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Operating lists should include the patients’ weight and body mass index (BMI), and the World Health Organization (WHO) Surgical safety checklist³⁶ should include obesity related issues such as correct equipment and manual handling.³⁵

​​​​​​The following policies should be held and easily accessible along with those outlined in chapter 3:

• infection control (including antibiotic prophylaxis, staff protection and post-exposure prophylaxis)¹⁹⁰
• an escalation plan for theatre capacity and staffing, including a locally agreed policy for the deferment of elective activity to accommodate emergency surgical activity when required³
• clear guidelines on whom to...

Hospitals should have policies for the management of the airway in emergency situations, which should include fasting times, preanaesthetic assessment of the airway, availability and maintenance of the equipment and training of staff.^94,192

Hospitals should have guidelines for the safe extubation of patients following emergency anaesthesia.

Clinicians undertaking emergency anaesthesia must be familiar with managing patients with a tracheostomy.^94,192

Anaesthetic personnel should be aware of the increased risk of awareness in emergencies, and take the necessary steps to minimise this risk, including monitoring the depth of anaesthesia, where indicated.^103,146

Utilisation of blood products should be minimised whenever possible by the employment of restrictive transfusion thresholds together with methods to minimise blood loss and allogenic transfusion.⁹⁰

Hospitals must have audited policies and procedures for the administration of blood and blood components that comply with standards set out by the National Blood Transfusion Committee.¹⁹³ Hospitals should have systems in place to ensure that blood can be cross matched, issued and supplied in a timely manner.

Hospitals should have a protocol for major haemorrhage in place and this should include clinical, laboratory and logistic responses.^90,98

Near patient coagulation testing should be considered in bleeding patients or centres where major bleeding is a regular occurrence.⁹⁰