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Hello all!

I am a recent new grad who was offered a position in Trauma in SoCal. Though, I had never expected going into trauma, I am very excited for this opportunity and challenge!! Unfortunately I do not have much experience in ER, but the trauma surgeon really liked my personality so is willing to invest serious training. I am the first Truama PA at this hospital, so I do not really have a mentor to ask for tips from. Does anyone have any recommendations for resources, books, apps they used to best prepare for this role? Any other advice from fellow Trauma PAs out there??

Thanks in advance!! :)

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Just recently left a Trauma Surgery job.  Are you doing any surgery assisting or covering the ICU?  If so, that is where your main challenges are. 

I'm assuming you can pick up the rounding stuff and/or have done it on rotations.  That part of it is not that difficult, although you would need to ask if those patients are admitted to you and you are the hospitalist for them during their stay and discharging them?  or are you a specialist who signs off at a certain point? If they are admitted to you, then you have to manage everything, quarterbacking specialists and managing their diabetes and other stuff along with their injuries.  You certainly will be doing anti-coagulation and VTE surveillance / proph as Trauma patients are often in bed for a while.

There are a couple handfuls of things that are unique to Trauma, but you will run across them in short order, like labs that can go crazy with Trauma to the body and stuff that can develop later on (like adrenal insufficiency).  It's not that much. It's a pattern you can pick up on.

The ICU may be different if you are involved there.  You will have to learn to manage ventilator or brain dead full life support patients, when to move to a Trach/PEG, eventually maybe stuff like organ donor and end of life issues.  I found two books helpful:  Marino's ICU and Fluids and Electrolytes made ridiculously simple.  The SCCM has a section on their website called LearnICU which I think is free, and they have Crit Care classes and conferences and such.  Take it slow and don't try to learn everything - this is really complex stuff for really dedicated learners.  Having said that, there's usually always a couple of patients in the SICU for non-complex reasons (policies or specific conditions) that are not going to give you serious problems, so you should be able to pick it up a little at a time.  

http://www.sccm.org/Pages/default.aspx

Surgery is something I know little about, since I don't do that - I was a hospitalist and don't even quite know where the OR even is. 

We would respond to Traumas and supervise the ER docs as they did their thing, then take the patient off their hands.  Some would go to surgery, where they are stabilized.  Trauma Surgery can get pretty hairy.  They put 200 units into a guy over about 90 minutes with a transected aorta, most of which poured right back onto the floor.  Saw a lot of penetrating/degloving injuries that were like "how did you manage to do that"? It was neat, but alas, the work environment was toxic so I left.  Long story.

You may have a clinic where you're looking at wounds, taking drains and sutures out, scheduling IVC filter removals, moving people into their next thing once the most serious thing is healed to your satisfaction.  You could take a look at some basic wound care (when surgical wounds go bad) and which abx to use in your area if you want to.  

Overall, I'd just come ready to learn.  It's a fun and cool gig, especially outside the ICU.  I loved the rounding on the floors , by far my favorite thing.  So I dunno, take a while to relax, maybe look at a few things (especially if you are first assist) but don't go crazy.  Good luck!

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I haven’t work trauma but have friends who do. My only advice would be get a clear explanation in writing of what the docs expectations for you are.  Hours can be grueling so knowing what to expected critical.  Also pay, even though you are a new grad don’t let yourself get low balled on salary 

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@MCHAD They offered $100k base with productivity of $30-40k annual. 401k, dental, medical, CME, etc included so it sounded pretty good to me!! No call and 40 hrs per week.

@south Thank you so much for your insight!!! That provided some relief and added to my excitement!! As of now, I have no call. I will work M-F 7AM-3PM mostly doing the rounding. While I will be in ICU, it is last priority for me in regards to my daily schedule because they have so many more eyes on them. When traumas come in throughout my shift, I will evaluate the patient with MD and write the notes, coordinate consults, and manage the pt from there on out. I do not believe surgery will be my focus, but I could first assist in future if desired (per the head trauma surgeon). Thank you so much for the resources and your feedback!!

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make sure you get the training to do chest tubes, central lines, thoracentesis, u/s, etc. some "trauma surgery" positions end up just being surgical wound care clinics. sounds like you will get some ICU exposure, so that is a big plus.

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I did a trauma rotation when I was a student and there were 2 PA's, one for each team consisting of attendings and residents. One PA basically did all the scut work- made sure all the orders were in, did all the documentation during rounds, arranged discharges, etc. She worked a 7am-3pm schedule and didn't take call. The PA on the other team was much more hands on. She would do procedures with the residents after rounds, take call on the weekends, scrub in for surgeries. If you're the first trauma PA at this hospital then you get to help set the expectations for what your role will be... don't get stuck doing all the scut work.

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Thanks for the feedback. I am especially excited for this opportunity because I did my surgery/trauma rotation with the head trauma surgeon (the one who recruited me for the position). He was always eager to show me how to do procedures and train me in as much as I wanted to be! Of course, I want to get rounding down and help in any way with the traumas that come in during my shift. As new opportunities to learn present themselves, you can bet that I will be right there to take it on! I did not sign up to be a Trauma PA for monotony :)

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