Advanced airway management in the emergency department: what are the training and skills maintenance needs for UK emergency physicians? | Emergency Medicine Journal

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Advanced airway management in the emergency department: what are the training and skills maintenance needs for UK emergency physicians?

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No opportunity for anaesthetic training.
Victoria A Mottram
Published on: 29 April 2016
More than just maintaining one's own skills
Andrew P Webster
Published on: 29 April 2016

Published on: 29 April 2016
No opportunity for anaesthetic training.
- Victoria A Mottram, Emergency Medicine Trainee
Dear Editor
I note with interest Graham's review of suggested desirable levels of anaesthetic and critical care experience for emergency medicine trainees and consultants. I entirely agree that RSI and endotracheal intubation are the gold standard for airway management in any seriously unwell patient, and as such, it is entirely appropriate and to be expected that emergency physicians are able to provide this. Ho...
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Dear Editor
I note with interest Graham's review of suggested desirable levels of anaesthetic and critical care experience for emergency medicine trainees and consultants. I entirely agree that RSI and endotracheal intubation are the gold standard for airway management in any seriously unwell patient, and as such, it is entirely appropriate and to be expected that emergency physicians are able to provide this. However, it is becoming less possible, rather than more, to achieve this competence as a trainee with the demise of the stand-alone anaesthetic SHO post. Anaesthetists are understandably unwilling to offer rotation posts to non-anaesthetists, and there are far too few emergency medicine rotations which include enough anaesthetics or critical care. Without the opportunity to undertake stand-alone post in anaesthetics and critical care I fail to see how my colleagues or myself can achieve this undoubtably worthwhile goal.
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Conflict of Interest:
None declared.
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Published on: 29 April 2016
More than just maintaining one's own skills
- Andrew P Webster, Specialist Registrar in Emergency Medicine
Dear Editor
Mr Graham has written an excellent article reviewing the latest evidence on minimum competencies required to manage the emergency airway.
In current emergency medicine practice there are many hurdles to overcome not just developing and maintaining skills. Most departments have not enough experienced practioners to offer this service more than sporadically. There are also other aspects other than...
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Dear Editor
Mr Graham has written an excellent article reviewing the latest evidence on minimum competencies required to manage the emergency airway.
In current emergency medicine practice there are many hurdles to overcome not just developing and maintaining skills. Most departments have not enough experienced practioners to offer this service more than sporadically. There are also other aspects other than the airway to look at, for example management of injuries, FAST ultrasound scanning. We are unlikely to be able to manage the airway and deal with everything else in the resuscitation. Another significant problem is the lack of an experienced airway assistant (ODP/ODA/anaesthetic nurse). It is considered standard practice in the UK to undertake RSI only in the presence of an assistant, if the anaesthetist is busy it is likely the ODP is too. I think it is unrealistic to expect to train Emergency department nursing staff to the same level, and in the heat of the moment are you going to trust them to the same degree. It is a skill I enjoy, but as the paper suggests we need to demonstrate safe practice to protect ourselves when things will inevitably go wrong.
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Conflict of Interest:
None declared.
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