Page 59 - JSOM Winter 2017

• Which surgical service(s) are we supporting (e.g., gen- Once an available and capable team is determined, a team
eral surgery, plastics, orthopedics)? leader needs to be selected. The anesthesia team lead should
• Where are we going (e.g., city, country)? meet with their team early to discuss expectations for the mis-
• When are we going and for how long? sion. We highly recommend the anesthesia team lead empha-
• Will we be working in an existing hospital or temporary size the planning and training/administrative requirements in
structures? the months and weeks leading up to the mission, reverify the
• Has this surgical service performed this mission at this specific dates of the mission with each member, and remind
location before? the team to focus on safety and remain flexible throughout
• What types of surgery are planned (e.g., ambulatory the process.
versus inpatient)?
• What ancillary support will be provided by the host When the team lead thinks they have sufficient answers to
nation? questions about the mission and the right team available for
• What is the expected patient population (e.g., adult ver- the mission, they can affirm to the surgical team lead that an-
sus pediatric) and case load? esthesia providers can support the mission.
• If pediatric cases are expected, what is the youngest age
anticipated? Mission-Specific Planning
• How many operating rooms will we be expected to run?
• What is the status of funding for the mission? Finalize the Anesthesia Team
• How many anesthesia personnel are funded? Once the team lead has committed to support the mission, the
• Will I be funded for supplies? real work begins. One of the first discussion topics the team
lead should have with the lead surgeon is the exact make-up of
An excellent resource to reference both before committing to sup- the anesthesia team (e.g., anesthesiologists, CRNAs, residents,
port the mission and throughout the planning phases is the Amer- student nurse anesthetists) needed to support the mission. The
ican Association of Nurse Anesthetist (AANA) webpage http:// anesthesia team lead should be prepared to defend each mem-
www.aana.com/resources2/professionalpractice/volunteerism ber of the team because of the travel costs associated with each
/Pages/FAQs.aspx. one. Do not compromise on securing funding for your team;
this is not the time to try to do more with less. The safety
Focused time spent seeking answers to these questions and re- of your patients depends on having the right anesthesia team
viewing the AANA website will prove invaluable in attempting available. Funding for supplies and equipment should also be
to answer whether anesthesia can support the mission. discussed early in the planning stages.

Realistically, it is unlikely that the surgical team lead will have Administrative Preparation
the answers to all of these questions, but any information will To facilitate timely international travel, it is never too early
lend insight into the status of the overall mission planning. to begin initiating passports and visas (if needed) for every
Hopefully, the surgical team has invested time and resources member of the anesthesia team. Failure to have these docu-
into their preliminary mission planning and has addressed ments prepared in timely manner will result in a team member
2
several ethical questions (e.g., the need for the services, post- not being available for the mission and, thus, in inadequate
operative care, safety of the patients and team members) about anesthesia support. Requirements for foreign country visa re-
the mission before agreeing to support it. 3–5 quirements can be found on the US State Department’s website
(www.travel.state.gov).
Decision to Support
Even with answers to the list of questions in the previous sec- International travel will also likely require certain immuniza-
tion, there are still several important decisions to make before tions and potential malaria prophylaxis be arranged before
agreeing to support the mission. First, determine whether the travel. The Centers for Disease Control and Prevention Yellow
right personnel and equipment are available for the mission Book: Health Information for International Travel is an excel-
during the planned dates. Availability should not be the only lent resource for health professionals and is available online,
criterion for selection of the anesthesia team, however. Ap- in hardcopy format, and on apps for mobile devices (http://
propriate selection depends heavily on the projected surgical wwwnc.cdc.gov/travel/page/yellowbook-home-2014).
case-load type and volume. For example, if the case load is
expected to include a substantial number of pediatric cases, Coordination with hospital credentialing is important so
then it is important to ensure providers are available who documentation required by the host nation hospital is com-
are comfortable and capable of handling pediatric cases in pleted and any necessary malpractice coverage is provided.
a potentially austere environment. Depending on the age Additionally, expect additional computer-based training and
range of the pediatric cases, a fellowship-trained pediatric paperwork required by the team’s respective armed services to
anesthesiologist may be necessary. If the case load is expected be assigned before departure. Timely accomplishment of these
to require a substantial amount of regional anesthesia, then tasks is important to avoid last-minute disruptions to mission
an anesthesia team capable of providing regional anesthet- planning.
ics and the appropriate ultrasound and additional regional
equipment must be available. If anesthesia residents or stu- Supplies and Medications
dent nurse anesthetists are available to support the mission, It is never too early to start planning for the supplies and medi-
coordination with their program leadership must be accom- cations needed for the mission. Our general recommendation
plished and the ability to provide appropriate supervision of is to not rely on the availability of any items from the host na-
their care must be built into the overall anesthesia manpower tion. Any specific equipment or supply needed for the mission
requirements. should have a plan for its acquisition and delivery in country.

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