Emergency

Core Generalist#

Knowledge#

CG.K.1#

Describe the following;

basic pathophysiology of cardiac arrest and the factors leading to circulatory and respiratory failure, and those factors relevant to post resuscitation care
basic pathophysiology of shock secondary to cardiogenic, haemorrhagic, hypovolaemic, anaphylactic, mechanical or other causes of shock
basic anatomy of the airway, circulatory and respiratory system in relation to life threatening conditions
relevant anatomical aspects of the neurological and musculoskeletal systems in relation to medical and surgical conditions
special considerations for facial and airway trauma
important age-specific differences and the anatomy and physiology of the child relevant to emergencies
essentials of acid-base balance and fluid and electrolyte management in emergencies

CG.K.2#

Discuss the principles of triage, prioritisation of patients for resuscitation, and resource allocation

CG.K.3#

Discuss personal safety responsibilities and limitations if attending an emergency in the community

CG.K.4#

Describe hazards identification, assessment and mitigation at a prehospital scene or incident

CG.K.5#

Identify medical capabilities and the relationship of emergency services police, fire, medical, specialist rescue and voluntary emergency services at a prehospital scene or incident

CG.K.6#

Describe the steps involved in the management of an acute emergency, proceeding logically through life support while advancing towards definitive diagnosis and management of underlying injury and disease

CG.K.7#

Discuss the principles of managing the acutely disturbed/agitated patient

CG.K.8#

Discuss the principles of retrieval, transfer and transport by road and by air

CG.K.9#

Discuss use of common chemo-therapeutic agents in emergency management particularly in relation to:

analgesia
sedation
antibiotics
thrombolysis
anticoagulation/platelet inhibition

CG.K.10#

Identify the contents and general layout of emergency and retrieval kits

CG.K.11#

Explain the principles of acute forensic presentation particularly with respect to victims of sexual assault and non-accidental injury

CG.K.12#

Identify the disaster response plan for the hospital and community

Skills#

CG.S.1#

Respond and provide initial treatment to emergencies in the hospital and community

CG.S.2#

Initially stabilise Australian Triage Category 1 and 2 patients with the support of an experienced colleague (which may be through distance technology) pending definitive emergency medical care

CG.S.3#

Competently provide definitive emergency medical care for most Australian Triage Category 3, 4 and 5 patients and determine when additional support is required.

CG.S.4#

Undertake the following:

organise and allocate resources
make appropriate pre-hospital arrival preparations
give telephone advice to transporting persons
hazard identification, assessment and mitigation
conduct initial resuscitation following the ABC algorithm
basic life support
primary survey
conduct further resuscitation as indicated
secondary survey
necessary investigations
definitive treatment where indicated
consultation as indicated
stabilise and monitor haemodynamics, oxygenation and acid/base balance
manage acutely disturbed/agitated/violent behaviour
set up and supervise retrieval as indicated

CG.S.5#

Ensure proper access/egress for all systems, in particular:

airway protection
adequate venous access
naso/orogastric intubation
urinary catheterisation
spinal stabilisation
stabilisation of injuries and fractures

CG.S.6#

Assist with response to a disaster or multi-trauma

CG.S.7#

Perform emergency procedures as detailed in the Procedural Skills Logbook

Attributes#

At.2#

Adaptability

At.15#

Reflection

At.17#

Resourceful

Advanced Specialised#

Knowledge#

AS.K.1#

Describe characteristics of rural and remote settings and their impact on emergency medicine that need to be considered including the differences when compared with metropolitan settings in:

prevailing social attitudes to health, illness and health care
rural occupations
incidence and prevalence of emergency medical conditions
Aboriginal and Torres Strait Islander Peoples Health
access to physical resources including investigations, medications and treatments
working in a resource limited environment
access to specialist services

AS.K.2#

Detail selection criteria, protocols, principles, limitations and interpretation of results of the tests listed in skills section

AS.K.3#

Be aware of congenital and acquired conditions that may predispose patients to emergency presentations or complicate emergency management including congenital heart disease, congenital maxillofacial and other anatomical abnormalities, acquired anatomical abnormalities

AS.K.4#

Discuss features of common conditions difficult to diagnose and potentially obscured by patient age, body habitus, co-morbidities etc

AS.K.5#

Identify diagnostic features and initial management of "less common" conditions for example. endocrine emergencies, environmental emergencies (hypothermia, hyperthermia, barotrauma, high altitude illness etc), neuromuscular disorders (Guillain-Barre disease)

AS.K.6#

Discuss risk factors for secondary injuries in emergency patients, discuss strategies for reducing these risks, and outline appropriate management for secondary injuries if these occur: renal failure, cardiac failure, adult respiratory distress, syndrome (ARDS), disorders of coagulation, cerebral hypoxia, multi-system failure, sepsis and neurovascular compromise.

AS.K.7#

Discuss anaesthetics, procedural sedation and analgesic decision-making and delivery, including factors involved in making difficult anaesthetics decisions; neonates, young children, elderly, shock, obesity, co-morbidities and burns

AS.K.8#

Describe clinical and medico-legal requirements for consent, management of physical and/or sexual assault cases, including:

sexual assault examination and specimen collection
recognition of non-accidental injury patterns in children and domestic partners
understanding the coronial investigation process
writing medico-legal reports
giving evidence in court
treatment of minors and persons in custody
guardianship, advanced care directives, mentally impaired patients
duty of care for alcohol/recreational drug affected patients

AS.K.9#

Illustrate the principles of triage and their application to emergency situations

AS.K.10#

Interpret the Australasian Triage Score and its application to the clinical setting

AS.K.11#

Identify potential complications (including possible treatment failure) of the emergency procedures and definitive therapies

AS.K.12#

Describe signs and symptoms of the following complications and outline appropriate rescue plans.

post-procedural complications – haemorrhage, thromboembolism, vascular insufficiency, infection/sepsis, wound breakdown, perforation/obstruction, mechanical failure, pneumothorax, spinal headache, renal failure, uncontrolled pain
complications of therapeutics, for example, adverse reaction, allergy/anaphylaxis, toxicity, drug interactions, GI bleeding, excessive sedation, dystonic reactions, neuroleptic malignant syndrome, transfusion reactions, over-hydration, over-anticoagulation, medication non-compliance and polypharmacy
complications of dialysis.

AS.K.13#

Describe the epidemiologic characteristics, prevention and control measures for infectious disease outbreaks, including:

immunisation and post-exposure prophylaxis
community epidemics
nosocomial outbreaks
tropical and exotic infections
sexually transmitted infections
patients requiring isolation
personal protective equipment and safe working practices for other staff

AS.K.14#

Discuss the principles for disaster prevention, preparedness, response and recovery in rural and remote communities

AS.K.15#

Discuss principles of injury prevention in rural and remote contexts, including implementing an injury prevention program

AS.K.16#

Discuss ethical issues around end of life presentations (either medical, surgical, oncological, geriatric based or trauma)

Skills#

AS.S.1#

Competently provide definitive emergency medical care including emergency medicine procedural interventions for individual patients across all presentations, of all age groups across all Australian Triage categories.

AS.S.2#

Undertake initial assessment and triage of patients with acute or life-threatening conditions, including:

seriously unwell conscious patients
patients with undifferentiated severe acute pain
undifferentiated unconscious patients
patients with undifferentiated shock
patients with undifferentiated fever or infective illness
undifferentiated sick children
major or complicated trauma – multiple trauma, head trauma, pelvic fracture, ENT, maxillofacial, abdominal (blunt and penetrating) and genital trauma
acutely psychotic patients, other mental illness including attempted self-harm and suicide

AS.S.3#

Recognition of the seriously unwell conscious patient, appropriate prioritisation and sequencing of assessments, investigations and management tasks in emergency cases

AS.S.4#

Recognise and evaluate variations in emergency presentations among Aboriginal and Torres Strait Islander patients that differ from the non- Aboriginal and Torres Strait Islander peoples including:

young age at presentation with acute coronary syndrome
stroke or acute kidney failure
acute rheumatic fever
severe pneumonia
crusted scabies, and
disseminated strongyloidiasis

AS.S.5#

Utilisation of relevant diagnostic and imaging modalities including performing bedside imaging and interpretation of Point of Care Ultrasound (POCUS) and CT imaging without immediate access to radiology reporting

AS.S.6#

Arrange with consideration of urgency, onward transfer for higher-level diagnostic services e.g. MRI, invasive cardiology, and complex endoscopic procedures

AS.S.7#

Provide high-level pain management skills including oral, intramuscular, intravenous and intranasal analgesia: topical and local infiltration analgesia: common nerve blocks, regional anaesthesia, including management of analgesia complications and adverse reactions

AS.S.8#

Competent in techniques for difficult peripheral and central intravenous or intraosseous access, including with ultrasound guided access

AS.S.9#

Competent in techniques for vital signs monitoring including invasive; intra-arterial BP measurement, ventilation monitoring, and temperature monitoring

AS.S.10#

Stabilise critically ill patients and provide primary and secondary care for emergency conditions including:

Airway and respiratory emergencies:

advanced airway management options and techniques
use of portable ventilators
use of non-invasive ventilation
techniques for pneumothorax drainage techniques including needle thoracostomy, Seldinger guided catheters and large intercostal catheters

Circulatory and cardiovascular emergencies:

application of Advanced Cardiac Life Support (ACLS) algorithms
defibrillation, cardioversion and external cardiac pacing
advanced thrombolytic therapy, including management of complications
platelet inhibitor and anticoagulant therapy
advanced hypotensive therapy
pericardiocentesis with on-site or distant guidance
advanced haemostatic therapy
advanced anti-arrhythmic therapy
competent and confident administration of inotropes
principles of angioplasty and stenting
principles of occult blood loss in trauma
competent and confident fluid resuscitation including minimum volume fluid resuscitation, use of blood products and Massive Transfusion Protocol

Neurological emergencies:

seizure monitoring and control
competent lumbar puncture for diagnostic and therapeutic procedures
basic surgical skills to undertake decompressive cranial burr holes with distant guidance from a neurosurgeon

Musculo-skeletal emergencies:

independent splinting, casting and reduction of simple fractures and dislocations
reduction of complex fractures/dislocations under distant or on-site guidance, including minimisation of neurovascular compromise
competent and confident initial management of compound wounds
competent and confident initial management of spinal injuries, including awareness of patterns of spinal injury without radiological abnormality
independent joint aspiration

Soft tissue emergencies and burns:

removal of superficial foreign bodies
independent abscess drainage
independent wound management, including prophylactic antibiotic administration, local anaesthetic, tetanus injections, wound cleaning, debridement and complex wound closure techniques
independent management of minor burns
initial management of moderate or severe burns including special area burns e.g. face, neck, airway, hands, genitalia, circumferential burns, chemical, electrical, other associated injury with on-site or distant guidance
management of rhabdomyolysis/acidosis
monitoring and management of compartment pressure, including escharotomy with distant or on-site guidance
pressure care of soft tissues at risk from ischaemia and infection
regulation of body temperature in patients with dermatological emergencies

Obstetric and gynaecologic emergencies:

competent and confident initial management of haemorrhage in early pregnancy
initial management of trauma in pregnancy
competent and confident management of miscarriage
timely recognition and transfer of patients requiring surgical intervention
competent and confident management of common labour and delivery complications
seizure control in eclampsia
management of precipitate delivery with distant guidance
initial management of post-partum problems

Abdominal and genitourinary emergencies:

competent and confident initial management of acute renal failure
recognition of gastrointestinal foreign bodies requiring removal
urethral and suprapubic catheterisation
control of oesophageal varices
drainage of abdominal ascites for symptom control
reduction of paraphimosis with on-site or distant guidance

Metabolic and endocrine emergencies:

competent and independent insulin infusion
competent and independent intravenous potassium replacement
competent and independent IV fluids for endocrine emergencies

Acute infections:

chemotherapeutics for undifferentiated sepsis
be aware of and able to follow protocol for management of needle stick injury and other body fluid exposure
competent and confident application of infection control procedures, public health reporting procedures and management of contact persons

Toxicologic and toxinological emergencies:

competent application of pressure immobilisation bandage
competent and independent antivenom and antidote administration
competent use of venom detection kit (VDK) with distance guidance
safety and decontamination procedures for deliberate CBR incidents – for patients, staff members and in an emergency department

Environmental emergencies:

re-warming techniques
cooling techniques
temperature monitoring
initial management of diving injuries, including hyperbaric medicine

Ophthalmological emergencies:

competent use of slit lamp
competent measurement of intra-ocular pressures
competent removal of simple superficial corneal foreign bodies
refer for removal of difficult foreign bodies
repair onsite or referral for repair peri-ocular lacerations

ENT and dental emergencies:

tooth preservation techniques
infection prevention and management
competent and independent management of anterior and posterior epistaxis
removal of simple nasal and aural foreign bodies and identification difficult foreign bodies

Psychiatric emergencies:

competent and confident differentiation between an acute severe behavioural disturbance due to acute delirium (including substance intoxication and withdrawal) and psychosis
competent and confident risk assessment, engagement and acute counselling skill

AS.S.11#

Competent verbal de-escalation techniques in high stress and potentially violent situations

competent and confident administration of rapid-acting antipsychotics sedatives and other medication where appropriate
appropriate administration of chemical restraint
use of relevant legislation for involuntary treatment admission
leadership to manage Code Black situation

AS.S.12#

Recognise and manage emergencies in all ages including the elderly, paediatric and neonatal groups and cover all emergency conditions including toxicology, obstetrics and psychiatric disease

AS.S.13#

Competent, sensitive and age-appropriate communication skills with anxious and distressed paediatric patients, parents and other carers including breaking bad news, onward referral, and engaging other support services

AS.S.14#

Competent and confident paediatric and neonatal emergency care, including:

initiation of Advanced Life Support
paediatric calculations – appropriate dosages and equipment size
estimation and administration of fluid requirements for resuscitation and ongoing maintenance
lumbar puncture, clean catch urine and phlebotomy in children
procedural sedation
warming techniques in children and neonates
paediatric pain management techniques
seizure management, including diagnosis of the underlying cause/s
airway management in children and neonates, including wound repair, foreign body removal, management of stridor, croup and epiglottitis, paediatric intubation
advanced intravenous access techniques – intraosseous infusion and neonatal umbilical catheterisation
management of acute infections in children, including neonatal infections, sepsis and meningitis
management of diabetic ketoacidosis (DKA) in children
management of serious gastro-intestinal conditions, including pyloric stenosis and intussusception
management of serious neonatal conditions including prematurity, sepsis, respiratory failure and congenital abnormalities

AS.S.15#

Coordinate, work with and/or provide leadership (clinical and operational) as appropriate to multidisciplinary and/or inter-professional teams encompassing emergency services (police, fire brigade, ambulance), retrieval services, emergency department staff members, inpatient services and community members

AS.S.16#

Establish and maintain appropriate emergency department systems and procedures

trauma and priority team organisation
multi-casualty preparedness and response
co-ordination with police and other agencies
risk management, critical decision making and dealing with uncertainty
use of electronic record systems
quality assurance and audit policies and procedures
storage and handling of blood products
organ donation and transplantation protocols
pharmaceutical dispensing
staff management and communication skills
inter-professional co-operation skills
complaint management
occupational health and safety measures

AS.S.17#

Perform emergency procedures as detailed in the AST Emergency Medicine Procedural Skills Logbook