Initial steps
A multidisciplinary steering group, initiated by consultants from the Adult Critical Care Unit (ACCU), maxillofacial surgery and anaesthesia, and joined by ENT, created a standard operating procedure (SOP) for all tracheostomies proceeding during the pandemic period (Figure 1). Senior nursing staff were also consulted. The group considered risks to staff and patients inherent in both percutaneous and surgical techniques and how techniques might be modified to mitigate risks. Deviations from usual institutional practice were set out. An early version of our local SOP was subsequently adopted by the British Laryngological Association [1] and we have subsequently developed our local SOP further, based on our evolving experience (Figure 1).