Abstract
BackgroundTreating critical illness in resource-limited settings during disease outbreaks is feasible and can save lives. Lack of trained healthcare workers is a major barrier to COVID-19 response. There is an urgent need to train healthcare workers to manage COVID-19. The World Health Organization and International Committee of the Red Cross’s Basic Emergency Care course could provide a framework to cross-train personnel for COVID-19 care while strengthening essential health services.MethodsWe conducted a prospective cohort study evaluating the Basic Emergency Care course for healthcare workers from emergency and inpatient units at two hospitals in Sierra Leone, a low-income country in West Africa. Baseline, post-course, and six month assessments of knowledge and confidence were completed. Questions on COVID-19 were added at six months. We compared change from baseline in knowledge scores and proportions of participants “very comfortable” with course skills using paired Student’s t-tests and McNemar’s exact tests, respectively.ResultsWe enrolled 32 participants of whom 31 completed pre- and post-course assessments. Six month knowledge and confidence assessments were completed by 15 and 20 participants, respectively. Mean knowledge score post-course was 85% (95% CI: 82% to 88%), which was increased from baseline (53%, 48% to 57%, p-value < 0.001). There was sustained improvement from baseline at six months (73%, 67% to 80%, p-value 0.001). The percentage of participants who were “very comfortable” performing skills increased from baseline for 27 of 34 skills post-training and 13 skills at six months. Half of respondents strongly agreed the course improved ability to manage COVID-19.ConclusionsThis study demonstrates the feasibility of the Basic Emergency Care course to train emergency and inpatient healthcare workers with lasting impact. The timing of the study, at the beginning of the COVID-19 pandemic, provided an opportunity to illustrate the strategic overlap between building human resource capacity for long-term health systems strengthening and COVID-19. Future efforts should focus on integration with national training curricula and training of the trainers for broader dissemination and implementation at scale.
Highlights
The West African Ebola virus disease epidemic of 2014– 2016 highlighted the vulnerability of the region’s chronically understaffed and underresourced health systems [1, 2]
Recognizing that the COVID-19 pandemic had created an increased demand for emergency and critical care services between initial study design and the pre-planned six month assessment, we developed a questionnaire with ten items related to COVID-19 and amended the study protocol to administer the COVID-19 questionnaire, in addition to the preplanned knowledge and confidence assessments, at six months
Participant characteristics We enrolled all 32 eligible participants, 14 (44%) in Kono training and 18 (56%) in Freetown, all of whom attended the first day of the course and completed baseline assessments
Summary
The West African Ebola virus disease epidemic of 2014– 2016 highlighted the vulnerability of the region’s chronically understaffed and underresourced health systems [1, 2]. Global shortages of human resources for health present an ongoing challenge as hospitals around the world struggle to maintain essential services while providing care for patients with severe and critical COVID-19. Data from the Ebola virus disease epidemic demonstrated that providing critical care in resource-limited settings during disease outbreaks is feasible and can save lives [3]. The scarcity of skilled healthcare workers in many low-income countries (LICs), where emergency and critical care training is limited, poses a significant challenge for COVID-19 response, and is likely one of several factors contributing to outcome disparities. The World Health Organization and International Committee of the Red Cross’s Basic Emergency Care course could provide a framework to cross-train personnel for COVID-19 care while strengthening essential health services
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