EHS-COVID (509) How to classify health services as 'essential' or 'non-essential'? (3)

27 December, 2021

Dear Tim Baker,

Thank you for sharing your BMJ Global Health paper.

Below are the citation, abstract and key findings/implications, and a comment from me. The expert panel was large and had a wide geographic distribution. The paper concludes: 'The content of EECC — and the essential care of critically ill patients with COVID-19 — has been specified using an inclusive global consensus. The content consists of effective, low-cost and low-complexity lifesaving care that is still frequently overlooked. The time has come to ensure that all patients in the world receive this care'.

CITATION: Essential Emergency and Critical Care: a consensus among global clinical experts

Carl Otto Schell1 et al. The EECC Collaborators

Correspondence to Dr Carl Otto Schell;


Background: Globally, critical illness results in millions of deaths every year. Although many of these deaths are potentially preventable, the basic, life-saving care of critically ill patients are often overlooked in health systems. Essential Emergency and Critical Care (EECC) has been devised as the care that should be provided to all critically ill patients in all hospitals in the world. EECC includes the effective care of low cost and low complexity for the identification and treatment of critically ill patients across all medical specialties. This study aimed to specify the content of EECC and additionally, given the surge of critical illness in the ongoing pandemic, the essential diagnosis-specific care for critically ill patients with COVID-19.

Methods: In a Delphi process, consensus (>90% agreement) was sought from a diverse panel of global clinical experts. The panel iteratively rated proposed treatments and actions based on previous guidelines and the WHO/ICRC’s Basic Emergency Care. The output from the Delphi was adapted iteratively with specialist reviewers into a coherent and feasible package of clinical processes plus a list of hospital readiness requirements.

Results: The 269 experts in the Delphi panel had clinical experience in different acute medical specialties from 59 countries and from all resource settings. The agreed EECC package contains 40 clinical processes and 67 requirements, plus additions specific for COVID-19.

Conclusion: The study has specified the content of care that should be provided to all critically ill patients. Implementing EECC could be an effective strategy for policy makers to reduce preventable deaths worldwide.


What is already known?

Critical illness is common throughout the world and COVID-19 has caused a global surge of critically ill patients.

There are large gaps in the quality of care for critically ill patients, especially in low-staffed and low-resourced settings, and mortality rates are high.

Essential Emergency and Critical Care (EECC) is the effective lifesaving care of low-cost and low-complexity that all critically ill patients should receive in all wards in all hospitals in the world.


The clinical processes that comprise EECC and the essential care of critically ill patients with COVID-19 have been specified in a large consensus among clinical experts worldwide.

The resource requirements for hospitals to be ready to provide this care has been described.


The findings can be used across medical specialties in hospitals worldwide to prioritise and implement essential care for reducing preventable deaths.

Inclusion of the EEEC processes could increase the impact of pandemic preparedness and response programmes and policies for health systems strengthening.

COMMENT (NPW): What do we know about the availability of care across the spectrum of EECC in different countries? How do policymakers in individual countries prioritise EECC, particularly during COVID-19? To what extent can this global consensus paper help them? Is there potential for countries to adopt this package of EECC measures and/or or to adapt it?

Best wishes, Neil

Neil Pakenham-Walsh, HIFA Coordinator,