So...who actually goes to MTF ED?

[StemiAlert]

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Please excuse this ridiculously naive question, as my medicine/military experience is very limited. I'm simply trying to understand the military medicine system as I look towards matriculating with USU.

My understanding is that the Army has two fairly large hospitals that are also trauma centers, i.e. Brooke/SAAMC and Madigan. When I looked at the stats for each hospital's annual number of Emergency Department visits, I was surprised that they were volume was quite high (75,000 per year according to Brooke) versus other urban hospitals I've come across (e.g. 45,000 per year at a Level I trauma center in California). My question is: what sort of patients do these MTFs actually get? They can't all be soldiers, veterans and their families (can it?!) Do civilians end up at these facilities too?

The reason why I'm asking is that at USU, Brooke and Madigan are internship/clerkship sites and I'm curious what types of patients we will see in the Emergency Department. If I want to go into Emed, I would want a wide variety of patients (i.e. it would be nice to see Stroke/STEMI/Traumas), so I'm very curious what I would see if I was fortunate enough to land a spot at a place like Brooke.

Thanks for any thoughts. Apologies for being so inexperienced and green.

 

[jabreal00]

Please excuse this ridiculously naive question, as my medicine/military experience is very limited. I'm simply trying to understand the military medicine system as I look towards matriculating with USU.

My understanding is that the Army has two fairly large hospitals that are also trauma centers, i.e. Brooke/SAAMC and Madigan. When I looked at the stats for each hospital's annual number of Emergency Department visits, I was surprised that they were volume was quite high (75,000 per year according to Brooke) versus other urban hospitals I've come across (e.g. 45,000 per year at a Level I trauma center in California). My question is: what sort of patients do these MTFs actually get? They can't all be soldiers, veterans and their families (can it?!) Do civilians end up at these facilities too?

The reason why I'm asking is that at USU, Brooke and Madigan are internship/clerkship sites and I'm curious what types of patients we will see in the Emergency Department. If I want to go into Emed, I would want a wide variety of patients (i.e. it would be nice to see Stroke/STEMI/Traumas), so I'm very curious what I would see if I was fortunate enough to land a spot at a place like Brooke.

Thanks for any thoughts. Apologies for being so inexperienced and green.

I can't speak for Madigan but Brooke is open to all civilian traumas (gun shots, stabs, MVA, heart attacks and strokes). It's the only burn center that caters to adults in San Antonio. UT has a burn center for children. This is why it's fairly busy.

 

[bogatyr]

I can't speak for Madigan but Brooke is open to all civilian traumas (gun shots, stabs, MVA, heart attacks and strokes). It's the only burn center that caters to adults in San Antonio. UT has a burn center for children. This is why it's fairly busy.

They also see everyone who can't get an acute care appointment in a reasonable amount of time, which works out to be a lot of people.

 

[NateintheED]

I trained in EM at Madigan. Incidentally, if you're going to refer to Emergency Medicine by an abbreviation/shorthand, EM (not Emed) is generally accepted.

As for what you see... Madigan is integrated into the Pierce County trauma system and is a Level 2 trauma center. There is 1 other level 2 trauma center in the county at any given time (shared on alternate days between 2 places in downtown Tacoma). What that means for Madigan is that any patient in the county, civilian or otherwise, that meets criteria for trauma activation by EMS can be transported to Madigan.

As far as medical patients are concerned (MI, CVA, etc), Madigan has a HUGE population of retirees and other dependents that it serves. If you become a resident there, you will have no shortage of these cases. Madigan residents also do a significant number of rotations in local community hospitals as well as 2 months at a level 1 trauma center in Portland, OR, so there's plenty of exposure to critically ill and injured Emergency Department patients.

As a med student during a clerkship, you may see these come through and have the opportunity to observe the management of all of these types of patients, but do NOT expect to be actively involved.

Remember that these patients are the minority of ED patients in general (military or civilian). The bread and butter of EM is things like undifferentiated abdominal pain, chest pain, difficulty breathing, pediatric illness, orthopedic injury and many other less-emergent complaints that still require care. Any place you go will have plenty of that to go around.

 

[Atlas Shrugged]

How competitive are the general/trauma surgery programs at these hospitals?

 

[Droopy Snoopy]

They also see everyone who can't get an acute care appointment in a reasonable amount of time, which works out to be a lot of people.

Brooke Army is also the final destination point to a good portion of medevacs from theater. Ft Sam Houston is home to several Army tech schools and therefore gets a buttload of droopy troopies and stupid trainees doing stupid things. Also San Antonio is home to probably half a million AD and veterans. I'm sure Madigan is the same, so I don't have a problem believing those numbers. And now that Lackland is closing up, the BAMC ED is only going to get busier.