The first recorded use of anesthesia support personnel occurred during the late 1930s in England. History of the specialty shows that Sir Robert Macintosh solicited the services of Richard Salt to take care of the equipment and facilitate the administration of anesthesia. Since that time, the administration of anesthesia has been supported by dedicated ancillary staff to address the maintenance and operation of equipment and supplies needed to administer a safe anesthetic. Over the years, the number and complexity of surgical interventions have grown. With this growth have come significant advances in instrumentation and technology, which has increased the complexity of administering modern anesthetics and increased the demand for qualified support personnel. During the majority of this period, anesthesia technicians lacked a formalized training program and were trained “on the job” (on-the-job training [OJT]).
Certification for anesthesia technicians and technologists is currently performed solely by the American Society of Anesthesia Technologists and Technicians (ASATT). ASATT is a nonprofit organization whose primary focus is the education of anesthesia technologists and technicians. The organization was officially founded in October 1989 when a core group of technicians met in New Orleans, Louisiana. Because of the overwhelming need for a formalized training program, the charter leadership was determined to legitimize the profession as well as provide educational support for the professionals practicing in this area. Realizing that they would need the support of the anesthesia providers to succeed, the timing and location for this historical meeting were fixed in conjunction with the annual meeting of the American Society of Anesthesiologists (ASA). As interest in the ASATT grew and a formalized training program was adopted, it was realized that to gain formal recognition of the importance of anesthesia support personnel, a process would need to be implemented demonstrating which individuals possessed the knowledge and qualifications to be employed as anesthesia technicians. In 1993, ASATT began laying the foundation for the development of a national certification examination. The entire process took 2 years to complete, and in May 1996, ASATT administered its very first written certification examination for anesthesia technicians. Because of the popularity of the certification exam, ASATT members expressed interest in an advanced level of certification, and in 2001, the first technologist-level exam was administered. After several years, interest waned and the exam was put on hiatus. However, as certification became more widely accepted, the technologist exam was reactivated in 2006 because of expressed interest from both technicians and employers.
As a condition of employment, the demand for certification has increased, as has the number of individuals seeking certification and taking the exam. To meet this increased demand, the ASATT began to administer the exam via computer in 2003, making it accessible year round. Because of expanded interest on the international level, ASATT began to offer a web-based exam to those candidates in 2006.
What may be considered a monumental hurdle, The Commission on Accreditation of Allied Health Education Programs (CAAHEP) officially recognized anesthesia technology as an official health science discipline in 2010. Based on the recommendation from CAAHEP and the Education/Accreditation Committee (CoA-ATE), the ASATT Board of Directors made the decision to retire the Certified Anesthesia Technician (Cer.A.T.) examination effective July 15, 2015.
ASATT has the only nationally recognized certification exam (NCE) for anesthesia technologists and will continue to recognize certified anesthesia technicians as long as they continue to meet the recertification standards. The technologist and technician certifications are endorsed by the ASA and the American Association of Nurse Anesthetists (AANA).
An Item Writers Committee evaluates and develops the ASATT certification standards and exam in conjunction with Applied Measurement Professionals (AMP), an organization that develops and administers certification exams. Test development is written in accordance with the standards set forth by the National Organization for Competency Assurance (NOCA), an organization dedicated to providing educational, networking, and advocacy resources for the credentialing community. The Item Writers Committee consists of the following:
Test items are written in accordance with a detailed educational content outline as set forth by ASATT and are enforced by the CoA-ATE through the educational entities that have been reviewed and/or accredited.
Test items cover six major domains: Equipment, Instrumentation, and Technology; Basic Sciences; Pharmacology; Basic Principles of Anesthesia; Advanced Principles; and Professional Aspects.
The Certified Technician Exam was officially retired on July 15, 2015. Although the exam is no longer being offered, the ASATT continues to recognize the certification designation as long as the individual meets the recertification standards. The certification must be renewed every 2 years to the ASATT Certification/Recertification Review Committee. At the end of each two full calendar year period, Cer.A.T.s must show that they have 20 continuing education hours (CEHs) relevant to their level of certification.
To be eligible for this examination, the candidate must be a graduate from an approved ASATT program or graduated from a CAAHEP-accredited educational program with at least an associate degree. Graduates from either program must submit an official student transcript with their application.
Certification for the technologist is also granted for a 2-year period. In order to maintain certification, a minimum of 30 CEHs must be submitted to the ASATT Certification/Recertification Review Committee. At the end of each 2-year period, Cer.A.T.T.s must reapply for certification.
Since the candidate took the exam earlier in the year, he or she has a longer grace period in which to earn CEHs compared to a candidate who passed the certification exam in November of 2017 because the 2-year certification period begins with the year following the year in which the applicant meets all certification requirements. Both candidates’ certification will expire on December 31, 2019.
Certified anesthesia technicians who seek to advance their career may challenge the National Certification Exam (NCE). The Cer.A.T. must establish minimum educational and clinical anesthesia experience needed to meet the standards and practice of the anesthesia technologist in preparation for the technologist NCE. The Advancement Program consists of 40 hours of continuing education (CE) which must be completed within a 2-year period and fall within the following categories:
Advancement Program credits are earned through completion of preapproved ASATT continuing education programs. The candidate must also show proof of current BCLS and ACLS certification.
In addition to the above requirements, the applicant must have worked as an anesthesia technician for 2 years and be employed as a Certified Anesthesia Technician for 3 years (total of 5 years’ experience) in a medical facility. The technologist NCE can be taken only after the Certified Anesthesia Technician has completed the CE credits and provides proof of employment requirements.
Certified anesthesia technologists/technicians who allowed their certification to lapse because of insufficient CEs or did not renew by their expiration date may apply for provisional certification within 30 days of expiring (following the grace period). Individuals must submit a completed application for Provisional Recertification along with a Remediation for Expired Certification Application including all associated fees. The applicant may begin to earn CE credits once the application has been reviewed and approved by the ASATT Continuing Education Committee. Specific criteria must be met within a 12-month period: Certified Anesthesia Technicians will need to earn 30 CEs, whereas a certified anesthesia technologist will need to earn 40 CEs. All CEs must be earned from ASATT preapproved programs.
Individuals who have to place their career on hiatus may reinstate their technologist certification status if they have not been actively employed as a certified anesthesia technologist for more than 2 years but less than 5 years. The program consists of successful completion of:
Once these criteria have been met, the individual will be allowed to retake the technologist NCE. The candidate will have three attempts to complete the exam within a 1-year period.
In April 2010, the CAAHEP approved anesthesia technology as an official health science discipline. Schools that offer an associate’s degree in anesthesia technology must become accredited through ASATT and CAAHEP in order for their graduates to be eligible for the NCE. As an official health science discipline, OJT will be phased out as college graduates enter the workforce. Although the certified technician designation will continue to be recognized by society, it will be imperative that these individuals keep their certification status in good standing.
There continues to be a steady increase of employers requiring certification as a condition of employment. Salaries may be based on whether the technician holds certification for the technician or technologist level, with additional credit being given to individuals holding an associate’s degree in anesthesia technology. Although some employers do not mandate certification as a condition of employment, most employers now prefer to hire certified anesthesia technologists or technicians. In addition, many employers have developed a clinical ladder for advancement based on certification.
There is also an added incentive for employers to hire and maintain certified technologists and technicians. These individuals are staying abreast on the latest technology employed in the operating room (OR) environment and actively participate in quality assurance for the monitoring devices in use. This enables the anesthesia department to remain compliant with local and state regulations as well as the Joint Commission (formerly the Joint Commission on Accreditation of Healthcare Organizations) and College of American Pathologists (CAP) accreditation. Certified technologists and technicians are skilled individuals who assist the anesthesia provider in line placement, difficult intubations, and patient monitoring, thus improving patient safety. They reduce operating costs and facilitate room turnovers by properly ensuring that all needed equipment and necessary supplies are readily available. The acronym for ASATT, “Assisting with Safe Anesthesia Today and Tomorrow,” guarantees that these qualified individuals are readily available to assist in both emergent and nonemergent patient situations.
The majority of anesthesia technologists and technicians in practice today were trained on the job. Looking at the history of the profession, the complexity of the surgical procedures, the medical acuity of patients, and the advancement in technology, no one can argue that the job has evolved in the last 25 years. Taking these factors into account, many institutions have realized that OJT is no longer feasible in this day and age. Employers are seeking qualified anesthesia technologists and technicians, and the demand is currently greater than the supply. CAAHEP accreditation not only provides opportunities for the profession to excel but also enables the employer to hire qualified individuals as anesthesia technicians, thereby phasing out the costly and time-consuming responsibility of OJT. The society’s original goal was to see certification to fruition. By all indications, this health science discipline will be one of the fastest growing disciplines the medical profession has experienced in the last decade.
1. The ASATT was established in this year:
A) 1986
B) 1989
C) 1996
D) 2001
E) None of the above
Answer: B
ASATT was established in New Orleans, LA, in 1989.
2. The first recorded use of anesthesia support personnel occurred in
A) England
B) Australia
C) Louisiana
D) China
E) California
Answer: A
The first recorded use of anesthesia support personnel occurred in England in the late 1930s.
3. ASATT issued its very first written certification exam for the technician in
A) 1889
B) 1993
C) 1996
D) 2001
E) 2010
Answer: C
ASATT offered the first written exam for anesthesia technicians in 1996.
4. The certification exam is administered in accordance with standards developed by
A) ASA
B) AANA
C) APSF
D) NOCA
E) JCAHO
Answer: D
NOCA developed the standards on which the certification exams are administered.
5. Certification for both the technologist and technician exams is granted on a
A) Four-year basis
B) Rotation of every other year
C) Two-year basis
D) Yearly basis
E) None of the above
Answer: C
Both the technician and the technologist must recertify every 2 years after completing the required number of CEHs for their discipline.
6. The Item Writers Committee is composed of
A) Anesthesiologists
B) CRNAs
C) Corporate representatives
D) Anesthesia technicians and technologists
E) All of the above
Answer: E
The Item Writers Committee consists of anesthesiologists, CRNAs, corporate representatives, anesthesia technologists, and educators, along with a representative from the test writing development company.
7. A certified anesthesia technician must show proof of this number of CEHs in a 2-year period:
A) 30
B) 20
C) 120
D) 125
E) 10
Answer: B
The anesthesia technician must show proof of 20 CEHs every 2 years as part of the recertification process. The anesthesia technologist must have 30 CEHs in the same time period.
McMahon DJ, Thompson GE. A survey of anesthesia support personnel in teaching programs. Med Instrum. 1987;21(5):269-274.
Standards and Guidelines for the Accreditation of Educational Programs in Anesthesia Technology . Commission on Accreditation of Allied Health Education Programs. 2011:1-11. https://www.caahep.org/CAAHEP/media/ CAAHEP-Documents/AnesthesiaTechnologyStandard 2015.pdf.