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Dear Editor,
The coronavirus disease 2019 (COVID-19) pandemic and other health emergencies have highlighted inadequate and inequitable access to critical care services. Many countries have strengthened critical care services through significant investment in repurposing and rehabilitating existing infrastructure and constructing new facilities. Underprovision of medical oxygen and increased demands for it from critical care services have driven investment in oxygen scale-up. Importantly, the pandemic laid bare the profound shortage of healthcare providers with training in critical care. From 2022, the European Society of Intensive Care Medicine (ESICM) and the World Health Organization (WHO) developed and delivered worldwide “C19_SPACE”, a COVID-19 skills preparation course initially funded by the European Union [1, 2].
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C19_SPACE aimed to strengthen clinical knowledge of evidence-based essential intensive care principles, encompassing hemodynamic support, respiratory support, sedation in the intensive care unit (ICU), and managing sepsis. The target audience were nursing and medical clinical staff who were newly engaged in critical care or who did not have contemporary or regular experience of ICU. WHO regional offices identified countries with urgent training needs and engaged the respective ministries of health to identify health workers who would be deployed during health emergencies or surges to manage critically ill patients. These participants were enrolled in the online self-paced learning programme. Face-to-face local training events were then delivered, each adapted to the local context, needs and resources. Programme effectiveness was assessed through an evaluation test and satisfaction questionnaire. The methodology of the programme is available in electronic supplementary material (ESM 1).
A total of 2863 trainees from 61 countries across all six WHO regions were enrolled in the programme. The trainees achieved a median knowledge score of 92 (60–98) out of 100. Eight face-to-face local events took place across three WHO regions, supported by 34 trainers, to deliver the skills course to 235 people (Fig. 1). Trainees expressed a high level of satisfaction with both the online and face-to-face training. The results of the satisfaction questionnaire are available in ESM 2.
Fig. 1
Number of participants enrolled in the training programme, both online and face to face across three World Health Organization regions
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C19_SPACE has demonstrated a successful collaborative approach for increasing critical care workforce capacity. It enables trainers to facilitate skills and knowledge acquisition in their regions, and healthcare providers to deliver basic critical care services in their local environment. Key examples of upgraded critical care capacity have been seen in Tanzania, establishing an additional 60 critical care units, and Lesotho opening 4 new ICU facilities. C19_SPACE rapidly trained more than 70 clinicians to underpin this expansion in the above-mentioned countries.
New and diverse health emergencies arise all the time, including those from natural disasters, conflict and disease outbreaks. A core need in all of these is basic and scalable critical care. C19_SPACE is now being further developed to address these wider needs. The expanded training programme will support country readiness strengthening. It will give healthcare workers and clinical managers the knowledge they need to face future health emergencies, through responsive provision of new critical care services which meet the needs of local populations.
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Acknowledgements
World Health Organization (WHO): Jamie Rylance, Vanessa Cramond, Jacob Goldberg, Rashidatu Fouad Kamara, Gary Greg Kuniyoshi, Mohamed Salem, Ludovic Reveiz, Takeshi Nishijima, Chiori Kodama, Mathias Bonk, Dina Pfeifer, Pushpa Ranjan Wijesinghe, Janeth Masuma, Francis Mupeta, Peter J. Chipimo, Joel Anani, Edwin Bolastig, Babacar Dieye and Sasha Peiris. European Society of Intensive Care Medicine (ESICM): ESICM Executive Committee 2022–2023: Elie Azoulay, President; Jan De Waele, President elect; Maurizio Cecconi Past President; Lennie Derde, Chair of Education and Training Committee; Ignacio Martin-Loeches, Chair Research Committee, Katia Donadello, Chair Social Media and Digital Content Committee; Katerina Iliopoulou, Chair N&AHP Committee; Laura Galarza Chair NEXT Committee, Giuseppe Citerio, Editor-in-Chief Intensive Care Medicine (ICM), Nicole Juffermans, Editor-in-Chief Intensive Care Medicine Experimental (ICMx); Joël Alexandre, Chief Executive Officer. ESICM Office: Melania Istrate, Head of Education and Learning Development; Anita Barth, Education Coordinator. C19_SPACE Task Force 2020–2021: Maurizio Cecconi, President, ESICM; Jozef Keseciouglu, Past President, ESICM; Frantisek Duska, Chair of Division of Professional Development, ESICM; Armand R. J. Girbes, Chair of Division of Scientific Affairs, ESICM; Johannes Mellinghoff, NAHP Chair, ESICM and Carole Boulanger, NAHP Past Chair; Stefan J. Schaller, NEXT Chair, ESICM. ESICM Executive Committee 2020–2021: Maurizio Cecconi, President; Jozef Kesecioglu, Past President; Elie Azoulay, President Elect; Lui Forni, Former Secretary; Jean-Louis Teboul, Former Treasurer, Congress Committee Chair; Armand R.J. Girbes, Former Congress Committee Chair; Frantisek Duska, Education Committee Chair; Adrian Wong, Social Media and Digital Content Committee Chair; Jan De Waele, Former Research Committee Chair; Johannes Mellinghoff, NAHP Committee Chair; Giuseppe Citerio, ICM Editor In Chief; Nicole Juffermans, ICMx Editor in Chief; Stefan J. Schaller, NEXT Committee Chair; Joel Alexandre, CEO. C19_SPACE experts are provided in the Appendix. European Commission, DG SANTE, in particular, Isabel de la Mata.
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