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

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.
Competing Interests: 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.
(© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ.)