The following procedures have been taken from the various Delineation of Privileges and divided into three groups based on how these skills would best be taught to the Midlevel Providers. The first grouping, EM Advanced Skills, will become the syllabus for the Procedures modules and Skills labs. The second group, taught at the bedside, will require one-on-one training. All procedures, I suggest, should be logged by MLP after training is completed.

EM Advanced Skills- Manual skills that require hands-on training in the lab using cadaver or simulation manikins:

1. Basic and advanced wound care techniques, including I/D abscesses, burn and abrasion debridement and care, and repair of nail bed lacerations, extensor tendon repair
2. Regional anesthesia
3. Arthrocentesis
4. Endotracheal intubation
5. Cricothyrotomy/surgical airway
6. Central venous access and central line placement
7. Intra-osseous device insertion and management
8. Needle thoracostomy
9.  Chest tube thoracostomy insertion and management
10.  Lumbar puncture
11.  Thoracentesis
12. Paracentesis

Procedures and manual skills that are taught in the ED by physicians in the ED practice environment with 1:1 supervision of the Midlevel Provider:

1. Nail trephination for subungual hematoma
2. Finger or toe nail removal
3. Procedural sedation and rapid sequence intubation
4. Administration of medication: oral, IV, IM
5. Venipuncture and blood collection
6. Peripheral vascular access techniques
7. Arterial puncture and AB sampling
8. Foreign body removal from nose, ears, soft tissue, throat, vagina, rectum
9. Anoscopy
10. Fracture reduction, joint reduction, application of splints
11. Spine immobilization techniques; immobilization device removal
12. Epistaxis management
13. Oro-gastric and nasogastric tube insertion and management
14. Slit lamp examination; corneal foreign body removal; ocular tonometry
15. Urethral catheter placement and management
16. Ordering and initial interpretation of EKGs
17. Ordering and initial interpretation of plain radiographs
18. Management of obstetric patients for non-obstetric complaints and conditions
19. Evaluation of obstetric patients for possible labor

Certified skills- Skills that are outsourced to pre-existing courses for certification

1. PALS
2. ACLS
3. EM ultrasonography for vascular access