1. The Emergency Department Professor Jonathan Benger College of Emergency Medicine 30/03/20111

2. What We Already Know RSI occurs every 4-5 days in an average ED Emergency airway management outside the operating theatre is hard! - Higher complication rate - Difficult intubation 10x more common - Surgical airway rate of 0.3 to 0.5% Patient versus system factors RSI in major trauma 30/03/20112

3. Spot The Difference... 30/03/20113

4. Emergency Department Numbers 15/184 (8%) of events occurred in the ED 40% ASA grade 1-2 67% male 80% aged < 60 years Half were classed as obese 7 cases in the day, 4 in the evening, 4 overnight 30/03/20114

5. Who Was In charge? Grade and specialtyNumber Consultant/AS in anaesthesia7 ST7 in anaesthesia1 ST6 in critical care (non-anaesthetist)2 SpR in emergency medicine1 ST3 in anaesthesia3 ACCS trainee in anaesthesia (month 5)1 30/03/20115

6. Emergency Department Problems Difficult or failed intubation in 14 cases - 1 aspiration 12 involved tracheal intubation - 2 surgical airways for obstruction - 1 facemask anaesthesia for cardioversion 10 surgical airways - 2 died, 2 permanent injury, 6 full recovery 2 unrecognised oesophageal intubations 30/03/20116

7. Key Learning Points 30/03/20117

8. Right Person 30/03/20118

9. Right Place 30/03/20119

10. Right Equipment 30/03/201110

11. Right Preparation 30/03/201111

12. Recommendations Excellent communication between specialties Predict and plan for problems Timely availability of skilled staff and support Standardise and familiarise Capnography Joint training Checklist Audit 30/03/201112

13. Recommendations Right person Right place Right equipment Right preparation 30/03/201113

14. Questions 30/03/201114