Safety Progresses Worldwide; Assistants Play Key Role in Practice

Ellison C. Pierce, Jr., M.D.

American anesthesiologists should be aware of the great strides in the development of anesthesia patient safety in many other nations. Particularly noteworthy are the Australian undertakings described in the last issue of the APSF Newsletter, as well as the recent publication in Britain, “Recommendations for Standards of Monitoring by The Association of Anesthetists of Great Britain and Ireland ‘” It should also be noted that the Netherlands was probably the first nation to have promulgated standards for monitoring and that currently, significant development in safety is being undertaken in Germany and France.

In my view, one the most important methods for improving safety in anesthesia is the utilization of anesthesia technical assistants as described for both the United Kingdom and Australia in the September, 1988, APSF Newsletter.

In my own departments, we have had one assistant for every four operating rooms for a number of years and, in as much as temporally possible, the assistant is present during induction of anesthesia to help with application of cricord pressure, taping of the endotracheal tube, positioning of the patient and providing knowledgeable assistance when there is equipment failure. As in the United Kingdom and Australia, qualifications do vary. The usual route to becoming an anesthesia assistant with us is through movement from an operating room aide into the position, with on the job training and a study period at one of the anesthesia machine manufacturer’s technical schools.

The rationale for such personnel is clearly described in the guideline, “Minimum Assistance Required for the Safe Conduct of Anesthesia,” from the Faculty of Anesthetists of the Royal Australian College of Surgeons (September, 1988, APSF Newsletter).

In addition, in our departments, the technicians have been trained in assisting with blood transfusion management in patients with large blood loss, as well as providing knowledgeable assistance during other crisis periods. They also greatly improve efficiency in anesthesia scheduling and turnaround time. It should be stated, however, as was done by Dr. Greg Purcell, Chairman, N.S.W. Regional Committee, Faculty of Anesthetists, Royal College of Surgeons, “An inadequately trained assistant, perhaps without commitment and insight into what is happening may be more of a liability than a value.”

Anesthesiologists should stress to their operating room and hospital administrations the important role these individuals play in furthering anesthesia patient safety. In 30 years of anesthesia practice, I can recall a great number of times when these hospitals employees were a major factor in preventing a significant negative outcome during an anesthesia management problem. The time for anesthesiologists to be treated differently than surgeons and other physicians in their needs for assistance has long gone

Ellison C. Pierce, Jr., M.D. President, APSF