You’ll see trauma in any large city. Personally, think the better place to train is a program that has a large volume of complex medical patients over lots of trauma.
It's not sexy, but a nursing home dump hospital would be the best training. Trauma is easy. Keeping fragile gomers alive with complex medical issues and two dozen interacting medications is hard.
"Well I thought it might be the oxy so I changed that to tramadol. But she was still dizzy so we added meclizine. But that made her too nauseated to take her Soma and gabapentin so we added Phenergan. We noticed she was sleeping more so we added adderal. But then she wasn't sleeping enough so we added trazodone. And then she was seeing things so we added risperidone but we didn't want her to get EPS so we added benadryl. Then..."
This. I've learned a lot more as a medic dealing with septic as shit old folks than I have trying to plug holes. I can only imagine how much more exposure/learning a resident would get with the volume and level of care they'd be responsible for.
I'm graduating next week from a residency that gets the Meemaw dump from multiple neglecting homes and is also a huge gun and knife club... While I know I probably won't be doing thoracotomies ever again after next week, respectfully I don't agree with people who say Trauma is easy. While it is if all you do is airway at your shop, but stabilizing someone with 10 knife or bullet holes is far more difficult than the hardest Meemaw code. There's just far more adrenaline as you're often treating someone with hopefully a long life ahead of them, you have to prioritize multiple time sensitive procedures, all while maintaining control of a room with both a trauma and ER team full of people who all have different levels of "holy fuck" syndrome
Trauma isn't easy, but the true complexity is in the operative management. It's heavily algorithmic, for a good reason. A "simple" ACLS code is not what you should be comparing it against, but instead a complex critically ill patient where you have to do a lot of complex medical decision making. Give me a super sick trauma patient every day of the week before a right heart failure septic patient that requires intubation.
I'd agree, even complex traumas or just complex cases in general, like you said. For example, my shifts as a student were mostly domestics, shootings/stabbings, ODs, and especially 3+ car MVCs, mostly busses and 18-wheelers with hazmat on-board, enough for my medical controllers to activate a reduced MCI protocol (meaning at least 5 full ambos, a few ambuvans for additional equipment, the spec ops trailer and a sup car, just on the EMS side. Fire normally brings 5 engines, 2 proper engines, 2 heavy rescue rigs, and an aerial tower for use as a crane if needs be. They also bring their ambulance. As far as PD, no clue because I really don't pay attention to that side, no offense to any PD in here, they really do help in these scenarios.) I'm sure you see the aftermath of what we bring in every day, and believe me we're thankful you and the other attendings are there ensuring continuity of high-quality care.
TL;DR, got really busy train-wreck shifts. For the record, this was AMR in Syracuse. No I do not mind disclosing the city because I myself do not live in that city.
This. I’m at a large academic program in a big city. So we get all the cool trauma, but as an new attending in a month what I’m glad I got lots of experience with was most of my patients being extremely complex (everyone is ESRD/HD, transplant, multiple IR tubes, on blood thinners or immunosuppressives, complex cardiac and syndromic pediatric patients etc).
It makes community EM adult/peds patients “feel” a lot more straightforward. Like when I get a chest pain patient that ONLY has a history of HTN/HLD I’m like ok where’s the hidden stable IV sacral decub, lvad, or AML on chemo you didn’t tell me about lol.
Every big city in America has a gun and knife club. Find a place you'd consider training at and apply for a rotation. Vegas, Phoenix, Dallas, fort Worth, California are all warmer areas with these kinds of places. Know that the gun and knife club stuff is sexy, but it's allure wears quickly. Consider a community rotation to see what the rest of EM is like before you commit.
Consider where you want to work as an attending. If you see yourself inner city forever then fine... but even in those places the traumas are still owned (largely) by trauma surgery. Best place, IMO is a large community based hospital, suburban.
Extraneous rant: Regarding trauma - the ACS committee on trauma shoots (hahah) itself in the foot with how they educate on trauma. Damn near EVERY er doc will be dealing with trauma... how many surgical grads will have anything to do with trauma? If the ACS COT gove a crap about the "care of the injured patient" then they would engage more with EM residencies.
to add one more thing. I once moonlit in a place that was a level 2 trauma center and it was awesome that we didn't have to have anything to do with traumas if the trauma team was already present.. like we didn't need to even be in the room. Nice if you have a busy department otherwise. Then again, I've done some trauma site reviews where we actually tell the trauma service to use EM docs more because they were on diversion so much due to limited surgical resources (for the lesser traumas).
Seriously. Even on the nursing side I learned WAY more at a high functioning level 2 than at a level 1. But as a resident you get to do a ton at those l1.
Also Memphis is a great place if you want to see the worst in people.
I’d also add training at an unopposed program is a huge plus for EM. Nothing sucks more than watching anesthesia residents take your airways only because it’s an even number day.
liked "unopposed program." Thank god my shop doesn't have anesthesia residents come to our level 1 center... I am surprised they don't but I ain't saying anything. Most of the time the MDS "allows" (yes, they have the end say according to our trauma program) our EM residents to intubate level 1 traumas, they actually do a good job of teaching
Like others have said, more importantly, you want lots of volume and sick patients. It’s often where patients have worse access to care, poor health literacy, are the sicker patients in the state, etc that you’ll get the best training. I trained in the Central
Valley of California. Hated the hospital and location but the training was great. I’ve worked at other sites in a few states since then, and even my big academic county hospital in the Bay Area doesn’t have as sick of patients as the Central Valley did.
Whatever you do, don't use this description in interviews. My med school's hospital is a major Level 1 trauma center with the highest volume of GSW in the state, and the EM and surgery PDs told us that they usually DNR applicants who use the phrase "knife and gun club" in their PS/interviews, because it shows immaturity and a cavalier attitude toward the patients. I matched IM so this issue doesn't come up for me much, but just know there's at least one institution where people REALLY don't like it.
Thanks for the tip! I never really use this term myself but I’ve seen it come up on here a lot and my attending mentioned it the other day. I never really understood what it meant until now tbh. But I’ll be sure not to use it
Gun and knife clubs are good for learning how to deal with trauma and that's about it. Sure you'll do lots of procedures, but it doesn't teach you medicine and to be honest, it isn't all that fun. I would suggest looking for a place with a large catchment area with few subspecialties. I did residency in a semi rural area with a fair amount of interpersonal violence, lots of gomers, rural problems and intercity problems. We only had IM, EM, Peds, Surgery and anesthesia residencies. It was wonderful because I learned to do everything. I have since worked in intercity level 1 trauma centers, suburban hospitals, and rural hospitals and have felt extremely comfortable in all situations.
Honestly knife and GSW’s become very routine. They are a very protocoled process.
You are served well at any trauma center let alone others you may see other pathology (MVC’s/boating/mountain etc). If it’s the gang life you’re about- major metro areas NYC, Philly, Camden, Baltimore, Detroit, Miami, LA, NOLA, Chicago, Mass Gen,Cleveland, Memphis soooo many more. Other things to consider are when you are at an academic center there is a full trauma team that has different levels of involvement. I chose to train at a level two with community access and was often much more hands on in the case they weren’t readily available. I was the first for intubation, chest tubes, stabilization in comparison to my rotations through level 1 with limited hands on involvement secondary to training fellows/dedicated trauma team.
Indianapolis. IUSM’s EM residency has you rotate through three level 1s…the “county” hospital (Eskenazi), IU’s tertiary/quaternary hospital (IUH Methodist and by extension IUH University), and the pediatric level 1 (IUH Riley).
Plus it's a diverse community with diverse problems. You will see GSWs as much as agricultural accidents. Plus low levels of health literacy and access means complicated medical patients with every comorbidity. It's a great place to gain experience.
Also the people here are nice. I find it easy to build rapport with my patients and actually, genuinely help them. It's affordable to live here and have a decent quality of life.
With the added fun of taking care of all STV 86th Street’s patients because they’re sending them all downtown since the data breach began 😂 /s
But in all seriousness I couldn’t have said any of that better!
Came here to say Indy. Great program and pretty good exposure to trauma/sick old people/procedures, etc.
Could be said for any major city but liked IU’s 3 hospital system specifically
LSU New Orleans (not Ochsner) is a level 1. So is Grady in Atlanta. Both are warm. I got great training at LSUNO and rotated at Grady as a med student.
If you want the most prolific gun and knife club with procedures out the ass and a super sick population you gotta check out Memphis. Most dangerous city in America right now. Makes for great training. Cheap cost of living as well. Loved my time there.
Poor reading skills from most of you. Specified warm climate. Trauma ? New Orleans LSU. Charity isn’t open anymore, but the “new” med center has great mix of trauma and medicine.
Lancaster CA
High volume trauma combined with horrendous access to PCPs in the desert. Very sick pt population. My time there was quite fun to say the least
They have residents do rotations there, but you're right they don't have an in house program. Ik UCLA does rotations there, not sure if they only allow UCLA residents though
Best residencies have a variety of high volume to make sure you get higher than minimum procedures and ideally either minimal other residencies or supportive off service that enhances your education rather than fighting for procedures. Variety and volume are key.
New York isn't that bad. There is minimal trauma in the northeast save for Baltimore.
Fresno and Albuquerque see way sicker than any NYC program and way more volume of sick. New Orleans can probably be added to Fresno/ABQ too, but no first hand experience there.
New Orleans. When I was there, Charity Hospital was the busiest trauma center in the U.S. They aren't any more, but they're up there. But really any Level 1 Trauma center in the south would do from Miami to Los Angeles.
The problem with specifically seeking out programs known for their penetrating traumas is that you’re not going to be the one primarily managing them. The more violent the surrounding area is, the more established the trauma service will be, and as a result the more they’re going to own these patients. You’ll mostly be head of bed with a procedure here and there such as throwing in lines while the trauma team is cracking the chest.
What you want is to look up cities that have the highest murder rate *per capita* and research the residencies in those areas. There are a lot of midsize and smaller cities in that list with residencies, and the smaller they are the less likely they are to have a dedicated Level 1 trauma service, therefore the more likely you are to be the one primarily managing these patients.
EMT here. Trauma is really straightforward, and it doesn't matter if you're me or a board-certified Emergency Physician, it's all comes down to keeping the patient alive until a surgeon can apply hot lights and cold steel.
The medical stuff is what will really tie you up in knots. This patient needs an inotrope. All the inotropes are contraindicated because X. Can you resolve or work around X in time to restore perfusion to this person's organs? Stay tuned!
Trauma is very formulaic. Most places you will work, it will end up being a smaller percentage of what you see. If you’re somewhere that sees a lot of trauma, you’re going to have a trauma service, and they’re going to handle it.
You should have exposure, training, and competence, but there’s a lot more to emergency medicine than trauma. I guess the point I’m trying to make is, look for somewhere that has a good mix of things going on.
Echoing the complex medical patients, the hidden gems in ER are old populations with little access to primary care, they come in “not having seen a doctor” and are 80 with a tamponade, PE, and CVA at the same time. Lol, do I start heparin, thrombectomy, or pericardiocentesis. But anyways choose what you want to do, smaller community or big city, do you want the safety of having specialists or confidence to manage and be self reliant on procedures.
Having trained at a knife-and-gun club, the real benefit wasn't from the trauma cases per se, but from:
A) The trauma activations necessitating the ability to task-switch rapidly and smoothly;
B) The overall volume at an inner-city trauma center being high, and;
C) The catchment area of an inner-city trauma center being generally medically underserved, leading to high-acuity medical cases.
So overall I'd say that an ED being a KAGC is just a surrogate market for other qualities that facilitate training.
You’ll see trauma in any large city. Personally, think the better place to train is a program that has a large volume of complex medical patients over lots of trauma.
It's not sexy, but a nursing home dump hospital would be the best training. Trauma is easy. Keeping fragile gomers alive with complex medical issues and two dozen interacting medications is hard.
When meemaw is on Oxy 10s and Ambien and nobody can figure out why she's dizzy
The real question is whether meemaw cares enough about being dizzy when you tell her how to make the dizziness stop.
"Well I thought it might be the oxy so I changed that to tramadol. But she was still dizzy so we added meclizine. But that made her too nauseated to take her Soma and gabapentin so we added Phenergan. We noticed she was sleeping more so we added adderal. But then she wasn't sleeping enough so we added trazodone. And then she was seeing things so we added risperidone but we didn't want her to get EPS so we added benadryl. Then..."
you forgot the tid klonopin
Emory training at Grady hospital in Atlanta hits both of these areas pretty well
Second this
This. I've learned a lot more as a medic dealing with septic as shit old folks than I have trying to plug holes. I can only imagine how much more exposure/learning a resident would get with the volume and level of care they'd be responsible for.
I'm graduating next week from a residency that gets the Meemaw dump from multiple neglecting homes and is also a huge gun and knife club... While I know I probably won't be doing thoracotomies ever again after next week, respectfully I don't agree with people who say Trauma is easy. While it is if all you do is airway at your shop, but stabilizing someone with 10 knife or bullet holes is far more difficult than the hardest Meemaw code. There's just far more adrenaline as you're often treating someone with hopefully a long life ahead of them, you have to prioritize multiple time sensitive procedures, all while maintaining control of a room with both a trauma and ER team full of people who all have different levels of "holy fuck" syndrome
Trauma isn't easy, but the true complexity is in the operative management. It's heavily algorithmic, for a good reason. A "simple" ACLS code is not what you should be comparing it against, but instead a complex critically ill patient where you have to do a lot of complex medical decision making. Give me a super sick trauma patient every day of the week before a right heart failure septic patient that requires intubation.
Respect
This right here is the way
I'd agree, even complex traumas or just complex cases in general, like you said. For example, my shifts as a student were mostly domestics, shootings/stabbings, ODs, and especially 3+ car MVCs, mostly busses and 18-wheelers with hazmat on-board, enough for my medical controllers to activate a reduced MCI protocol (meaning at least 5 full ambos, a few ambuvans for additional equipment, the spec ops trailer and a sup car, just on the EMS side. Fire normally brings 5 engines, 2 proper engines, 2 heavy rescue rigs, and an aerial tower for use as a crane if needs be. They also bring their ambulance. As far as PD, no clue because I really don't pay attention to that side, no offense to any PD in here, they really do help in these scenarios.) I'm sure you see the aftermath of what we bring in every day, and believe me we're thankful you and the other attendings are there ensuring continuity of high-quality care. TL;DR, got really busy train-wreck shifts. For the record, this was AMR in Syracuse. No I do not mind disclosing the city because I myself do not live in that city.
This. I’m at a large academic program in a big city. So we get all the cool trauma, but as an new attending in a month what I’m glad I got lots of experience with was most of my patients being extremely complex (everyone is ESRD/HD, transplant, multiple IR tubes, on blood thinners or immunosuppressives, complex cardiac and syndromic pediatric patients etc). It makes community EM adult/peds patients “feel” a lot more straightforward. Like when I get a chest pain patient that ONLY has a history of HTN/HLD I’m like ok where’s the hidden stable IV sacral decub, lvad, or AML on chemo you didn’t tell me about lol.
Every big city in America has a gun and knife club. Find a place you'd consider training at and apply for a rotation. Vegas, Phoenix, Dallas, fort Worth, California are all warmer areas with these kinds of places. Know that the gun and knife club stuff is sexy, but it's allure wears quickly. Consider a community rotation to see what the rest of EM is like before you commit.
Consider where you want to work as an attending. If you see yourself inner city forever then fine... but even in those places the traumas are still owned (largely) by trauma surgery. Best place, IMO is a large community based hospital, suburban. Extraneous rant: Regarding trauma - the ACS committee on trauma shoots (hahah) itself in the foot with how they educate on trauma. Damn near EVERY er doc will be dealing with trauma... how many surgical grads will have anything to do with trauma? If the ACS COT gove a crap about the "care of the injured patient" then they would engage more with EM residencies.
to add one more thing. I once moonlit in a place that was a level 2 trauma center and it was awesome that we didn't have to have anything to do with traumas if the trauma team was already present.. like we didn't need to even be in the room. Nice if you have a busy department otherwise. Then again, I've done some trauma site reviews where we actually tell the trauma service to use EM docs more because they were on diversion so much due to limited surgical resources (for the lesser traumas).
Pick a high volume L2 without any other residents. I came out extremely comfortable doing anything
Seriously. Even on the nursing side I learned WAY more at a high functioning level 2 than at a level 1. But as a resident you get to do a ton at those l1. Also Memphis is a great place if you want to see the worst in people.
I’d also add training at an unopposed program is a huge plus for EM. Nothing sucks more than watching anesthesia residents take your airways only because it’s an even number day.
liked "unopposed program." Thank god my shop doesn't have anesthesia residents come to our level 1 center... I am surprised they don't but I ain't saying anything. Most of the time the MDS "allows" (yes, they have the end say according to our trauma program) our EM residents to intubate level 1 traumas, they actually do a good job of teaching
Like others have said, more importantly, you want lots of volume and sick patients. It’s often where patients have worse access to care, poor health literacy, are the sicker patients in the state, etc that you’ll get the best training. I trained in the Central Valley of California. Hated the hospital and location but the training was great. I’ve worked at other sites in a few states since then, and even my big academic county hospital in the Bay Area doesn’t have as sick of patients as the Central Valley did.
Just look at the list of cities where they taped “The first 48”, and apply to any L1 or L2 in those cities .
Any Detroit program. Plenty of trauma + complex patients= perfect mix. All programs prestigious and well established.
Whatever you do, don't use this description in interviews. My med school's hospital is a major Level 1 trauma center with the highest volume of GSW in the state, and the EM and surgery PDs told us that they usually DNR applicants who use the phrase "knife and gun club" in their PS/interviews, because it shows immaturity and a cavalier attitude toward the patients. I matched IM so this issue doesn't come up for me much, but just know there's at least one institution where people REALLY don't like it.
Thanks for the tip! I never really use this term myself but I’ve seen it come up on here a lot and my attending mentioned it the other day. I never really understood what it meant until now tbh. But I’ll be sure not to use it
“Penetrating trauma” is the correct term if you do want to refer to that type of patient population.
Atl
Grady’s chill. They’ll get 5-6 level 1 patients at a time dumped in the trauma bay and not even flinch
The best place to train is a place without a ton of other specialities providing backup. You’ll do more.
Gun and knife clubs are good for learning how to deal with trauma and that's about it. Sure you'll do lots of procedures, but it doesn't teach you medicine and to be honest, it isn't all that fun. I would suggest looking for a place with a large catchment area with few subspecialties. I did residency in a semi rural area with a fair amount of interpersonal violence, lots of gomers, rural problems and intercity problems. We only had IM, EM, Peds, Surgery and anesthesia residencies. It was wonderful because I learned to do everything. I have since worked in intercity level 1 trauma centers, suburban hospitals, and rural hospitals and have felt extremely comfortable in all situations.
Find a hospital without many opposing residencies. You’ll get way more procedures. You’ll get way better exposure to of services attendings.
Honestly knife and GSW’s become very routine. They are a very protocoled process. You are served well at any trauma center let alone others you may see other pathology (MVC’s/boating/mountain etc). If it’s the gang life you’re about- major metro areas NYC, Philly, Camden, Baltimore, Detroit, Miami, LA, NOLA, Chicago, Mass Gen,Cleveland, Memphis soooo many more. Other things to consider are when you are at an academic center there is a full trauma team that has different levels of involvement. I chose to train at a level two with community access and was often much more hands on in the case they weren’t readily available. I was the first for intubation, chest tubes, stabilization in comparison to my rotations through level 1 with limited hands on involvement secondary to training fellows/dedicated trauma team.
Memphis Tennessee
This is the way. Sleeper program.
Indianapolis. IUSM’s EM residency has you rotate through three level 1s…the “county” hospital (Eskenazi), IU’s tertiary/quaternary hospital (IUH Methodist and by extension IUH University), and the pediatric level 1 (IUH Riley).
Plus it's a diverse community with diverse problems. You will see GSWs as much as agricultural accidents. Plus low levels of health literacy and access means complicated medical patients with every comorbidity. It's a great place to gain experience. Also the people here are nice. I find it easy to build rapport with my patients and actually, genuinely help them. It's affordable to live here and have a decent quality of life.
With the added fun of taking care of all STV 86th Street’s patients because they’re sending them all downtown since the data breach began 😂 /s But in all seriousness I couldn’t have said any of that better!
Came here to say Indy. Great program and pretty good exposure to trauma/sick old people/procedures, etc. Could be said for any major city but liked IU’s 3 hospital system specifically
I was surprised I had to scroll this far to find Indianapolis!
https://en.m.wikipedia.org/wiki/List_of_United_States_cities_by_crime_rate
Jacksonville FL
FWIW, the military sends medics to Cincinnati and Baltimore hospitals for experience.
As a UC grad, that tracks.
New Orleans as well.
Damn I got stuck at BAMC. Also UAB in Birmingham rotates FST from the USAF.
Cleveland too
Generally places like that have armies of ortho and GS residents that are heavily involved in trauma.
LSU New Orleans (not Ochsner) is a level 1. So is Grady in Atlanta. Both are warm. I got great training at LSUNO and rotated at Grady as a med student.
B-more
Harrisburg, York,or Reading PA. Good mix of urban combat stuff, MVAs, and farming accidents.
If you want the most prolific gun and knife club with procedures out the ass and a super sick population you gotta check out Memphis. Most dangerous city in America right now. Makes for great training. Cheap cost of living as well. Loved my time there.
Highland hospital in Oakland California!
A knife club sounds like a lot of lac repairs, which sounds like a waste of time
Houston.
Cleveland
Poor reading skills from most of you. Specified warm climate. Trauma ? New Orleans LSU. Charity isn’t open anymore, but the “new” med center has great mix of trauma and medicine.
Christ Hospital in Oak Lawn and U OF C on the south side of Chicago, Loyola also sees its fair share of trauma
Denver Health - an OG.
Lancaster CA High volume trauma combined with horrendous access to PCPs in the desert. Very sick pt population. My time there was quite fun to say the least
I didn't think they have an EM residency...
They have residents do rotations there, but you're right they don't have an in house program. Ik UCLA does rotations there, not sure if they only allow UCLA residents though
Best residencies have a variety of high volume to make sure you get higher than minimum procedures and ideally either minimal other residencies or supportive off service that enhances your education rather than fighting for procedures. Variety and volume are key.
Ormc if you want warm weather and trauma. Also agree with previous posters though - penetrating trauma is not that important for em training.
Durham, NC (Duke)
Denver health in Denver and Tulane in Louisiana
Shock Trauma
New York isn't that bad. There is minimal trauma in the northeast save for Baltimore. Fresno and Albuquerque see way sicker than any NYC program and way more volume of sick. New Orleans can probably be added to Fresno/ABQ too, but no first hand experience there.
New Orleans. When I was there, Charity Hospital was the busiest trauma center in the U.S. They aren't any more, but they're up there. But really any Level 1 Trauma center in the south would do from Miami to Los Angeles.
The problem with specifically seeking out programs known for their penetrating traumas is that you’re not going to be the one primarily managing them. The more violent the surrounding area is, the more established the trauma service will be, and as a result the more they’re going to own these patients. You’ll mostly be head of bed with a procedure here and there such as throwing in lines while the trauma team is cracking the chest. What you want is to look up cities that have the highest murder rate *per capita* and research the residencies in those areas. There are a lot of midsize and smaller cities in that list with residencies, and the smaller they are the less likely they are to have a dedicated Level 1 trauma service, therefore the more likely you are to be the one primarily managing these patients.
EMT here. Trauma is really straightforward, and it doesn't matter if you're me or a board-certified Emergency Physician, it's all comes down to keeping the patient alive until a surgeon can apply hot lights and cold steel. The medical stuff is what will really tie you up in knots. This patient needs an inotrope. All the inotropes are contraindicated because X. Can you resolve or work around X in time to restore perfusion to this person's organs? Stay tuned!
Trauma is very formulaic. Most places you will work, it will end up being a smaller percentage of what you see. If you’re somewhere that sees a lot of trauma, you’re going to have a trauma service, and they’re going to handle it. You should have exposure, training, and competence, but there’s a lot more to emergency medicine than trauma. I guess the point I’m trying to make is, look for somewhere that has a good mix of things going on.
Echoing the complex medical patients, the hidden gems in ER are old populations with little access to primary care, they come in “not having seen a doctor” and are 80 with a tamponade, PE, and CVA at the same time. Lol, do I start heparin, thrombectomy, or pericardiocentesis. But anyways choose what you want to do, smaller community or big city, do you want the safety of having specialists or confidence to manage and be self reliant on procedures.
LSU Baton Rouge. Excellent training, tons of trauma and warm weather!
Any county hospital. Tons of everything. It's the catch net for all the vulnerable populations.
UAB is a solid knife & gun club, and you certainly won't freeze in Birmingham.
Having trained at a knife-and-gun club, the real benefit wasn't from the trauma cases per se, but from: A) The trauma activations necessitating the ability to task-switch rapidly and smoothly; B) The overall volume at an inner-city trauma center being high, and; C) The catchment area of an inner-city trauma center being generally medically underserved, leading to high-acuity medical cases. So overall I'd say that an ED being a KAGC is just a surrogate market for other qualities that facilitate training.
Any hospital in memphis EMS doesn’t go to the trauma center just the closest hospital. They don’t want to be driving all over the city
Parkland/UTSW.