Provider Skills Assessment and Development Guideline
Provider Skills Assessment and Development GuidelineNational Disaster Medical System, Disaster Medical Assistance Team PA-1Version 1.0 , 1/18/13Comments to Keith Conover, M.D., FACEP, Team Medical Director kconover@pitt.eduDownload from and comment (Adobe Reader 9 or X), or as a Word file () send to kconover@pitt.eduRationaleThere is a basic core of cognitive and performance skills that we expect of each practitioner, to competently perform the duties expected of a DMAT provider. This is separate from training in DMAT-specific equipment, medications and supplies, which is accomplished at team and National Disaster Medical System training. It also is separate from disaster-specific training for WMD (weapons of mass destruction) and the like. It is the skills needed for basic urgent medical care. The choice of items for the core skills list depends on:How frequently it will occur in our practice (mostly in a DMAT tent-ED, sometimes as backfill in an ED, less commonly other duties). If we get sent into a hospital to do other tasks, we’ll match skills beyond the core with the jobs as best we can.How hard it is to acquire and maintain the skill.How important the skill is – will it save lives? Prevent morbidity?The skill set should be a subset of emergency medicine, with a few additions from primary care and other specialties, and slanted to DMAT’s specific needs. AuthorityWe have no funding for any of this training. We also have no authority to require practitioners to meet any standards we set. However, we still have a volunteer ethos in the team, and we can ask practitioners assess themselves against this standard, and we will do the best we can to help them towards this level of competence.Team SupportDMAT PA-1 leadership will do their best to help providers obtain this training with the least expense possible. Potential means include:Arranging for local skills training for skills that suffer significant skill decay. An example might be arranging difficult airway management sessions at simulation centers such as the STAR center at Western Pennsylvania Hospital or the WISER Center at the University of Pittsburgh.Encouraging and tracking the development of internal instructors and course coordinators for recommended courses, such as PALS, ACLS, or ADLS, so that the team can offer such courses to team members at reduced or no cost.Arranging continuing medical education credit for internal team training (accomplished for physicians and midlevels, free for team members; working on it for RNs and EMS personnel) so that team members will have more flexibility in CME spending for courses of benefit to disaster operations.GuidelineCompliance with this guideline is entirely voluntary. For all courses, completion suffices; there is no need to maintain certification. Practitioners who don’t practice a skill regularly should retake course as they think needed. Those with American Board of Emergency Medicine (ABEM) or American Osteopathic Board of Emergency Medicine (AOBEM) certification are deemed to comply with topics noted EM. Those with board certification from the American Board of Internal Medicine (ABIM), American Board of Anesthesiology (ABA), American Board of Obstetrics and Gynecology (ABOG), or the American College of Surgeons (ACS), are deemed to comply with topics noted CC. Similarly, some providers might have experience that actually would be superior to taking such a course. For instance, a CRNA at a burn center wouldn’t need ACLS or ABLS. This will be up to the judgment of the provider in consultation with the Team Medical Director in consultation with the team Commander and Training Officer.Key to Sources of TrainingABLS: Advanced Burn Life Support (American Burn Association)ACLS: Advanced Cardiac Life Support (American Heart Association)ATLS: Advanced Trauma Life Support; Early Management of Severe Trauma (EMST) outside North America (American College of Surgeons)Buttaravoli: textbook Minor Emergencies by Philip Buttaravoli, MD, FACEPDAM: Difficult Airway Management Emergency Medicine – Community (DAM EM COMM) course of the University of Pittsburgh’s Winter Institute for Simulation Education and Research (WISER)EMBC: Emergency Medicine Boot Camp (The Center for Emergency Medicine Education)FCCS: Fundamental Critical Care Support Course (The Society of Critical Care Medicine)MedExpress: The “CRASH” course offered by MedExpress to its urgent care center employees, including such things as X-ray and EKG interpretation, and management of common urgent care problems. (MedExpress)PALS: Pediatric Advanced Life Support (American Heart Association) or equivalent APLS: Advanced Pediatric Life Support (American Academy of Pediatrics, American College of Emergency Physicians)TopicNotesWhere obtainedInfectious disease common problems, including Lyme disease and STARI, viral and bacterial meningitisEMEMBCDermatologic problems, acute: contact dermatitis, arthropod bites, cutaneous larva migrans, diaper dermatitis, friction blisters, shingles, impetigo, pediculosis, pityriasis rosea, pyogenic granuloma, scabies, sea lice, sunburn, tick removal, tinea (capitis, corporis, cruris, pedis), urticariaEMMedExpress,ButtaravoliAbscess, cellulitis, erysipelas and ecthyma diagnosis and management, including incision and drainageEMMedExpress,Buttaravoli, EMBCAnalgesia (including IV medications)EM, CCEMBCBartholin cyst incision and drainageEMButtaravoli, EMBCBladder CatheterizationEM, CCEMBCBurns: management (comprehensive)EMABLS, EMBCCardiac defibrillationEM, CCACLS, PALSCardiac pacing (external = transthoracic)EM, CCACLS, PALSCardiac Resuscitation (including defibrillation and synchronized cardioversion, ACLS drugs)EM, CCACLS, PALSCold-related disorders: hypothermia, chilblain, frostnip, deep frostbiteEMButtaravoli, EMBCClosed reduction of herniaEMEMBCCPAP and BiPAP managementEM, CCFCCS, EMBCCritical Care: Recognition and Assessment of the Seriously Ill Patient, Airway Management, Cardiopulmonary/Cerebral Resuscitation, Diagnosis and Management of Acute Respiratory Failure, Mechanical Ventilation,Monitoring Blood Flow, Oxygenation, and Acid-Base Status, Diagnosis and Management of Shock, Neurologic Support, Basic Trauma and Burn Support, Acute Coronary Syndromes, Life-Threatening Infections: Diagnosis and Antimicrobial Therapy Selection, Management of Life-Threatening Electrolyte and Metabolic Disturbances, Critical Care in Pregnancy, Ethics in Critical Care Medicine, Critical Care in Infants and Children: The BasicsCCFCCSCricothyrotomyEMATLSDelivery of newbornEMEMBCDislocations, diagnosis and closed reduction, including: nursemaid’s elbow, patellar dislocations, finger and toe dislocations, shoulder dislocations, elbow and hip dislocationsEMButtaravoli, EMBCLacerations and other soft tissue problems, acute: simple and complex (2-layer) laceration management and repair, contusions, puncture wounds, abrasions, small impaled objects (fishhooks, splinters and foreign bodies in skin and under nails), nail avulsions, subungual ecchymosis and hematomas and nailbed lacerations, paronychia, ring removal, torn earlobes, and zipper entrapment.EMButtaravoli, EMBCElectrocardiogram interpretationEM, CCACLS, MedExpress, EMBCElectrolyte and metabolic managementEM, CCFCCS, EMBCEndotracheal intubation (oral, nasal)EM, CCACLS, DAMEnvenomation and stings and bites, diagnosis and treatment: marine envenomations, North American poisonous snakebite, black widow and brown recluse spider bites, scorpion bites, mammalian and human bites, bee and wasp stings, fire ant bites/stingsEMButtaravoli, EMBCHeat Illness (Dehydration, Heat Exhaustion, Heatstroke) management EMButtaravoli, EMBCEye examination: Wood’s light (slit lamp skills helpful but not essential)EMButtaravoli, EMBCEye problems, simple, diagnosis and treatment: conjunctivitis, corneal abrasion, styes, subconjunctival hemorrhage EMButtaravoli, EMBCENT problems, simple, diagnosis and treatment: wax impaction, nosebleed, foreign bodies in ear and nose and throat, croup, tonsillitis, mononucleosis, nasal fracture, otitis media (serous and suppurative), perforated TM, acute rhinosinusitisEMButtaravoli, EMBCOral and dental problems, simple, diagnosis and treatment: aphthous ulcers, dental fractures, subluxation, and luxation, dental pain (abscess, caries, pericoronitis, dry socket, pulpitis), oral lacerations, gingivitis, thrush, oral herpes, angular cheilitis, salivary duct stones, TMJ capsulitis and syndrome, uvulitisEMMedExpress, Buttaravoli, EMBCForeign body removal: corneal/conjunctivalEMMedExpress, Buttaravoli, EMBCForeign body removal: cutaneousEMMedExpress, Buttaravoli, EMBCFracture splinting with plaster and fiberglass material: thumb spica splint, ulnar gutter splint, volar arm splint, sugar tongs arm splint, long arm splint, posterior leg splint, sugar tongs leg splintEMMedExpress, Buttaravoli, EMBCMuscular and tendon and related problems, acute, diagnosis and management: bursitis (subdeltoid, trochanteric, subacromial), carpal tunnel syndrome, cervical, thoracic and lumbar strains, torticollis, De Quervein’s Tenosynovitis, Achilles tendinitis, boutonniere deformity, mallet finger and splay finger injuries, patellar, plantaris gastrocnemius and biceps tendon rupture, rotator cuff injuries, muscle cramps, fibromyalgia, polymyalgia rheumatica, plantar fasciitisEMMedExpress, Buttaravoli, EMBCJoint problems, acute: ganglion cysts, acute inflammatory arthritis including goutEMMedExpress, Buttaravoli, EMBCFractures, diagnosis and management/closed reduction, including: boxer’s fracture of hand, clavicle fractures, fingertip (tuft) and finger and toe fractures, radial head fracture, scaphoid fractures, wrist fractures, spinal fractures including coccyx fractures, pelvic fracturesEMMedExpress, Buttaravoli, ATLS, EMBCLaboratory study interpretation (iStat common studies)EM, CCMedExpress, Buttaravoli, EMBCLocal anaesthesiaEMMedExpress, Buttaravoli, EMBCLumbar punctureEM, CCEMBCNasal cautery and packingEMMedExpress, Buttaravoli, EMBCNasogastric intubationEM, CCEMBCNerve blocks: digital, dental, facialEMMedExpress, Buttaravoli, EMBCNeurological problems, acute: migraines, seizures, Bell’s palsy, concussion, vertigo, weakness, strokeEMMedExpress, Buttaravoli, EMBCPulmonary and chest problems, acute, diagnosis and treatment: asthma, bronchitis, pneumonia, smoke inhalation, irritant exposure, rib fractures and other chest wall injuriesEMMedExpress, Buttaravoli, EMBCGastrointestinal problems, acute, diagnosis and management: esophageal foreign body, vomiting, upper GI bleeding, hiccups, nonsurgical rectal foreign body removal, hemorrhoids, anal fissures, diarrhea, constipationEMMedExpress, Buttaravoli, EMBCUrologic problems, acute, diagnosis and treatment: blunt scrotal trauma, testicular torsion, epididymitis, genital herpes, phimosis, paraphimosis, prostatitis, urethritis, urinary retention, cystitis and pyelonephritisEMMedExpress, Buttaravoli, EMBCGynecologic problems, acute, diagnosis and treatment: Bartholin abscess, dysmenorrhea, vaginal foreign body, emergency contraception, Pelvic Inflammatory Disease, vaginal bleeding and vaginitisEMMedExpress, Buttaravoli, EMBCSprains and related injuries, diagnosis and treatment: AC joint, ankle, midfoot, fingers and toes, knee ligaments (and meniscus injuries), lateral and medial epicondylitis, locked knees, gamekeeper’s thumbEMMedExpress, Buttaravoli, EMBCOxygen therapyEM, CCFCCS, ACLS, EMBCPediatric resuscitationEM, CCPALSPericardiocentesisEM, CCACLSPoisoning, treatment of EM, CCEMBCPrehospital Airways (Combitube, King LT)EM, CCACLSPsychiatric evaluation and therapy (initial) and management of related issues, including: dystonic reactions, tardive dyskinesia, and serotonin syndromeEMEMBCRadiographic study interpretationEM, CCMedExpress, EMBCRespirator managementEM, CCFCCSSedation, proceduralEM, CCButtaravoli, EMBCSexual Assault examination collection of specimensEMEMBCSexually transmitted diseases evaluation and treatmentEMButtaravoli, EMBCSpinal immobilization and clearingEMATLS, EMBCSubungual hematoma trephinationEMButtaravoli, EMBCThoracentesisEM, CCEMBCThoracostomy tube drainage (chest tube)EM, CCATLSUltrasound: perform basic limited emergency bedside ultrasound procedures, including the following: FAST (focused abdominal ultrasound in trauma), urinary retention, renal for hydronephrosis, gallbladder for gallstones, abdominal aortic aneurysm, intrauterine pregnancy, skin: foreign body and abscess; musculoskeletal: fracture.EM plan to set up team training for this.Venous access: central lines (subclavian, internal jugular)EM, CCACLS, ATLSVenous access: external jugular IVEM, CCEMBCVenous access: femoral venipunctureEM, CCEMBCVenous access: intraosseous accessEM, CCPALSVenous access: peripheral IVEM, CCEMBCWound Debridement and RepairEMButtaravoli, EMBC ................
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