(1) For purposes of the inquest received an expert report from Dr Andrew Hartle Reference was also made to the Difficult Airway Society Guidelines 2004 and 2015. The DAS guidelines suggest that; for an anaesthetist, an appropriate progression would be to undertake surgical (scalpel) cricothyroidotomy after unsuccessful cannula cricothyroidotomy: In this case; an ENT surgeon (clinical fellow grade) arrived and took over before scalpel cricothyroidotomy was attempted: The ENT surgeon decided to attempt tracheostomy rather than scalpel cricothyroidotomy: The benefit of tracheostomy is that it would have provided a more permanent airway. The evidence was that this is an unusual situation and that the experience of all the witnesses was therefore limited in performing emergency cricothyroidotomy and emergency tracheostomy: concluded that the decision as to whether to opt for tracheostomy or scalpel cricothyroidotomy was & clinical judgment made in the light of the circumstances at the time. However; this was rapidly deteriorating situation and the ENT surgeon accepted that scalpel cricothyroidotomy may have been a simpler procedure_ This became a "Can't Intubate Can't Oxygenate" situation in which both anaesthetists and ENT surgeons were present: My understanding is that the DAS guidelines are provided for anaesthetists: Different considerations may apply to ENT surgeons; The question as to the preferred mode of front of neck access in this situation therefore appears not to be covered by the existing guidelines Individual practitioners faced with such a situation are to have Iimited experience. My understanding is that there is currently no joint guidance to cover this type of situation when both anaesthetists and ENT surgeons are present, appreciate that this is an uncommon situation in a specialist area and understand that you may consider it necessary to forward this report to, for example, the Difficult Airway Society: