Features  |   December 2015
Comparison and Contrast of Anesthesia Practice in Europe and the U.S.
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Critical Care / Neuromuscular Diseases and Drugs / Practice Management / Features
Features   |   December 2015
Comparison and Contrast of Anesthesia Practice in Europe and the U.S.
ASA Monitor 12 2015, Vol.79, 18-20.
ASA Monitor 12 2015, Vol.79, 18-20.
There are interesting similarities and differences in clinical anesthesia practice and organization between the U.S. and Europe. A detailed analysis stratified for all European countries and the different regions of the U.S. is beyond the scope of this newsletter. However, since both authors have worked in public hospitals in both Switzerland and San Francisco, the comparison of pertinent practice variances will mainly focus on these two settings.
In most western European countries, the clinical anesthesiologist is more longitudinally involved in patient care. It starts with a heavy involvement in prehospital emergency medicine. Anesthesiologists are trained and available to go to the scene of an accident or medical emergency. In some systems, dispatch will activate them with the initial call and the anesthesiologist gets to the scene as part of the crew with the primary ambulance. Another approach has the anesthesiologist on standby with a dedicated emergency physician vehicle and driver that will bring her/him to the patient if called upon by the primary team. While the topic of scoop and run versus stay and play approach remain subjects for debate, the presence of a well-trained physician enables more complex protocols and front-line decision-making. It also provides an early starting point for continued care. Not only do anesthesiologists govern the prehospital portion of emergency medicine, but also once the intrahospital care begins. Together with the primary team, an anesthesiologist is usually involved in the care of the most ill medical and surgical patients in the hospital. Also in those settings, the anesthesiologist stays with the patient for the entire critical period and provides a very helpful continuum of care. In Europe there is also a heavy involvement of anesthesiologists in both medical and surgical ICUs. Additionally, operation room (O.R.) management, preoperative and pain clinics as well as services for palliative care have been a mainstay for even small anesthesia departments for a long time. This contrasts to most U.S. practices, where anesthesiologists have predominantly focused on the intraoperative and critical care period.
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