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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

The safe management of unstable patients depends on close liaison between emergency physicians and anaesthetists,^33,34 to ensure that clear guidelines are in place, emergency department support staff are trained to assist with tracheal intubation, and audit and discussion of complications is undertaken regularly.

Emergency airway management in the ED should follow the joint guidance from the RCoA and Royal College of Emergency Medicine (RCEM).³⁴

The use of an emergency induction checklist is recommended.^34,34

Many of these patients will require inter-hospital transfer to the regional trauma centre and local and national guidelines for transfer should be followed.^35,36

Transfer of patients within the hospital to the intensive care unit (ICU), radiology department or the operating theatre is not without risk and will require the use of a tipping transfer trolley, oxygen cylinders, suction, a transport ventilator, infusion pumps, monitor with adequate battery life and a portable defibrillator if appropriate. Local guidelines along with use of a formal intra-hospital...

Procedural sedation and analgesia in the ED should follow the recommendations from the RCoA and the RCEM.³⁷

Exposure to ionising radiation should be kept to a minimum by the use of screens or lead gowns; remote slave monitors in screened viewing areas should be provided and staff should remain as distant from the imaging source as possible if they must remain in the x-ray environment.³⁸

The anaesthetist accompanying transferred patients from the ED should be suitably skilled and experienced to manage all eventualities in an isolated environment and should be accompanied by a dedicated trained assistant.³⁹

As not all radiology tables tilt into a head down position, a tipping trolley should be available for patients who require general anaesthesia.