Emergency Health Systems

Founded: 2019
Faculty Lead: Sean Kivlehan, MD, MPH
Status: Active Program
Regions of Focus: Tanzania, Uganda, Nigeria, Ukraine, Pakistan, Haiti, Turkey
Research Theme: Risk, Resilience and Response

Description

Strong emergency care systems improve the effectiveness of humanitarian action. An effective humanitarian response must include strengthening of emergency care systems to build resilience. The HHI Emergency Health Systems program works to bridge the gap between system development and humanitarian response and improve the quality and access of emergency care for those who need it most.

This mission is achieved through intertwined research, education, and advocacy efforts. By evaluating, implementing, and disseminating normative emergency care guidance, the Emergency Health Systems program aligns humanitarian response with the Sustainable Development Goals to increase the capacity of front-line providers and improve emergency care delivery processes and outcomes.

Projects

WHO Global Health Cluster

Represent HHI at the Global Health Cluster and participate in cluster projects, most recently including the COVID-19 Technical Task Force and the Capacity Development Consultation Group.

WHO Emergency Care Toolkit

Support the dissemination and evaluation of the WHO-ICRC Basic Emergency Care course and associated products.

Academic-NGO Consortium

Work closely with several NGOs to provide emergency care and COVID guidance for field operations and support a roster of emergency physicians available for field deployment.

Fellowship in Global Emergency Medicine

The Brigham and Women’s Hospital Department of Emergency Medicine supports two fellows who participate in development, disaster response, and displaced populations work.

Global Emergency Medicine Literature Review

A team of 24 reviewers and editors from around the world who conduct an annual review of literature focused on humanitarian and emergency care as well as an annual systematic review.

Global Emergency Care Organization Collaboration

Active participation in organizations support the advancement of emergency care and humanitarian action around the world.

Academic Consortium for Emergency Systems

A research network spanning several institutions in the US focused on implementing and evaluating emergency care interventions globally.

waxwork dummy strapped in a gurney being raiseed into an ambulance by two men

Save a Life Educational Videos

Methodology

The Emergency Health Systems program strives to apply rigorous methods to evaluate the effectiveness and impact of emergency care interventions in humanitarian and limited resourced settings. Quantitative and qualitative approaches are used as part of our program’s implementation science efforts. Systematic and descriptive reviews of the literature describing interventions of interest are performed to better understand the available evidence.

Publications

Sean M Kivlehan, Amy Allen, Olha Viun, Dmitry A Makarov, Daniel Schnorr, Sonny Patel, Sergii A Ryzhenko, Phuong Pham, and Timothy B Erickson. 6/14/2022. “Evaluation of change in emergency care knowledge and skills among front-line healthcare providers in Ukraine with the Basic Emergency Care course: a pretest/post-test study.” BMJ Open. Read Publication Abstract

Objective: Evaluate the change in participant emergency care knowledge and skill confidence after implementation of the WHO-International Committee of the Red Cross (ICRC) Basic Emergency Care (BEC) course.

Design: Pretest/post-test quasi-experimental study.

Setting: Mechnikov Hospital in Dnipro, Ukraine.

Participants: Seventy-nine participants engaged in the course, of whom 50 (63.3%) completed all assessment tools. The course was open to healthcare providers of any level who assess and treat emergency conditions as part of their practice. The most common participant profession was resident physician (24%), followed by health educator (18%) and prehospital provider (14%).

Interventions: The 5-day WHO-ICRC BEC course.

Primary and secondary outcome measures: Change in pre-course and post-course knowledge and skill confidence assessments. Open-ended written feedback was collected upon course completion and analysed for common themes.

Results: Participant knowledge assessment scores improved from 19 (IQR 15–20) to 22 (IQR 19–23) on a 25-point scale (p<0.001). Participant skill confidence self-assessment scores improved from 2.5 (IQR 2.1–2.8) to 2.9 (IQR 2.5–3.3) on a 4-point scale (p<0.001). The most common positive feedback themes were high-quality teaching and useful skill sessions. The most common constructive feedback themes were translation challenges and request for additional skill session time.

Conclusions: This first implementation of the WHO-ICRC BEC course for front-line healthcare providers in Ukraine was successful and well received by participants. This is also the first report of a BEC implementation outside of Africa and suggests that the course is also effective in the European context, particularly in humanitarian crisis and conflict settings. Future research should evaluate long-term knowledge retention and the impact on patient outcomes. Further iterations should emphasise local language translation and consider expanding clinical skills sessions.

Frederick M. Burkle, Krzysztof Goniewicz, and Amir Khorram-Manesh. 3/2022. “Bastardizing Peacekeeping and the Birth of Hybrid Warfare.” Prehospital and Disaster Medicine. Read Publication

Eric Goralnick, MD, MS

Associate Professor of Emergency Medicine, Harvard Medical School

Eric Goralnick, MD, MS is focused on improving patient care in two main areas: ensuring equitable access to healthcare for our most vulnerable...

Donell Harvin, DrPH, MPH, MPA

Visiting Scientist, Harvard T.H. Chan School of Public Health

Donell Harvin is a public health and weapons of mass destruction expert from Washington, DC who oversees the Harvard Humanitarian Initiative’s (HHI...