OJAnes  Vol.4 No.2 , February 2014
The Training and Performance of Emergency Physicians as Anesthetists for International Medical Surgical Response Teams: The Emergency Physician’s General Anesthesia Syllabus (EP GAS)
Abstract: Background: The availability of an anesthesiologist is often a limiting factor in the number of operations that can be performed by International Medical Surgical Response Teams (IMSuRT). Because emergency physicians (EPs) possess skills in airway control, management of moderate and deep sedation, and ventilator management, we propose that with proper training in general anesthesia, EPs can serve as anesthetists for IMSuRT with anesthesiologist supervision. Methods: During a 10-week period, a board-certified EP administered general anesthesia to 60 patients prior to a surgical medical mission trip. The breakdown of surgical cases was: 11 orthopedic, 2 genitourinary, 20 ear, nose, and throat, 8 obstetrics and gynecological, 13 general surgery, and 6 vascular. A simplified protocol for induction, maintenance, and emergence was adhered to for all cases. Results: Fourteen orthopedic cases using general anesthesia were performed in a one-week period in Haiti. These cases involved open reduction and internal fixation (ORIF), hemiarthoplasty, hardware removal, tendon transfer and external fixation of fractured bone. Conclusion: We demonstrate the feasibility of a model curriculum to train EPs in the basics of anesthesia. The EP can safely and effectively deliver general anesthesia for major cases on surgical medical mission trips under the auspices of an anesthesiologist in an austere environment.
Cite this paper: R. Skupski, M. Walsh, M. Jbara, D. Zimmer, B. Patel, M. McCurdy, J. Lantry, B. Fritz, P. Davis, H. Musunuru, A. Newbold, A. Toth, R. Frechette, T. Alexander, M. Sundararajan, J. Lovejoy, D. Hottinger, J. Capannari, R. Kurcz, G. Bernard and H. Previl, "The Training and Performance of Emergency Physicians as Anesthetists for International Medical Surgical Response Teams: The Emergency Physician’s General Anesthesia Syllabus (EP GAS)," Open Journal of Anesthesiology, Vol. 4 No. 2, 2014, pp. 53-61. doi: 10.4236/ojanes.2014.42009.

[1]   M. Dünser, I. Baelani and L. Ganbold, “The Specialty of Anesthesia Outside Western Medicine with Special Consideration of Personal Experience in the Democratic Republic of the Congo and Mongolia,” Der Anaesthesist, Vol. 55, No. 2, 2006, pp. 118-132.

[2]   B. T. Ugwu and E. L. Isamade, “Interoperative Cardiac Arrest—A Tropical Experience,” West African Journal of Medicine, Vol. 19, No. 4, 2000, pp. 277-280.

[3]   I. A. Walker and I. H. Wilson, “Anaesthesia in Developing Countries—A Risk for Patients.” The Lancet, Vol. 371, No. 9617, 2008, pp.968-969.

[4]   S. Jochberger, F. Ismailova, W. Lederer, V. Mayr, G. Luckner and V. Wenzel, “Anesthesia and Its Allied Disciplines in the Developing World: A Nationwide Survey of the Republic of Zambia,” Anesthesia & Analgesia, Vol. 106, No. 3, 2008, pp. 942-948.

[5]   K. W. Grathwohl and S. G. Venticinque, “Organizational Characteristics of the Austere Intensive Care Unit: The Evolution of Military Trauma and Critical Care Medicine; Applications for Civilian Medical Care Systems,” Critical Care Medicine, Vol. 36, No. 7, 2008, pp. S275-S283.

[6]   C. L. Gwinnutt, “The Interface between Anaesthesia and Emergency Medicine,” Emergency Medicine Journal, Vol. 18, No. 5, 2001, pp. 325-239.

[7]   C. H. Schultz and G. J. Annas, “Altering the Standard of Care in Disasters—Unnecessary and Dangerous,” Annals of Emergency Medicine, Vol. 59, No. 3, 2012, pp. 191195.

[8]   K. Peleg and A. L. Kellerman, “Medical Relief after Earthquakes: It’s Time for a New Paradigm,” Annals of Emergency Medicine, Vol. 59, No.3, 2012, pp. 188-190.

[9]   M. Bisanzo, K. Nichols, H. Hammerstedt, B. Dreifuss, S. Nelson, S. Chamberlain, et al., “Nurse-Administered Ketamine Sedation in an Emergency Department in Rural Uganda,” Annals of Emergency Medicine, Vol. 59, No. 4, 2012, pp. 268-275.

[10]   R. K. Stoelting and R. D. Miller, “Basics of Anesthesia,” 5th Edition, Churchil Livingstone, Inc., New York, 2007, pp. 1-697.

[11]   A. H. Giesecke and W. H. Montgomery, “The Role of Anesthesiologists in Paramedic Training,” American Society of Anesthesiologists Newsletter, Vol. 69, 2005, p. 11.

[12]   L. C. Berkow, R. S. Greenberg, K. H. Kan, E. Colantuoni E, et al., “Need for Emergency Surgical Airway Reduced by a Comprehensive Difficult Airway Program,” Anesthesia & Analgesia, Vol. 109, No. 6, 2009, pp. 1860-1869.

[13]   M. L. Sivilotti, D. W. Messenger, J. van Vlymen, P. E. Dungey and H. E. Murray, “A Comparative Evaluation of Capnometry Versus Pulse Oximetry During Procedural Sedation and Analgesia on Room Air,” Canadian Journal of Emergency Medicine, Vol. 12, No. 5, 2010, pp. 397404.

[14]   S. L. Chritton, J. Weinkauf, C. D. McClain, J. E. O'Flaherty, P. Livingston, F. M. Evans, S. Kessler, E. P. Nelson and M. E. Durieux, “Teaching Anesthesiology in Rwanda: A Multi-pronged Approach,” American Society of Anesthesiologists Newsletter, Vol. 77, 2013, pp. 52-55.

[15]   M. J. Rice, A. Gwertzman, T. Finley and T. E. Morey, “Anesthetic Practice in Haiti after the 2010 Earthquake,” Anesthesia & Analgesia, Vol. 111, No. 6, 2010, pp. 11451149.

[16]   M. McCunn, M. A. Ashburn, T. F. Floyd, C. W. Schwab, P. Harrington, C. W. Hanson, et al., “An Organized, Comprehensive, and Security-Enabled Strategic Response to The Haiti Earthquake: A Description of Pre-Deployment Readiness Preparation and Preliminary Experience From an Academic Anesthesia Department with No Preexisting International Disasters Response Program,” Anesthesia & Analgesia, Vol. 111, No. 6, 2010, pp. 14381444.

[17]   A. L. Kushner, M. N. Cherian, L. Noel, D. A. Spiegal, S. Groth and C. Etienne, “Addressing The Millennium Development Goals from a Surgical Perspective: Essential Surgery and Anesthesia in 8 Low and Middle Income Countries,” Archives of Surgery, Vol. 145, No. 2, 2010, pp. 154-160.

[18]   C. Doherty and H. Holtby, “Pediatric Cardiac Anesthesia in the Developing World,” Pediatric Anesthesia, Vol. 21, No. 5, 2011, pp. 609-614.

[19]   S. M. Green, K. J. Clem and S. G. Rothrock, “Ketamine Safety Profile in the Developing World: Survey of Practitioners,” Academic Emergency Medicine, Vol. 3, No. 6, 1996, pp. 598-604.

[20]   I. A. Walker, A. F. Merry, I. H. Wilson, G. A. McHugh, E. O’Sullivan, G. M. Thoms, et al., “Global Oximetery: An International Anesthesia Quality Improvement Project,” Anesthesia, Vol. 64, No. 10, 2009, pp. 1051-1060.

[21]   S. Jochberger, O. Bataar, N.Mendsaikhan, W. Grander, G. Tsenddori, G. Lundeg, et al., “Anesthesia Care in A Medium-Developed Country: A Nationwide Survery of Mongolia,” Journal of Clinical Anesthesia, Vol. 22, No. 6, 2010, pp. 443-449.

[22]   O. A. Ogunbiyi and C. N. Mato, “Anesthetic Accidents: An Experience in Sub-Saharan Africa,” Southern African Journal of Anaesthesia & Analgesia, Vol. 12, No. 3, 2006, pp. 111-113.

[23]   J. B. Cooper, R. S. Newbower and R. J. Kitz, “An Analysis of Major Errors and Equipment Failures in Anaesthesia Management: Considerations for Prevention and Detection,” Anesthesiology, Vol. 60, No. 1, 1984, pp. 34-42.

[24]   A. Gawande, “The Check List Manifesto: How to Get Things Right,” Metropolitan Books, New York, 2010.

[25]   J. E. Ziewacz, A. F. Arriaga, A. M. Bader, W. R. Berry, L. Edmondson, J. M. Wong, et al., “Crisis Checklists for the Operating Room: Development and Pilot Testing,” Journal of American College of Surgeons, Vol. 213, No. 2, 2011, pp. 212-217.

[26]   J. M. Ehrenfeld, L. M. Funk, J. VanSchalkwyk, F. Merry, W. S. Sandbergand A. A. Gawande, “The Incidence of Hypoxemia during Surgery: Evidence from Two Institutions,” Canadian Journal of Anesthesia, Vol. 57, No. 10, 2012, pp. 888-897.

[27]   C. L. Parks and M. E. Schroeder, “Military Anesthesia Trainees in WWII at the University of Wisconsin: Their Training, Careers, and Contributions,” Anesthesiology, Vol. 118, No. 5, 2013, pp. 1019-1027.

[28]   A. Schubert, G. Eckhout and K. Tremper, “An Updated View of the National Anesthesia Personnel Shortfall,” Anesthesia & Analgesia, Vol. 96, 2003, pp. 207-214.

[29]   D. Marchbein, “Humanitarian Surgery: A Call to Action for Anesthesiologists,” Anesthesiology, Vol. 119, No. 5, 2013, pp.1001-1002.