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MTC and TU anaesthetic departments should consider appointing anaesthetists with an interest in prehospital care (see Glossary). Anaesthetists who provide prehospital care outside the hospital setting should be qualified to do so.⁹⁷

Anaesthetists who manage patients with major trauma should consider undertaking Advanced Trauma Life Support (ATLS), European Trauma Course or equivalent training, and should update their training at regular intervals.

Anaesthetists providing anaesthesia for trauma and orthopaedic surgery should learn and maintain expertise in a wide range of regional anaesthetic techniques, including central and peripheral neural blockade.⁹⁶

All anaesthetists involved in the management of major trauma should understand the principles and techniques of haemorrhage control resuscitation to prevent the lethal diamond of hypothermia, acidosis, coagulopathy and hypocalcemia using low-volume fluid resuscitation, blood products and damage control surgery.^94,98,99

Appropriately trained theatre staff should be available when treating patients with multiple injuries. They should be skilled and experienced in all surgical specialties that may present in the treatment of patients with multiple injuries.

Anaesthetic trauma theatre teams should be trained in the correct use of all essential anaesthetic theatre equipment used for trauma surgery.

Staff in the recovery area and in the wards who receive patients after surgery with epidural infusions, nerve blocks or intravenous opioid infusions (including patient controlled analgesia) should have received up to date formal training in caring for such patients.

Staff expected to top up medication for patients with epidurals and continuous nerve blockade should be trained in administration of such medications.

Anaesthetic practitioners involved in the administration of anticoagulant therapies should have current and up to date knowledge in their use.

There should be regular multidisciplinary in-situ simulation training for the initial management of major trauma care and resuscitation to standardise clinical practice. Simulation can improve technical and non-technical skills including communication and teamwork.¹⁰⁰