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Anaesthesia for non-theatre environment should be delivered by a competent individual with appropriate supervision; the level of supervision should reflect the severity of the case and the seniority of the individual in accordance with the RCoA's Guidance on Supervision Arrangements for Anaesthetists.¹⁷

Protocols should be developed to ensure that accurate clinical information is available in a timely manner to the anaesthetist to avoid any delays in treatment. There should be an agreed process for alerting the mechanical thrombectomy team if anaesthetic provision is unavailable to allow referral to another mechanical thrombectomy centre.

Clinical leaders within anaesthetic services should be an integral part of system planning including how to deliver planned care and emergency care. They should have influence in all areas in which anaesthetists contribute to service delivery.⁸

Anaesthetists who provide out of hours cover to areas of practice that they do not provide in working hours, should be able to demonstrate the maintenance of appropriate skills and knowledge through regular clinical involvement and CPD. This should be facilitated during working hours where possible.

For children, a staff member with an advanced paediatric life support qualification or an anaesthetist with paediatric competencies should be immediately available.^32,33,42

A dedicated, appropriately trained anaesthetic assistant, who is familiar with that specific environment, should be available in all non-theatre environments where anaesthesia or deep sedation is undertaken by an anaesthetist.^8,9

Appropriate exposure should be given to anaesthetists during their training to develop skills in reasonable adjustments and anxiolysis. Allied professionals specialising in this area should also be given training.^44,45

In a designated major trauma centre, the receiving trauma team should include an anaesthetist with appropriate airway and damage control resuscitation competencies to manage trauma patients.^48,49

Anaesthetists should have specialised knowledge of the effect of concurrent medications, anaesthetic agents, anaesthetic techniques and equipment on the conduct and efficacy of ECT, as well as the specific anaesthetic contraindications.^70,71