No abstract

Background: The COVID-19 was declared as a pandemic by the World Health Organization (WHO). Globally, countries took actions to slow the spread and avoid overwhelming the health system. The WHO issued interim guidelines on critical preparedness, readiness and response actions against COVID-19 to assist level of preparedness and readiness.Aim: This study reviewed the work of Australia, Singapore, Sri Lanka and the United Kingdom on actions and priority areas of work as described in interim guidelines by the WHO in relation to the first two phases of disease transmission scenario.Methods: A non-systematic narrative review was conducted. Relevant documents available in selected websites were searched. The data generated were compiled, and information was synthesised within the WHO framework for critical preparedness, readiness and response actions against COVID-19. Further, scenarios of “no cases” and “sporadic cases” were analysed against the actions and priority areas of work of said framework.Results: Study revealed differences in implementation approach of strategic actions and priority areas of work, such as in terms of activation, timeliness of implementing emergency response plans, variations in case management strategies as seen in contact tracing, management of asymptomatic contacts, isolation, quarantine and selection of cohort for laboratory investigation. Besides, gaps were found in availability and activation of business continuity plans.Conclusion: Global political and health authorities need much robust mechanisms for preparedness, response and coordination of contagious diseases with similar nature. Even the occurrence of one case shall trigger stringent transmission prevention measures and initiate the actions and priority areas of work as stated in the WHO interim guideline.Keywords: pandemics, emergency response, health policy, COVID-19, emergency preparedness.

COVID-19 is an infectious disease that rapidly developed into a pandemic status. This deemed a need for new strategies to carry out routine health care activities. The recent practices and adaptations of the system as a response to the pandemic status were called a new normal situation. The aim of the study was to describe principles for adaptation to a new normal context for health care settings in COVID-19 pandemic. This narrative review of literature was conducted based on policy documents, guidelines, and public notices issued by the government and other key policymakers from the United Kingdom, Australia, Singapore, and Canada between June 15, 2020, and July 15, 2020, available on their government websites. The study revealed several principles, namely, enhanced surveillance, phasedown strategy for restoring routine services, vulnerability, dynamics of the service demand, new principles in human resource management, infection control measures, supply and usage of personal protective equipment, demand for intensive-care unit bed capacity, coordination and collaboration internally and externally, promotion and utility of remote care, ensuring equity, pre-hospital communication and assessment before reaching service facility, enhancing clinician participation in local-level decision-making, and risk assessments within all levels of service facility. The results of this study exposed new principles that facilitated managerial decision-making to the adaptation of new strategies. This new normal context created many challenges for resource management, which needed to consider dynamics of demand of services, prevention of spreading infections, and readiness for surge of cases while safeguarding quality and safety.

Ischemic heart disease is the leading cause of mortality that raised the demand for pre-hospital emergency care in Sri Lanka. Understanding the performance of Sri Lanka's 1990 Suwa Seriya ambulance service is essential to improve its quality and to reduce morbidity and mortality associated with the disease. This study aims to describe socio-demographic characteristics and evaluate the clinical assessment and management process of patients presenting with acute chest pain of cardiac in origin. A descriptive study was conducted in Gampaha District of the Western Province of Sri Lanka. A total of 154 records of patients with acute chest pain who rang the 1990 call centre over a 3-month period were selected. Composite values for treatment and examinations as a percentage were plotted on run charts to assess the performance and its variations over the study period. About 47.4% of the study group were in 35–65 age group, 53.2% were males, and 81.8% had a typical presentation. The median for composite value for examination as a percentage was 89.5%, indicating substantial control and alignment with the reference package with normal cause variation. The median composite value for treatment as a percentage was 9.96%, a low value with normal cause variation. A good control of the processes of clinical examination and treatment is apparent. A higher median for composite value for examination as a percentage attributed to the formal training process of the ambulance staff. Although a low median was obtained for the composite value for treatment as a percentage, it was stable and pointed room for improvement.