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If the consultant on call is not a neuroanaesthetist, there should be a clearly defined and understood process for the provision of specialist advice from neuroanaesthesia colleagues. Where possible, local arrangements should be considered to facilitate this telephone advice in non-neuroscience centres when required.

To act as duty anaesthetist without direct supervision from a consultant, the anaesthetist should meet the basic training specifications and have attained the RCoA’s Initial Assessment of Competency in Obstetric Anaesthesia.²²

In cases of pregnant orthopaedic trauma patients diversion to a major trauma centre directly from the scene of an injury should be considered, to avoid delay of appropriate specialist care.⁴⁷   

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.

Protocols should be in place for the transfer of patients from isolated units who become ill unexpectedly. They should be moved safely and rapidly to a facility which provides an appropriate higher level of care.¹²

If the consultant on call is not a neuroanaesthetist, there should be a clearly defined and understood process for the provision of specialist advice from neuroanaesthesia colleagues. Where possible, local arrangements should be considered to facilitate this telephone advice in non-neuroscience centres when required.

Policies and equipment must be in place to protect patients and staff from cross infection, including the safe disposal of sharps¹⁹ and healthcare waste.²⁰

Cardiac and thoracic anaesthesia is a ‘key unit of training’ for intermediate level training in anaesthesia.⁶¹ Trainee anaesthetists should be of appropriate seniority to be able to benefit from this area of training.

Anaesthesia departments should have a nominated anaesthetist immediately available and free from direct clinical responsibilities to provide cover in clinical emergencies, as well as providing advice and support to other anaesthetists.³⁹

Elective theatres should offer spare capacity (such as that resulting from cancellations) to the emergency theatres.⁶⁵ Elective cases may be cancelled to make way for emergency work if required.