Objective

The objective of this chapter is to:

• consider the interface between the emergency department and other hospital departments in relation to advanced airway management.

Introduction

A successful programme for advanced airway management outside the operating theatre is dependent on collaboration between several hospital departments. Collaboration is required to establish an effective airway management training programme, to undertake advanced airway management appropriately and safely, to enhance the transfer of patient care from the emergency department to the receiving team and to enable continued practice in airway management. The interface between the emergency department, the intensive care unit (ICU) and the anaesthesia department is particularly important.

Interface with the intensive care unit

Data provided by the Intensive Care National Audit and Research Centre (ICNARC) indicate that 26% of admissions to the ICU come through the emergency department. Just over three quarters of these are admitted directly from the emergency department. Early referral of critically ill patients to the intensive care team is vitally important. Whenever possible intensivists should be involved in the decision to anaesthetize and intubate a patient: they are likely to be responsible for taking on the patient's subsequent care.

The intubation decision

The decision to admit a patient to the ICU will depend on their severity of illness, their pre-existing functional capacity and physiological reserve, and the reversibility of the acute illness. In some cases, in particular those with severe, progressive, chronic disease, intubation will be inappropriate because of the limited chance of long-term survival.