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Trauma PA - anybody?


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Many large urban hospitals have strictly trauma teams. Most places have designated general surgery members as the trauma team. I have truly enjoyed my role as a trauma surgery PA. I found the most frustrating part to be poor ER response whether it be delayed x-ray tech, vanishing nurses or just failure of the staff to properly stock the trauma bay.

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Many large urban hospitals have strictly trauma teams. Most places have designated general surgery members as the trauma team. I have truly enjoyed my role as a trauma surgery PA. I found the most frustrating part to be poor ER response whether it be delayed x-ray tech, vanishing nurses or just failure of the staff to properly stock the trauma bay.

Speaking somewhat in defense of the ER, that maybe because as part of the trauma team, you are focused on ONE patient... We have usually 40-70 other patient's at the same time, and usually 4-6 level 1s concurrently. We have achieved and maintained airway and initial hemodynamic support before you got there. A lot of times we have put in the tubes and lines by the time you arrive..

If you respond as part of the code trauma and meet the patient with us, then your frustration for that one patient is what we live with for every patient. So which takes precedence, your trauma patient possibly needing surgical intervention for stabization or the thrombotic stroke needing thromolytics?

I would maintain that to a greater degree than not, unless you are going to the OR, the things that you find frustrating are simply in convinces to you, centered on your desire to wrap up your visit.

 

As to the OP, trauma is a fantastic field for a PA.. but you have to be very willing to be a party of the "team"... Maryfram123 started as a solo pa with a trauma team, took the mlp concept and sold it to her teaching hospital, and now directs a trauma residency for PAs and oversees the whole MLP trauma PAs and NPs.

Trauma more than most fields must be looked at algorithmically... ABCDEF... You simply cannot miss the little things. If you are willing to be a little humble, work hard and read/study.. When you become good at trauma, You will find that there is little in medicine which scares you.

Good luck.

 

vr

davis

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The single best rotation I had in PA school was my general surgery rotation at Hurley Medical Center in Flint, MI. My Trauma elective at one of Chicago's supposedly gnarly South Side hospitals was a sorry joke of an experience compared to Hurley. PAs are the core of the Trauma team; there's a couple of Trauma MDs in the building at any time one NP running the SICU, one PA on duty tucked away in the ED, and at least one PA in each OR where there's a trauma surgeon.

 

12 hours on, 12 hours off, 7 days in a row, and then completely off the following 7 days in a row. That's 26 (very long) work weeks per year. If it didn't involve living in Flint and being paid a pittance, I'd have done their Trauma PA fellowship and come out the other side afraid of nothing.

 

Trauma's awesome. You quickly learn that the only thing more dangerous than your own fear is overconfidence, and if you're good at Trauma, you vanquish them both. It's not for everyone, but those who do it are just about my favorite kind of person to work and/or drink with.

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  • 2 weeks later...
I heard of a job opening for a trauma service. I'm interested but I haven't heard of many mid levels doing this exclusively. Thoughts? Were you happy or frustrated most of time?

 

It can be exciting, fun and rewarding. But you should know that it's not a constant blur of chest tubes and open thoracotomies. Trauma is becoming an increasingly NON-surgical specialty. Over the last 15-20 years, advances in knowledge, imaging & technology in trauma and critical care have led to a different paradigm. This has caused no small amount of consternation on the part of surgeons.

 

 

Here is an article from Annals of EM from Feb of 2009, "Trauma Surgery: Discipline in Crisis" - http://home.comcast.net/~jasoncillo/Trauma%20Crisis.pdf

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So, here is my $.02 for what it is worth....

 

I have been a Trauma/Critical Care PA since 1992.

I currently work at a Level 1 Trauma center with ~ 2700 contacts annually. To clarify...but thanks for the props RC!! ;).....I am the assistant director of our NP/PA post grad Trauma/SCC fellowship, purposely turned down the directorship to focus on the clinical teaching and avoid the adminstrative angst. ;)

 

Prior to this I worked at a level 1 Trauma center in Camden NJ and a level 2 in Chester PA and did a year at Walter Reed Medical Center working solely with TBI pts.

 

This quote by RetNavy sums up the specialty pretty well

Trauma is becoming an increasingly NON-surgical specialty. Over the last 15-20 years, advances in knowledge, imaging & technology in trauma and critical care have led to a different paradigm.

Many cases that would typically go to the OR now are able to be managed non operatively and/or with IR agram/embolization. Trauma is quickly becoming a non surgical/non operative specialty. If being in the OR is what you are looking for, Trauma may not be for you, unless you work at a place that does a high percentage of penetrating trauma.

 

The specialty has changed in many ways. When I first started there were few PA's in the field. It is now very much an up and coming specialty for PAs. Working as a core member of a team, being flexible enough to shift between differences in attending approach go along way to longevity in the field.

 

The patient population, particularly here in Pennsylvania, continues to get older. Our trauma center's median age is one of the highest in the state.

Yes, do we get the critically ill, crashing, bilaterally chest tubes, place a cordis, unstable pelvis, open the chest type patients, of course.

however, the meat and potatoes of a typical day tends to be much less dramatic or exciting.

 

There are ALOT of days of managing the myriad of co-morbid medical conditions and complications they precipitate, dealing with discharge dispositions...family can't take care of mom but won't pick out a place for her to go for a week, dealing with the new world of medicare qualifiers...for example a Gr III spleen admitted to the ICU for non op management is consider an "observation" pt, NOT an inpt because we weren't running the IVF at 125ml/hr and other such nonsense.

 

I am an "anomaly" in the field. I never have, nor do I now, enjoy doing procedures or the OR. What I love about Trauma and Critical Care is the minutae...track the trends anticipating the potential complication and treating it before it causes real harm, following and managing the details, being able to confidently discuss care with a subspecialist, such as NeuroSurgery/Ortho, etc and feel confident in my ability to communicate my clinical concerns and the pt's needs, etc. The glory of the Trauma Bay/Alert goes away pretty quickly...less than 30mins if are doing it well....but the stuff that comes after that "golden hour" ends up mattering as much and that is where I glean the most professional satisfaction.

 

For me, Trauma/SCC is the greatest blend of medical minutae intertwined with the adrenalie rush of the trauma bay or decompensating trauma pt in the ICU or floors. I have worked in FP, urgicare, a west philly ED and nothing has provided me with the job and intellectual satisfaction that finding my niche in Trauma/SCC has.

 

Trauma jobs are also facility depending. I happen to have been lucky enought to work at places where I have had alot of autonomy. I know other's that have not been as fortunate and this can make or break a trauma job.

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