Whilst there has been great excitement and funding for complex treatments for COVID-19 patients, such as invasive mechanical ventilation and monoclonal antibodies, basic life-saving clinical processes are often overlooked in settings of both high and low resources. In critical illness, the patient’s airway, breathing, or circulation may become compromised, and early identification of the problem and timely care can be lifesaving. Equipment, consumables, drugs, staffing, and routines for this are often missing, and guidelines may be too specialised or not context-appropriate. In this blog we report on phase 1 of our research into Essential Emergency and Critical Care (EECC), which focused on reaching a global consensus on the components of EECC.
Essential Emergency and Critical Care
Critical illness is the most severe stage of acute illness and, if left untreated, often leads to the death of the patient. Critical illness can occur in anyone of any age or gender, can begin at home or in hospital, and does not respect traditional divisions into medical specialties. Patients with conditions such as sepsis, pneumonia, eclampsia, haemorrhage, trauma, peritonitis, asthma, and stroke can all develop critical illness, which has been estimated to result in several million deaths globally each year.
To improve outcomes for critically ill patients that can be delivered in all hospital settings, the Essential Emergency and Critical Care concept was devised. EECC is defined as the care that should be provided to all critically ill patients in all hospitals worldwide. Importantly, it is about strengthening the basics, and stands in stark contrast to advanced critical care, represented by ventilators and dialysis units, that are expensive, difficult to provide at the scale needed, and are not necessary (or may even be harmful) for many critically ill patients.
EECC is distinguished by three principles. First, priority to those with the most urgent clinical need, including both early identification and timely care. Second, provision of the life-saving treatments that support and stabilise failing vital organ functions. And third, a focus on effective care of low cost and low complexity. In this recent project, we have worked with clinical experts from high-, middle- and low-income countries to reach consensus on the content of EECC – the essential care necessary for all critically ill patients.
The project was carried out by a team of international researchers and funded by the Wellcome Trust. It included 272 clinical experts from 59 countries worldwide in a Delphi consensus methodology. Agreement was reached on 40 clinical processes and 67 hospital resources necessary for the essential care of all critically ill patients. These include, for example: monitoring basic vital signs to identify critical illness; provision of oxygen therapy and intravenous fluids; and positioning of unconscious patients to maintain a free airway.
The specified essential care should now be used for implementation by clinicians worldwide and for integration by policy makers and health leaders into quality improvement programmes and policies
EECC should become a pillar of the COVID-19 response, increasing the impact of recent global efforts to scale-up oxygen, and become an integral part of Universal Health Coverage
Organisations such as the WHO, donors, global and regional specialist societies, and other partners should use the COVID-19 policy window as an opportunity to support interested countries to implement and scale up EECC
Researchers must address remaining questions around the optimal implementation strategies and the cost-effectiveness of EECC