ThomasM.FlowersDO

Summary

• I’ve been practicing full-time emergency medicine since 1991, initially in the US Air Force and then, since 1993 in the civilian world, primarily in Texas but recently in New Zealand. My practice has been in various locations and levels, from community hospitals with limited or no sub-specialty care, to Level 1 & 2 trauma centers with full-time cardiac cath lab and stroke team capabilities. For the last 18 months I have worked in Whanganui, New Zealand.
  I also had 5 years of practice before residency as a general medical officer in the USAF and I feel my varied background provides me with a unique perspective on the practice of emergency medicine in these different settings. As the importance of the emergency medicine specialty being established with the goal of providing residency-trained specialists at all hospitals (including small community and rural facilities), the different challenges to be met at facilities like these need to be addressed. Not all emergency medicine graduates will be going to Level 1 or Level 2 trauma centers. Training should include how to make difficult decisions working in a limited technological and diagnostic environment. Also, the expanding role of ultrasound in the hands of trained emergency physicians can help make up for these other limitations. It’s been really interesting to participate in emergency medicine's high-tech changes: FAST exams, central lines with US guidance, and to diagnose conditions (such as pneumothorax and pneumonia and pericardial effusion) with ultrasound. I have recently trained on how to quantify papilledema by ultrasonic measurement of the optic nerve sheath diameter. Having gained many years of practical and theoretical knowledge, I would welcome an opportunity to pass on my knowledge and experience to future ED physicians at a residency training program.