Level I Trauma Certification and Emergency Medicine Resident Major Trauma Experience

Objective: American 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.
Methods: A 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.
Results: There were 95 (94%) survey respondents. Estimates of the percentage of trauma resuscitations directed by EM residents were significantly lower at level I centers (52% X 27%, 95% CI 45–59%) than they were at non–level I centers (70% X 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.
Conclusions: EM 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.