EICCD,MOH

National Emergency Service Leveling

Guidline

Aman Safewo (BSc, MPH in Field Epidemiology)

February 26/2021
Adama, Ethiopia
MOH-ECCD, BEC Training 1
 Outline

• Introduction
• Goal
• Objectives
• Scope
• Level of Emergency Service
• Monitoring & Evaluation
• Next steps

12/09/2024 2
 Introduction

• Modern emergency medical care is a recent

phenomenon on the health system
• It focuses on providing emergency care to all
types of emergencies, at one center using
emergency
– professional team,

– emergency care standard approaches and

– organizations to prevent avoidable deaths and disabilities

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 Continuum of care of emergency
patients

Scene

Discharge/
dispostion to Transportion/
different Referal
department

Facility
Emergency
care

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 Emergency units/departments
main function

Triage

Main
function of Resuscitati
Disposition on
emergency
units/dep't

Stabilization

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 Continued

• FMoH with its stakeholders has been working on

equipping health facility with
– necessary medical equipment,

– expanding specialty care

• ICU,

• toxicology center,

• burn care center and

• Trauma care centers,

– distributing ambulances and

– developing guidelines and protocols.

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 Continued

• These efforts have led to significant improvement

in emergency service delivery
• But there is still lack of guideline for quality
emergency service delivery at different levels of
facilities with delineated scope of services.
• Therefore, development of this guideline is found
essential in improving the quality of service.

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 Goal

•Reduce mortality, morbidity and inappropriate referral of

emergency cases by ensuring provision of emergency service in
all facilities based on set agreed level of care.

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 Objective

 To determine level of emergency care & minimum requirements

 To guide health facilities during emergency service organization

 To minimize unnecessary patient referral & transfer between

facilities
 To inform resource mobilization and distribution among

facilities
 To ensure provision of timely emergency service at all level of

the health care

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 Scope

This leveling document will be implemented in all health

centers and all level of hospitals

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 Levels of Emergency Services

• Based on Level of the services they provide

emergency service categorized into 4:-

Levels of Emergency
Services

Intermediate Center of
Basic level Advanced level
level Excellence

HC Primary General Referral

Hospital Hospital Hospital

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 Determinant of Emergency Service
Level

Operational
requirement
Laboratory Human
tests
power

Resource Determinant
requirements of Emergency
Service Level

Emergency
unit
Medical arrangement
Em. equipment
drugs & Supplies

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 Center of excellence

1. Postgraduate and undergraduate emergency training programs.

2. A training center providing different in-service short courses for

national and internal consumption

3. Dedicated emergency care budget and finance utilization

4. A dedicated supportive human resource structure: administrator,

finance, social worker, quality assurance unit and other necessary

staff.

5. Active research should be conducted with a minimum of 2 annual

publications.

6. There should be a minimum of 2 active quality improvement

projects.
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 Monitoring & Evaluation

• Checklist
• Quality project
• Selected indicators

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 Scoring Criteria

Scoring Criteria:

1.If all are completed give ‘1’ if not give ‘0’

2.For Yes/No questions Yes=1, No=0

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 Scoring Criteria
•This assessment tool consists of 5 major components as listed below

1. Emergency unit arrangement and service process (15%)

2. Human Resource (20%)

3. Material resources (15%)

4. Emergency Laboratory (25%)

5. Drugs (25%)

• Total percentage: 100%

Qualification standard

• Grand total value of more than 70%= Qualifies for its level

• Grand total value of less than 70%= Does not qualify

12/09/2024 16
 Continued
Scoring Criteria….
For quantity checks

• Values that meet/exceed the minimum standard mentioned in

bracket= 1

• Values that are below the minimum standard mentioned in

bracket= use proportions in reference to the minimum values set in

bracket.

• N.B for values less than half of the minimum requirement give 0,

and for values between the half values and set minimum

requirement use proportional values in reference to the minimum

requirement. For E.g if the minimum requirement for monitors is

10 and the facility got 7, we will give a value of 0.7.

12/09/2024 17
 Scoring Criteria….

Conversion factors
-For ER service and structure section= 0.44

– Material resource= 0.47

– HR= 1.53

– Lab= 3.57

– Drugs= 0.26

12/09/2024 18
 Next steps
 Orientation on checklist

 Facility assessment (252 facilities national)

 MEICIP Sites

 All Referral Hospital

 All hospital from Gembella, Somali, BGR, Afar

 50% of general & primary hospitals from Amhara, Oromia, SNNPR,

Sidama.

 Deciding level for facility for emergency service

 Emergency service improvement plan

 Guideline distribution in soft copy & hard copy

 Next year continuity

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 ECS-BEC Toolkit Implementation

Aman Safewo (BSc, MPH in Field Epidemiology)

February 26/2021
Adama, Ethiopia

MOH-ECCD, BEC Training 20

 Outline
Outline
• BEC overview
• BEC toolkit Implementation
• HC Emergency Leveling Assessment
checklist
• Reporting checklist
• Follow up framework
• Team composition

MOH-ECCD, BEC Training 21

 Introduction Emergency Care System

• Emergency care is an
Service at the
essential component of scene

universal health coverage

aim at providing:
Emergency
– Timely recognition, ICU
Care Transportation

– Resuscitation, System
– Delivery of definitive care ,
and Service at the
facility
– Referral for severely ill
patients

12/09/2024 ECCD, MOH 22

 overview
• A recent study showed an increase of 6% in overall
mortality due to emergency medical diseases from 1990-
2015
• In 2015 there were 28.3 million deaths due to emergency
medicine diseases contributing to:
– 50.75% of mortality and

– 41.5% of all burden of diseases globally

• Emergency disease burden in LIC is 4.4x that of HIC

• The WHO estimates that 54% all cause deaths that occur in
LMICs each year could be prevented by organized pre
hospital and facility-based emergency care
12/09/2024 ECCD, MOH 23
 overview
• The WHO has defined a series of essential
functions for acute care systems including:-
I. WHO Basic Emergency Care (BEC) short course,
II. A consensus-based integrated triage tool,
III. Trauma and medical care checklists,
IV. Standardized clinical charts and
V. Critical emergency receiving area process guidance,
• The organization of a dedicated resuscitation area for
high-acuity patients

12/09/2024 ECCD, MOH 24

 Basic Emergency Care Course
• Health emergencies happen every day, everywhere

– It includes injuries and infections, heart attacks and strokes,

acute complications of pregnancy and of chronic disease.

• Emergency care providers must respond to ‘undifferentiated’

patients, those with acute symptoms for which the cause may not
be known

• As specialized care may never be available at all times in all places,

a systematic approach to emergency conditions saves lives.
• Thus, BEC has developed by WHO, in collaboration with
– the International Committee of the Red Cross (ICRC) &

– the International Federation for Emergency Medicine (IFEM)

12/09/2024 ECCD, MOH 25

 BEC
• BEC teach a practical and systematic approach to four
acute and potentially life- threatening presentations:
(Trauma, difficulty in breathing, shock, altered mental
status)
• Most life-threatening conditions, whether the original
cause was medical or surgical, infection or injury, will
present with one of these presentation.
• Ethiopia, experiences substantial mortality, morbidity
and cost due to acute medical and traumatic
conditions
12/09/2024 ECCD, MOH 26
Emergency Care System
(ECS) Toolkits

MOH-ECCD, BEC Training 27

 ECS toolkit
• Studies conducted on the ECS toolkit showed a
reduction in mortality in selected acute conditions
• Study conducted in Uganda indicated that more than
50% reduction in emergency mortality after
implementation of ECS toolkit.
• There are two charts and two checklist
– Trauma form

– General form

– Medical checklist

– Trauma check list

MOH-ECCD, BEC Training 28

 General & Trauma form
• Both form have the following component
– Past medical history

– Physical exam

– Diagnostics

– Additional interventions

– Assessment (include summary and differential) and plan

– Reassessment

– Disposition

– Diagnoses/impressions (list all)

– Emergency unit provider name/title (include handovers)

MOH-ECCD, BEC Training 29
 General Forms

• Use for all non trauma emergency patients seen

at emergency
– Neonate

– Pediatric

– Adult

– Pregnant women

MOH-ECCD, BEC Training 30

 Background history

MOH-ECCD, BEC Training 31

 High Risk Signs

MOH-ECCD, BEC Training 32

History of Present Illness and System Review

MOH-ECCD, BEC Training 33

 Past Medical History

MOH-ECCD, BEC Training 34

 Diagnostic

MOH-ECCD, BEC Training 35

 Assessment

MOH-ECCD, BEC Training 36

 Trauma Form
• Use for all trauma emergency patients seen at emergency
– Neonate

– Pediatric

– Adult

– Pregnant women

• Injury kills more people every year than HIV, TB and malaria
combined, and the overwhelming majority of these deaths
occur in low- and middle-income countries.
• Timely emergency care saves lives:
– If fatality rates from severe injury were the same in LMIC countries as in
HIC countries, nearly 2 million lives could be saved every year

MOH-ECCD, BEC Training 37

 Trauma Form

MOH-ECCD, BEC Training 38

 Cont.…

MOH-ECCD, BEC Training 39

 Cont.…

MOH-ECCD, BEC Training 40

 Cont.…

MOH-ECCD, BEC Training 41

 Cont.…

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 Cont.…

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 Medical Checklist
• Used with WHO Emergency general form.
• Is simple tool to use
• Emphasize on life saving intervention

MOH-ECCD, BEC Training 44

 Medical Checklist

MOH-ECCD, BEC Training 45

 Cont.….

MOH-ECCD, BEC Training 46

 Cont.…

MOH-ECCD, BEC Training 47

 Trauma Checklist

MOH-ECCD, BEC Training 48

 Cont.…

MOH-ECCD, BEC Training 49

 Cont.…

MOH-ECCD, BEC Training 50

 Cont.…

MOH-ECCD, BEC Training 51

WHO Emergency Form & Checklist
– Trauma

Form:-https://www.who.int/docs/default-source/documents/emergency-
care/who-standardized-emergency-unit-form-trauma.pdf?
sfvrsn=182aac88_2

– General form:-

https://www.who.int/docs/default-source/documents/emergency-care/who-
standardized-emergency-unit-form-general.pdf?sfvrsn=a41b9931_2 and

– Trauma checklist:-https://www.who.int/publications/i/item/trauma-care-

checklist

– Medical form:-

– Reference:https://m.nearbyme.io/search/?search_term=WHO%20Emergency

%20Reference%20form&brand=gc1

MOH-ECCD, BEC Training 52

 2. BEC Implementing Reporting Checklist

• Use ER leveling checklist tool for assessment

– Look at Health_Center_ER_Leveling_Assessment_Checklist.docx

• Used to send monthly, quarterly and annual

achievement on ECS toolkit implementation by
all stakeholders

MOH-ECCD, BEC Training 53

 Regional Level
Reporting
Region/ City administration DD/MM/YY

S# Indicators Number %

1 Total number of zone/sub city planned to implement Emergency care system toolkit in planned EFY

2 Number of zone/sub city currently implementating Emergency care system toolkit in planned EFY

3 Total number of woreda planned to implement Emergency care system toolkit in planned EFY

4 Number of woreda currently implementating Emergency care system toolkit in planned EFY
Total number of health facilities planned to implement Emergency care system toolkit in planned
5 EFY

6 Number of health facilitities currently implementating Emergency care system toolkit in planned EFY

7 Monthly Emergency toolkit implementing Percentage

7.1 WHO Emergency General form chart

7.2 WHO Emergency Trauma form chart

7.3 WHO Emergency Medical Checklist

7.4 WHO Emergency Trauma Checklist

MOH-ECCD, BEC Training 54

 3.1. Regional Level
Date of reporting
Region/ City adminstration DD/MM/YY
S# Indicators Number %
8 Facility Emergency Service
8.1 Health faclities with dedicated Emergency OPD, assigned health professions
8.2 Health faclities with emergency triage service
8.3 Health faclities currently using triage sheet
8.4 Health facilities with dedicated examination and resustation area/room
8.5 Health facilities with demarcated observation area/room
8.6 Health facilties with dedicated Procuducers area/room
8.7 Health facilities with dedicated Isolation area/room
9 Health facilities using Emergency Registry form
Health Facilities with Crush cart equiped with emergency drugs and supplies per
10 standard
11 Number of trained health profession in Basic Emergency Training
12 Number of health profession trained in BEC and currently working in EOPD

MOH-ECCD, BEC Training 55

 Zonal level

BEC Zone/ Sub City Level Reporting Template

Reporting
Zone/ Sub City DD/MM/YY
Region

S# Indicators Number %

1 Total number of woreda planned to implement Emergency care system toolkit in EFY

2 Number of woreda currently implementing Emergency care system toolkit in EFY

3 Total number of health facilities planned to implement Emergency care system toolkit in EFY

4 Number of health facilities currently implementing Emergency care system toolkit in EFY

5 Monthly Emergency toolkit implementing Percentage

5.1 WHO Emergency General form chart

5.2 WHO Emergency Trauma form chart

5.3 WHO Emergency Medical Checklist

5.4 WHO Emergency Trauma Checklist

MOH-ECCD, BEC Training 56

 Zonal level
BEC Zone/ Sub City Level Reporting Template
Date of
reporting
Zone/ Sub City DD/MM/YY
Region
S# Indicators Number %
6 Facility Emergency Service
6.1 Health facilities with dedicated Emergency OPD, assigned health professions
6.2 Health facilities with emergency triage
6.3 Health facilities currently using triage sheet
6.4 Health facilities with dedicated examination and resustation area/room
6.5 Health facilities with demarcated observation area/room
6.6 Health facilities with dedicated Producers area/room
6.7 Health facilities with dedicated Isolation area/room
7 Health facilities using Emergency Registry form
8 Health Facilities with Crush cart equipped with emergency drugs and supplies
9 Number of trained health profession in Basic Emergency Training
10 Number of health profession trained in BEC and currently working in EOPD

MOH-ECCD, BEC Training 57

 Woreda Level

BEC Woreda Level Reporting Template

Date of
reporting
DD/MM/Y
Woreda Y

Zone/Sub city Region

S# Indicators Number %

1 Total number of facilities planned to implement Emergency care system toolkit in EFY
Number of health facilitates currently implementing Emergency care system toolkit in
2 EFY

3 Monthly Emergency toolkit implementing Percentage

3.1 WHO Emergency General form chart

3.2 WHO Emergency Trauma form chart

3.3 WHO Emergency Medical Checklist

3.4 WHO Emergency Trauma Checklist

MOH-ECCD, BEC Training 58

 Woreda Level
BEC Woreda Level Reporting Template
Reporting
Woreda DD/MM/YY
Zone/Sub city Region
S# Indicators Number %
4 Facility Emergency Service
4.1 Health facilities with dedicated Emergency OPD, assigned health professions
4.2 Health facilities with emergency triage
4.3 Health facilities currently using triage sheet
4.4 Health facilities with dedicated examination and resuscitation area/room
4.5 Health facilities with demarcated observation area/room
4.6 Health facilities with dedicated Producers area/room
4.7 Health facilities with dedicated Isolation area/room
5 Health facilities using Emergency Registry form
6 Health Facilities with Crush cart equipped with emergency drugs and supplies
7 Number of trained health profession in Basic Emergency Training
8 Number of health profession trained in BEC and currently working in EOPD

MOH-ECCD, BEC Training 59

 3.4. Facility Level

BEC Facility Level Reporting Template

Region/ City administration Zone/ Sub city

Facility
Woreda Name
Date of reporting DD/MM/YY
S# Indicators Number %

1 Monthly Emergency toolkit implementing Percentage

1.1 WHO Emergency General form chart

1.2 WHO Emergency Trauma form chart

1.3 WHO Emergency Medical Checklist

1.4 WHO Emergency Trauma Checklist

2 Facility Emergency Service

2.1 Health facilities with dedicated Emergency OPD, assigned health professions

2.2 Health facilities with emergency triage

2.3 Health facilities currently using triage sheet

MOH-ECCD, BEC Training 60

 3.5.Facility Level
BEC Facility Level Reporting Template
Region/ City administration Zone/ Sub city
Facility
Woreda Name
Date of reporting DD/MM/YY
S# Indicators Number %
2.4 Health facilities with dedicated examination and resuscitation area/room
2.5 Health facilities with demarcated observation area/room
2.6 Health facilities with dedicated Producers area/room
2.7 Health facilities with dedicated Isolation area/room
3 Health facilities using Emergency Registry form
4 Health Facilities with Crush cart equipped with emergency drugs and supplies
5 Number of trained health profession in Basic Emergency Training
6 Number of health profession trained in BEC and currently working in EOPD

Note: To calculate the WHO toolkit implementation randomly select ten patient folder from
monthly patiet seen at emergency department and check for the presence of toolkits.

MOH-ECCD, BEC Training 61

 1.Follow up Framework

Coordinator FMOH/EICCD
, Focal

RHBO City Adm

Focal

ZHD (Optional) Sub city

Focal WoHO WoHO (Optional)

Facility Head Facility Head

CRCH CRCH

Emergency
Emergency Head
Head

MOH-ECCD, BEC Training 62

 Thank you!!
I’m SAVE only when you are
Save!!

MOH-ECCD, BEC Training 63