Search

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.

The following ancillary anaesthetic equipment is required for the safe delivery of anaesthesia, and should also be available at all sites where patients are anaesthetised:

• oxygen supply
• self-inflating bag
• facemasks
• suction
• airways (nasopharyngeal and oropharyngeal)
• laryngoscopes including videolaryngoscopes and fibreoptic scopes as clinically required
• appropriate range of tracheal tubes and connectors
• intubation aids (bougies, forceps, etc)
• supraglottic airways
• heat and...

The clinical lead (see glossary) anaesthetist in burn and plastic surgery units will be responsible for the provision of service, teaching, production of guidelines, management, research, and audit, and be able to support quality improvement initiatives. Sufficient time should be included in job plans to support these activities and the continuing professional development of those anaesthetists.

A difficult airway trolley, including the equipment necessary for failed intubation and surgical airway access, should be available.¹⁴ Appropriate specialist intubation equipment, including fibre-optic intubation equipment should be available. A fibre-optic scope should be available to assess inhalational injury.^{15,16,17,18,19}