Achieving Entrustment in SLO 4: A Practical Guide for Emergency Physicians Caring for Acutely Injured Patients in UK Emergency Departments
1. Defining SLO 4: The Continuum of Acute Injury Care and Professional Progression
The Royal College of Emergency Medicine (RCEM) Specialty Learning Outcome (SLO) 4 mandates the capability to provide "Care for acutely injured patients across the full range of complexity." This outcome represents the fundamental role of the Emergency Physician in trauma care, demanding competence across the entire spectrum, from minor soft tissue injuries to complex, life-threatening polytrauma.[1] Achieving entrustment in SLO 4 requires not merely technical skill but sophisticated leadership, adherence to systematic protocols, and demonstrated engagement with quality improvement initiatives.
1.1 The Core Mandate: From ACCS Fundamentals to Consultant-Level Capability
The curriculum establishes a clear progression model, building clinical competence and professional responsibility throughout training. The core mandate for all trainees is the ability to assess, investigate, and manage patients attending with all injuries, regardless of complexity.[2] This clinical responsibility is inseparable from the professional requirements of high standards of documentation and effective communication with other specialties to ensure seamless continuity of care.[1]
Progression Milestones
The trajectory of training is marked by increasing levels of expected autonomy and complexity in leadership:
1. Foundational Skills (ACCS): Trainees at the core level must master the Primary Survey and Secondary Survey (<C>ABCDE) and possess the necessary examination skills to identify and diagnose injuries, including critical vascular and neurological consequences.[2] Basic management of wounds, soft tissue injuries, fractures, and dislocations, including the safe use of basic local anaesthetic techniques, is expected.[2]
2. Intermediate Training Target: At this stage, the trainee must demonstrate the ability to provide leadership of the Trauma Team.[2] While leading, the Educational Supervisor remains "on call" from home for queries, retaining ultimate responsibility and able to attend the bedside for direct supervision if required. The trainee is operationally autonomous but remains within a framework of senior oversight.[2]
3. Higher Training Target: This level demands true expertise. The trainee must be an expert in assessment, investigation, and initial management, and crucially, must provide expert leadership of the Major Trauma Team.[2]
The distinction between "leadership" (Intermediate) and "expert leadership" (Higher) is pivotal for the Faculty Entrustment Group (FEG) decision. The ability to demonstrate expert leadership involves moving beyond simply following protocols to enacting strategic command and system management. Evidence for the Higher trainee must demonstrate the capacity to lead safely and effectively when the consultant is only remotely available, showcasing competence in rapid, independent strategic decision-making, such as coordinating theatre access, managing complex secondary transfers, and ensuring continuous governance compliance until the patient reaches definitive care.[3]
1.2 Specialized Considerations for Trauma Complexity: Frailty and Prognosis
Achieving clinical expertise under SLO 4 necessitates managing complex patient factors that complicate traumatic injury. Two specialized areas require detailed competency:
• Frailty in Trauma: Trainees must understand the profound impact of injury on patients exhibiting markers of frailty.[2] These patients often present with atypical physiological responses and higher risks of complications, requiring adjusted targets for resuscitation, careful pain management, and early involvement of multidisciplinary teams specializing in geriatric care or rehabilitation.
• Predicting Outcomes and Prognosis: A core capability in Higher Training is the ability to accurately predict the likely prognosis and recovery time for injuries, including anticipation of potential complications.[2] This capability is critical for effective communication with both patients/families (setting realistic expectations) and with specialist services, facilitating appropriate bed allocation and long-term care planning.[1]
2. Clinical Proficiency in Low-to-Intermediate Complexity Trauma
While major trauma garners significant attention, the majority of SLO 4 documentation focuses on the consistent, high-quality management of non-life-threatening injuries, ensuring safety in procedures involving pain control and manipulation.
2.1 Managing Soft Tissue Injuries, Fractures, and Dislocations
The Intermediate and Higher trainee must manage all wounds, soft tissue injuries, fractures, and dislocations.[2] This scope includes specific procedural competencies that must be documented frequently:
• Wound Management: Competency encompasses the use of a range of techniques for wound closure, including simple dressing, formal suturing, skin adhesive, and steri-strips.[2] The application of appropriate investigations, including X-ray, CT, Ultrasound, and MRI, to confirm the diagnosis and identify any vascular or neurological consequences of the injury, is mandatory.[2]
• Fracture and Dislocation Management: This requires expertise in manipulation and reduction techniques under appropriate analgesia and/or sedation.
2.2 Regional Anaesthesia and Procedural Sedation: Safety and Governance
A critical component of modern trauma management is the skillful use of regional anaesthesia and procedural sedation and analgesia (PSA) to ensure safe and effective reductions.
Mandatory Regional Blocks
Trainees must demonstrate the safe and effective use of local anaesthetic techniques, specifically mastering essential regional blocks.[2] The fascia iliaca block (FIB) is frequently highlighted in the curriculum as a key procedural expectation, alongside techniques like the digital nerve block.[2] Documentation (via Mini-CEX or DOPS) should confirm anatomical knowledge, aseptic technique, and effective post-procedure pain assessment.
Principles of Procedural Sedation and Analgesia (PSA)
PSA aims to relieve anxiety and facilitate cooperation during painful procedures, such as manipulation of a fractured neck of femur or dislocated joint.[4] Competence in PSA requires adherence to strict governance standards:
1. Analgesia Precedence: Sedative agents typically possess minimal analgesic effect. Therefore, adequate analgesia must be administered before the sedative agent.[4] Drug sedation should function as a supplement to pain management, not a substitute.
2. Competency and Monitoring: Formal competency-based training is essential, recognizing the potential for life-threatening complications, particularly in frail or comorbid patients.[4] If a patient's level of consciousness is reduced to the point where they cannot respond to verbal or simple physical stimulation, they require the same level of physiological monitoring and supervision as a patient undergoing general anaesthesia.[4]
3. Staffing Models and Risk Mitigation: Clinical practice in many emergency departments relies on a single emergency physician simultaneously managing both the procedural sedation and the orthopedic reduction, often supported by a credentialed registered nurse.[5] Although some advocate for a dual-physician model, studies confirm that sedation-assisted closed reduction of major joint dislocations and forearm fractures can be performed effectively and safely using a one physician/one nurse model, provided stringent safety protocols are followed.[5]
The acceptance of the single-physician model places a significant burden on the trainee to demonstrate uncompromised safety standards. High-quality WPBAs or procedural logs focusing on PSA must explicitly address the use of pre-procedure checklists, continuous monitoring standards, and, critically, demonstrate the clinical judgment to escalate care or abandon the procedure if adequate safety margins are jeopardized (e.g., managing respiratory depression or desaturation).[4] Documentation must prove not only technical dexterity but robust clinical governance, linking the procedure to the wider patient safety outcome (SLO 6).
3. Major Trauma Resuscitation and Damage Control Strategy
The core clinical expectation for SLO 4 is the expert initial management of the polytraumatized patient, defined as one who has sustained multiple injuries involving multiple organs or systems.[6] This is governed by national frameworks, primarily NICE Guideline NG39, emphasizing rapid assessment and the principles of Damage Control Resuscitation (DCR).
3.1 Initial Assessment and NICE NG39 Adherence
All trauma resuscitations must adhere to the structured Primary Survey (<C>ABCDE) protocol.[7] Timely and judicious use of investigations is critical:
• Airway and Breathing: In patients who cannot maintain their airway, definitive control using drug-assisted rapid sequence induction (RSI) is mandated.[7] If RSI fails, basic airway manoeuvres, adjuncts, or a supraglottic device should be used until a surgical airway is achieved.[7] For chest trauma, clinical assessment for pneumothorax is paramount, potentially augmented by eFAST (Extended Focused Assessment with Sonography for Trauma).[7]
• Imaging Strategy: The TTL must demonstrate critical judgment in selecting the appropriate imaging modality:
◦ Immediate CT is considered for adults (16 or over) with suspected chest trauma who are responding to resuscitation or are haemodynamically normal.[7]
◦ Immediate Chest X-ray and/or eFAST should be considered for adults with severe respiratory compromise, noting that negative eFAST results do not reliably exclude pneumothorax.[7]
◦ Crucially, routine CT should not be used as the first-line imaging for assessing chest trauma in children (under 16s).[7]
3.2 Damage Control Resuscitation (DCR) and the Lethal Triad
Damage Control Resuscitation focuses on temporizing measures that prioritize rapid control of life-threatening hemorrhage and physiological derangements, followed by staged, definitive care.[8] The goal is to avoid or mitigate the lethal triad of hypothermia, acidosis, and coagulopathy.
Fluid Management and Targets
The UK standard dictates a restrictive approach to volume resuscitation in patients with active bleeding until definitive early control is achieved.[7]
• Targets: Volume resuscitation should be titrated to maintain a palpable central pulse (carotid or femoral) in the pre-hospital setting, and to maintain central circulation until definitive control is achieved in the hospital setting.[7]
• Fluid Choice: In the hospital setting, crystalloids must not be used for volume replacement in patients with active bleeding.[7] For adults (16 or over), the resuscitation strategy should employ a high ratio of blood products, specifically a 1:1 ratio of 1 unit of plasma to 1 unit of red blood cells.[7]
Temperature Control
Aggressive reduction of heat loss is essential, as hypothermia is a major contributor to trauma-induced coagulopathy.[7] Measures include actively warming fluids using a blood warmer and minimizing ongoing environmental heat loss.[7, 9]
3.3 Major Haemorrhage Protocol (MHP) Activation and Pharmacological Management
The activation and execution of the Major Haemorrhage Protocol (MHP) is a central skill of SLO 4 management:
• Activation Criteria: MHP activation must be prompt and relies primarily on physiological criteria, including the patient’s haemodynamic status, their response to immediate volume resuscitation, or the anticipated need for at least 4 units of red cells within the next hour.[7, 10] Trauma calls involving traumatic cardiac arrest, penetrating chest injury, or life-threatening hemorrhage (e.g., severe pelvic or multiple long bone fractures) should trigger a high-level response.[11]
• Tranexamic Acid (TXA): Intravenous TXA must be administered as soon as possible in patients with major trauma and active or suspected active bleeding.[7] Administration should not occur more than 3 hours after injury unless there is evidence of hyperfibrinolysis.[7]
• Anticoagulation Reversal: Rapid reversal of anticoagulation is mandatory.[7] For emergency reversal of Vitamin K Antagonists (VKAs), Prothrombin Complex Concentrate (PCC) should be used immediately, avoiding the use of plasma.[7, 10] For patients taking Novel Oral Anticoagulants (NOACs), immediate consultation with a Haematologist is required for advice on reversal strategies.[7]
The Haemodynamic Paradox in Co-Dominant Injury
A critical differentiator of expert practice is the management of patients with concurrent traumatic brain injury (TBI) and haemorrhagic shock. These two conditions require fundamentally conflicting resuscitation goals: TBI management requires maintaining higher cerebral perfusion pressure (often achieved through less restrictive volume use), whereas haemorrhagic shock mandates a restrictive approach.
The expert practitioner must perform a dynamic risk assessment to determine the dominant condition.[7] If haemorrhagic shock is dominant, continued restrictive volume resuscitation is appropriate. If TBI is dominant (and hemorrhage is controlled or minor), a less restrictive volume approach is utilized to maintain cerebral perfusion.[7] Documented practice, usually via a Case-Based Discussion (CbD) or Enhanced Structured Learning Experience (ESLE), must articulate the physiological rationale for this decision, linking it to the primary clinical findings, CT imaging, and neurosurgical consultation. This level of nuanced decision-making demonstrates competence in managing the "full range of complexity."
Table 1: Key Principles of Damage Control Resuscitation (DCR) in the UK ED (NICE NG39 Compliant)
DCR Principle | Actionable Advice (ED Phase) | Supporting UK Standard/NICE NG39 Reference |
Volume Resuscitation | Restrictive approach until definitive haemorrhage control achieved. Titrate to palpable central pulse (pre-hospital) or maintain central circulation (hospital). | Restrictive volume resuscitation.[7] |
Fluid Choice | Do not use crystalloids for active bleeding in the hospital setting. Use a fixed ratio of 1 unit of Plasma to 1 unit of Red Blood Cells (1:1 ratio) for adults. | No crystalloids; 1:1 Plasma:RBCs.[7] |
Pharmacology | IV Tranexamic Acid (TXA) ASAP (within 3 hours). Rapidly reverse Vitamin K Antagonists (VKAs) with PCC. | TXA within 3 hours; PCC for VKA reversal.[7, 10] |
Temperature | Minimise heat loss actively using warming devices and techniques to avoid precipitating coagulopathy. | Minimise heat loss.[7, 9] |
Definitive Control | Activate Major Haemorrhage Protocol (MHP) based on physiological criteria; initiate definitive haemorrhage control (surgery/IR) in parallel. | Physiological activation criteria; simultaneous control.[7, 10] |
4. Trauma Team Leadership (TTL): Non-Technical Skills and Delegation
Achievement of SLO 4 is fundamentally linked to demonstrated leadership capacity. The Trauma Team Leader (TTL) role requires the coordination of a multi-disciplinary team (MDT) under intense pressure, heavily relying on non-technical skills (NTS).
4.1 Establishing Command: The Executive Function of the TTL
The TTL must provide calm and effective leadership in major trauma scenarios.[2] This executive function goes beyond directing clinical actions during the primary survey; it involves strategic oversight of the entire patient journey from resuscitation bay to definitive care.
Coordination of Definitive Care and Flow
The TTL’s primary responsibility is to ensure all injuries are identified, the secondary survey is initiated, and a definitive plan for care is formulated.[3]
• System Navigation: The TTL is the system owner until formal handover occurs.[3] They coordinate theatre booking with the Named Anaesthetic Consultant and liaise with the Site Manager.[3] The Site Manager's involvement is crucial for ensuring swift patient flow to definitive care, whether that be an immediate theatre slot, an ICU bed (Neurosurgical or General), or a specialty ward.[3]
• The CT Scanner Mandate: A non-negotiable governance requirement in Major Trauma Centres (MTCs) is that the TTL (or MTC Consultant) must always attend the CT scanner.[3] This mandate is imposed to ensure continued patient monitoring, maintain haemodynamic safety during the transfer and scan, and facilitate immediate liaison with the Anaesthetist and radiology team regarding scan findings and planned destination post-CT.[3]
• Formal Handover: Handover of the multi-trauma patient to the receiving specialty team must always be formal, documented, and conducted in person.[3]
The demonstration of expert leadership is evidenced by the clinician's ability to optimize patient flow and resource management. By physically attending the CT scanner and coordinating directly with the Site Manager, the TTL minimizes administrative friction and communication gaps, thereby accelerating the patient’s transfer from the ED to the required theatre or critical care unit. This systemic effectiveness is a key indicator of expert-level SLO 4 competence.
4.2 Multi-Disciplinary Team (MDT) Supervision and Communication
The TTL is responsible for supervising the MDT, including nurse practitioners (NPs) and Advanced Clinical Practitioners (ACPs).[2] Effective delegation is a core leadership capability, which includes designating one team member to record all trauma team findings and interventions contemporaneously.[3, 7] The TTL is ultimately responsible for checking this documentation for completeness.[7]
Managing Secondary Trauma Transfers
A critical responsibility within the Major Trauma Network structure is the coordination of secondary trauma transfers. The trainee must be fully aware of the regional transfer tool (e.g., Wessex Trauma Network) that ensures rapid, automatic acceptance of patients with certain major injuries from a Trauma Unit (TU) to the MTC.[3] The TTL must ensure the MTC is pre-alerted and that the hospital activates a full Level 1 Trauma Call upon the patient's arrival.[3] This includes coordinating specialist receiving teams (e.g., Neurosurgery, Cardiothoracics) and critical care beds in advance of arrival.[3]
4.3 Human Factors and Non-Technical Skills (NTS)
Expert trauma care relies heavily on the application of non-technical skills (NTS), or human factors, which significantly affect team performance.[2] These skills include decision-making, task management, teamwork, and situational awareness.[12]
• Assessment Tools: Trainees should seek objective feedback on their behavioural skills during resuscitation. Validated instruments such as the T-NOTECHS (Non-Technical Skills scale for Trauma) are specifically designed to observe and rate these behavioural aspects in trauma team resuscitations.[13, 14] This structured approach enables transparent assessment of training needs.[12]
• Simulation Training: Simulation-based learning (SBL) is explicitly mandated for training in trauma team leadership.[2] Immersive manikin simulation is particularly useful for situated learning, integrating existing skills, and providing stress inoculation training, but is generally less effective for teaching brand new skills.[15] Trainees must seek feedback (ESLEs) on simulated complex trauma scenarios to formally assess NTS performance.[2]
• Post-Trauma Governance: The Higher trainee is expected to lead a multi-professional team brief immediately after major trauma resuscitation.[2] This debriefing process is a critical governance activity that demonstrates leadership and facilitates collective reflection and system improvement.
5. Trauma Governance, Quality Improvement, and Network Engagement
Achieving expertise under SLO 4 requires the trainee to demonstrate active engagement in improving the system of care, ensuring safety, and driving standards across the Major Trauma Network.
5.1 Participation in Trauma Audit and Research
Participation in local and national audit and research into trauma care is a specific, mandatory capability descriptor for SLO 4.[2]
• Quality Improvement (QI): Quality Improvement is a core component of the RCEM curriculum.[16] Trainees are encouraged to participate in structured programs, such as the RCEM Quality Improvement Programmes (QIPs) [17], focusing on data-driven improvement work. These efforts establish departmental performance against national standards and facilitate benchmarking against other UK departments.[16]
• Assessment of QI: A measurable QI project related to trauma care must be documented and assessed using the Quality Improvement Assessment Tool (QIAT).[18] A successful project demonstrates the ability to identify a problem, define criteria, collect data, assess performance, and identify changes.[16]
The ability to successfully run an audit or QI project that results in a measurable improvement in a critical trauma pathway (e.g., time to definitive hemorrhage control, MHP compliance, or TXA administration compliance) provides objective evidence of system mastery, supporting the subjective assessment of "expert leadership." This demonstrates that the clinician is not just competent in one case, but contributes to the safety and efficacy of the entire trauma system.
5.2 Adherence to Regional and National Protocols
A fundamental requirement is awareness of local, regional, and national trauma protocols and guidelines, including the specific governance requirements of the Major Trauma Network.[2, 19]
• NICE Guideline Compliance: Adherence to NICE NG39 guidance on immediate destination after injury, airway management, haemorrhage control, and pain management is non-negotiable.[7]
• Network Role: Trainees must understand the role of their host hospital (Trauma Unit or MTC) within the network configuration and comply with standards for secondary transfer coordination, ensuring smooth, sustainable services that meet patient needs.[3, 19]
6. Portfolio Strategy for SLO 4 Entrustment (ARCP Success)
Entrustment at the Intermediate or Higher level is granted by the Faculty Entrustment Group (FEG) based on the triangulation of evidence in the e-portfolio.[20] The strategy for SLO 4 must focus on quality, reflection, and strategic mapping of WPBAs to the most complex capabilities.
6.1 Triangulating Evidence for FEG Entrustment
The curriculum emphasizes that the quality of the learning or reflection is of greater importance than the absolute number of WPBAs.[20] The purpose of the portfolio is to provide supportive evidence for the FEG statement, demonstrating the trainee's development as a self-regulating learner.[20]
• Assessment Requirements: Trainees in Intermediate and Higher training must complete at least three Enhanced Structured Learning Experiences (ESLEs) per year and one Multi-Source Feedback (MSF) per year (the latter ideally completed early to address training needs).[20]
• Frequency: Aiming for around one observed clinical episode (Mini-CEX, ESLE, etc.) every week across all clinical SLOs is a reasonable target.[20] These episodes should be focused, exploring a relevant learning point, rather than lengthy.[20]
6.2 The Role of Experiential Learning and Simulation
Experiential opportunities must be prioritized to gain the necessary clinical exposure:
• Major Trauma Centre (MTC) Exposure: Higher Specialty Trainees require at least 6 months in a designated MTC with direct experience in the Trauma Team Leader (TTL) role, coupled with consultant review and feedback.[2]
• Formal Courses: Completion of mandatory trauma education, specifically ATLS (more suited to core training) and ETC (European Trauma Course, appropriate for higher training), is required.[2]
• Simulation and Feedback: Simulation-based learning (SBL) is a required element.[2] Trainees must proactively seek WBA feedback on their performance in simulated trauma scenarios, especially those designed to assess NTS and TTL capabilities.[2]
6.3 Strategic Portfolio Evidence Mapping for SLO 4 Capabilities
To ensure entrustment is achieved, WPBAs must be intentionally mapped to the complex capabilities that differentiate Intermediate and Higher trainees.
Table 2: SLO 4 Capability Progression: Intermediate vs. Higher Training
Capability Domain | Intermediate Trainee (SLO 4 Target) | Higher Trainee (SLO 4 Expert Target) |
Clinical Competence | Assess, investigate, and manage all injuries, regardless of complexity. | Be expert in assessment, investigation, and initial management of all injuries, regardless of complexity. |
Leadership Level | Provide leadership of the Trauma Team (Supervisor 'on call' from home). | Provide expert leadership of the Major Trauma Team (TTL role with minimal supervision). |
Procedural Scope | Provide basic management (LA techniques, simple wound closure, basic management of neck of femur). | Manage all wounds, soft tissue injuries, fractures and dislocations, including advanced local anaesthetic techniques and procedural sedation. |
Governance & Teaching | Participation in trauma teams; aware of local/national protocols. | Supervision of a multi-disciplinary team (including NPs/ACPs); participation in local/national audit and research; leads post-trauma team brief. |
Table 3: Strategic Portfolio Evidence Mapping for SLO 4 Entrustment
RCEM SLO 4 Key Capability | Recommended WBA Tool | Focus of Commentary/Reflection |
TTL Leadership & NTS | ESLE (Simulation or Live Trauma) | Non-technical skills (NTS/T-NOTECHS), delegation effectiveness, system coordination (e.g., attending CT scan, liaising with site manager), ensuring complete primary survey documentation.[2, 3, 13] |
Complex Trauma Management (DCR/TBI) | CbD (Case-Based Discussion) | Analysis of decision-making under uncertainty, such as balancing conflicting resuscitation strategies (e.g., TBI vs. Shock), interpreting complex imaging, and defining the definitive care pathway/destination plan.[3, 7] |
Procedural Competence (FIB/Sedation) | Mini-CEX or DOPS | Adherence to procedural sedation safety guidelines and monitoring standards [4], mastery of regional block anatomy (e.g., Fascia Iliaca Block) and safety protocols.[2] |
Governance & Quality Improvement | QIAT (Quality Improvement Assessment Tool) | Participation in trauma audit, measuring compliance with national guidelines (e.g., MHP compliance, time-to-TXA), and linking findings to MTC Network standards.[16] |
6.4 Developing High-Quality Reflection and Commentary
High-quality reflection transcends mere description of events. Trainees must clearly link clinical activity to the SLO 4 Key Capabilities.[2] For a major trauma call, the reflection should not just recount the resuscitation steps but should critically analyze the effectiveness of the team brief, the delegation strategy, and the adherence to DCR protocols, focusing on the quality of learning and goal setting for future development.[20, 21] Reflections on Serious Incidents are particularly valuable for demonstrating professional growth and understanding of system failures.[18]
Conclusions
Achieving SLO 4 requires the Emergency Physician to develop a layered competence that spans clinical dexterity, dynamic leadership, and system governance. Entrustment is granted when the trainee reliably demonstrates:
1. Clinical Breadth: Mastery of all aspects of injury management, from high-stakes regional anaesthesia and procedural sedation to the evidence-based execution of Damage Control Resuscitation (DCR) protocols, strictly adhering to NICE NG39 guidance on fluid management (avoiding crystalloids and utilizing 1:1 blood product ratios) and time-critical pharmacological interventions (TXA, PCC).[4, 7]
2. Expert Leadership: The ability to provide expert Trauma Team Leadership (TTL), characterized by calm command, effective delegation, and high-level Non-Technical Skills (NTS). This includes proactive systemic coordination, such as mandatorily attending the CT scanner and liaising directly with the Site Manager to optimize patient flow to definitive care (theatre or ICU).[3]
3. System Accountability: Active engagement in trauma network protocols, including seamless management of secondary transfers, and documented contribution to quality improvement initiatives and audits (QIAT) that demonstrably enhance departmental performance against national standards.[2, 16]
Success in SLO 4 is ultimately measured by the triangulation of evidence in the e-portfolio, where quality, documented observation of NTS and complex decision-making (especially in TBI/shock scenarios), and systemic contribution validate the trainee's readiness for independent expert practice.
--------------------------------------------------------------------------------
1. RCEM SLOs Explained: The Key to Mastering Emergency Medicine - EM Learning Centre, https://www.emlearningcentre.com/blog/rcem-slos-explained-the-key-to-mastering-emergency-medicine
2. SLO 4 - Care for injured patients across the full range of complexity - RCEMCurriculum, https://rcemcurriculum.co.uk/care-for-an-injured-patient/
3. UHS adult major trauma guidelines - University Hospital Southampton, https://www.uhs.nhs.uk/Media/SUHTExtranet/WessexTraumaNetwork/UHS-adult-major-trauma-guidelines.pdf
4. Safe Sedation Procedures in Adults - RCEMLearning, https://www.rcemlearning.co.uk/reference/adult-procedural-sedation/
5. Sedation-assisted Orthopedic Reduction in Emergency Medicine: The Safety and Success of a One Physician/One Nurse Model - NIH, https://pmc.ncbi.nlm.nih.gov/articles/PMC3582522/
6. Polytraumatized Patient - StatPearls - NCBI Bookshelf - NIH, https://www.ncbi.nlm.nih.gov/books/NBK554426/
7. Overview | Major trauma: assessment and initial management ..., https://www.nice.org.uk/guidance/ng39
8. EMS Tactical Damage Control Resuscitation Protocol - StatPearls - NCBI Bookshelf - NIH, https://www.ncbi.nlm.nih.gov/books/NBK599525/
9. Major haemorrhage protocol: Highland HSCP (Guidelines) | Right Decisions - NHS Scotland, https://rightdecisions.scot.nhs.uk/tam-treatments-and-medicines-nhs-highland/adult-therapeutic-guidelines/emergency-medicine/major-haemorrhage-protocol-highland-hscp-guidelines/
10. Major Haemorrhage in Adults - Whittington Hospital, https://www.whittington.nhs.uk/document.ashx?id=6032
11. Emergency Department Medical Guidelines 4.4 MANAGEMENT OF MASSIVE BLOOD LOSS IN TRAUMA - Sheffield Children's Hospital, https://www.sheffieldchildrens.nhs.uk/download/1721/acute-injury-and-orthopaedics/64198/4-4-management-of-massive-blood-loss-in-trauma.pdf
12. Workplace-based assessments (WPBAs) - RCOG, https://www.rcog.org.uk/careers-and-training/training/assessment-and-progression-through-training/workplace-based-assessments-wpbas/
13. Translatability and validation of non-technical skills scale for trauma ..., https://d-nb.info/1179761014/34
14. Translatability and validation of non-technical skills scale for trauma (T-NOTECHS) for assessing simulated multi-professional trauma team resuscitations - PubMed, https://pubmed.ncbi.nlm.nih.gov/30700296/
16. RCEM QUALITY IMPROVEMENT GUIDE, https://heeoe.hee.nhs.uk/sites/default/files/rcem_quality_improvement_guide.pdf
18. RCEM Curriculum - Kaizen Assessment Forms, https://rcemcurriculum.co.uk/wp-content/uploads/2021/10/Kaizen-Assessment-Forms.pdf
19. Major Trauma Clinical Network Specification | NHS England, https://www.england.nhs.uk/wp-content/uploads/2024/03/PRN231106-major-trauma-network-specification-2023.pdf
21. RCEM Curriculum - Further guidance on Generic SLO - AWSEM, https://awsem.co.uk/wp-content/uploads/2021/07/Appendix-3-Generic-SLO-Curriculum-Supporting-Material.pdf
=======================================
MEM-EM PODCAST
2.4 Practical Advice for Mastering SLO 4
.png)
No comments:
Post a Comment