Rural Arizona Emergency Medicine Rotations
Rural Site: Tuba City Regional Hospital
Location: Tuba City, Arizona
Distance from Tucson: 339 miles (5 hours 20 min)
Physician Site Director: Dr. Steve Coniaris
Tuba City Regional Health Center is a 73 bed facility located 1 hour north of Flagstaff, Arizona, serving 150 square miles with an ED volume of 25,000. This is a unique opportunity for upper level family medicine residents to work in a rural emergency medicine setting. Residents are provided a supportive situation where they can grow as independent practitioners and yet be safe-there is always an attending on with them.
There is the opportunity to do a lot of hands on procedures, run traumas & codes, arrange transfers and handle critical care patients with long transport times. Tuba City has significant level one trauma from motor vehicle collisions, to assault and battery, to rodeo. They treat patients with MI (lytics), sepsis, and those with end-stage renal disease on hemodialysis, with all of the complications you might expect. Occasionally patients present with hanta virus, plague, rattlesnake bite and black widow or scorpion bites. The pathology is varied and the patients are nice. Approximately 25% of the patients are pediatric. Some residents choose to work with OMFS (oral surgery) to learn to pull teeth.
Consultants all live in Tuba City, so they respond promptly (and usually happily), to see their patients: IM, FP, Peds, Ob/Gyn, Surgery, Ortho and Dental. Partial coverage: ENT, OMFS, Ophtho. There is a 64 slice CT 24/7, MRI during day, Sonosite in ED and US 8am-8pm. Residents work 13 x 12 hr ED shifts and then 1-2 optional shifts - one is usually with EMS to see how folks live, as well as a bit of the countryside.
The residents receive PowerPoint Presentations and are asked to give one. They are also asked to help with supervision of medical students once they feel comfortable. The ED has 24/7 MD coverage, 12/7 PA coverage and 12-12 fast track coverage by MD or PA (residents never work in Fast Track and are not here to cover for someone - they are here to learn and do). Housing is provided in Tuba City.
Residents are given a chance to explore the area around Tuba: Grand Canyon, Monument Valley, Lake Powell, Zion/Bryce National Parks, Telluride and Moab to name a few of the more famous places that are within an easy drive. Tuba City has a population of 8,000 with 65% living under poverty line, 33% living without indoor plumbing and 25% with dirt floors. Tuba City is on the Navajo Reservation (the size of West Virginia with population of 180,000). The ED sees Navajo and Hopi patients as well as a few tourists from Grand Canyon (45 miles away).
Rural Site: Sells Hospital and Clinics Emergency Room
Location: Sells, Arizona (Tohono O'odham Reservation)
Distance from Tucson: 59 miles (approximately one hour)
Physician Site Director: Dr. Barb Vize
The Sells Hospital Emergency Room has approximately 10,000 visits per year, or about 30/day. The most common procedures include endotracheal intubation and incision and drainage. Some traumas are dealt with at the facility, though many are transferred on to Tucson. Medical diagnoses commonly encountered include those related to complications of diabetes & chronic kidney disease, cellulitis, pneumonia and urgent care problems. The facility does not yet have a CT scanner, though plans to within the year.
The preferred resident schedule includes shifts from 12PM to 12AM, four/weeks (weekends are optimal for patient volume). Housing will be available for after shifts-residents are discouraged from traveling on the highway between Sells and Tucson after dark for multiple safety reasons.
The Tohono O'odham "Desert People" are peaceful, patient people and have a strong sense of personal and cultural dignity. For centuries the Sonoran Desert has been their homeland. Tohono O'odham society is based on the family, traditionally consisting of the parents, their children and their sons' families. The individual has never been a focus cooperation and consensus has always ruled. Even today, proposed tribal legislation is often referred back to local councils and villages for decision making consistent with traditional ways. The Tohono O'odham are closely linked to the land. Mother Earth is a spiritual entity and is considered as the provider of all that is necessary. Baboquivari Peak is inhabited by I'toi, The Creator and is central to much of the intriguing Tohono O'odham lore and oral tradition.
Dr. Vize and her colleagues are looking forward to hosting our new residents at their facility. |