Emergency Department Administration, Ethics, and Evidence-Based Medicine
Core concepts
Understand the principles of emergency department flow, triage, and disaster management, including mass casualty incident triage and surge capacity. Know the ethical frameworks relevant to emergency medicine: autonomy, beneficence, nonmaleficence, and justice. Understand informed consent, capacity assessment, and the management of patients who refuse care.
Know the principles of evidence-based medicine: study design, sensitivity and specificity, likelihood ratios, and the interpretation of clinical trials. Understand the concept of number needed to treat and the hierarchy of evidence. Recognize the importance of clinical guidelines and their limitations.
Traps
Questions test whether you can assess decision-making capacity and whether you know that a patient with capacity may refuse treatment even if the clinician disagrees. Another trap is misinterpreting sensitivity and specificity or confusing likelihood ratios with predictive values. Watch for disaster triage questions where the goal is to do the greatest good for the greatest number.
Worked example / rule of thumb
A patient who refuses a lifesaving procedure but has capacity: respect autonomy after informed discussion and documentation. Rule of thumb: "Capacity requires understanding, appreciation, reasoning, and communication of a choice - document it."