The interface between anaesthesia and emergency medicine

Ten years ago, the Association of Anaesthetists of Great Britain and Ireland published a document outlining the role of anaesthetists in the emergency service.1 Despite a wide range of activities, in most hospitals the main interface between the two specialties was in the emergency management of a patient's airway. Anaesthetic assistance would generally be sought for any airway intervention beyond the most basic and specifically in the presence of airway compromise or when drugs needed to be administered to facilitate tracheal intubation. Similarly, with a range of “time critical” conditions other specialists were called to assist; cardiologists would deal with patients suffering from an acute myocardial infarction, physicians with the acute asthmatic patients while surgeons resuscitated trauma patients. Such working practices had their origins in the casualty departments of the 1960s, where the medical staff were often “supervised” by other specialties, for example, orthopaedic surgeons, whom were often little more than absentee landlords as a result of a lack of sessional allocation and with little experience or interest in dealing with medical admissions.2 The past 15 years has witnessed a dramatic change in the specialty of emergency medicine. The development of a structured training programme, fellowship examination and intercollegiate faculty, have produced a breed of emergency physicians who now manage most time critical conditions within their own departments. At a time when increasing emphasis is placed upon the importance of early and effective airway management of all major emergencies (ATLS, ALS, APLS), emergency physicians are now looking at extending their airway management skills, which will inevitably mean the administration of anaesthetic agents and muscle relaxants to facilitate tracheal …