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Hello Shahab

I certainly am not saying that you should not do 'basic surgical' procedures. I honestly hope that you are already performing a few as part of your daily practice of EM. I feel that you should be able to do those basic procedures not only when the specialists are unavailable but whenever you feel there is need for one. Now what you describe as 'basic procedure' is for you or your hospital or SEMI to decide.

As you had mentioned before, it has to be part of your training in EM (EM doesn't mean that there is no surgery involved!!!) and eventually there has to be some form of competency based assessment at work.

I feel that you should be well versed with emergency (medical and surgical) procedures like (A: RSI, needle/surgical cricothyroidotomy, mini tracheostomy etc B: needle / tube thoracostomy, Emergency 'clam-shell' thoracotomy, pericardiocentesis C: splinting fractured limbs, pelvic braces, performing FAST scans, DPL, securing central access (fem/IJV/Subclavian), IO access, Venous cutdown, arterial lines (for inv monitoring) D: Assessing the head injured patient, maintaing adquate cerebral perfusion and minimising cerebral hypoxia, management of cerebral oedema etc. Other procedures like Manipulation of fractures, reduction of dislocations, pain management, SPCs etc are our bread and butter. There are a whole myriad of other medical problems which we should be competent in dealing with.

Though I have seen a lot of Burr holes and 'bolts' being put into heads to evacuate EDH or monitor ICP, I haven't ever done one. This does not mean that I feel no EM physician should do it. If you see these patients frequently and availability of neuro-surgeons is a problem, then you should certainly get more training in it.

Whether the neurosurgeon feels that the 'world should wait for him' or not is his opinion. Perhaps he feels that he is important because he is a 'neurosurgeon', which he got by fighting a stiff competition in the qualifying exam. As EM specialists we should certainly work hard to gain the credibility and respect. I am sure we do not get it served on a silver platter.

I would still stand by what I said earlier regarding patient care and 'meaningful' intervention. Knowing our limitations and calling for help when needed does not make us less competent. What we definitely do not want is for everyone else to think of EM specialists as a bunch of 'cowboys' who have lost the plot!!!

(PS: I think I have echoed similar sentiments under the thread 'The enemies within' )