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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.

There should be a dedicated trained assistant, i.e. an operating department practitioner (ODP) or equivalent, who holds a valid registration with the appropriate regulatory body, immediately available in every location in which anaesthesia care is being delivered, whether this is by an anaesthetist or a AAs.^3,5

Patients presenting with a neurological deficit should have immediate referral to a specialist unit and be discussed with the neurosurgical or spinal surgeon.

In suspected spinal injury, hard spinal boards should only be used as a prehospital extrication device and not be used for transport.³⁸ A scoop stretcher or full length vacuum mattress should be used for transfer.

Acute nerve or spinal cord compression requires immediate referral to a neurosurgeon or specialist spinal surgeon within four hours of injury.⁴⁰

A fully equipped high dependency unit (HDU) of Level 2 standards should be available on site for high risk patients undergoing major orthopaedic surgery, including revision joint replacement and surgery involving instrumentation of the spine. If the hospital does not have a Level 3 facility, protocols should be in place to determine when and how to transfer to a hospital...