Safer prehospital anaesthesia: updated guidelines from the Association of Anaesthetists

Introduction

Prehospital emergency anaesthesia is recognised as a high-risk clinical intervention. These updated guidelines consider changes in prehospital practice and parallel changes in the practice of in-hospital emergency anaesthesia, with the aim of encouraging standardised safe anaesthetic practice in a challenging clinical area.

Method

A working group was set up by the Association of Anaesthetists to include experts and resident doctors working in prehospital emergency medicine, anaesthesia, intensive care medicine and emergency medicine. There was also representation from relevant specialist groups and societies. We used a modified Delphi process and conducted targeted literature reviews to inform recommendations.

Results

We formulated recommendations in several key areas of prehospital emergency anaesthetic practice including general techniques; sedation before prehospital emergency anaesthesia; personnel and training; equipment and monitoring; prehospital emergency anaesthesia in children; and transport.

Discussion

Clinical teams that provide prehospital emergency anaesthesia must be well trained and competent to deliver the procedure to the same standards as their colleagues in the receiving emergency department. Although patients requiring prehospital emergency anaesthesia are often physiologically unstable and have pathology associated with a high mortality, there is good evidence that prehospital emergency anaesthesia can be delivered safely and to high standards.

Plain Language Summary:

What we did:

We brought together a group of doctors and experts who work in emergency care, anaesthesia and intensive care. They looked at research and shared their experience to update safety rules for giving anaesthesia before a patient reaches hospital (e.g. at the scene of an accident or in an ambulance). They worked together using several rounds of discussion to agree on the best advice.

Why did we do it:

Giving anaesthesia outside a hospital can be risky and difficult. Doctors and paramedics work in busy, stressful places and patients are often very sick or badly injured. We wanted to make the care safer and more consistent and make sure patients get the same high standard of anaesthesia before hospital as they would inside hospital.

What we found:

We created clear recommendations about how to give anaesthesia safely; what training staff should have; what equipment and monitoring should be used; how to care for children; and how to move patients safely after anaesthesia. We found that prehospital emergency anaesthesia can be done safely, but only when staff are well trained and properly equipped, and when they follow the same high standards used in hospital. Overall, these guidelines help emergency teams give safer anaesthesia to very sick or injured patients before they arrive at hospital.