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Expanded Roles of EMS Personnel
Policy Statements REFERENCE 1. American College of Emergency Physicians. Patient satisfaction surveys [policy statement]. Approved by the Board September 2010. Available at: http://www.acep.org/Clinical—Practice-Management/PatientSatisfaction-Surveys/. http://dx.doi.org/10.1016/j.annemergmed.2016.04.046
Disaster Planning and Response [Ann Emerg Med. 2016;68:149.] The American College of Emergency Physicians (ACEP) encourages emergency physicians to: 1. Assist their institutions and community to prepare for and respond to disasters. 2. Continue to serve their communities and nation during time of disasters. 3. Implement actions to protect themselves, their families, their coworkers, and their patients from risks. 4. Work with institutional and public leaders to effectively communicate public health and safety information to coworkers and the public. 5. Serve as subject-matter experts on the allocation of scarce health care resources, when necessary. ACEP will, when possible and appropriate during disasters, use its resources to disseminate current, scientifically based information from national experts. Revised June 2015 Revised and approved by the ACEP Board of Directors June 2015 Originally approved by the ACEP Board of Directors June 2008 http://dx.doi.org/10.1016/j.annemergmed.2016.04.047
Ethical Issues of Resuscitation [Ann Emerg Med. 2016;68:149.] The American College of Emergency Physicians supports the following principles: Patients who may benefit from resuscitation efforts should have equitable access to such efforts. Decisions to attempt resuscitation must take into account the accepted standards of medical care and the safety of the medical personnel, as well as known patient preferences. It is appropriate for out-of-hospital providers to honor valid orders to limit life-sustaining interventions at the end of life. Standardized guidelines and protocols should exist in all emergency medical services (EMS) systems to direct out-of-hospital personnel’s resuscitative efforts. Educational information about such policies should be disseminated to the community and to out-of-hospital and hospital providers. Volume 68, no. 1 : July 2016
Patient goals for end-of-life care should be honored by out-of-hospital and hospital providers at the end of life. EMS out-of-hospital order systems should support efforts to intervene or forgo these treatments in accordance with available information. The appropriate surrogate decision maker, as defined by state law, should be involved in decisions about lifesustaining treatments if immediately available. Additional sources of information to guide treatment decisions may come from patient advance directives, family, or primary physicians as time permits. EMS systems should honor state-recognized orders addressing life-sustaining treatments such as Physician Orders for Life-Sustaining Treatments (POLST). If the patient’s goals or medical circumstances are unclear, medically appropriate resuscitative measures should be undertaken. It is ethically permissible for treatments, once started, to be withdrawn when additional information is available. This information may include the lack of response to treatment or definitive information about the patient’s goals for life-sustaining treatments. Resuscitative efforts may be appropriately withheld, withdrawn, or limited in circumstances such as the lack of immediately available resuscitation resources, or when there is no realistic likelihood of benefit to the patient according to existing scientific evidence and reasonable medical judgment. When resuscitative efforts are not indicated, emergency physicians should ensure appropriate medical and psychosocial care during the dying process. Approved June 2015 Revised and approved by the ACEP Board of Directors June 2015 Approved by the ACEP Board of Directors June 2008 titled “Ethical Issues of Resuscitation” by combining “Ethical Issues of Resuscitation” approved October 2001 and “Do Not Attempt Resuscitation (DNAR) in the Out-of-Hospital Setting” approved September 2003 http://dx.doi.org/10.1016/j.annemergmed.2016.04.050
Expanded Roles of EMS Personnel [Ann Emerg Med. 2016;68:149-150.] The American College of Emergency Physicians (ACEP) acknowledges expanded scope-of-practice programs are being developed to meet unique and local health care needs, as well as disaster scenarios. ACEP recognizes that emergency medical services (EMS) providers are likely to be used in the workforce for these programs. With proper design and medical oversight, potential benefits may include improved access to health care in underserved areas, improved patient care, and reduced costs. Annals of Emergency Medicine 149
Policy Statements
The evidence must be clear and compelling that significant patient benefit will result from any such expansion of roles for EMS providers. To expand the scope of practice for EMS personnel, the following principles must be met: Close medical oversight by physicians with experience and an understanding of the roles and capabilities of EMS personnel is mandatory. Education programs with quality assurance mechanisms to ensure maintenance of standards must be in place before implementing an expanded scope for EMS providers. Quality assurance mechanisms for the care provided by EMS personnel operating under expanded roles must be in place at the time of implementation of such programs to ensure appropriate and safe patient care. Expanded roles for out-of-hospital providers must adhere to legal requirements. Physician oversight of any such expanded roles is a necessity. The existing emergency response system must not suffer for the sake of an expanded scope program. Access to emergency care must not be compromised by efforts to alter the basic emergency response system as a part of medical care integration. Needs assessment with physician input must guide the development of any expanded-scope program. Attempts to expand the scope of provider practice without the support of all involved parties and adequate medical oversight are not in the best interest of good patient care. Any current pilot programs for expanded roles of EMS personnel are strongly encouraged to share the results of their programs with ACEP and other EMS organizations. Approved April 2015 Revised and approved by the ACEP Board of Directors April 2015, April 2008 Reaffirmed by the ACEP Board of Directors October 2001 Originally approved by the ACEP Board of Directors June 1997 http://dx.doi.org/10.1016/j.annemergmed.2016.04.048
Guidelines for Undergraduate Education in Emergency Medicine [Ann Emerg Med. 2016;68:150.] The American College of Emergency Physicians (ACEP) believes that all medical students should be taught the basic principles of emergency medicine in order to recognize a 150 Annals of Emergency Medicine
patient requiring urgent or emergency care and initiate evaluation and management. ACEP further believes that every medical student should receive clinical exposure to emergency department patients and care. ACEP also believes that the public expects all medical students to be able to provide basic emergency care and disaster management. The curricular basics can be accomplished by a specific curriculum designed by emergency medicine faculty, or by incorporating essential topics of emergency medicine into the existing curriculum. The emergency medicine environment places a premium on focused history and physical examination skills, functioning as part of a health care team, and diagnostic reasoning and critical thinking. These skills are essential for students entering any clinical specialty. The general educational objectives for all graduating medical students include general assessment skills for the undifferentiated patient, recognition and stabilization of life-threatening illnesses, injury prevention and disease identification, unique content areas, management of the health care system, and basic procedural competency. An appropriate curriculum incorporates these 6 elements to create a progressive learning environment during the entire undergraduate educational experience, from the preclinical to the clinical years. The exact format of teaching emergency medicine to medical students can take a variety of designs and should be tailored to local abilities, resources, or curriculum needs. Approved June 2015 Revised and approved by the ACEP Board of Directors June 2015, April 2008, and January 1997 Reaffirmed by the ACEP Board of Directors October 2001 Originally approved by the ACEP Board of Directors September 1986 As an adjunct to this policy statement, ACEP’s Academic Affairs Committee developed a Policy Resource and Education Paper (PREP) titled “Guidelines for Undergraduate Education in Emergency Medicine.” http://dx.doi.org/10.1016/j.annemergmed.2016.04.049
Immunization of Adults and Children in the Emergency Department [Ann Emerg Med. 2016;68:150-151.] The American College of Emergency Physicians (ACEP) recognizes that vaccine-preventable infectious diseases have a significant effect on the health of adults and children. The emergency department (ED) is used frequently for health care by many inadequately vaccinated adults and children Volume 68, no. 1 : July 2016
Disaster Planning and Response [Ann Emerg Med. 2016;68:149.] The American College of Emergency Physicians (ACEP) encourages emergency physicians to: 1. Assist their institutions and community to prepare for and respond to disasters. 2. Continue to serve their communities and nation during time of disasters. 3. Implement actions to protect themselves, their families, their coworkers, and their patients from risks. 4. Work with institutional and public leaders to effectively communicate public health and safety information to coworkers and the public. 5. Serve as subject-matter experts on the allocation of scarce health care resources, when necessary. ACEP will, when possible and appropriate during disasters, use its resources to disseminate current, scientifically based information from national experts. Revised June 2015 Revised and approved by the ACEP Board of Directors June 2015 Originally approved by the ACEP Board of Directors June 2008 http://dx.doi.org/10.1016/j.annemergmed.2016.04.047
Ethical Issues of Resuscitation [Ann Emerg Med. 2016;68:149.] The American College of Emergency Physicians supports the following principles: Patients who may benefit from resuscitation efforts should have equitable access to such efforts. Decisions to attempt resuscitation must take into account the accepted standards of medical care and the safety of the medical personnel, as well as known patient preferences. It is appropriate for out-of-hospital providers to honor valid orders to limit life-sustaining interventions at the end of life. Standardized guidelines and protocols should exist in all emergency medical services (EMS) systems to direct out-of-hospital personnel’s resuscitative efforts. Educational information about such policies should be disseminated to the community and to out-of-hospital and hospital providers. Volume 68, no. 1 : July 2016
Patient goals for end-of-life care should be honored by out-of-hospital and hospital providers at the end of life. EMS out-of-hospital order systems should support efforts to intervene or forgo these treatments in accordance with available information. The appropriate surrogate decision maker, as defined by state law, should be involved in decisions about lifesustaining treatments if immediately available. Additional sources of information to guide treatment decisions may come from patient advance directives, family, or primary physicians as time permits. EMS systems should honor state-recognized orders addressing life-sustaining treatments such as Physician Orders for Life-Sustaining Treatments (POLST). If the patient’s goals or medical circumstances are unclear, medically appropriate resuscitative measures should be undertaken. It is ethically permissible for treatments, once started, to be withdrawn when additional information is available. This information may include the lack of response to treatment or definitive information about the patient’s goals for life-sustaining treatments. Resuscitative efforts may be appropriately withheld, withdrawn, or limited in circumstances such as the lack of immediately available resuscitation resources, or when there is no realistic likelihood of benefit to the patient according to existing scientific evidence and reasonable medical judgment. When resuscitative efforts are not indicated, emergency physicians should ensure appropriate medical and psychosocial care during the dying process. Approved June 2015 Revised and approved by the ACEP Board of Directors June 2015 Approved by the ACEP Board of Directors June 2008 titled “Ethical Issues of Resuscitation” by combining “Ethical Issues of Resuscitation” approved October 2001 and “Do Not Attempt Resuscitation (DNAR) in the Out-of-Hospital Setting” approved September 2003 http://dx.doi.org/10.1016/j.annemergmed.2016.04.050
Expanded Roles of EMS Personnel [Ann Emerg Med. 2016;68:149-150.] The American College of Emergency Physicians (ACEP) acknowledges expanded scope-of-practice programs are being developed to meet unique and local health care needs, as well as disaster scenarios. ACEP recognizes that emergency medical services (EMS) providers are likely to be used in the workforce for these programs. With proper design and medical oversight, potential benefits may include improved access to health care in underserved areas, improved patient care, and reduced costs. Annals of Emergency Medicine 149
Policy Statements
The evidence must be clear and compelling that significant patient benefit will result from any such expansion of roles for EMS providers. To expand the scope of practice for EMS personnel, the following principles must be met: Close medical oversight by physicians with experience and an understanding of the roles and capabilities of EMS personnel is mandatory. Education programs with quality assurance mechanisms to ensure maintenance of standards must be in place before implementing an expanded scope for EMS providers. Quality assurance mechanisms for the care provided by EMS personnel operating under expanded roles must be in place at the time of implementation of such programs to ensure appropriate and safe patient care. Expanded roles for out-of-hospital providers must adhere to legal requirements. Physician oversight of any such expanded roles is a necessity. The existing emergency response system must not suffer for the sake of an expanded scope program. Access to emergency care must not be compromised by efforts to alter the basic emergency response system as a part of medical care integration. Needs assessment with physician input must guide the development of any expanded-scope program. Attempts to expand the scope of provider practice without the support of all involved parties and adequate medical oversight are not in the best interest of good patient care. Any current pilot programs for expanded roles of EMS personnel are strongly encouraged to share the results of their programs with ACEP and other EMS organizations. Approved April 2015 Revised and approved by the ACEP Board of Directors April 2015, April 2008 Reaffirmed by the ACEP Board of Directors October 2001 Originally approved by the ACEP Board of Directors June 1997 http://dx.doi.org/10.1016/j.annemergmed.2016.04.048
Guidelines for Undergraduate Education in Emergency Medicine [Ann Emerg Med. 2016;68:150.] The American College of Emergency Physicians (ACEP) believes that all medical students should be taught the basic principles of emergency medicine in order to recognize a 150 Annals of Emergency Medicine
patient requiring urgent or emergency care and initiate evaluation and management. ACEP further believes that every medical student should receive clinical exposure to emergency department patients and care. ACEP also believes that the public expects all medical students to be able to provide basic emergency care and disaster management. The curricular basics can be accomplished by a specific curriculum designed by emergency medicine faculty, or by incorporating essential topics of emergency medicine into the existing curriculum. The emergency medicine environment places a premium on focused history and physical examination skills, functioning as part of a health care team, and diagnostic reasoning and critical thinking. These skills are essential for students entering any clinical specialty. The general educational objectives for all graduating medical students include general assessment skills for the undifferentiated patient, recognition and stabilization of life-threatening illnesses, injury prevention and disease identification, unique content areas, management of the health care system, and basic procedural competency. An appropriate curriculum incorporates these 6 elements to create a progressive learning environment during the entire undergraduate educational experience, from the preclinical to the clinical years. The exact format of teaching emergency medicine to medical students can take a variety of designs and should be tailored to local abilities, resources, or curriculum needs. Approved June 2015 Revised and approved by the ACEP Board of Directors June 2015, April 2008, and January 1997 Reaffirmed by the ACEP Board of Directors October 2001 Originally approved by the ACEP Board of Directors September 1986 As an adjunct to this policy statement, ACEP’s Academic Affairs Committee developed a Policy Resource and Education Paper (PREP) titled “Guidelines for Undergraduate Education in Emergency Medicine.” http://dx.doi.org/10.1016/j.annemergmed.2016.04.049
Immunization of Adults and Children in the Emergency Department [Ann Emerg Med. 2016;68:150-151.] The American College of Emergency Physicians (ACEP) recognizes that vaccine-preventable infectious diseases have a significant effect on the health of adults and children. The emergency department (ED) is used frequently for health care by many inadequately vaccinated adults and children Volume 68, no. 1 : July 2016