EMTs provide adequate pain management for their patients. This includes general anaesthesia for patients experiencing trauma and awaiting referral to higher levels of care, as well as procedural and perioperative anaesthesia.

Treatment of pain is a basic human right. EMTs should be able to manage acute pain and comply with minimum standards.28 This includes considering a multimodal approach and availability of a range of treatment options and pharmaceuticals. Specific procedures such as regional anaesthesia also allow safe anaesthesia for patients in settings with scarce resources. The ability to provide safe general anaesthesia is mandatory for Type 2 and 3. The choice of anaesthetic approach depends on the nature and extent of surgical intervention.

  1. An EMT anaesthesiologist licenced to perform anaesthetics and trained and experienced to work in resource-poor environments.
  2. Documentation for each patient should include appropriate history, physical examination and consent, expected progress and follow up.
  3. Assure patient safety and comfort during the entire surgical process.
  4. Pain relief
    • Provide local anaesthesia for procedures and analgesia for pain control.
    • Assess pain upon patient arrival and on a regular basis during the stay, providing treatment with medications of increasing potency when effect is insufficient.
    • Provide patient pain medication as indicated and instruct them on follow-up care.
  5. Procedural sedation Type 2 and 3
    • Use a sedative to induce a state that allows the patient to tolerate uncomfortable (short) procedures. This maintains airway reflexes, respiratory drive and cardiovascular functions.
    • Requires careful patient selection, personnel, equipment, peri- and
      post-procedure monitoring.
  6. Anaesthesia

Type 2 and 3

    • Perform safe paediatric and adult regional, spinal and general anaesthesia.
    • Ensure documentation and processes such as preoperative evaluation, anaesthesia plan, consent, pre-procedure ‘’time-out’’.
    • Provide a dedicated recovery space close to the operating theatre with a dedicated postoperative nurse to patient ratio of 1 : 2 and monitoring equipment.
    • Install resuscitation equipment both in the operating theatre (OT) and in the recovery area.
    • Supply medications, equipment and trained staff to provide resuscitation in the event of an anaesthetic complication.
    • Provide supplemental oxygen, suction, basic monitoring of vital signs, access to defibrillator in the OT and a carbon dioxide (CO2) detector.
    • Stock basic airway adjuncts and self-inflating breathing bags in adult and paediatric sizes.
    • Establish perioperative management including pain management and post-anaesthetic care unit with appropriate post-operative staffing and equipment.

Type 3

    • Provide ventilator, defibrillator, syringe pump, blood warmer and neural stimulator or ultrasound.
    • Ensure advanced monitoring including cardiac monitoring and end-tidal CO2 (ETCO2).
    • Establish perioperative management including pain management, post-anaesthetic care unit with ICU level staffing and equipment.
  • Minimum anaesthesiologist–OT table ratio of 2 : 1
  • Minimum anaesthesiologist–surgeon ratio of 1 : 1
  • Minimum surgeon–OT table ratio of 2 : 1

If the technical expertise, ability to monitor the patient and reverse and manage potential side effects is present in the team, procedural sedation can be accepted in Type 1 Fixed.