Training requirements and personnel

The requirements for Emergency Department sedation are listed in table 5 and are taken from the RCoA/RCEM 2012 report2.

Table 5: Requirements for ED sedation

Depth of sedation  Minimum staffing levels  Competencies of sedating practitioner  Locations and facilities  Monitoring 
Minimal sedation with Entonox One Physician or Emergency Nurse Practitioner (ENP) Current Immediate Life Support (ILS) or Advanced Life Support (ALS) certification or equivalent agreed locally Anywhere within the Emergency Department (ED) Pulse oximetry
Moderate sedation/ analgesia (‘conscious’ sedation) using intravenous agents, typically benzodiazepines One physician as seditionist and one Physician or ENP as operator and one Nurse Current ILS or ALS certification Local sign off for Level 1 sedation training* Resuscitation room facilities**** ECG, NIBP, pulse oximetry The use of capnography is recommended
Deep sedation/ analgesia As above Royal College of Anaesthetists initial assessment of competence Local sign off for Level 2 sedation training** Resuscitation room facilities**** Standards conforming to AABGI guidelines for general anaesthesia.The use of capnography is mandatory
Dissociative sedation using ketamine As above As above As above As above

Specific requirements for level 1 and 2 sedation training are illustrated in table 6.

Table 6: Training requirements for ED sedation
 

Level 1 sedation training (moderate sedation)

·       ASA grading

·       Pre-procedural assessment including prediction of difficulty in airway management

·       Pre-procedural fasting and risk benefit assessment

·       Consent and documentation

·       Drug selection and preparation: benzodiazepine/opioid combinations, intervals between increments and reversal

·       drugs

·       Monitoring, complications (e.g. hypoxia and hypotension) and rescue strategies

·       Governance and audit

Level 2 sedation training (deep sedation/general anaesthesia)

·       As per level 1

·       Drug selection with emphasis on potential alternative strategies and/or lighter sedation

·       Safe use of propofol

·       Safe use of ketamine