Challenges Locating the Scene of Emergency: A Qualitative Study of the EMS System in Rwanda

Hunt, Mary A.; Niyonsaba, Mediatrice; Uwitonze, Jean Marie; Nyinawankusi, Jeanne D’Arc; Davies, Justine; Maine, Rebecca; Nkeshimana, Menelas; Jayaraman, Sudha; Watt, Melissa H.

doi:10.1080/10903127.2023.2225195

Cited by 4 publications

(1 citation statement)

References 15 publications

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“…Kigali participants were presented with an urban process map produced previously in 2018 with a focus on understanding dispatch processes 24 and requested to check its accuracy and make corrections when appropriate. In Musanze, a process map was created by participants de novo as no previous mapping work had been done.…”

Section: Methodsmentioning

confidence: 99%

Mapping the processes and information flows of a prehospital emergency care system in Rwanda: a process mapping exercise

2024

BMJ Open

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ObjectiveA vital component of a prehospital emergency care system is getting an injured patient to the right hospital at the right time. Process and information flow mapping are recognised methods to show where efficiencies can be made. We aimed to understand the process and information flows used by the prehospital emergency service in transporting community emergencies in Rwanda in order to identify areas for improvement.DesignTwo facilitated process/information mapping workshops were conducted. Process maps were produced in real time during discussions and shared with participants for their agreement. They were further validated by field observations.SettingThe study took place in two prehospital care settings serving predominantly rural and predominantly urban patients.Participants24 healthcare professionals from various cadres. Field observations were done on 49 emergencies across both sites.ResultsTwo maps were produced, and four main process stages were described: (1) call triage by the dispatch/call centre team, (2) scene triage by the ambulance team, (3) patient monitoring by the ambulance team on the way to the health facility and (4) handover process at the health facility. The first key finding was that the rural site had multiple points of entry into the system for emergency patients, whereas the urban system had one point of entry (the national emergency number); processes were otherwise similar between sites. The second was that although large amounts of information were collected to inform decision-making about which health facility to transfer patients to, participants found it challenging to articulate the intellectual process by which they used this to make decisions; guidelines were not used for decision-making.DiscussionWe have identified several areas of the prehospital care processes where there can be efficiencies. To make efficiencies in the decision-making process and produce a standard approach for all patients will require protocolising care pathways.

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Section: Methodsmentioning

confidence: 99%

Mapping the processes and information flows of a prehospital emergency care system in Rwanda: a process mapping exercise

2024

BMJ Open

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Challenges and opportunities to improve efficiency and quality of prehospital emergency care using an mHealth platform: Qualitative study in Rwanda

Niyonsaba,

Nkeshimana,

Uwitonze

et al. 2023

African Journal of Emergency Medicine

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Navigating into the unknown: exploring the experience of exposure to prehospital emergency stressors: a sequential explanatory mixed-methods

Afshari,

Torabi,

Navkhasi

et al. 2023

BMC Emerg Med

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Introduction The unpredictability of prehospital emergencies combined with constantly changing circumstances can lead to increased stress and mental health issues among Emergency Medical Technicians (EMTs). To accurately determine the stress-inducing factors in the prehospital environment, it is important to first identify the stressful events that occur in this environment. Therefore, this study strives to provide a thorough analysis of the stressors in the prehospital environment. Methods Sequential explanatory mixed methods were conducted in Hamadan prehospital emergency centers in 2022. The study included 251 EMTs, who were selected through a method in the quantitative phase. The quantitative part used a questionnaire consisting of basic information and the Posttraumatic Stress Questionnaire (PCL-5). In the qualitative phase, 17 with extensive experience in dealing with prehospital stressors were selected based on their PCL-5 scores (above 33). The qualitative phase analysis was carried out using the contractual content method using the Graneheim and Ladman's approach. Statistical analyzes for the quantitative and qualitative phases were performed using SPSS 21 and maxqda 10, respectively. Results The study revealed that the EMTs had an average PTSD score of 21. 60 ± 11. 45. Multivariate linear regression analysis showed that the number of shifts had a statistically significant relationship with PTSD scores (t = 26.38, P < 0.001). The qualitative phase of the study included 17 interviews, resulting in 14 subcategories, which consisted of four categories: “the overall impact of the stress crisis on technicians,” “missing links in the communication network in incident management,” "professional shortcomings in pre-hospital care,” and “the complex and multifaceted context of stressful pre-hospital emergencies.” Additionally, the study's theme was centered around “surveying the experiences of EMTs in stressful environments.” Conclusion As the number of shifts increased, the primary cause of the high prevalence of PTSD in EMTs was revealed. Prehospital emergency stress can be reduced and managed more skillfully by adjusting various factors such as shortening workdays, offering continuous training, augmenting workforce, supplying ambulance equipment insurance, refraining from hiring personnel devoid of clinical training, hiring psychologists, hiring midwives in an emergency, updating prehospital protocols and guidelines, encouraging cooperation between EMTs and other relief groups, and utilizing cutting-edge technologies.

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Challenges Locating the Scene of Emergency: A Qualitative Study of the EMS System in Rwanda

Cited by 4 publications

References 15 publications

Mapping the processes and information flows of a prehospital emergency care system in Rwanda: a process mapping exercise

Mapping the processes and information flows of a prehospital emergency care system in Rwanda: a process mapping exercise

Challenges and opportunities to improve efficiency and quality of prehospital emergency care using an mHealth platform: Qualitative study in Rwanda

Navigating into the unknown: exploring the experience of exposure to prehospital emergency stressors: a sequential explanatory mixed-methods

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