Building Trauma and EMS Systems Capacity in Rwanda: Lessons and Recommendations

Abstract

Background: Surgical capacity building has gained substantial momentum. However, care at the hospital level depends on improved access to emergency services. There is no established model for facilitating trauma and EMS system capacity in LMIC settings. This manuscript describes our model for multi-disciplinary collaboration to advance trauma and EMS capacity in Rwanda, along with our lessons and recommendations.Methods: After high-level meetings at the Ministry of Health in Rwanda (MOH), in 2016, a capacity building plan focusing on improved clinical services, quality improvement/ research and leadership capacity across prehospital and emergency settings. The main themes for the collaborative model included for empowerment of staff, improving clinical service delivery, and investing in systems and infrastructure. Funding was sought and incorporated into the Sector Wide Approaches to Planning process at the Ministry of Health of Rwanda.Findings: A shared mental model was created through a fully funded immersion program for Rwandese leaders from emergency medicine, nursing, prehospital care, and injury policy. Prehospital care delivery was standardized within Kigali through a train-thetrainers program with four new context-appropriate short courses in trauma, medical, obstetric/neonatal, and pediatric emergencies and expanded across the country to reach >600 staff at district and provincial hospitals. Forty-two protocols and checklists were implemented to standardize prehospital care across specialties. The WHO Trauma SUDHA

Barriers to equitable access to quality trauma care in Rwanda: a qualitative study

“…However, discussions at the aforementioned workshop and in the 2019 Rwanda trauma symposium highlighted that efficiency could be improved with better location of the patient and communication between the ambulances and facilities 9 16. Studies are ongoing to address these issues 17 18. Although our participants in Kigali stated that injured people often used ambulances, it was clear that their availability was much lower in rural areas.…”

Emergency unit capacity in Northern Tanzania: a cross-sectional survey

“…In settings such as in our study, where, for example, there is only one hospital with a CT scanner, it is imperative that appropriate referrals are made to higher level facilities based on a predefined network 24. A comprehensive approach should be taken when developing these systems of care, including development of unified clinical practice guidelines, education of clinicians, quality improvement and registries 24 31 33…”

Governance for injury care systems in Ghana, South Africa and Rwanda: development and pilot testing of an assessment tool

“…Rwanda scored relatively highly in our survey. This could be because having successfully achieved the MDGs (Millennium Development Goals), Rwanda has committed to reducing morbidity and mortality due to injuries 8 30. This includes developing policies, training healthcare providers, investing in data collection and hosting its first national symposium on trauma and injuries in 2019 31.…”

“…On the other hand, WHO has developed a trauma registry for LMIC settings that can be tailored to individual country needs, uptake at national levels is lacking, and the use of data collected for health service quality improvement is underdeveloped. Rwanda is the only country in our study that uses the WHO-based trauma registry, and this is only used in five hospitals and without an active quality improvement programme, although there are plans to develop this 30…”