Statement on Anesthesiologist Head Injuries in Anesthetizing Locations

Developed by: Committee on Occupational Health
Original Approval: October 23, 2024

Ceiling-mounted systems both movable and fixed, such as monitors, surgical equipment, lights, and their supporting booms, as well as ceiling mounted access to anesthesia gases and electric outlets are commonplace in modern procedural settings. “Minimally invasive” and other “hybrid” surgical suites, as well as procedural locations such as interventional radiology and endoscopy units, are often designed to optimize conditions for the proceduralist, with multiple movable screens. However, these arrangements are often inconsistent with overhead safety considerations. Head injuries amongst health care professionals as a result of impacts with dangling objects in procedural settings (oftentimes termed “boom strikes”) are increasingly frequent. These incidents may be severe, incapacitating, and distracting, thereby impacting patient safety. 

Anesthesia teams are arguably the most vulnerable to these head injuries because of the limited and often shared space in anesthetizing locations, and their frequent need to make sudden and abrupt movements to deliver urgent patient-focused actions. During endoscopic, laparoscopic, robotic, and radiologic procedures, ambient lighting is typically maintained at a low level to enhance screen visualization, increasing the likelihood of collisions with low-hanging objects. 

An anesthesiologist incapacitated or impaired by a boom strike constitutes a potential medical emergency and can  pose a significant patient safety issue. This is especially concerning when it occurs at a procedure site physically separated or distant from hospital operating rooms or during off hours when relief by another anesthesiologist is not readily available. Even momentary pain, bleeding, or visual disturbance can distract an anesthesiologist and pose a safety risk to patients. 
  
A few measures can help to protect against such head injuries. A critical first step is to increase awareness of this problem. Leaders can hold safety meetings with all operating room staff to alert personnel to this widespread issue and generate proposed solutions to avoid these head injuries. Safety teams can also be formed to evaluate reports of boom strikes, identify high-risk circumstances, and correct conditions that are likely to produce head injuries. Anesthesia department staff should participate in planning or design of rooms or procedural suites to provide input to protect anesthesiologists who will be working in those areas. A focus on Human Factors to improve the work environment for anesthesiologists will reduce poor physical ergonomics and awkward postures, but also prevent head injuries. 

Summary Recommendations 

Each department should track head injuries occurring to anesthesiologists in the workplace, including mechanism and severity, either in addition to or in conjunction with hospital and/or local occupational health offices. Data collection, even anonymous reports, may provide insight into effective interventions. 

Anesthesia department clinical staff should participate in planning or design of rooms or procedure suites to provide input to protect anesthesiologists who will be working in those areas. 

Strong communication between participants in the procedural space should be encouraged before equipment is moved to maximize safety and minimize injury. 

Departments should develop robust contingency plans for an injured or suddenly disabled anesthesiologist, consistent with accreditation standards. This should be updated regularly to adapt to changing and variable work environments and made easily accessible to all staff members. 

References:

ASA Committee on Occupational Health Committee Resource on Boom Strikes 

ASA Workplace Safety and Injury Survey Results. ASA 2023 HOD Handbook report 512-2.3. 

Webster KLW, Haut ER. Chapter 7 – Human factors and ergonomics in the operating room.  Handbook of Perioperative and Procedural Patient Safety, Editor(s): Juan A. Sanchez, Robert S.D. Higgins, Paula S. Kent, Elsevier, 2024, Pages 75-86, https://doi.org/10.1016/B978-0-323-66179-9.00011-7

Fassbinder M, Abernathy III JH. Chapter 14 – Redesigning the operating room for safety. Handbook of Perioperative and Procedural Patient Safety, Editor(s): Juan A. Sanchez, Robert S.D. Higgins, Paula S. Kent, Elsevier, 2024, Pages 231-244, ISBN 9780323661799

Heinke TL, Joseph A, Carroll D. Safety in Health Care: The Impact of Operating Room Design. Anesthesiol Clin. 2023 Dec;41(4):789-801. 

Joseph A, Bayramzadeh S, Zamani Z, Rostenberg B. Safety, Performance, and Satisfaction Outcomes in the Operating Room: A Literature Review. HERD: Health Environments Research & Design Journal. 2018;11(2):137-150.

Kelly, F.E., Frerk, C., Bailey, C.R., Cook, T.M., Ferguson, K., Flin, R., Fong, K., Groom, P., John, C., Lang, A.R., Meek, T., Miller, K.L., Richmond, L., Sevdalis, N. and Stacey, M.R. (2023), Human factors in anaesthesia: a narrative review. Anaesthesia, 78: 479-490.