• anaesthesia

Editor,—I would like to highlight an example of “specialty interface problem” and how the problem may be tackled. Although I was an anaesthetist for over three years and possess the anaesthetic fellowship, I have come into criticism from anaesthetists for intubating patients using anaesthetic drugs in my role as Specialist Registrar in Emergency Medicine (year 5). The first time it happened I ignored the criticism, but it has occurred since in different English hospitals. There are several issues arising out of this.

(1) There is a need to inform anaesthetic colleagues that not only is anaesthesia a core secondment but specialist registrars are keen to put the skills into practice.

(2) There is a need for individual clinicians to audit their practice of intubating patients in the emergency department. My personal logbook (kept on Microsoft Access) covers patient name, date, indication for intubation, drugs and adjuncts used (if any), morbidity and mortality. Thus it covers not only the “flat overdose patient” or “coma ?subarachnoid” but also patients who arrive in cardiac arrest unintubated.

(3) There is a risk management need, as a specialty, to nationally audit morbidity and mortality in relation to patients being intubated by emergency department staff. In addition to the criteria above, timeliness and appropriateness of intubation should be considered.

So what if we do not audit this particular area of activity? When the inevitable disaster happens the clinical governance committee of the hospital may judge rapid sequence induction and intubation to be a procedure for the elite few doctors who satisfy the following criteria: confident, competent, qualified and employed as anaesthetists!