Airway training in the UK

Abstract

Dr Cook has made some important points about airway training [1]. He makes a case for the adoption of the Difficult Airway Society (DAS) guidelines on airway management [2]. It is noteworthy that within 10 years from its inception the DAS is being put forward in a leading editorial as an authority for airway training, not just for difficult cases. There is some irony here because the DAS considered changing its name to ‘The Airway Society’ a few years ago, but decided against this. It is worth noting that the guidelines refer to unanticipated difficulty in tracheal intubation for adults. As explicitly stated in the paper [2], the guidelines were limited to adult, non-pregnant patients. Obstetric and paediatric practice were excluded. Additionally, and importantly, management of patients with airway obstruction, an ongoing source of morbidity and mortality, was also excluded. The guidelines took about 5 years to produce, backed up with over 300 references. Adoption or modification of guidelines beyond their intended scope deserves careful consideration and whoever takes on these tasks may be unable to devote sufficient time or the effort necessary. Dr Cook calls upon the Royal College of Anaesthetists to adopt a pro-active role in setting training standards for airway management. I would go further and suggest that the DAS, College and Association of Anaesthetists join forces on this crucial issue. There is a pressing need for airway management issues, be they about training, equipment or skill assessment to take centre stage. This requires a major change in attitudes and behaviours away from ‘high risk strategies as a consequence of a low range of skills’[3]. This is neither quick, nor easy. Consider the ‘10 year rule’[4]. What separates the expert from the ordinary is ‘effortful study’, pushing to learn and teach. It takes about a decade of sustained effort to gain expert status. This effort applies to institutions as well as individuals. Dr Cook is right: patient demand and expectation is changing quickly. What was deemed acceptable clinical practice previously may not be acceptable now. These changes affect all aspects of our work. Airway management is a high consequence, risk intolerant activity and mandates an expert approach. As such, it should be at the centre of our practice, not at the sideline. There is no room for complacency. Like Dr Cook, I am a member of the DAS and gave advice before publication of the guidelines. These views are my own.