Editor,—The paper by Walker and Brenchley¹ highlights a crucial area of emergency medicine practice. The key issues are “How are skills maintained” and “What is an acceptable period of training”.

The authors state in their conclusions that the majority of accident and emergency (A&E) consultants thought that rapid sequence induction (RSI) would be undertaken by A&E staff if an anaesthetist were unavailable. If the A&E staff are only performing this procedure rarely then they will become de-skilled and will have a higher complication rate than a colleague performing the procedure on a regular basis. Anaesthesia is defined as an essential secondment for training, why have this secondment if the skills are not going to be actively used.

In order to be given the responsibility of “on call” the anaesthesia minimum requirement is three months of supervised training. I feel that it is no coincidence that this also is the length of our secondment.