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Implementation of EMS Interventions
POLICY STATEMENTS
Policy Statements Policy statements and clinical policies are the official policies of the American College of Emergency Physicians and, as such, are not subject to the same peer review process as articles appearing in the journal. Policy statements and clinical policies of ACEP do not necessarily reflect the policies and beliefs of Annals of Emergency Medicine and its editors. Implementation of EMS Interventions Reaffirmed by the ACEP Board of Directors September 1998, September 2003, and June 2010 Approved June 2010 Originally approved by the ACEP Board of Directors June 1992 Civil Commitment Reaffirmed by the ACEP Board of Directors October 2001 Approved June 2010 Revised and approved by the ACEP Board of Directors March 1997 and June 2010 Originally approved by the ACEP Board of Directors June 1991 Use of Nurse-Implemented Order Sets Approved by the ACEP Board of Directors June 2010 Expert Witness Guidelines for the Specialty of Emergency Medicine Approved June 2010 Revised and approved by the ACEP Board of Directors September 1995, August 2000, and June 2010 Originally approved by the ACEP Board of Directors September 1990 Emergency Contraception for Women at Risk of Unintended and Preventable Pregnancy Reaffirmed by the ACEP Board of Directors June 2010 Approved June 2010 Originated as CR19 and approved by the ACEP Board of Directors as a policy statement October 2004 E-codes and Injury Surveillance Data Systems Reaffirmed by the ACEP Board of Directors October 1998 and September 2003 Approved June 2010 Revised and approved by the ACEP Board of Directors, titled E-codes and Injury Surveillance Data Systems, June 2010 Originated as Council Resolution CR016 and approved by the ACEP Board of Directors, titled E-Codes, September 1990 Triage Scale Standardization: Joint Statement by the American College of Emergency Physicians and the Emergency Nurses Association Approved June 2010 Revised and approved by the ACEP Board of Directors June 2010 Originally approved by the ACEP Board of Directors September 2003 Emergency Physician Shift Work Reaffirmed by the ACEP Board of Directors October 1998 Approved June 2010 Revised and approved by the ACEP Board of Directors September 2003 and June 2010 Originally approved by the ACEP Board of Directors September 1994 As an adjunct to this policy, ACEP has prepared a Policy Resource Education Paper (PREP) titled “Circadian Rhythms and Shift Work” 0196-0644/$-see front matter Copyright © 2010 by the American College of Emergency Physicians.
448 Annals of Emergency Medicine
Volume , . : October
Policy Statements
Implementation of EMS Interventions [Ann Emerg Med. 2010;56:449.] The American College of Emergency Physicians (ACEP) encourages the continuous development and improvement of emergency medical services (EMS) systems. The implementation of EMS equipment, medications, and procedures should be patient centered and evidence based. To help ensure quality care, ACEP believes that EMS systems should adopt devices, medications, and procedures only after carefully considering multiple factors. These factors include available evidence on safety, cost for implementation, and effectiveness in the out-of-hospital setting. Further, out-of-hospital care providers and EMS physician medical directors should participate in the ongoing evaluation of EMS interventions. Approved June 2010 Reaffirmed by the ACEP Board of Directors September 1998, September 2003, and June 2010 Originally approved by the ACEP Board of Directors June 1992 doi:10.1016/j.annemergmed.2010.07.011
who may be in need of commitment and strongly supports access for patients to appropriate mental health consultation. Approved June 2010 Revised and approved by the ACEP Board of Directors March 1997 and June 2010 Reaffirmed by the ACEP Board of Directors October 2001 Originally approved by the ACEP Board of Directors June 1991 doi:10.1016/j.annemergmed.2010.07.012
Use of Nurse-Implemented Order Sets [Ann Emerg Med. 2010;56:449-450.] The American College of Emergency Physicians (ACEP) recognizes the practice of using nurse-implemented order sets. These sets are predetermined collections of departmental orders initiated according to nursing assessment of the patient and are consistent with high-quality emergency care and enhanced patient safety and satisfaction. It is the position of the College that the use of such order sets does not, in and of itself, create a patient-physician relationship. Approved June 2010
Civil Commitment [Ann Emerg Med. 2010;56:449.] Emergency physicians are often called on to care for patients for whom involuntary commitment may be a consideration. Civil commitment, the term used to describe the only noncriminal process by which the law allows individuals to be detained and their freedom of movement restricted, is applied to persons who, because of psychiatric illness or another disease, pose a danger to themselves or others. The laws delineating and governing this process are state laws, but federal regulations and oversight may also apply. Commitment involves an infringement of civil liberties and may create special concerns for emergency department personnel. When participating in commitment procedures, the emergency physician should consider the following: ● aspects of the process of commitment, including relevant laws, regulations, institutional policies, documentation, and patient rights ● performing an appropriate history and physical examination with ancillary diagnostic procedures and with attention not only to the psychiatric evaluation but also to the possibility of other causative underlying medical problems ● the patient’s right to confidentiality and privacy The American College of Emergency Physicians (ACEP) supports the use of written department guidelines or policies addressing the commitment of emergency patients. ACEP further recognizes the importance of psychiatric and other mental health care professionals in the evaluation of patients Volume , . : October
Approved by the ACEP Board of Directors June 2010 doi:10.1016/j.annemergmed.2010.07.013
Expert Witness Guidelines for the Specialty of Emergency Medicine [Ann Emerg Med. 2010;56:449.] Expert witnesses are asked to render opinions to assess the requisite standard of care pertaining to emergency physicians in cases of alleged medical malpractice and peer review. Because medical expert witness testimony has demonstrated the potential to establish standards of medical care, and because physician expert witnesses hold themselves out as qualified to render an opinion by virtue of a medical degree, such testimony is considered by the American College of Emergency Physicians (ACEP) to constitute the practice of medicine. To qualify as an expert witness in the specialty of emergency medicine, a physician should: ● Be currently licensed in a state, territory, or area constituting legal jurisdiction of the United States as a doctor of medicine or osteopathic medicine; ● Be certified by a recognized certifying body in emergency medicine1; ● Be in the active clinical practice of emergency medicine for 3 years immediately preceding the date of the event giving rise to the case2; ● Abide by the following guidelines: ● The expert witness should possess current experience and ongoing knowledge in the area in which he or she is asked to testify. Annals of Emergency Medicine 449
Policy Statements Policy statements and clinical policies are the official policies of the American College of Emergency Physicians and, as such, are not subject to the same peer review process as articles appearing in the journal. Policy statements and clinical policies of ACEP do not necessarily reflect the policies and beliefs of Annals of Emergency Medicine and its editors. Implementation of EMS Interventions Reaffirmed by the ACEP Board of Directors September 1998, September 2003, and June 2010 Approved June 2010 Originally approved by the ACEP Board of Directors June 1992 Civil Commitment Reaffirmed by the ACEP Board of Directors October 2001 Approved June 2010 Revised and approved by the ACEP Board of Directors March 1997 and June 2010 Originally approved by the ACEP Board of Directors June 1991 Use of Nurse-Implemented Order Sets Approved by the ACEP Board of Directors June 2010 Expert Witness Guidelines for the Specialty of Emergency Medicine Approved June 2010 Revised and approved by the ACEP Board of Directors September 1995, August 2000, and June 2010 Originally approved by the ACEP Board of Directors September 1990 Emergency Contraception for Women at Risk of Unintended and Preventable Pregnancy Reaffirmed by the ACEP Board of Directors June 2010 Approved June 2010 Originated as CR19 and approved by the ACEP Board of Directors as a policy statement October 2004 E-codes and Injury Surveillance Data Systems Reaffirmed by the ACEP Board of Directors October 1998 and September 2003 Approved June 2010 Revised and approved by the ACEP Board of Directors, titled E-codes and Injury Surveillance Data Systems, June 2010 Originated as Council Resolution CR016 and approved by the ACEP Board of Directors, titled E-Codes, September 1990 Triage Scale Standardization: Joint Statement by the American College of Emergency Physicians and the Emergency Nurses Association Approved June 2010 Revised and approved by the ACEP Board of Directors June 2010 Originally approved by the ACEP Board of Directors September 2003 Emergency Physician Shift Work Reaffirmed by the ACEP Board of Directors October 1998 Approved June 2010 Revised and approved by the ACEP Board of Directors September 2003 and June 2010 Originally approved by the ACEP Board of Directors September 1994 As an adjunct to this policy, ACEP has prepared a Policy Resource Education Paper (PREP) titled “Circadian Rhythms and Shift Work” 0196-0644/$-see front matter Copyright © 2010 by the American College of Emergency Physicians.
448 Annals of Emergency Medicine
Volume , . : October
Policy Statements
Implementation of EMS Interventions [Ann Emerg Med. 2010;56:449.] The American College of Emergency Physicians (ACEP) encourages the continuous development and improvement of emergency medical services (EMS) systems. The implementation of EMS equipment, medications, and procedures should be patient centered and evidence based. To help ensure quality care, ACEP believes that EMS systems should adopt devices, medications, and procedures only after carefully considering multiple factors. These factors include available evidence on safety, cost for implementation, and effectiveness in the out-of-hospital setting. Further, out-of-hospital care providers and EMS physician medical directors should participate in the ongoing evaluation of EMS interventions. Approved June 2010 Reaffirmed by the ACEP Board of Directors September 1998, September 2003, and June 2010 Originally approved by the ACEP Board of Directors June 1992 doi:10.1016/j.annemergmed.2010.07.011
who may be in need of commitment and strongly supports access for patients to appropriate mental health consultation. Approved June 2010 Revised and approved by the ACEP Board of Directors March 1997 and June 2010 Reaffirmed by the ACEP Board of Directors October 2001 Originally approved by the ACEP Board of Directors June 1991 doi:10.1016/j.annemergmed.2010.07.012
Use of Nurse-Implemented Order Sets [Ann Emerg Med. 2010;56:449-450.] The American College of Emergency Physicians (ACEP) recognizes the practice of using nurse-implemented order sets. These sets are predetermined collections of departmental orders initiated according to nursing assessment of the patient and are consistent with high-quality emergency care and enhanced patient safety and satisfaction. It is the position of the College that the use of such order sets does not, in and of itself, create a patient-physician relationship. Approved June 2010
Civil Commitment [Ann Emerg Med. 2010;56:449.] Emergency physicians are often called on to care for patients for whom involuntary commitment may be a consideration. Civil commitment, the term used to describe the only noncriminal process by which the law allows individuals to be detained and their freedom of movement restricted, is applied to persons who, because of psychiatric illness or another disease, pose a danger to themselves or others. The laws delineating and governing this process are state laws, but federal regulations and oversight may also apply. Commitment involves an infringement of civil liberties and may create special concerns for emergency department personnel. When participating in commitment procedures, the emergency physician should consider the following: ● aspects of the process of commitment, including relevant laws, regulations, institutional policies, documentation, and patient rights ● performing an appropriate history and physical examination with ancillary diagnostic procedures and with attention not only to the psychiatric evaluation but also to the possibility of other causative underlying medical problems ● the patient’s right to confidentiality and privacy The American College of Emergency Physicians (ACEP) supports the use of written department guidelines or policies addressing the commitment of emergency patients. ACEP further recognizes the importance of psychiatric and other mental health care professionals in the evaluation of patients Volume , . : October
Approved by the ACEP Board of Directors June 2010 doi:10.1016/j.annemergmed.2010.07.013
Expert Witness Guidelines for the Specialty of Emergency Medicine [Ann Emerg Med. 2010;56:449.] Expert witnesses are asked to render opinions to assess the requisite standard of care pertaining to emergency physicians in cases of alleged medical malpractice and peer review. Because medical expert witness testimony has demonstrated the potential to establish standards of medical care, and because physician expert witnesses hold themselves out as qualified to render an opinion by virtue of a medical degree, such testimony is considered by the American College of Emergency Physicians (ACEP) to constitute the practice of medicine. To qualify as an expert witness in the specialty of emergency medicine, a physician should: ● Be currently licensed in a state, territory, or area constituting legal jurisdiction of the United States as a doctor of medicine or osteopathic medicine; ● Be certified by a recognized certifying body in emergency medicine1; ● Be in the active clinical practice of emergency medicine for 3 years immediately preceding the date of the event giving rise to the case2; ● Abide by the following guidelines: ● The expert witness should possess current experience and ongoing knowledge in the area in which he or she is asked to testify. Annals of Emergency Medicine 449