is going to do is establish an airway, establish access, rarely do a direct intervention on the inury (ie thoracotomy), and then get the patient into a CT scanner and into the hands of the doctors who can really save their lives -- the surgeons!!

2. The lifelong practice of EM is highly unlikely to involve a significant amount of penetrating trauma. Many trauma centers are academic institutions with surgical trauma teams. Community emerg med is very trauma poor excepting minor blunt trauma.

3. This whole concept of "EM running the traumas" is kind of silly in my humble opinion, though I would welcome discussion on the topic. The only thing this is good for is sparing our surgical colleagues from coming down to see the BS low-speed MVCs. I've seen programs where EM "runs" trauma and here's how it works: penetrating trauma gets immediate surgical trauma team activation, bad blunt trauma gets immediate trauma activation. So alot of teams the EM resident would "run" the trauma by calling the surgery residents.

4. I fully recognize how relatively exciting trauma is compared to vaginal bleeding or abdominal pain. I know that it's a large part of the appeal for medical students looking at EM. I just think it's very instructive to look at the discrepancy between how med students view trauma (super exciting!) and how residents, both EM/Surg, tend to view it (painful).

I think you covered this very well. I wasn't sure at first if it was trolling (just to start the surgery argument) or if it was sincere. After the second comment, it seems sincere, but (as you said) I don't think EM is the way to go for trauma.

 

[Station51]

All good points by AmoryBlaine on why EM may not be the right field for anyone who wants "to do trauma." Me, I like trauma but I'm perfectly happy about the role I have with trauma. But I still wanted to put in my two cents about the importance of trauma training in residency.

Sounds fairly non-trollish to me as well. But several points bear repeating.

1. Management of trauma is not THAT complex. It is VERY algorhythmic (sp?) as opposed to managed sick medical patients. Even for people that seem to have all sorts of injuries about all that an EM doc is going to do is establish an airway, establish access, rarely do a direct intervention on the inury (ie thoracotomy), and then get the patient into a CT scanner and into the hands of the doctors who can really save their lives -- the surgeons!!

I agree it's not that complex but I'm a believer that good trauma experience in residency is invaluable. It's the time to get comfortable with trauma airways, chest tubes, lines, throwing in that stitch in an active bleeder, etc. And depending on where you want to practice, there are plenty of trauma patients that have active medical issues and it's nice to have experiences in residency where traumatic and medical issues coincide.

2. The lifelong practice of EM is highly unlikely to involve a significant amount of penetrating trauma. Many trauma centers are academic institutions with surgical trauma teams. Community emerg med is very trauma poor excepting minor blunt trauma.

I also agree that most EP's will not see the amount of trauma they see in residency. While bad trauma can be extremely infrequent in a small non-academic hospital, it can happen and it can happen when there is no surgeon in-house overnight. I would still argue for the benefit of a wide variety of trauma experience in residency even if the practice of EM in the community doesn't involve a whole lot of trauma.

3. This whole concept of "EM running the traumas" is kind of silly in my humble opinion, though I would welcome discussion on the topic. The only thing this is good for is sparing our surgical colleagues from coming down to see the BS low-speed MVCs. I've seen programs where EM "runs" trauma and here's how it works: penetrating trauma gets immediate surgical trauma team activation, bad blunt trauma gets immediate trauma activation. So alot of teams the EM resident would "run" the trauma by calling the surgery residents.

I guess it all depends on where you see yourself ending up after residency. And just because surgery team is called doesn't mean that EM just sits back. Again, while infrequent, bad trauma can occur in the suburban non-academic center where there may be no in-house surgeon.

4. I fully recognize how relatively exciting trauma is compared to vaginal bleeding or abdominal pain. I know that it's a large part of the appeal for medical students looking at EM. I just think it's very instructive to look at the discrepancy between how med students view trauma (super exciting!) and how residents, both EM/Surg, tend to view it (painful).

Again, agree that most traumas aren't really that exciting which is why I advocate for programs with good trauma experience because it will only give you more experience with the bad traumas as well as the atypical/benign presentations of trauma that turn out to be something.

 

[TysonCook]

Also don't forget that if you have multiple traumas (which is very common here), that the trauma surgeons are in the OR, so you definitely will end up managing traumas as an EP....although it has been said several times before, trauma can become very algorhythmic, and other things become "cool" during residency (eg undiff sepsis).

As far as "running" traumas, at Carolinas us and trx surg alternate every other day with running trx & procedures. I've never have a problem with who's running etc, and it usually ends up with one of us saying "you want to run it, or should I" and a response of "nah, we have two more on the way, let me know if you need X done".

LOTS of trauma here, and very congenial 🙂

Bottom line, we both stabilize the patient, then the surgeons take the ball and run with it (cold steel saves lives)

 

[ditch doctor]

If trauma is what you want, then you should look into LSU-New Orleans. They have around 60% penetrating trauma. I think the nearest competitor is around 30%. The EM residents run all trauma resuscitations, manage all airways and alternate procedures with surgery.

 

[DocZ]

Despite the usual discussion regarding the complexity of medicine patients and the cookbook mgmt of trauma patients, there are certainly plenty of EM docs that take jobs and make careers because of an interest in the trauma experience and not the pathology of the medical cases. That being said, in the NY area, consider UMDNJ-Newark, SUNY Downstate and Lincoln (Bx). All have high overall volume and all still get their share of penetrating trauma (especially for the NY area) and I believe the EM docs at all three have a fairly signif role w/ procedures and "running the resusc".

 

[a_ditchdoc]

If you're really looking for trauma, come to Detroit. There is no shortage of people here willing to shoot each other over a few words. I came here looking for trauma, found it, and am now over it for the most part. I usually don't even peek my head in the trauma bay if I am not the one responsible for running it. It is so frequent the newspapers don't even bother to report on most if it.

It is exciting at first, but then it gets a little depressing that humans can be so sadistic to one another. And, as they have all said, it is all pretty much run the same every time. Just go somewhere that will give you the exposure to be comfortable.

 

[AmoryBlaine]

All good points by AmoryBlaine on why EM may not be the right field for anyone who wants "to do trauma." Me, I like trauma but I'm perfectly happy about the role I have with trauma. But I still wanted to put in my two cents about the importance of trauma training in residency. I agree it's not that complex but I'm a believer that good trauma experience in residency is invaluable. It's the time to get comfortable with trauma airways, chest tubes, lines, throwing in that stitch in an active bleeder, etc. And depending on where you want to practice, there are plenty of trauma patients that have active medical issues and it's nice to have experiences in residency where traumatic and medical issues coincide.

I also agree that most EP's will not see the amount of trauma they see in residency. While bad trauma can be extremely infrequent in a small non-academic hospital, it can happen and it can happen when there is no surgeon in-house overnight. I would still argue for the benefit of a wide variety of trauma experience in residency even if the practice of EM in the community doesn't involve a whole lot of trauma.

I guess it all depends on where you see yourself ending up after residency. And just because surgery team is called doesn't mean that EM just sits back. Again, while infrequent, bad trauma can occur in the suburban non-academic center where there may be no in-house surgeon.

Again, agree that most traumas aren't really that exciting which is why I advocate for programs with good trauma experience because it will only give you more experience with the bad traumas as well as the atypical/benign presentations of trauma that turn out to be something.

All good points. 👍

 

[roja]

Not to be redundant, but anyone who is choosing EM to 'do trauma' is going to be very disappointed overall.

Not that trauma isn'nt important and that there aren't places where you can train and work where there is trauma, but no place has so much trauma that it will be a huge part of your practice.

Trauma, while VERY important, is a small part of EM and if that is the only part you like, it might not be the field for you.

 

[DrQuinn]

To the OP:

Penetrating trauma you will have to go to the major cities. I would guess Chicago, NY, New Orleans, Miami, LA, Denver, Detroit, etc.

I did my training in Tampa and the majority of our trauma was blunt.

I'm in DC now but our program is still in transition (being a new program), though we see a lot, i mean, a LOT, of penetrating trauma.

Q

 

[deleted52758]

i imagine detroit is the place to be for penetrating trauma. im at cook county. i've seen enough to where i feel like im very good with trauma, but i imagine any program in detroit is going to have more penetrating trauma. but then again, you'd have to live in detroit. which is a whole nother discussion.

 

[Winged Scapula]

The OP should ask him/herself what they like about trauma.

If it is the resuscitation, management of complex problems, then EM or Trauma Surgery is a good choice.

If it is doing procedures, you must ask yourself what a procedure is. Intubation, placing lines, FAST, etc.? Plenty of those in most EM programs. But if you are looking to frequently crack chests, manage abdominal trauma, etc. - ie, doing surgery, then you need to be a trauma surgeon.

As others have noted, EM, even at the most busy knife and gun club is not all trauma guts and glory and can often be shuttled to the side when the trauma surgeons come in. Its very hospital and program dependent.

 

[GeneralVeers]

In Corpus Christi, TX, the EM residents ran the trauma service and did all procedures. No surgery residents to steal anything.