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Routine anaesthesia monitoring according to the Association of Anaesthetists standards of monitoring should be available for all areas where anaesthesia is undertaken.¹⁰² Departments should follow national clinical guidelines for the use of monitoring equipment, or local guidelines when national guidelines are not available.

An anaesthetist should preoperatively assess all patients undergoing emergency surgery who require anaesthesia. This should take place outside of the theatre complex if possible and adequate time should be available for this to occur as clinical urgency allows.¹⁸¹

There should be a minimum of one member of the recovery staff, or an anaesthetist, with advanced training in paediatric life support on duty and all members of recovery staff should have up-to-date paediatric competencies including resuscitation.¹⁰

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