Editor’s note: The September issue contained a discussion of the suggestion that an assistant is essential during administration of anesthesia and a listing of the Australian policy on minimum assistance for the safe conduct of anesthesia. A December editorial advocated these assistants be utilized mainly in the U.S. This letter follows up with a discussion of the training of some of these assistants.
To the Editor
Anesthetic assistants in the state of Queensland, Australia have ousted since the State Health Department approved a course to be conducted by the Royal Brisbane Hospital (R.B.H.) in January, 1978 and this course has been conducted every year since. The duration of the course is two years and, after graduation, the anesthetic assistants are presented with a hospital certificate and badge. About 50 anesthetic assistants are employed in hospitals throughout this state. Most are employed under the department of anesthetics and are responsible to the medical superintendent via the senior assistant and director of anesthetics.
These assistants are trained to dean, prepare, and setup the equipment along with assisting the anaesthetists in the operating rooms during anesthetic procedures. In the large hospitals, an assistant is provided in the intensive care units to attend to the ventilators and circuits and carry out other anesthetic-related duties.
This category of staff was introduced as a result of the many problems that were being experienced by the anaesthetists. Nursing staff had been filling this role prior to 1978 and very often the nurses were being changed about on a daily basis. Some days the anaesthetists found they had no assistant at all, while on other days they would he given a junior student nurse who didn’t know a magill forcep from a laryngoscope. On some occasions, the anaesthetists would have to clean their own equipment before they could start an anesthetic.
Now there are permanent trained anesthetic assistants and some trainees working in the operating rooms. The anaesthetists take part in the training course by giving lectures and practical demonstrations. The assistants My setup the anesthetic equipment including arterial lines and other special equipment before the anaesthetists arrive to start the anesthetic. As the assistants monitor the working of the equipment, very seldom will faulty equipment find its way into an operating room. Some of our assistants previously were enrolled nurses, orderlies, and some came from other areas such as students and ambulance bearers. The anesthetic department interviews all applicants for assistant positions.
Any person with the required qualifications can apply to do the course. This included nurses of all categories. All do the full two years of training. The trainees are employed full-time at the hospital while carrying out full-time anesthetic duties. In Queensland, 11 large hospitals have anesthetic assistants, while some other hospitals have nurses of various experience. Some smaller hospitals don’t have either and the anesthetists are left to go it alone without any assistants.
There is great support for assistants from the various anaesthetists and the course at R.B.H. is supported strongly by the anesthetic department.
We provide one assistant to every two operating rooms; however, this at times is not enough especially if the procedures are major ones. There is always the anesthetic work-room assistant that can be called upon if necessary.
The training program is expanding with more outside hospitals wanting to take part and other hospitals now employing the newly-trained assistants. The anesthetic assistants at R.B.H. now play an important role in the practical experience to the post-basic theater nurses’ experience in the anesthetic field, assistants demonstrate to the course nurses the checking and setting-up of anaesthesia equipment.
The assistants do not give anesthetics, intubate or cannulate. The legal responsibility is taken by each anesthetic. These assistants were introduced to provide trained assistance to the anesthetists in any area where anesthetic procedures were being conducted.
In conclusion, I must state that I have received many comments from anaesthetists during my ten years at R.B.H. and no anaesthetist has ever stated their concern of assistants being a liability. Many comments are of the appreciative type, along with positive support for assistants to be introduced into areas of hospital resuscitation teams and casualty departments.
Mr. K.P. Kerrisk, Senior Anesthetic Assistant, Royal Brisbane Hospital, Queensland, Australia.