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

Area of Science:

• Global Health
• Critical Care Medicine
• Public Health Policy

Background:

• Millions of annual deaths worldwide are attributed to critical illness.
• Basic, life-saving care for critically ill patients is frequently neglected in healthcare systems.
• Essential Emergency and Critical Care (EECC) is proposed as universally applicable, low-cost, and low-complexity care for critically ill patients.

Purpose of the Study:

• To define the core components of Essential Emergency and Critical Care (EECC).
• To identify essential diagnosis-specific care for critically ill patients with COVID-19, addressing the pandemic's impact.
• To establish a feasible framework for implementing critical care standards globally.

Main Methods:

• A Delphi process involving 269 global clinical experts from diverse specialties and resource settings.
• Iterative rating of proposed treatments and actions based on existing guidelines and WHO/ICRC Basic Emergency Care principles.
• Adaptation of Delphi outputs by specialist reviewers into a structured package of clinical processes and hospital readiness requirements.

Main Results:

• Consensus (>90% agreement) was achieved on 40 clinical processes and 67 hospital readiness requirements for EECC.
• Specific additions for COVID-19 critical care were incorporated into the EECC package.
• The expert panel represented 59 countries and various resource settings, ensuring broad applicability.

Conclusions:

• The study successfully specified the essential content of care for all critically ill patients.
• Implementing EECC offers a viable strategy for policymakers to decrease preventable global mortality.
• Standardizing critical care through EECC can improve outcomes in diverse healthcare settings.