PS8

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The presence of a trained assistant for the anaesthetist during the conduct of anaesthesia is a major contributory factor to safe patient management. The assistant must have undertaken appropriate training in order to provide effective support to the anaesthetist.  The recommendations that follow establish both the practical and educational responsibilities of a competent assistant to the anaesthetist. 

1. PRINCIPLES 

1. These recommendations apply wherever general anaesthesia, regional anaesthesia, local anaesthesia and/or sedation are administered by an anaesthetist. Henceforth, these activities are referred to as “anaesthesia”.

1.2 The presence of a trained assistant for the anaesthetist is essential for the safe and efficient conduct of anaesthesia: 

1.2.1 during preparation for and induction of anaesthesia. The assistant must remain under the immediate direction of the anaesthetist until instructed that this level of assistance is no longer required. 

1.2.2 at short notice if required during the maintenance of anaesthesia. 

1.2.3 at the conclusion of anaesthesia. 

1.3 Facilities in which anaesthesia is administered must provide a service which ensures that anaesthetic equipment is available, properly maintained, checked before use and appropriately cleaned, as per College Professional Documents T1 (2006) Recommendations on Minimum Facilities for Safe Administration of Anaesthesia in Operating Suites and Other Anaesthetising Locations and PS31 (2003) Recommendations on Checking Anaesthesia Delivery Systems. 

1.4 Staff employed for these roles must be properly trained, as defined below. 

2. DEPLOYMENT OF ASSISTANTS 

2.1 The assistant to the anaesthetist is an essential member of the staff establishment in all locations where anaesthesia is administered. 

2.2 Management must ensure that staff establishments and rostering practices allow the allocation of an assistant to the anaesthetist for every case where anaesthesia is administered.  

2.3 The number and status of assistants in the staff establishment will be determined by the number and types of procedures undertaken by the anaesthesia service at each facility. 

2.4 The duties of the assistants in each location must be specified in an appropriate job description. 

2.5 Where a number of assistants are employed, an appropriately trained and experienced senior member of the group should be designated as the supervisor.  

2.6 Whilst assisting the anaesthetist, the assistant must be wholly and exclusively responsible to that anaesthetist. 

3. EDUCATIONAL REQUIREMENTS FOR ASSISTANTS 

An adequately trained assistant to the anaesthetist must have completed a training course which has met, as a minimum, the following criteria: 

3.1 Eligibility 

3.1.1 Those without previous health sector experience must have the Higher School Certificate or its equivalent. 

3.1.2 Those with nursing experience must hold a certificate as a Registered Nurse (Registered Nurse Division 1) or as an Enrolled Nurse (Registered Nurse Division 2), or their equivalents. 

3.1.3 Registered Nurses, Division 1 or 2 or their equivalents, must be in current clinical employment or have been so employed within one year of acceptance into a training course. 

3.2 Course of Instruction 

The course should be developed and administered by an appropriate institute of learning. Courses may include a distance learning component where appropriate, and may be provided full-time, part-time or as a combination of full-time and part-time. There should be continuous employment of trainee anaesthesia assistants during any part-time components of the course.  

As a minimum, the course must include: 

3.2.1 A course of lectures of at least 150 hours duration.  

3.2.3 Supervised practical experience in anaesthetising locations, which should be documented in a log book describing the type of instruction received and the competencies demonstrated. 

3.2.4 Successful completion of assignments appropriate to the curriculum that are suitable for presentation to trainees and supervisors. 

5. Successful completion of internal assessments, including demonstrated competencies and designated examinations.

3.2.6 Input from anaesthestists in curriculum development, preparation and delivery of lectures, practical supervision and assessments. The minimum curriculum content for courses is outlined in the Addendum.  

3.3 Duration of the Course 

3.3.1 Those without previous hospital experience must complete three years of full-time employment comprising study and work as a trainee anaesthesia assistant. 

3.3.2 Those with Registered Nurse Divison 2 qualifications or similar must complete two years of full-time employment comprising study and work as a trainee anaesthesia assistant. 

3.3.3 Those with Registered Nurse Division 1 qualifications must complete one year of full-time employment comprising study and work as a trainee anaesthesia assistant. 

4. CONTINUING EDUCATION OF ASSISTANTS 

Anaesthesia assistants must maintain and upgrade their knowledge and skills with regular continuing education activities. Management must ensure that staff establishments and rostering practices allow for continuing education of anaesthesia assistants. 

ADDENDUM

RECOMMENDED CONTENT OF TRAINING COURSES

FOR THE ASSISTANT TO THE ANAESTHETIST 

1. Basic Sciences 

Instruction must include appropriate elements of the following basic sciences as they apply to anaesthesia: 

Physics

Chemistry

Pharmacology

Anatomy

Physiology

Clinical Measurement

Microbiology 

2. Anaesthesia 

In-depth understanding of the following topics is necessary and must be reinforced by appropriate practical experience obtained while providing assistance to anaesthetists. 

(a) Anaesthetic Equipment 

(i) The care, use and servicing of equipment  

Anaesthesia delivery systems and ventilators

Monitoring equipment including ultrasound devices

Airways devices including fiberoptic instruments

Intravascular devices 

(ii) Cleaning and sterilisation of equipment 

(iii) Infection control issues for staff, equipment and patients 

(iv) Pollution prevention 

(b) Safety

Electrical safety

Gas cylinders and pipelines

Hazards in anaesthetising locations

Patient safety

Staff safety 

(c) Anaesthetic techniques  

including all areas of perioperative practice (preparation, monitoring, induction, securing the airway, maintenance, recovery) in both theoretical and practical terms. 

4. Invasive Techniques

including insertion of peripheral, central venous and pulmonary artery catheters and arterial lines, as well as their ongoing management; intercostal tube drainage; red cell salvage, and endoscopy of the airways. 

4. Regional and Local Anaesthesia

including all commonly used techniques for regional and local blockade. 

(e) Ultrasound 

including use for nerve and vascular localisation. 

(f) Therapeutics 

 including the storage, preparation and use of all drugs, fluids and other therapeutic substances administered during anaesthesia. 

7. Emergency Care

including knowledge of appropriate algorithms for crisis management, assistance to the anaesthetist, and provision and care of necessary equipment for: 

Cardiopulmonary resuscitation

Management of the difficult airway and failed intubation

Cardiac defibrillation and cardioversion

Massive blood transfusion

Anaphylaxis

Malignant hyperthermia 

8. Postoperative Pain

      including management and equipment required. 
 

3. Management 

Rostering

Budgets

Anaesthesia standards and protocols

Incident monitoring

Workplace, Occupational Health & Safety Regulations

Communication

Privacy Protection

Interfaces with other healthcare workers

Legal responsibilities

Human resources management

COLLEGE PROFESSIONAL DOCUMENTS

College Professional Documents are progressively being coded as follows: 

TE Training and Educational

EX Examinations

PS Professional Standards

T Technical 

POLICY - defined as ‘a course of action adopted and pursued by the College’.  These are matters coming within the authority and control of the College. 

RECOMMENDATIONS – defined as ‘advisable courses of action’. 

GUIDELINES – defined as ‘a document offering advice’.  These may be clinical (in which case they will eventually be evidence-based), or non-clinical. 

STATEMENTS – defined as ‘a communication setting out information’. 

This document is intended to apply wherever anaesthesia is administered. 

This document has been prepared having regard to general circumstances, and it is the responsibility of the practitioner to have express regard to the particular circumstances of each case, and the application of this document in each case. 

Professional documents are reviewed from time to time, and it is the responsibility of the practitioner to ensure that the practitioner has obtained the current version.  Professional documents have been prepared having regard to the information available at the time of their preparation, and the practitioner should therefore have regard to any information, research or material which may have been published or become available subsequently. 

Whilst the College endeavours to ensure that professional documents are as current as possible at the time of their preparation, it takes no responsibility for matters arising from changed circumstances or information or material which may have become available subsequently. 

Promulgated:   June 1989

Reviewed: October  1993, 1998, 2003

Date of Current Document: Apr 2008  

©  This document is copyright and cannot be reproduced in whole or in part without prior permission. 

College Website: http://www.anzca.edu.au/