EAMS Country Information

NETHERLANDS
Under Construction
	COUNCIL MEMBER	Dr Pieter BORG 2006 Dr Nicoline KLAVER 2007-
	CONTACT	nicoline.klaver@inter.nl.net
	COUNTRY	Netherlands (Nederland)
	POPULATION	17,000,000
	NUMBER OF ANAESTHETISTS	Specialists: 1137 Trainees: 300
	NUMBER OF HOSPITALS	149 with anaesthetic department
	SPECIALISED AIRWAY MANAGEMENT SOCIETY?	None

ANAESTHETIC TRAINING
	LENGTH OF TRAINING
	SYLLABUS
	TRAINING SUPERVISOR	The Nederlands Vereniging voor Anesthesiologie (NVA) is the Dutch medical professional anaesthesia association. It organises training and examinations of the trainees and it supervises professional standards for anaesthesia. The Inspectie voor de Volksgezondheid is the govermental body supervising all heathcare in the country.

AIRWAY MANAGEMENT
	TRAINING SYLLABUS AVAILABLE?	The official goals for airway management are global: 'be familiar with the airway management algorithm, be able to manage a difficult airway, and be able to make one or two alternative plans for airway management.' Specific techniques are hardly mentioned.
	WHAT ARE THE CORE AIRWAY SKILLS OF ALL ANAESTHETISTS?	These are best estimates of the proportion of Dutch anaesthetists with competence in the following airway techniques. A new survey will give more reliable figures. Bag/mask ventilation 100% Direct laryngsocopy 100% Laryngeal mask 100% Use of the introducer (gum-elastic bougie) 95% Flexible fibreoptic intubation 30% Trachlight 30% Awake intubation 15% Cricothyrotomy 15% ILMA 5% Jet ventilation <1% Tracheotomy <1%
	ANY NATIONAL GUIDELINES?	At the moment there are no official national guidelines. The Dutch Anaesthesia Association (NVA) has asked the authors of the Dutch Difficult Airway Algorithm to develop this into a national guideline
	GUIDELINES	Dutch Difficult Airway Algorithm (English) Dutch Difficult Airway Algorithm (Dutch) Dutch Difficult Airway Scheme (Dutch)
	EQUIPMENT	In the explanatory text of the Dutch Difficult Airway Algorithm advice is given on the acquisition of airway equipment depending on local patient characteristics and familiarity with the techniques and instruments by the anaesthetists
	WORKSHOP AVAILABILITY	There is a national airway management course 'Access to the Airway' given by a group of anaesthetists from several hospitals three times a year for groups of 28 'trainees'. This national course has been in existence for 11 years and more than 1000 anaesthetists have completed the course.

AIRWAY MORTALITY
	DATA COLLECTION	No reliable national data collection but software for anaesthetic complication registration has been implemented in a few hospitals since 2003 No local data collection
	LINK BETWEEN MORTALITY AND IMPROVEMENT IN NATIONAL PRACTICE	No link currently

DEVELOPMENTS
	Advanced techniques will be mastered by more colleagues If the Dutch Airway Algorithm becomes a national guideline it will be the political push to help hospital departments purchase the required equipment The gum-elastic bougie will be replaced by a disposable stylet The Trachlight may be replaced by a direct sight or video stylet More disposable materials will be used in daily practice

DEFICIENCIES
	Under construction