We train at the Erlanger Baroness Hospital in downtown Chattanooga. Erlanger is the county safety net hospital for the city of Chattanooga and Hamilton County. The hospital has a large rural catchment area served by six LifeForce Helicopters. It is the only level one trauma center in a 120 mile radius. The downtown hospital serves about 90,000 patients each year.
Shifts at Erlanger are dense with high acuity medical and trauma resuscitation-- about thirty-five percent of patients admitted require ICU or OR care. This high volume of acuity is attributed to a patient population with: (1) significantly above average rates of chronic medical disease such as diabetes, coronary artery disease, and obesity; (2) an urban region with an above average violent crime rate per capita; and (3) a rural demographic where more than thirty percent of the population lives below the poverty line.
The sum of this is a place not only rich in pathology, but one where the work done each day has impact. Patients, overall, are grateful for the care received and we have a palpable role serving our community.
The department essentially is run by residents. Because we have such a high volume of critical patients, residents here have more autonomy and responsibility than those at most other programs.
Emergency physicians are responsible for intubations and conscious sedations in the department. Our hospital does not have an anesthesia residency, and thus there are no other residents competing for airway experience. This includes off-service rotations.
For level one and level two trauma activations, emergency residents are responsible for securing the airway, and then performing an extended-FAST exam as an adjunct to the primary survey. Trauma procedures occur under the direction of the chief surgery resident, but procedures are performed by both emergency and surgery residents. The high volume of trauma patients encountered on each shift leads to a training environment abundant with procedures and resuscitations, and a well-defined and cordial relationship with our surgery colleagues.
PGY1 residents work seventeen twelve-hour shifts per month (7am to 7pm, 12pm to 12am, 7pm to 7am). PGY1 residents spend six months in the emergency department, and six months off-service.
PGY2/3 residents work eighteen ten-hour shifts per month. PGY2 residents spend eight months in the emergency deparment, and PGY3 residents work nine months in the department.
Residents who pass step three are allowed to moonlight after approval by the program director. Residents tend to moonlight because they find it fun, and a unique educational experience that enriches their training. Most moonlight at free standing emergency departments in rural Tennessee.
Erlanger uses EPIC with Dragon dictation software.
Yes. During PGY1 interns will work a full month in the pediatric emergency department. PGY2 and PGY3 residents work about four to five pediatric shifts per month.
Intern year could be seen as a broad primer in all skills needed for emergency care. Two months are spent in the medical intensive care unit learning critical care and the management of medical resuscitation. One month is dedicated to a combined anesthesia, ultrasound, and procedures rotation. Labor and delivery, pediatric emergency medicine, and trauma are all one month rotations. The remaining six months are spent in the emergency department. Interns have graded responsibility, and their roles in the department expand as they progress through the year.
Second year marks the transition from intern to a more senior role in the emergency department. PGY2s work eight months in the emergency department. They have three off-service rotations that include: one month in the pediatric intensive care unit; one month with orthopedic surgery; and one month of combined neurology, ems, and opthalmology. Finally, they have one full month to complete a research project.
Third year residents spend nine months in the emergency department. They work one off-service rotation in the trauma intensive care unit. They have one month for elective, and one for administration.