Page 63 - JSOM Winter 2017

Figure 4 Anesthesia humanitarian surgical mission support active in supporting the surgeon and staying involved with
checklist. daily planning and decision-making.
Action ✓
Advanced planning Upon arrival on site, invest the time to orient the team to the
Which surgical services need support? mission location, especially the ORs. During the unpacking of
Destination/duration of mission/type of facility (fixed/ equipment and supplies, the entire anesthesia team must be
temporary/number of operating rooms/number of cases) diligent in verifying that all necessary medications and sup-
Ancillary support available? (nursing, translators, plies have arrived on site. If any host-nation equipment (e.g.,
transportation, security, if needed) anesthesia machines, oxygen cylinders) is being used, its oper-
Status of funding for mission (supplies/equipment, personnel) ability must be verified. We also recommend an orderly un-
Decision to support packing of supplies so the team can efficiently resupply the
Do I have the right personnel for the mission? ORs once cases get started and recognize any supply shortfalls
early.
Do I have the right supplies/equipment for the mission?
Select a team leader and meet with surgical team/mission leader Perform a walk-through of the areas selected to be the preop-
Mission-specific planning erative clinic, same-day surgery, PACU, and other locations
Select anesthesia team; obtain commitments for support from the team may be involved in during care of patients. If the plan
anesthesia team is to run more than one OR during the mission, request a stag-
Administration: passports, visas, immunizations, credentialing gered first start on the initial day of surgery to ensure patient
Supplies/equipment: order and plan for transport safety as the first case makes their way through the system.
(check status weekly!)
Meet with surgical team/mission leader to evaluate progress: As surgical cases begin, remember to constantly reassess sup-
define mission objectives, discuss case load, translators, plies and determine if there are any unanticipated shortfalls.
supplies/equipment available at location, obtain as much
information as possible about host-country support (e.g., Based on the nature of the shortfall, anesthetic plans may need
operating rooms, laboratories, consulting services) to be altered or the anesthesia team lead may need to discuss
Make travel arrangements for team members (consider with the surgeon whether a case later in the mission can be
sending an advanced team if necessary) completed. Track the cases accomplished each day for ac-
Final mission planning/mission execution countability purposes.
Verify travel arrangements and visa/passport status
Once on site: orient team, unpack equipment/supplies, We have found it beneficial to have anesthesia team meetings
perform walk through of facility in the evening after cases are completed to review the day and
Test all equipment and perform a dry run of planned cases discuss plans for the following day. These meetings should be
Daily: reassess supplies, check equipment, have evening used to answer questions anyone on the team may have, dis-
meetings with surgical team leader cuss special cases that are planned, or implement changes to
Verify travel arrangements for leaving the country for all the current process based on lessons learned from the day. If
team members possible, have the surgical team lead available as part of the
Carefully pack all equipment for shipment back to meeting to verify the surgical cases planned for the next day.
home country
Postmission follow-up The anesthesia team lead should meet with team members of-
Ensure safe arrival home of all team members and equipment/ ten throughout each day to ensure they are getting enough
supplies sleep, enough to eat, have adjusted to the different country or
Obtain feedback from all team members immediately time zone, or have any concerns regarding the mission.
upon return
Prepare after-action report for surgical/mission team leader Hopefully there will be some down time during the mission.
Take this opportunity to plan team meals to local restaurants
Additionally, the anesthesia team lead must remain steadfast or, if possible, plan a trip to a local site of interest. This time is
on the acceptable number of personnel and the specific types important to team bonding and is a good break from a poten-
of supplies they need to perform the mission safely. No com- tially demanding surgical schedule. Again, keep the safety of
promises in these areas should be made. the team in mind when planning any travel around the mission
location.
Mission Execution
As the mission comes to an end, travel arrangements home
On the day before traveling, we recommend double checking for the team must be verified by the anesthesia team lead in
with everyone on the team that they know their flight times, coordination with the surgical team lead. Additionally, plans
have their travel documents, and have packed all the equip- for excess supplies and the return of all necessary equipment
ment/supplies they may be bringing with them for the mission. must be implemented.
If possible, avoid having any clinical responsibilities on the
day before departure to accomplish any last-minute tasks re- An excellent time to solicit feedback from the team is during
quired to support the mission. the last few days of the mission. The team lead should seek
recommendations on ways to improve the mission both in the
Leadership of the entire mission team often reverts to the lead planning and execution phases. We advise not waiting to do
surgeon upon arrival at the mission location, which will prob- this upon return home because it will be much more difficult
ably be the first time the entire team is physically present in to have the full attention of the team when they return to their
one place. However, the anesthesia team lead must remain primary clinical responsibilities.

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