Department of Essential Health Technologies - Emergency and Essential Surgical CareDepartment of Essential Health Technologies – Emergency and Essential Surgical Care

Each year 1.2 million people are losing their lives because of road traffic accidents and more than 500 000 women are dying from pregnancy-related complications. Young people between the ages of 15 and 44 years account for almost 50% of global injury-related mortality. In addition to primary prevention of these tragedies, the ability to apply the correct emergency, surgical and anaesthesia procedures is vital.

Conditions treatable by surgery account for 11% of the global burden of disease.

Primary HospitalTwo simple yet neglected measures can drastically reduce death and disability from fundamental surgical conditions:• Increase trained human resources• Increase access to essential surgical equipment

Essential surgical care makes a difference

Causes of injury worldwide

n Interpersonal violence 10%n War 6%n Other 17%n Road traffic injury 25%n Poisoning 6%n Falls 6%n Fires 5%n Drowning 9%n Self-inflicted violence 16%

10%6%

17%

25%6%

6%

5%

9%

16%

Integrated Management toolkit for Emergency and Essential Surgical Care (IMEESC)

The WHO Integrated Management for Emergency & Essential Surgical Care e-learning toolkit provides a comprehensive package of WHO recommendations on a single compact disc. This toolkit targets policy-makers, program managers and health care providers (non-specialist doctors, nurses and paramedics)

Teaching & Reference Guidelines: Surgery, Emergency, Obstetrics, Anesthesia, Trauma & Orthopedics at District Hospital:: Surgical Care at the District Hospital manual :: Surgical Care at the District Hospital (SCDH) teaching slides :: Evaluation of Self Learning

Training Workshops:: Trainer’s Guide:: Model Agenda:: Participants Evaluation:: Sample Report of Training Workshop

Best Practice Protocols:: Best Practice Protocols for Clinical Procedures Safety :: Hand Washing Techniques:: Waste Disposal for Clinical Procedures :: Disaster Management Guidelines:: Burn Management:: Post-operative Pain Management :: HIV Prevention Protocols

Equipment Lists & Needs Assessment:: Essential Emergency Equipment Generic List:: Anaesthetic Infrastructure/Supplies:: Needs Assessment for Essential Emergency Room Equipment

Policy Management:: Aide-Memoire: Surgical & Emergency Obstetrical Care:: Training Curriculum on Emergency & Essential Surgical Skills:: Organization & Management

Quality & Safety:: Safe Surgery & Safe Anaesthesia Protocols:: Obstetric Safety Protocols:: Monitoring & Evaluation

Research Tool:: WHO Situation Analysis to Assess Emergency & Essential Surgical Care

Videos:: Surgery at the District Hospital Training Videos (7 films, 30 minutes each)

10-20% of deaths of young adults in developing countries are directly attributable to inadequate surgical knowledge.

Simple surgery makes a difference.

Emergency and Essential Surgical CareClinical Procedures unitDepartment of Essential Health TechnologiesWorld Health OrganizationGeneva 27, SwitzerlandFax: +41 22 791 4836www.who.int/surgery

WHO/EHT/CPR/2009

QUALITY & SAFETY

IMEESC toolkit

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TRAUMA OBSTETRICS

INFECTIONCONGENITAL

EMERGENCY

SURGERYand

ANAESTHESIA

Department of Essential Health Technologies – Emergency and Essential Surgical Care

24%

15%

13%12%

8%

8%

20%

n Severe bleeding 24%n Infection 15%n Unsafe abortion 13%n Eclampsia 12%n Obstructed labor 8%n Other direct causes 8%n Indirect causes 20%

Causes of maternal death worldwide

Emergency and Essential Surgical Care (EESC)

The WHO Emergency and Essential Surgical Care (EESC) program is aimed at strengthening emergency, surgery and anaesthesia services for injuries, disasters, pregnancy-related complications and other surgical conditions at first referral level health facilities through education, skills building and research.

EESC is an integral part of Primary Health Care (PHC), providing technical support to countries in scaling up frontline health providers in life-saving and disability-preventive surgical care which requires no expensive technology or sophisticated facilities.

2,000,000,000 people have no access to emergency or surgical care.

In East Africa, only 40 orthopaedic surgeons serve a population of over 200 million. In Uganda, only 13 physician anaesthesiologists serve 27 million. Due to these extreme circumstances, EESC is often provided by non-specialist doctors, nurses and paramedics in rural and remote health facilities. Scaling up the health work force in life-saving and disability preventing EESC is urgent for PHC.

Providing clinical recommendations to safely manage these and other conditions:

Pregnancy-related complications• obstructed labour• unsafe abortions

Injuries• road traffic• violence• burns• falls• disasters

Other surgical conditions• male circumcision• congenital clubfoot• hernias• hydrocoele• female genital mutilation• infection

Global Initiative for Emergency and Essential Surgical Care (GIEESC)

WHO GIEESC was established in December 2005 with the objective to improve collaboration among Ministries of Health, WHO country offices, local and international organizations and academia. GIEESC is involved in reducing death and disability from road traffic accidents, trauma, burns, falls, pregnancy related complications, domestic violence, disasters and other surgical conditions. The specific objectives are

• strengthen capacity to deliver effective emergency surgical care at the first referral level facility, working towards achieving the WHO Millennium Development Goals

• improve the quality of care through safe and appropriate use of emergency and essential surgical procedures and linked equipment in resource limited healthcare facilities

• strengthen existing training and education programs in safety of essential procedures in low and middle income countries

EESC in Primary Health Care

• UNIVERSAL ACCESSIncreasing the number of appropriately trained providers leads to improved access for underserved populations

• SERVICE DELIVERYSupport capacity building in EESC skills and equipment leading to a greater range of services available in PHC

• LEADERSHIPSupport worldwide collaboration and partnerships through WHO GIEESC

• POLICYProviding guidance on comprehensive and integrated EESC for strengthening health systems

Third Bi-Annual GIEESC Meeting, Ulaanbaatar, Mongolia, 5-6 June, 2009ONLINE RESOURCES

for CAPACITY BUILDING

POLICY

Patient Assessment during an EESC training workshop in Mozambique

“SCDH is an indispensable manual for outlying health centres.”International Federation of Surgical Colleges

Complete text available online: http://www.who.int/surgery/publications/en/SCDH.pdf

EDUCATION

AWARENESS

Airway Management during an EESC training workshop

in Tanzania

Emergency and essential surgical care

AIDE-MEMOIRESurgical and Emergency Obstetrical Care at First Referral Level Well-organized surgical, obstetric, trauma care and anaesthetic services

are essential for a district hospital to be an effective community

resource. These services should be developed within the framework of

the country and district’s health care infrastructure.

Without such services, up to 10% of the population will die from injury

and 5% of pregnancies will result in maternal death. Unacceptable

rates

of death from non-traumatic surgical disorders, infections and disability

from injury will also result.

Death and disability from trauma, pregnancy-related complications and

disasters can be substantially reduced through the following integrated

strategy to maximize the effectiveness of district hospitals.

1. Personnel with appropriate education and training.

2. Practical continuing education programmes in clinical management to maintain the quality of care.

3. Appropriate physical facilities.

4. Equipment and instruments to meet the needs of district surgical services.

5. A reliable system for the supply of drugs and medications, surgical materials and other consumables.

6. A quality assurance system.

Words of advice

1. Develop a national plan for district level surgical services,with the consensus and collaboration of all relevantstakeholders.

2. Obtain support from educational institutions andprofessional bodies.

3. Ensure continuing education to enable practitioners to provide an effective surgical, obstetrics, trauma care andanaesthetic service.

4. Provide guidance for referral to specialized health facilities.

5. Maintain, repair and upgrade district hospitals to requiredlevels and equip facilities adequately.

6. Assure adequate and reliable supplies of drugs, surgicalmaterials and other consumables.

7. Ensure quality and provision of care.

� Checklist

Personnel� Clinical personnel with appropriate education and training in:

• Anaesthesia and resuscitation • Obstetrics and gynaecology • General surgery • Traumatology • Orthopaedics

� Clinical support staff Education programmes� Evaluation of training needs � Coordinated plan for education and

training � Training in skills needed for surgical

care at district hospital level in both: • Basic training • Continuing education

� Educational resources in hospitals � Monitoring and evaluation Facilities� Casualty area, operating room, labour

and delivery room, high dependency area

� Continuous oxygen supply � Blood bank and laboratory � Diagnostic imaging � Sterilization � Water, electricity, safe waste disposal

and communications

Equipment and instruments� Surgical instruments for:

• Minor surgery • Major surgery • Obstetrics and gynaecology • Orthopaedic surgery

� Anaesthetic equipment � Resuscitation equipment � Basic monitoring equipment Supplies system� Drugs, medications, blood and

intravenous fluids � Surgical materials � Other consumables Quality system� Management � Communication � Supervision � Evaluation

© WHO 2006

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Department of Essential Health Technologies – Emergency and Essential Surgical CareDepartment of Essential Health Technologies – Emergency and Essential Surgical Care