Table 5 The quality requirement framework

Basic level of care: physicians

· A training program in which the physician works supernumerary in which competencies given below are taught and tested^a

· During the training program a training in the ABCDE systematic, comparable to the level of the Advanced Trauma Life Support® training is required

· At all times, the ED should be able to have a physician who is trained in resuscitation (ALS or training provided by hospital^b) and intubation within 5 min at the bed of the patient

Basic level of care: nurses

· Per shift availability of one nurse with specific training in triage

· Per shift availability of one nurse with specific training in trauma nursing, comparable to the level of the Trauma Nursing Core Course®

· Per shift availability of one nurse with specific training in pediatric nursing, comparable to the level of the Emergency Nurse Pediatric Course®

(Acute) Abdominal aortic aneurysm (AAA)

Indication:

· Clinical suspicion of (acute) abdominal aortic aneurysm

Facilities:

· Direct availability of vascular surgeon· Direct availability of CT scan

· Availability of endovascular stenting procedure in the hospital

· Presence of intensive care.

Acute coronary syndrome (ACS)

Indications:

· Patients with acute coronary syndrome and ST elevation on the electrocardiogram (ECG)

· Patients with acute coronary syndrome without ST elevation on the ECG, but with other indications for PCI such as NYHA-4, diabetes mellitus, hemodynamic instability

Facilities:

· Direct availability of interventional cardiologist

· Cardiac catheterization facilities: fractional flow reserve, intravascular ultrasound, defibrillation, balloon pump, ablation technique, resynchronization therapy

Acute psychiatric behavioral disorder

Indication:

· Patients with an (acute) behavioral disorder possibly due to intoxication, suicidality or psychotic condition

Facilities:

· Direct availability of psychiatrist and psychiatric nurse.

· A room at the ED, which is suited to treat confused patients and to conduct clinical investigation

· Availability of a psychiatric department in hospital

Cerebral vascular accident (CVA)

Indication:

· Acute CVA (hemorrhagic and non-hemorrhagic)

Facilities:

· Direct availability of neurologist

· Direct availability of CT scan

· Nursing team familiar with thrombolysis procedure

Pediatric critical care

Indication:

· Severely ill children

Facilities:

· Direct availability of pediatrician

· Residents have had training in treating children in need of intensive care comparable to the level of Pediatric Advanced Life Support® training

· Presence of pediatric intensive care unit

Infants with low birth weight

Indication:

· Imminent birth with gestational age under 32 weeks and or a birth weight less than 1,250 g

Facilities:

· Direct availability of gynecologist and pediatrician

· Neonatal intensive care unit