Procedural Sedation

The Centers for Medicare & Medicaid Services (CMS) responded to ACEP’s concerns and now allows an exception for emergency departments in their interpretive guidelines on use of anesthesia services. Along with other emergency clinician groups, ACEP asked CMS to revise their anesthesia policy interpretations, citing potential harm to patients.
Letter from ACEP Past President Dr. Sandra Schneider about CMS Decision on Anesthesia Guidelines
Letter from the American Society of Anesthesiologists Clarifying Their Position on Emergency Physicians and Sedation
Updated CMS Guidelines

ACEP and ASA Issue Joint Statement on Ketamine Use

August 26, 2020 - The American College of Emergency Physicians (ACEP) and the American Society of Anesthesiologists (ASA) announced a collaborative statement on the use of ketamine in prehospital settings.

Ketamine is a dissociative anesthetic that is widely used in the emergency department and in prehospital care for effective pain management, sedation, the control of delirium in acute psychotic emergencies and drug intoxications. Its safe use in prehospital care is dependent on an appropriate medical assessment by a paramedic with medical direction guiding appropriate dosing, monitoring as soon as feasible, and timely transport to an emergency department for further assessment and treatment.

ACEP and ASA firmly oppose the use of ketamine or any other sedative/hypnotic agent to chemically incapacitate someone solely for a law enforcement purpose and not for a legitimate medical reason.

Unscheduled Sedation

Unscheduled Procedural Sedation: A Multidisciplinary Consensus Practice Guideline 

Frequently Asked Questions: Unscheduled Sedation Guidelines

ACEP Policy Statements

Procedural Sedation in the Emergency Department

Verification of Endotracheal Tube Placement

ACEP Clinical Policies

Clinical Policy: Procedural Sedation and Analgesia in the Emergency Department 

ACEP Establishes Position on Sedation

Procedural Sedation and Analgesia in the Emergency Department: Recommendations for Physician Credentialing, Privileging and Practice
At its June 2011 Board meeting, the ACEP Board of Directors approved this article that reflects ACEP’s position on procedural sedation and analgesia in the emergency department.    

Procedural Sedation Consensus Statement, Addendum and Bibliography
Signed by ACEP, ENA and 7 other organizations, this statement supports the routine use of procedural sedation by appropriately trained and credentialed emergency nurses and physicians.

ENA Advocacy Package

Procedural Sedation and Analgesia in the ER
This packet was developed by the Emergency Nurses Association to assist state leaders in developing collaborative strategies to advocate for state board of nursing policies that support the administration of medications such as propofol during procedural sedation in the emergency department.

Comment Letters and Testimony

Letter to Vermont Nursing Board   
Letter to Wyoming State Board of Nursing  
Letter to North Dakota Board of Nursing
Testimony presented at the Iowa Board of Nursing

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