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Equipment available in remote sites should mirror equipment available in the main paediatric facility.

Guidance for paediatric sedation should be developed for the local context, by a multidisciplinary team.²⁸

Paediatric sedation should be managed in accordance with recognised national guidelines.³⁰

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