Easy as ABCDE - Basic Emergency Care for Frontline Providers

Supporting frontline healthcare providers around the world manage the most life-threatening emergency medical conditions.

Health disparities between high and low resource countries is multifactorial. However, low- and middle income countries (LMICs) suffer a greater burden from preventable and treatable conditions, particularly due to a lack of emergency services. Studies suggest over half of deaths, and nearly one third of disability adjusted life years there are potentially addressable by pre-hospital and facility-based emergency care. Access to emergency care could substantially reduce the morbidity and mortality associated with injury and a wide range of acute conditions. However, in part due to lack of training, few LMICs have adapted functional emergency care systems.

As such, the World Health Organization has embarked in a project to develop and implement a Basic Emergency Care (BEC) course designed to provide a freely available, standardized training in basic assessment and life-saving techniques using an in-person lecture format. While in-person courses are great for hands-on training, they are only available occasionally throughout the year despite a continuous education need, and adult learning theory suggests limitations for knowledge retention. But, with the increasing ubiquity of mobile phone and computer access, comes a unique opportunity to provide supporting material and continual support for frontline providers at the time they need it and throughout the year.

We are building a decision aid app and online suite of cases for healthcare providers of all experience levels so that they will be prepared for and can review time-sensitive information when needed to help direct care for those patients whose greatest opportunity for life comes from timely intervention. Whatsmore, learning from this multinational deployment will help further knowledge in emergency and disaster education as well as implementation science for public health initiatives like this in the future, helping to describe best practices and lowering the barrier to implementation in the future.

The Basic Emergency Care Pathway app presents both a new application of existing technology and its method of implementation a new process for approaching education interventions in LMICs. Decision aids are not new to the medical community, and neither is the primary survey evaluation. What is unique, however, is the synthesis of the two in a way that is simple, direct and easy to understand for learners of all backgrounds - not just emergency physicians. Whatsmore, it’s meant to target those vulnerable populations that stand to gain from simple interventions impacting some of the highest morbidity and mortality conditions.

Though death and disability from trauma, infection or obstetric emergencies remain a top 10 cause of morbidity and mortality worldwide, they represent a population for whom directed intervention can have a significant impact. Unfortunately, each condition requires a different stabilizing measure and physical tables and charts have been found to offer limited utility due to the complexity of decision branches; making them unreadable and bulky at times of greatest need. However, this results in conditions well-suited to technological interventions allowing for easy, step-by-step just-in-time instruction available across medical platforms and in multiple languages, which would otherwise not be possible.

The goals of the next 12 months are three-fold: technical, deployment and research. We plan to build the infrastructure into the app to allow for easy updating, user tracking and language support. Then, we plan to pilot our initial, download-ready version of the app with WHO partner institutions in Uganda where the BEC coursework will be taught simultaneously. While performing this pilot, we will utilize the consolidated framework for implementation research to collect stakeholder feedback, which we will use to direct subsequent roll-outs.

We plan to expand past the pathway, making the entire BEC course material available through the app and website. Further, we aim to use our implementation research from initial pilots to direct expansion to our first non-African countries as well as introduce our first non-english app version. Enabling location-specific features and recommendations as well as utilizing pathway tracking will help us target communities requiring further hands-on training to make sure that all partners are getting the support they need and can respond to changing demands and making basic emergency care easy and accessible to those who need it most.

Our beneficiaries will be reached primarily through staged deployment of the BEC course through the WHO and their partner institutions, the African Federation of Emergency Medicine (AFEM) and the International Federation of Emergency Medicine (IFEM). Each time the BEC course is taught, the ABCDE app will then be obtained along with the education materials that each participant receives upon commencement of the course, which they can access and download from the above link which will then be hosted on the WHO website for easy access.

We do not currently have any “active” daily users as our solution is still being piloted. However, we have served over 50 nurses, EMTs and doctors in South Africa and Tanzania who served as beta testers for the BEC app. The BEC course itself has been introduced in Tanzania, Uganda, and Zambia. Preliminary data analysis of the introduction of the course and tools has led to decreased mortality in these settings by 30-50%.   However, as resource constraints limit often retraining, WHO and local stakeholders requested we develop the app pathway to support providers after completion of the course.

Within the next 12 months, we expect to deploy to WHO partners in East Africa, providing the app for free to approximately 500 urban and rural pre-hospital care providers, nurses and physicians. We then plan expansion to 5-10,000 participants within three years by expansion to remaining partners in Africa followed by those in Asia and South America. Given prior results from pilots and studies currently being prepared for publication, we expect all providers to show increased knowledge retention, improved comfort with life-saving procedures and lastly a survival benefit for the local population immediately after introduction to the course and app.

Our multidisciplinary team is made up of academic emergency medicine physicians, product managers, former Chief Technology Officers (CTO) and global health researchers who specialize in the research and development for emergency and disaster preparedness. Whether developing protocols for Ebola management or technologies through LEAN processes, our team has been able to bootstrap the production and field-testing of a functioning Minimal Viable Product (MVP). Furthermore, we have on-site contacts at partner institutions and have an implementation pathway prepared for the BEC coursework which we will utilize to piggyback the app feedback and development onto, allowing for seamless integration into large-scale deployment.

We are not pursuing a revenue model at this time. We aim to utilize grant funding and support from partners to make this model available free of charge to frontline health workers.

We believe that Solve’s core values are inline with those of our team. We strive to be optimistic in the face of conditions that many would consider gruesome, to utilize technological advances to help provide the healing hand necessary in times of distress. Further, Emergency Medicine is a team sport, requiring unique characteristics from a wide range of backgrounds. As such, we have a high regard for how teams solve big problems, partnering with those who can offer their unique expertise to be greater than the sum of their parts.

Developing solutions for international health, and particularly intervening in time-sensitive conditions, can be difficult for number of reasons. Complex environments make identifying accurate and effective interventions costly as multiple variables must be assessed and the ability to implement solutions across varying settings requires equal rigor. Furthermore, technological literacy barriers offer another hurdle for mobile solutions. We hope to gain funding for on-site research, directed feedback to developers and experience with technological interventions, hosting and maintenance from the Solve team so that we might learn from their expertise and offer the most robust solution possible for our partners.