Lisa Munro-Davies PGC (Med US) CFEU

“Emergency medicine is a field of practice based on

the knowledge and skills required for the
prevention, diagnosis and management of acute
and urgent aspects of illness and injury affecting
patients of all age groups with a full spectrum of
undifferentiated physical and behavioural
disorders. It further encompasses an
understanding of the development of pre-
hospital and in-hospital emergency medical
systems and the skills necessary for this
development.”
International Federation for Emergency Medicine
` Taking a thorough but focussed history

` Performing a comprehensive physical

examination

` Diagnostic reasoning

` Rapid critical decision making with balanced risk

assessment

` Competency in practical resuscitative

interventions
The use of focussed bedside ultrasound in:

` FAST / FAFF

` AAA

` Vascular access

` ELS (as of 2009)

` FAST / FAFF ` Physical Examination

` Diagnostic Reasoning
` AAA
` Decision Making and
` Vascular access Risk Assessment

` ELS (as of 2009) ` Resuscitative

Interventions

History ?
` Historical practice and attitudes – from all
parties (‘Someone elses job’)

` Equipment costs – biggest single change in

last 10 years

` ‘Fear factor’ & governance issues

` The challenge of rolling out training – the

future is in your hands.
` 2002 NICE Guidelines recommend the use
of ultrasound guidance in central line
insertion.

` 2005 Royal College of Radiologists

published ‘Ultrasound Training
Recommendations for Medical and Surgical
Specialties’

` 2008 NPSA Guidance on ICD Insertion

` 2000/5 Ultrasound sub-committee ‘formed’

` 2006 Level 1 Curriculum Published

(FAST/AAA/Vascular Access)

` 2006 CEM Approved Training Courses.

Triggered Assessment & Grandfather
Accreditation

` 2009 Level 1 Curriculum Revised (ELS

added)
` 2008 Level 2 Curriculum Published - 9
modules with Triggered
Assessments.(Currently being
revised)

` 2009 CEM Accredited Certificate in

Focussed Ultrasound (CFEU)

` 2010 Level 1 a training requirement by

ST5 year for ALL EM trainees.
FCEM OSCE
 YES !
` Enhances practice and expedites patient care
as an adjunct to the physical examination

` Training requirement

` FCEM assessed

` Likely to extend in the future – Echo, Shock,

Thoracic
` Brighton 28th – 30th September 2010

` BASIC echo

` USS Guided Procedures

` Regional Nerve Blocks

` MSK USS