ACEP Will Not Endorse New Sepsis Guidelines from the Surviving Sepsis Campaign

After a thorough and comprehensive review by a panel of experts convened from the membership of the College, ACEP informed the Surviving Sepsis Campaign (SSC) that ACEP will not endorse the organization’s latest update to guidelines for treatment of sepsis in emergency departments (EDs).

The decision not to endorse the guidelines was based on concerns about conflicting guidelines for the treatment of adult and pediatric patients, and a belief that the guidelines developed do not fully reflect the most up-to-date and reality-based approach to the care of all patients in the ED, including those with sepsis.

In addition, ACEP also remains deeply concerned that the absence of emergency physician organizational involvement in the governance structure of the SSC serves to limit the perspectives offered by practicing emergency physicians in the United States when guidelines are being developed.

While ACEP does have individual representatives involved in specific writing groups within the project, the governance structure is comprised of physician representation from the specialty of critical care medicine alone. Given that the ED  environment is unique and faces incredible day-to-day challenges of hospital crowding/boarding and workforce shortages, ACEP believes that any guideline recommending care of patients in the ED  should be based upon the realities of the practice care environment in which they are implemented. While acknowledging the importance of caring for patients with sepsis, the ED  is also charged with caring for patients with many other critical and life-threatening conditions. For example, there appears to be little attention to the harm that aggressive fluids and antibiotic treatments can cause when applied within too broad a population just to meet apparently arbitrary time requirements, particularly in the adult guidelines.

For the first time, there are different guidelines for pediatric and adult patients. The guidelines for pediatric and adult patients were not aligned regarding both clinical treatment and operational pathways. ACEP believes that the recommended implementation of different clinical guidelines, for the same clinical condition, could lead to confusion among ED staff and  potential patient safety issues. In addition, ACEP is worried that the focus of the SSC is strictly on those patients with sepsis while appearing to ignore the potential harm that the guidelines might cause for patients without sepsis.

The ACEP-convened expert panel provided direct feedback, with referenced citations of the published literature on sepsis, in response to the original draft guidelines. The concerns and recommendations for changes were acknowledged. A revised version of the guidelines was provided for review by ACEP. However, the final version that was developed did not adequately address the key concerns that had been identified in a manner that reflects the reality of practice within EDs in the United States.

ACEP will continue to work to ensure that guidelines developed for the care of patients with sepsis are based on the strongest and most up-to-date science and developed to ensure ease and effectiveness of implementation, while also reflective of the experience and realities of practicing emergency physicians.

ACEP Advocacy Win: DEA Issues Long-Awaited EMS “Standing Orders” Final Rule

In a long-awaited victory, the federal Drug Enforcement Administration (DEA) issued the Registering Emergency Medical Services Agencies under the Protecting Patient Access to Emergency Medications Act of the 2017 Final Rule to ensure continued access to pain and anti-seizure medications for patients experiencing medical emergencies.

This regulation implements the ACEP-supported “Protecting Patient Access to Emergency Medications Act of 2017,” originally sponsored by one of ACEP’s longtime legislative champions, Rep. Richard Hudson (R-NC). Signed into law on November 17, 2017, the measure addressed issues regarding how EMS agencies store, handle, and administer controlled substances. The final regulation explicitly permits physician medical directors to issue standing orders to EMS personnel so that they may administer controlled substances to their patients.

ACEP was largely supportive of the DEA’s proposed rule issued in 2020 but did provide the agency with technical and clarifying comments, many of which were accepted in the final rule. Of note, the DEA agreed with our suggestions to more accurately reflect the way that EMS agencies operate throughout the country, and ease burdensome recordkeeping requirements to provide greater logistical flexibility — especially important for EMS in rural areas.

ACEP and National Health Care Groups Issue Joint Statement on Pediatric Readiness in Emergency Departments

An estimated 2,000 children could be saved if emergency departments follow a set of new recommendations focused on caring for young people in emergencies, leading organizations in emergency medicine stated. ACEP, the American Academy of Pediatrics, the Emergency Nurses Association, and the American College of Surgeons outline critical steps that emergency departments can take to be ready to care for sick or injured children.

“More than 80 percent of children who come to an emergency department go to a local community hospital, not a children’s hospital,” said Kate Remick, MD, FAAP, FACEP, FAEMS, lead author of the statement. “Every emergency department should be fully prepared for kids, no matter how often they see them. These recommendations save lives.”

The statement informs the work of the National Pediatric Readiness Project (NPRP), an initiative of the Emergency Medical Services for Children Program — part of the Department of Health and Human Services’ Health Resources and Services Administration — in collaboration with multidisciplinary organizations. The NPRP supports more than 5,000 emergency departments nationwide to improve their pediatric capabilities through self-assessments, benchmarking, checklists, quality dashboards, and other resources.

Updates to the previous recommendations include decision support tools; nationally vetted pediatric quality measures; an emphasis on a multidisciplinary review surrounding pediatric deaths and adverse events for local quality improvement; a deeper focus on pediatric mental health; reinforcement of the importance of immediately available, portable, weight-based pediatric resuscitation carts and use of medication dosage tools; and broader expectations for pediatric considerations in disaster preparedness.

The previous assessment published in 2023 noted improvements in five of six categories measured since 2013, including an increase in the number of emergency departments with pediatric equipment and supplies (90 to 97 percent) and the number of emergency departments with a pediatric mental health care policy (44 to 73 percent).

This year’s nationwide NPRP Assessment period starts on March 3 and runs through May 31. Emergency departments will be assessed on a 100-point scale and receive a score for benchmarking and a gap report identifying areas for improvement. 

“The 2026 assessment is our chance to see where we stand — and where we can do better,” said Marianne Gausche-Hill, MD, FACEP, FAAP, FAEMS, and a statement co-author. “The NPRP Assessment helps emergency care teams lead efforts to quantify the progress made and improvements needed to optimize emergency care for children. Further, participation in pediatric readiness efforts is among [the] criteria for ACEP’s ED Accreditation (EDAc) program, which demonstrates a commitment to quality and safety.”