THE EVOLUTION OF THE SURGICAL TECHNOLOGISTEboni Saurage - October 24, 2019
When a patient undergoes surgery, it takes a team of perioperative staff to ensure it happens safely and efficiently. The number of team members will differ depending on the type of surgery but will always include the surgeon, the anaesthesiologist the nurse anaesthetist, a circulating perioperative nurse, and a surgical technologist.
In some areas of the world the surgical technologist may still be referred to as an Operating Room Technician (OR-T) or Scrub Nurse. In addition to the core team members, there may also be surgical assistants who may be visiting physicians, Physician Assistants, Registered Nurse First Assistants, or Certified Surgical First Assistants.
I'd like to highlight the surgical technologist and share with you an insight into the profession as it is an often overlooked part of the team, yet an integral member of the team delivering surgical care.
The profession of surgical technology traces its beginnings to a period in world history when militaries from around the world prepared to enter World War II. As the military strategy for the Invasion of Normandy (D-Day) developed in 1944, the United States War Department, along with the American Medical Association and Surgeon General worked together to build the Medical Department of the War which would train and deploy medical personnel alongside the infantry in order to care for the injured.
The need to procure and assign medical personnel brought about a pressure to abbreviate medical training in order to meet the needs of the war. Experienced surgeons were recruited by the American Medical Department of the War to act as commanding officers. During that period surgical residencies were condensed to 27 months. The US Army and Navy technical schools were quickly filled with patriots who were trained as Army combat medical technicians (medics, red) and Navy corpsmen. These young men quickly learned the skills of the operating theatre and were coordinated into surgical units based around one surgeon as the commanding officer.
The ‘model’ surgical team for the war included: a general surgeon, a thoracic surgeon, ‘a younger man with a strong surgical background’, an anaesthetist, and four enlisted men with ‘clear heads and steady hands’.
As the team of the ideal model surgical team became difficult to assemble, the roles of the US Army medics and Navy Corpsmen expanded. Back in the day, female nurses were not allowed aboard combat ships or on the front lines of the battle field of the 1940s. This led to a new profession within the military called operating room technicians (ORT).
As the War departments prepared for D-Day, the US Medical Department of the War prepared Auxiliary Surgical Groups (ASG). The ASG were attached to front-line units, with the 3rd ASG arriving on the beaches of Normandy the day after D-Day. Their supplies were brought in using unmanned gliders. Though many were shot down, the Medics and ORT’s salvaged what they could to construct temporary operating theatres and began caring for the injured. The 3rd ASG served more than 13,000 surgical patients from June 6, 1944 through December 1, 1944 and was eventually given the new name of Mobile Army Surgical Hospital (M.A.S.H.).
Medical research was put on hold during this time to give way for training young surgeons in battlefield techniques. But after the war medical personnel returned to their respective nations and committed themselves to a period of remarkable clinical advancement based on the crisis management techniques implemented while in the field. This included advances in plastic surgery, ophthalmology, cardiac and peripheral vascular surgical specialties as well as the advances in orthopaedic surgical specialty based on German techniques, such as the Kirshner fixation system was brought back to the United States.
The role of the medics and nurses working as Operating Room Technicians (ORT) expanded as new technology was brought into the operating theatre. By the 1960s the Association of Surgical Technologists was established by members of the American College of Surgeons (ACS), the American Hospital Association (AHA) and the Association of peri-Operative Registered Nurses (AORN).
The title Operating Room Technician became known as Surgical Technologist as their unique specialised training in surgical techniques, procedures and technology continued to expand with the advancement of surgery.
Surgical technologists quickly recognised the evolution of technology and implemented an appreciation and understanding, helping to incorporate it into the day to day operations of the operating room and incorporating it into the curriculum at schools across the nation.
Today the Association of Surgical Technologists (AST) recognises more than 80,000 practitioners nationwide, more than 78,000 are certified through the National Board of Surgical Technology and Surgical Assisting (NBSTSA).
The Accreditation Review Council on Education in Surgical Technology and Surgical Assisting (ARC/STSA) oversee over 400 accredited surgical technology programs ensuring the profession continues to meet the needs of the advancing surgical community.
Surgical Technologists are now equipped with not only the theory of surgical procedures, sterile techniques and advancing technologies, but also with the efficiency of the surgical environment, logistics of supply chain processes and theories of teamwork to help the surgical team function as a cohesive unit. We are seeing certified surgical technologist (CST) assuming roles away from the mayo stand as they transition into leadership positions within surgery, materials management and sterile processing departments.
Ask around, you'll be surprised at how many people within the surgical department began their careers as a ‘scrub nurse’, ‘OR Tech’, or as we are referred to in the US, surgical technologists.
Often the team member who receives the least recognition, (if anaesthesia does their jobs, our patients don't remember us) the surgical tech, is in the room making preparations before the patient and surgeon arrive and in the room after the surgery is over ensuring the patient is safe and our equipment and instrumentation is cared for properly so it can be used again.
Though most surgical technologist don't possess advanced academic degrees, we must be proficient in every surgical specialty and learn surgical procedures as well as any surgical resident in order to stay three to five steps ahead of the operating surgeon as a method of assistance and efficiency. We are masters in sterile technique and will teach any new surgical team member proper methods in order to protect our patients. Because at the end of the day, we are in this together, but the patient is always first.
Eboni Saurage is a practicing surgical technologist and surgical technology educator with 15 years experience as a Certified Surgical Technologist (CST). She holds degrees in Surgical Technology, Health Science and Academic Administration and recently began working towards her Doctorate of Education in Healthcare.
She is currently the director of surgical service programs at Baton Rouge Community College in Baton Rouge, Louisiana, serves as Vice-President of the Louisiana State Assembly of the Association of Surgical Technologists, and Deputy Chair of the US Chapter of The Operating Room Global.
Her passion for advancing safe perioperative patient care through fundamental and continuing education has driven her to serve on numerous regional, state, and national committees for surgical technology and education. Current interests include reflective practice, leadership development, Interprofessional Education and Simulation in Healthcare.
To get in touch with Eboni head to her profile on LinkedIN or at Baton Rouge Community College-Surgical Technology Program
Alternatively you can send her an email