Experienced emergency medicine providers know the ins and outs of how to approach and assess any patient of any age with a critical illness. As has been discussed previously on this blog, the need to rapidly identify and manage sick and dying patients requires a systematic approach. When a new patient arrives for care, or alternatively when a patient decompensates and gets acutely sicker, the emergency medicine provider is tasked with systematically identifying and treating such conditions.
Because most trauma and critical care approaches and training modules were developed and implemented in high-income, resource-rich contexts, there has long been a need for a systematic approach to critically ill patients in lower-income settings.
Over the past several years, the World Health Organization, the International Committee of the Red Cross/Red Crescent, and the International Federation for Emergency Medicine have been working together to develop and create a training course to aid frontline providers in managing acute illness and acute injury in resource-limited contexts.
Since 2018, the World Health Organization’s Basic Emergency Care course has been developed and refined as a way to teach a systematic, high-yield approach to urgent and emergent health problems. Using both triage and interventional strategies, the course trains participants to be prepared to deal with a variety of critical illnesses, with a focus on trauma, breathing, shock, and altered mental status.
The BEC course is generally given as a 4 to 6-day course to individuals working in healthcare systems around the world. The BEC course is intended for individuals who might be able to or expected to provide emergent patient care, including students, trainees, nurses, physicians, and even pre-hospital or inpatient care providers, among others. This course is not only intended for emergency medicine physicians, but for all types of locally appropriate providers.
The BEC course participants first learn about the ABCDE approach to ill patients, with a recurring emphasis on obtaining a focused patient history using the SAMPLE mnemonic. These skills are crucial and can be applied to almost any patient in any context.
The knowledge gained around ABCDEs and the SAMPLE histories are then applied across the four main care modules in the course, which are: trauma, breathing, shock, and altered mental status. As has been pointed out by others, before any patient goes from alive to dead, they usually pass through the framework of one of these four critical care modules. The hypoglycemic patient develops altered mentation, or the patient with pneumonia develops respiratory distress. As such, lifesaving interventions at these crucial action points can truly save lives.
Each day of the 5-day training course generally has a mix of lectures, group discussions, case scenarios, and hands-on skills stations. The freely available WHO BEC Handbook can help one to better understand the course structure and content.
It should be noted that the BEC course does presume the participant has a very basic but pre-existing knowledge of some of the following: basic human anatomy, basic history taking, basic physical examination skills including vital signs auscultation and abdominal exam, use of a glucometer, and the use of intravenous and intramuscular medications.
In several locations around the world, after the completion of the 5-day course, a Training of the Trainers course has been given, where top course participants and other health system leaders come together to learn how to teach the BEC course. As such, there is a goal for developing and cultivating both local leadership regarding the skills and knowledge around care during critical illness. Subsequently, a locally perpetual training around BEC can take root and become the new standard of emergency care.
Early research by Tenner et al., among others, into the efficacy and impact of the BEC course is showing that indeed, the WHO BEC course is both effective and helpful. For those who are interested in either taking the course, or in becoming a certified trainer, you can contact your national or local emergency medicine leaders and ask for times and locations near you where there may be the opportunity to take this incredibly valuable and impactful course. One such BEC and follow-on training of the trainer course will be taking place in Rwanda in March of 2020; to contribute financially to this Rwandan effort, consider a small donation: here.
- Tenner AG, Sawe HR, Amato S, et al. Results from a World Health Organization pilot of the Basic Emergency Care Course in Sub Saharan Africa. PLoS One. 2019;14(11):e0224257. Published 2019 Nov 13. doi:10.1371/journal.pone.0224257 – pdf link