DESCRIPTION

Training level involves intensive period of training and skills acquisition. Implies little or no previous experience in A&E.

EXPERIENCE

Insufficient A & E or other relevant experience to meet the requirements of higher levels.

DIAGNOSTIC

May possess limited diagnostic skills at entry.

MANAGEMENT

Resuscitation

- Resuscitation skills as outlined in Annexure A  #

Procedural Skills

- May possess limited skills at entry but is rapidly acquiring those necessary for progression into higher grades.   #

General

- Possess only limited knowledge of management of A & E presentations.   #

# Indicates core element. An individual must demonstrate competency in 100% of core elements and a significant number of non-core elements to qualify for this grade.

* Indicates procedures that, owing to limited opportunities, individuals may have only limited experience in. They must however demonstrate a thorough understanding of the procedure.

DESCRIPTION

Competently functions unsupervised in the A & E sphere though may still be required to consult for the diagnosis and management of some presentations.

EXPERIENCE

>12 months full-time (or its part-time equivalent) A & E experience at SRMO or Registrar level. OR > 6 months full-time (or its part-time of equivalent) A & E experience plus other relevant experience all at SRMO or Registrar level, the combined total of which is > 12 months full- time (or it part-time equivalent)

DIAGNOSTIC

Able to interpret results of history, physical examination, pathology, ECG and radiological investigations in order to arrive at a diagnosis or differential diagnosis for a comprehensive range of A & E presentations, though assistance of referral may be required for the diagnosis of some presentations.

MANAGEMENT

Resuscitation

- Resuscitation skills as defined in Annexure A.  #

Procedural Skills

- Competence in the following skills, this implies not just technical proficiency but, where applicable a knowledge of indications, contraindications plus complications and their management.  #

- Uncomplicated intubation (unconscious pt/adult and paediatric)
- intercostal catheter
- manual ventilation (BVM/ETT/jet insufflation)
- needle cricothyrotomy  *
- direct laryngoscopy
- venesection (adult & paediatric)
- peripheral venous access (adult & paediatric)
- intraosseus cannula  *
- ABG
- cardioversion (unconscious pt/arrest situation)
- BCLS
- guedels airway
- use of CPAP
- lumbar puncture
- urethral catheterisation
- proctoscopy
- nasogastric tube insertion
- nasal packing
- r/o ENT foreign body
- r/o superficial ocular foreign body
- vaginal speculum skills
- application of splints
- digital nerve blocks
- uncomplicated suturing (lacerations superficial to fascia)

General

Able to initiate management for the majority of A & E presentations though assistance or referral may be required for the management of more complex presentations.

# Indicates core element. An individual must demonstrate competency in 100% of core elements and a significant number of non-core elements to qualify for this grade.

* Indicates procedures that, owing to limited opportunities, individuals may have only limited experience in. They must however demonstrate a thorough understanding of the procedure.

DESCRIPTION

Competently functions independently in the A & E Sphere. Able to supervise more junior staff.

EXPERIENCE

> 24 months full-time (or its part-time equivalent) A & E experience at SRMO or Registrar level.

OR

> 12 months full-time (or its part-time equivalent) A & E experience plus other relevant experience all at SRMO or Registrar Level, the combined total of which is > 24 months full- time (or its part-time equivalent).

AND

Must have attained level 2 or greater in at least one additional area.

DIAGNOSTIC

Able to interpret results of history, physical examination, pathology, ECG and radiological investigations in order to arrive at a diagnosis or differential diagnosis for a comprehensive range of A & E presentations.

MANAGEMENT

Resuscitation

- Resuscitation skills as defined in Annexure A. #

Procedural Skills

- Competence in the following skills. This implies not just technical proficiency but where applicable a knowledge of indications, contraindications plus complications and their management

- all skills specified at level 2 plus   #
- recognition of the complicated airway  #
- rapid sequence induction  #
- failed intubation drill (including use of introduces. Laryngeal mask)  #
- use of mechanical ventilation   #
- central venous access   #
- pacemakers (transcutaneous and/or temporary tranvenous)  #
- cardioversion in the conscious patient  #
- pleural aspiration
- biers block
- femoral nerve block
- neurolept anaesthesia
- use of tourniquets/mast suit
- basic fracture and dislocation management
- epistaxis balloon
- cricothyrotomy*
- peripheral venous cutdown*
- pericardiocentesis*
- suprapubic catheterisation*
- urethrogram*
- peritoneal aspiration and lavage*
- ocular tonometry*
- arterial line*
- sengstaken-blackmore tube*
- escharotomy*
- complex suturing (involving structures deep to fascia)*

General

- Able to provide initial management for all and ongoing Emergency Dept management for the majority of A & E presentations.   #

# Indicates core element. An individual must demonstrate competency in 100% of core elements and a significant number of non-core elements to qualify for this grade.

* Indicates procedures that, owing to limited opportunities, individuals may have only limited experience in. They must however demonstrate a thorough understanding of the procedure.