Emergency anaesthetic management in critically ill and injured patients: the STEPS approach (self, team, environment, patient and system)

Contemporary airway management paradigms focus heavily on the anatomical and the technical considerations of 'Difficult Airway' management. Such pervasive language does not always fully capture the critical importance of many other technical and non-technical factors that routinely impact on the safe delivery of emergency anaesthesia in the out-of-theatre environment. The authors believe that it is important to consider the factors beyond anatomy and physiology in emergency anaesthesia (EA) and recommend the following acronym and categories: Self, Team, Environment, Patient (anatomical/physiological) and System (STEPS). The aim of this mnemonic is to provide a cognitive framework that can be utilised in real-time to better identify the perceived and latent threats surrounding EA that will hopefully encourage a more holistic management approach to airway management in critically ill and injured patients.