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If no anaesthetist is present in theatre, an appropriately trained anaesthetic nurse, ophthalmic theatre nurse or operating department practitioner (ODP) should be present to monitor the patient during establishment of local anaesthesia and throughout the operative procedure. This should be their sole responsibility.²

The Anaesthesia Associates (AAs) should work at all times within an anaesthesia team led by a consultant anaesthetist who has overall responsibility for anaesthesia care of the patient and whose name should be recorded in the individual patient’s medical notes.³

Educational opportunities for trainees in MTC and TU will undoubtedly occur out of hours due to the nature of trauma. Hospitals in which trainee anaesthetists work a full or partial shift system should consider providing additional consultant programmed activities to allow training and supervision to take place in the evening.

Nationally agreed key performance indicators should be used to monitor the performance of the pathways for hip fractures and major trauma and reviewed by a multidisciplinary committee including a Trauma Lead anaesthetist. In addition, local quality indicators should be developed proactively, to support continuing improvement of these services within organisations.

Anaesthetists who prescribe oral sedation for paediatric burn patients do not need to be physically present for the procedure for which sedation is being prescribed, but they, or other suitably trained and experienced staff, need to be available to return immediately if the need arises.⁴²

Anaesthetists must undertake at least level 2 training in safeguarding/child protection,⁸⁴ and must maintain this level of competence by regular annual updates on current policy and practice and case discussion.⁸⁵

The output from consultations with patients at increased risk of mortality or morbidity should be documented in the patient’s medical notes. In addition, mechanisms for clear communication of these consultations to patients, anaesthetists, surgeons, general practitioners and other healthcare workers should be in place.²⁷

All women requiring caesarean section should, except in extreme emergency, be visited and assessed by an anaesthetist before arrival in the operating theatre. This should be timed to allow women sufficient time to weigh up the information they have been given, in order to give informed consent for anaesthesia.

Each hospital should have a multidisciplinary committee for paediatric care to formulate and review provision. This committee should involve anaesthetists, paediatricians, surgeons, emergency department representatives, senior children’s nurses, managers and other professionals, such as paediatric pharmacists. In some hospitals, this will also include PICU physicians.

Major trauma patients arriving in the ED of MTCs and TUs should be met by a multidisciplinary team 24/7. An anaesthetist with appropriate airway and damage control resuscitation competencies to manage trauma patients should be part of this team.^{6, 7}