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

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).