There is a subtle distinction between ad hoc EPAs and those EPAs you can do when carrying the call pager during the day or overnight.
Ad hoc EPAs would typically mean you have started management in an emergent setting or management was unexpected for this complication. You will most likely have to retrospectively ask for an EPA assessment within a reasonable amount of time after your management, e.g. later that day or the next day.
There are many EPAs that you need to demonstrate in an urgent or emergent setting but there is likely enough time to prospectively ask for an EPA assessment. For example, EPA 2.10 for perioperative management of an ASA 1E or 2E patient for low-moderate risk surgeries. In addition to preparing your OR for this patient, you will also have enough time to recognize this is an EPA the moment your consultant or the surgical resident tells you about the patient.
2.10 Providing perioperative anesthetic management for adult ASA 1E or 2E patients undergoing urgent/emergent low or moderate risk surgical procedures
Collect 5 observations of achievement
- At least 3 different surgical procedures
- No more than 2 observations from the same assessor
3.11 Providing perioperative anesthetic management for adult patients with complex medical issues undergoing scheduled or emergent surgical procedures
Collect seventy (70) observations of achievement
- At least 20 observations in emergency patients
- Must include broad range of surgeries, patient complexity ratings and co-morbidities
- Observations must be collected across the breadth of the duration of Core stage
3.21 Providing perioperative anesthetic management for parturients (low and high risk) with or without significant comorbidities for scheduled, urgent or emergent cesarean section
- At least one urgent with epidural previously inserted for labour
- At least one under general anesthesia
3.22 Providing peripartum anesthetic management and resuscitation of parturients (including intra-uterine resuscitation) presenting with serious and life-threatening obstetrical complications
Collect 6 observations of achievement
- At least two hemorrhage
- At least one severe pre-eclampsia
3.26 Providing perioperative anesthetic management of pediatric ASA 1-3 patients (above the age of one year) undergoing scheduled or urgent/emergent procedures of low to moderate complexity
- At least 3 emergency surgery
3.32 Providing perioperative anesthetic management for patients undergoing scheduled, urgent/emergent major aortic surgery, carotid surgery, or peripheral vascular surgery
- At least 2 emergency procedures
3.33 Providing perioperative anesthetic management for patients with or without increased intracranial pressure undergoing scheduled, urgent or emergent intracranial procedures
- At least one emergency procedure
3.34 Providing perioperative anesthetic management for patients undergoing scheduled or emergent spinal procedures
- At least 2 emergency
3.35 Providing perioperative anesthetic management for patients undergoing thoracic surgery via thoracotomy or thoracoscopy including pulmonary resection surgery
- At least one emergency
3.37 Providing perioperative anesthetic management for organ retrieval surgery including perioperative anesthetic management of the donor, and determination of neurologic death
- At least one of each timing (preop/ICU, intraop)
4.4 Managing all aspects of patient care for an afterhours list (overnight, weekend), including postanesthesia care unit management and the organizational aspects related to the management of the operating room case load
*but no specific minimum number required in an emergency
2.15 Providing neuraxial anesthesia for ASA 1 and 2 patients undergoing scheduled or emergency non-obstetrical surgery
No specific minimum of emergent non-OB surgeries
3.7 Providing care for patients whose goals of care are palliative, including comprehensive pain and perioperative management and demonstration of appropriate communication skills (elective)
3.17 Providing resuscitation and comprehensive management, including crisis resource management, for patients presenting with a life-threatening emergency, across the spectrum of age
3.18 Providing perioperative management for patients with major polytraumatic injury
Collect 5 observations of achievement
- At least 2 with hemodynamic instability
- At least one massive transfusion protocol
- At least 3 assessors
*but no specific minimum number required in an urgent setting
3.1 Assessing, investigating, optimizing, and formulating anesthetic management plans for patients with complex medical issues
2.27 Managing uncomplicated patients with acute pain, either postoperative or traumatic, and managing common complications of acute pain management modalities in the post anesthesia care unit or in the surgical ward
3.29 Managing patients with common, serious or life-threatening complications of regional anesthesia (elective)