Where EM Gets Trauma Procedures

[Ltsnsrns]

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I know it's "over-rated" blah, blah, blah, but can we compose a list of how different EM programs divvy up the Trauma Procedures? I noted some from interviews and websites, but forget/don't know what the CURRENT policy is for others. Figured this might be a thread that could be of interest to many of us trauma-lovers!
I'll start a list - please add to it if possible (and please note if any of my categories conflict with your info)!

ALL/MOST: EM HANDLES MAJORITY OF PROCEDURES
Denver
Jacobi
BMC

HALF: EM SHARES PROCEDURES WITH TRAUMA SURG
Mount Sinai
LSU-NO
St Lukes Roosevelt
BIDMC

NONE: EM ONLY DOES PROCEDURES WHEN ON TRAUMA ROTATION
Temple
Cook County (has separate Trauma area)

 

[JMC2010]

I'm a third year resident at Temple. We do trauma procedures all the time when not on Trauma service. There are plenty of gsw's for everyone to get involved.

 

[Ltsnsrns]

Awesome! Thanks for the clarification! I'll add you guys to the "share" category!

 

[Ltsnsrns]

ALL/MOST: EM HANDLES MAJORITY OF PROCEDURES
Denver
Jacobi
BMC

HALF: EM SHARES PROCEDURES WITH TRAUMA SURG
Mount Sinai
LSU-NO
St Lukes Roosevelt
BIDMC
Temple

NONE: EM ONLY DOES PROCEDURES WHEN ON TRAUMA ROTATION
Cook County (has separate Trauma area)[/QUOTE]

 

[bad virus]

ALL/MOST: EM HANDLES MAJORITY OF PROCEDURES
Denver
Jacobi
BMC

HALF: EM SHARES PROCEDURES WITH TRAUMA SURG
Mount Sinai
LSU-NO
St Lukes Roosevelt
BIDMC
Temple

NONE: EM ONLY DOES PROCEDURES WHEN ON TRAUMA ROTATION
Cook County (has separate Trauma area)

[/QUOTE]

UNM = Share
Hennepin = All
Cinci = Share
Highland = All
Harbor = Share
Maricopa = Share
Tuscon = Share
Indy = Share
El Paso = Share

 

[Ltsnsrns]

ALL/MOST: EM HANDLES MAJORITY OF PROCEDURES
Denver
Jacobi
BMC
Highland
Hennepin

HALF: EM SHARES PROCEDURES WITH TRAUMA SURG
Mount Sinai
LSU-NO
St Lukes Roosevelt
BIDMC
Temple
UNM
Cinci
Harbor
Maricopia
Tuscon
Indy
El Paso

NONE: EM ONLY DOES PROCEDURES WHEN ON TRAUMA ROTATION
Cook County (has separate Trauma area)

 

[Doctor Bob]

University of Illinois at Peoria - share
San Antonio Military Medical Center - share

 

[migm]

Univ South Carolina/Palmetto - share
Washington University in Saint Louis - share

 

[RustedFox]

University of Toledo - Share.

 

[Ltsnsrns]

ALL/MOST: EM HANDLES MAJORITY OF PROCEDURES
Denver
Jacobi
BMC
Highland
Hennepin

HALF: EM SHARES PROCEDURES WITH TRAUMA SURG
Mount Sinai
LSU-NO
St Lukes Roosevelt
BIDMC
Temple
UNM
Cinci
Harbor
Maricopia
Tuscon
Indy
El Paso
San Antonio Military Medical Center
University of Illinois at Peoria
Washington University in Saint Louis
Univ South Carolina/Palmetto
University of Toledo

NONE: EM ONLY DOES PROCEDURES WHEN ON TRAUMA ROTATION
Cook County (has separate Trauma area)

 

[Hamhock]

IIRC, Highland handles all trauma airway but trauma is responsible for the resus and the procedues...however, a big chunk of the trauma team is made up of EM residents.

Disclaimer: I do not work at Highland and I did not train there. So, if someone who does either is around: please correct me.

HH

 

[medicsb]

In my research of NYC area residencies, it seems that many (most?) of the EM programs, including ones at Trauma centers have to ship out residents to bigger trauma centers for experience.

Anyhow, University of Maryland has trauma completely separate as they have the infamous R Adams Cowley Shock Trauma Center in a separate wing.

Drexel/Hahnemann shares trauma.

 

[Rendar5]

Suny Stony Brook shares trauma procedures.

 

[Ltsnsrns]

Anyone know about Northwestern or BWH/MGH?

 

[Mighty Mouse]

Henry Ford Hospital -- ALL
Mercy St Vincent (Toledo) -- ALL

 

[DPCJ2]

BWH/MGH:
EM does 100% of airways at both. At MGH it alternates every other trauma who runs it. The team running it gets first procedure. At BWH the opposite team of who is running it gets first procedure. At BWH, EM and surg alternate 12 hour shifts who runs it.

Of note, all non trauma procedures belong to EM. Ie. 100% of medical chest tubes, thoracentesis, etc.

 

[deleted109597]

I know it's "over-rated" blah, blah, blah, but can we compose a list of how different EM programs divvy up the Trauma Procedures?

No really, it's overrated. Honest to God.
Other than thoracotomy, I can't think of any procedure that only "trauma" does that you wouldn't do in the ED. Central line? Intubation? Chest tube (yes, we still do those for other than trauma reasons)? A line?
Help me out here.

 

[la gringa]

No really, it's overrated. Honest to God.
Other than thoracotomy, I can't think of any procedure that only "trauma" does that you wouldn't do in the ED. Central line? Intubation? Chest tube (yes, we still do those for other than trauma reasons)? A line?
Help me out here.

agree. in all honesty, i kind of hated my trauma time... a whole lotta drama. who doesn't love shoving rectal tubes in prisoners, being up all night sewing up crazy lacerations on drunk people, and smelling of beer, BO, and blood?

 

[Ltsnsrns]

Regarding the last 2 posts: that's fine if you disagree - I get it - you're attendings that have been around the block, but please let us make our silly list. I happen to love trauma and actually care what the answer is, so just let me become cynical and figure out how "obnoxious" it is with time per the normal instead of speeding it up online by hijacking the thread with the not-so-helpful anti-trauma comments I was clearly trying to avoid.
Thank you so much to everyone contributing to the list thus far! It's been very helpful for me and hopefully for others as well!

 

[Tiger26]

The main reason to look at trauma is for the ability to develop your leadership skills in a room full of people looking at you to guide a team, not necessarily for the procedures.

Sure, they're fun procedures, however, I lead medical codes better and the ED overall, because we start leading traumas the first day of our second year. It allows you to get comfortable making decisions in the spotlight.

I would place more emphasis on who has leadership, rather than who gets to cut or poke somebody with a needle.

 

[Emurgency]

The main reason to look at trauma is for the ability to develop your leadership skills in a room full of people looking at you to guide a team, not necessarily for the procedures.

Sure, they're fun procedures, however, I lead medical codes better and the ED overall, because we start leading traumas the first day of our second year. It allows you to get comfortable making decisions in the spotlight.

I would place more emphasis on who has leadership, rather than who gets to cut or poke somebody with a needle.

I agree completely! Can we add a section to the list for who runs the traumas?

 

[jethro136]

Add USC to the list of most/all, as well as runs all traumas.

And yes, these are important questions and skills. Learning to be the leading voice in a room of chaos is an important skill for an EP, as much as performing critical procedures under pressure.

 

[la gringa]

the aforementioned "list" will do nothing to accomplish the stated goals... ya'll love to try to make lists to make a decision, but this one won't help you pick a quality program.

i know it's been said before, but it's true - if you "love trauma" then EM is really not the right field!!!

 

[alphaholic06]

The main reason to look at trauma is for the ability to develop your leadership skills in a room full of people looking at you to guide a team, not necessarily for the procedures.

Sure, they're fun procedures, however, I lead medical codes better and the ED overall, because we start leading traumas the first day of our second year. It allows you to get comfortable making decisions in the spotlight.

I would place more emphasis on who has leadership, rather than who gets to cut or poke somebody with a needle.

This is key! More important than doing procedures, is the ability to lead the resuscitation and make quick decisions under pressure.

 

[deleted109597]

Regarding the last 2 posts: that's fine if you disagree - I get it - you're attendings that have been around the block, but please let us make our silly list. I happen to love trauma and actually care what the answer is, so just let me become cynical and figure out how "obnoxious" it is with time per the normal instead of speeding it up online by hijacking the thread with the not-so-helpful anti-trauma comments I was clearly trying to avoid.
Thank you so much to everyone contributing to the list thus far! It's been very helpful for me and hopefully for others as well!

Honestly I don't care if you choose your residency based on what the cafeteria serves on Friday. It will have the same outcome and would be equally as silly a list. However, you go to residency where you think you would have the best fit.
As an aside, I didn't dislike trauma as a rotation, and time in the SICU is usually the highest density of super sick patients you'll ever have.
I just think that who gets to do the procedure is not that important in the grand scheme of things. There's a reason the RRC doesn't require 100 CVLs, or 100 chest tubes.
Hell, if anything we are bumping this thread back up to the top.

For people still interviewing this year or future years, I will say that if you ask about trauma too much, it will make your interviewer curious as to your motivation. Trauma is and always will be a surgical subspecialty.

 

[blackavar]

NONE: EM ONLY DOES PROCEDURES WHEN ON TRAUMA ROTATION
Cook County (has separate Trauma area)

So I feel like this description is a bit inaccurate...Yes, Cook County has an independent trauma unit that is separate from the ED. So anything that would be considered an activated major trauma (GSW, Stabbings, major fall, high speed motor vehicles, big time assaults) goes there...and the major traumas are where you're getting your procedures. Minor traumas come to the regular ED.

The trauma unit is staffed with a trauma attending, but the front room (which is 16 rooms worth of arriving traumas) is run by an ED senior, and staffed by ED juniors and maybe 1 junior surgery resident. The ED juniors get every airway, unless then can't, then it goes to the ED senior. The surgery residents generally don't care about lines, so the ED residents end up doing most of them. Like everywhere else, everyone wants to do the chest tubes, so while there's no official schedule, we all try to be fair and let everyone take their turn as it comes up.

Cook County isn't "none," call it "separate" like Maryland at Shock Trauma, because trust me we see plenty of trauma and we basically run the majority of the traumas as they come in cause the surgery peeps are all in the OR.

 

[TysonCook]

ALL/MOST: EM HANDLES MAJORITY OF PROCEDURES
Denver
Jacobi
BMC
Highland
Hennepin

HALF: EM SHARES PROCEDURES WITH TRAUMA SURG
Carolinas
Mount Sinai
LSU-NO
St Lukes Roosevelt
BIDMC
Temple
UNM
Cinci
Harbor
Maricopia
Tuscon
Indy
El Paso
San Antonio Military Medical Center
University of Illinois at Peoria
Washington University in Saint Louis
Univ South Carolina/Palmetto
University of Toledo

NONE: EM ONLY DOES PROCEDURES WHEN ON TRAUMA ROTATION
Cook County (has separate Trauma area)

...added Carolinas which we alternate by date (odd/even). One runs, one is procedures, then swap. Agree with the other Attendings, trauma is overrated significantly...

 

[Ltsnsrns]

ALL/MOST: EM HANDLES MAJORITY OF PROCEDURES
Denver
Jacobi
BMC
Highland
Hennepin
USC
Henry Ford Hospital
Mercy St Vincent (Toledo)

HALF: EM SHARES PROCEDURES WITH TRAUMA SURG
Carolinas
Mount Sinai
LSU-NO
St Lukes Roosevelt
BIDMC
Temple
UNM
Cinci
Harbor
Maricopia
Tuscon
Indy
El Paso
San Antonio Military Medical Center
University of Illinois at Peoria
Washington University in Saint Louis
Univ South Carolina/Palmetto
University of Toledo
BWH/MGH
Stonybrook
Drexel

NONE: EM ONLY DOES PROCEDURES WHEN ON TRAUMA ROTATION
Univ of Tennessee-Chattanooga
UPenn

TRAUMA IS SEPARATE
Cook County
UMD

EM LEADS ALL TRAUMA RESUS
Add!

 

[StevieStud]

You haven't done trauma until you have treated "Pedestrian versus Train" and the nursing staff is taking bets on how many units of blood will be wasted on trying to preserve the organ donor.

Treat your second "Pedestrian versus Train" and the thrill of trauma will be gone.

I hear "Farmer versus Mechanical Farm Implement" can be a something to avoid.

 

[deleted77919]

…

 

[Apollyon]

But...but...but...

A thread on SDN, especially in the EM forum, is not complete until the OP in a thread (with a topic that has been addressed, in one form or another, several-to-many times) comes back butthurt and saying "thank you" for "helpful" posts and "no thank you" for "unhelpful" posts, and "asking" people to not clutter up their threads with experience and reality.

Silly, I tells ya!

 

[Arcan57]

You haven't done trauma until you have treated "Pedestrian versus Train" and the nursing staff is taking bets on how many units of blood will be wasted on trying to preserve the organ donor.

Treat your second "Pedestrian versus Train" and the thrill of trauma will be gone.

I hear "Farmer versus Mechanical Farm Implement" can be a something to avoid.

I still remember the day I learned what a power takeoff on a combine was. That was not a happy lower extremity. On the plus side, farmers are ludicrously stoic.

 

[Apollyon]

On the plus side, farmers are ludicrously stoic.

Saw it in the Carolinas - drive in on a broken leg, walk on it, adamantly refuse ANYTHING (NSAIDS included) for pain. Being fully cognizant of the injury (no denial), but still denying that it was anything 'serious'.

 

[PaddyMelt]

Sinai-Grace Hospital = ALL, and LEADS.
Detroit Receiving Hospital = Share and Share.

 

[engineeredout]

On a similar note, I have interview at probably no less than 10 places that send residents to Baltimore Shock Trauma for a trauma month. Is that place just exploding with residents? Don't people end up diving all over each other to try and get procedures?

 

[dotcb]

While that would probably be OK, to me that's a sign the trauma experience at the residency itself is not great, or is seriously lacking. May be just personal preference, but a longitudinal experience will be much better, seeing trauma day in and day out.

 

[Hair Police]

No. In a single month, I made my residency requirement of trauma resus and thoracotomies, as well as a ton of tubes, lines, reductions, and so on. When STC sees nearly 9,000 patients per year, there's more than enough to go around.

 

[totalbodypain]

I know it's "over-rated" blah, blah, blah, but can we compose a list of how different EM programs divvy up the Trauma Procedures? I noted some from interviews and websites, but forget/don't know what the CURRENT policy is for others. Figured this might be a thread that could be of interest to many of us trauma-lovers!
I'll start a list - please add to it if possible (and please note if any of my categories conflict with your info)!

ALL/MOST: EM HANDLES MAJORITY OF PROCEDURES
Denver
Jacobi
BMC

HALF: EM SHARES PROCEDURES WITH TRAUMA SURG
Mount Sinai
LSU-NO
St Lukes Roosevelt
BIDMC

NONE: EM ONLY DOES PROCEDURES WHEN ON TRAUMA ROTATION
Temple
Cook County (has separate Trauma area)

Congrats on the most innacurate and useless list of this interview season. Trauma is a surgical disease. No program "runs" traumas without any surgery input unless they are specializing in malpractice and basketweaving... I trained at a place where we did most of the legwork/paperwork/ED procedures (i.e. trauma's biatches) to the detriment of my education. There was no procedure that I did in a trauma patient that I did not also do in a medical patient. The medical patients were much more educational and interesting though. I am glad your happy with your list though...

 

[migm]

Wow with the vitriol

 

[Glitterbox]

why do the old people on this forum always get so upset when this topic comes up? I'm not too pressed about seeing a lot of trauma, myself, and I like managing the medically unstable patients a lot more, but I have the maturity to understand that "it takes all kinds" and I know its something that some people like and actively seek out within their training. I have had PDs tell me they love seeing trauma, others will recruit based on trauma, so its not just the young and experience who value the experience highly.

y'all need to learn to live and let live.

 

[DrMom]

Sure, the "old people" have no idea what they're talking about.

 

[Glitterbox]

Sure, the "old people" have no idea what they're talking about.

i didn't say the old people didn't know what they were talking about. i said i wasn't sure why they always get so upset when this issue pops up. it doesn't upset me that a student wants to go somewhere where they see trauma. i sleep just fine at night. not sure why it upsets y'all.

 

[dotcb]

Congrats on the most innacurate and useless list of this interview season. Trauma is a surgical disease. No program "runs" traumas without any surgery input unless they are specializing in malpractice and basketweaving... I trained at a place where we did most of the legwork/paperwork/ED procedures (i.e. trauma's biatches) to the detriment of my education. There was no procedure that I did in a trauma patient that I did not also do in a medical patient. The medical patients were much more educational and interesting though. I am glad your happy with your list though...

Trauma is rarely a surgical disease. See below. Surgeons admit trauma and rarely it is vital they must operate on trauma patients, but it is primarily a non-operative field. Because of this, emergency physicians must be experts in trauma care. One would never say "sepsis is a critical care disease." The care begins in the ED, and the initial steps are every bit as life saving. Same analogy applies.


"INTRODUCTION
In 2008, the American College of Surgeons (ACS) abandoned its traditional assertion that “trauma is a surgical disease,”1 tacitly acknowledging the largely nonoperative nature of modern trauma care.2-4 At my large tertiary medical center, for example, the prevalence of emergency operative intervention by a trauma surgeon is just 3.0% of adult trauma team activations and just 0.35% of pediatric activations,5 with these frequencies decreasing to 1.2% and 0.09%, respectively, if one excludes penetrating mechanisms. For blunt trauma at my hospital, emergency operation by a trauma surgeon averages once every 7 weeks for adults and less than once every 3 years for children.5 Comparable numbers have been reported elsewhere.6-9"

Ann Emerg Med. 2011 Aug;58(2):172-177.e1. doi: 10.1016/j.annemergmed.2011.04.030. Epub 2011 Jun 12.
Trauma is occasionally a surgical disease: how can we best predict when?
Green SM.

 

[Apollyon]

i didn't say the old people didn't know what they were talking about. i said i wasn't sure why they always get so upset when this issue pops up. it doesn't upset me that a student wants to go somewhere where they see trauma. i sleep just fine at night. not sure why it upsets y'all.

"Upset" rather overstated it. "Upset" would be, for example, "You are a ****ing complete idiot ******* that pisses me off to no end. I can't believe you said that, and I feel like I either need to punch someone, or get drunk, or both. You suck as a person."

Experience is just saying that this is an abstract undertaking. No one is "upset".

 

[StevieStud]

why do the old people on this forum always get so upset when this topic comes up?

Pick a reason:

Trauma often involves otherwise healthy young people and children and the outcomes are not always very nice.

You treat enough dead and dying children and teens and one tends to get a big jaded and cynical.

Trauma is the leading source of death in various young age groups.

If we are successful, and there will be successes, some glory hound trauma surgeon swoops in for the win. Once a year I would like to be thanked for saving the patient long enough for somebody else to claim the glory.

Trauma is text book. ABC. Generally, there is no thought or decision making process. And when there is thought involved, it usually done by others (trauma surgeon) long after our involvement in the case.

Trauma is a bloody mess. Trying to sew humpty dumpty back together is difficult, time consuming and often not very successful.

Trauma is time consuming, but not profitable. Often the patients lack insurance, so the fianancial payoff is not present. Worse, the time required for many trauma patients often means medical patients are ignored or care delayed.

If you want to treat trauma, then become a surgeon.

Intercity trauma, often associated with big name hospitals and medical schools, is different than suburbia trauma.


Like I said, pick a reason.

 

[strongboy2005]

Having surgery come down for every trauma is as ludicrous as having a cardiologist come down for every chest pain. Trauma is NOT primarily a surgical disease. Major trauma, like a STEMI, requires prompt specialist intervention and definitive management. Having surgeons come down to assess non-surgical trauma cases is redundant and wasteful. Instead, they should wait to be consulted like everyone else. If a trauma comes in requiring surgery per the emergency physician's assessment, then the surgeon is consulted. Again, a vast majority of traumas do not need to involve a surgeon's assessment. WE should be the experts at evaluating trauma, not the surgeons who shouldn't even be there seeing the patient 95% of the time.

 

[DrMom]

i didn't say the old people didn't know what they were talking about. i said i wasn't sure why they always get so upset when this issue pops up. it doesn't upset me that a student wants to go somewhere where they see trauma. i sleep just fine at night. not sure why it upsets y'all.

You're seriously misinterpreting the responses that have been posted.

"Upset" rather overstated it. ...
Experience is just saying that this is an abstract undertaking. No one is "upset".

This.

 

[Hamhock]

I am trying...sooooo...hard to...hold off from posting in this thread....

....must hold my..tongue... (I suspect people who know me here have already heard enough from me on this topic...and those who don't are probably tired of my ranting posts)

Trauma is rarely a surgical disease. See below. Surgeons admit trauma and rarely it is vital they must operate on trauma patients, but it is primarily a non-operative field. Because of this, emergency physicians must be experts in trauma care.

"INTRODUCTION
In 2008, the American College of Surgeons (ACS) abandoned its traditional assertion that “trauma is a surgical disease,”1 tacitly acknowledging the largely nonoperative nature of modern trauma care.2-4 At my large tertiary medical center, for example, the prevalence of emergency operative intervention by a trauma surgeon is just 3.0% of adult trauma team activations and just 0.35% of pediatric activations,5 with these frequencies decreasing to 1.2% and 0.09%, respectively, if one excludes penetrating mechanisms. For blunt trauma at my hospital, emergency operation by a trauma surgeon averages once every 7 weeks for adults and less than once every 3 years for children.5 Comparable numbers have been reported elsewhere.6-9"

Ann Emerg Med. 2011 Aug;58(2):172-177.e1. doi: 10.1016/j.annemergmed.2011.04.030. Epub 2011 Jun 12.

Green SM.

Thanks for this, doctb...I think it goes MUCH further than this, but your perspective is a good start.

Although I will probably not be able to resist giving a long post on this topic soon, for now I will just say:

1. Trauma is NOT a surgical disease
2. Listen to Billy Mallon: trauma is needed for one's testicles to descend (and ovary equivalent)
3. Programs that RUN every trauma and are FIRST call on every trauma procedure and airway are important to identify...not because trauma is the most difficult part of EM (although it has been minimized way to much in this thread), but because these programs are FIRST call on every ED procedure and RUN the emergency department, which can't be said for many programs
4. Trauma is not ATLS (thank god!), just like ACLS is not the guide for medical resuscitations in the ED...the folks who think that trauma is as easy as 'following' ATLS have not managed trauma beyond the cookbook first 10 minutes, have minimal understanding of trauma critical care, or are old enough to have trained when EM was a specialty that was still just trying to combine the "acute aspects" of other specialties...vs. developing our own skills and knowledge

HH

 

[Birdstrike]

.

 

[Ltsnsrns]

HH - thank you - I would actually enjoy reading a long post by you - I'm 100% on board with your outlook. And after a trauma rotation where Trauma Surg trounced all over EM, ran all traumas, performed all procedures, and had zero respect for anyone in the ED, I want to be damn sure I dont end up at a program anything like this!

On the interview trail, the programs that see and run lots of trauma always let you know bc they understand many applicants are interested since residency is our chance to train for as much as possible (not just procedures and running resus, but having to juggle incoming traumas with beds full of medical patients whose needs dont go on hold when a trauma rolls in). But I've been to a number of programs that appear to be dancing around the subject when asked, and rather than ASSUME this means they don't run this aspect of the ED or get the experience I'm hoping to gain, it's more helpful to identify who is doing what by ollaborating with others. Because like it or not, I want training that allows me to handle both medical and trauma patients like a CHAMP. And at this point in time, neither are a total boring breeze to me, so I welcome a program that makes me so comfortable I get to that point.
So if you don't mind, I will continue the list - which certainly wont be the deciding factor in who I rank, but will help me make a better informed decision about where I best fit for residency.
Updates from PMs and interviews to be posted shortly. For now, I have to go brave Target.