Advanced airway management in the prehospital arena remains controversial. This paper aims to explore some of the evidence and options available and propose a way forward. Options for provision of, and training in, pre-hospital emergency anaesthesia are explored and alternative strategies are discussed. Where classical rapid sequence induction of anaesthesia proves impractical for operational reasons or due to lack of facilities, training opportunities or skills maintenance, a potential ‘silver standard’ is suggested as an alternative.
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