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Facilities and suitable staff to enable immediate life, limb or organ saving surgery should be available at hospitals accepting emergency surgical patients. Sites that accept patients for emergency surgery should ensure access to all core specialties and include postoperative care facilities, a full range of laboratory and radiological services and sufficient critical care capacity appropriate to the case load and...

There should be explicit arrangements made for the provision of care from specialties that are not available onsite, such as neurosurgery, cardiothoracic, vascular, ENT, maxillofacial, hepatobiliary, burns and plastic surgery.

Designated thoracic, or cardiothoracic wards should be considered.

Thoracic surgery should ideally be performed in dedicated operating rooms. It is unlikely that an operating room will be kept available at all times for emergencies. Local arrangements for urgent and emergency situations should be in place.

RATS should be delivered in a theatre with adequate capacity to allow comfortable movement of staff around the patient and robot, to safely accommodate all of the additional equipment including robot, operating console and monitoring stack, and to allow sufficient space for rapid removal of the robot in an emergency to facilitate resuscitation.

After major thoracic surgery, patients should be transferred to an appropriately sized, equipped and staffed post-anaesthetic recovery area. Planned or emergency access to intensive or high-dependency care should be available.¹¹

Non-invasive ventilation facilities should be available in the immediate postoperative period, for example bilevel positive airway pressure (BiPAP), CPAP and high-flow nasal oxygen therapy (HFNO). HFNO should be available in theatres for induction and support of anaesthesia as required.¹²

Thoracic surgery units should develop an enhanced recovery after surgery programme.^13,14

Preoperative assessment clinics should be established to optimise patient preparation for surgery and reduce same day cancellations. Smoking cessation support should be available to all thoracic patients.

The level of staffing should be sufficient for the consultant leading the emergency anaesthesia team to be able to provide a continuous emergency anaesthesia service in the theatre complex without interruption. Other service requirements, e.g. remote sites, trauma calls and advice should be anticipated and managed through local arrangements.²⁵ Anaesthetists assigned to provide cover for emergency lists should not...