Integrated Management toolkit for Emergency and

Essential Surgical Care (IMEESC)

The WHO Integrated Management for Emergency & Essential Surgical Care
e-learning toolkit provides a comprehensive package of WHO recommendations
on a single compact disc. This toolkit targets policy-makers, program managers

IMEESC toolkit
and health care providers (non-specialist doctors, nurses and paramedics)
Teaching & Reference Guidelines: Surgery, Emergency, Obstetrics,
Essential surgical care
Anesthesia, Trauma & Orthopedics at District Hospital
:: Surgical Care at the District Hospital manual
makes a difference
:: Surgical Care at the District Hospital (SCDH) teaching slides
:: Evaluation of Self Learning
Training Workshops Causes of maternal
:: Trainer’s Guide death worldwide
Each year 1.2 million people are losing their lives because of road traffic
:: Model Agenda
accidents and more than 500 000 women are dying from pregnancy-related
:: Participants Evaluation
complications. Young people between the ages of 15 and 44 years account for
:: Sample Report of Training Workshop
20% 24% almost 50% of global injury-related mortality. In addition to primary prevention
of these tragedies, the ability to apply the correct emergency, surgical and
Best Practice Protocols
anaesthesia procedures is vital.
:: Best Practice Protocols for Clinical Procedures Safety 8%
:: Hand Washing Techniques 15%
:: Waste Disposal for Clinical Procedures
8%
Conditions treatable by surgery account for
:: Disaster Management Guidelines 12%
11% of the global burden of disease.
QUALITY & SAFETY :: Burn Management
13%

:: Post-operative Pain Management

:: HIV Prevention Protocols n Severe bleeding 24%
Equipment Lists & Needs Assessment n Infection 15%
:: Essential Emergency Equipment Generic List n Unsafe abortion 13%
:: Anaesthetic Infrastructure/Supplies n Eclampsia 12%
:: Needs Assessment for Essential Emergency Room Equipment n Obstructed labor 8%
n Other direct causes 8%
Policy Management
n Indirect causes 20%
:: Aide-Memoire: Surgical & Emergency Obstetrical Care
:: Training Curriculum on Emergency & Essential Surgical Skills
:: Organization & Management
Causes of injury worldwide
Quality & Safety
:: Safe Surgery & Safe Anaesthesia Protocols
:: Obstetric Safety Protocols 16% 10%
6%
:: Monitoring & Evaluation
Primary Hospital
9%
Research Tool 17% Two simple yet neglected measures can drastically reduce death and disability
:: WHO Situation Analysis to Assess Emergency & Essential Surgical Care 5% from fundamental surgical conditions:
6% • Increase trained human resources
Videos • Increase access to essential surgical equipment
:: Surgery at the District Hospital Training Videos (7 films, 30 minutes each) 6% 25%

EMERGENCY

10-20% of deaths of young adults in developing countries are n Interpersonal violence 10%
Emergency and Essential Surgical Care directly attributable to inadequate surgical knowledge. n War 6%
TRAUMA OBSTETRICS
Clinical Procedures unit SURGERY
n Other 17%
Simple surgery makes a difference.
Department of Essential Health Technologies and
World Health Organization n Road traffic injury 25% ANAESTHESIA
Geneva 27, Switzerland n Poisoning 6%
Fax: +41 22 791 4836 n Falls 6% CONGENITAL INFECTION
www.who.int/surgery
n Fires 5%
4 1
WHO/EHT/CPR/2009 n Drowning 9%
Department of Essential Health Technologies – Emergency and Essential Surgical Care n Self-inflicted violence 16% Department of Essential Health Technologies – Emergency and Essential Surgical Care
Department of Essential Health Technologies - Emergency and Essential Surgical Care
 Emergency and Essential Surgical Care (EESC) Global Initiative for Emergency and Essential
Surgical Care (GIEESC)
The WHO Emergency and Essential Surgical Care (EESC) program is
aimed at strengthening emergency, surgery and anaesthesia services for WHO GIEESC was established in December 2005 with the objective to
injuries, disasters, pregnancy-related complications and other surgical improve collaboration among Ministries of Health, WHO country offices,
conditions at first referral level health facilities through education, skills local and international organizations and academia. GIEESC is involved
building and research. in reducing death and disability from road traffic accidents, trauma, burns,
falls, pregnancy related complications, domestic violence, disasters and
AWARENESS EESC is an integral part of Primary Health Care (PHC), providing technical POLICY other surgical conditions. The specific objectives are
support to countries in scaling up frontline health providers in life-saving
and disability-preventive surgical care which requires no expensive Emergency and
essential surgical care • strengthen capacity to deliver effective emergency surgical care at
technology or sophisticated facilities. AIDE-MEMOIRE the first referral level facility, working towards achieving the WHO
�
Millennium Development Goals
Surgical and Emergency Obstetrical Care
at First Referral Level Checklist
Well-organized surgical, obstetric, trauma care and anaesthetic services
are essential for a district hospital to be an effective community Personnel

• improve the quality of care through safe and appropriate use of

� Clinical personnel with appropriate
resource. These services should be developed within the framework of
education and training in:
the country and district’s health care infrastructure. • Anaesthesia and resuscitation
• Obstetrics and gynaecology
Without such services, up to 10% of the population will die from injury
• General surgery

2,000,000,000 people have no access

and 5% of pregnancies will result in maternal death. Unacceptable • Traumatology

emergency and essential surgical procedures and linked equipment

• Orthopaedics
rates
� Clinical support staff
of death from non-traumatic surgical disorders, infections and disability
from injury will also result. Education programmes
� Evaluation of training needs

to emergency or surgical care.

Death and disability from trauma, pregnancy-related complications and

in resource limited healthcare facilities

� Coordinated plan for education and
disasters can be substantially reduced through the following integrated training
� Training in skills needed for surgical
strategy to maximize the effectiveness of district hospitals.
care at district hospital level in both:
1. Personnel with appropriate education and training. • Basic training
• Continuing education

• strengthen existing training and education programs in safety of

2. Practical continuing education programmes in clinical � Educational resources in hospitals
management to maintain the quality of care. � Monitoring and evaluation

3. Appropriate physical facilities. Facilities

� Casualty area, operating room, labour
4. Equipment and instruments to meet the needs of district

essential procedures in low and middle income countries

and delivery room, high dependency
surgical services.
area
5. A reliable system for the supply of drugs and medications,
� Continuous oxygen supply
surgical materials and other consumables. � Blood bank and laboratory
� Diagnostic imaging
� Sterilization

In East Africa, only 40 orthopaedic

6. A quality assurance system.
� Water, electricity, safe waste disposal
and communications

Words of advice Equipment and instruments

� Surgical instruments for:

surgeons serve a population of over

1. Develop a national plan for district level surgical services, • Minor surgery
with the consensus and collaboration of all relevant • Major surgery
stakeholders. • Obstetrics and gynaecology
• Orthopaedic surgery
2. Obtain support from educational institutions and � Anaesthetic equipment
professional bodies. � Resuscitation equipment

200 million. In Uganda, only 13

� Basic monitoring equipment
3. Ensure continuing education to enable practitioners to
provide an effective surgical, obstetrics, trauma care and Supplies system
anaesthetic service. � Drugs, medications, blood and
intravenous fluids

physician anaesthesiologists serve

4. Provide guidance for referral to specialized health facilities.
� Surgical materials
5. Maintain, repair and upgrade district hospitals to required
� Other consumables
levels and equip facilities adequately.
Quality system
6. Assure adequate and reliable supplies of drugs, surgical � Management

27 million. Due to these extreme

materials and other consumables. � Communication
� Supervision
7. Ensure quality and provision of care. � Evaluation
© WHO 2006

circumstances, EESC is often provided

by non-specialist doctors, nurses
and paramedics in rural and remote
health facilities. Scaling up the health
work force in life-saving and disability
preventing EESC is urgent for PHC.

EDUCATION Airway Management during

an EESC training workshop
in Tanzania ONLINE RESOURCES
for CAPACITY Third Bi-Annual GIEESC Meeting, Ulaanbaatar, Mongolia, 5-6 June, 2009

BUILDING
Providing clinical recommendations to safely EESC in Primary Health Care
manage these and other conditions:
• UNIVERSAL ACCESS
Pregnancy-related complications Increasing the number of appropriately trained providers leads to
• obstructed labour improved access for underserved populations
• unsafe abortions
• SERVICE DELIVERY
Injuries Support capacity building in EESC skills and equipment leading
• road traffic to a greater range of services available in PHC
• violence
• burns • LEADERSHIP
• falls Support worldwide collaboration and partnerships through WHO
“SCDH is an indispensable • disasters GIEESC
manual for outlying health
centres.”
International Federation of Surgical
Other surgical conditions • POLICY
Colleges • male circumcision Providing guidance on comprehensive and integrated EESC for
• congenital clubfoot strengthening health systems
Complete text available online: http://
www.who.int/surgery/publications/en/
• hernias
SCDH.pdf • hydrocoele
• female genital mutilation Patient Assessment during an EESC training workshop
in Mozambique
• infection
2 3

Department of Essential Health Technologies – Emergency and Essential Surgical Care Department of Essential Health Technologies – Emergency and Essential Surgical Care