Major procedures shall be performed in the Salem VAMC Emergency Department when safe and appropriate to do so for procedures such as central venous line placement, arterial catheter placement, emergency chest tube or needle thoracostomy to relieve tension pneumothorax, peritoneal lavage, defibrillation and synchronized cardioversion, endotracheal intubation, lumbar puncture, proctoscopy / anoscope, pericardiocentesis, simple closed fracture and dislocation reduction, arthrocentesis, local and up to moderate systemic anesthesia (intravenous/regional), pericardiocentesis, temporary pacemaker placement, chest tube thoracostomy and cricothyroidotomy.