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In a designated major trauma centre the receiving trauma team should include an anaesthetist,³² and, where possible, this should be an appropriately experienced consultant.³³

Anaesthetists providing sedation for dental procedures should follow the guidance on safe sedation published by the Academy of Medical Royal Colleges and Intercollegiate Advisory Committee on Sedation for Dentistry (IACSD).^35,36,37

Departments might occasionally need to consider allocating two consultants  or other autonomously practicing anaesthetists to work together to provide direct clinical care to patients undergoing major vascular procedures. Examples might include the exploration of infected aortic stent grafts or open thoraco-abdominal aneurysm repair.

Adequate emergency theatre time should be provided throughout the day to minimise delays and avoid emergency surgery being unnecessarily undertaken out of hours when the hospital may have reduced staffing to care for complex postoperative patients. Consideration should be given to staffing of additional evening (twilight) emergency sessions with autonomously practising anaesthetists.

An anaesthetist, anaesthesia associate or advanced nurse practitioner should preoperatively assess all patients undergoing emergency surgery who require anaesthesia. Adequate time should be available for this assessment to occur as clinical urgency allows.^43,47

Anaesthetists with a job plan that includes emergency anaesthesia should demonstrate continuing education in emergency anaesthesia and continuing professional development as required for this aspect of their work. Departments have a responsibility to enable this development with local teaching where appropriate and by facilitating access to other education and training.19

Children with severe comorbidities who require emergency anaesthesia should be treated in a specialist paediatric centre. However, if transfer is not feasible, the most appropriately experienced senior anaesthetist should provide anaesthesia and support resuscitation and stabilisation.^170,171

Patients requiring head and neck procedures should be attended by anaesthetists who have had an appropriate level of training in this field and who have acquired the relevant knowledge and skills needed to care for these patients.^41,42 

Departments should review the responsibilities of anaesthetists as part of job planning.  This includes out of hours commitments and the scope of the individual’s practice, as well as any additional roles and responsibilities.^{17, 24, 25}

Job reviews should take into consideration individual risk assessments for anaesthetists in the context of environmental threats, ill health, pregnancy and breastfeeding, menopause, fatigue, and the impacts of ageing. Where relevant advice from an accredited specialist in occupational medicine should be sought.²⁷