Loma Linda University Medical Center is a level 1 trauma center, receiving patients from a wide area and providing services to the residents of Inyo, Mono, Riverside, and San Bernardino Counties not available elsewhere. The hospital has 797 beds and is equipped with a heliport for rapid transport of critical patients.
The clinical service in rehabilitation at LLUMC is organized as a hospital department under the direction of Dr. Murray Brandstater. Inpatients are treated on a ward of 40 beds designed for rehabilitation within the main teaching hospital. The ward has adjacent dining and recreational facilities, and is close to the ward services of neurology, neurosurgery and orthopaedics. Common diagnostic categories of patients admitted to the ward during the past year include stroke, head injury, spinal cord injury, amputation and debility associated with general medical disorders. The care of patients on this ward involves an interdisciplinary team approach under medical direction. The faculty in PM&R act as attending physicians. When assigned to this ward, residents have direct day-to-day responsibility for the care of patients under medical staff supervision. There were over 500 admissions to the PM&R service during 1999.
Outpatient rehabilitation is provided in a large new facility, the Outpatient Rehabilitation Center. A wide variety of patients are treated, including stroke, spinal cord injury, head injury, amputation, and cerebral palsy. There is a high volume of orthopedic and musculoskeletal patients. New patients and follow-up of discharged patients are seen by the medical staff in the faculty clinic which is located within the Center. One senior resident is assigned to these follow-up and assessment clinics on a rotating basis. The PM&R clinic operates a special clinic for the evaluation and treatment of spasticity, and residents are able to observe and participate in the various procedures offered.
The Center for Pain Management at Loma Linda is based in the PM&R clinic and is staffed by two anesthesiologists. There is a close working relationship between the staff in the Pain Management Clinic and the PM&R clinics. Residents have the opportunity to participate in pain clinic evaluation, and to observe numerous injection procedures such as epidural injections.
Physical medicine and rehabilitation participates in the electromyography (EMG) lab service. Approximately 120 EMG studies per month are performed, plus additional evoked potential studies. Clinical supervision is provided by a PM&R and neurology attending. Weekly case conferences are held with all residents and attendings. Dr. Brandstater is the designated faculty person responsible for the didactic teaching program in EMG for PM&R residents.
Jerry L. Pettis Memorial Veteran's Medical Center, a 203-bed acute general medical and surgical hospital, has over 140,000 outpatient visits and over 7,000 admissions per year. Twenty beds are assigned for inpatient rehabilitation. There are about 60 nursing home care unit beds which contain a varying number of patients benefiting from rehabilitation and out-of-hospital outreach services in the community. The VA Medical Center is in Loma Linda, about 1 mile from Loma Linda University Medical Center.
Patients present with a wide variety of trauma, fractures, neurologic injuries, arthritis, joint deterioration, and neurologic disorders, offering the trainee exposure to the problems and management of virtually every disabling condition.
In addition to the inpatient responsibilities, the PM&R service provides consultation and therapy services to and receives support from a wide range of hospital services. Prominent among these are orthopaedic, vascular, plastic, general and neurologic surgery services, opthalmology and otolaryngology, audiology and speech pathology, psychology including biofeedback, career center, substance abuse programs, and a full range of medical specialties including nuclear medicine. Included in the hospital is a 42,000-square-foot research facility with animal quarters, engineering and technical support services, and computer backup.
Excellent cooperation exists with all clinical and research services at the VA Medical Center. Especially close are neurology, rheumatology, orthopaedics, cardiology, pulmonary medicine, and psychiatry. Prosthetics and orthotics clinics are scheduled on alternate weeks. General rehabilitation clinics are held weekly, and orthopaedic clinics are held twice a week. Electromyography and electrodiagnostic services are provided through the neurology service, in part, by a qualified physiatrist.
The PM&R service holds regular ambulatory clinics which provide follow-up for patients discharged from the inpatient unit, and evaluation of new patients with musculoskeletal problems. Three residents are scheduled full-time in the ambulatory clinics. One resident in the outpatient department acts as liaison to other services, and is integrated into the primary care activities of the hospital.
During the Kaiser rotation, residents are assigned full-time to the outpatient department, where they evaluate new patients and follow patients receiving therapy. The patients represent a broad cross-section of musculoskeletal disorders. The service is extremely busy with residents seeing patients on a fully scheduled basis during the rotation. Supervision is provided by the attending staff. A modest number of EMG studies are performed during this rotation. Kaiser is located in Fontana, about a 10-minute drive from Loma Linda. While at Kaiser Hospital, residents continue to attend all didactic and other teaching sessions offered by the program.