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An appropriately trained and experienced anaesthetist with regular commitments to burn and plastic surgery should be present during the conduct of general and regional anaesthesia for operative procedures, including those procedures requiring intravenous sedation where it has been agreed that this will be provided by the anaesthetic department.

An anaesthetist should be physically present when a general anaesthetic is administered. In exceptional circumstances, anaesthetists working singlehandedly may be called on briefly to assist with or perform a lifesaving procedure nearby. This is a matter for individual judgement, and the dedicated anaesthetic assistant should be present to monitor the unattended patient.⁸

A clinical lead for burn and plastic surgery anaesthesia should be appointed in each hospital providing anaesthesia for this specialty.

Anaesthetists should always be supported by dedicated, appropriately skilled and trained assistants, and the recovery facilities should be staffed during all operating hours and have appropriate anaesthetic support until the patient meets agreed discharge criteria.⁹

There should be adequate numbers of competent medical and non-medical staff to provide 24/7 cover for emergency burn and plastics anaesthesia.¹⁰

Where a paediatric service is being provided, all of the medical and non-medical staff, including recovery room staff, should have relevant and recent training in paediatric anaesthesia and resuscitation.^11,12

There should be specific consultant programmed activity for burn anaesthesia in hospitals where burn surgery is undertaken.¹¹

Where burn services are providing a Burn Centre level of care, there should be a 24/7 rostered availability of ST3 or above specialty registrars or appropriately experienced staff grade, associate specialist and specialty (SAS) doctors and emergency consultants. In Burn Centres that provide paediatric services, there should be a 24-hour rostered availability of consultant paediatric anaesthetists.¹¹

There should be sufficient programmed activity time available for anaesthetists to assess patients perioperatively and attend multidisciplinary ward rounds.

There should be sufficient programmed activity to provide support to sedation and analgesia services for burn patients.