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Healthcare workers, including the anaesthetist, must be aware of the local policy for child protection, and that they have an obligation to document and report any concerns to a responsible individual.⁴¹

Hospitals must have guidelines in place to ensure the safety of children admitted to hospital, to monitor injured children known to be at risk, and identify concerns arising from any injury or pattern of injuries.⁴² They must provide the appropriate training related to these guidelines.

A multidisciplinary team approach is highly recommended, typically involving anaesthetists, obstetricians, surgeons, paediatricians and midwives.^43,44,45

Provision for fetal monitoring and emergency lower (uterine) segment caesarean section should be available if indicated in the ED.^44,45,46

Assessment for a cervical spine injury should follow the existing NICE guidance.³⁷

There should be a specified and therefore identifiable group of neuroanaesthetists who cover the neuroanaesthesia service and have sufficient programmed activities to deliver the elective and emergency service.⁴

The definitive care of complex spinal and pelvic injuries requires specialist spinal (orthopaedic or neurosurgical) and pelvic surgery. The anaesthetist managing such cases should have appropriate training and experience in the management of these cases and their associated complications.

Clear protocols should be in place for the management of cases of suspected spinal injury. This should include a spinal clearance policy.³⁵

Immobilisation equipment including a range of appropriately sized semi rigid collars, head blocks, tape, a vacuum mattress and a scoop board should be available.

Spinal clearance should be achieved as soon as clinically possible, to minimise discomfort and complications from prolonged immobilisation in patients who do not have spinal injuries.