Yes, emergency physicians should be running the trauma, but you still must
have an anaesthetist's input for all cases of severe injury. To think
otherwise would be arrogant to the point of inviting disaster.
Adrian Fogarty

I agree that you may need an anaesthetic registrar there from an airway
point of view (although we never did in Jo'burg) but as emergency physicians
shouldn't we be capable of running a trauma?
Rob Dawes

--> AF, I find myself in 100% agreement with your statement (would ya
believe it!) - I think we should be capable of "running a trauma", Rob, but
while dragging a multi-specialty team along with us. Some reasons:
- It's not a question of "need" - it's "want" an anaesthetist. I personally
can intubate and take care of the AB side instead of an anaesthetist. Have
done it lots. So have most on this list, I am certain. (Ditto for central
lines, arterial lines, IVs, urinary catheters and any other means of
plumbing you'd find relevant), but I'd rather conduct and lead the effort
instead of doing this bit or that. I think I am the one with the training
for the role. And I also know some anaesthetists who can lead a trauma as
well as any EP, but that's not the point.
- If you don't call in the anaesthetist AND orthopod AND surgeon, etc.
ESPECIALLY when they are still in training posts and TRAINABLE, then they
will de-skill in that most important of skills - of learning to comply with
the EP's direction in helping to run HIS/HER trauma in HIS/HER department on
HIS/HER patient. And, by goob, do some of them need the practice!
- In particular, it would be handy to get them used to this for when you
leave to go home to the family and a less experienced EP-trainee has to lead
a trauma. How useful it is to then have an anaesthetist who can receive the
correct instructions on what to do even if the EP-trainee is having trouble
giving them...
- On practical side, I find that it is so much less effort to have the
anaesthetist there all along than to have to hand over at the relevant later
time and have him/her miss the point of what we've been doing all along.
- Bringing in "outsiders" for trauma calls leaves more ED bods on the shop
floor to keep things rolling while you're in resus and/or for them to tag
along with you and be taught/shown how it's done
- If you need the intubation practice AND you insist on doing it on a
particular trauma case, there's still no harm in having the anaesthetist
there to take over once it's done (this is best explained by asking them to
kindly "observe and critique" the EP's practice, which allows either some
useful teaching or some showing off)
- As far as trauma intubations go, most anaesthetists are grateful for the
expeience with an EP guide, giving them the benefit of experience with a
presentation they have less exposure to (but thankfully SOME if you call
them) - after all, who do YOU think should teach them this? Their own
consultants up in theatre somewhere?

And, just to complete the picture, I have met and been taught by some
excellent anaesthetists who had TONS of trauma experience and could easily
run a trauma like EPs do at better than I can intubate. I have met EP
consultants who intubate less well than others.

And I have yet to hear a good reason for NOT having anaesthetists there if
you use them appropriately.