UNITED KINGDOM

  COUNCIL MEMBERDr Adrian PEARCE
2006-		 
  CONTACTadrian.pearce@gstt.nhs.uk 
  COUNTRYUnited Kingdom 
  POPULATION58,000,000 
  NUMBER OF ANAESTHETISTSAll anaesthetists are doctors
Specialists: 5,000
Trainees: 3,000		 
  NUMBER OF HOSPITALS300 with anaesthetic department 
  SPECIALISED AIRWAY MANAGEMENT SOCIETY?Difficult Airway Society
1995-
www.das.uk.com		 

 

ANAESTHETIC TRAINING

  LENGTH OF TRAINING7 years 
  SYLLABUSPrepared and published by the
Royal College of Anaesthetists (RCA)
www.rcoa.ac.uk		 
  TRAINING SUPERVISORPostgraduate Medical Education and Training Board
(PMetB)
www.pmetb.org.uk		 

 

AIRWAY MANAGEMENT

  TRAINING SYLLABUS AVAILABLE?Prepared in 2000 by the Royal College of Anaesthetists.
Download syllabus		 
  WHAT ARE THE CORE AIRWAY SKILLS OF ALL ANAESTHETISTS?
  • Facemask
  • Laryngeal mask
  • Intubation by Direct Laryngoscopy
  • Use of the introducer (gum-elastic bougie)
  • Capnography
 
  ANY NATIONAL GUIDELINES?Difficult Airway Society Guidelines
  • Failed elective direct laryngoscopy
  • Failed intubation during RSI
  • CVCI
  • Airway equipment each theatre
  • Equipment on difficult airway trolley

There are no specific airway management guidelines from the Royal College of Anaesthetists

 
  GUIDELINES

Charts free from
www.das.uk.com/guidelines/downloads

Explanation of guidelines from
www.das.uk.com/guidelines/guidelineshome

Guidelines published in Anaesthesia 2004; 63:544-567

 
  EQUIPMENT

In each location of anaesthesia
Facemask, laryngeal mask, Macintosh laryngoscopes (2), introducer, oral airways, range of tracheal tubes oral/nasal, Magill forceps, suction catheters, capnography, pulse oximetry.

Present in > 90% hospitals
Difficult Airway Trolley
Intubating fibrescope

Present in 50-90% hospitals
ILMA, Proseal LM, emergency cricothyrotomy kit

 
  WORKSHOP AVAILABILITY

Numerous and popular: run by the Royal College of Anaesthetists and many individual hospitals or Regions. For both trainee and specialists.

However there are 8000 anaesthetists and many have still had no formal airway training

Workshops generally teach FOI, low-skill FOI via LM or ILMA, use of ILMA and Proseal, emergency cricothyrotomy. Some are 2-3 day courses and include case discussion, lectures and mannikin practice.

An increasing number of workshops teach awake FOI on the delegates

The most comprehensive list of available workshops is on the DAS website www.das.uk.com

 

 

AIRWAY MORTALITY

  DATA COLLECTION

No national data collection

Local hospital meetings usually review hospital events

Estimated or guessed figure of 20-50 deaths per year in the UK but true figure unknown

 
  LINK BETWEEN MORTALITY AND IMPROVEMENT IN NATIONAL PRACTICENo link. Many airway related deaths not investigated and no mechanism of learning from individual deaths. A serious deficiency. 

 

DEFICIENCIES

 
  • Not all hospitals have all recommended equipment
  • Not all anaesthetists have received airway training
  • No Royal College compulsory airway training syllabus or course
  • Workshops put-on by local enthusiasts with no central organisation or funding
  • No national data collection
  • Airway deaths go unreported and uninvestigated
  • No link between airway related mortality or morbidity and education/training to improve the situation