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At all times, there should be an on site anaesthetist who has the ability and training to undertake immediate clinical care of all emergency surgical patients. Explicit arrangements should be in place to provide support from additional anaesthetists appropriate to local circumstances.

The emergency anaesthesia team should be led by a consultant anaesthetist and include all medical and other healthcare professionals involved in the delivery of anaesthesia for emergency surgery.^13,43 Part of this role should include liaison with other departments such as radiology, medicine and emergency departments (ED).

All patients should have a named and documented supervisory consultant anaesthetist who has overall responsibility for the care of the patient.^44,45 A suitably trained and experienced staff grade, associate specialist and specialty (SAS) doctor could be the named anaesthetist on the anaesthetic record if local governance arrangements have agreed in advance that the individual doctor can take...

Whenever emergency surgery is undertaken, the post-anaesthesia care unit (PACU) should be open continuously and adequately staffed.⁴⁷ Until patients can maintain their own airway, breathing and circulation, they should be cared for on a one-to-one basis, with an additional member of staff available at all times.⁴⁴

Recovery staff should have immediate access to the appropriate clinician in the perioperative period, e.g. anaesthetist, surgeon, radiologist.

Members of clinical staff working within the recovery area should be certified to a standard equivalent to intermediate life support providers, and training should be provided.⁴⁴ An advanced life support provider or an anaesthetist should be available at all times.

When a critically ill patient is managed in a PACU because of a critical care bed is temporarily unavailable, it is necessary to have clarity as to who has the primary responsibility for the management of the patient. Usually the primary responsibility for the patient lies with the hospital’s critical care team, but other specific local arrangements may be sometimes...

Working to deliver emergency surgery is often a stressful, challenging environment. Stress, 'burn out' and mental ill health are major causes of sickness absence. NHS organisations should ensure that those in leadership positions work to promote and protect the health and well being of staff.⁵⁴

The particular needs of children should be considered at all stages of perioperative care. They should ideally attend a preoperative clinic staffed by nurses experienced in preassessing children. Children may benefit from a visit to the locality to which they will be admitted, and familiarisation with the environment and personnel.¹⁴ There should be access to play specialists.

Staff should be empowered to shape their working environment and ensure their workload is not overwhelming.²⁶