TITLE:
The Training and Performance of Emergency Physicians as Anesthetists for International Medical Surgical Response Teams: The Emergency Physician’s General Anesthesia Syllabus (EP GAS)
AUTHORS:
Richard Skupski, Mark Walsh, Manar Jbara, Donald Zimmer, Bhavesh M. Patel, Michael T. McCurdy, James Lantry, Braxton Fritz, Patrick Davis, Harsha Musunuru, Anne Newbold, Art Toth, Richard Frechette, Tiffany Alexander, Madhura Sundararajan, John Lovejoy, Dan Hottinger, Joe Capannari, Rachel Kurcz, Gerard Bernard, Harold Previl
KEYWORDS:
Emergency Physicians; General Anesthesia Syllabus; International Medical Surgical Response Teams; Anesthetists; Induction; Maintenance; Emergence; Anesthesia
JOURNAL NAME:
Open Journal of Anesthesiology,
Vol.4 No.2,
February
11,
2014
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.