Page 58 - JSOM Winter 2017

Humanitarian Surgical Missions

Guidelines for Successful Anesthesia Support

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Brian M. Fitzgerald, MD *; Christopher J. Nagy, MD ; Eric F. Goosman, CRNA ;
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Matthew C. Gummerson, MD ; John E. Wilson Jr, CRNA 5

ABSTRACT
Many anesthesiologists and CRNAs are provided little train- Based on the authors’ support and collective lessons learned
ing in preparing for a humanitarian surgical mission. Further- from multiple humanitarian missions and worldwide deploy-
more, there is very little published literature that outlines how ments, this article attempts to serve as the first-of-its-kind
to plan and prepare for anesthesia support of a humanitarian (to their knowledge), in-depth planning guide for anesthe-
surgical mission. This article attempts to serve as an in-depth sia support of humanitarian surgical missions. A timeline is
planning guide for anesthesia support of humanitarian sur- provided (Figure 1) to give the reader a basic time frame in
gical missions. Recommendations are provided on planning which the planning activities discussed in this article should
requirements that most anesthesiologists and CRNAs do not be accomplished.
have to consider on routinely, such as key questions to be an-
swered before agreeing to support a mission, ordering and Figure 1 Mission planning timeline.
shipping supplies and medications, travel and lodging arrange-
ments, and coordinating translators in a host nation. Detailed
considerations are included for all the phases of mission plan-
ning: advanced, mission-specific, final, mission-execution, and
postmission follow-up planning, as well as a timeline in which
to complete each phase. With the proper planning and execu-
tion, the anesthetic support of humanitarian surgical missions
is a very manageable task that can result in an extremely sat-
isfying sense of accomplishment and a rewarding experience.
The authors suggest this article should be used as a reference
document by any anesthesia professional tasked with planning
and supporting a humanitarian surgical mission.
Advanced Mission Planning
Keywords: humanitarian surgical mission; anesthesia; planning
It is important to be involved as early as possible in planning
for a mission, because humanitarian surgical missions can be as
varied as the organizations that support them and the popula-
Introduction
tions they are treating. In our experience, anesthesia providers
International organizations, private organizations, nongovern- often first become aware of a mission when the lead surgeon for
mental organizations, and militaries have delivered life- changing the mission contacts someone from the anesthesia department
surgical care in low-resource and underserved populations for with basic information about the mission and asks for support.
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many years. The opportunity to deliver the anesthesia support
for these surgical efforts can be both a daunting and rewarding Answering this question is one of the most important steps in the
moment in the career of an anesthesiologist or certified regis- planning process and must be given serious consideration before
tered nurse anesthetist (CRNA). The success of such a mission moving forward. Given that anesthesia providers (i.e., physician
is as much about the anesthetic care delivered during the mis- anesthesiologists and CRNAs) are comfortable with tackling
sion as it is about the quality of planning and coordination uncertain and dynamic situations, many might be tempted to
that goes on well before the team arrives on site in the host answer “yes” immediately and then figure out how exactly to
nation’s hospital or medical treatment location. Unfortunately, support the team as the mission date gets closer. Unfortunately,
many anesthesiologists and CRNAs are provided little train- in our experience, premature acknowledgement of support will
ing in preparing for a humanitarian surgical mission. Further- not lead to a successful mission and should be avoided.
more, there is very little published literature that outlines how
to plan and prepare for anesthesia support of a humanitarian • Before agreeing to support the mission, several ques-
surgical mission. tions need to be answered first. These include:
*Address correspondence to brian.m.fitzgerald.mil@mail.mil
1 Lt Col Fitzgerald is the program director of the San Antonio Uniformed Services Health and Education Consortium’s Anesthesiology Residency
Program, San Antonio Military Medical Center, San Antonio, TX. Col (s) Nagy is the chairman, Department of Anesthesiology, San Antonio
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Military Medical Center, San Antonio, TX. Lt Col Eric Goosman is chief scheduler and a Tactical Critical Care Evacuation Team (TCCET)-
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trained CRNA, Department of Anesthesiology, San Antonio Military Medical Center, San Antonio, TX. Lt Col Gummerson recently separated
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from the Air Force and is currently employed as a pediatric anesthesiologist in private practice. Maj Wilson Jr is a Special Operations CRNA,
Department of Anesthesiology, San Antonio Military Medical Center, San Antonio, TX.
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