White Paper on Early Critical Care Services in Limited Resource Settings

Losonczy, Lia I. and Papali, Alfred and Kivlehan, Sean and Calvello Hynes, Emilie J. and Calderon, Georgina and Laytin, Adam and Moll, Vanessa and Al Hazmi, Ahmed and Alsabri, Mohammed and Aryal, Diptesh and Atua, Vincent and Becker, Torben and Benzoni, Nicole and Dippenaar, Enrico and Duneant, Edrist and Girma, Biruk and George, Naomi and Gupta, Preeti and Jaung, Michael and Hollong, Bonaventure and Kabong, Diulu and Kruisselbrink, Rebecca J. and Lee, Dennis and Maldonado, Augusto and May, Jesse and Osei-Ampofo, Maxwell and Omer Osman, Yasein and Owoo, Christian and Rouhani, Shada A. and Sawe, Hendry and Schnorr, Daniel and Shrestha, Gentle S. and Soshoni, Aparajita and Sultan, Menbeu and Tenner, Andrea G. and Yusuf, Hanan and Adhikari, Neill K. J. and Murthy, Srinvas and Kissoon, Niranjan and Marshall, John and Khoury, Abdo and Bellou, Abdelouahab and Wallis, Lee and Reynolds, Teri (2021) White Paper on Early Critical Care Services in Limited Resource Settings. Annals of Global Health, 87 (1). p. 105. ISSN 2214-9996

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Official URL: http://doi.org/10.5334/aogh.3377


This White Paper has been formally accepted for support by the International Federation for Emergency Medicine (IFEM) and by the World Federation of Intensive and Critical Care (WFICC), put forth by a multi-specialty group of intensivists and emergency medicine providers from low- and low-middle-income countries (LMICs) and high-income countries (HiCs) with the aim of 1) defining the current state of caring for the critically ill in low-resource settings (LRS) within LMICs and 2) highlighting policy options and recommendations for improving the system-level delivery of early critical care services in LRS. LMICs have a high burden of critical illness and worse patient outcomes than HICs, hence, the focus of this White Paper is on the care of critically ill patients in the early stages of presentation in LMIC settings. In such settings, the provision of early critical care is challenged by a fragmented health system, costs, a health care workforce with limited training, and competing healthcare priorities. Early critical care services are defined as the early interventions that support vital organ function during the initial care provided to the critically ill patient—these interventions can be performed at any point of patient contact and can be delivered across diverse settings in the healthcare system and do not necessitate specialty personnel. Currently, a single “best” care delivery model likely does not exist in LMICs given the heterogeneity in local context; therefore, objective comparisons of quality, efficiency, and cost-effectiveness between varying models are difficult to establish. While limited, there is data to suggest that caring for the critically ill may be cost effective in LMICs, contrary to a widely held belief. Drawing from locally available resources and context, strengthening early critical care services in LRS will require a multi-faceted approach, including three core pillars: education, research, and policy. Education initiatives for physicians, nurses, and allied health staff that focus on protocolized emergency response training can bridge the workforce gap in the short-term; however, each country’s current human resources must be evaluated to decide on the duration of training, who should be trained, and using what curriculum. Understanding the burden of critical Illness, best practices for resuscitation, and appropriate quality metrics for different early critical care services implementation models in LMICs are reliant upon strengthening the regional research capacity, therefore, standard documentation systems should be implemented to allow for registry use and quality improvement. Policy efforts at a local, national and international level to strengthen early critical care services should focus on funding the building blocks of early critical care services systems and promoting the right to access early critical care regardless of the patient’s geographic or financial barriers. Additionally, national and local policies describing ethical dilemmas involving the withdrawal of life-sustaining care should be developed with broad stakeholder representation based on local cultural beliefs as well as the optimization of limited resources.

Item Type: Journal Article
Additional Information: Also at: https://www.ifem.cc/wp-content/uploads/2021/03/IFEM-White-Paper-on-Early-Critical-Care-Services-in-Low-Resource-Settings-in-Low-and-Middle-Income-Countries-February-2021.pdf
Keywords: White Paper, Critical Care, Low Resource Settings, Low-Middle-Income Countries
Faculty: Faculty of Health, Education, Medicine & Social Care
SWORD Depositor: Symplectic User
Depositing User: Symplectic User
Date Deposited: 03 Sep 2021 12:43
Last Modified: 15 Nov 2021 12:40
URI: https://arro.anglia.ac.uk/id/eprint/706891

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