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Local policies should be easily accessible to all staff caring for trauma and orthopaedic patients. These include but are not limited to:

• preoperative screening for complex pain issues and access to acute pain services and advanced pain management methods
• pain management pathways for patients with chest injuries                                               
• supervision and monitoring of patients by competent clinical staff during surgery performed under...

Units should use a delirium assessment tool and a delirium policy describing preventative measures and its management.¹⁷

There should be specific guidelines for assessing a suspected difficult airway in patients with spine and joint disease and for measuring lung function in patients with kyphoscoliosis.¹⁸

Patients at risk of acute compartment syndrome should be identified on admission to hospital or at the time of surgery, and the condition should be managed within agreed multidisciplinary protocols.¹¹

Regular multidisciplinary mortality and morbidity meetings should take place in all trauma centres and follow the guidance of the World Health Organization (WHO).⁸

Anaesthetists should be involved in multidisciplinary governance meetings. Perioperative outcome data should be discussed in these meetings.

Care pathways and care bundles for common procedures such as hip fracture improve outcomes. Anaesthetists should be involved in developing, delivering and evolving these pathways and bundles.

Governance meetings should take place across the entire trauma network at defined intervals. Besides individual case discussion, feedback information from the Trauma Audit and Research Network (TARN) should be disseminated, and mechanisms set in place to correct any problems identified.¹ 

When transporting a trauma patient, the following should be available:

• appropriately trained and competent staff
• insurance (personal and medical indemnity)
• crash test compliant equipment
• ambulance booking procedures
• procedures for receiving patients
• communication between medical teams and families
• documentation and procedures for repatriation of staff and equipment once the transfer and handover are completed.^9,40,41

Transport of patients within the hospital and between hospitals (e.g. transfers to major trauma, neurosurgical or paediatric centres) should be undertaken in a timely manner, without unnecessary delays, and in accordance with established guidelines and standards.^{9,40,41,42,43} Hospital transfers may involve a retrieval service.