physician workforce needs. Our hope is that the specialty of emergency medicine and academic medical centers will be able to effectively address the need for residency trained emergency physicians in metropolitan and higher volume rural EDs. Jeff Reames, MD Integris Baptist Medical Center Department of Emergency Medicine Oklahoma City, OK A. F. Al-Assaf, MD College of Public Health University of Oklahoma Health Sciences Center Oklahoma City, OK John P. Zubialde, MD University of Oklahoma College of Medicine Oklahoma City, OK doi:10.1016/j.annemergmed.2006.08.037 1. Moorhead JC, Gallery ME, Mannie T, et al. A study of the workforce in emergency medicine. Ann Emerg Med. 1998;31:595-607. 2. Moorhead JC, Gallery ME, Hirshkorn C, et al. A study of the workforce in emergency medicine: 1999. Ann Emerg Med. 2002;40:3-15. I Have a Nail “Stuck” In My Hand To the Editor: Nail guns are commonly used in the construction industry in order to drive various sizes of nails into wood or concrete. These devices are publically available and in use by general public. Safety and handling instructions present with the tool may not be read or could be easily forgotten by users. When nail guns are used inappropriately, there is an increased risk of causing significant injuries to the person handling the tool. 1 The most frequent parts of the body injured are the hands and digits (66%). 2,3 The hazards of using this high powered tool and a possible pitfall in the surgical removal of the nail are illustrated here. A 54-year-old worker was referred by the local Accident and Emergency Department with a history of penetrating injury to his right hand after handling a pneumatic nail gun. The patient presented with the proximal part of the nail protruding 25 mm from his right index finger on the radial aspect of the proximal phalanx. The rest of the nail was not visible. Thorough clinical examination of his right hand did not reveal any functional or sensory deficit to his index, middle or ring finger. Hand radiographs showed the oblique nail trajectory from index finger to the palm (the level of ring finger metacarpal) (Figure 1). A few hours later, the patient underwent exploration and removal of the nail. Despite the close proximity of the nail to the flexor tendons and neurovascular bundles no major structure was damaged. The nail was identified penetrating the tissues in a plane Figure 1. Radiological examination of the hand. Figure 2. Image of a nail with a layer of hardened glue around it. Figure 3. Palmar view of a nail gun injury to hand. Note the hooked barbs seen in the palm. Correspondence Volume , .  : February  Annals of Emergency Medicine 249