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The Basic Emergency Care course equips first contact health workers in resource-limited settings with the skills they need to act quickly and confidently when every second counts.
When the 45-year-old man with multiple stab wounds to his chest was first brought into Tumbi Regional Referral Hospital, in Kibaha, eastern Tanzania, he appeared stable. He was conscious and talking, and his airway was clear. The emergency team knew he might not stay that way for long.
Previously, they would have immediately started planning to insert a chest tube to help keep him breathing, a process that takes time. But this time, they first took a moment to perform a systematic assessment of the patient using the ABCDE framework — airway, breathing, circulation, disability, and exposure — something they had recently learned in the Basic Emergency Care (BEC) training course. As they were checking him over, the man’s blood pressure plummeted, and he started gasping for breath. The team stayed focused on their step-by-step exam.
That was how they discovered signs of a tension pneumothorax, a life-threatening condition where air trapped in the chest compresses the lungs and heart. If they had simply gone ahead with the chest tube, they might not have caught it in time, said Dr Sami Kyaruzi, who was on the emergency team that day. They used a needle to relieve the pressure on the man’s lungs, buying precious time to safely insert the chest tube and continue with his care. The man stabilized and later recovered.
He said, “Without the BEC training, the outcome could have been different — not necessarily because we lacked clinical exposure, but because our approach may not have been as structured or deliberate. It helped us remain calm and analytical, rather than reactive.”
Every day, in hospitals and clinics around the world, patients arrive in distress — struggling to breathe, suffering from injuries, or experiencing dangerous complications during childbirth. In many cases, what happens in the first few minutes determines whether they live or die.
But in many health systems, the healthcare workers who see those patients first have not received dedicated emergency care training. In low-resource settings, they have the added challenge of handling medical emergencies without the equipment that hospitals in other countries take for granted, such as cardiac monitors.
Developed by the World Health Organization (WHO), the International Committee of the Red Cross (ICRC), and the International Federation for Emergency Medicine (IFEM), the BEC course is specifically designed for first contact providers working in resource-limited environments. “It builds on the tools that the healthcare worker already has, especially their clinical reasoning, and adds a framework to act quickly and confidently within the parameters of their available resources,” said Dr Joseph Bonney, President of the African Federation for Emergency Medicine, which implements the training in several African countries and certifies trainers.
If health workers can catch serious complications before a patient’s condition deteriorates to the point where they need resuscitation, that reduces the need for expensive equipment and specialized resources.
Bonney said the course is the first time many health workers encounter any kind of structured emergency care training, even doctors who have been practicing for years. “You can see them reflecting on all those patients they might not have followed a procedure for,” he said. “You can clearly see it on their faces.”
Hybrid training lowers cost
Since it launched in 2018, BEC has been implemented in one form or another in more than 100 countries. The course focuses on the most common conditions that can quickly become fatal if not treated promptly, including breathing difficulties, shock, injuries, and complications of pregnancy and childbirth. The goal, said Dr Joseph Kalanzi, an emergency physician based in Kampala, Uganda, is to bridge the knowledge and skills gap among health workers in many health systems in lower-and-middle-income countries, where emergency care training hasn’t always been seen as a priority.
“Providers might receive training in surgery, obstetrics and gynecology, or pediatrics, but nothing that covers managing emergency patients across all age groups and conditions,” he said.
The BEC’s five core modules can be delivered either as a five-day in-person course or through a hybrid model that combines online learning with two days of hands-on skills training, helping to keep the cost down and making it easier for health workers to fit it into their schedules.
These factors are crucial in a world going through what Dr Teri Reynolds, lead for WHO’s integrated health services and models of care team says is a “crisis of financing for health that we have never seen before.” WHO’s focus now is on making BEC as accessible as possible to bring the life-saving training to health workers wherever it’s needed. “The countries where BEC has been implemented are islands of success that have not been brought to scale,” Reynolds said. She added,“We are in a perfect position now to fill in the gaps between those islands.”
Confidence saves lives
Initial training is run through international and regional emergency care societies such as IFEM, as well as universities, nongovernmental organizations (NGOs) and government programs. Then, after taking the course, some participants will be asked to become trainers themselves, passing on what they learned to their colleagues. This way, training teams are empowered to adapt the course to meet the specific strengths and challenges of their local facilities.
“You end up with a program that is both globally meticulous and also relevant to the needs of the community that it would be serving,” said Dr Simon Tumusiime, an Educational Technical Consultant at AFEM.
A group of researchers analyzing the course in Nigeria tested the emergency care knowledge and confidence levels of 32 participants before and after taking the course. They found the average pre-course score was 73%, which “significantly increased” to 86.5% after the training. Similar studies in Malawi, Ukraine, and Zambia also showed knowledge and confidence scores rising among those who took the course.
“Many participants admit to us that, before the training, when a bleeding patient was brought into their hospital, they would sometimes make up an excuse to leave the room because they felt powerless and had no clue what to do,” Tumusiime said. “After BEC, they send us messages saying, ‘I feel so confident now.’”
This confidence can save lives. Several studies show that offering BEC training can lead to lower mortality rates. In one example, preliminary data analysis in Tanzania and Uganda showed that the number of patients who died within 48 hours of being admitted to hospital dropped by 45% in facilities where training had taken place.
Catalyst for deeper learning
For Joseph Kalanzi, who took the course before becoming a trainer, equally significant is how often he’s seen BEC training inspire health workers to become champions of deeper skills development and better resources for themselves and their colleagues in the hospitals and clinics they work in.
“After the course, they come back to us and say, ‘What more can I do? What else do we need?’ The course can be a big catalyst,” he said.
AFEM is currently working on ways to keep that momentum going. The organization is collaborating with WHO, IFEM and others to develop a program of short, regular and repeated interventions to keep emergency care knowledge fresh beyond the one-time BEC course.
The aim is to create a continuous cycle of learning and skills development so that emergency care becomes embedded into health systems everywhere, at all levels, from nurses to specialists.
“It would introduce a kind of team culture and cohesiveness that you need in effective emergency care delivery,” said Dr Lauren Lai King, AFEM’s CEO. “One that recognizes that every health provider has a role in the outcome of the patient and the system as a whole. And that’s invaluable.”
The WHO Foundation is mobilizing funding to deliver Basic Emergency Care Training to an estimated 1000 hospitals and health facilities in five African countries. Find out more.
