Safer prehospital anaesthesia: updated guidelines from the Association of Anaesthetists

Summary 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.