The evolution of the international emergency care workforce: a thematic analysis

Acute care has historically been a relatively peripheral area on the global health agenda. Emergency care was first identified as a global priority at the WHO’s 60th World Health Assembly in 2007.  The WHO first mandated international coordination over the global shortage of human resources in health (HRH) in 2006. Little research has focused on the intersection of these problems, regarding the international workforce working in acute care.MethodsA systematic search was conducted to retrieve articles evaluating components of secondary-level local, local, regional or national acute services published in academic journals from 2000 onwards. A thematic analysis of selected articles was completed with a focus on human resource capacities, utilising a framework-based synthesis approach. Results73 articles based in 44 countries were retrieved, of which 43 were cross-sectional studies and 22 were qualitative case reports. Articles largely reported inadequate competencies, training opportunities and insufficient physical resource within local emergency medical systems. Emergency departments worldwide are widely staffed by unspecialised personnel.  Task-shifting within the acute care sector is frequently employed across the Subsaharan African region. Workforce issues were not restricted to low-income settings. However, a rigorous and stratified global dataset of workers in this category is not available and would be useful.ConclusionEmergency medical systems are undergoing a period of development worldwide. Inadequacies regarding supervision, infrastructure, and support services are not frequently addressed and should not be neglected in human resource policy. Identifying the successes and failures of systems on a global scale to date can prove useful for health systems planning and policy.