This is my third posting. SDN doesn't like the level 1 discussion.
Level 1 is not an important designation in and of itself. However, it is an indirect proxy of exposure and experience. Many EMS systems do not take traumas to level 2's unless they are unstable or there is not one close by. (for further understanding of the designation, go here:
http://www.ilga.gov/commission/jcar/admincode/077/077005150H20300R.html).
While I would not advise dismissing programs without level 1 status, or a level1 rotation, I would simply take a few extra moments to explore that programs level of exposure.
Even with level 1 status, there are trends that experience is declining.
Incompatibility Between RRC Requirements and Actual Number of Emergent Procedures in Trauma Patients
G. Garraa, A. Wacketta, J.E. McCormacka, A.J. Singera, M. Shapiroa, H.C. Thode Jr.a and M.C. Henrya
aStony Brook University, Stony Brook, NY
Available online 21 August 2007.
Article Outline
Study Objectives Methods Results Conclusion
Study Objectives
The RRC requires EM and surgical residents to have sufficient opportunities to perform invasive procedures. Each resident is required to perform 20 central lines, 10 chest tubes, 3 cricothyrotomies, 35 intubations, 3 pericardiocenteses, and 3 peritoneal lavages, during residency. We determined the number of procedures needed by trauma patients at a regional trauma center to see whether there were enough procedures to credential all our residents.
Methods
Study Design-Secondary analysis of regional trauma registry.
Setting-Suburban, academic, level 1 trauma center with affiliated residencies in EM (10 residents/year) and surgery (6 residents/year).
Measures-Demographic and clinical data extracted from computerized trauma registry between 1996-2005.
Outcomes-Mean number of procedures per resident over residency. Data Analysis-Descriptive statistics.
Results
There were 15,606 trauma patients admitted to our trauma service. Over 11 years there were 622 chest tubes, 143 peritoneal lavages, 50 emergent thoracotomies, 6 surgical airways, 1,002 intubations, 14 pericaridiocenteses, and 666 central lines placed on trauma patients. The mean annual number of procedures were chest tubes 56, pericardiocentesis 1.3, thoracotomies 4.5; surgical airways 0.5, intubations 91.5, and central lines 60.5. Over the study period the number of peritoneal lavages and thoracotomies has declined while the number of central lines has increased. With 60 emergency and surgical residents at our center, on average each resident would perform 3 chest tubes, 9 trauma intubations, 6 central lines, and very few if any surgical airways, emergent thoracotomies and peritoneal lavages in the ED during residency, assuming they are evenly distributed.
Conclusion
In order to maximize procedural experience, surgical and EM residents must collaborate. Alternative venues (simulation lab, animal lab, operating room) are necessary for mastering the skill of trauma procedures.