Basic Emergency Care (BEC) Course: Dealing with the Injured and Acutely Ill
Overview
The World Health Organization (WHO), in collaboration with the International Committee of the Red Cross (ICRC) and the
International Federation of Emergency Medicine (IFEM), developed the Basic Emergency Care (BEC) Course: Approach to the
Management of the Injured and acutely ill. This course is intended for frontline medical providers handling acute life-
threatening situations with limited resources. These providers include students, nurses, prehospital technicians, physicians,
and physician assistants who work in both the prehospital and hospital settings. The BEC presents a systematic method for
managing life-threatening acute disorders and injuries even before the diagnosis is known.
The BEC can be implemented in many different ways depending on local needs, but a five-day timeline is recommended,
which is described in detail in the coordination section of the facilitator's guide. It can also be taught as a multi-week nursing
or medical degree program module. The course was designed to support the efforts of governments, educational institutions,
professional societies and others to train emergency care providers operating within their designated scope of practice. WHO
does not certify or accredit courses, trainers, or providers.
Course Scope
Acute clinical pictures
These modules cover four acute and life-threatening clinical presentations:
o Trauma
o Shortness of breath
o State of shock
o Impaired mental status
Most life-threatening disorders and injuries, whether the original cause is medical or surgical, or an infection or injury, will
present with one of these characteristics. These modules present a systematic method of evaluation and treatment that can
be applied whether the diagnosis has been made or not.
Frontline healthcare providers will encounter many more clinical presentations than this course covers. It is not intended to
cover all acute conditions but to help providers deal with situations where time is crucial and early intervention can save a
patient's life. Many participants may have already been trained or will be trained in the future, to provide broader care than
described here. Transfer recommendations indicate the need for a level of care beyond the scope of this course, and
participants may already be trained to provide this additional care.
Other emergency clinical pictures
Other symptoms that may indicate a life-threatening disorder or injury even before it progresses to one of the major acute
clinical conditions described above include:
o Molestia in the chest
o Poisoning/ingestion/exposure
o Poisoning(by sting or bite)
o Any strong odor of uncertain origin
o Contractions, pain, or bleeding in late pregnancy
These symptoms may indicate a critical illness requiring prompt intervention, even when the person appears well. Evaluation
and treatment of these conditions are beyond the scope of this course but should always involve referral or consultation to
an advanced provider.
In addition, certain exposures to infectious agents require immediate prophylaxis (preventive treatment) since a delay may
reduce effectiveness. These are the following cases:
o Healthcare workers who were injured with a needle
o People who have been sexually assaulted or have had an unprotected sexual encounter
o People who were exposed to saliva from an animal that may have rabies
These exposures should be assessed as soon as possible in a facility that is able to provide prophylaxis.
Childbirth care and neonatal resuscitation
This course does not cover childbirth care or neonatal resuscitation.
Expected background knowledge of participants
This course assumes that participants have prior knowledge in the following areas:
o How to Use Personal Protective Equipment
o Basic human anatomy
o How to Get Basic Background
o Basic physical examination skills, such as measuring vital signs, listening to the chest, and examining the abdomen
o How to check your blood glucose level
o How to prepare an intravenous infusion
o How to give an intramuscular injection
o Cardiopulmonary resuscitation (CPR)
Cardiopulmonary resuscitation (CPR)
Whether CPR is appropriate for a patient depends on many factors, including the cause, knowledge of available resources,
and institutional protocols and practices. Although this course covers several aspects of resuscitation, it does not include CPR
protocols, as they can vary greatly from one setting to another.
Medication
The medications discussed in this course are readily available and appropriate for use by first-line providers. They can be
used in pre-hospital or healthcare facilities and are important early treatments in emergencies. The medications included
provide a foundation for initial emergency care, but nearly all of the disorders and injuries discussed in this book will require
additional treatments. Many emergency treatments used by advanced providers are not included in this course.
Transfer/Transfer
This course is intended to help providers provide initial treatment for acute and life-threatening disorders or injuries. Most
critically ill patients will require care beyond this initial stage. This may be ongoing care provided by the same provider but
will generally need to be transferred to a more advanced provider or facility. The modules include special considerations
about patient fate for each acute clinical picture and related diagnoses.
Triage
Triage is the systematic process of classifying patients according to their severity to ensure a better match between available
resources and needs. This topic is not specifically addressed in this course.
Participant Requirements
Participants should confirm with the facilitators what the course requirements are. When the BEC is delivered in its entirety,
it is necessary to meet all the requirements listed below.
Knowledge test
Before receiving the BEC exercise book, participants must have completed this short confidential test, which helps facilitators
understand their current level of knowledge.
Attendance List
Participants must register each day for the morning and afternoon sessions. Participants must attend all sessions to pass the
course.
Complete the workbook
As described above, participants must define all the keywords and answer all the workbook questions in the corresponding
module before each lesson. All keywords must be defined, and all questions must be answered so that the workbook can be
considered complete. Facilitators will review the workbooks daily. Participants must complete the book to pass the course.
Skills Practice Stations
On skills practice day, facilitators will demonstrate skills at a practice station. Participants will be able to practice the skill at
each station several times. They can do it as often as needed within the allotted time per station. During the practice,
participants can reference the workbook and skills checklist and ask the facilitators the necessary questions. During the
evaluation, reference materials will not be allowed, so participants must practice without them, under the observation of
other participants, who will alert them if they miss any steps. Participants will have plenty of time to practice and feel
confident with the skills before the assessment; When they are ready, they should ask the instructor to evaluate their skill
practice. To pass the assessment, all steps in the skills checklist must be met. Participants must pass skills practice station
assessments to pass the course.
Hypothetical cases
All participants must effectively lead and handle a hypothetical case to pass the course. These cases allow participants to
practice an integrated treatment method in groups of 3 or 4 members. Facilitators will talk to the group about approaching
cases using the ABCDE method. In subsequent modules, each participant's ability to lead and handle a case will be assessed.
Managing a hypothetical case involves determining the key aspects of assessment and treatment and submitting a summary
transfer report (see section "Transfer" in Skills). Facilitators will complete the following checklist to evaluate the participant
leading the case. Those participants who fail to identify and manage critical disorders or injuries in the case will be assigned
a second case in the same or the next session. Assessments are based on a standardized guide and are noted in the form
below.
Final written exam
In order to sit for the final exam, participants must:
o Complete the knowledge test
o Complete the key terms and questions from the workbook
o To attend all sessions of the course
o Didentify a hypothetical case
o Roastall skill practice stations, examined by an instructor.
The final exam will consist of multiple-choice questions; participants must score at least 75% to pass.
Reference
1. Reynolds T, Roddie N, Tenner A, Geduld H. Basic emergency care: management of the injured and acutely ill. World
Health Organization and the International Committee of the Red Cross (ICRC), 2020. ISBN (WHO) 978-92-4-000633-1
(electronic version) https://www.who.int/es/publications/i/item/basic-emergency-care-approach-to-the-acutely-ill-
and-injured. [Access date: 09.10.2020]
