Two (possibly) lame questions about EM

[banana5]

-

---

Members don't see this ad.

 

[In da know]

Our trauma team consists of Trauma Surgery Attending, Emergency Medicine Attending, Surgery Chief Resident, Surgery Resident, Surgery Intern, maybe a med student taking noted, one procedure nurse, one charting (primary) nurse, an RT and the charge nurse usually passes through. There is usually a tech running blood to the lab or to the blood bank, xray is standing by, RT if they come in tubed. Ortho rotates through on trauma service but not a standard.

 

[southerndoc]

Our trauma team for modifieds is a surgery PGY-2 during the day (7a-7p)/EM PGY-2 during the night (7p-7a), EM PGY-3 or 4 supervising, EM attending, trauma nurse, trauma tech, and a resource or triage nurse documenting.

Full traumas get: EM senior (runs during the day), another EM senior (airways all the time; only 1 EM senior shows up during the night though), surgery chief (runs during the night), surgery PGY-2, surgery PGY-1, medical student, trauma nurse, trauma tech, resource nurse or triage nurse to document, respiratory tech, x-ray techs, EM attending, trauma attending, SICU fellow when in-house, attending radiologist (to overread the FAST exam EM does and to advise on studies), and ortho PGY-3. Yes, we mobilize a LOT of resources for a full trauma.

 

[SoCuteMD]

I work in EMS in Westchester, NY and have taken patients to Westchester Medical Center (NYMC's hospital) several times. I know a lot of the doctors, and it seems that most of the time the ones in the bay for big traumas are hte orthopods, gas guy, and an EM attending. Is this how it works in other places? How come on like Discovery Health all of the trauma team are general surgeons?

Second, what's considered to be the best EM program in NYC? Just curious.

A few friends of mine shadowed trauma surgeons all summer at WMC, so I'm relatively certain that it's usually a trauma surgeon who responds to traumas there.

 

[WilcoWorld]

Yes, we mobilize a LOT of resources for a full trauma.

How is the decision made to make a trauma modified vs. full? At my institution they're all run as "full", at least though the primary survey.

 

[DropkickMurphy]

Most places I have worked, it's either "trauma code" meaning the patient is either dying or about to, and this is probably what SouthernDoc is referring to as a "full trauma" (also called 'code trauma' in some places to avoid confusion with an arrested trauma patient) or "trauma alert" (bad injuries but not immediately life threatening) or the patient is minor enough to not warrant an alert.

 

[southerndoc]

How is the decision made to make a trauma modified vs. full? At my institution they're all run as "full", at least though the primary survey.

We have a protocol the triage nurses follow. I.e., witnessed LOC is a modified, GCS <14 is a full, hanging is a full, possible spinal cord injury a full, GSW to chest/abdomen is a full, etc. GSW to the extremities is a modified. >2 modified criteria is a full.

 

[roja]

We have trauma alerts vs codes with set parameters for each. Trauma team consists of EM attending(supervising), EM3 (running it) EM2 (airway) and EM1 (lines). Surgery shows up at some point with usually a senior and some juniors. Almost never an attending.

We have full control of the all traumas until the patient is in the OR or admitted to the surgical team.


There is no *best* program in NYC. (do a search for the general concept of 'best programs' and what people think about it).

 

[SoCuteMD]

There is no *best* program in NYC. (do a search for the general concept of 'best programs' and what people think about it).

Come on roja - you of all people must know the answer to that!

kidding.

Hope all is well!

 

[Ceez]

Come on roja - you of all people must know the answer to that!

kidding.

Hope all is well!

seriously. there has to be some programs that are better than others.

 

[SoCuteMD]

seriously. there has to be some programs that are better than others.

I was actually teasing roja as she is a grad of an NYC program.

Do a search on the forum to see what people think are the "best programs."

 

[roja]

Come on roja - you of all people must know the answer to that!

kidding.

Hope all is well!

Well, duh, I *know* what is the truely bestest program. But if I tell, then everyone will want to come and you know, then its just work work work...

 

[SoCuteMD]

Well, duh, I *know* what is the truely bestest program. But if I tell, then everyone will want to come and you know, then its just work work work...

And if everyone wants to come there won't be any room for me in 2009!!

Hope you are well - sounds like you've been working/studying a lot.

 

[a_ditchdoc]

.
There is no *best* program in NYC. (do a search for the general concept of 'best programs' and what people think about it).

But there is a best "Fellow" at one of the programs. She's the one that didn't yell at me over a hand lac with a FB. Thanks Roja...

 

[roja]

Well, that gets a great big "AWWWWWWWWWWWWW"



No worries. You did an awesome job.

 

[margaritaboy]

seriously. there has to be some programs that are better than others.

I think you will find that judging which programs are better than others is very subjective and very much in the eye of the beholder. Different things are important to different people. It was frustrating as an applicant, and I think it is natural to wonder which residencies are the best since we have been trained to think this way for most of our academic careers. But there is no U.S. News and World Reports for best EM residencies, and if there ever were, I'd really have to wonder what criteria they used to build the list.

One of the biggest parts of residency selection is asking yourself what is important to you. Most students want to ask, "Will XYZ residency give me excellent training and prepare me to practice in the real world?" If asked, I think the vast majority of residents would say their programs does exactly that. If that is true, then where you end up will depend more on what is important to you, than the perceived rigor of any individual program.

That's just my opinion though.