Essential Emergency and Critical Care: a consensus among global clinical experts

• Published in: BMJ global health Vol. 6; no. 9; p. e006585
• Main Authors: Schell, Carl Otto, Khalid, Karima, Roy, Nobhojit, Sanga, Alex, Marshall, John C, Rylance, Jamie, Kayambankadzanja, Raphael K., Baker, Tim, Laytin, Adam D, Holloway, Adrian J, Adib, Ahmed Rhassane El, Michaelides, Alexia, Muzuka, Amos, Pembe, Andrea B, Wellhagen, Andreas, Smith, Andrew G, Agulnik, Asya, Godard, Aurélie, Venkatesh, Balasubramanian, Yousif, Bargo Mahamat, Ben Morton, Bhakti Sarang, Kumar, Bharath, Vijayaraghavan, Tirupakuzhi, King, Bobby, Rice, Brian, Louise Thwaites, C, Owoo, Christian, Skinner, David Lee, Kinyua, Denis, Ghosh, Dhruva, Riviello, Elisabeth, Molyneux, Elizabeth M, Heyns, Ellena, Nsutebu, Emmanuel Fru, Montalvo, Erika, Moreno, Ernesto Gerardo, Pascal, Blaise, Richards, Guy A, Ammar, Hala, Ghali, Hasanein H, Abdullahi, Ibrahim Salim, Martin-Loeches, Ignacio, von der Osten, Ingrid T, Mcknight, Jacob, Namagga, Jane Kasozi, Armour-Marshall, Jasmine, Kellett, John, Moore, Jolene, Blixt, Jonas, Langton, Josephine, Soni, Kapil Dev, Kohne, Karl Martin, Rowan, Kathryn, Doi, Kent, Rudd, Kristina E., Irestedt, Lars, Losonczy, Lia I, Bains, Lovenish, Nyaika, Margaret, Castegren, Markus, Loftus, Matthew, Cox, Megan, Mer, Mervyn, Lipnick, Michael S, English, Mike, Lipcey, Miklos, Khajanchi, Monty, Ulisubisya, Mpoki, Nyirenda, Mulinda, Halmin, Märit Amanda, Nielsen, Nathan D, Adhikari, Neill KJ, Vlok, Neville, Kissoon, Niranjan, Kobuh, Ntogwiachu Daniel, Rostello, Oscar Fernández, Sonenthal, Paul D, Baker, Peter, Bjurling-Sjöberg, Petronella, Silvers, Rebecca, Wang, Richard J, Kojan, Richard, Rahden, Richard Peter Von, Sweeney, Rob Mac, Arduini, Rodrigo Genaro, Gundo, Rodwell, Sixtus, Ruyumbu, Mndolo, Samson Kwazizira, Rouhani, Shada A., Massawe, Siriel Nanzia, Peterson, Stefan Swartling, Touray, Sunkaru, Aslanidis, Theodoros, Bashford, Tom, Wolbrink, Traci A, Lalla, Usha, Theodore Barnett, V, Kannan, Vijay Christopher, Ioos, Vincent, Obeng, William
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group Ltd 01.09.2021; BMJ Publishing Group LTD; BMJ Publishing Group
• Subjects: Consensus; COVID-19; Critical Care; Delphi method; Emergency medical care; Emergency Medical Services; health policy; health services research; health systems; Hospitals; Humans; Illnesses; Intensive care; Medicin och hälsovetenskap; Mortality; Obstetrics; Original Research; Pandemics; Patients; Pediatrics; Preventable deaths; SARS-CoV-2; surgery; COVID-19; health services research; health systems; health policy; surgery
• ISSN: 2059-7908; 2059-7908
• DOI: 10.1136/bmjgh-2021-006585

BackgroundGlobally, critical illness results in millions of deaths every year. Although many of these deaths are potentially preventable, the basic, life-saving care of critically ill patients are often overlooked in health systems. Essential Emergency and Critical Care (EECC) has been devised as the care that should be provided to all critically ill patients in all hospitals in the world. EECC includes the effective care of low cost and low complexity for the identification and treatment of critically ill patients across all medical specialties. This study aimed to specify the content of EECC and additionally, given the surge of critical illness in the ongoing pandemic, the essential diagnosis-specific care for critically ill patients with COVID-19.MethodsIn a Delphi process, consensus (>90% agreement) was sought from a diverse panel of global clinical experts. The panel iteratively rated proposed treatments and actions based on previous guidelines and the WHO/ICRC’s Basic Emergency Care. The output from the Delphi was adapted iteratively with specialist reviewers into a coherent and feasible package of clinical processes plus a list of hospital readiness requirements.ResultsThe 269 experts in the Delphi panel had clinical experience in different acute medical specialties from 59 countries and from all resource settings. The agreed EECC package contains 40 clinical processes and 67 requirements, plus additions specific for COVID-19.ConclusionThe study has specified the content of care that should be provided to all critically ill patients. Implementing EECC could be an effective strategy for policy makers to reduce preventable deaths worldwide.