• J M Howell, D Savitt, D Cline, C D Chisholm, and K Kleinschmidt.
• SAEM Residency Committee, Lansing, MI, USA. jhowel102@gumedlib.dml.georgetown.edu
• Acad Emerg Med. 1996 Apr 1; 3 (4): 366-70.

ObjectiveAmerican College of Surgeons (ACS) and Residency Review Committee for Emergency Medicine (RRC-EM) guidelines conflict regarding the role of emergency physicians in directing major trauma resuscitations. This article describes the impact of ACS level I trauma certification on emergency medicine (EM) resident trauma experience.MethodsA written survey and a follow-up letter were sent to all 101 EM program directors as of August 16, 1994. The survey addressed demographics and trauma experience at hospitals designated by the RRC-EM as primary training sites.ResultsThere were 95 (94%) survey respondents. Estimates of the percentage of trauma resuscitations directed by EM residents were significantly lower at level I centers (52% +/- 27%, 95% CI 45-59%) than they were at non-level I centers (70% +/- 30%, 95% CI 58-82%) (p < 0.01). There was no significant difference in trauma census between level I and non-level I centers. Of 14 respondents who said they were cited by the RRC-EM for inadequate trauma experience, ten (71%) were in ACS level I trauma centers (p = 1.0). Twelve of the 14 respondents cited for inadequate trauma experience were in either the Northeast or the Midwest.ConclusionsEM residents direct a smaller percentage of major trauma resuscitations at ACS level I hospitals than they do at non-level I facilities. This finding is not offset by an increased trauma census at level I facilities and may be more pronounced in the Northeast and the Midwest.

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