Boston Medical Center, Department of Emergency Medicine, Boston, Massachusetts, USA.
Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.
Emerg Med J. 2018 Jul;35(7):412-419. doi: 10.1136/emermed-2017-207396. Epub 2018 Apr 7.
Essential medicines lists (EMLs) are efficient means to ensure access to safe and effective medications. The WHO has led this initiative, generating a biannual EML since 1977. Nearly all countries have implemented national EMLs based on the WHO EML. Although EMLs have given careful consideration to many public health priorities, they have yet to comprehensively address the importance of medicines for treating acute illness and injury.
We undertook a multistep consensus process to establish an EML for emergency care in Africa. After a review of existing literature and international EMLs, we generated a candidate list for emergency care. This list was reviewed by expert clinicians who ranked the medicines for overall inclusion and strength of recommendation. These medications and recommendations were then evaluated by an expert group. Medications that reached consensus in both the online survey and expert review were included in a draft emergency care EML, which underwent a final inperson consensus process.
The final emergency care EML included 213 medicines, 25 of which are not in the 2017 WHO EML, but were deemed essential for clinical practice by regional emergency providers. The final EML has associated recommendations of desirable or essential and is subdivided by facility level. Thirty-nine medicines were recommended for basic facilities, an additional 96 for intermediate facilities (eg, district hospitals) and an additional 78 for advanced facilities (eg, tertiary centres).
The 25 novel medications not currently on the WHO EML should be considered by planners when making rational formularies for developing emergency care systems. It is our hope that these resource-stratified lists will allow for easier implementation and will be a useful tool for practical expansion of emergency care delivery in Africa.
基本药物清单（EML）是确保获得安全有效的药物的有效手段。世界卫生组织（WHO）领导了这一倡议，自 1977 年以来每半年发布一次 EML。几乎所有国家都根据世界卫生组织的 EML 制定了国家 EML。尽管 EML 已经仔细考虑了许多公共卫生重点，但它们尚未全面解决治疗急性疾病和伤害的药物的重要性。
我们采用多步骤共识程序为非洲急救护理建立 EML。在审查现有文献和国际 EML 之后，我们为急救护理生成了一份候选清单。该清单由专家临床医生进行了审查，他们对药物进行了总体纳入和推荐强度的排名。然后，专家组对这些药物和建议进行了评估。在在线调查和专家审查中均达成共识的药物被纳入草案急救护理 EML，并经过最终的面对面共识程序。
最终的急救护理 EML 包括 213 种药物，其中 25 种不在 2017 年世界卫生组织的 EML 中，但被区域急救提供者认为是临床实践所必需的。最终的 EML 具有理想或必要的相关建议，并按设施级别进行细分。39 种药物被推荐用于基本设施，另外 96 种药物用于中级设施（例如，地区医院），另外 78 种药物用于高级设施（例如，三级中心）。
当前不在世界卫生组织 EML 中的 25 种新型药物应在制定急救护理系统的合理配方时供规划者考虑。我们希望这些资源分层清单将使实施变得更加容易，并成为在非洲实际扩大急救护理服务的有用工具。
