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We read with interest the excellent review by Graham.1 An important related issue is the training of the assistant to the emergency physician.
We wished to ascertain if use of an emergency nurse as an anaesthetic assistant is common practice. We conducted a short telephone survey of the 12 Scottish emergency departments with attendances of more than 50 000 patients per year. We interviewed the duty middle grade doctor about usual practice in that department. In three departments, emergency physicians will routinely perform rapid sequence intubation (RSI), the assistant being an emergency nurse in each case. In nine departments an anaesthetist will usually be involved or emergency physicians will only occasionally perform RSI. An emergency nurse will assist in seven of these departments.
The Royal College of Anaesthetists2 have stated that anaesthesia should not proceed without a skilled, dedicated assistant. This also applies in the emergency department, where standards should be comparable to those in theatre.3
The training of nurses as anaesthetic assistants is variable and is the subject of a Scottish Executive report.4 This consists of at least a supernumerary in-house program of 1 to 4 months. Continued professional development and at least 50% of working time devoted to anaesthetic assistance follow this.4
The Faculty of Emergency Nursing has recognised that anaesthetic assistance is a specific competency. We think that this represents an important progression. The curriculum is, however, still in its infancy and is not currently a requirement for emergency nurses (personal communication with L McBride, Royal College of Nursing). Their assessment of competence in anaesthetic assistance is portfolio based and not set against specified national standards (as has been suggested4). We are aware of one-day courses to familiarise nurses with anaesthesia (personal communication with J McGowan, Southern General Hospital). These are an important introduction, but are clearly incomparable to formal training schemes.
While Graham has previously demonstrated the safety of emergency physician anaesthesia,5 we suggest that when anaesthesia does prove difficult, a skilled assistant is of paramount importance. Our small survey suggests that the use of emergency nurses as anaesthetic assistants is common practice. If, perhaps appropriately, RSI is to be increasingly performed by emergency physicians,5 then the training of the assistant must be concomitant with that of the doctor. Continued care of the anaesthetised patient is also a training issue1 and applies to nurses as well. Standards of anaesthetic care need to be independent of its location and provider.