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| Volume 11, Issue 1 | January 2008 |
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President’s Message Perioperative Blood Management and the International Board of Blood Management By Alfred H. Stammers, MSA, CCP AmSECT President |
“80% of success is showing up.” - Woody Allen There are few who would argue that perfusion is evolving into an entity that few who have been practicing since the ‘80’s could have predicted. Back then the field was awash with a burgeoning caseload that led to huge shortages in practioners and abundant opportunities for those in the field. So much so that Perfusionists found it difficult to support extracorporeal practices such as ECMO, ventricular assist and cell salvage. Indeed, these were ‘given’ to other allied health professionals with arguably only a perfunctory glance for input from Perfusionists. Perfusion education programs blossomed to meet the expanding need for clinicians to operate the heart-lung machine in support of cardiac surgery. Job opportunities were plentiful and economic prosperity seemed without limit. Yes, those were the good old days. Fast forward to the beginning of the new century and, oh, what a different tack this profession of ours has taken. “Times go by turns, and chances change by course, from foul to fair, from better hap to worse.” However, this editorial is not written to reflect upon the negative, nor to document the factors that have led to the current state of cardiac surgery, and hence, perfusion. Instead, it is to look at opportunities for the continued advancement of our profession and describe what AmSECT is doing in pursuit of these. No profession in medicine is better positioned to address the rapidly expanding field of blood management then perfusion. The comprehensive curriculum on perfusion education identifies no less than seven pages of techniques for blood conservation (management) in the Comprehensive Curriculum for Perfusion Education. The Commission on Accreditation for Allied Health Education Programs lists ‘Autotransfusion’ in only two of the 20 profession’s Standards and Guidelines for the Accreditation of Health Specialties: Perfusionist and Surgical Assistants (personal communication with Bill Horgan, Chair, Accreditation Committee on Perfusion Education and President of the Committee on Accreditation of Allied Health Professions (CAAHEP), Bruce Bartel, AmSECT Representative to CAAHEP. And the Surgical Assistants only refer to it in regards to the operative field and not the use of the cell-washing devices. The fact that these educational standards are developed by the combined efforts of numerous health specialties, including physician organizations, is testament to the importance in which the perfusion profession plays in the safe and competent administration of this task. The term extracorporeal takes on many meanings and is open to interpretation of the reader as well as the context to which it is applied. Wikipedia defines it as “a medical procedure which is carried outside the body.” When Perfusionists or cardiac surgeons speak or use the term ‘extracorporeal’ it is most often referred to as a descriptor of circulation, and hence, the use of the heart-lung machine. However, almost all hospitals where perfusionists practice use ‘extracorporeal’ to include multiple areas of blood management. These include autotransfusion, cell salvage, intraoperative platelet pheresis, acute normovolemic hemodilution and intraoperative hemofiltration. Two of the major organizations that have promoted the safe utilization of standards for perioperative blood management have been the AABB (formerly the American Association of Blood Banks) and the Society for the Advancement of Blood Management (SABM). In 2006 these organizations jointly published a monograph entitled Perioperative Blood Management: A Physician’s Handbook (AABB, ISBN 1-56395-235-1), edited by Jon Waters, MD. This well written and concise overview identifies the complexity of techniques of blood management and the need for protecting patients by providing safe and competent applications. The editors have correctly identified a major deficiency in the field of blood recovery, and reflect: “Primary to these standards is the requirement for personnel who have been given adequate time and training to operate the equipment effectively and safely.” Furthermore, almost all of the state licensure bills that have passed to date have generic language that includes autotransfusion and techniques of blood conservation (personal communication Robert D. Longenecker, Chairman, AmSECT Government Relations Committee). Although the American Board of Cardiovascular Perfusion (ABCP) remains the forbearer for certification for Perfusionists listing the “protection of the public through the establishment and maintenance of standards in the field of cardiovascular perfusion, ” these standards were created to provide certification, and recertification, for individuals meeting minimum criteria to undergo examination to receive the Certified Clinical Perfusionist (CCP) designation . Although the ABCP examination does address ancillary duties of perfusion, it is clearly directed at cardiac surgery and the practicing Perfusionist. Numerous individuals currently providing blood management services would not be eligible to sit for the ABCP examination according to the way current requirements are stated. Clearly, the void of a certifying agency for blood management technicians is not in the best interest of patients exposed to these techniques. To address this shortcoming, and improve the safety and care that blood management clinicians provide to their patients, AmSECT is working closely with the AABB to coordinate this rapidly developing field. During the past two years, the Perioperative Blood Management Taskforce, consisting of over 70 members from diverse clinical specialties, has worked diligently to create a process for formal recognition of individuals involved in blood management. One of the first steps was the creation of the International Board of Blood Management and its mission “to promote education and sound scientific principles to advance the safe and competent practice of perioperative blood management, which will lead to recognition of this specialization through examination and certification.” The IBBM has created a new specialization termed the Perioperative Blood Management Technologist (PBMT) for individuals primarily responsible for providing autotransfusion during operations where blood loss is to be expected. An examination has been developed using the American Board of Clinical Autotransfusion examination as a template. The examination review process has been coordinated by Jeffrey B. Riley, MHPE, CCT and has involved Taskforce members who have been working diligently during the past 16 months. Criteria are being established to determine eligibility for taking the PBMT examination which will be posted on the IBBM website located at IntIBBM.org. Once successful completion of all criteria for certification has been passed, the individual will be awarded the credential of PBMT. The first examination will be given April 8, 2007 at the Hilton Walt Disney World Resort immediately preceding AmSECT’s 46th Annual International Conference in Orlando, FL. To maintain this PBMT designation there will be a yearly recertification requirement that will have both a continuing education requirement along with a clinical activity segment, again established by the IBBM. Although both the AABB and AmSECT provide continuing education venues for blood management, other formal mechanisms for continuing education will be accepted as determined by the IBBM. Upon evaluation of the breadth and diversity of blood management techniques, it became evident that a second specialty would need to be created to address these additional areas. The task force has recommended that the second designation provided by the IBBM should be that of Perioperative Blood Management Specialist (PBMS). This is directed at individuals who, in addition to providing perioperative autotransfusion, would also be utilizing techniques of platelet pheresis for the production of platelet gel and other developing technologies. The criteria for the PBMS have yet to be developed, with certification anticipated to begin in 2009. During the past year, AmSECT has made a concerted effort to inform its members, and concerned individuals, about these developments. We encourage anyone who has questions or comments concerning this development to contact any of the Directors of the IBBM, whose contact information can be found at www.IntBBM.org. Common Questions Concerning the New Specialization
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