While the National EMS Core Content task force (Appendix I), led by the National Association of EMS Physicians in cooperation with the American College of Emergency Physicians, was created in the fall of 2001, their deliberations were delayed by the tragic events of September 11, 2001. The task force met several times to develop the structure and format of the National EMS Core Content – a formidable task considering the absence of relevant EMS-specific examples and information. The task force reviewed examples from other professions including the Model of Clinical Practice of Emergency Medicine.
Initial task force efforts were focused on developing the rationale and underlying assumptions with subsequent work focused on the National EMS Core Content itself. Following opportunities for public input, the task force completed its draft document in the winter of 2003-2004.
The following assumptions and principles guided the development of the National EMS Core Content:
- While the medical community leads the development of the Core Content , physician involvement and direction is also imperative during the development of each component of the National EMS Education Agenda: A Systems Approach .
- Core Content defines the entire domain of out-of-hospital practice and identifies the universal body of knowledge and skills for emergency medical services providers who do not function as independent practitioners. The National EMS Core Content serves as the total domain from which the National EMS Scope of Practice Model derives national EMS provider levels. However, the Core Content may identify knowledge and skills that are outside the scope of practice of the highest level of EMS provider. While the actual number of provider levels is dependent on the National EMS Scope of Practice Model , the following illustration depicts the relation between the Core Content and the Scope of Practice :
NOTE: Above illustration is an example only. The number and names of EMS provider levels will be determined by the National EMS Scope of Practice Model process.
- The Core Content remains flexible within the established parameters to allow local systems to incorporate into their practice the latest evidence-based medical advances consistent with applicable state laws and administrative rules.
- Core Content does not represent a minimum level of knowledge and competency. The National Scope of Practice Model will determine the minimum level of knowledge and competency for various levels of EMS providers.
Model of the Clinical Practice of Emergency Medicine
The Model of Clinical Practice of Emergency Medicine1 is a consensus document describing both the process of clinical practice of emergency medicine and the knowledge one must possess. This model was developed by reviewing physician tasks for a variety of patient presentations (signs and symptoms) and pathophysiologies. The rationale for inclusion of signs and symptoms, in addition to pathophysiology, is that most patients are not diagnosed at the time of their presentation to emergency medicine.
The Model has several interrelated components:
- Listing of Conditions and Components: The universal body of knowledge one must possess to practice emergency medicine.
- Definitions of Acuity: Definitions of acuity are fundamental to determining the sequence of events in which the physician tasks are carried out.
- List of Patient-Physician Interactions: This list defines all processes used by the physician in delivering care to the patient in the emergency department.
- Matrix: The matrix provides a listing of patient-physician interactions and a corresponding level of acuity (critical, emergent, or lower priority). The patient acuity is fundamental to determining the sequence of patient-physician interactions. The dynamic matrix defines the complex set of interactions that describes the process of delivery of patient care in the emergency department – i.e., the emergency physician modifies the patient interactions based on the patient acuity.
The Model of the Clinical Practice of Emergency Medicine is not simply a listing of knowledge and skills, but rather a complex, interactive process that defines a patient-centered practice. The physician must first master the Listing of Conditions and Components, determine the level of criticality when first assessing a patient, and then perform the physician-patient interactions in an order that is dependent on patient criticality.
1American Board of Emergency Medicine. www.abem.org .