The University of Maryland Medical Systems (UMMS) is a Level I Trauma Center. The UMMS Emergency Room (ER) is staffed with emergency medicine attendings and residents at all times.
The urology resident is called for all urologic problems, ranging from the minor to major trauma from inside the Baltimore Beltway (primarily gunshot wounds). The attending is contacted regarding problem cases and admissions. The UMMS ER educates the resident broadly in general ER urologic cases seen in an urban environment.
The Maryland Institute for Emergency Medical Services Systems (MIEMSS) is one of the premiere shock trauma units in the nation. All major traumas within the State of Maryland occurring outside the Baltimore Beltway are airlifted to the MIEMSS by a State helicopter system. The trauma bays are manned at all times by trauma fellows and attending trauma surgeons. The urology attending on-call (Drs. Naslund, Alexander, Chai, Phelan or Kramer) is also on-call for shock trauma.
The urology resident on-call is the first person called for urologic trauma. The urology resident on-call contacts the URO-4 resident, who then contacts the attending on-call. All surgical procedures are directly supervised by the attending on-call. Virtually all of the shock trauma patients have multiple injuries; the urology service generally cares for their urologic problem only. This experience gives the residents a broad-based practical education, not only in urologic trauma care, but also in general trauma care.
The Veterans Administration Medical Center (VA) does not have an ER, but does have a screening area where acute cases appear after-hours. The area is staffed by medical and surgical residents with attending back-up on-call. Very few true urologic emergencies are admitted through this area, but patients do need to be seen with retention, stones, hematuria, epididymitis, etc. The experience contributes to the resident's education only as these cases can train. The Sinai Hospital is the State's 3rd Level I Trauma Center. The ER is staffed by emergency physicians and medical and surgical residents from Johns Hopkins' programs.
The urology resident is called for urologic emergencies and then contacts the attending on-call about each case. Urology attendings are available on a rotational basis (two months/year), 24 hours/day. The emergencies tend to be less life-threatening, although some gunshot wounds are seen. This more suburban ER experience is particularly heavy with acute ureteral calculi in the summer months.
The Johns Hopkins Hospital Emergency Department is a full-service Level I Trauma Center. Patients are seen by the urology resident on-call and is discussed with the chief resident. The chief resident will then discuss the patient’s care with the attending urologist on-call, as necessary. The entire spectrum of pediatric urologic emergencies is seen, particularly including trauma and testicular torsion.
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