During the first year of EM residency training, all EM-1 residents will be fully supervised by the on duty EM faculty or EM-3 Emergency Medicine residents. First year EM-1 residents will be responsible for performing any basic non-nursing procedures on any patients for whom they are responsible. In the latter half of this year, they will initiate life-saving care and perform more invasive procedures under senior EM resident or EM faculty supervision.

During the second year of EM residency training, the care given by the EM-2 residents in the ED will continue to be supervised by more senior EM residents or faculty. EM-2 residents will be responsible for the performance of any significant procedures on their patients, as well as being responsible for procedures during the treatment of medical and trauma resuscitations, which will be led by a senior EM resident. The EM-2 resident will also provide definitive airway management for critically injured trauma patients in the ED, alternating with Anesthesiology. They will serve as online medical control for the local EMS system.

During the third year of EM residency training, the EM-3 resident will see patients more autonomously, consistent with increased responsibility and clinical expectations. The EM-3 resident also will act as the on-site administrative resident physician during his/her time in the ED. The EM-3 resident will be the team leader for any medical resuscitations during their shift. Procedures often will be delegated to the junior EM residents or other junior residents on duty in the ED. Senior residents will also be assigned junior house-staff to supervise. In the latter half of the year, the EM-3 resident will be expected to "run" the ED, under the guidance of on-site EM faculty.

At Children's Hospital of Alabama, the EM resident responsibilities will be similar, but supervision will be provided by both Pediatric EM fellows and attending physicians. EM residents will evaluate and treat all patients presenting to Children's Hospital Emergency Department. There are a total of 53 beds (47 patient rooms, 4 resuscitation/trauma rooms, one minor procedure room and a pelvic examination room). Interns are assigned a one-month block during their first year. To ensure that EM residents experience the seasonal variations in pediatric illness, second and third year residents will work several shifts per block in the Children's Hospital ED when assigned to the University ED.

The resident will participate broadly in the care of critically ill, traumatized patients, along with surgical residents and the PGY-2 EM resident on the Senior Trauma rotation. The resident will be on day call in the trauma bay twice a week and will respond to all trauma activations. The resident will run the primary survey at the supervision of the trauma lead, as well as both ED and trauma attendings. They will assist in trauma consults, and appropriate disposition. You will learn procedures including chest thoracostomy, emergent line placement, lateral canthotomy, ED thoracotomy, become proficient at the eFAST, among others.

As part of the ED rotation during PGY-2 and PGY-3 years, the resident will be assigned ~2-3 trauma shifts per month during their months in the ED. The ED resident will rotate with a trauma senior resident between Trauma Lead and Procedures. On even days the ED resident will function as Trauma Lead and run the resuscitation, assigning roles, coordinating consults and designating the next steps in care. On odd days, the ED resident will function is the “procedure resident” and perform all indicated procedures as designated by the trauma lead, including airway management. Shifts are 12 hours, 12p-12a.

Residents will take primary care of patients on Coronary Care Unit, many of whom are in critically ill condition. The team consists of two interns, two upper level residents, a cardiology fellow, and an attending. Residents will assess patients when called to the ED for consideration of admission to the Cardiology service. They will interpret 12-lead EKGs, monitor strips and administer cardioactive medications, including thrombolytic therapy. They will learn to manage patients with temporary cardiac assistive devices including intra-aortic balloon pumps, impella devices, and implantable left ventricular assistive devices. Residents will take q4 day call (ends at 6pm) where you will admit new patients from the ER or direct transfers.

The resident will assist the OB junior in running the Maternal Evaluation Unit (MEU), which functions as an emergency department for women at or greater than 20 weeks pregnant. In addition, the resident will take primary responsibility for all Labor and Delivery patients (8-12/day) presenting during regular business hours to the Labor and Delivery (L&D) triage area. The resident will accompany the senior Ob/Gyn resident for any ED consultations when not busy in L&D triage. The resident will assist in complicated deliveries and fetal emergencies including management of shoulder dystocia, forceps delivery, and perform obstetrical ultrasounds. The resident will be supervised by a L&D PGY-2 or greater, chief resident, fellow or Obstetrics attending. Residents are expected to work 8 hour shifts, Monday-Friday.

The resident will work as a part of a team of junior and senior Internal Medicine residents. All residents take primary care of MICU patients. The team will manage patients in an 18-bed Medical Intensive Care unit, typically carrying 3-5 patients each. The resident will have two (max) 28hr call days during their MICU month and will spend one week on nights. The resident will be supervised by the critical care fellows and attending physicians on the MICU service. You will have the opportunity to attend advanced imaging conferences, M&M, among other pertinent high yield critical care conferences. This block is critical to improve procedural skills such as central venous lines, lumbar punctures, ultrasound, and chest thoracostomy. Here you will hone your advanced procedural skills and learn to proficiently run medical resuscitations and codes on critically ill patients.

The resident will spend several EMS shifts during each University ED block participating in EMS activities under the direction of the Director of the Office of EMS. Following a brief orientation and completion of the Alabama EMS Medical Directors course, he/she will perform an observership with the Birmingham Fire & Rescue (BF&R) service assisting in the clinical care of patients at 911 call locations along with existing EMS staff. Supervision will be provided by BF&R senior personnel. Residents will observe at the BF&R Communication Center and may participate in provision of field care with the Air Medical service, Huntsville, Alabama (on-board flight participation is strictly optional). Throughout residency training, the EM resident will be encouraged to assist the Alabama Disaster Medical Assistance Team or the National Disaster Medical System, through interactions with the director of the Office of EMS.

The resident will rotate in the PICU at Children's Hospital of Alabama as part of a team comprising pediatric residents, pediatric emergency medicine fellows, pediatric critical care fellows, and pediatric critical care attending physicians. The resident will participate in the evaluation and management of critically ill and critically injured pediatric patients. Dedicated time also is allotted for training in pediatric airway management in the operating rooms at Children's Hospital, supervised by pediatric anesthesiology personnel.

Residents will assist or perform the induction of general anesthesia, endotracheal intubation, and monitoring in patients undergoing a surgical operation requiring general anesthesia (usually 3-5 cases/intubation per day). The resident is supervised in airway management by Anesthesia attending and CRNA Monday-Friday. There is no overnight call. This block is combined with ultrasound. Residents are expected to complete intubations in the morning, and then report to the ED for ultrasound scanning in the afternoon.

Residents will perform emergency bedside ultrasound exams under the supervision of dedicated Emergency Ultrasound faculty and Ultrasound fellows as well as EM attending physicians in the University ED during the afternoon, Monday through Friday, after finishing Anesthesia rotation requirements in the morning. Residents will receive dedicated training in FAST exam, cardiac, AAA and biliary exams, pelvic ultrasonography, ocular, ultrasound guided vascular access, and soft tissue ultrasound exams. Residents will also participate in weekly Ultrasound Image Review, in which the ultrasound images from the preceding week are reviewed and discussed. Residents also will review current ED ultrasound-related medical literature and textbook chapters.

The resident will evaluate and manage a wide variety of adult and pediatric patients in a busy, urban community ED setting at Baptist Medical Center South in Montgomery, Alabama. This ED receives approximately 50,000 visits per year. The resident will work closely with board-certified emergency physicians in all aspects of adult and pediatric emergency care, including the initial primary and secondary evaluation of trauma patients presenting to the ED. Housing is provided by the medical center and scheduling is flexible to accommodate other obligations.

The resident will be exposed to the daily management decision-making processes of the chair of the Department of EM and the medical director of the University Emergency Department. They will attend the weekly UED administrative committee meeting and attend appropriate local, regional, and state EM-related activities with an EM faculty member. They will assist with departmental decision-making in the areas of scheduling, capital budget planning, complaint resolution, interdisciplinary relationships, staffing patterns, and other management activities. They will participate in the regular EM faculty meetings as well as standing EM departmental committee meetings during this block. The resident will participate in all Quality Improvement activities for the department throughout this block.

Each resident is required to complete a scholarly project while enrolled in the residency program. Although the project may continue throughout residency, time during the ED Admin/Research block is scheduled during the EM-3 year. The project may encompass bench research, a community project, clinical research, administrative projects, etc.