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April 2014

Safeguarding children and young people: roles and compentences for health care staff  - This RCPCH document provides a competency framework for all groups (ranging from non-clinical staff to experts), information on education and training and role descriptions for named and designated professionals. This document will help all health staff understand their responsibilities in recognising child maltreatment and how to take effective action.

MARCH 2014

Intravenous Regional Anaesthesia for Distal Forearm Fractures (Bier’s Block) - Revised guidance published - The College has revised and reissued our best practice guideline on Bier's Blocks. 

College Guidelines

HEE EM Overseas Development ProjectHealth Education England (HEE), along with the College of Emergency Medicine (EM) UK, is offering places for doctors from India to develop your emergency medicine skills and gain valuable clinical experience. The programme is up to four years, after which you will return home to use your skills to care for patients and share learning with colleagues.

Eligible candidates are invited to apply and, if successful in the interviews, will be offered a rotational post in hospitals in one region of England. The programme will last up to four years and will include the opportunity to attend a College of Emergency Medicine organised programme to prepare you for either the Membership of the College of Emergency Medicine (MCEM) or the Fellowship of the College of Emergency Medicine (FCEM) examinations, depending on your existing experience. You will also be given access to the College’s e-portfolio so you can officially document your progression and reflect on the skills you’ve acquired, as well as access the College’s e-learning resources.

Press Statement - Patient Focused Health Targets in Wales - 27/03/2014 - The College is concerned about the new targets being considered by the Welsh Government especially their plans to change the targets affecting A&Es. Press release: Wales health targets

Baseline Emergency Staffing Tool (BEST) - BEST is a workforce planning tool for use at local level in your Emergency Department (ED) to allow any disparity between nursing workload and staffing to be highlighted. The tool allows you to:

  • analyse the volume and pattern of nursing workload in your ED
  • track this against your rostered staffing level
  • calculate the whole time equivalent workforce and skill mix which would be required to provide the nursing care needed in the department during the audit period.

The tool has been developed by the RCN Emergency Care Association (ECA) and Faculty of Emergency Nursing (FEN).

Baseline Emergency Staffing Tool

Pioneers of Care Award 2014 - The award is designed to celebrate and reward trailblazing nurses who have gone out of their way to work effectively, efficiently and empathetically with their patients and have introduced new techniques to solve problems and help improve lives.

This year, there are three categories:
Pioneering Emergency Nurse
Pioneering Practice Nurse
Inspirational Student Nurse

The winner of each category will be awarded a £500 bursary and a hand crafted, unique Pioneers of Care broach, which will be presented at the Welcome Foundation, Central London on the 4th July 2014.

EMF International Emergency Medicine Outcomes and Efficacy Research Grant – Deadline March 21, 2014
The Emergency Medicine Foundation (EMF) is seeking proposals for a $10,000 international emergency medicine research grant. The proposal deadline has been extended to March 21, 2014 at 5:00 pm CST.  You can find the RFP and submission instructions on the EMF website at  Early submissions are appreciated. 

Design the Smartest ED: Process, Space and People. 7 - 9 July 2014, Cambridge - CEM has brought together an international faculty to deliver a short course that offers clinicians and design professionals an opportunity to understand the requirements and evidence that supports the design of the smartest Emergency Department. Read more here. To apply go to


Mental Health Crisis Care Concordat - Improving outcomes for people experiencing mental health crisis - On 18 February 2014 the Government published a joint statement about how public services should work together to respond to people who are in mental health crisis. The College of Emergency Medicine is a signatory to the concordat and welcomes and supports this commitment to work together to improve the system of care and support so people in a crisis because of a mental health condition are kept safe and helped to find the support they need, whatever the circumstances in which they need help and form whichever service they turn to first.

Read the Press Statement

Read the Concordat in full

Prevention and management of clinically challenging behaviour - NHS Protect have published a series of videos that have been developed to complement the meeting needs and reducing distress guidance and assist in challenging behaviour awareness training, staff inductions or as a standalone learning resource for staff involved in direct patient care. Suitable for both clinical and non-clinical staff working in a range of settings.


Updated NICE guideline on Head Injury published

New National Patient Safety Alerting System in England - In January 2014 the new National Patient Safety Alerting System (NPSAS) was launched to strengthen the rapid dissemination of urgent patient safety alerts to healthcare providers via the Central Alerting System (CAS). This three-stage alerting system also provides useful educational and implementation resources to support providers to put appropriate measures in place to prevent harm and encourage and share best practice in patient safety. The system builds on the strengths of the previous National Patient Safety Agency (NPSA) patient safety alerts and rapid response reports and is based on systems used in other high risk industries. For more information about the new system go to: 

National Tariff Payment System - Monitor and NHS England have published the 2014/15 National Tariff Payment System. This document sets out national prices for services; the operation of national business rules, such as the marginal rate, which affect national prices, and; the efficiency factor and deflators which apply to services under national and local tariffs. Download this document here.

Press Statement: Important changes to the acute admissions tariff rules 21/01/2014 - The College welcomes the confirmation today of changes to the acute admissions tariff rules. Meetings with the Secretary of State in December recognised the need for such changes. The College would expect the Commons Health Select Committee to explore the issue of tariff reform with Sir Bruce Keogh and Professor Keith Willetts during their testimony this afternoon, as financial realities will be a key driver in delivering their reforms. Download this statement here.

Staff Care - How to engage staff in the NHS and why it matters - The Point of Care Foundation is an independent charity working to improve patients’ experience of care and increase support for the staff who work with them. The foundation has published a report emphasising that caring about the people who work in healthcare is the key to developing a caring and compassionate health service.

Press Statement: The spend on Locum Doctors in Emergency Departments 14/01/2014

Developing generic clinical behaviours and skills checklist - The College has prepared a document to support doctors in developing their clinical skills. This document includes checklists for various generic skills (history taking, examination, leadership of a resuscitation station) that shows the steps in these skills. It is hoped that candidates will find this useful in their preparation for workplace based assessments and OSCEs.


NHS Change Day 3.03.2014 - what will you pledge to do?

The countdown has begun to NHS Change Day 2014. The first NHS Change Day on March 13th 2013 was unprecedented. It was a 'game changer' that provided the amazing grassroots momentum so many staff, patients and people working with the NHS needed.

A single tweet grew into a movement that managed to successfully harness the passion, drive, commitment and innovation that we see every single day from staff. Last year saw 189,000 pledges to make things better. This year our goal is for 500,000.

Anyone can make a pledge. We ask everyone to embrace the energy of Change Day and to PLEDGE, SHARE, DO and INSPIRE. To make the NHS the best is can be. Let's do something better and courageous together. It's time for NHS Change Day 2014 to begin.

International Consortium in Emergency Geriatrics launches new website:

Run Through Training offer to existing eligible trainees - In 2014, an Emergency Medicine Run Through Training pilot will commence. Whilst there are various components within the pilot, this guidance has been specifically created to clarify arrangements for offering run through training to existing, eligible Acute Care Common Stem (ACCS) Emergency Medicine (EM) and CT3 EM trainees.



Liaison Psychiatry for every Acute Hospital - Every acute hospital needs a liaison psychiatry service to manage the mental health needs of patients being treated primarily for physical health conditions, according to a new report published on 20th December 2013 by the Royal College of Psychiatrists. Implementing liaison services could improve quality of care for patients, reduce rates of readmission, decrease length of stay, and save trusts millions of pounds.

The report, Liaison psychiatry for every acute hospital, has the backing of six other professional bodies: the College of Emergency Medicine, College of Mental Health Pharmacy, Royal College of General Practitioners, Royal College of Nursing, Royal College of Physicians and the Society for Acute Medicine.

The report makes a series of recommendations on how liaison services should be designed, including:

  • Liaison psychiatry services should be funded and planned in conjunction with physical services, so that both the physical and mental health problems of patients can be well managed.
  • Patients in acute hospitals should have equitable access to a consultant psychiatrist for mental health problems, as well as to a consultant for their physical health.
  • All liaison psychiatry service functions should be provided five days a week, and all emergency or urgent clinical problems should be covered seven days a week.
  • Liaison services should aim for a maximum response time of within 1 hour for emergency referrals and 1 day (usually within 5 working hours) for urgent referrals.

Download the full report

Press statement: 5 Key challenges for Emergency Medicine The College of Emergency Medicine today issues a call to readdress the previous term 'crisis' into five key challenges facing Emergency Medicine. Considerable progress has been made in discussions with HEE, Monitor and the DH. Negotiations with employers are ongoing via the BMA, and the Keogh review has identified the need for improved access to alternatives to A&E departments. These developments are evidence that we have made progress; but the 5 key challenges we identified in our document 'Priorities for Resolving the Emergency Crisis' remain and their resolution will take significant concerted action over the coming months. Download this press release here.

Press statement: Emergency Medicine - Background to HEE & CEM proposals to address workforce shortages 18/12/2013

The College of Emergency Medicine welcomes the publication of the report by Health Education England entitled 'Emergency Medicine - Background to HEE proposals to address workforce shortages'.

The report’s proposals and recommendations are for improvements in the future workforce of emergency departments to ensure that patients receive consistent, high quality, safe and effective care.

Download press statement

Download full report



Press statement: Access to Primary Care 18/12/2013 - The College of Emergency Medicine endorses the concerns of the Patients Association and the findings of the National Audit Office. Access to primary care is a key determinant of attendances to emergency departments. Where access is good, attendance rates are substantially lower. Patients value the ability to consult a general practitioner for most of their health concerns. Emergency departments are neither designed nor resourced to deal with primary care issues.

Download press statement

Survey of Psychological Health in Emergency Medicine Consultants The University of Exeter is researching Emergency Department (ED) consultants' perceptions of their psychological health and wellbeing. All physicians working at consultant level in emergency departments (EDs) across England have been invited to take part in an online questionnaire. If you agree to join the study it will take around 10-15 minutes to complete and your answers will be stored electronically and anonymously.

Please click on this link   to participate. The survey will remain open until enough responses have been gathered. Thank you for your support.



The Safety Toolkit

The Safer Care Committee has developed the safety toolkit which aims to describe the structures, processes and skills required for a ‘safe’ Emergency Department. There are resources identified within each section to stimulate, provoke and challenge, as well as to guide personal development. There are overlapping references and differing perspectives but the vision is of a resource for change and development. Download the toolkit: Care/Safety in your ED/The Safety Toolkit



Bridging the Gap: The financial case for a reasonable rebalancing of health and care resources
Bridging the Gap is a joint report from the Royal College of Psychiatrists and Centre for Mental Health which focuses on immediate improvements that can be made to the care and support offered to millions of NHS patients by  enhancing mental health support within or on the interface with physical health services.

Meeting needs and reducing distress: Guidance for the prevention and management of clinically related challenging behaviour in NHS settings - New NHS guidance on how to prevent and manage challenging behaviour related to clinical conditions is launched today, Thursday 5th December, 2013. It is for the use of clinical and non-clinical NHS staff and managers and may also be of interest to patients and service users, carers and families.



Updated CEM/NPIS Antodote Availability Guidance - This guideline updates the previous 2008 version and provides guidance on the stocking of antidotes in Emergency Departments in the UK.

'A better A&E' - design solutions to reduce violence and aggression - A design solution to reduce levels of violence and aggression in Accident & Emergency (A&E) departments created by PearsonLloyd and commissioned by the Department of Health and Design Council, has found significant improvements in overall patient experience, a reduction in levels of frustration hostility, and cost saving benefits.

New Carbon Monoxide poisoning diagnosis algorithm - Donwload the latest algorithm from Public Health England

IFEM Newsletter - November 2013 - Find out the latest news from the International Federation for Emergency Medicine

Guidance for doctors looking to work in the UK - The College has published a basic guide to working in Emergency Medicine for the NHS in the UK to help doctors familiarise themselves with the structure and terminology.

Latest version of Unified Diagnostic DAtaset released - The Unified Diagnostic DAtaset (UDDA) integrates ICD10, SNOMED, CDS and ‘real world’ descriptions of disease. The aim is to enable consistent coding in Emergency Departments, in a way that is easy for IT systems providers to implement. Download the latest version and release notes here

Commissioning the delivery of high quality care in the Integrated Emergency Department: Guidance for Commissioners, clinicians and managers - This position papers provides guidance on commissioning an integrated emergency care system and provides ten key recommendations which should always be considered when the configuration of locals EDs are made. Download this guide here.

Press statement: New contractual arrangements for GPs - The College of Emergency Medicine welcomes the news this morning that an agreement has been reached on new contractual arrangements for General Practitioners. The GP community is an important part of the answer to the challenges faced by Emergency Departments as we cope with rising patient numbers.

Press statement: Review of Urgent and Emergency Care by NHS England - The College of Emergency Medicine welcomes the review announcement made today (13th November 2013). However, this review is very much future focussed and the crisis is here with us now. For further information about this review please see this link:

10 priorities for resolving the A&E crisis - The College has published ’10 priorities for resolving the crisis in Emergency Departments’ which clearly sets out what action needs to be taken to address the current crisis in A&E. The College through its Members is playing its part and we are working in 5 key areas. However, this crisis cannot be solved by us alone, we need urgent action by all stakeholders to work with us to provide a stable long term future for A&E services whilst tackling the short term immediate pressures. This is why we have identified 5 priorities for us and 5 for the Government and NHS leadership to grasp to address this crisis. Our proposals are the collective view of practicing Emergency Physicians; they represent cost-effective solutions to ensure we can deliver safe patient care.

MHRA recall - certain batches of Novomix 30 Insulin: See full details here

Support the 8th National Carbon Monoxide Awareness Week: 18 –24 November 2013 - CO Awareness and the College are keen for all to support the 8th national carbon monoxide awareness week by raising awareness of the dangers from carbon monoxide poisoning, how to avoid it and supporting victims of CO poisoning. A variety of posters and information leaflets for display in your ED are available from and from the College's guidelines page.

Follow the work of CO Awareness on Twitter






Integration of Safety Checklist – How well is safety integrated into your ED? The Safer Care Committee has developed a safety checklist. This allows you to assess how well you integrate and consider safety in your departmental activities and makes suggestions for which staff need to be involved. 

ICEM 2014, Hong Kong, 11-14 June 2014 - Registration is now open. The deadline for submission of abstracts is 30th November 2013. Go to for more details.

Press release - GMC report: The state of medical education and practice in the UK The College of Emergency Medicine welcomes this report from the General Medical Council (GMC) which identifies the important issues relating to the medical workforce in Emergency Departments.

CEM Patient Safety Award 2013 - The Patient Safety Award is awarded annually to an individual or hospital team that can demonstrate evidence of improved patient safety as a direct result of an innovation within their emergency department. The inaugural prize was awarded to Imperial College Healthcare NHS Trust for ‘Project to improve accurate identification of emergency patients’ at the 2013 CEM Scientific Conference at Twickenham. Read more about this here.

Never Events - Could they occur in your Emergency Department? - Never Events are incidents which are considered unacceptable and eminently preventable. The Safer Care Committee has prepared a guide which higlights Never Events that could occur within your Emergency Department and how to mitigate their risks. Download this guide here.

Stretched to the limit - A survey of Emergency Medicine consultants in the UK - This report, the first of its kind, describes the working practixes of consultants and other senior decision makers in the Emergency Department, the pressures they face and the impact on their working lives. It shows that overall 62% regard the job they are doing running the Emergency Medicine service as unsustainable in its current form and 94% of respondents tell us that they regularly work in excess of their normal planned hours to help deliver the service. The College calls for change to address this. Download the report and press statement here.

Creating satisfaction and maintaining wellbeing in Emergency Medicine - The College has published a series of documents to provide better guidance for doctors, employers and commissioners on ways in which to protect the senior medical workforce in Emergency Medicine (EM) in their present working practices. This is vital not only to retain safe, sustainable working but also to create careers that are attractive to our future trainees and satisfying for our present colleagues. The documents are out for consultation and we want to hear your views on how to develop this work.

View the consultation documents


Survey on Psychological Health in Emergency Medicine Consultants - Please complete this online survey from the University of Exeter which investigates Emergency Department (ED) consultants' perceptions of their psychological health and wellbeing.



Revalidation guide for Emergency Medicine - The Revalidation Guide for Emergency Medicine brings together key information regarding current revalidation requirements and processes in all four countries of the United Kingdom. It has been developed as a web-resource for Emergency Medicine (EM) doctors who may have queries about their revalidation. The guide advises on the requirements of revalidation which are current at the time of publication.

Download the guidance




New GEMNet guideline - Suspected Scaphoid Fractures This document has been developed in response to a perceived need to improve and standardise clinical care in patients with a suspected fracture of the scaphoid bone. The intention is to distil the best available evidence into practical advice for clinicians working in the Emergency Department. The information is presented in the form of clinical decision support guidelines, readily available for use in the ED.

Download the full guideline

Download the flowchart





ICEM 2014*, Hong Kong, 11-14 June 2014 - Registration opens on 8th October 2013. The deadline for submission of abstracts is 30th November 2013. Go to for more details.

* Please note: There is an event in London in Sept 2014 entitled 'ICEM 2014', organised by the World Academy of Science, Engineering and Technology. This event is for scientists and is not related to the College or the International Federation for Emergency Medicine.

Press statement: Time to act. Severe sepsis: rapid diagnosis and treatment saves lives Sepsis is a significant cause of death and disability in the UK. The College welcomes the first clinical report from the Health Ombudsman that highlights the death of patients in the NHS after failure to diagnose and rapidly treat severe sepsis. It focuses on ten cases investigated where patients did not receive the treatment they urgently needed. In every case, tragically, the patient died.

Download CEM press statement

Read the full report

Press statement: Future Hospital Commission The College welcomes the report Future hospital: caring for medical patients, which sets out the Commission’s vision for hospital services structured around the needs of patients, now and future. The Commission’s recommendations are drawn from the very best of our hospital services, taking examples of existing innovative, patient-centred services to develop a comprehensive model of hospital care that meets the needs of patients, now and in the future.

Download CEM press statement

Read the full report



Thromboprophylaxis in ambulatory trauma patients requiring temporary limb immobilisation - This GEMNet guideline has been rebised prior to publication in the EMJ.

CEM submission to review of Urgent and Emergency Care in England - The College of Emergency Medicine has provided direct input into the Review of Urgent and Emergency Care being led by Sir Bruce Keogh.

A promise to learn – a commitment to act: improving the safety of patients in England - Read the report from Prof Don Berwick that highlights the main problems affecting patient safety in the NHS and makes recommendations to address them, stating that the health system must:

  • recognise with clarity and courage the need for wide systemic change
  • abandon blame as a tool and trust the goodwill and good intentions of the staff
  • reassert the primacy of working with patients and carers to achieve health care goals
  • use quantitative targets with caution - they should never displace the primary goal of better care
  • recognise that transparency is essential and expect and insist on it
  • ensure that responsibility for functions related to safety and improvement are established clearly and simply
  • give NHS staff career-long help to learn, master and apply modern methods for quality control, quality improvement and quality planning
  • make sure pride and joy in work, not fear, infuse the NHS

Press statement - £500 million to relieve pressures on A&E departments in England - The College welcomes the government announcement of additional funding but calls for long term solutions.

Continuing Professional Development Guidance - The College has revised and updated our guidance for doctors undertaking CPD. The guidance describes how to plan, undertake and record effective CPD that enables doctors to maintain their fitness to practice.

Standards for the clinical structure and content of patient records - The standards for the clinical structure and content of patient records were published in July 2013 by the Academy of Medical Royal Colleges. They were developed through extensive consultation to ensure that they address the requirements of clinicians, patients, carers and health information technology professionals.

Management of pain in children

The CEM best practice guidance has been revised following the recent recommendations from the MHRA restricting the use of codeine in those less than 12 years old, following a review of safety.

See the MHRA recommendations

Best practice guidelines




Consent, Capacity and Restraint of Adults, Adolescents and Children in Emergency Departments*

The College has revised and republished this best practice guidance to include children and adolescents and the legal distinctions in Scotland.

Best practice guidelines

*IMPORTANT: We recommend Fellows and Members in Scotland refer to the Mental Welfare Commission for Scotland publication Right to treat: 





Supporting medical students with mental health conditions - New guidance from the GMC and Medical Schools Council that includes suggesting preventative measures that may help to reduce mental health problems in their students, the use of occupational health and how to handle students with mental health conditions in relation to fitness to practise. It is also relevant to people and organisations involved in postgraduate medical education and training.


JULY 2013

FASSGEM conference 12-15 November 2013- View the provisional programme for this exciting event. Registration is now open via booking form.

Press release: CEM welcomes the House of Commons Health Committee Second Report on Urgent and Emergency Services (24 July 2013) - The College welcomes the report and calls for immediate action to reform urgent care and make careers in Emergency Medicine sustainable. 

NHS Institute resources for Paediatric EM - Following the closure of the NHS Institute for Innovation and Improvement, a variety of resources for Paediatric EM can now be found on the College website, including assessment tools, pathways, management plans, patient advice leaflets for specific conditions. Guidelines/External Guidelines/Paediatric EM guidance (NHS Institute)

Francis Report Recommendations – A Checklist for Senior Teams in Emergency Departments

The Francis report has many recommendations for organisations as a result of the enquiry. The College has developed this checklist for Clinical Directors of the Emergency Department – taking the most relevant recommendations and identifying key actions for clinical leaders of emergency departments. While the list is not exhaustive it is meant as a handy guide to action that might usefully be taken in the first instance


Urgent and emergency care: a prescription for the future (18 July 2013)

The Royal College of Physicians, NHS Confederation, the Society of Acute Medicine and the College of Emergency Medicine have set out ten priorities for action to address the challenges faced by urgent and emergency care services. These challenges include:

            • Rising demand and the changing needs of an ageing population
            • Lack of comprehensive, effective alternatives to hospital admission across seven-days
            • Complex discharge issues
            • Handover and flow
            • Recruitment into emergency and acute medicine


Download full report: Urgent and emergency care: a prescription for the future

Press statement from CEM

Supporting the Second Victim

Second victims are health care providers who are involved in an unanticipated adverse patient event, in a medical error and/or become victims in the sense that they are traumatised by the event. The Safer Care SubCommittee has prepared a guidance document for supporting Emergency Department colleagues who experience such events. This guide advocates key recommendations for individuals and the senior team within the Emergency Department.





CEM response to GMC report 'Medical Education's Frontline'- The College welcomes the GMC report and recommends that safe and sustainable working patterns for trainees and consultants must be found to be able to provide clinical care and time for supervision that reflects that intensity of work.

Funding Emergency Departments in England - why the current system is failing our patients and what needs to be done about it

Care delivered in the urgent and emergency setting in England is increasingly important, and complex. Funding mechanisms need to be re-evaluated. Existing systems fail to adequately fund current care, and are not driving improvements in care. A fundamental change is needed so that resources are allocated to produce the most cost-effective outcomes.

Download the College recommendations




MHRA Class2 Drugs recall - Hydroxyethyl Starch (HES) products

B Braun Melsungen AG

•Tetraspan 10% solution for infusion (500ml) PL 03551/0107
•Tetraspan 6% solution for infusion (500ml) PL 03551/0106
•Venofundin 60mg/ml solution for infusion (500ml) PL 03551/0097

Fresenius Kabi Limited

•Voluven 10% solution for infusion (500ml) PL 08828/0207
•Voluven 6% solution for infusion (500ml) PL 08828/0145
•Volulyte 6% solution for infusion (500ml) PL 08828/0174

Recommendations for Safe Trainee Changeover - Doctors in training in the UK have historically started new six-monthly rotations in February and August, with the majority of junior doctors rotating to new training programmes during the first week of August. There is an increasing body of evidence to suggest that simultaneous trainee changeover is associated with higher mortality, reduced efficiency and lower satisfaction. The Academy of Medical Royal Colleges (AoMRC) and NHS Employers have worked with partner organisations to develop simple, practical recommendations that can help mitigate these problems.
The four key recommendations are recognised as best practice and could be implemented within the current arrangements:

1. Consultants must be appropriately available
2. Flexible and intelligent rota design
3. High quality clinical induction at all units
4. Reduction of elective work at changeover times

Improving Efficiency, Interoperability and Resilience of our Blue Light Services Report - A report from Parliament - author Tobias Ellwood MP and Mark Philips.  - In the aftermath of the London Olympics, which exposed gaps in overall response and recovery capability, resulting in bespoke, but temporary, resilience procedures. This paper considers the significant financial and operational efficiencies to be gained with simpler and strongerministerial leadership, streamlining of government policy formulation and unambiguous inter-agency operational command at both national and local levels.


 The complete archive for the EMJ is now available to members at the site below:

Previous College statements


CEM e-Newsletters