Anesthesia Assistants: A Timely Idea for Safety

A.P. Adams; G.M. Purcell

Anesthetists in Other Countries Routinely Have Help During Cases

In the U.K.:

In the U.K., anesthetists can receive assistance during the administration of anesthesia under either of two systems.

The first system is based on “Anesthetic Nurses”. However, these are not nurse anesthetists such as you have in the U.S.A. Our Anesthetic nurses are firstly SRNs (State Registered Nurses) who join a hospital offering the joint Board of Clinical Nursing Studies Course No. 182 in Anesthetic Nursing which is approved by the English National Board. At the end of the period of study the nurse has an examination conducted locally by the hospital department concerned and, if successful, is given a certificate, again by the local hospital.

The best known center which operates this system of Nurse Anesthetists is the Nuffield Department of Anesthetics in Oxford. Apart from here, with only three exceptions, all other hospitals in the U.K. work under the second (ODA) system described below. Anesthetic nurses in the U.K. are not responsible for administering anesthetics: they assist in the preparation and setting-up of equipment and act as a skilled and dedicated assistant to the Anesthetist (help with the puncture, application of cricoid pressure, etc.).

The alternative to the above is a system which uses ODAs (Operating Department Assistants). These are men and women who serve much the same function as the nurses in the first system. However, they are also trained as surgical assistants (they may “scrub up”) as well as being responsible for surgical equipment. Trainee ODAs are recruited from Operating Department Orderlies (whose duties are mainly pottering) and school leavers. The minimum educational requirements are very variable but it is not unknown for some of them to possess a University degree!

ODAs undergo two years of training (which includes a minimum of 290 hours theoretical study plus a minimum of 35 weeks practical experience in each of anesthetics and surgery) in certain hospitals which have a designated training school. At the end of this time the candidates are examined by an Institute called the “City and Guilds” (C&G).

The C&G negotiates courses of education and training with the various hospitals to provide an integrated system of syllabuses, examinations and certification. The course number is C&G 752, and is run in association with the National Health Service (NHS).

The examination (MCQ) system for ODAs comprises a two-hour paper in each of Anesthetics and Related Subjects, and in Surgery and Related Subjects. The course work is also taken into consideration before which satisfactory completion of a record book of practical instruction and experience is required. Finally, practical assessments of the candidate are conducted in anesthetics and in surgery; safety measures form part of these assessments.

It is a matter of concern which extends over very many years that the pay of an ODA is abysmal. A trainee starts at $6,550, rising to $8,270 on qualification with $1 1,800 for a Senior ODA on the maximum point of the scale. These dedicated men and women are thus financially grossly abused and can only make ends meet by overtime working and agency locums.

The Association of Anesthetists of Great Britain and Ireland has made a special study of the subject of “Assistance for the Anesthetist”.

Professor A. P. Adams

Department of Anaesthefics

Guy’s and St. Thomas’ Hospitals London.

In Australia:

Anesthetic assistance is a variable entity in Australian practice. The principle persists that assistance is essential for safe and efficient conduct of anesthesia.

In up to 40% of cases, an assistant designated exclusively to assist the Anesthetist/s at all times is available. Such a person’s qualifications vary; they may be an Anesthetic assistant (usually an enrolled nurses aide), an Anesthetic Sister (a State registered nurse) or an Anesthetic technician (usually with a Technical Diploma). An Anesthetic and Operating Room Technician’s Diploma course is available in Sydney, conducted through the Royal Prince Alfred Hospital and affiliated with an Institute of Technology.

The skills and training of all the above “assistants” are variable, however, any in-house training and support provided by anesthetists is usually reciprocated.

Otherwise, for the majority of cases, an O.R. Sister is designated to provide anesthetic assistance at the induction and conclusion of anesthesia. She may very well be the “scout nurse” for the operative period.

Anesthetists generally concur with the Faculty of Anesthetist’s guidelines espoused in the Faculty’s Policy Statement “Minimum Assistance Required for the Safe Conduct of Anesthesia”.

However, they do not aggressively involve themselves in training programs for such assistants and are wary that an inadequately trained assistant, perhaps without commitment and an insight into what is happening, may be more of a liability than of value

Dr. GM Purcell, Chairman, N.S.W. Regional Committee, Faculty of Anesthetists,

Royal Australian College of Surgeons.