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Post induction hypotension associated with poor outcomes in patients with a high ISS. Standard operating procedures should be in place to minimise hypotension post induction.⁹³

Consultant anaesthetists and intensivists should be involved in the planning of local trauma services. Those with defined responsibility for major trauma management should be engaged in the layout and logistics of the resuscitation room.

In MTCs, multidisciplinary mortality and morbidity meetings should take place and follow the guidance of the World Health Organization (WHO).⁹⁴

Decision support systems for crisis scenarios should be available, for example the advanced life support algorithm, difficult airway guidelines and major haemorrhage protocols.^17,18

Governance meetings should take place across the entire trauma network at defined intervals. Besides individual case discussion, feedback information from the Trauma Audit and Research Network (TARN)¹ should be disseminated, and mechanisms set in place to correct any problems identified.

Commitment to early screening of trauma patients at risk of severe pain and opioid related adverse events by the acute pain service along with interdisciplinary protocol implementation of multimodal analgesia will lead to improved patient outcomes.⁹⁵

Research in anaesthesia for trauma and orthopaedic surgery should be encouraged. Staff undertaking research should have received training on ethical and organisational issues. They should complete a good clinical practice course with regular updates.

Trauma and orthopaedic surgery should be included in anaesthetic departmental audit programmes, including ongoing audit of complications and adverse events. The trauma anaesthetists should have provision in their job plan to attend trauma MDT meetings for discussion regarding high risk patients.

All hospitals treating patients with hip fractures should participate in national audits, e.g. National Hip Fracture Database or the National Joint Registry⁹⁶,⁹⁷ to monitor its performance against national benchmarks and quality standards. Outcomes from these audits should be distributed to anaesthetic staff.

All hospitals receiving major trauma cases should contribute to TARN,¹ to monitor its performance against national benchmarks and quality standards and contribute to research. Comparative data analysis and display on the national major trauma dashboard (via TARN) is invaluable for quality assurance.