The Training and Performance of Emergency Physicians as Anesthetists for International Medical Surgical Response Teams: The Emergency Physician’s General Anesthesia Syllabus (EP GAS)

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

Department of Anesthesia and Trauma Services, Memorial Hos-pital of South Bend, South Bend, USA.
Department of Anesthesia and Trauma Services, Memorial Hos-pital of South Bend, South Bend, USA; Sacred Heart Hospital, Milot, Haiti.
Department of Anesthesia and Trauma Services, Memorial Hos-pital of South Bend, South Bend, USA; St. Damien and St. Luc’s Hospital, Port au Prince, Haiti.
Department of Anesthesia and Trauma Services, Memorial Hos-pital of South Bend, South Bend, USA; St. Damien and St. Luc’s Hospital, Port au Prince, Haiti; Sacred Heart Hospital, Milot, Haiti.
Department of Anesthesia and Trauma Services, Memorial Hos-pital of South Bend, South Bend, USA; St. Damien and St. Luc’s Hospital, Port au Prince, Haiti;Mayo Clinic—Emergency Medicine Residency Program, Rochester, USA.
Sacred Heart Hospital, Milot, Haiti.
St. Damien and St. Luc’s Hospital, Port au Prince, Haiti.
St. Damien and St. Luc’s Hospital, Port au Prince, Haiti; University of Maryland School of Medicine, Baltimore, USA.
St. Damien and St. Luc’s Hospital, Port au Prince, Haiti; University of Maryland School of Medicine, Baltimore, USA..
St. Damien and St. Luc’s Hospital, Port au Prince, Haiti;Mayo Clinic—Critical Care Medicine, Scottsdale, USA.

DOI: 10.4236/ojanes.2014.42009                

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.

Keywords

Emergency Physicians; General Anesthesia Syllabus; International Medical Surgical Response Teams; Anesthetists; Induction; Maintenance; Emergence; Anesthesia

Conflicts of Interest

The authors declare no conflicts of interest.

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