Surgical

EMTs provide safe surgical care within the expected range of services based on their typology. They form part of a referral mechanism for those procedures that are beyond their scope of practice.

Type 2 and 3 offer surgical capacity/capability with the required resources and planning to provide the best possible outcome for the patients. They hold a register of all surgical procedures executed in the EMT, with sufficient details to comply with reporting mechanisms (Minimum Data Set or other format as agreed with health authorities).

1. Safe surgery
   • Abide to and document use of WHO Safe Surgery checklist,29 modified for the disaster setting and local context.
   • Use comprehensive clinical records such as the pre-operative assessment in all patient records, including counts of such items as sponges
     and sharps, anaesthesia record, operation note, post-operative plan rehabilitation plan.
   • Ensure that staff are trained and licenced for every procedure they perform and experienced in the pathologies and circumstances faced in disaster settings that require various treatment protocols.
2. Pre- and post-operative care
   • Ensure informed consent for all surgical procedures. This must be in line with local culture/context and in the patient’s own language.
   • Develop SOPs for when patients cannot give consent and have no relatives.
   • Record consent and all surgical procedures in the patient’s notes along with a brief description of the ongoing treatment plan to inform other treating teams or the patient’s future caregivers.
   • Prepare the surgical site (shower, no shaving but hair can be removed with scissors).
   • Patient remains in recovery area until well awake and signed off by anaesthesiologist.
   • Provide a plan for postoperative recovery and rehabilitation to patient and staff.
   • Ensure a system for recording and evaluating perioperative complications.
3. Capacities and capabilities
   • Ensure availability of dedicated equipment, including OT table with pressure area control/protection, surgical sets, a lighting system powerful enough to visualize deep intra-abdominal organs.

Type 1 mobile and fixed

• • Perform minor procedures with adequate sterility and analgesia/local anaesthesia, carried out in an outpatient setting.

Type 2

• • Provide general emergency surgical care such as laparotomy, orthopaedic (traction and external fixation, amputation), chest drain insertion and debridement.
  • Management of at least seven major or 15 minor surgical procedures per day (paediatric as well as adult surgical cases).
  • At least one surgical table and at least five OT Technical staff (nurses or equivalent)
  • Any additional OT table includes 20 additional inpatient beds, to ensure adequate post-operative capacity.

Type 3

• • Provide specialized trauma and advanced reconstructive surgical care, wound care and fracture management (orthoplastic, maxillofacial reconstruction).
  • At least two surgical tables.
  • Be able to perform at least 15 major or 30 minor surgical cases per day.
  • Ensure air control (10 micron-filter G4).

1. Establish an adequate daily planning system to factor for emergency cases.
2. Minimize movements to the OT in order to limit air turbulence and the risk of infection.
3. Access to the OT is organized via a unidirectional flow and restricted to essential personnel only.
4. Maintain the operating theatre at 21–24 °C to prevent hypothermia of the patient (higher incidence in paediatric cases).
5. Provide consumables for surgical procedures and protective equipment for staff for at least 200 cases.
6. Availability of electrocautery.

• Anaesthetic technician’s qualifications are not recognized in many countries. Therefore, during a deployment, they need to work under the responsibility of a licenced anaesthesiologist.
• A minor surgical procedure can acceptably be performed with local anaesthesia and superficial procedures, not involving vital structures, such as skin excision. These usually do not require hospitalization.
• A major surgical procedure is defined as a procedure that usually requires general anaesthetics and hospitalization, for example, laparotomy and external fixation.