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Abstract Background The Basic Emergency Care (BEC) course was created by the World Health Organization (WHO) in collaboration with the International Committee of the Red Cross (ICRC) and the International Federation for Emergency Medicine (IFEM) to train frontline providers in low-resource settings. This study aims to evaluate long-term retention and maintenance of emergency care knowledge and confidence among University of Nairobi School of Medicine graduates after completing the BEC course. Methods This longitudinal, prospective, comparative study was conducted with recent graduates of the University of Nairobi School of Medicine from October 2021 to May 2023. Participants’ retention of emergency medicine knowledge was assessed comparing a pre/post course test and a multiple-choice examination 12 to 18 months after completing the BEC course. A survey assessed participants’ confidence in managing patients with emergencies 12–18 months after completing the BEC course using a 4-point Likert scale. These results were compared to a control group of recent University of Nairobi School of Medicine graduates who did not take the BEC course. Results The follow-up test scores were lower than the immediate post-course test scores, which suggests some knowledge loss over time. Compared to the control group, the BEC participants had higher test scores during the follow-up period although the difference was not significant. There was no difference between most of the immediate post-course and follow-up survey responses. On follow-up evaluation, BEC participants reported a significant decrease in confidence in understanding emergency drugs and managing an obstructed airway and a patient requiring immobilization. However, compared to the control group, BEC participants had significantly higher self-reported confidence in most areas assessed by the survey. Conclusion The WHO BEC course is effective for emergency care training for medical students at the University of Nairobi. However, the participants’ decrease in knowledge and confidence 12 to 18 months after the BEC course suggests the need for regular refresher courses.

Abstract Background In 2021, the Nepal national emergency care system’s assessment (ECSA) identified 39 activities and 11 facility-specific goals to improve care. To support implementation of the ECSA facility-based goals, this pilot study used the World Health Organization’s (WHO) Hospital Emergency Unit Assessment Tool (HEAT) to evaluate key functions of emergency care at tertiary hospitals in Kathmandu, Nepal. Methods This cross-sectional study used the standardized HEAT assessment tool. Data on facility characteristics, human resources, clinical services, and signal functions were gathered via key informant interviews conducted by trained study personnel. Seven tertiary referral centers in the Kathmandu valley were selected for pilot evaluation including governmental, academic, and private hospitals. Descriptive statistics were generated, and comparative analyses were conducted. Results All facilities had continuous emergency care services but differed in the extent of availability of each item surveyed. Academic institutions had the highest rating with greater availability of consulting services and capacity to perform specific signal functions including breathing interventions and sepsis care. Private institutions had the highest infrastructure availability and diagnostic testing capacity. Across all facilities, common barriers included lack of training of key emergency procedures, written protocols, point-of-care testing, and ancillary patient services. Conclusion This pilot assessment demonstrates that the current emergency care capacity at representative tertiary referral hospitals in Kathmandu, Nepal is variable with some consistent barriers which preclude meeting the ECSA goals. The results can be used to inform emergency care development within Nepal and demonstrate that the WHO HEAT assessment is feasible and may be instructive in systematically advancing emergency care delivery at the national level if implemented more broadly.

Background: Resource limited settings have an ongoing need for access to quality emergency care. The World Health Organization – International Committee of the Red Cross Basic Emergency Care (BEC) course is one mechanism to address this need. Training of BEC trainers has been challenging due to barriers including cost, travel logistics, scheduling, and more recently, social distancing regulations related to the coronavirus pandemic. Objective: We seek to determine if an online virtual format is an effective way to train additional trainers while overcoming these barriers. Methods: The BEC Training-of-Trainers (ToT) course was adapted to a virtual format and delivered entirely online. Participants were assessed with a multiple choice pre- and post-test and completed a course feedback form upon completion. Results from the virtual course were then compared to the results from an in-person ToT course. Findings: The in-person course pre- and post-tests were completed by 121 participants with a pre-test mean of 87% (range 60–100%) and a post-test mean of 95% (range: 75–100; p < 0.05). Virtual course pre- and post-tests by 27 participants were analyzed with a pre-test mean of 89% (range 75–100%) and a post-test mean of 96% (range: 79–100; p < 0.05). No difference in test improvements between the courses was detected (z = –0.485; p = 0.627). The course feedback was completed by 93 in-person participants and 28 virtual participants. Feedback survey responses were similar for all questions except for course length, with in-person participant responses trending towards the course being too long. Conclusions: A virtual format BEC ToT course is effective, feasible, and acceptable. When compared to an in-person course, no difference was detected in nearly all metrics for the virtual format. Utilizing this format for future courses can assist in scaling both the BEC ToT and, by extension, the BEC course globally, particularly in regions facing barriers to in-person training.