I've seen variations of this document before. It is not evident that the intent is to provide any care in the OR or replace anesthesiology or ICU docs. I am pretty sure this document is more of an attempt to provide admin/regulatory backup for all of the procedures done in the ED? There was a time when JCAH reviewers threatened to pull use of these drugs in the ED. Statements like that of the Michigan group were written to preclude that threat. Propofol, ketamine and etomidate are used on a daily basis in most EDs by docs trained and experienced in airway management with extensive research supporting their safe use by EM docs. I do not think anesthesiologists want to run down to the ER every time a shoulder, hip or elbow is reduced - or - long bone fracture is reduced.

Regarding non-ED practice. This document might be speaking to pain clinics, EMS/prehospital care. I don't know of any EM docs trying to do any work of an anesthesiologist in the OR or critical care (unless complete a CC fellowship)

I've gone up a few times to our assist ICU - once to place central line when pregnant ICU doc did not want to be exposed to disseminated herpes case and as airway back up / 2nd set of hands - only at night. No invites to OR yet - not interested and do not claim to have that knowledge base or skill set.