The COVID-19 pandemic continues to have profound impacts on global health systems, including Emergency Care (EC) systems. The Pacific Island Countries and Territories (PICTs), comprising of low- and middle-income countries (LMICs), have similarly been affected. Despite considerable diversity within and between PICTs, there is an established framework for regionalism to support collaboration, cooperation and coordination.1Pacific Islands Forum LeadersThe Framework for Pacific Regionalism. Pacific Islands Forum Secretariat, Suva, Fiji2014https://www.forumsec.org/wp-content/uploads/2017/09/Framework-for-Pacific-Regionalism.pdfGoogle Scholar One such avenue for collaboration is through the Pacific Community (SPC), the principal regional scientific and development organisation. In earlier research, undertaken in partnership with SPC, EC stakeholders identified that constrained resources and competing priorities across the Pacific region contributed to a low baseline capacity in EC systems, with limited resilience within the system to support disaster and surge response.2Phillips G Creaton A Airdhill-Enosa P et al.Emergency care status, priorities and standards for the Pacific region: a multiphase survey and consensus process across 17 different Pacific Island countries and territories.Lancet Reg Health – West Pac. 2020; 1100002Google Scholar Despite these pre-existing challenges, EC clinicians across PICTs have played major roles supporting the pandemic response. Following the early success of many PICTs in maintaining zero or minimal COVID-19 transmission, all PICTs have since experienced COVID-19 cases, though the extent to which they have been affected is variable.3Pacific CommunityCOVID-19: Pacific Community Updates Noumea. Pacific Community, New Caledonia2022https://www.spc.int/updates/blog/2022/05/covid-19-pacific-community-updates#CurrentStatusGoogle Scholar EC clinicians have led these frontline efforts, continuing to provide care for patients with routine emergencies as well as COVID-19, while also managing the increased workload associated with the pandemic.4Bornstein SL Elton LG Kennedy F et al.Rising to the challenge: the emergency nursing response to COVID-19 in the Pacific.Australas Emerg Care. 2021; 24: 1-3Google Scholar They have also contributed to their local departmental, hospital and sometimes jurisdictional pandemic planning, preparation and response activities.4Bornstein SL Elton LG Kennedy F et al.Rising to the challenge: the emergency nursing response to COVID-19 in the Pacific.Australas Emerg Care. 2021; 24: 1-3Google Scholar,5Woodruff IG Mitchell RD Phillips G et al.COVID-19 and the Indo–Pacific: implications for resource-limited emergency departments.Med J Aust. 2020; 213: 345-349Google Scholar In The Lancet Regional Health – Western Pacific, Dr Cox and colleagues present across a series of papers their qualitative research exploring the experiences of EC clinicians in PICTs during the early period of the COVID-19 pandemic.6Cox M, Phillips G, Mitchell R, et al. Lessons from the frontline: documenting the experiences of Pacific emergency care clinicians responding to the COVID-19 pandemic. Lancet Reg Health – West Pac. https://doi.org/10.1016/j.lanwpc.2022.100514Google Scholar, 7Brolan C, Korver S, Phillips G, et al. Lessons from the frontline: the COVID-19 pandemic emergency care experience from a human resource perspective in the Pacific region. Lancet Reg Health – West Pac. https://doi.org/10.1016/j.lanwpc.2022.100514Google Scholar, 8Cox M, Sharma D, Phillips G, et al. Lessons from the frontline: documenting the pandemic emergency care experience from the Pacific region – infrastructure and equipment. Lancet Reg Health – West Pac. https://doi.org/10.1016/j.lanwpc.2022.100516Google Scholar, 9Mitchell R, O'Reilly G, Herron L, et al. Lessons from the frontline: the value of emergency care processes and data to pandemic responses across the Pacific region. Lancet Reg Health – West Pac. https://doi.org/10.1016/j.lanwpc.2022.100515Google Scholar, 10Phillips G, Kendino M, Brolan C, et al. Lessons from the frontline: leadership and governance experiences in the COVID-19 pandemic response across the Pacific region. Lancet Reg Health – West Pac. https://doi.org/10.1016/j.lanwpc.2022.100518Google Scholar, 11Herron L, Phillips G, Brolan C, et al. “When all else fails you have to come to the emergency department”: overarching lessons about emergency care resilience from frontline clinicians in Pacific Island countries and territories during the COVID-19 pandemic. Lancet Reg Health – West Pac. https://doi.org/10.1016/j.lanwpc.2022.100519Google Scholar This work collectively adds considerable new knowledge to deepen our understanding of the challenges faced by PICT EC clinicians and systems during the pandemic, with valuable implications for guiding future development of EC systems through application of the interlocking adapted WHO health system building block framework.6Cox M, Phillips G, Mitchell R, et al. Lessons from the frontline: documenting the experiences of Pacific emergency care clinicians responding to the COVID-19 pandemic. Lancet Reg Health – West Pac. https://doi.org/10.1016/j.lanwpc.2022.100514Google Scholar These findings are relevant beyond the PICT and, indeed, LMICs contexts, as many of the challenges faced by the EC workforce are shared globally. In particular, the human resources issues identified by Brolan et al.7Brolan C, Korver S, Phillips G, et al. Lessons from the frontline: the COVID-19 pandemic emergency care experience from a human resource perspective in the Pacific region. Lancet Reg Health – West Pac. https://doi.org/10.1016/j.lanwpc.2022.100514Google Scholar resonate with findings of pandemic exacerbated workforce anxiety, shortage, burnout, and retention issues that remain inadequately resolved globally.12Nguyen J Liu A McKenney M Liu H Ang D Elkbuli A. Impacts and challenges of the COVID-19 pandemic on emergency medicine physicians in the United States.Am J Emerg Med. 2021; 48: 38-47Google Scholar,13Li C Sotomayor-Castillo C Nahidi S et al.Emergency clinicians’ knowledge, preparedness and experiences of managing COVID-19 during the 2020 global pandemic in Australian healthcare settings.Australas Emerg Care. 2021; 24: 186-196Google Scholar Notably, there is perhaps as much to benefit from sharing their methodology as the findings themselves. This research was undertaken in partnership between the SPC and the Australasian College of Emergency Medicine (ACEM), a relatively enduring relationship that has supported a growing body of research.2Phillips G Creaton A Airdhill-Enosa P et al.Emergency care status, priorities and standards for the Pacific region: a multiphase survey and consensus process across 17 different Pacific Island countries and territories.Lancet Reg Health – West Pac. 2020; 1100002Google Scholar Cox et al.’s6Cox M, Phillips G, Mitchell R, et al. Lessons from the frontline: documenting the experiences of Pacific emergency care clinicians responding to the COVID-19 pandemic. Lancet Reg Health – West Pac. https://doi.org/10.1016/j.lanwpc.2022.100514Google Scholar approach encompasses qualitative methods that are underpinned by strengths-based principles and which centre PICT participant researchers in all aspects of the research process. Through incorporation of Participant-Action Research, PICT participant-researchers also served as leaders, working with their regional collaborators towards a “Pacific teaching Pacific” capacity building model.6Cox M, Phillips G, Mitchell R, et al. Lessons from the frontline: documenting the experiences of Pacific emergency care clinicians responding to the COVID-19 pandemic. Lancet Reg Health – West Pac. https://doi.org/10.1016/j.lanwpc.2022.100514Google Scholar The use of phenomenological approaches similarly aligns with efforts to decolonise global health research by enabling participants to directly articulate their experiences and perspectives.14Lawrence DS Hirsch LA. Decolonising global health: transnational research partnerships under the spotlight.Int Health. 2020; 12: 518-523Google Scholar As such, this research elevates the voices of PICT EC clinicians and celebrates their resilience, as well as the cultural strengths of PICTs.11Herron L, Phillips G, Brolan C, et al. “When all else fails you have to come to the emergency department”: overarching lessons about emergency care resilience from frontline clinicians in Pacific Island countries and territories during the COVID-19 pandemic. Lancet Reg Health – West Pac. https://doi.org/10.1016/j.lanwpc.2022.100519Google Scholar This serves as a model for supporting regional collaboration and unity that will be vital to ongoing efforts to improve global health security. PICTs are facing a looming triple burden of disease, with continuing challenges of high rates of communicable and non-communicable diseases, and both further exacerbated by the direct and indirect health impacts of climate change.15Karn M Sharma M. Climate change, natural calamities and the triple burden of disease.Nat Clim Change. 2021; 11: 796-797Google Scholar In this climate crisis century, as we anticipate increasing frequency and intensity of climate change related natural disasters, there is an urgent need to enhance the resilience of EC systems globally. There are major co-benefits in that activities that strengthen EC systems and disaster response preparedness will also improve capacity to provide timely care for the acutely ill and injured, towards realising the health-related Sustainable Development Goals.2Phillips G Creaton A Airdhill-Enosa P et al.Emergency care status, priorities and standards for the Pacific region: a multiphase survey and consensus process across 17 different Pacific Island countries and territories.Lancet Reg Health – West Pac. 2020; 1100002Google Scholar,16Shanahan T Risko N Razzak J Bhutta Z. Aligning emergency care with global health priorities.Int J Emerg Med. 2018; 11: 52Google Scholar Similarly, given the increased risk climate change poses by entrenching and exacerbating gender inequity17International Labour Organization. Just Transition: an Essential Pathway to Achieving Gender Equality and Social Justice. Geneva, Switzerland: International Labour Organization; 2022. Available from:https://www4.unfccc.int/sites/SubmissionsStaging/Documents/202204141910---ILO%20submission%20-%20Just%20transition%20-%20An%20essential%20pathway%20to%20achieving%20gender%20equality%20and%20social%20justice.pdf.Google Scholar and the gendered impacts of the pandemic, the feminist-informed analysis enabled emergence of findings that begin to illuminate the gendered experiences of PICT EC clinicians.7Brolan C, Korver S, Phillips G, et al. Lessons from the frontline: the COVID-19 pandemic emergency care experience from a human resource perspective in the Pacific region. Lancet Reg Health – West Pac. https://doi.org/10.1016/j.lanwpc.2022.100514Google Scholar,10Phillips G, Kendino M, Brolan C, et al. Lessons from the frontline: leadership and governance experiences in the COVID-19 pandemic response across the Pacific region. Lancet Reg Health – West Pac. https://doi.org/10.1016/j.lanwpc.2022.100518Google Scholar Further dedicated research may support deeper understanding of the gendered clinician experience in this context and inform tailored strategies for advancing gender diversity in health system leadership. Beyond the pragmatic and policy implications of this research to guide further development of EC systems and future pandemic and disaster preparedness in PICTs and beyond, a major contribution from Cox et al. is the demonstration of an effective model to facilitate longer-term collaboration between international researchers towards capacity building and co-learning outcomes. This series demonstrates unequivocally the expertise of EC clinicians in PICTs and celebrates their experience-informed perspectives as advocates; in speaking “truth to power” they represent the needs of their patients, their colleagues, and their communities.10Phillips G, Kendino M, Brolan C, et al. Lessons from the frontline: leadership and governance experiences in the COVID-19 pandemic response across the Pacific region. Lancet Reg Health – West Pac. https://doi.org/10.1016/j.lanwpc.2022.100518Google Scholar The lessons learnt from these papers serve as a call to action with recommendations and tools that are relevant for policy makers and clinicians to strengthen EC systems globally. LSG is an ACEM trainee and the recipient of an ACEM SUPRA Scholarship to support her PhD research. Lessons from the frontline: Leadership and governance experiences in the COVID-19 pandemic response across the Pacific regionEffective governance occurs when political, administrative and clinical actors work collaboratively in relationships characterised by trust, transparency, altruism and evidence. Trained, supported EC leadership will enhance frontline service provision, health security preparedness and future Universal Health Coverage goals. Full-Text PDF Open AccessLessons from the frontline: The COVID-19 pandemic emergency care experience from a human resource perspective in the Pacific regionThis study significantly contributes to the limited scientific literature on HCW experiences responding to COVID-19 across the Pacific. Recommendations arising out of this research align with consensus priorities and standards that were identified pre-pandemic by health stakeholders across the Pacific for enhancing EC system development. With limited HCWs available for many Pacific nations, it is imperative the dignity and welfare of local HCWs is genuinely prioritised. Full-Text PDF Open AccessLessons from the frontline: Documenting the experiences of Pacific emergency care clinicians responding to the COVID-19 pandemicLow- and middle-income countries (LMICs) across the Pacific region have been severely impacted by the COVID-19 pandemic, and emergency care (EC) clinicians have been on the frontline of response efforts. Their responsibilities have extended from triage and clinical management of patients with COVID-19 to health system leadership and coordination. This has exposed EC clinicians to a range of ethical and operational challenges. This paper describes the context and methodology of a rapid, collaborative, qualitative research project that explored the experiences of EC clinicians in Pacific LMICs during the COVID-19 pandemic. Full-Text PDF Open AccessLessons from the frontline: The value of emergency care processes and data to pandemic responses across the Pacific regionDeveloping effective processes for triage, screening and streaming, among other areas, was critical to an effective EC response. Beyond the pandemic, strengthening processes and data management capacity will build resilience in EC systems. Full-Text PDF Open Access“When all else fails you have to come to the emergency department”: Overarching lessons about emergency care resilience from frontline clinicians in Pacific Island countries and territories during the COVID-19 pandemicThe COVID-19 pandemic continues to test health systems resilience worldwide. Low- and middle-income country (LMIC) health care systems have considerable experience in disasters and disease outbreaks. Lessons from the preparedness and responses to COVID-19 in LMICs may be valuable to other countries. This policy paper synthesises findings from a multiphase qualitative research project, conducted during the pandemic to document experiences of Pacific Island Country and Territory (PICT) frontline clinicians and emergency care (EC) stakeholders. Full-Text PDF Open AccessLessons from the frontline: Documenting the pandemic emergency care experience from the Pacific region – Infrastructure and equipmentInvesting in adequate infrastructure and appropriate equipment is crucial for an effective response to the COVID-19 pandemic. The sustainability of such investments in the Pacific context is paramount for ongoing EC and preparation for future surge responses and disasters. Full-Text PDF Open AccessRealising potential: Strong leadership and resilience of Pacific emergency care cliniciansThe Pacific Island Countries and Territories (PICTs) are home to more than 12 million people, dispersed across 22 countries in the world's largest ocean. Although great strides in the pursuit of health have been made in the PICTs, the region remains vulnerable to the health impacts of climate change, natural disasters, and disease outbreaks. As such, strengthening emergency preparedness and response is a regional health priority. An effective emergency care system is central to preparing for and responding to health emergencies. Full-Text PDF Open Access
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