Search

Introduction: Free open-access medical education (FOAM) is a collection of interactive online medical education resources—free and accessible to students, physicians and other learners. This novel approach to medical education has the potential to reach learners across the globe; however, the extent of its global uptake is unknown. Methods: This descriptive report evaluates the 2016 web analytics data from a convenience sample of FOAM blogs and websites with a focus on emergency medicine (EM) and critical care. The number of times a site was accessed, or “sessions”, was categorized by country of access, cross-referenced with World Bank data for population and income level, and then analyzed using simple descriptive statistics and geographic mapping. Results: We analyzed 12 FOAM blogs published from six countries, with a total reported volume of approximately 18.7 million sessions worldwide in 2016. High-income countries accounted for 73.7% of population-weighted FOAM blog and website sessions in 2016, while upper-middle income countries, lower-middle income countries and low-income countries accounted for 17.5%, 8.5% and 0.3%, respectively. Conclusion: FOAM, while largely used in high-income countries, is used in low- and middle-income countries as well. The potential to provide free, online training resources for EM in places where formal training is limited is significant and thus is prime for further investigation.

The global imperative to expand prehospital emergency care in low and middle-income countries to reduce health disparities and improve outcomes for time-sensitive health conditions is well established in academic literature and public policy discussions. However, the governance and legal frameworks essential for the strategic development of prehospital systems remain understudied and inadequately addressed. This paper delves into the critical role of governance in prehospital systems, emphasizing its impact on equity, human rights, and the provision of timely, quality emergency care. Health system governance, defined as a complex interplay of mechanisms, processes, and institutions, is a neglected yet pivotal component of prehospital care. By highlighting previously described barriers, we underscore the opportunity to strengthen prehospital care through improved governance, particularly in leadership and legislative standards. Drawing on the World Health Organization's Health System Building Blocks and the Emergency Care System Framework, we elucidate the multifaceted nature of governance in the prehospital context, including the coordination of diverse stakeholders, the establishment of standards, and the creation of accountability mechanisms. We emphasize the importance of applying a human rights perspective to governance, ensuring non-discriminatory and timely access to emergency care. Through the application of an established governance framework of 10 principles to assess prehospital system governance, we offer policymakers and stakeholders a structured approach to identify weaknesses, propose solutions, and evaluate progress in the prehospital system. To provide practical insights, we present a contemporary case study of Ghana's National Ambulance Service Act and the Health Institutions and Facilities Act of 2011, which establish a structured approach to governance and oversight while reflecting Ghana's commitment to advancing emergency care yet faces common challenges to operationalizing the laws. We advocate for a renewed focus on governance as an essential building block for effective prehospital emergency care. By providing a comprehensive framework and case study analysis, the paper offers actionable insights to guide policymakers and stakeholders in developing and evaluating governance initiatives that improve the availability, accessibility, acceptability, and quality of prehospital care globally. [ABSTRACT FROM AUTHOR]

Introduction: Little is known about the frequency and locations in which emergency physicians (EPs) are bystanders to an accident or emergency; equally uncertain is which contents of an “emergency kit” may be useful during such events. The aim of this study was to describe the frequency and locations of Good Samaritan acts by EPs and also determine which emergency kit supplies and medications were most commonly used by Good Samaritans.Methods: We conducted an electronic survey among a convenience sample of EPs in Colorado.Results: Respondents reported a median frequency of 2.0 Good Samaritan acts per five years of practice, with the most common locations being sports and entertainment events (25%), road traffic accidents (21%), and wilderness settings (19%). Of those who had acted as Good Samaritans, 86% reported that at least one supply would have been useful during the most recent event, and 66% reported at least one medication would have been useful. The most useful supplies were gloves (54%), dressings (34%), and a stethoscope (20%), while the most useful medications were oxygen (19%), intravenous fluids (17%), and epinephrine (14%).Conclusion: The majority of EPs can expect to provide Good Samaritan care during their careers and would be better prepared by carrying a kit with common supplies and medications where they are most likely to use them.

Objective To systematically review and appraise the quality of cost-effectiveness analyses of emergency care interventions in low- and middle-income countries. Methods Following the PRISMA guidelines, we systematically searched PubMed[R], Scopus, EMBASE[R], Cochrane Library and Web of Science for studies published before May 2019. Inclusion criteria were: (i) an original cost-effectiveness analysis of emergency care intervention or intervention package, and (ii) the analysis occurred in a low-and middle- income setting. To identify additional primary studies, we hand searched the reference lists of included studies. We used the Consolidated Health Economic Evaluation Reporting Standards guideline to appraise the quality of included studies. Results Of the 1674 articles we identified, 35 articles met the inclusion criteria. We identified an additional four studies from the reference lists. We excluded many studies for being deemed costing assessments without an effectiveness analysis. Most included studies were single-intervention analyses. Emergency care interventions evaluated by included studies covered prehospital services, provider training, treatment interventions, emergency diagnostic tools and facilities and packages of care. The reporting quality of the studies varied. Conclusion We found large gaps in the evidence surrounding the cost-effectiveness of emergency care interventions in low-and middle-income settings. Given the breadth of interventions currently in practice, many interventions remain unassessed, suggesting the need for future research to aid resource allocation decisions. In particular, packages of multiple interventions and system-level changes represent a priority area for future research. [phrase omitted] [phrase omitted] Objectif Revoir systematiquement et evaluer la qualite des analyses de rentabilite des interventions d'urgence dans les pays a faible et moyen revenu. Methodes Conformement aux lignes directrices de la methode PRISMA, nous avons effectue une recherche systematique des etudes publiees avant mai 2019 sur PubMed[R], Scopus, EMBASE[R], Cochrane Library et Web of Science. Les criteres d'inclusion etaient les suivants : (i) analyse de rentabilite originale des interventions ou ensembles d'interventions d'urgence, et (ii) analyse menee dans des pays a faible et moyen revenu. Pour identifier d'autres recherches primaires, nous avons egalement depouille les listes de reference des etudes incluses. Enfin, nous avons applique la grille CHEERS (Consolidated Health Economic Evaluation Reporting Standards) pour evaluer la qualite des etudes prises en compte. Resultats Sur les 1674 articles identifies, 35 articles correspondaient aux criteres d'inclusion. Nous avons egalement repere quatre etudes supplementaires dans les listes de reference. En revanche, nous avons exclu de nombreuses etudes car elles ne tenaient compte que des evaluations de couts sans effectuer d'analyse de rentabilite. La plupart des etudes retenues etaient des analyses portant sur une seule intervention. Les interventions d'urgence examinees par ces etudes comprenaient les services prehospitaliers, la formation des prestataires, les programmes de traitement, les etablissements et outils diagnostiques d'urgence, ainsi que le continuum de soins. La qualite des rapports figurant dans ces etudes etait variable. Conclusion Nous avons trouve de vastes lacunes dans les indications relatives a la rentabilite des interventions d'urgence dans les pays a faible et moyen revenu. Etant donne la large gamme d'interventions pratiquees actuellement, nombre d'entre elles ne font encore l'objet d'aucune evaluation. Lors de futures recherches, il pourrait donc s'averer necessaire d'aider a la prise des decisions liees a l'attribution des ressources. Ces futures recherches devront etre orientees en priorite vers les ensembles constitues de multiples interventions ainsi que vers les changements systemiques. [phrase omitted] Objetivo Revisar y evaluar sistematicamente la calidad de los analisis de rentabilidad de las intervenciones de atencion de emergencia en los paises de ingresos bajos y medios. Metodos Siguiendo las directrices de PRISMA, se realizaron busquedas sistematicas en PubMed[R], Scopus, EMBASE[R], Cochrane Library y Web of Science sobre los estudios publicados antes de mayo de 2019. Los criterios de inclusion fueron: (i) un analisis original de rentabilidad de la intervencion de atencion de emergencia o del paquete de intervenciones, y (ii) el analisis se llevo a cabo en un lugar de ingresos bajos y medios. Para identificar estudios primarios adicionales, se realizaron busquedas manuales en las listas de referencias de los estudios incluidos. Se utilizo la directriz de las Normas consolidadas de los informes de la evaluacion economica de la salud (Consolidated Health Economic Evaluation Reporting Standards) para evaluar la calidad de los estudios incluidos. Resultados De los 1674 articulos que se identificaron, 35 articulos cumplian los criterios de inclusion. Se identificaron cuatro estudios adicionales de las listas de referencia. Se excluyeron muchos estudios por considerarse evaluaciones de costos sin un analisis de efectividad. La mayoria de los estudios incluidos eran analisis de intervencion unica. Las intervenciones de atencion de emergencia evaluadas por los estudios incluidos abarcaron servicios prehospitalarios, formacion de proveedores, intervenciones de tratamiento, herramientas de diagnostico de emergencia e instalaciones y paquetes de atencion. La calidad de la informacion de los estudios era variada. Conclusion Se encontraron grandes diferencias en las evidencias sobre la rentabilidad de las intervenciones de atencion de emergencia en lugares de ingresos bajos y medios. Dada la amplitud de las intervenciones actualmente en practica, muchas intervenciones permanecen sin evaluar, lo que sugiere la necesidad de investigaciones futuras para contribuir a las decisiones de asignacion de recursos. En particular, los paquetes de intervenciones multiples y los cambios a nivel de sistema representan un aspecto prioritario de las investigaciones futuras., Introduction Emergency care is a health systems and service delivery innovation that facilitates early recognition and life-saving interventions for time sensitive acute injuries and illnesses, where a delay of hours [...]

Background: Global emergency medicine (GEM) is situated at the intersection of global health and emergency medicine (EM), which is built upon a history of colonial systems and institutions that continue to reinforce inequities between high‐income countries (HICs) and low‐ and middle‐income countries (LMICs) today. These power imbalances yield disparities in GEM practice, research, and education. Approach: The Global Emergency Medicine Academy (GEMA) of the Society for Academic Emergency Medicine formed the Decolonizing GEM Working Group in 2020, which now includes over 100 worldwide members. The mission is to address colonial legacies in GEM and catalyze sustainable changes and recommendations toward decolonization at individual and institutional levels. To develop recommendations to decolonize GEM, the group conducted a nonsystematic review of existing literature on decolonizing global health, followed by in‐depth discussions between academics from LMICs and HICs to explore implications and challenges specific to GEM. We then synthesized actionable solutions to provide recommendations on decolonizing GEM. Results: Despite the rapidly expanding body of literature on decolonizing global health, there is little guidance specific to the relatively new field of GEM. By applying decolonizing principles to GEM, we suggest key priorities for improving equity in academic GEM: (1) reframing partnerships to place LMIC academics in positions of expertise and power, (2) redirecting research funding toward LMIC‐driven projects and investigators, (3) creating more equitable practices in establishing authorship, and (4) upholding principles of decolonization in the education of EM trainees from LMICs and HICs. Conclusions: Understanding the colonial roots of GEM will allow us to look more critically at current health disparities and identify inequitable institutionalized practices within our profession that continue to uphold these misguided concepts. A decolonized future of GEM depends on our recognition and rectification of colonial‐era practices that shape structural determinants of health care delivery and scientific advancement. [ABSTRACT FROM AUTHOR]

The delivery of emergency care is an effective strategy to reduce the global burden of disease. Emergency care cross cuts traditional disease-focused disciplines to manage a wide range of the acute illnesses and injuries that contribute substantially to death and disability, particularly in low- and middle-income countries. While the universal health coverage (UHC) movement is gaining support, and human rights and health systems are integral to UCH, few concrete discussions on the human right to emergency care have been taken place to date. Furthermore, no rights-based approach to developing emergency care systems has been proposed. In this article, we explore key components of the right to health (that is, availability, accessibility, acceptability and quality of health facilities, goods and services) as they relate to emergency care systems. We propose the use of a rights-based framework for the fulfilment of core obligations of the right to health and the progressive realization of emergency care in all countries. La prestation de soins d'urgence constitue une strategie efficace pour reduire la charge mondiale de morbidite. Les soins d'urgence recoupent les disciplines traditionnelles centrees sur les maladies pour prendre en charge de nombreuses blessures et affections aigues qui contribuent sensiblement aux deces et aux handicaps, en particulier dans les pays a revenu faible et intermediate. Alors que le mouvement pour la couverture sanitaire universelle prend de l'ampleur et que les droits de l'homme et les systemes de sante en font partie integrante, peu de discussions concretes sur le droit a des soins d'urgence ont eu lieu a ce jour. En outre, aucune demarche fondee sur les droits et visant a developper des systemes de soins d'urgence n'a ete proposee. Dans cet article, nous nous interessons aux composantes cles du droit a la sante (a savoir la disponibilite, l'accessibilite, l'acceptabilite et la qualite des etablissements, des produits et des services de soins) pour ce qui est des systemes de soins d'urgence. Nous proposons d'utiliser un cadre fonde sur les droits pour l'execution des obligations essentielles du droit a la sante et la mise en place progressive de soins d'urgence dans tous les pays. La prestacion de atencion de emergencia es una estrategia eficaz para reducir la carga mundial de morbilidad. La atencion de emergencia trasciende las disciplinas tradicionales centradas en las enfermedades para tratar una amplia gama de enfermedades y lesiones agudas que contribuyen sustancialmente a la muerte y la discapacidad, en particular en los paises de ingresos bajos y medianos. Si bien el movimiento de la cobertura sanitaria universal (CSU) esta ganando apoyo, y los derechos humanos y los sistemas de salud son parte integral de la CSU, hasta la fecha se han llevado a cabo pocas discusiones concretas sobre el derecho humano a la atencion de emergencia. Ademas, no se ha propuesto un enfoque basado en los derechos para desarrollar sistemas de atencion de emergencia. En este articulo exploramos los componentes clave del derecho a la salud (es decir, disponibilidad, accesibilidad, aceptabilidad y calidad de las instalaciones, bienes y servicios sanitarios) en relacion con los sistemas de atencion de emergencia. Proponemos el uso de un marco basado en los derechos para el cumplimiento de las obligaciones basicas del derecho a la salud y la realizacion progresiva de la atencion de emergencia en todos los paises., Introduction Increasingly, the global health community is recognizing the important role that emergency care plays in delivery of health services. Estimations suggest that emergency care could address 54% to 90% [...]