Special Feature
Sept 03

First Assistants - Stepping in,
and Stepping up to the Table

Surgical First Assistants provide a crucial role in operating rooms around the country acting as a second set of eyes, ears and hands for the surgeon. It's a demanding job, one that requires a level head, a steady hand and the ability to move in tandem with the operating surgeon. Increasingly, Certified First Assistants (CFA) are adopting the role of a second surgeon during both complex and routine procedures.

"You develop a second sense," CFA Thomas Thompson says. "You need that to be able to respond before the surgeon has to ask. First Assistants always think one step ahead of the surgeon's routine. It's crucial that the doctor never has to wait for anything. I think of it like a dance; you have to anticipate your partner's every move. First Assistants and technologists are trained specifically to assist the operating doctor in every surgery, from complex cardiac and transplant operations to routine appendectomies and cesarean sections.

"Normally, you work with one doctor or one group of doctors," Thompson explains. "You learn (the doctor's) routine, learn what (the doctor) does and then you provide assistance as (the doctor) needs it. You don't wait for (the doctor) to ask for an instrument, you have it ready when (the doctor's) going to need it.

Once called "scrubs," First Assistants provide important assistance in the operating room. Trained and certified professionals, they are responsible for everything from sterilizing instruments used in surgery to closing the incision at the end of an operation. Surgeon Barbara Okamoto says First Assistants are being used more frequently during operations, a departure from the days when they were solely responsible for sterility and providing instruments to the surgeon.

"They are assisting during the operation more and more frequently," she said. "There is a critical shortage of surgical residents and interns at this time. First Assistants have stepped in, filled that role and help with the procedure." Many patients never realize the critical role a First Assistant plays in their operation. Their assistance not only shortens the time a patient is on the operating table, it also serves to lower health care costs.

"First Assistants cost the hospital less than having a second surgeon available during the operation," CFA Susan Fisher said. "Our role is to enhance the surgeon, which makes the surgery better for the patient." Fisher currently oversees the surgical technology program at hospitals in Eastern Maryland. She believes that certification is crucial to the First Assistant's success. "You are there to do everything from clamping vessels to tying knots and suturing,"she said. "You have to have a clear view of the operating field, and you need to be completely trained and certified to do a reliable job."

The job of certifying First Assistants and surgical technologists falls to the Liaison Council on Certification for the Surgical Technologist. The LCC-ST reviews credentials, verifies experience, and tests First Assistants on their knowledge base and skills, providing them with an important designation, distinguishing them from peers who have not gone through the certification process. LCC-ST President Donovan Traverse believes that certification is an important step for those who want to be part of the profession.

"Through the certification process, hospitals and surgeons can be assured that the First Assistant has the technical and academic background in the field. LCC-ST both directs the testing and creates the exam," he said. "The certification process is the last step for entry-level professionals in the field. Sometimes it is a requirement for employment, but it is a vital part of the education process. It shows that you are willing to go the extra distance needed to become certified."

Surgeon Okamoto said certified Assistants show their expertise where it counts - in the operating room. She currently serves as the secretary/treasurer for the certifying body, LCC-ST. "The certification shows they know the job and are intimately familiar with surgery," she said. "In the past, you could get an Assistant who has never been trained as a surgical technician. Without the certification background, there could be problems in the operating room. With it, you can be confident they have the ability to perform well."

First Assistants who hold certification credentials "show their worth," Thompson said. "There are stringent requirements, and you've proven you can meet them. You've shown the knowledge base is there to benefit the patient and the surgeon. Through certification, the field is required to be standardized.

Growing technology also plays a role in the need to be certified, Fisher said. As implants and transplant operations become commonplace, CFAs must keep their certification current and must stay actively involved in educating themselves. "I work mostly in orthopedics," she said. "And as technology changed the way surgeons performed operations, I had to stay on top of the latest information out there through workshops and classes."

The field of First Assistants is still in its infancy, Traverse said. The role originated in the 1940s, when student nurses trained to assist in the operating room, since then, the need for trained surgical staff has only grown. The Association of Surgical Technologists (AST) started in 1969, the First certification exams were given by the LCC-ST in 1970, and an advanced certification for First Assistants was not created until 1992. The Association of Surgical Assistance was created as a component division of AST in 2001. Most recently, Texas issued the First license for surgical Assistants December 13, 2002.

"I've seen estimates that the field is about 50 percent understaffed. Allied healthcare is one of the fasting growing fields and estimates are that we will need 43,000 surgical technologists by 2006," Traverse said. "In my area = Detroit, Mich. students are getting job offers even as they finish their training." In some parts of the country, surgical First Assistants are a rarity. In Thompson's home state of Arkansas, hospitals have very few trained specialists on whom to rely. "But the field is growing by leaps and bounds,"he said. "In the next year, even more people will be trained. Here in Arkansas, the First Assistants work with specific surgeons, not for a hospital. It makes it easier to know their routine, once you become accustomed to each doctor."

As the field continues its phenomenal growth, the presence of First Assistants in the operating room will only benefit the patient, Okamoto said. "It reduces the amount of time they are in surgery and helps the surgeon get done quicker," she said. "That all benefits the patient, and that's what we're here to do. First Assistants are only going to become more invaluable as time goes on. Their background in microbiology and pharmacology, as well as the technical aspects of surgery, provide total care management for the patient.

FASTFACTS
States employing the most CFAs: Texas • Florida • Ohio • Michigan Indiana • Illinois •  Tennessee • Kentucky • Colorado • California

National Surgical Technologist Week September 21-27, 2003

Requirements for Certified First Assistants: AS or BS in surgical technology, nursing, or physician Assistant, or MD, proof of 350 cases as a First Assistant, and passing the national certification exam.

Certified Surgical Technologist, graduation from an accredited FA program, proof of 135 cases as a First Assistant, and passing the national certification exam.

Certified Surgical Technologist, proof of 350 cases as a First Assistant, and passing the national certification exam (option ends 1/2007).

Surf the Web
Certification for First Assistants: Liaison Council on Certification for Surgical Technologists www.lcc-st.org

Membership Organizations and Continuing Education:
Association of Surgical Assistants
• www.surgicalAssistant.org
Association of Surgical Technologists
• www.ast.org
State Licensure Requirements:
Texas, www.tsbme.state.tx.us