Pioneers Memorial ED

Please contact the Rotation Director and Rotation Coordinator Dr. Olga Diaz at Olga.Diaz@vituity.com at least 4-5 weeks prior to the start of the rotation. Points of contact may also be found under Rotation Information.

Please also complete the rotation paperwork below NLT 8 weeks in advance.

POC: 

• Olga Diaz, MD 

• Email Leti Vicuna (lvicuna@pmhd.org) for your username and password for the EMR. If you are starting on a weekday during business hours, Leti will be your department contact to set you up with a key, badge, and a brief department tour. If you are starting on a weekend or night shift, you'll need to email Leti and Olga Diaz about a week prior to your start date to remind ensure you have the key and badge ready for you.

• Application for rotation must be done more than one month in advance 

• Practice/review airway and vascular access 

• Pioneers site rotation guide and PulseCheck (EMR) guide:

 https://drive.google.com/drive/folders/1L06zu6uaXu7jRbgoJjVguCzjxP4hj0sN

Uniform: Bring your own scrubs

Food: May show your badge in the cafeteria for free hot food, hours are somewhat limited

Lodging: Trailer 12 behind the ED, one bedroom and communal living space with several beds for when multiple residents/PA students are staying in the trailer. Fridge, Microwave, Stove all available. Cleaned M/W/F.

Pioneer ED is located in Brawley, CA approximately 2 hours east of San Diego. This is a very rural site, close to the Mexican border. Your patient population is mainly Spanish speaking and very poor. Meth abuse is high. You will see incredibly sick patients. The hospital also contracts with the nearby state prisons and you’ll get a lot of trauma from the prisons. Additionally, you have very little subspecialty support.

Brawley is the exact reason most of us do EM, we like seeing sick patients and doing a lot of procedures. If your patient has a problem; you’re probably going to have to fix it…no trauma surgeons to run trauma or place your chest tube, you do ALL emergent procedures. Got a STEMI? Get ready to push thrombolytics, there’s no cath lab. ICU patient crashing? You guessed it, the ED responds to ICU codes/need for central lines/intubations; as there is no intensivist in house.

The staff physicians are overall great. Remember, they’re community docs, their not professional educators. They have a ton to teach you, but their not going to stop everything their doing to give you a 10-minute run down. That being said, if any point, you’re not comfortable with doing a procedure or your concerned about a patient, make sure you let them know right away.  The nurses and ancillary staff are VERY good and easy to work with; enjoy!

It takes approximately 2 hrs and 15 minutes to get to Brawley from NMCSD, possibly longer depending on where you live. Winds can be very high, use caution when driving, and slow down, especially around the curves! You’ll lose radio and cell signals for a large portion of the drive as well. Also, I ran into really thick fog a few nights that made the drive considerably longer.

RESIDENT GUIDE

PIONEERS RURAL EMERGENCY MEDICINE ELECTIVE

IMPORTANT:

-Assign your attending in the EMR immediately on signing up for a patient

-Finish all your charts before leaving your shift

-Electronically sign all charts before leaving your shift

Welcome to our resident rotation.  You are among the few emergency medicine trainees in this country to have a rotation in rural medicine.  While most things are the same, the emergency physician will function with a great deal more independence than in the city. Many emergency physicians thrive in that sort of setting.  Others prefer to work in a setting where you always have a specialist ready to come to the ED. If you are rotating from UCSD this rotation will help you decide what sort of practice setting might be right for you. If you are rotating from the Navy this rotation will give you additional experience of practicing on higher acuity patients in settings with relatively fewer resources.  You do have your specialist colleagues in San Diego only a phone-call away.  Almost always, they are helpful to rural practitioners.

You will encounter the entire gamut of health issues that afflict a community on a given day.  Be aggressive on procedures, ideally you should be participating in whatever interesting procedures happen from the time you walk in to the time you leave.

Glamis recreational vehicle riding occurs in the winter, from about Halloween through April. Generally holiday weekends are the best for this, though we do so all-terrain vehicle accidents any day of the week, especially during school holiday weeks and during Christmas break. My impression is that Saturday has the most trauma procedures all winter long and if there are two residents we will try to schedule for overlap on Saturdays. When there is only one resident, the shifts are 10-10. When there are two it can vary based on resident convenience, safest time to drive, and optimal procedure load.

Drive safe!  Highway 8 gets high winds where the mountains meet the desert (called Devils’ Canyon).  I try to drive slower for this brief winding stretch.  Accidents happen here when people go too fast.

Sleeping quarters:  We have an ED trailer we stay in that will usually have an extra bed. We have an air mattress if that is needed, it is either in the MD trailer or the PA trailer. If that is not available we will put you in the ED physician call-room.  The code is 4331. Finally, the PAs have an extra room in their trailer that can usually be used.

Address:

Pioneers Memorial Hospital

207 W Legion Rd

Brawley, CA 92227

Parking - free, park anywhere, but the back is the best

Code for backdoor of ED and ED Break Room 4321*

Code for physicians lounge 8420