About S.E.C.U.R.E

SECURE is a UK wide, cross-specialty service evaluation of Rapid Sequent Intubation (RSI) events. Setting: All acute hospitals within the UK Population: All adult populations (>18) Aim: SECURE aims to define the perceived indications for, specific techniques used in and the immediate complications of RSIs in current UK in-hospital practice across anaesthesia, critical care and emergency medicine. Pre-specified hypothesis: It is likely that there will emerge both centre-specific and specialty-specific differences in the conduct of RSIs across the UK. SECURE is also expected to serve as an audit tool for the international PUMA (Project of the Universal Management of the Airway) guidelines on RSI conduct, as well as to contribute towards shaping future RSI guidelines and checklists. Objectives • Describe what specific equipment, protocols and training related to RSI are in place in different clinical areas across different UK acute hospital sites. • Describe, through the use of clinical vignettes, practitioner self reported RSI practice in the UK. • Describe, through observational study, current RSI practice in the UK, across different specialties and in different clinical areas. • Identify if observed practice is in line with practitioner self-reported practice, or if a “say-do gap” exists. • Compare self reported practice, observed practice, and site provision of equipment/protocols/training with international recommendations on RSI practice (PUMA guidelines - Project for Universal Management of the Airway) • Describe incidence of pre-specified complications associated with RSI, and identify specific components of practice and/or patient factors associated with these through case reviews. The broader why question: Pamela Marking: Prevention of Future Deaths Report. The coroners concerns: (A) A lack of ‘Updated’ National Guidelines for Rapid Sequence Induction (RSI) of Anaesthesia for emergency surgery (B) Lack of ‘Updated’ National Guidelines to support the use of TIVA for RSI (C) Lack of ‘Updated’ Guidelines for use of Cricoid pressure and other measures to protect the airway in a RSI anaesthetic. https://www.judiciary.uk/prevention-of-future-death-reports/pamela-marking-prevention-of-future-deaths-report/