Norwegian Society of Extracorporeal Technology (NorSECT) was founded on August 15th, 1975, but then under the name Norske thorax-ingeniørers forening (Norwegian Thorax Engineers Association).
The association changed its name on June 2nd, 1977, to Norsk thoraxteknisk forening (Norwegian thorax-technical association) until August 26th, 1980, when NorSECT became the current name of the society.
The objectives of NorSECT are to promote cooperation, development, research and education within extracorporeal technology. Together with the Swedish and Danish societies NorSECT formed the common Scandinavian Society, ScanSECT, in Oslo 1980.
ScanSECT established guidelines for a formal, acceptable educational program and training of student perfusionists. 2 different theoretical educational programs in Scandinavia were accredited by ScanSECT: the perfusion programs in Gothenburg (SE) and in Aarhus (DK). The perfusionist students received their practical training at the different heartcenters. ScanSECT established criteria for authorisation of perfusionists and since 1990 issued a scandinavian certificate of cardiovascular perfusion.
In the early years it has been a tradition in Norway to hire electronical engineers as perfusionist trainees and after the employment send them to school and give them practical experience at the local hospital. In the recent years also specialized nurses and bio-engineers have been hired as perfusionist trainees.
In 1996 NorSECT established an authorisation committee in order to achieve a national authorisation of the perfusionists. In july 1999 Norway got a new health personnel act which stated that perfusionists should be among the authorized health-personnel. Since january 2001 perfusionists can apply for a national authorisation certificate which is issued to persons who have passed the perfusion education at an EBCP-accredited school. The certificate gives them the right to name themselves perfusionists. Furthermore this certificate will probably be granted to all the clinical perfusionists. Every new employed norwegian trainee has attended an EBCP-accredited school for the last years.
Currently only one school in Scandinavia is EBCP-accredited: the Scandinavian School of Perfusion affiliated to the Aarhus University in Denmark. Norway does not have any educational perfusion program.
The national authorisation process of the Norwegian perfusionists
At the general assembly of NORSECT in 1996, national authorisation was one of the main topics.
The new board of NORSECT established an authorisation committee with the members Else Nygreen, Arve Mongstad and Finn Eliassen.
The first major task for the authorisation committee was to gather information and get documentation, to be able to apply for an authorisation. We studied an official report on health personnel thoroughly.
In 1993 the Norwegian Ministry of Health and Social Affairs published this report “Rights and duties of Health personnel”, concerning a draft of a new act. The Norwegian government wanted to make one common act for health personnel instead of the existing nine. The aim of this bill was to unite the different health professions and to focus on the patient, getting a safe and high quality health service.
In this report there was a general description of which groups of employees should be authorised as health personnel. The main criteria were: working independently, interacting with the patients, having a unique profession skill and thus a special educational program.
The authorisation committee sent out an inquiry to the seven heartcenters in Norway. We asked them to send us their last advertisement for perfusionists and in this way document the personal qualities we seek for a perfusionist. The answers revealed that in this profession the person must be able to work independently, making their own decisions concerning perfusion technique and yet in close cooperation with other professions.
At each heartcenter the head of thoracic surgery was urged to make a statement concerning authorisation for the perfusionists. Every statement was in favour for authorisation. The arguments stressed the need of well educated personnel and the responsibility the perfusionist has in caring for the patients. In Norway the heartcenters have preferred to hire engineers in these positions and then educate them to perfusionists. Since 1992 every new hired perfusionist has been sent to an EBCP accredited school , in Sweden or Denmark.
In September 1997 the committee sent an application for authorisation to the Norwegian Ministry of Health and Social Affairs. This application contained a job description which in a detailed manner described all the different tasks a perfusionist performs during a perfusion. Along with this we sent in the job advertisements since they are a description and presentation themselves.
Secondly we sent in information about the European Board of Cardiovascular Perfusion, their structure and their aims.
Thirdly we presented the two Scandinavian perfusion programs, and sent in the information folder from the Danish perfusion school at the University of Aarhus and from the Swedish perfusion course at the University of Gothenburg.
At last but not least we sent in the statements from the heads of thoracic surgery department at the different heartcenters and a statement from the Norwegian society of thoracic surgery, everyone in favour of authorisation and with splendid arguments. Three weeks later the Ministry sent us an answer but this letter was lost in the mail system. After a month I called them and got a copy of the letter by fax.
The ministry had at this moment send a draft bill out for official consultations, or hearings, to give other government bodies and agencies, organizations, institutions and associations affected by the legislation an opportunity to make their views known. In the letter the authorities asked us specifically to comment the criteria for authorisation within November 1st.
The committee had a fourth night to respond and in the draft bill perfusionists were not mentioned at all as a potential group of health personnel.
The criteria were: education, content of work and international relationship.
The committee sent in comments specifically for every aspects mentioned in the draft bill concerning these criteria and how it applied for the perfusionists.
However I felt that these were only words on paper and that it probably was difficult for an outsider to grasp the content. Therefore I telephoned to the secretary of the projectleader of this new health-personnel act and asked if the committee could meet them, present the case and discuss the subject.
They welcomed us to a meeting the 31st Oktober . Arve Mongstad presented the profession with the help of illustrative slides. Showing the still heart, the respirator shut off, and the extracorporeal circulation taking care of the patient.
Then I briefly presented the comments of criteria and we had a discussion.
In the end of the meeting, the committee suggested a site-visit at a hospital to see it in live and observe the interaction between different health professions during a heart operation. “Rikshospitalet” welcomed us to a site-visit the 27th of November.
When the statements from the official consultations had been collected, the ministry prepared a proposition to the “Odelsting” in November 1998. In this proposition they recommended that the perfusionists should be authorised as health personnel. The committee of health and Social affairs considered the bill and returned it to the “Odelsting” in the form of a recommendation in march 1999. The “Odelsting” accepted the recommendation, it went to the “Lagting” in the form of an “Odelsting” resolution. It was approved, and sent to the King in Council in July 1999. From January 2001 this law has been actively functioning.
The health personnel act is first and foremost a law for the patient. The issue is to protect the patient, to ensure that they get a safe and high qualified health service. This goal is obtained through a certification of the health personnel.
Only persons authorised as health personnel are allowed to perform a health service and they can only perform a health service they have qualifications for.
If a person presents himself with a title, it involves that this person has got an authorisation certificate from the authorities. The word "perfusionist" is a protected title a person is allowed to use after obtaining the certificate from the authorities. This authorisation certificate is given to persons having passed the exam from a EBCP accredited school. There exist some special rules for persons having performed perfusions for a long time but not attended such school, a sort of grand personal clause in a transition period. There is an office of authorisation, responsible for issuing these certificates. Their internet address is www.safh.no.
If the health personnel violates this law, the persons may be out of work for ever as health personnel in worst case.
Haukeland University Hospital Bergen