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Prehospital emergency anaesthesia: time taken to care for and respond to a critically injured patient

02 July 2019
Volume 11 · Issue 7


The 2007 National Confidential Enquiry into Patient Outcome and Death (NCEPOD) Trauma: Who Cares? report recommended that people trained to administer anaesthesia and intubate severely injured patients should be available in prehospital environments. Published articles, reference documents and guidance reports were reviewed to compare the management plans and standard operating procedures produced by an ambulance trust in England that provides prehospital emergency anaesthesia (PHEA). Documents reviewed all provide a common un-referenced patient injury list showing indications to perform PHEA but do not state a time frame within which it should be performed. No minimum time before PHEA is started and how long is acceptable to wait for a specialist resource to arrive before an ambulance can transport to a hospital were found. Further work is required to establish and formalise this time frame.

The National Confidential Enquiry into Patient Outcome and Death (NCEPOD) published a report in 2007 entitled Trauma: Who Cares? in which they state ‘the current structure of prehospital management is insufficient to meet the needs of the severely injured patient’ and that ‘there is a high incidence of failed intubation and a high incidence of patients arriving at hospital with a partially or completely obstructed airway’ (NCEPOD, 2007: 7). As an immediate recommendation, it suggested that a process be introduced that called for either the use of different airway adjuncts or the provision of persons trained and able to administer anaesthesia and intubate in the prehospital environment (NCEPOD, 2007). Prehospital emergency anaesthesia (PHEA) is an advanced airway technique involving the administration of anaesthetic drugs to facilitate a successful tracheal intubation.

In 2009, the Association of Anaesthetists of Great Britain and Ireland (AAGBI) produced a guidance document entitled, Safer Prehospital Anaesthesia, following the recommendations made in the NCEPOD report. Within this original guidance document is a position still used as the opening statement in the current AAGBI guidance: regardless of unpredictable prehospital circumstances, the model of care provided must be equivalent to that of in-hospital anaesthesia (Lockey et al, 2017).

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