Course syllabus for Anesthesia with limited resources

Anestesi med begränsade resurser

Specific entry requirements

Specialised physician or nurse in anaesthesia and/or intensive care or ST physician in anaesthesia and intensive care with at least 3 years of their education completed.

Outcomes

The aim is to provide competence, strategies and tools for performing anesthesia and critical care in humanitarian and disaster context.

At the end of the course, participant should be able to:

Knowledge and understanding

• describe and give examples of how cultural and contextual factors influence ethical reasoning and medical decisions in humanitarian interventions.
• understand principles in and planning for a mass casualty event

Proficiency and ability

In the humanitarian context, the participant should be able to:

• carry out anaesthesia and critical care in a patient safe way
• manage available equipment and drugs for anaesthesia and critical care
• make clinical decisions about medical priorities in resource-limited settings

Judgement and approach

• to reason on ethics in relation to patients, relatives, and co-workers in a humanitarian context

Content

The course is based on a context with limited resources, either in low-income countries or in a disaster context. With limited access to drugs and equipment and in deficient health care systems, specific knowledge is necessary to apply medical knowledge in clinical practice. The course highlights such difficulties and provides tools to practise anaesthesia and critical care in a medically safe and ethical way in resource-limited contexts.

The course includes 4 days on campus with seminars, workshops, hands-on training and interactive discussions. Occasional lectures are also included. Mandatory preparatory reading and digital content is included.
The course focuses on anaesthesia and critical care in humanitarian interventions including following areas:

• Introduction to Global health
• Anaesthesia and critical care
• Coaching, ethical dilemmas and medical priorities

Detailed contents:
Introduction to Global Health and health in disasters:

• The global burden of diseases
• Global surgery and anaesthesia
• Health systems and funding
• Components of a health disaster
• Humanitarian assistance and principles

Anaesthesia and critical care in humanitarian context:

• Anesthetic equipment such as "drawover anesthesia", open circles, oxyconcentrators
• Available drugs in resource limited environments; indications, advantages, risks
• Blood transfusions in resource limited environments; whole blood, testing, autotransfusion, alternatives to blood transfusion "Damage controlled Resucitation" with its included components
• Mass casualty event; organisation, triage
• Stabilisation of vital organ functions (respiratory failure, kidney failure, circulatory failure) without advanced equipment
• Paediatric anaesthesia and critical care in resource limited environments
• Obstetric anaesthesia in resource limited environments

Coaching, decision-making, ethical dilemmas:

• Decisions about treatment limitations and palliative care in resource-limited settings and in different cultural contexts
• Ethical dilemmas and medical priorities
• Coaching in resource-limited settings

Teaching methods

Interactive teaching sessions, discussion seminars, case-based workshops, hands-on training with specific equipment, simulation training for mass casualty event.

Examination

Examination through individual oral case-presentation and approved participation in the simulation training.

The participant receives final grade for the whole course (Pass/Fail). To pass, one must be approved on the examination and be present on mandatory training sessions.

Compulsory participation
The examiner assesses if, and how, absence from compulsory educational elements can be compensated for. Before the participant has participated in the compulsory educational elements or compensated the absence in accordance with the examiner's instructions, the final course results will not be reported. Absence from a compulsory educational component may mean that the participant cannot compensate for the missed compulsory educational element until the next time the course is given.

Limitation of number of occasions to write the exam
The number of occasions to write the exam is regulated in the contract for executive education.

If there are special grounds, or a need for adaptation for a participant with a disability, the examiner may decide to deviate from the syllabus's regulations on the examination form, the number of examination opportunities, the possibility of supplementation or exemptions from the compulsory section/s of the course etc. Content and learning outcomes as well as the level of expected skills, knowledge and abilities may not be changed, removed or reduced.

Transitional provisions

The course is an executive education and transitional provisions are regulated in the contract.

Other directives

Course evaluation will be carried out in accordance with the guidelines established by the Committee for Higher Education.

The course language is English.

Literature and other teaching aids

Mandatory literature

• Essential drugs: Practical guidelines: Médecins Sans Frontières, 2023 https://medicalguidelines.msf.org/en, 
• A Guidance document for medical teams responding to health emergencies in armed conflicts and other insecure environments, World Health Organization. Geneva, 2021 https://extranet.who.int/emt/guidelines-and-publications, 
• EMACC guidelines/protocols, Emergency Medicine Anesthesia and Critical Care Working group, MSF

Recommended literature

• Health in Humanitarian Emergencies: Principles and Practice for Public Health and Healthcare Practitioners, Townes, David, Cambridge : Cambridge University Press, 2018 - 1 online resource (504 pages) ISBN: 9781107477261, LIBRIS-ID: nxptc9rxl8xz7jq8, Table of contents / Abstracts
• Jacobsen, Introduction to Global Health, Jones and Bartlett Learning, 2018 LIBRIS-ID: 22540864

Additional material and reference literature will be added during the course.