Nurses—Making a Difference in Global Health

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Jette Nørr Møllebjerg (to the right) checks car equipment before intervention

Susanne Rasmussen seen at initial therapy in unconscious man after fall from ladder.

Jette Nørr (left) delivers a severely injured patient to trauma center.

Anette Klitmose (middle) examines and treats a patient at home.

The Nurse Anaesthetist as the Hospital’s “Front-line Person” Handling Treatment in a Pre-hospital Setting

In Denmark there has not been a tradition for a pre-hospital network due to a small geographical area, a well-organized infrastructure and few citizens per hospital. High specialization has been demanding fewer hospitals that result in an increased distance between the citizens and the hospital. The focus on advanced life support and trauma have given added weight to advanced pre-hospital treatment. The first place in Denmark to use nurse anaesthetists as “first responders” whenever a quick turn-out is requested has been the county of West-Zealand.

Since 2001 the nurse anaesthetist has been acting on the pre-hospital scene using her extended competencies for high priority ambulance calls. She works part time in the pre-hospital field while her primary function is in the department of anesthesiology. She uses her clinical and practical knowledge with key competencies in advanced airway management. She treats pathophysiological conditions with drugs, fluid therapy, analgesic, sedation and anesthetic following protocols.

The nurse anaesthetist can provide treatment for the patient in specialized branches such as the cardiovascular medical department and trauma center. If treatment is necessary during the journey, she can accompany the patient for final treatment to the correct hospital. Using her broad nursing experience of the sciences and a humanistic and social approach, patients can be fully assessed and treated on the scene and may even be able to stay at home without requiring hospitalization.

The intention of the nurse anaesthetist as a “first responder” was to reduce the response-time and to ensure quick contact with a health care professional. It was also started to increase the feeling of safety for the citizens and to ensure correct distribution of patients among hospitals. The “first-responder” unit is staffed with a special trained nurse anaesthetist and an assistant from the local ambulance staff. The unit responses to high priority calls is with an ordinary ambulance. The unit is on call from 8:00 am to 24.00 pm and covers an area of 350 kilometers. The area has a winter population of 33,000 citizens and a summer population of 100,000 citizens. The aim of the pre-hospital plan is as follows:

  • To save lives
  • To improve on morbidity and mortality predictions
  • To alleviate pain and other symptoms
  • To shorten the course of the disease
  • To render care and create peace of mind.

The nurses are placed on the same level as the county’s quick response unit manned with doctors. As regard to the health care responsibility, the nurse anaesthetist acts on behalf of the doctors’ instructions and guidelines. These nurses still primarily work in the department of anaesthesiology where the competences in “handling the air-way”, in intravenous drug medication and in sustaining the circulation is maintained on both elective and acute patients.

The nurse anaesthetist in action by a major road accident in cooperation with the rescue team.

The pre-hospital nurses’ education and background and professional qualifications are as follows:

  • A minimum of 6 years practical work as a nurse anaesthetist in a department in which acute medical and surgical patients are routinely treated.

  • Successfully passing the examination following the ATCN course.
  • Complete a course in medical coordination.
  • Complete a course in handling medical disasters.
  • The training before start-up and practice includes the following:
  • 1 day medical staff course.
  • 1 day course in handling trauma.
  • Practical training at accident site.
  • 4 days as a trainee with one of the quick response units manned by a doctor.

The theoretical knowledge includes:

  • Emergency medicine

To maintain competencies the following is included:

  • Compulsory participation in frequent theoretical and practical exercises.

The nurse anaesthetist makes a difference.

The nurse anaesthetist fully assesses and treats the patients on the scene in high priority calls that results in 20 percent of the patients remaining at home and requiring no hospital admission. The primary survey assessment depends on age, physiology and prehistory. Patients’ ages range from three months to 96 years which is a great challenge in the emergency situation. The typical patient who stays at home after definitive treatment is older than 60 years. He often presents with multiple pathology and diverse needs that the nurse anaesthetist is well equipped to manage. Frequently the patients may suffer with chronically diseases such as diabetes, COLD, epilepsy, circulatory and psychiatric disorders. He is often medicated in a complex way and may present a prehistory that includes multiple and often short time hospital admissions. He is typically socially well-functioning with good contacts to relatives or is a part of the community care.

In the primary survey the nurse anaesthetist provides the advanced life support, and also explores and treats the multiple needs of the patient with her understanding from the past history and presenting situation to ensure that the patient is left well treated, satisfied and confident. Studies show that the nurse anaesthetist’s ability to observe, analyze, reflect and treat the patient makes it possible for the patient to stay at home and is not subsequently hospitalized with symptoms which can be related to the acute situation.

The research paints a picture of the impact of an aging society with an increasing number of patients with chronically diseases. The society will benefit from the nurse anaesthetist preventing patients from unnecessary admissions saving preparedness for acute life-saving interventions. The nurse has a role to play in this as in all other parts of the health service. By developing and maintaining the nurse’s role in the pre-hospital setting, it is possible to deal with the growing problem in Danish health service of recruitment and retention in nursing.


Jette Nørr Møllebjerg - 
Susanne Rasmussen -  
Nurse Anaesthetists
Holbæk Hospital
Region Sjælland, Denmark