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Abstract
Background Globally, 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.
Methods In 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.
Results The 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.
Conclusion The 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.
- COVID-19
- health systems
- health policy
- health services research
- surgery
Data availability statement
All data relevant to the study are included in the article or uploaded as supplementary information. Access to anonymised data may be provided to researchers after provision of a study protocol and justification to the corresponding author.
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Data availability statement
All data relevant to the study are included in the article or uploaded as supplementary information. Access to anonymised data may be provided to researchers after provision of a study protocol and justification to the corresponding author.
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Footnotes
Handling editor Seye Abimbola
Twitter @CarlOttoSchell, @nobsroy, @jamierylance, @mariajirwe
The EECC Collaborators (group authors) Adam Asghar, Adam D Laytin, Adrian J Holloway, Ahmed Rhassane El Adib, Alexia Michaelides, Alvaro Coronado Munoz, Amos Muzuka, Analía Fernández, Andrea B Pembe, Andreas Wellhagen, Andrew G Smith, Anita Gadgil, Anna Hvarfner, Anuja Abayadeera, Asya Agulnik, Aurélie Godard, Balasubramanian Venkatesh, Bargo Mahamat Yousif, Ben Morton, Bhakti Sarang, Bharath Kumar Tirupakuzhi Vijayaraghavan, Bobby King, Brian Rice, C Louise Thwaites, Chian Wern Tai, Christian Owoo, Cornelius Sendagire, Dan Brun Petersen, Daniel Tatay, David Lee Skinner, Denis Kinyua, Dhruva Ghosh, Diptesh Aryal, Donald Mlombwa, Duyen Thi Hanh Bui, Edwin R Lugazia, Elisabeth Riviello, Elizabeth M Molyneux, Ellena Heyns, Emmanuel Fru Nsutebu, Erika Montalvo, Ernesto Gerardo Moreno, Esther Banda Kanyangira, Fiona Muttalib, Francis Mupeta, Franco Diaz, Fred Bulamba, Furaha Nzanzu Blaise Pascal, Gavin Wooldridge, Gibonce Mwakisambwe, Guy A Richards, Hala Ammar, Halinder S Mangat, Hasanein H Ghali, Hiral A Shah, Hoi Ping Shum, Ibrahim Salim Abdullahi, Ignacio Martin-Loeches, Ingrid T von der Osten, Jacob Mcknight, James S Lee, Jane Kasozi Namagga, Jaran Eriksen, Jasmine Armour-Marshall, John Kellett, John Z Metcalfe, Jolene Moore, Jonas Blixt, Josephine Langton, Juan Gutierrez Mejia, Juan Ignacio Silesky-Jiménez, Kapil Dev Soni, Karl Martin Kohne, Kathryn Rowan, Kazuhiro Yokobatake, Kent Doi, Kristina E Rudd, Kwame Asante Akuamoah-Boateng, Lars Irestedt, Lia I Losonczy, Lina Zhang, Lisa Kurland, Lorna Guinness, Lovenish Bains, Margaret Nyaika, Markus Castegren, Matthew Loftus, Matti Reinikainen, Megan Cox, Mervyn Mer, Michael Jaung, Michael S Lipnick, Mike English, Miklos Lipcey, Monty Khajanchi, Mpoki Ulisubisya, Mulinda Nyirenda, Märit Amanda Halmin, Naman Shah, Natalie L Cobb, Nathan D Nielsen, Neill KJ Adhikari, Neville Vlok, Nicholas Risko, Niranjan Kissoon, Ntogwiachu Daniel Kobuh, Oscar Fernández Rostello, Patricia Duque, Paul D Sonenthal, Paul Patrick Mwasapi, Peter Baker, Petronella Bjurling-Sjöberg, Piedad Sarmiento, Pryanka Relan, Raymond Towey, Rebecca Silvers, Rehema Mlay, Rich Branson, Richard J Wang, Richard Kojan, Richard Peter Von Rahden, Richard Venn, Rob Mac Sweeney, Rodrigo Genaro Arduini, Rodwell Gundo, Ruyumbu Sixtus, Samson Kwazizira Mndolo, Samuel Akech, Shada A Rouhani, Siriel Nanzia Massawe, Stefan Swartling Peterson, Steven A Webb, Sunkaru Touray, Susana Guido, Teresa Kortz, Theodoros Aslanidis, Thomas G Weiser, Tom Bashford, Traci A Wolbrink, Usha Lalla, V Theodore Barnett, Vijay Christopher Kannan, Vincent Ioos, Waleed S Eldebsy, Wangari Waweru-Siika, Wezzie Kumwenda Mwafulirwa, William Obeng, Wim Van Damme, Yasein Omer, Zione Banda.
Contributors COS conceptualised and designed the study, acquired and analysed the data, and developed the first draft of the manuscript. TB and KK conceptualised and designed the study, and acquired and analysed the data. AW-S and MJ contributed to the design, acquisition and analysis of data. LAW provided input into study design and JO, HRS, NR, JCM, JR, CH and RK contributed to the design and analysis. All the authors interpreted the findings, critically revised the manuscript and approved the final version.
Funding This work was supported by the Wellcome Trust [221571/Z/20/Z], as part of the 'Innovation in low-and middle-income countries' Flagship. COS received grants from the Centre for Clinical Research Sörmland, Uppsala University [DLL-941999].
Competing interests JCM declares personal fees from Gilead Pharmaceuticals, support for meetings from Sphingotec, participation in advisory boards for AKPA Pharma and AM Pharma, and the position of Associate Editor at Critical Care Medicine, all outside the submitted work. JR declares grants from Wellcome Trust, NIHR, and the position of Vice Chair of the Adult and Child Lung Health Section of the Union (unpaid). TB declares personal fees from UNICEF, the World Bank, USAID and the Wellcome Trust, all outside the submitted work. The other coauthors declare no conflicts of interest. Among the EECC Collaborators, AA declares the positions of Vice-Chair of the Rural Doctors of Southern Africa (RuDASA) and of the editorial board of South African Family Practice journal (both unpaid). AL declares personal fees from JHIPIEGO and the position of Vice-Chair of the International Federation of Emergency Medicine (IFEM) Critical Care subgroup (both unpaid). AREA declares the positions of Immediate Past President of the Moroccan Society of Anaesthesiology and Intensive Care (SMAR), of Vice-President of the Moroccan Society of Medical Simulation (Morocco Sim), of the African Regional Section World Federation of Societies of Anaesthesiologists (WFSA) Board and of the WFSA Safety and Quality of Practice Committee (all unpaid). BV declares speaking fees from Baxter and grants from NHMRC, MRFF and Baxter—all outside the submitted work. FB declares personal fees from Gradian Health, honoraria from Smile Train, and the position of member of the scientific committee of WFSA. JAM declares personal fees from the Swiss Institute of Tropical Medicine and Public Health outside the submitted work. MM declares the position as Chair of the European Society of Intensive Care Medicine (ESICM) Global Intensive Care Working Group. MSL declares grants from USAID Star outside the submitted work. PS declares payments from Drageer outside the submitted work. RPVH declares the position of the Scientific Advisory Board for Fresenius-Kabi South Africa 2019. The other EECC Collaborators declare no conflicts of interest.
Provenance and peer review Not commissioned; externally peer reviewed.
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