Hello,
I'm a second year resident at the Vegas EM program now and would be happy to answer your questions since I just finished consecutive months on Trauma and Trauma ICU. Right off the bat
I totally agree that we have great pathology, high volume, good didactics, and an awesome location.
Firstly I'd like to address the trauma anesthesiologist comment brought up earlier. We rotate with anesthesia as first years and they teach us many pearls on airways and we have a great relationship with them. During all trauma activations (see below) the ED resident gets the airway and the anesthesiologist serves as a back up function, which is nice to have. Ideally, there is always back up in a critical situation while you are given independence as a resident. I have rotated for 2 months on Trauma Surgery, one month on Trauma ICU, and about 6 months on EM and have NEVER had my airway stolen by anyone else, so that above comment by the med student on "sometimes" we get the airway from anesthesia is totally off base.
There is a free standing trauma center at the program's primary hospital in Vegas (University Medical Center). This trauma center is one of the busiest in the nation and one of a handful of free standing centers in the country.
There are 2 versions of trauma there: activated and non-activated.
There is an ED attending and resident(s) in the center 24 hours a day.
All non-activated trauma will go to this group. Now the out of area transfers are not usually activated no matter how sick they are and critical patients will still go directly to the ED team. I've admitted C-spine fractures, bad IC bleeds, etc from this team. The non-activated traumas are the majority of trauma in the country and you will get tons of reductions, conscious sedation experience, and wound care experience, i.e. bread and butter EM.
Activated traumas include most penetrating trauma among other things. Here the Trauma surgery resident team is paged once EMS calls the trauma center. There are a number of times that EMS beats them there and at that time the ED team takes care of the initial stabilization of the patient. The rest of the time there are 1 or 2 EM residents on trauma surgery and they have airway dibs, do reductions, etc. As a senior you will be the one running the traumas on Trauma surgery.
After stabilization from any team, all critical patients go to the Trauma ICU where the ongoing resuscitation (blood, ffp, vent/medical managemt) goes on. Here most of the time a second year ED resident is on the team. This is a great learning experience.
In terms of experience the ED residents at my program do a total of 3 months of Trauma Surgery and one month of Trauma ICU. These months are a ton of fun and you have unbelievable experiences that you will never forget. Also, every ED month we do shifts in the Trauma center with the ED doc and get experience on the bread and butter traumas that 99% of ED docs actually see all the time.
We get tons of intubations on ED, Trauma, Trauma ICU, MICU, etc. We also cover emergent tubes in the entire hospital 24 hours a day and we get a ton from this source too. This is not a training area to be concerned about in my program.
You asked about tapping a knee, reductions, and transvenous pacers. I've done all of those in the ED already too and we never call a consultant for these procedures. The ED attendings here mostly trained at large county centers like ours and have an impressive range in terms of procedural experience.
And lastly, yes, we've got it together just fine and it's a blast over here.
Any other questions please feel free to post. If you want to ask them without a public setting feel free to go to lasvegasemr.com and look me up and shoot me an email.
DM
