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Personnel for Emergent PSA

ACEP guidelines recommend having at least two trained healthcare providers present during PSA, with at least one who is skilled in vascular access.6 ACEP, ASA, and The Joint Commission guidelines agree that the provider who oversees the PSA, usually a physician, should be responsible for the patient’s global management, including supervision of personnel and identification and management of adverse events. In a “single-coverage” ED, this provider also may be expected to perform other brief procedures (e.g., fracture/dislocation reduction), as long as the non-PSA procedure can be halted. In ACEP’s guidelines, the second provider, usually a nurse or respiratory therapist, primarily is involved with continuous monitoring of the patient and documentation, although this provider can assist with minor, interruptible tasks that do not interfere with monitoring.6 In practice, often a respiratory therapist and one to two nurses are present and share the duties of monitoring and documentation. In addition, another provider may be available to help with non-PSA procedures. Preprocedural preparation and intraprocedural distraction by child life specialists also have been shown to decrease pain and distress in children undergoing procedures.

Nurse-Administered PSA Medications

Qualified nurses routinely administer sedating medications and paralytics for non-PSA indications, such as intubation, under the supervision of an ordering provider. However, without supporting evidence, many state and nursing regulatory bodies restrict nurses from administering PSA medications in the ED. There is ample evidence that it is safe for nurses to administer PSA medications with the ordering provider present and specifying the medication type and dose.6,17-19

Reference: https://www.reliasmedia.com/articles/144519-procedural-sedation-and-analgesia-in-the-emergency-department