The 2019 Model of the Clinical Practice of Emergency Medicine

Michael S. Beeson; Felix Ankel; Rahul Bhat; Joshua S. Broder; Sara Paradise Dimeo; Diane L. Gorgas; Jonathan S. Jones; Viral Patel; Elizabeth Schiller; Jacob W. Ufberg; Julia N. Keehbauch

doi:10.1016/j.jemermed.2020.03.018

Education| Volume 59, ISSUE 1, P96-120, July 2020

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The 2019 Model of the Clinical Practice of Emergency Medicine

Michael S. Beeson, MD, MBA
Michael S. Beeson
Affiliations
American Board of Emergency Medicine, East Lansing, Michigan
Summa Health, Akron, Ohio
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Felix Ankel, MD
Felix Ankel
Affiliations
American Board of Emergency Medicine, East Lansing, Michigan
Regions Hospital, St. Paul, Minnesota
Health Partners Institute, Bloomington, Minnesota
University of Minnesota Medical School, Minneapolis, Minnesota
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Rahul Bhat, MD
Rahul Bhat
Affiliations
American College of Emergency Physicians, Irving, Texas
Georgetown University School of Medicine, Washington, District of Columbia
Medstar Washington Hospital Center, Washington, District of Columbia
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Joshua S. Broder, MD
Joshua S. Broder
Affiliations
Society for Academic Emergency Medicine, Des Plaines, Illinois
Duke University School of Medicine, Durham, North Carolina
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Sara Paradise Dimeo, MD
Sara Paradise Dimeo
Affiliations
Emergency Medicine Residents' Association, Irving, Texas
Prisma Health–Upstate, Greenville, South Carolina
University of South Carolina, Greenville, South Carolina
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Diane L. Gorgas, MD
Diane L. Gorgas
Affiliations
Residency Review Committee for Emergency Medicine, Chicago, Illinois
Department of Emergency Medicine, The Ohio State University College of Medicine, Columbus, Ohio
Health Sciences Center for Global Health, The Ohio State University, Columbus, Ohio
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Jonathan S. Jones, MD
Jonathan S. Jones
Affiliations
American Academy of Emergency Medicine, Milwaukee, Wisconsin
College of Osteopathic Medicine, William Carey University, Jackson, Mississippi
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Viral Patel, MD
Viral Patel
Affiliations
Society for Academic Emergency Medicine, Des Plaines, Illinois
University of Massachusetts, Worcester, Massachusetts
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Elizabeth Schiller, MD, FACEP
Elizabeth Schiller
Affiliations
American College of Emergency Physicians, Irving, Texas
Saint Francis Hospital and Medical Center, Hartford, Connecticut
University of Connecticut Integrated Program in Emergency Medicine, Farmington, Connecticut
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Jacob W. Ufberg, MD
Jacob W. Ufberg
Affiliations
Council of Emergency Medicine Residency Directors, Irving, Texas
Department of Emergency Medicine, The Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
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for the2019 EM Model Review Task Force
Julia N. Keehbauch
Julia N. Keehbauch
Correspondence
Reprint Address: Julia N. Keehbauch, American Board of Emergency Medicine, 3000 Coolidge Road, East Lansing, MI 48823
Affiliations
American Board of Emergency Medicine, East Lansing, Michigan
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for theAmerican Board of Emergency Medicine

Open AccessPublished:May 28, 2020DOI:https://doi.org/10.1016/j.jemermed.2020.03.018

Emergency Medicine has a scientifically derived and commonly accepted description of the domain of its clinical practice. That document, The Model of the Clinical Practice of Emergency Medicine (EM Model), was developed through the collaboration of six organizations: the American Board of Emergency Medicine (ABEM), the administrative organization for the project, the American College of Emergency Physicians (ACEP), the Council of Emergency Medicine Residency Directors (CORD), the Emergency Medicine Residents' Association (EMRA), the Residency Review Committee for Emergency Medicine (RRC-EM), and the Society for Academic Emergency Medicine (SAEM). Development of the EM Model was based on an extensive practice analysis of the specialty. The practice analysis relied on both empiric data gathered from actual emergency department visits and several expert panels (

1

Hockberger R.S.
LaDuca A.
Orr N.A.
et al.

Creating the model of a clinical practice: the case of emergency medicine.

). The resulting product was first published in 2001, and has successfully served as the common source document for all emergency medicine organizations (

2

Core Content Task Force II. The Model of the Clinical Practice of Emergency Medicine.

,

3

Core Content Task Force II. The Model of the Clinical Practice of Emergency Medicine.

). One of its strengths is incorporating the reality that emergency medicine is a specialty driven by symptoms not diagnoses, requiring simultaneous therapeutic and diagnostic interventions.

The task force that developed the EM Model recommended that a new task force, composed of representatives from all six organizations, be formed every 2 years to assess the success of the document in accomplishing its objective of supporting the ongoing development of the specialty of emergency medicine; to consider alterations to the EM Model suggested by the collaborating organizations; and to recommend changes to the six sponsoring organizations.

The initial 2-year review occurred in 2003, with representatives from each of the six organizations suggesting changes and reporting how their respective organizations had used the document. The initial 2-year update was published in Annals of Emergency Medicine and Academic Emergency Medicine in 2005 (

4

Hockberger R.S.
Binder L.S.
Chisholm C.D.
et al.

The Model of the Clinical Practice of Emergency Medicine: a 2-year update.

,

5

Hockberger R.S.
Binder L.S.
Chisholm C.D.
et al.

The Model of the Clinical Practice of Emergency Medicine: a 2-year update.

). Subsequently, a task force met every 2 years to review the EM Model and recommend changes (

6

Thomas H.A.
Binder L.S.
Chapman D.M.
et al.

The 2003 Model of the Clinical Practice of Emergency Medicine: the 2005 update.

,

7

Thomas H.A.
Binder L.S.
Chapman D.M.
et al.

The 2003 Model of the Clinical Practice of Emergency Medicine: the 2005 update.

,

8

Thomas H.A.
Beeson M.S.
Binder L.S.
et al.

The 2005 Model of the Clinical Practice of Emergency Medicine: the 2007 update.

,

9

Thomas H.A.
Beeson M.S.
Binder L.S.
et al.

The 2005 Model of the Clinical Practice of Emergency Medicine: the 2007 update.

,

10

Perina D.G.
Beeson M.S.
Char D.M.
et al.

The 2007 Model of the Clinical Practice of Emergency Medicine: the 2009 update.

,

11

Perina D.G.
Beeson M.S.
Char D.M.
et al.

The 2007 Model of the Clinical Practice of Emergency Medicine: the 2009 update.

,

12

Perina D.G.
Brunett C.P.
Caro D.A.
et al.

The 2011 Model of the Clinical Practice of Emergency Medicine.

,

13

Counselman F.L.
Borenstein M.A.
Chisholm C.D.
et al.

The 2013 Model of the Clinical Practice of Emergency Medicine.

). In 2013, a seventh organization, the American Academy of Emergency Medicine (AAEM), was added as a collaborating organization. In 2014, the collaborating organizations made the decision to review the EM Model on a 3-year review cycle, beginning in 2016. The 2016 update was published in Journal of Emergency Medicine in 2017 (

14

Counselman F.L.
Babu K.
Edens M.A.
et al.

The 2016 Model of the Clinical Practice of Emergency Medicine.

). In 2019, the AAAEM Resident and Student Association was added as an eighth collaborating organization.

This article provides a brief review of the original EM Model, along with the changes to the EM Model as recommended by the 2019 EM Model Review Task Force. Significant changes occurred with the 2019 review, including the addition of oncologic emergencies in the newly renamed “Category 8, Hematologic and Oncologic Disorders.” A summary of all 2019 changes and an update on current uses of the EM Model by the seven collaborating EM organizations are also included in this article.

The EM Model

The EM Model is a three-dimensional description of EM clinical practice. The three dimensions are patient acuity; physician tasks; and a listing of medical knowledge, patient care, and procedural skills. All of these dimensions are interrelated and used concurrently by a physician when providing patient care. The emergency physician's initial approach is determined by the acuity of the patient's presentation. While assessing the patient, the physician completes a series of tasks in collecting information. Through this process, the physician is able to select the possible etiologies of the patient's problem from the listing of medical knowledge, patient care, and procedural skills. Through simultaneous application of all three components, the physician is able to determine the most probable diagnosis and implement a treatment plan for the patient. The three dimensions, as revised in 2019, are included in Table 1, Table 2, Table 3, Table 4.

Table 1Matrix of Physician Tasks by Patient Acuity

Physician Tasks	Patient Acuity
Physician Tasks	Critical	Emergent	Lower Acuity
Prehospital care Emergency stabilization Performance of focused history and physical examination Modifying factors Professional issues Legal issues Diagnostic studies Diagnosis Therapeutic interventions Pharmacotherapy Observation and reassessment Consultation Transitions of care Prevention and education Documentation Task switching/Multiple patient care Team management Mass casualty/Disaster management Patient-centered communication skills Prognosis

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Table 2Patient Acuity Definitions

Critical	Emergent	Lower Acuity
Patient presents with symptoms of a life-threatening illness or injury with a high probability of mortality if immediate intervention is not begun to prevent further airway, respiratory, hemodynamic, and/or neurologic instability.	Patient presents with symptoms of an illness or injury that may progress in severity or result in complications with a high probability for morbidity if treatment is not begun quickly.	Patient presents with symptoms of an illness or injury that have a low probability of progression to more serious disease or development of complications.

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Table 3Physician Task Definitions

Physician Task	Definition
Prehospital care	Participate actively in prehospital care; provide direct patient care or on-line or off-line medical direction or interact with prehospital medical providers; assimilate information from prehospital care into the assessment and management of the patient.
Emergency stabilization	Conduct primary assessment and take appropriate steps to stabilize and treat patients.
Performance of focused history and physical examination	Effectively interpret and evaluate the patient's symptoms and history; identify pertinent risk factors in the patient's history; provide a focused evaluation; interpret the patient's appearance, vital signs and condition; recognize pertinent physical findings; perform techniques required for conducting the examination.
Modifying factors	Recognize age, gender, ethnicity, barriers to communication, socioeconomic status, underlying disease, gender identity, sexual orientation, and other factors that may affect patient management.
Professional issues	Understand and apply principles of professionalism and ethics pertinent to patient management.
Legal issues	Understand and apply legal concepts pertinent to the practice of emergency medicine.
Diagnostic studies	Select and perform the most appropriate diagnostic studies and interpret the results, e.g., electrocardiogram, emergency ultrasound, and radiographic and laboratory tests.
Diagnosis	Develop a differential diagnosis and establish the most likely diagnosis in light of the history, physical, interventions, and test results.
Therapeutic interventions	Perform procedures and nonpharmacologic therapies, and counsel.
Pharmacotherapy	Select, prescribe, and be aware of adverse effects of appropriate pharmaceutical agents based on relevant considerations such as intended effect, financial considerations, possible adverse effects, patient preferences, institutional policies, and clinical guidelines; monitor and intervene in the event of adverse effects in the emergency department.
Observation and reassessment	Evaluate and re-evaluate the effectiveness of a patient's treatment or therapy, including addressing complications and potential errors; monitor, observe, manage, and maintain the stability of one or more patients who are at different stages in their workups.
Consultation	Collaborate with physicians and other professionals to help guide optimal management of patients.
Transitions of care	Arrange for patient admission, discharge (including follow-up plan), observation, or transfer and transitions of care as appropriate, and communicate these arrangements effectively with patients, family, and involved health care team members.
Prevention and education	Apply epidemiologic information to patients at risk; conduct patient education; select appropriate disease and injury prevention, and harm reduction techniques.
Documentation	Communicate patient care information in a concise and appropriate manner that facilitates quality care. This includes documentation and medical decision-making variables related to billing, coding, and reimbursement for patient care.
Task switching/Multiple patient care	Prioritize and implement the evaluation and management of multiple patients in the emergency department, including handling interruptions and task-switching, in order to provide optimal patient care.
Team management	Coordinate, educate, or supervise members of the patient management team and utilize appropriate hospital resources.
Mass casualty/Disaster management	Understand and apply the principles of disaster and mass casualty management including preparedness, triage, mitigation, response, and recovery.
Patient-centered communication skills	Establish rapport with and demonstrate empathy toward patients and their families; listen effectively to patients and their families. Identify situations that require individualized communication, such as goals of care, end of life care, and palliative options.
Prognosis	Forecast the likely outcome of a medical disease or traumatic condition.

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Table 4Medical Knowledge, Patient Care, and Procedural Skills

1.0 SIGNS, SYMPTOMS, AND PRESENTATIONS
	Critical	Emergent	Lower Acuity
1.1 Abnormal Vital Signs
1.1.1 Hypothermia	X	X	X
1.1.2 Fever	X	X	X
1.1.3 Bradycardia	X	X	X
1.1.4 Tachycardia	X	X
1.1.5 Bradypnea/Apnea	X	X
1.1.6 Tachypnea	X	X
1.1.7 Hypoxia	X	X
1.1.8 Hypotension	X	X
1.1.9 Hypertension	X	X	X
1.2 Pain
1.2.1 Pain (unspecified)	X	X	X
1.2.2 Headache (See 12.3)	X	X	X
1.2.3 Eye pain		X	X
1.2.4 Chest pain	X	X	X
1.2.5 Abdominal pain	X	X	X
1.2.6 Pelvic and genital pain	X	X	X
1.2.7 Back pain	X	X	X
1.2.8 Chronic pain			X
1.2.9 Extremity pain	X	X	X
1.2.10 Neck pain	X	X	X
1.3 General
1.3.1 Altered mental status	X	X	X
1.3.2 Anuria/Oliguria		X
1.3.3 Ascites		X	X
1.3.4 Ataxia		X	X
1.3.5 Auditory disturbances			X
1.3.6 Bleeding	X	X	X
1.3.7 Congestion/Rhinorrhea			X
1.3.8 Constipation/Obstipation		X	X
1.3.9 Cough		X	X
1.3.10 Crying/Fussiness		X	X
1.3.11 Cyanosis	X
1.3.12 Dehydration	X	X
1.3.13 Diarrhea		X	X
1.3.14 Dysmenorrhea			X
1.3.15 Dysphagia		X	X
1.3.16 Dysuria			X
1.3.17 Edema		X	X
1.3.18 Failure to thrive		X	X
1.3.19 Fatigue/Malaise		X	X
1.3.20 Feeding problems			X
1.3.21 Hematemesis	X	X
1.3.22 Hematuria		X	X
1.3.23 Hemoptysis	X	X
1.3.24 Hiccup			X
1.3.25 Jaundice		X
1.3.26 Joint swelling		X	X
1.3.27 Lethargy	X	X	X
1.3.28 Lightheadedness/Dizziness		X	X
1.3.29 Limp		X	X
1.3.30 Lymphadenopathy			X
1.3.31 Mechanical and indwelling devices, complications	X	X	X
1.3.32 Nausea/Vomiting		X	X
1.3.33 Occupational exposure		X	X
1.3.34 Palpitations	X	X	X
1.3.35 Paralysis	X	X
1.3.36 Paresthesia/Dysesthesia		X	X
1.3.37 Poisoning	X	X	X
1.3.38 Pruritus		X	X
1.3.39 Rash	X	X	X
1.3.40 Rectal bleeding	X	X	X
1.3.41 Shock	X
1.3.42 Shortness of breath	X	X
1.3.43 Sore throat		X	X
1.3.44 Stridor	X	X
1.3.45 Syncope/Near syncope	X	X	X
1.3.46 Tinnitus			X
1.3.47 Tremor		X	X
1.3.48 Urinary incontinence			X
1.3.49 Urinary retention		X
1.3.50 Vaginal bleeding	X	X	X
1.3.51 Vaginal discharge			X
1.3.52 Visual disturbances		X	X
1.3.53 Weakness		X	X
1.3.54 Wheezing	X	X
1.3.55 Toxidromes	X	X	X
1.3.56 Sudden unexpected infant death (SUID)	X
1.3.57 Suicidal ideation	X	X	X
1.3.58 Brief resolved unexplained events (BRUE)	X	X	X
1.3.59 Intoxication syndromes	X	X	X
1.3.60 Postsurgical complications	X	X	X
2.0 ABDOMINAL AND GASTROINTESTINAL DISORDERS
	Critical	Emergent	Lower Acuity
2.1 Abdominal Wall
2.1.1 Hernias		X	X
2.1.2 Hematoma			X
2.2 Esophagus
2.2.1 Infectious disorders
2.2.1.1 Candida (See 4.4.2.1, 7.4.6)		X	X
2.2.1.2 Viral esophagitis		X	X
2.2.2 Inflammatory disorders
2.2.2.1 Esophagitis		X	X
2.2.2.2 Gastroesophageal reflux (GERD)			X
2.2.2.3 Toxic effects of caustic agents (See 17.1.16.1)
2.2.2.3.1 Acid	X	X
2.2.2.3.2 Alkali	X	X
2.2.3 Motor abnormalities
2.2.4 Structural disorders
2.2.4.1 Boerhaave's syndrome	X	X
2.2.4.2 Diverticula		X	X
2.2.4.3 Foreign body		X
2.2.4.4 Hernias		X	X
2.2.4.5 Mallory-Weiss syndrome	X	X
2.2.4.6 Stricture and stenosis		X	X
2.2.4.7 Tracheoesophageal fistula	X	X
2.2.4.8 Varices	X	X
2.2.5 Tumors		X	X
2.3 Liver
2.3.1 Noninfectious hepatitis/Cirrhosis		X	X
2.3.1.1 Alcoholic		X	X
2.3.1.2 Biliary obstructive		X
2.3.1.3 Drug-induced		X	X
2.3.1.4 Nonalcoholic steatohepatitis (NASH)			X
2.3.2 Hepatorenal failure	X	X
2.3.3 Infectious disorders		X	X
2.3.3.1 Abscess		X
2.3.3.2 Hepatitis		X
2.3.3.3 Perihepatitis			X
2.3.4 Tumors		X	X
2.3.5 Hepatic encephalopathy	X	X
2.4 Gallbladder and Biliary Tract
2.4.1 Cholangitis	X	X
2.4.2 Cholecystitis	X	X
2.4.3 Cholelithiasis/Choledocholithiasis		X	X
2.4.4 Tumors		X	X
2.5 Pancreas
2.5.1 Pancreatitis	X	X
2.5.2 Tumors		X	X
2.5.3 Pseudocyst			X
2.6 Peritoneum
2.6.1 Spontaneous bacterial peritonitis	X	X
2.6.2 Abdominal compartment syndrome	X	X
2.7 Stomach
2.7.1 Infectious disorders			X
2.7.2 Inflammatory disorders
2.7.2.1 Gastritis		X	X
2.7.3 Peptic ulcer disease		X	X
2.7.3.1 Hemorrhage	X	X
2.7.3.2 Perforation	X	X
2.7.4 Structural disorders
2.7.4.1 Congenital hypertrophic pyloric stenosis		X
2.7.4.2 Foreign body		X	X
2.7.5 Tumors		X	X
2.7.6 Gastroparesis		X	X
2.7.7 Cyclic vomiting syndrome (See 17.1.24.1.1)		X	X
2.8 Small Bowel
2.8.1 Infectious disorders		X	X
2.8.2 Inflammatory disorders
2.8.1.1 Regional enteritis/Crohn's disease	X	X
2.8.1.2 Gluten enteropathy/Celiac disease		X
2.8.3 Motor abnormalities
2.8.3.1 Obstruction	X	X
2.8.3.2 Paralytic ileus		X
2.8.4 Structural disorders
2.8.4.1 Aortoenteric fistula	X
2.8.4.2 Congenital anomalies		X	X
2.8.4.3 Intestinal malabsorption		X	X
2.8.4.4 Meckel's diverticulum		X	X
2.8.5 Tumors		X	X
2.8.6 Vascular insufficiency	X	X
2.9 Large Bowel
2.9.1 Infectious disorders
2.9.1.1 Antibiotic-associated		X
2.9.1.2 Bacterial		X	X
2.9.1.3 Parasitic		X	X
2.9.1.4 Viral		X	X
2.9.2 Inflammatory disorders
2.9.2.1 Appendicitis		X
2.9.2.2 Necrotizing enterocolitis (NEC)	X	X
2.9.2.3 Radiation colitis		X
2.9.2.4 Ulcerative colitis		X	X
2.9.2.5 Neutropenic enterocolitis/Typhlitis	X	X
2.9.3 Motor abnormalities
2.9.3.1 Hirschsprung's disease		X	X
2.9.3.2 Irritable bowel			X
2.9.3.3 Obstruction	X	X
2.9.4 Structural disorders
2.9.4.1 Congenital anomalies		X	X
2.9.4.2 Diverticula		X	X
2.9.4.3 Intussusception	X	X
2.9.4.4 Volvulus	X	X
2.9.5 Tumors		X	X
2.10 Rectum and Anus
2.10.1 Infectious disorders
2.10.1.1 Perianal/Anal abscess		X	X
2.10.1.2 Perirectal abscess		X
2.10.1.3 Pilonidal cyst and abscess		X	X
2.10.2 Inflammatory disorders
2.10.2.1 Proctitis			X
2.10.3 Structural disorders
2.10.3.1 Anal fissure			X
2.10.3.2 Anal fistula		X	X
2.10.3.3 Congenital anomalies			X
2.10.3.4 Foreign body		X	X
2.10.3.5 Hemorrhoids			X
2.10.3.6 Rectal prolapse		X
2.10.4 Tumors		X	X
2.11 Spleen
2.11.1 Asplenism		X	X
2.11.2 Splenomegaly			X
2.11.3 Vascular insufficiency/Infarction	X	X	X
2.12 Specific Post-surgical Populations
2.12.1 Bariatric surgery	X	X	X
2.12.2 Ostomy		X	X
3.0 CARDIOVASCULAR DISORDERS
	Critical	Emergent	Lower Acuity
3.1 Cardiopulmonary Arrest	X
3.2 Congenital Abnormalities of the Cardiovascular System	X	X	X
3.2.1 Tetralogy of Fallot spells	X	X
3.2.2 Patent ductus arteriosus-dependent congenital heart anomalies	X	X
3.3 Disorders of Circulation
3.3.1 Arterial
3.3.1.1 Aneurysm	X	X	X
3.3.1.2 Dissection	X
3.3.1.2.1 Aortic	X	X	X
3.3.1.2.2 Non-aortic	X	X	X
3.3.1.3 Thromboembolism	X	X
3.3.2 Venous
3.3.2.1 Thromboembolism (See 16.6.2)	X	X
3.4 Disturbances of Cardiac Rhythm
3.4.1 Cardiac dysrhythmias	X	X	X
3.4.1.1 Ventricular	X	X
3.4.1.2 Supraventricular	X	X	X
3.4.1.3 Pulseless electrical activity	X
3.4.2 Conduction disorders	X	X	X
3.5 Diseases of the Myocardium, Acquired
3.5.1 Cardiac failure	X	X
3.5.1.1 Cor pulmonale	X	X
3.5.1.2 High output	X	X
3.5.1.3 Low output	X	X
3.5.2 Cardiomyopathy	X	X	X
3.5.2.1 Hypertrophic	X	X	X
3.5.2.2 Dilated	X	X	X
3.5.3 Congestive heart failure	X	X
3.5.4 Coronary syndromes	X	X
3.5.5 Ischemic heart disease	X	X
3.5.6 Myocardial infarction	X	X
3.5.7 Myocarditis	X	X	X
3.5.8 Ventricular aneurysm	X	X	X
3.6 Diseases of the Pericardium
3.6.1 Pericardial tamponade (See 18.1.2.6)	X	X
3.6.2 Pericarditis		X	X
3.7 Hypertension	X	X	X
3.7.1 Asymptomatic hypertension			X
3.7.2 Hypertensive emergency	X	X
3.8 Tumors	X	X
3.9 Valvular Disorders	X	X	X
3.9.1 Endocarditis	X	X
3.10 Cardiovascular Devices
3.10.1 Pacemaker/Automatic implantable cardioverter-defibrillator (AICD)	X	X	X
3.10.2 Left ventricular assist device (LVAD)	X	X	X
4.0 CUTANEOUS DISORDERS
	Critical	Emergent	Lower Acuity
4.1 Cancers of the Skin
4.1.1 Basal cell			X
4.1.2 Kaposi's sarcoma			X
4.1.3 Melanoma			X
4.1.4 Squamous cell			X
4.2 Ulcerative Lesions
4.2.1 Decubitus		X	X
4.2.2 Venous stasis			X
4.2.3 Diabetic foot ulcers		X	X
4.3 Dermatitis
4.3.1 Atopic/Eczema			X
4.3.2 Contact			X
4.3.3 Psoriasis			X
4.3.4 Seborrhea			X
4.4 Infections
4.4.1 Bacterial
4.4.1.1 Abscess		X	X
4.4.1.2 Cellulitis		X	X
4.4.1.3 Erysipelas		X
4.4.1.4 Impetigo			X
4.4.1.5 Necrotizing infection	X	X
4.4.2 Fungal
4.4.2.1 Candida (See 2.2.1.1, 7.4.6)			X
4.4.2.2 Dermatophytes			X
4.4.3 Ectoparasites			X
4.4.4 Viral
4.4.4.1 Aphthous ulcers			X
4.4.4.2 Childhood exanthems (See 10.6.8, 10.6.9)			X
4.4.4.3 Herpetic infections (See 10.6.4, 10.6.5, 13.1.3.1)		X	X
4.4.4.4 Human papillomavirus (HPV) (See 13.1.3.2)			X
4.4.4.5 Molluscum contagiosum			X
4.5 Maculopapular Lesions
4.5.1 Erythema multiforme		X	X
4.5.2 Pityriasis rosea			X
4.5.3 Urticaria		X	X
4.5.4 Drug eruptions		X	X
4.6 Papular/Nodular Lesions
4.6.1 Hemangioma/Lymphangioma			X
4.6.2 Lipoma			X
4.6.3 Sebaceous cyst			X
4.6.4 Erythema nodosum			X
4.7 Vesicular/Bullous Lesions
4.7.1 Pemphigus		X
4.7.2 Staphylococcal scalded skin syndrome	X	X
4.7.3 Stevens-Johnson syndrome	X	X
4.7.4 Toxic epidermal necrolysis	X	X
4.7.5 Bullous pemphigoid		X	X
4.8 Purpuric Rash	X	X	X
4.8.1 Henoch-Schӧnlein purpura (HSP)		X
5.0 ENDOCRINE, METABOLIC, AND NUTRITIONAL DISORDERS
	Critical	Emergent	Lower Acuity
5.1 Acid–base Disturbances
5.1.1 Metabolic or respiratory
5.1.1.1 Acidosis	X	X
5.1.1.2 Alkalosis	X	X	X
5.1.2 Mixed acid–base balance disorder	X	X
5.2 Adrenal Disease
5.2.1 Corticoadrenal insufficiency	X	X
5.2.2 Cushing's syndrome		X	X
5.3 Fluid and Electrolyte Disturbances
5.3.1 Calcium metabolism	X	X	X
5.3.2 Hypervolemia/Hypovolemia	X	X	X
5.3.3 Potassium metabolism	X	X	X
5.3.4 Sodium metabolism	X	X	X
5.3.5 Magnesium metabolism		X	X
5.3.6 Phosphorus metabolism		X	X
5.4 Glucose Metabolism
5.4.1 Diabetes mellitus	X	X	X
5.4.1.1 Complications in glucose metabolism
5.4.1.1.1 Hyperglycemia		X	X
5.4.1.1.2 Diabetic ketoacidosis (DKA)	X	X	X
5.4.1.1.3 Hyperosmolar hyperglycemic state	X	X
5.4.1.1.4 Hypoglycemia	X	X
5.5 Nutritional Disorders
5.5.1 Vitamin deficiencies			X
5.5.2 Wernicke-Korsakoff syndrome		X
5.5.3 Malabsorption		X	X
5.5.4 Malnutrition		X	X
5.6 Parathyroid Disease		X	X
5.7 Pituitary Disorders		X	X
5.7.1 Panhypopituitarism		X
5.8 Thyroid Disorders
5.8.1 Hyperthyroidism	X	X	X
5.8.2 Hypothyroidism	X	X	X
5.8.3 Thyroiditis		X	X
5.8.4 Thyroid storm	X	X
5.9 Tumors of Endocrine Glands
5.9.1 Adrenal		X	X
5.9.1.1 Pheochromocytoma	X	X
5.9.2 Pituitary		X	X
5.9.3 Thyroid		X	X
6.0 ENVIRONMENTAL DISORDERS
	Critical	Emergent	Lower Acuity
6.1 Bites and Envenomation (See 18.1.3.2)
6.1.1 Arthropods		X	X
6.1.1.1 Insects			X
6.1.1.2 Arachnids		X	X
6.1.2 Mammals		X	X
6.1.3 Marine organisms (See 17.1.20)	X	X	X
6.1.4 Reptiles	X	X	X
6.2 Dysbarism
6.2.1 Air embolism	X	X
6.2.2 Barotrauma	X	X	X
6.2.3 Decompression syndrome	X	X
6.3 Electrical Injury (See 18.1.3.3.1)	X	X	X
6.3.1 Lightning	X	X
6.4 High-altitude Illness
6.4.1 Acute mountain sickness		X	X
6.4.2 High-altitude cerebral edema	X	X
6.4.3 High-altitude pulmonary edema	X	X
6.5 Submersion Incidents	X	X	X
6.6 Temperature-related Illness
6.6.1 Heat	X	X	X
6.6.2 Cold	X	X	X
6.6.2.1 Frostbite		X	X
6.6.2.2 Hypothermia	X	X
6.7 Radiation Emergencies	X	X	X
7.0 HEAD, EAR, EYE, NOSE, THROAT DISORDERS
	Critical	Emergent	Lower Acuity
7.1 Ear
7.1.1 Foreign body		X	X
7.1.1.1 Impacted cerumen			X
7.1.2 Labyrinthitis			X
7.1.3 Mastoiditis		X
7.1.4 Ménière's disease			X
7.1.5 Otitis externa			X
7.1.5.1 Infective			X
7.1.5.1.1 Malignant		X
7.1.6 Otitis media		X	X
7.1.7 Perforated tympanic membrane (See 18.1.11.2)			X
7.1.8 Perichondritis		X	X
7.2 Eye
7.2.1 External eye
7.2.1.1 Burn confined to eye (See 18.1.10.2)		X
7.2.1.2 Conjunctivitis			X
7.2.1.3 Corneal abrasions (See 18.1.10.1)		X	X
7.2.1.4 Disorders of lacrimal system		X	X
7.2.1.5 Foreign body		X	X
7.2.1.6 Disorders of the eyelids			X
7.2.1.7 Keratitis		X	X
7.2.2 Anterior pole
7.2.2.1 Glaucoma		X	X
7.2.2.2 Hyphema (See 18.1.10.5)		X	X
7.2.2.3 Iritis (See 18.1.10.8)		X	X
7.2.2.4 Hypopyon		X
7.2.3 Posterior pole
7.2.3.1 Choroiditis/Chorioretinitis		X
7.2.3.2 Optic neuritis		X
7.2.3.3 Papilledema	X	X
7.2.3.4 Retinal detachments and defects (See 18.1.10.7)		X
7.2.3.5 Retinal vascular occlusion		X
7.2.4 Orbit
7.2.4.1 Cellulitis
7.2.4.1.1 Preseptal		X
7.2.4.1.2 Septal/Orbital		X
7.2.4.2 Endophthalmitis		X
7.3 Nose
7.3.1 Epistaxis	X	X	X
7.3.2 Foreign body		X	X
7.3.3 Rhinitis			X
7.3.4 Sinusitis			X
7.4 Oropharynx/Throat
7.4.1 Dentalgia			X
7.4.2 Diseases of the oral soft tissue
7.4.2.1 Ludwig's angina	X	X
7.4.2.2 Stomatitis			X
7.4.2.3 Gingival and periodontal disorders		X	X
7.4.2.4 Odontogenic infections/Abscesses		X	X
7.4.3 Diseases of the salivary glands
7.4.3.1 Sialolithiasis		X	X
7.4.3.2 Suppurative parotitis		X
7.4.4 Foreign body	X	X
7.4.5 Larynx/Trachea
7.4.5.1 Epiglottitis (See 16.1.1.2)	X	X
7.4.5.2 Laryngitis			X
7.4.5.3 Tracheitis		X	X
7.4.5.4 Tracheostomy complications	X	X	X
7.4.6 Oral candidiasis (See 2.2.1.1, 4.4.2.1)			X
7.4.7 Peritonsillar abscess		X
7.4.8 Pharyngitis/Tonsillitis			X
7.4.9 Retropharyngeal abscess	X	X
7.4.10 Temporomandibular joint disorders			X
7.5 Tumors	X	X	X
8.0 HEMATOLOGIC AND ONCOLOGIC DISORDERS
	Critical	Emergent	Lower Acuity
8.1 Blood Transfusion
8.1.1 Complications	X	X
8.2 Hemostatic Disorders
8.2.1 Coagulation defects	X	X	X
8.2.1.1 Acquired	X	X	X
8.2.1.2 Hemophilias	X	X	X
8.2.1.3 Anticoagulation agents	X	X	X
8.2.2 Disseminated intravascular coagulation	X
8.2.3 Platelet disorders	X	X	X
8.2.3.1 Thrombocytopenia		X	X
8.2.3.2 Idiopathic thrombocytopenic purpura	X	X	X
8.2.3.3 Thrombotic thrombocytopenic purpura	X	X
8.3 Lymphomas		X	X
8.4 Pancytopenia	X	X
8.5 Red Blood Cell Disorders
8.5.1 Anemias
8.5.1.1 Aplastic	X	X
8.5.1.2 Hemoglobinopathies		X	X
8.5.1.2.1 Sickle cell anemia	X	X	X
8.5.1.2.2 Thalassemia		X	X
8.5.1.3 Hemolytic		X
8.5.1.4 Hypochromic
8.5.1.4.1 Iron deficiency		X	X
8.5.1.5 Megaloblastic		X	X
8.5.2 Polycythemia		X	X
8.5.3 Methemoglobinemia (See 17.1.21)	X	X
8.6 White Blood Cell Disorders
8.6.1 Leukemia		X	X
8.6.2 Multiple myeloma		X	X
8.6.3 Leukopenia		X	X
8.7 Oncologic Emergencies	X	X	X
8.7.1 Febrile neutropenia	X	X	X
8.7.2 Hypercalcemia of malignancy	X	X	X
8.7.3 Hyperviscosity syndrome	X	X	X
8.7.4 Malignant pericardial effusion	X	X	X
8.7.5 Spinal cord compression (See 12.10)	X	X
8.7.6 Superior vena cava syndrome	X	X
8.7.7 Tumor hemorrhage	X	X	X
8.7.8 Tumor lysis syndrome	X	X
9.0 IMMUNE SYSTEM DISORDERS
	Critical	Emergent	Lower Acuity
9.1 Collagen Vascular Disease
9.1.1 Raynaud's disease			X
9.1.2 Reactive arthritis (See 11.3.1.6)		X	X
9.1.3 Rheumatoid arthritis (See 11.3.1.3)		X	X
9.1.4 Scleroderma		X	X
9.1.5 Systemic lupus erythematosus		X	X
9.1.6 Vasculitis		X	X
9.2 Hypersensitivity
9.2.1 Allergic reaction		X	X
9.2.2 Anaphylaxis	X
9.2.3 Angioedema	X	X
9.2.4 Drug allergies	X	X	X
9.3 Transplant-related Problems	X	X	X
9.3.1 Immunosuppression		X	X
9.3.2 Rejection	X	X
9.4 Immune Complex Disorders		X
9.4.1 Mucocutaneous lymph node syndrome (Kawasaki syndrome)		X	X
9.4.2 Rheumatic fever		X	X
9.4.3 Sarcoidosis		X	X
9.4.4 Post-streptococcal glomerulonephritis (See 15.3.1)		X
9.5 Medication-induced Immunosuppression	X	X
9.5.1 Chemotherapeutic agents	X	X
9.5.2 Steroids	X	X
9.5.3 Targeted immune modulators	X	X
10.0 SYSTEMIC INFECTIOUS DISORDERS
	Critical	Emergent	Lower Acuity
10.1 Bacterial
10.1.1 Bacterial food poisoning		X	X
10.1.1.1 Botulism	X	X
10.1.2 Chlamydia		X	X
10.1.3 Gonococcus		X	X
10.1.4 Meningococcus	X	X
10.1.5 Mycobacterium
10.1.5.1 Atypical mycobacteria		X	X
10.1.5.2 Tuberculosis		X	X
10.1.6 Other bacterial diseases	X	X
10.1.6.1 Gas gangrene (See 11.6.3)	X	X
10.1.7 Sepsis/Bacteremia	X	X
10.1.7.1 Shock	X
10.1.7.2 Toxic shock syndrome	X	X
10.1.8 Spirochetes
10.1.8.1 Syphilis		X	X
10.1.9 Tetanus	X	X
10.2 Biological Warfare Agents	X	X
10.3 Fungal Infections		X	X
10.4 Protozoan/Parasites
10.4.1 Malaria		X
10.4.2 Toxoplasmosis		X	X
10.5 Tick-borne
10.5.1 Anaplasmosis (Ehrlichiosis)		X
10.5.2 Lyme disease		X
10.5.3 Rocky Mountain spotted fever		X
10.5.4 Babesiosis		X
10.6 Viral		X	X
10.6.1 Infectious mononucleosis		X	X
10.6.2 Influenza/Parainfluenza		X	X
10.6.3 Arbovirus	X	X	X
10.6.4 Herpes simplex (See 4.4.4.3, 13.1.3.1)		X	X
10.6.5 Herpes zoster/Varicella (See 4.4.4.3)		X	X
10.6.6 HIV/AIDS	X	X	X
10.6.7 Rabies	X
10.6.8 Roseola (See 4.4.4.2)			X
10.6.9 Rubella (See 4.4.4.2)			X
10.6.10 Measles	X	X	X
10.6.11 Mumps (Paramyxovirus)		X	X
10.7 Emerging Infections/Pandemics	X	X	X
10.8 Drug Resistance	X	X	X
11.0 MUSCULOSKELETAL DISORDERS (NONTRAUMATIC)
	Critical	Emergent	Lower Acuity
11.1 Bony Abnormalities
11.1.1 Aseptic/Avascular necrosis		X	X
11.1.2 Osteomyelitis		X
11.1.3 Tumors		X	X
11.1.4 Atypical fractures		X	X
11.1.4.1 Osteoporotic		X	X
11.1.4.2 Tumor-related		X	X
11.1.4.3 Congenital disorders		X	X
11.2 Disorders of the Spine
11.2.1 Disc disorders		X	X
11.2.2 Inflammatory/Infectious spondylopathies		X	X
11.2.3 Radiculopathy (See 12.7.3)		X	X
11.2.4 Spinal stenosis		X	X
11.2.5 Cervical pain	X	X	X
11.2.6 Thoracic pain	X	X	X
11.2.7 Lumbosacral pain	X	X	X
11.2.7.1 Cauda equina syndrome (See 18.1.15.1)	X	X
11.2.7.2 Sacroiliitis			X
11.2.7.3 Sciatica		X	X
11.2.8 Discitis		X	X
11.3 Joint Abnormalities
11.3.1 Arthritis
11.3.1.1 Septic		X
11.3.1.2 Crystal arthropathies		X	X
11.3.1.3 Rheumatoid (See 9.1.3)			X
11.3.1.4 Juvenile			X
11.3.1.5 Osteoarthrosis			X
11.3.1.6 Reactive arthritis (See 9.1.2)		X	X
11.3.2 Developmental dysplasia of the hip		X	X
11.3.3 Slipped capital femoral epiphysis		X
11.3.4 Synovitis		X	X
11.4 Muscle Abnormalities
11.4.1 Myositis			X
11.4.2 Rhabdomyolysis	X	X
11.5 Overuse Syndromes
11.5.1 Bursitis			X
11.5.2 Muscle strains			X
11.5.3 Peripheral nerve syndrome			X
11.5.3.1 Carpal tunnel syndrome			X
11.5.4 Tendinopathy			X
11.5.5 Stress reaction fracture		X	X
11.6 Soft Tissue Infections
11.6.1 Fasciitis	X	X	X
11.6.2 Felon		X
11.6.3 Gangrene (See 10.1.6.1)	X	X
11.6.4 Paronychia		X	X
11.6.5 Tenosynovitis		X	X
12.0 NERVOUS SYSTEM DISORDERS
	Critical	Emergent	Lower Acuity
12.1 Cranial Nerve Disorders			X
12.1.1 Idiopathic facial nerve paralysis (Bell's palsy)			X
12.1.2 Trigeminal neuralgia			X
12.2 Demyelinating Disorders	X	X
12.2.1 Multiple sclerosis		X	X
12.3 Headache (See 1.2.2)	X	X	X
12.3.1 Tension			X
12.3.2 Vascular		X	X
12.3.3 Cluster		X	X
12.4 Hydrocephalus		X	X
12.4.1 Normal pressure		X	X
12.4.2 Shunt complications		X
12.5 Infections/Inflammatory Disorders
12.5.1 Encephalitis	X	X
12.5.2 Intracranial and intraspinal abscess	X	X
12.5.3 Meningitis
12.5.3.1 Bacterial	X	X
12.5.3.2 Viral	X	X	X
12.5.3.3 Fungal	X	X	X
12.5.4 Myelitis		X
12.5.4.1 Acute flaccid myelitis		X
12.5.5 Neuritis			X
12.6 Movement Disorders		X	X
12.6.1 Dystonic reaction		X	X
12.6.2 Chorea/Choreiform			X
12.6.3 Tardive dyskinesia			X
12.7 Neuromuscular Disorders
12.7.1 Guillain-Barré syndrome	X	X
12.7.2 Myasthenia gravis	X	X	X
12.7.3 Peripheral neuropathy (See 11.2.3)		X
12.8 Other Conditions of the Brain
12.8.1 Dementia (See 14.5.2)			X
12.8.2 Parkinson's disease			X
12.8.3 Idiopathic intracranial hypertension	X	X
12.8.4 Cerebral venous sinus thrombosis	X	X	X
12.8.5 Posterior reversible encephalopathy syndrome (PRES)	X	X
12.8.6 Transient global amnesia			X
12.9 Seizure Disorders
12.9.1 Epileptiform	X	X	X
12.9.1.1 Neonatal	X	X
12.9.1.2 Febrile	X	X	X
12.9.1.3 Status epilepticus	X
12.9.1.4 Nonconvulsiveac	X	X
12.9.1.5 Drug-induced	X	X
12.9.2 Nonepileptiform			X
12.10 Spinal Cord Compression (See 8.7.5)	X	X
12.11 Stroke
12.11.1 Hemorrhagic
12.11.1.1 Intracerebral	X	X
12.11.1.2 Subarachnoid	X	X
12.11.2 Ischemic
12.11.2.1 Embolic	X	X
12.11.2.2 Thrombotic	X	X
12.12 Transient Cerebral Ischemia		X	X
12.13 Tumors	X	X	X
12.14 Delirium	X	X	X
12.14.1 Excited delirium syndrome	X	X
13.0 OBSTETRICS AND GYNECOLOGY
	Critical	Emergent	Lower Acuity
13.1 Female Genital Tract
13.1.1 Cervix
13.1.1.1 Cervicitis and endocervicitis		X	X
13.1.1.2 Tumors			X
13.1.2 Infectious disorders
13.1.2.1 Pelvic inflammatory disease		X
13.1.2.1.1 Fitz-Hugh-Curtis syndrome		X
13.1.2.1.2 Tuboovarian abscess		X
13.1.2.2 Urethritis			X
13.1.2.3 Gangrene of perineum	X	X
13.1.3 Lesions
13.1.3.1 Herpes simplex (See 4.4.4.3, 10.6.4)			X
13.1.3.2 Human papillomavirus (HPV) (See 4.4.4.4)			X
13.1.4 Ovary
13.1.4.1 Cyst			X
13.1.4.2 Torsion		X
13.1.4.3 Tumors		X	X
13.1.5 Uterus
13.1.5.1 Abnormal bleeding		X	X
13.1.5.2 Endometriosis			X
13.1.5.3 Prolapse			X
13.1.5.4 Tumors		X	X
13.1.5.4.1 Gestational trophoblastic disease			X
13.1.5.4.2 Leiomyoma			X
13.1.6 Vagina and vulva
13.1.6.1 Bartholin's cyst		X	X
13.1.6.2 Foreign body		X	X
13.1.6.3 Vaginitis/Vulvovaginitis			X
13.2 Normal Pregnancy			X
13.3 Complications of Pregnancy
13.3.1 Abortion		X
13.3.2 Ectopic pregnancy	X	X
13.3.3 Hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome	X	X
13.3.4 Hemorrhage, antepartum
13.3.4.1 Abruptio placentae (See 18.2.1)	X	X
13.3.4.2 Placenta previa	X	X
13.3.5 Hyperemesis gravidarum		X	X
13.3.6 Gestational hypertension		X	X
13.3.6.1 Eclampsia	X	X
13.3.6.2 Preeclampsia		X
13.3.7 Infections		X
13.3.8 Rh isoimmunization		X
13.3.9 First trimester bleeding	X	X	X
13.3.10 Gestational diabetes		X	X
13.4 High-risk Pregnancy	X	X
13.4.1 Assisted reproductive therapies	X	X	X
13.4.2 Pre-existing medical problems	X	X	X
13.5 Normal Labor and Delivery		X	X
13.6 Complications of Labor
13.6.1 Fetal distress	X
13.6.2 Premature labor (See 18.2.3)		X
13.6.3 Premature rupture of membranes		X
13.6.4 Rupture of uterus (See 18.2.4)	X
13.7 Complications of Delivery
13.7.1 Malposition of fetus	X	X
13.7.2 Nuchal cord	X
13.7.3 Prolapse of cord	X
13.7.4 Amniotic fluid embolism	X	X
13.8 Postpartum Complications
13.8.1 Endometritis		X
13.8.2 Hemorrhage	X	X
13.8.3 Mastitis		X	X
13.8.4 Pituitary infarction	X	X
13.9 Contraception		X	X
14.0 PSYCHOBEHAVIORAL DISORDERS
	Critical	Emergent	Lower Acuity
14.1 Substance Use Disorders
14.1.1 Alcohol use disorder (See 17.1.1)	X	X	X
14.1.2 Illicit drug use	X	X	X
14.1.3 Prescription drug use	X	X	X
14.1.3.1 Drug diversion			X
14.1.4 Tobacco use disorder			X
14.1.5 Withdrawal syndromes	X	X	X
14.1.6 Opioid use disorder (17.1.2.3)	X	X	X
14.1.7 Stimulant use disorder	X	X	X
14.1.8 Medication-assisted treatment (MAT)		X	X
14.2 Mood Disorders and Thought Disorders
14.2.1 Acute psychosis	X	X
14.2.2 Bipolar disorder		X	X
14.2.3 Depression		X	X
14.2.3.1 Suicidal risk	X	X
14.2.4 Grief reaction			X
14.2.5 Schizophrenia		X	X
14.3 Factitious Disorders		X	X
14.4 Neurotic Disorders
14.4.1 Anxiety/Panic			X
14.4.2 Obsessive compulsive			X
14.4.3 Phobic			X
14.4.4 Post-traumatic stress			X
14.5 Organic Psychoses
14.5.1 Chronic organic psychotic conditions			X
14.5.1.1 Alcoholic psychoses		X	X
14.5.1.2 Drug psychoses		X	X
14.5.2 Dementia (See 12.8.1)			X
14.6 Patterns of Violence/Abuse/Neglect
14.6.1 Interpersonal violence
14.6.1.1 Child	X	X	X
14.6.1.2 Intimate partner	X	X	X
14.6.1.3 Elder	X	X	X
14.6.2 Homicidal Risk	X	X
14.6.3 Sexual assault		X
14.6.4 Staff/Patient safety		X
14.6.5 Human trafficking		X	X
14.7 Personality Disorders			X
14.8 Psychosomatic Disorders
14.8.1 Hypochondriasis			X
14.8.2 Hysteria/Conversion			X
14.9 Feeding and Eating Disorders	X	X	X
15.0 RENAL AND UROGENITAL DISORDERS
	Critical	Emergent	Lower Acuity
15.1 Acute and Chronic Renal Failure	X	X	X
15.2 Complications of Dialysis	X	X
15.2.1 Vascular	X	X	X
15.2.2 Peritoneal	X	X	X
15.3 Glomerular Disorders
15.3.1 Glomerulonephritis (See 9.4.4)		X	X
15.3.2 Nephrotic syndrome		X	X
15.4 Infection
15.4.1 Cystitis			X
15.4.2 Pyelonephritis		X
15.4.3 Asymptomatic bacteriuria			X
15.5 Male Genital Tract
15.5.1 Genital lesions			X
15.5.2 Hernias		X	X
15.5.3 Inflammation/Infection
15.5.3.1 Balanitis/Balanoposthitis		X	X
15.5.3.2 Epididymitis/Orchitis		X	X
15.5.3.3 Gangrene of the perineum (Fournier's gangrene)	X	X
15.5.3.4 Prostatitis		X	X
15.5.3.5 Urethritis			X
15.5.4 Structural
15.5.4.1 Paraphimosis/Phimosis		X
15.5.4.2 Priapism		X
15.5.4.2.1 Medication induced		X	X
15.5.4.3 Prostatic hypertrophy (BPH)			X
15.5.4.4 Torsion		X
15.5.5 Testicular masses			X
15.6 Nephritis		X	X
15.6.1 Hemolytic uremic syndrome		X
15.7 Structural Disorders
15.7.1 Calculus of urinary tract		X	X
15.7.2 Obstructive uropathy	X	X
15.7.3 Polycystic kidney disease			X
15.8 Tumors			X
16.0 THORACIC-RESPIRATORY DISORDERS
	Critical	Emergent	Lower Acuity
16.1 Acute Upper Airway Disorders
16.1.1 Infections
16.1.1.1 Croup		X
16.1.1.2 Epiglottitis (See 7.4.5.1)	X	X
16.1.2 Obstruction/Foreign body (See 16.4.7)	X
16.2 Disorders of Pleura, Mediastinum, and Chest Wall
16.2.1 Costochondritis			X
16.2.2 Mediastinitis	X	X
16.2.3 Pleural effusion		X	X
16.2.4 Pleuritis			X
16.2.5 Pneumomediastinum		X
16.2.6 Pneumothorax (See 18.1.2.7)
16.2.6.1 Simple		X
16.2.6.2 Tension	X
16.2.6.3 Open	X
16.2.7 Empyema		X	X
16.3 Acute Respiratory Distress Syndrome	X	X
16.4 Obstructive/Restrictive Lung Disease
16.4.1 Asthma/Reactive airway disease	X	X
16.4.2 Bronchitis and bronchiolitis		X	X
16.4.3 Bronchopulmonary dysplasia		X	X
16.4.4 Chronic obstructive pulmonary disease	X	X	X
16.4.5 Cystic fibrosis	X	X	X
16.4.6 Environmental/Industrial exposure	X	X	X
16.4.7 Foreign body (See 16.1.2)	X	X
16.5 Physical and Chemical Irritants/Insults
16.5.1 Pneumoconiosis		X	X
16.5.2 Toxic effects of gases, fumes, vapors (See 18.1.3.3.2)	X	X	X
16.6 Pulmonary Embolism/Infarct
16.6.1 Septic emboli	X	X
16.6.2 Venous thromboembolism (See 3.3.2.1)	X	X	X
16.6.2.1 Massive and submassive embolism	X	X
16.6.3 Fat emboli	X	X
16.7 Pulmonary Infections
16.7.1 Lung abscess		X
16.7.2 Pneumonia
16.7.2.1 Aspiration	X	X
16.7.2.2 Community-acquired	X	X	X
16.7.2.3 Hospital-acquired pneumonia	X	X	X
16.7.2.4 Pneumocystis	X	X	X
16.7.3 Pulmonary tuberculosis		X
16.7.4 Respiratory syncytial virus (RSV)	X	X	X
16.7.5 Pertussis	X	X	X
16.8 Tumors
16.8.1 Breast			X
16.8.2 Pulmonary		X	X
16.9 Pulmonary Hypertension	X	X	X
17.0 TOXICOLOGIC DISORDERS
	Critical	Emergent	Lower Acuity
17.1 Drug and Chemical Classes
17.1.1 Alcohol (See 14.1.1)
17.1.1.1 Ethanol	X	X	X
17.1.1.2 Ethylene glycol	X	X
17.1.1.3 Isopropyl	X	X	X
17.1.1.4 Methanol	X	X
17.1.2 Analgesics
17.1.2.1 Acetaminophen	X	X
17.1.2.2 Nonsteroidal anti-inflammatories (NSAIDS)		X	X
17.1.2.3 Opioids (See 14.1.6)	X	X
17.1.2.4 Salicylates	X	X
17.1.3 Anticholinergics	X	X
17.1.3.1 Antihistamines		X
17.1.4 Anticoagulants/Antithrombotics/Antiplatelets	X	X
17.1.4.1 Direct thrombin inhibitors	X
17.1.4.2 Factor Xa inhibitors	X
17.1.4.3 Heparins	X	X
17.1.4.4 Vitamin K antagonists	X		X
17.1.5 Anticonvulsants	X	X
17.1.6 Antidepressants	X	X
17.1.6.1 Bupropion		X
17.1.6.2 Selective serotonin reuptake inhibitors		X	X
17.1.6.3 Tricyclic antidepressants	X	X
17.1.7 Antiemetics		X
17.1.8 Antimicrobials
17.1.8.1 Antibiotics		X	X
17.1.8.1.1 Isoniazid	X	X
17.1.8.2 Antimalarials	X	X	X
17.1.8.3 Antiretrovirals	X	X	X
17.1.9 Antipsychotics	X	X
17.1.10 Carbon monoxide	X	X
17.1.11 Cardiovascular drugs
17.1.11.1 Antidysrhythmics	X	X
17.1.11.1.1 Digoxin	X	X
17.1.11.2 Antihypertensives	X	X
17.1.11.2.1 Central acting	X	X
17.1.11.2.2 Peripheral Acting	X	X
17.1.11.3 Beta blockers	X	X
17.1.11.4 Calcium channel blockers	X	X
17.1.12 Cholinergics	X	X
17.1.12.1 Nerve agents	X	X
17.1.12.2 Organophosphates	X	X
17.1.13 Cyanides, hydrogen sulfide	X	X
17.1.14 Heavy metals	X	X
17.1.15 Herbicides, insecticides, and rodenticides	X	X
17.1.16 Household/Industrial chemicals	X	X	X
17.1.16.1 Caustic agents (See 2.2.2.3)	X	X
17.1.16.2 Hydrocarbons	X	X
17.1.16.3 Inhaled irritants	X	X
17.1.17 Hypoglycemics/Insulin	X	X
17.1.18 Lithium	X	X	X
17.1.19 Local anesthetics	X	X
17.1.20 Marine toxins (See 6.1.3)	X	X	X
17.1.21 Methemoglobinemia (See 8.5.3)	X	X
17.1.22 Mushrooms/Poisonous plants	X	X
17.1.23 Nutritional supplements		X	X
17.1.23.1 Iron	X	X
17.1.23.2 Performance enhancing and weight-loss drugs	X	X	X
17.1.24 Recreational drugs	X	X	X
17.1.24.1 Cannabis			X
17.1.24.1.1 Cannabinoid hyperemesis syndrome/Cyclic vomiting (See 2.7.7)			X
17.1.24.2 Synthetic cannabinoids	X	X	X
17.1.24.3 Hallucinogens	X	X	X
17.1.24.4 GHB	X	X	X
17.1.25 Sedatives/Hypnotics	X	X
17.1.26 Stimulants/Sympathomimetics	X	X
17.1.26.1 Amphetamines	X	X
17.1.26.2 Cocaine	X	X	X
18.0 TRAUMATIC DISORDERS
	Critical	Emergent	Lower Acuity
18.1 Trauma
18.1.1 Abdominal trauma
18.1.1.1 Diaphragm	X	X
18.1.1.2 Hollow viscus	X	X
18.1.1.3 Penetrating	X	X
18.1.1.4 Retroperitoneum	X	X
18.1.1.5 Solid organ	X	X
18.1.1.6 Vascular	X	X
18.1.1.7 Abdominal wall		X	X
18.1.2 Thoracic trauma
18.1.2.1 Aortic dissection/Disruption	X
18.1.2.2 Contusion
18.1.2.2.1 Cardiac	X	X	X
18.1.2.2.2 Pulmonary	X	X
18.1.2.3 Fracture
18.1.2.3.1 Clavicle		X	X
18.1.2.3.2 Ribs/Flail chest	X	X	X
18.1.2.3.3 Sternum		X	X
18.1.2.3.4 Scapula		X	X
18.1.2.4 Hemothorax	X	X
18.1.2.5 Penetrating chest trauma	X	X
18.1.2.6 Pericardial tamponade (See 3.6.1)	X
18.1.2.7 Pneumothorax (See 16.2.6)
18.1.2.7.1 Simple		X
18.1.2.7.2 Tension	X
18.1.2.7.3 Open	X
18.1.3 Cutaneous trauma
18.1.3.1 Avulsions		X	X
18.1.3.2 Bite wounds (See 6.1)		X	X
18.1.3.3 Burns
18.1.3.3.1 Electrical (See 6.3)	X	X	X
18.1.3.3.2 Chemical (See 16.5.2)	X	X	X
18.1.3.3.3 Thermal	X	X	X
18.1.3.4 Lacerations		X	X
18.1.3.5 Puncture wounds		X	X
18.1.3.6 Nail injuries			X
18.1.4 Facial trauma			X
18.1.4.1 Dental		X	X
18.1.4.2 Le Fort	X	X	X
18.1.4.3 Mandibular		X	X
18.1.4.4 Orbital		X	X
18.1.4.5 Nasal			X
18.1.4.5.1 Septal hematoma		X
18.1.4.6 Zygomaticomaxillary complex			X
18.1.5 Genitourinary trauma
18.1.5.1 Bladder		X
18.1.5.2 External genitalia		X
18.1.5.3 Renal		X	X
18.1.5.4 Ureteral		X
18.1.5.5 Urethral		X	X
18.1.6 Head trauma
18.1.6.1 Intracranial injury	X	X
18.1.6.1.1 Concussion		X	X
18.1.6.1.2 Intracranial hemorrhage	X	X
18.1.6.2 Scalp lacerations/Avulsions		X	X
18.1.6.3 Skull fractures		X	X
18.1.7 Spine trauma
18.1.7.1 Dislocations/Subluxations	X	X
18.1.7.2 Fractures	X	X	X
18.1.7.3 Sprains/Strains			X
18.1.8 Extremity bony trauma
18.1.8.1 Dislocations/Subluxations		X
18.1.8.2 Fractures (open and closed)		X	X
18.1.9 Neck trauma
18.1.9.1 Laryngotracheal injuries	X	X
18.1.9.2 Penetrating neck trauma	X	X
18.1.9.3 Vascular injuries	X	X
18.1.9.4 Strangulation	X	X	X
18.1.10 Ophthalmologic trauma
18.1.10.1 Corneal abrasions/Lacerations (See 7.2.1.3)		X	X
18.1.10.2 Corneal burns (See 7.2.1.1)
18.1.10.2.1 Acid		X
18.1.10.2.2 Alkali		X
18.1.10.2.3 Ultraviolet		X	X
18.1.10.3 Periorbital lacerations		X
18.1.10.3.1 Eyelid		X
18.1.10.3.2 Lacrimal duct		X
18.1.10.4 Foreign body (See 19.4.4.8)		X
18.1.10.5 Hyphema (See 7.2.2.2)		X
18.1.10.6 Penetrating globe injuries		X
18.1.10.7 Retinal detachments (See 7.2.3.4)		X
18.1.10.8 Traumatic iritis (See 7.2.2.3)		X	X
18.1.10.9 Retrobulbar hematoma		X
18.1.11 Otologic trauma
18.1.11.1 Hematoma		X	X
18.1.11.2 Perforated tympanic membrane (See 7.1.7)		X
18.1.12 Pediatric fractures
18.1.12.1 Epiphyseal		X	X
18.1.12.1.1 Salter-Harris classification		X	X
18.1.12.2 Greenstick		X
18.1.12.3 Torus			X
18.1.12.4 Apophyseal avulsion			X
18.1.13 Pelvic fracture	X	X
18.1.14 Soft-tissue extremity injuries
18.1.14.1 Amputations/Replantation		X
18.1.14.2 Compartment syndromes		X
18.1.14.3 High-pressure injection		X
18.1.14.4 Injuries to joints		X	X
18.1.14.5 Penetrating trauma		X	X
18.1.14.6 Periarticular			X
18.1.14.7 Sprains/Strains			X
18.1.14.8 Tendon injuries
18.1.14.8.1 Lacerations/Transections		X
18.1.14.8.2 Ruptures		X	X
18.1.14.9 Vascular injuries	X	X
18.1.15 Spinal cord and nervous system trauma
18.1.15.1 Cauda equina syndrome (See 11.2.7.1)	X	X
18.1.15.2 Injury to nerve roots		X	X
18.1.15.3 Peripheral nerve injury		X	X
18.1.15.4 Spinal cord injury	X	X	X
18.1.15.4.1 Spinal cord injury without radiologic abnormality (SCIWORA)		X
18.2 Trauma in Pregnancy
18.2.1 Abruptio placentae (See 13.3.4.1)	X	X
18.2.2 Resuscitative hysterotomy (See 19.4.8.2)	X
18.2.3 Premature labor (See 13.6.2)		X
18.2.4 Rupture of uterus (See 13.6.4)	X
18.3 Multi-system Trauma	X	X
18.3.1 Blast injury	X	X
18.3.2 Falls	X	X	X
18.3.3 Motor vehicle collision	X	X	X
18.3.4 Assault	X	X	X
19.0 PROCEDURES AND SKILLS INTEGRAL TO THE PRACTICE OF EMERGENCY MEDICINE
19.1 Airway Techniques
19.1.1 Intubation
19.1.2 Airway adjuncts
19.1.3 Surgical airway
19.1.4 Mechanical ventilation
19.1.5 Noninvasive ventilatory management
19.1.6 Ventilatory monitoring
19.2 Resuscitation
19.2.1 Cardiopulmonary resuscitation
19.2.2 Neonatal resuscitation
19.2.3 Pediatric resuscitation
19.2.4 Post-resuscitative care
19.2.4.1 Therapeutic hypothermia (or targeted temperature management)
19.2.5 Blood, fluid, and component therapy
19.2.6 Arterial catheter insertion
19.2.7 Central venous access
19.2.8 Intraosseous line placement
19.2.9 Defibrillation
19.2.10 Thoracotomy
19.2.11 Extracorporeal membrane oxygenation (ECMO)
19.2.12 Thermoregulation procedures
19.3 Anesthesia and Acute Pain Management
19.3.1 Regional anesthesia
19.3.2 Procedural sedation
19.3.3 Analgesia
19.4 Diagnostic and Therapeutic Procedures
19.4.1 Abdominal and gastrointestinal
19.4.1.1 Anoscopy
19.4.1.2 Excision of thrombosed hemorrhoid
19.4.1.3 Gastrostomy tube replacement
19.4.1.4 Nasogastric tube
19.4.1.5 Paracentesis
19.4.1.6 Mechanical control of upper gastrointestinal bleeding
19.4.2 Cardiovascular and Thoracic
19.4.2.1 Cardiac pacing
19.4.2.2 Cardioversion
19.4.2.3 ECG interpretation
19.4.2.4 Pericardiocentesis
19.4.2.5 Thoracentesis
19.4.2.6 Thoracostomy
19.4.3 Cutaneous
19.4.3.1 Escharotomy
19.4.3.2 Incision and drainage
19.4.3.3 Trephination, nails
19.4.3.4 Wound closure techniques
19.4.3.5 Wound management
19.4.4 Head, ear, eye, nose, and throat
19.4.4.1 Control of epistaxis
19.4.4.2 Drainage of peritonsillar abscess
19.4.4.3 Laryngoscopy
19.4.4.4 Lateral canthotomy
19.4.4.5 Slit lamp examination
19.4.4.6 Tonometry
19.4.4.7 Tooth stabilization
19.4.4.8 Corneal foreign body removal (See 18.1.10.4)
19.4.4.9 Drainage of hematoma
19.4.5 Systemic infectious
19.4.5.1 Personal protection (equipment and techniques)
19.4.5.2 Universal precautions and exposure management
19.4.6 Musculoskeletal
19.4.6.1 Arthrocentesis
19.4.6.2 Compartment pressure measurement
19.4.6.3 Fracture/Dislocation immobilization techniques
19.4.6.4 Fracture/Dislocation reduction techniques
19.4.6.5 Spine immobilization techniques
19.4.6.6 Fasciotomy
19.4.7 Nervous system
19.4.7.1 Lumbar puncture
19.4.8 Obstetrics and gynecology
19.4.8.1 Delivery of newborn
19.4.8.2 Resuscitative hysterotomy (See 18.2.2)
19.4.8.3 Sexual assault examination
19.4.9 Psychobehavioral
19.4.9.1 Psychiatric screening examination
19.4.9.2 Violent patient management/Restraint
19.4.10 Renal and urogenital
19.4.10.1 Bladder catheterization
19.4.10.1.1 Urethral catheter
19.4.10.1.2 Suprapubic catheter
19.4.10.2 Cystourethrogram
19.4.10.3 Testicular detorsion
19.4.11 Toxicologic
19.4.11.1 Decontamination
19.4.11.2 Antidote administration
19.5 Ultrasound
19.5.1 Diagnostic ultrasound
19.5.2 Procedural ultrasound
19.6 Other Diagnostic and Therapeutic Procedures
19.6.1 Foreign body removal
19.6.2 Collection and handling of forensic material
20.0 OTHER CORE COMPETENCIES OF THE PRACTICE OF EMERGENCY MEDICINE
20.1 Interpersonal and Communication Skills
20.1.1 Interpersonal skills
20.1.1.1 Inter-departmental and medical staff relations
20.1.1.2 Intra-departmental relations, teamwork, and collaboration skills
20.1.1.3 Patient and family experience of care
20.1.2 Communication skills
20.1.2.1 Complaint management and service recovery
20.1.2.2 Conflict management
20.1.2.3 Crisis resource management
20.1.2.4 Delivering bad news/Death notifications
20.1.2.5 Cultural competency
20.1.2.6 Negotiation skills
20.1.2.7 Management of patient expectations
20.2 Practice-based Learning and Improvement
20.2.1 Performance improvement and lifelong learning
20.2.1.1 Evidence-based medicine
20.2.1.2 Interpretation of medical literature
20.2.1.3 Knowledge translation
20.2.1.4 Patient safety and medical errors
20.2.1.5 Performance evaluation and feedback
20.2.1.6 Research
20.2.2 Practice guidelines
20.2.3 Education
20.2.3.1 Patient and family
20.2.3.2 Provider
20.2.4 Principles of quality improvement
20.3 Professionalism
20.3.1 Advocacy
20.3.1.1 Patient
20.3.1.2 Professional
20.3.1.3 Healthcare disparities
20.3.2 Ethical principles
20.3.2.1 Conflicts of interest
20.3.2.2 Diversity and inclusion awareness
20.3.2.3 Electronic communications/Social media
20.3.2.4 Medical ethics
20.3.2.5 Stewardship of resources
20.3.2.6 Care of vulnerable populations
20.3.3 Leadership and management principles
20.3.4 Well-being and resilience
20.3.4.1 Fatigue and impairment
20.3.4.1.1 Sleep hygiene
20.3.4.2 Time management/Organizational skills
20.3.4.3 Work/Life balance
20.3.4.4 Work dysphoria (burn-out)
20.3.4.5 Job and contract evaluation
20.3.4.6 Care for the caregiver
20.4 Systems-based Practice
20.4.1 Clinical informatics
20.4.1.1 Computerized order entry
20.4.1.2 Clinical decision support
20.4.1.3 Electronic health record
20.4.1.4 Health information exchange and interoperability
20.4.2 ED Administration
20.4.2.1 Contracts and practice models
20.4.2.2 Patient flow and throughput
20.4.2.2.1 Patient triage and classification
20.4.2.2.2 Hospital crowding and diversion
20.4.2.2.3 Observation and rapid treatment units
20.4.2.3 Financial principles
20.4.2.3.1 Billing and coding
20.4.2.3.2 Cost-effective care and resource utilization
20.4.2.3.3 Reimbursement issues
20.4.2.4 Human resource management
20.4.2.4.1 Allied health professionals
20.4.2.4.2 Recruitment, credentialing, and orientation
20.4.2.4.3 Staffing/Scheduling
20.4.2.5 Emergency preparedness
20.4.3 ED operations
20.4.3.1 Policies and procedures
20.4.3.2 ED data acquisition and operational metrics
20.4.3.3 Safety, security, and violence in the ED
20.4.3.4 Patient satisfaction
20.4.4 Health care coordination
20.4.4.1 Advance directives
20.4.4.2 Palliative care
20.4.4.2.1 Patient identification for palliative care
20.4.4.2.2 Withdrawal of support
20.4.4.2.3 Hospice referral
20.4.4.3 Placement options
20.4.4.3.1 Activities of daily living/Functional assessment
20.4.4.4 Outpatient services
20.4.4.5 Organ donation
20.4.5 Regulatory/Legal
20.4.5.1 Accreditation
20.4.5.2 Compliance and reporting requirements
20.4.5.3 Confidentiality and privacy
20.4.5.4 Consent, capacity, and refusal of care
20.4.5.5 Emergency Medical Treatment and Active Labor Act (EMTALA)
20.4.5.6 External quality metrics
20.4.5.7 Good Samaritan emergency care
20.4.6 Risk management
20.4.6.1 Liability and litigation
20.4.6.2 Professional liability insurance
20.4.6.3 Risk mitigation
20.4.6.4 Error disclosure
20.4.6.5 Root cause analysis
20.4.7 Evolving trends in health care delivery
20.4.7.1 Public policy
20.4.7.2 Gender identity and sexual orientation
20.4.7.2.1 Transgender care
20.4.7.3 Social determinants of health
20.4.7.4 Firearm injury prevention
20.4.8 Regionalization of emergency care

ED = emergency department.

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The Accreditation Council for Graduate Medical Education (ACGME) requires each specialty to develop outcomes-based milestones for resident performance within the six general (core) competencies (i.e., patient care, medical knowledge, practice-based learning and improvement, interpersonal skills, professionalism, and system-based practice). The six general competencies are an integral part of the practice of emergency medicine and are embedded in the EM Model (

15

Chapman D.M.
Hayden S.
Sanders A.B.
et al.

Integrating the Accreditation Council for Graduate Medical Education Core Competencies into the Model of the Clinical Practice of Emergency Medicine.

,

16

Chapman D.M.
Hayden S.
Sanders A.B.
et al.

Integrating the Accreditation Council for Graduate Medical Education Core Competencies into the Model of the Clinical Practice of Emergency Medicine.

). The EM Model is closely aligned with the general competencies, using section headings with similar terminology.

The EM Model is designed for use as the core document for the specialty. It provides the foundation for developing medical school and residency curricula; certification examination specifications; continuing education objectives; research agendas; residency program review requirements; and other documents necessary for the definition, skills acquisition, assessment, and practice of the specialty. In conjunction with the EM Model, these six general competencies construct a framework for evaluation of physician performance and curriculum design to further refine and improve the education and training of competent emergency physicians. The six competencies and the EM Model also form the core of ABEM's continuing certification process. For further information on this process see ABEM's website (www.abem.org/).

Changes in the EM Model

The 2019 EM Model Review Task Force met to consider changes based on input received from the seven collaborating organizations. Each organization was asked to comment on how it uses the EM Model, identify changes in practice or updated evidence, and recommend changes in the document that would address any deficiencies. The changes recommended by the 2019 EM Model Review Task Force and accepted by the seven organizations can be found in the Appendix.

Current Uses of the EM Model

AAEM

AAEM uses the EM Model as a reference document to identify topics for annual conference programming.

ABEM

ABEM uses the EM Model to define its examination specifications. Each question or structured case used in any ABEM examination is referenced to the EM Model. Every test and examination that ABEM develops is based on a blueprint derived directly from the EM Model.

ACEP

ACEP uses the EM Model primarily as the basis for its educational activities. In addition, the ACEP Academic Affairs Committee uses the EM Model to align programming with academic educational needs. This information is used to develop a comprehensive list of web-based educational resources that can be incorporated into residency curricula.

CORD and the RRC-EM

The integration of the competencies into the EM Model meets the program requirements of the RRC-EM that the six core competencies are included in residency training. The EM Model is a major tool for CORD and Emergency Medicine program faculty to use when integrating the competencies into the training, residency curricula, and evaluation of residents.

EMRA

EMRA uses the EM Model as a reference document to identify content at risk for testing on the in-training and certification examinations.

SAEM

SAEM uses the EM Model as a reference document to identify topics and plan programming.

In summary, the EM Model is accomplishing the intended purposes for which it was developed. The 2019 review of the EM Model resulted in significant changes and clarifications, including the addition of an oncology section within Category 8, Hematologic and Oncologic Disorders. Several emergency medicine organizations are using the EM Model to support the ongoing development of the specialty of emergency medicine. The complete updated 2019 EM Model can be found on the websites of each of the eight collaborating organizations.

Acknowledgments

The 2019 Model of the Clinical Practice of Emergency Medicine is used with permission of the American Academy of Emergency Medicine, the American Board of Emergency Medicine, the American College of Emergency Physicians, the Council of Emergency Medicine Residency Directors, the Emergency Medicine Residents' Association, the Residency Review Committee for Emergency Medicine, and the Society for Academic Emergency Medicine, copyright 2020.

Supplementary Data

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References

- Hockberger R.S.
- LaDuca A.
- Orr N.A.
- et al.
Creating the model of a clinical practice: the case of emergency medicine.
Acad Emerg Med. 2003; 10: 161-168
View in Article
Core Content Task Force II. The Model of the Clinical Practice of Emergency Medicine.
Ann Emerg Med. 2001; 37: 745-770
View in Article
Core Content Task Force II. The Model of the Clinical Practice of Emergency Medicine.
Acad Emerg Med. 2001; 8: 660-681
View in Article
- Hockberger R.S.
- Binder L.S.
- Chisholm C.D.
- et al.
The Model of the Clinical Practice of Emergency Medicine: a 2-year update.
Ann Emerg Med. 2005; 45: 659-674
View in Article
- Hockberger R.S.
- Binder L.S.
- Chisholm C.D.
- et al.
The Model of the Clinical Practice of Emergency Medicine: a 2-year update.
Acad Emerg Med. 2005; 12: 543-558
View in Article
- Crossref
- Google Scholar
- Thomas H.A.
- Binder L.S.
- Chapman D.M.
- et al.
The 2003 Model of the Clinical Practice of Emergency Medicine: the 2005 update.
Ann Emerg Med. 2006; 48: e1-e17
View in Article
- Thomas H.A.
- Binder L.S.
- Chapman D.M.
- et al.
The 2003 Model of the Clinical Practice of Emergency Medicine: the 2005 update.
Acad Emerg Med. 2006; 13: 1070-1073
View in Article
- Thomas H.A.
- Beeson M.S.
- Binder L.S.
- et al.
The 2005 Model of the Clinical Practice of Emergency Medicine: the 2007 update.
Acad Emerg Med. 2008; 15: 776-779
View in Article
- Thomas H.A.
- Beeson M.S.
- Binder L.S.
- et al.
The 2005 Model of the Clinical Practice of Emergency Medicine: the 2007 update.
Ann Emerg Med. 2008; 52: e1-e17
View in Article
- Perina D.G.
- Beeson M.S.
- Char D.M.
- et al.
The 2007 Model of the Clinical Practice of Emergency Medicine: the 2009 update.
Acad Emerg Med. 2011; 18: e8-e26
View in Article
- Perina D.G.
- Beeson M.S.
- Char D.M.
- et al.
The 2007 Model of the Clinical Practice of Emergency Medicine: the 2009 update.
Ann Emerg Med. 2011; 57: e1-e15
View in Article
- Perina D.G.
- Brunett C.P.
- Caro D.A.
- et al.
The 2011 Model of the Clinical Practice of Emergency Medicine.
Acad Emerg Med. 2012; 19: e19-e40
View in Article
- Counselman F.L.
- Borenstein M.A.
- Chisholm C.D.
- et al.
The 2013 Model of the Clinical Practice of Emergency Medicine.
Acad Emerg Med. 2014; 21: 574-598
View in Article
- Counselman F.L.
- Babu K.
- Edens M.A.
- et al.
The 2016 Model of the Clinical Practice of Emergency Medicine.
J Emerg Med. 2017; 52: 846-849
View in Article
- Chapman D.M.
- Hayden S.
- Sanders A.B.
- et al.
Integrating the Accreditation Council for Graduate Medical Education Core Competencies into the Model of the Clinical Practice of Emergency Medicine.
Ann Emerg Med. 2004; 43: 756-759
View in Article
- Chapman D.M.
- Hayden S.
- Sanders A.B.
- et al.
Integrating the Accreditation Council for Graduate Medical Education Core Competencies into the Model of the Clinical Practice of Emergency Medicine.
Acad Emerg Med. 2004; 11: 674-685
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Published online: May 28, 2020

Accepted: March 18, 2020

Received: February 6, 2020

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Disclosure: Joshua S. Broder is a shareholder in OmniSono Inc. His spouse is employed by GlaxoSmithKline. The remaining authors disclose no conflicts.

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DOI: https://doi.org/10.1016/j.jemermed.2020.03.018

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The 2019 Model of the Clinical Practice of Emergency Medicine

The EM Model

Changes in the EM Model

Current Uses of the EM Model

AAEM

ABEM

ACEP

CORD and the RRC-EM

EMRA

SAEM

Acknowledgments

Supplementary Data

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