Basic Emergency Care (BEC): A New Global Health Framework

BEC WHO

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.

BEC in Uganda 2
Zambian BEC course facilitators Hassan, Alex, Chipoya (doctors), and Irene (nurse) demonstrate how to safely move an injured patient.

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.

BEC in Uganda
Tanzanian BEC course facilitators, Suzie (nurse) and Juma (doctor) demonstrate infant resuscitation.

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.

References

  • 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
Cite this article as: J. Austin Lee, USA, "Basic Emergency Care (BEC): A New Global Health Framework," in International Emergency Medicine Education Project, February 17, 2020, https://iem-student.org/2020/02/17/basic-emergency-care/, date accessed: July 12, 2020

Death on the Roads

Death on the Roads

Save the date:

Why? Because road victims will be remembered that day. Starting from 2005, The World Day of Remembrance for Road Traffic Victims is held on the third Sunday of November each year to remember those who died or were injured from road crashes (1).

Road traffic injuries kill more than 1.35 million people every year and they are the number one cause of death among 15–29-year-olds. There are also over 50 million people who are injured in non-fatal crashes every year. These also cause a real economic burden. Total cost of injuries is as high as 5% of GDP in some low- and middle-income countries and cost 3% of gross domestic product (2). It is also important to note that there has been no reduction in the number of road traffic deaths in any low-income country since 2013.

The proportion of population, road traffic deaths, and registered motor vehicles by country income, 2016 (Source: Global Status Report On Road Safety 2018, WHO)

Emergency care for injury has pivotal importance in improving the post-crash response. “Effective care of the injured requires a series of time-sensitive actions, beginning with the activation of the emergency care system, and continuing with care at the scene, transport, and facility-based emergency care” as outlined in detail in World Health Organization’s (WHO) Post-Crash Response Booklet.

As we know, the majority of deaths after road traffic injuries occur in the first hours following the accident. Interventions performed during these “golden hours” are considered to have the most significant impact on mortality and morbidity. Therefore, having an advanced emergency medical response system in order to make emergency care effective is highly essential for countries.

Various health components are used to assess the development of health systems by country. Where a country is placed in these parameters also shows the level of overall development of that country. WHO states that 93% of the world’s fatalities related to road injuries occur in low-income and middle-income countries, even though these countries have approximately 60% of the world’s vehicles. This statistic shows that road traffic injuries may be considered as one of the “barometer”s to assess the development of a country’s health system. If a country has a high rate of road traffic injuries, that may clearly demonstrate the country has deficiencies of health management as well as infrastructure, education and legal deficiencies.

WHO has a rather depressing page showing numbers of deaths related to road injuries. (Source: Death on the Roads, WHO, https://extranet.who.int/roadsafety/death-on-the-roads/ )

WHO is monitoring progress on road safety through global status reports. Its’ global status report on road safety 2018 presents information on road safety from 175 countries (3).

We have studied the statistics presented in the report and made two maps (All countries and High-income countries) illustrating the road accident death rate by country (per 100,000 population). You can view these works below (click on images to view full size).

References and Further Reading

  1. Official website of The World Day of Remembrance, https://worlddayofremembrance.org
  2. WHO. Road traffic injuries – https://www.who.int/news-room/fact-sheets/detail/road-traffic-injuries
  3. WHO. Global status report on road safety 2018 – https://www.who.int/violence_injury_prevention/road_safety_status/2018/en/
Cite this article as: Ibrahim Sarbay, Turkey, "Death on the Roads," in International Emergency Medicine Education Project, November 1, 2019, https://iem-student.org/2019/11/01/death-on-the-roads/, date accessed: July 12, 2020