Emergency Care and the SDGs Lee Wallis President, International Federation for Emergency Medicine
Background and need for global action The SDGs WHO ETA programmes Lancet NCDI Poverty commission
Emergencies occur everywhere, and each day they consume resources regardless of whether there are systems capable of achieving good outcomes. Kobusingye, Bulletin of WHO
Emergency care covers a spectrum of activities, including: prehospital care and transport; initial evaluation, diagnosis and resuscitation; and in-hospital care Calls on member states and WHO to assess, establish and monitor integrated prehospital and facility-based emergency care systems
Urges Member States to identify and prioritize a core set of emergency and essential surgery and anaesthesia services at the primary health care and first-referral hospital level
Calls on all member states to have pre-hospital care systems, and emergency medicine training programmes
3.1 3.2 3.3 3.4 SDG Target By 2030, reduce the global maternal mortality ratio to < 70 per 100,000 live births Treatment for obstetric emergencies 3.5 3.6 3.8 3.9 11.5 16.1
3.1 3.2 3.3 3.4 3.5 3.6 3.8 3.9 11.5 16.1 SDG Target By 2030, end preventable deaths of newborns and children under 5, reduce neonatal mortality to 12 per 1,000 live births and under-5 mortality to 25 per 1,000 live births Treatment for acute paediatric conditions including diarrhoea and pneumonia
3.1 3.2 3.3 3.4 3.5 3.6 3.8 3.9 11.5 16.1 SDG Target By 2030, end the epidemics of AIDS, TB, malaria and neglected tropical diseases and combat hepatitis, water-borne diseases and other communicable diseases Treatment of acute infections and sepsis
3.1 3.2 3.3 3.4 3.5 3.6 3.8 3.9 11.5 16.1 SDG Target By 2030, reduce by one third premature mortality from NCDs through prevention and treatment and promote mental health and well-being Treatment of acute exacerbations of NCDs
3.1 3.2 3.3 3.4 3.5 3.6 3.8 3.9 11.5 16.1 SDG Target Strengthen the prevention and treatment of substance abuse, including narcotic drug abuse and harmful use of alcohol Emergency care and harm reduction
3.1 3.2 3.3 3.4 3.5 3.6 3.8 3.9 11.5 16.1 SDG Target By 2020, halve the number of global deaths and injuries from road traffic accidents Post-crash emergency care
625,000 RTA deaths SDG 3.6 RTA fatality reduction target
Lives potentially saved every year in LMIC by improvements in trauma care >500,000 625,000 RTI deaths SDG 3.6 RTI fatality reduction target Mock et al. (2012) An estimate of the number of lives that could be saved through improvements in trauma care globally. WJS
3.1 3.2 3.3 3.4 3.5 3.6 3.8 3.9 11.5 16.1 SDG Target Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all Emergency care is an essential component of universal healthcare
3.1 3.2 3.3 3.4 3.5 3.6 3.8 3.9 11.5 16.1 SDG Target By 2030, substantially reduce the number of deaths and illnesses from hazardous chemicals and air, water and soil pollution and contamination Treatment for acute exposure to hazardous materials
3.1 3.2 3.3 3.4 3.5 3.6 3.8 3.9 11.5 16.1 SDG Target By 2030, significantly reduce the number of deaths and the number of people affected and substantially decrease the direct economic losses relative to global gross domestic product caused by disasters, including water-related disasters, with a focus on protecting the poor and people in vulnerable situations Disaster preparedness and response for resilient health systems
3.1 3.2 3.3 3.4 3.5 3.6 3.8 3.9 11.5 16.1 SDG Target Significantly reduce all forms of violence and related death rates everywhere Treatment for victims of violence
10 SDG Targets 3.1 Reduce by three quarters, between 2015 and 2030, the maternal mortality ratio Treatment for obstetric emergencies 3.2 Reduce by three quarters, between 2015 and 2030, the under-five mortality rate Treatment for acute paediatric conditions including diarrhoea and pneumonia 3.3 Reverse the incidence of malaria and other major diseases and reduce deaths caused by half by 2030 Treatment of acute infections and sepsis 3.4 By 2030, reduce by one-third premature mortality from NCDs Treatment of acute exacerbations of NCDs 3.5 Strengthen the treatment of substance abuse Emergency care and harm reduction interventions 3.6 Halve the number of global road traffic crash fatalities and serious injuries by 2020 Post-crash emergency care 3.8 Achieve universal health coverage including financial risk protection and access to quality essential healthcare Emergency care is an essential component of universal health care 3.9 By 2030, substantially reduce the number of deaths and illnesses from hazardous chemicals Treatment for acute exposure to hazardous materials 11.5 By 2030, significant reduce the number of deaths caused and people affected by disasters Disaster preparedness and response for resilient health systems 16.1Significantly reduce all forms of violence and related death rates everywhere Treatment for victims of violence
Basic Emergency Care Course
Basic Emergency Care Course
ECS Framework Consensus-based essential functions of emergency care systems Designed for ministries, policy makers, health system administrators, and general advocacy Facilitates the identification of system gaps to aid in priority setting
WHO Emergency Care Systems Framework WHO Health System Building Blocks Site Primary Function Function Component Detailed Activities Human Resources and Training Essential Medical Products, Information and Technologies and Research Leadership and Governance WHO Infrastructure Emergency Care Systems Framework Bystander Response System Activation Bystander Care Bystander +/- community-based training (including first aid, education on system activation and care-seeking behaviour) Universal access number or activation system; centralized call processing Patient protection at scene Basic lay provider kit Site Primary Function Function Component Detailed Activities Limited assistance of local materials for immediate threats Legislative mandate for universal activation of system; legislation regarding telephone company responsibility for UAN calls Laws on theft/assault of the injur ed. Training accreditation for lay providers. Essential Bystander Medical Human Resources protection and (Good Samaritan Products, Laws) Training WHO Health System Building Blocks Technologies and Infrastructure Information and Research Leadership and Governance Scene Dispatch Provider Response Instructions to Bystanders Dispatch of Personnel Scene Control Scene Care Field to Facility Communication Destination Triage Information to aid patient Transfer Patient and provider scene safety Initial assessment Initial resuscitation and stabilisation Packaging of patient Preliminary diagnoses Facility Patient Transport Dispatch operator Transport Care Providers may include formally trained lay responders (e.g. EFAR, police); professional responders (e.g. EMT, paramedic, nurse, doctor) Field and facility based Reception providers, technical experts Communication technologies, including a form of centralized call processing; system should be redundant by design Basic provider kit Registration Communication Screening structure in field unit and receiving facility Triage Data collection Transport for patient performance metrics (time to call, time to dispatch, time to scene) Positioning (airway and injury protection) Monitoring Intervention (ABCD, OB delivery, pain Screening surveillance control) Clinical documentation (including chief complaint and diagnosis), process measures, performance metrics Protocols, regulations, and guidelines for dispatch (including jurisdiction, remote Vehicle care (with direction, ambulance destination Driver, technical triage, coordination functionality, of public space and to private fleet ambulance director services). Protocols give care) for coordination with other emergency response agencies, and essential resource suppliers. Laws addressing access to emergency care without regard to ability to pay. Provider Transport care kit EMS Director. Minimum standards of care, treatment protocols. Regulation/legislation to create certification process for designated pre-hospital cadre Clerical staff Information system Case definitions, Referral and transport protocols, including base screening criteria hospital advising protocols Facility certification: regionalization of care, centre Basic evaluation kit Administrative designation or provider Clinical documentation (including chief complaint and diagnosis), process measures, performance metrics Screening, demographics, chief complaint Process metrics (time-flow); percent compliance with triage designations Laws and regulation governing use of emergency vehicles Minimum standards for transport care Laws addressing access to emergency care (requirement to provide initial evaluation and management) regardless of ability to pay Regulation and protocols governing relationship between triage and registration Triage protocols emergencycare@who.int Handover Syndromic surveillance guidelines
Scene Transfer Facility Bystander Response Dispatch Provider Response Patient Transport Transport Care Reception Emergency Unit Care Disposition Inpatient Care
Site Primary Functions Components Scene Transfer Facility Bystander Response Dispatch Provider Response System Activation Bystander Care Instructions to Bystanders Dispatch of Personnel Scene Control Scene Care Field to Facility Communication Destination Triage
Site Primary Functions Components Scene Transfer Patient Transport Transport Care Facility
Site Primary Functions Components Scene Transfer Facility Reception Emergency Unit Care Disposition Inpatient Care Registration Screening Triage Handover Initial Assessment & Resuscitation Monitoring and Revaluation Detailed Assessment Diagnostic Studies Additional Therapeutics Establishing Diagnoses Communication System with Protocols Early Operative Care Early Critical Care
EC Assessment
Essential data sets
Essential Resources for Emergency Care Review and integration of existing essential resource lists 16 sources WHO ICRC DCP3 AMAT MSF Others Consensus-based expert consultation 13 groups including international national, NGO, academia Candidate List 454 items organized by ECS framework element Resource List Kit Multi Country Review
WHO Emergency Care Initiatives Emergency Care System Framework Emergency Care System Assessment Tool Basic Emergency Care Course Essential Data Sets for Injury and Emergency Care Trauma Care Checklist Essential Resources for Emergency Care Emergency Care Metrics and Indicators
THE LANCET NCDI POVERTY Commission
The Global Framework for NCDs is not designed for Low Income Countries or the poor in Middle Income Countries
Bottom billion by MPI 28 countries
Bottom billion by subnational MPI 368 regions in 44 countries
Commission objectives Redefine the nature of the NCDI burden on the poorest billion Work with countries to develop actionable pro poor pathways for expansion of NCDI interventions Move investment cases and priority planning from interventions to human resource strategies that cross diseases Develop the basis for a post 2020 NCD Global Action Plan that is more inclusive
4 workgroups Poverty and disease burden Policy, Health System Response and Priority Setting Financing and commodities History, Advocacy and Governance
WG2: Policy, Health System Response and Priority Setting Review the interventions likely to make an impact on the NCDI burden. Assemble data regarding the size of the effects due to these interventions (both on health and poverty) and what is known about their cost. Draw lessons about commonalities in intervention integration pathways based on the work on the national NCDI Poverty Commissions.
WG2: Emergency care plan Search for evidence for the essential package of emergency care What is the essential package What is the clinical effectiveness What is the cost effectiveness & impact on poverty reduction Which staff are needed and how should they be trained? Map onto the BoD for the poorest Billion
Questions, or to be involved http://www.ncdipoverty.org/ www.who.int/emergencycare lee.wallis@uct.ac.za