Developing sustainable prehospital trauma education in Rwanda

Abstract

Introduction Every year, >5 million people worldwide die from trauma. In Kigali, Rwanda, 50% of prehospital care provided by SAMU, the public prehospital system, is for trauma. Our collaboration developed and implemented a context-specific, prehospital Emergency Trauma Care Course (ETCC) and train-the-trainers program for SAMU, based on established international best practices. Methods A context-appropriate two-day ETCC was developed using established best practices consisting of traditional 30-minute lectures followed by 20-minute practical scenario-based team-driven simulation sessions. Also, hands-on skill sessions covered intravenous access, needle thoracostomy and endotracheal intubation among others. Two cohorts participated — SAMU staff who would form an instructor core and emergency staff from ten district, provincial and referral hospitals who are likely to respond to local emergencies in the community. The instructor core completed ETCC 1 and a one-day educator course and then taught the second cohort (ETCC2). Pre and post course assessments were conducted and analyzed using Student's t- test and matched paired t -tests. Results ETCC 1 had 17 SAMU staff and ETCC 2 had 19 hospital staff. ETCC 1 mean scores increased from 40% to 63% and ETCC 2 increased from 41% to 78% after the course (p < 0.001 using matched pair analysis). A one-way ANOVA mean square analysis showed that regardless of the baseline level of training for each participant, all trainees reached similar post-course assessment scores, F (1) = 15.18, p = 0.0004. Discussion This study demonstrates effective implementation of a context-appropriate prehospital trauma training program for prehospital staff in Kigali, Rwanda. The course resulted in improved knowledge for an instructor core and for staff from district and provincial hospitals confirming the effectiveness of a train-the-trainers model. This program may be effective to support capacity development for prehospital trauma care in the country using a qualified local source of instructors.

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

“…All instructors received mentorship to give their first independent course and received immediate individual feedback after they delivered their first course to ensure instructional quality. Pre- and post-course assessments showed statistically significant (p < 0.05) improvements in knowledge for both the SAMU Instructor core and the district and provincial hospital staff, regardless of the level of question difficulty [ 20 21 ].…”

“…The Instructor core of SAMU staff trained nearly 300 staff from district hospitals within the first year and moved on to deliver the trauma course independently and successfully to over 300 additional staff at nine hospitals around the country in the second year. The effectiveness of these courses have been published [ 20 21 ]. These courses have been integrated into the budget for standard outreach across the country by the Division of EMS for long term sustainability.…”

The Current Status and Challenges of Prehospital Trauma Care in Low- and Middle-Income Countries: A Systematic Review

“…There were 11 studies that discussed the effects of first responder training in LMICs, comprising 7428 participants of various backgrounds, including health care professionals and non-medical community members [23][24][25][26][27][28][29][30][31][32][33] . Non-medical community members, in this context, include police officers, firefighters, taxi drivers, commercial drivers, and the general public.…”

Prehospital Care System in Low-Resource Setting: Experiences Learned from Newly Established System in Jimma City, Southwest of Ethiopia

“…A hospital-based or local (municipality level fire department or legal enforcement) model can also be used to organize a tier-two system that provides professional prehospital care within a defined jurisdiction and will be linked to the tier-one system (3,6). Moreover, Mould-Millman et al (18) have clearly Perspective PAJEC outlined the steps towards establishing such a two-tier emergency medical dispatch system in small-and large-scale areas in the African context, while success stories have been reported in a few countries on the continent (7,(19)(20)(21)(22)(23)(24) and countries on other continents such as Pakistan (25). Nevertheless, organizing and sustaining PHC systems, in particular a large-scale two tier system continued to be challenging both technically and financially in resource-limited settings, primarily in many African countries (26)(27)(28)(29).…”