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Niyonsaba M, Nkeshimana M, Uwitonze JM, Davies J, Maine R, Nyinawankusi JD, Hunt M, Rickard R, Jayaraman S, Watt MH. Challenges and opportunities to improve efficiency and quality of prehospital emergency care using an mHealth platform: Qualitative study in Rwanda. Afr J Emerg Med 2023; 13:250-257. [PMID: 37767314 PMCID: PMC10520315 DOI: 10.1016/j.afjem.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 07/17/2023] [Accepted: 07/26/2023] [Indexed: 09/29/2023] Open
Abstract
Introduction Prompt, high-quality pre-hospital emergency medical services (EMS) can significantly reduce morbidity and mortality. The goal of this study was to identify factors that compromise efficiency and quality of pre-hospital emergency care in Rwanda, and explore the opportunities for a mobile health (mHealth) tool to address these challenges. Methods In-depth interviews were conducted with 21 individuals representing four stakeholder groups: EMS dispatch staff, ambulance staff, hospital staff, and policymakers. A semi-structured interview guide explored participants' perspectives on all aspects of the pre-hospital emergency care continuum, from receiving a call at dispatch to hospital handover. Participants were asked how the current system could be improved, and the potential utility of an mHealth tool to address existing challenges. Interviews were audio-recorded, and transcripts were thematically analyzed using NVivo. Results Stakeholders identified factors that compromise the efficiency and quality of care across the prehospital emergency care continuum: triage at dispatch, dispatching the ambulance, locating the emergency, coordinating patient care at scene, preparing the receiving hospital, and patient handover to the hospital. They identified four areas where an mHealth tool could improve care: efficient location of the emergency, streamline communication for decision making, documentation with real-time communication, and routine data for quality improvement. While stakeholders identified advantages of an mHealth tool, they also mentioned challenges that would need to be addressed, namely: limited internet bandwidth, capacity to maintain and update software, and risks of data security breaches that could lead to stolen or lost data. Conclusion Despite the success of Rwanda's EMS system, this study highlights factors across the care continuum that could compromise quality and efficiency of prehospital emergency care. Mobile health tools hold great promise to address these challenges, but contextual issues need to be considered to ensure sustainability of use.
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Affiliation(s)
| | - Menelas Nkeshimana
- University Teaching Hospital of Kigali (Centre Hospitalier Universitaire de Kigali), Rwanda
| | | | - Justine Davies
- University of Birmingham, Institute of Applied Health Research, United Kingdom
- Stellenbosch University, Centre for Global Surgery, Department of Global Health, South Africa
- University of the Witwatersrand, Faculty of Health Sciences, School of Public Health, South Africa
| | - Rebecca Maine
- University of Washington, Department of Surgery, United States
| | | | - McKenna Hunt
- University of Utah, Honors College, United States
| | - Rob Rickard
- Rwanda Build Program, Common World Inc., Rwanda
| | | | - Melissa H. Watt
- University of Utah, Department of Population Health Sciences, United States
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Hunt M, Niyonsaba M, Uwitonze JM, Nyinawankusi JD, Davies J, Maine R, Nkeshimana M, Jayaraman S, Watt MH. Challenges Locating the Scene of Emergency: A Qualitative Study of the EMS System in Rwanda. PREHOSP EMERG CARE 2023; 28:501-505. [PMID: 37339274 PMCID: PMC10755071 DOI: 10.1080/10903127.2023.2225195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 06/08/2023] [Accepted: 06/10/2023] [Indexed: 06/22/2023]
Abstract
BACKGROUND Timely prehospital emergency care significantly improves health outcomes. One substantial challenge delaying prehospital emergency care is in locating the patient requiring emergency services. The goal of this study was to describe challenges emergency medical services (EMS) teams in Rwanda face locating emergencies, and explore potential opportunities for improvement. METHODS Between August 2021 and April 2022, we conducted 13 in-depth interviews with three stakeholder groups representing the EMS response system in Rwanda: ambulance dispatchers, ambulance field staff, and policymakers. Semi-structured interview guides covered three domains: 1) the process of locating an emergency, including challenges faced; 2) how challenges affect prehospital care; and 3) what opportunities exist for improvement. Interviews lasted approximately 60 min, and were audio recorded and transcribed. Applied thematic analysis was used to identify themes across the three domains. NVivo (version 12) was used to code and organize data. RESULTS The current process of locating a patient experiencing a medical emergency in Kigali is hampered by a lack of adequate technology, a reliance on local knowledge of both the caller and response team to locate the emergency, and the necessity of multiple calls to share location details between parties (caller, dispatch, ambulance). Three themes emerged related to how challenges affect prehospital care: increased response interval, variability in response interval based on both the caller's and dispatcher's individual knowledge of the area, and inefficient communication between the caller, dispatch, and ambulance. Three themes emerged related to opportunities for processes and tools to improve the location of emergencies: technology to geolocate an emergency accurately and improve the response interval, improvements in communication to allow for real-time information sharing, and better location data from the public. CONCLUSION This study has identified challenges faced by the EMS system in Rwanda in locating emergencies and identified opportunities for intervention. Timely EMS response is essential for optimal clinical outcomes. As EMS systems develop and expand in low-resource settings, there is an urgent need to implement locally relevant solutions to improve the timely locating of emergencies.
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Affiliation(s)
- McKenna Hunt
- College of Social and Behavioral Science and Honors College, University of Utah, Salt Lake City, United States
| | - Mediatrice Niyonsaba
- Division of Emergency Medical Services, Rwanda Biomedical Center, Kigali, Rwanda
| | - Jean Marie Uwitonze
- Division of Emergency Medical Services, Rwanda Biomedical Center, Kigali, Rwanda
| | | | - Justine Davies
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Rebecca Maine
- Department of Surgery, University of Washington, Seattle, United States
| | - Menelas Nkeshimana
- University Teaching Hospital of Kigali (Centre Hospitalier Universitaire de Kigali), Kigali, Rwanda
| | - Sudha Jayaraman
- Department of Surgery, Center for Global Surgery, University of Utah, Salt Lake City, United States
| | - Melissa H. Watt
- Department of Population Health Sciences, University of Utah, Salt Lake City, United States
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Rosenberg A, Wojick M, Asay B, Williams K, Wolfe L, Baghdassarian A, Umuhoza C, Ntaganda E, Kabagema I, Uwitonze JM, Dushime T, Jayaraman S. Developing Sustainable Prehospital Pediatric Care in Rwanda. Pediatr Emerg Care 2022; 38:224-227. [PMID: 35482495 DOI: 10.1097/pec.0000000000002699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Unintentional injury is the leading cause of death in children older than 1 year and disproportionately affects pediatric patients in low- and middle-income countries.Improved prehospital care capacity has demonstrated the ability to improve care and save lives. Our collaboration developed and implemented a sustainable prehospital emergency pediatrics care course (EPCC) for Service d'Aide Medicale Urgente, the public emergency medical service in Rwanda. METHODS A 1-day context-specific EPCC was developed based on international best practices and local feedback. Two cohorts were created to participate in the course. The first group, EPCC 1, was made of 22 Service d'Aide Medicale Urgente providers with preexisting knowledge on the topic who participated in the course and received training to lead future sessions. After completion of the EPCC1, this group led the second cohort, EPCC 2, which was composed of 26 healthcare providers from around Rwanda. Each group completed a 50 question assessment before and after the course. RESULTS Emergency pediatrics care course 1 mean scores were 58% vs 98% (pre vs post), EPCC 2 mean scores were 49% vs 98% (pre vs post), using matched-pair analysis of 22 and 32 participants, respectively. When comparing unequal variances across the groups with a 2-tailed paired t test, EPCC 1 and EPCC 2 had a statistically significant mean change in pretest and posttest assessment test scores of 40% compared with 46%, P < 0.0001, with 95% confidence interval. A 1-way analysis of variance mean square analysis for the change in scores showed that regardless of the baseline level of training for each participant, all trainees reached similar postassessment scores (F(1) = 1.45, P = 0.2357). CONCLUSIONS This study demonstrates effective implementation of a context-appropriate prehospital pediatric training program in Kigali, Rwanda. This program may be effective to support capacity development for prehospital care in Rwanda using a qualified local source of instructors.
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Affiliation(s)
- Ashley Rosenberg
- From the Division of Acute Care Surgery, Department of Surgery, Virginia Commonwealth University School of Medicine
| | - Megan Wojick
- Virginia Commonwealth University School of Medicine
| | | | - Kenneth Williams
- Center for Trauma and Critical Care Education, Department of Surgery, Virginia Commonwealth University
| | - Luke Wolfe
- From the Division of Acute Care Surgery, Department of Surgery, Virginia Commonwealth University School of Medicine
| | - Aline Baghdassarian
- Department of Pediatric Emergency Medicine, Virginia Commonwealth University School of Medicine, Richmond, VA
| | | | - Edmond Ntaganda
- Department of Pediatrics, University Teaching Hospital of Kigali
| | - Ignace Kabagema
- Service d'Aide Medicale Urgente, Rwanda Ministry of Health, Kigali, Rwanda
| | | | - Theophile Dushime
- Service d'Aide Medicale Urgente, Rwanda Ministry of Health, Kigali, Rwanda
| | - Sudha Jayaraman
- From the Division of Acute Care Surgery, Department of Surgery, Virginia Commonwealth University School of Medicine
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Jayaraman S, Ntirenganya F, Nkeshimana M, Rosenberg A, Dushime T, Kabagema I, Uwitonze JM, Uwitonize E, Nyinawankusi JD, Riviello R, Bagahirwa I, Williams KL, Krebs E, Maine R, Banguti P, Rulisa S, Kyamanywa P, Byiringiro JC. Building Trauma and EMS Systems Capacity in Rwanda: Lessons and Recommendations. Ann Glob Health 2021; 87:104. [PMID: 34754760 PMCID: PMC8555476 DOI: 10.5334/aogh.3324] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
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-the-trainers 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 Registry was instituted across four major referral centers in the country capturing over 5,000 injured patients. Long-term research capacity development included Masters' Degree support for 11 staff. Conclusions and Recommendations This collaboration was highly productive in empowering staff and leadership, standardizing clinical service delivery in EMS, and investing in systems and infrastructure. This can be a useful model for trauma and EMS system capacity development in other LMICs.
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Affiliation(s)
- Sudha Jayaraman
- Virginia Commonwealth University, Department of Surgery, US
- University of Utah, Department of Surgery, US
| | | | - Menelas Nkeshimana
- University Teaching Hospital – Kigali, Department of Accident and Emergency, RW
| | | | | | - Ignace Kabagema
- Ministry of Health of Rwanda, Service d’Aide Medicale Urgente, RW
| | | | - Eric Uwitonize
- Ministry of Health of Rwanda, Service d’Aide Medicale Urgente, RW
| | | | - Robert Riviello
- Brigham and Women’s Hospital/Harvard Medical School, Department of Surgery, US
| | | | | | - Elizabeth Krebs
- Thomas Jefferson University Hospital, Department of Emergency Medicine, US
| | - Rebecca Maine
- Harborview Medical Center, University of Washington, Department of Surgery, US
| | - Paulin Banguti
- University of Rwanda, Department of Anaesthesia, Emergency Medicine and Critical Care and King Faisal Hospital, RW
| | - Stephen Rulisa
- University Teaching Hospital – Kigali, Department of Obstetrics and Gynecology, RW
- University of Rwanda College of Medicine and Health Sciences, RW
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Rosenberg A, Williams K, Nyinawankusi JD, Asay B, Wolfe L, Ntirushwa D, Ndikuryayo E, Ritter A, Uwitonze JM, Kabagema I, Dushime T, Jayaraman S. Prehospital emergency obstetric and neonatal care train-the-trainers program in Rwanda. Int J Gynaecol Obstet 2020; 153:503-507. [PMID: 33217766 DOI: 10.1002/ijgo.13491] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 09/16/2020] [Accepted: 11/18/2020] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To improve maternal mortality rates, our collaboration developed and implemented a context-specific, prehospital Emergency Obstetrics and Neonatal Course (EONC) and train-the-trainers program in Rwanda. METHODS Two cohorts of staff participated in the program-the SAMU emergency medical service and staff from district hospitals. A 2-day course was developed, consisting of skills stations, simulations, and didactics. A 50-question assessment was administered to both cohorts before and after the courses. Student's t test and matched paired t tests were used to evaluate the assessments through retrospective analysis of the data. RESULTS EONC1 median scores were 60% versus 92% (pre vs post), using matched-pair analysis of 20 participants. EONC2 median scores were 52% versus 96% (pre vs post), using matched-pair analysis of participants. A one-way analysis of variance 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) = 8.35, P = 0.0059). CONCLUSION Optimal prehospital management of obstetric emergencies is essential to prevent needless mortality and morbidity. This study demonstrated that a context-appropriate prehospital obstetric and neonatal training program could be effectively developed and implemented for the SAMU team in Kigali, Rwanda.
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Affiliation(s)
- Ashley Rosenberg
- Division of Acute Care Surgery, Department of Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Kenneth Williams
- Center for Trauma and Critical Care Education, Department of Surgery, Virginia Commonwealth University, Richmond, VA, USA
| | | | | | - Luke Wolfe
- Division of Acute Care Surgery, Department of Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - David Ntirushwa
- Department of Obstetrics and Gynecology, University Teaching Hospital of Kigali, Kigali, Rwanda
| | - Emmanuel Ndikuryayo
- Department of Obstetrics and Gynecology, University Teaching Hospital of Kigali, Kigali, Rwanda
| | - Amanda Ritter
- Department of Obstetrics and Gynecology, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | | | - Ignace Kabagema
- Service d'Aide Medicale Urgente, Rwanda Ministry of Health, Kigali, Rwanda
| | - Theophile Dushime
- Service d'Aide Medicale Urgente, Rwanda Ministry of Health, Kigali, Rwanda
| | - Sudha Jayaraman
- Division of Acute Care Surgery, Department of Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
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Rosenberg A, Mukeshimana L, Uwamahoro A, Dworkin M, Nsengimana V, Kankindi E, Niyonsaba M, Uwitonze JM, Kabagema I, Dushime T, Jayaraman S. The Initial Prehospital Management of Traumatic Brain Injuries in Kigali, Rwanda. Prehosp Disaster Med 2020; 35:533-537. [PMID: 32600486 PMCID: PMC10536786 DOI: 10.1017/s1049023x20000813] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Traumatic brain injuries (TBIs) are an important cause of mortality and disability around the world. Early intervention and stabilization are necessary to obtain optimal outcomes, yet little is written on the topic in low- and middle-income countries (LMICs). The aim is to provide a descriptive analysis of patients with TBI treated by Service d'Aide Medicale Urgente (SAMU), the prehospital ambulance service in Kigali, Rwanda. HYPOTHESIS/PROBLEM What is the incidence and nature of TBI seen on the ambulance in Kigali, Rwanda? METHODS A retrospective descriptive analysis was performed using SAMU records captured on an electronic database from December 2012 through May 2016. Variables included demographic information, injury characteristics, and interventional data. RESULTS Patients with TBIs accounted for 18.0% (n = 2,012) of all SAMU cases. The incidence of TBIs in Kigali was 234 crashes per 100,000 people. The mean age was 30.5 (SD = 11.5) years and 81.5% (n = 1,615) were men. The most common mechanisms were road traffic incidents (RTIs; 78.5%, n = 1,535), assault (10.7%, n=216), and falls (7.8%, n=156). Most patients experienced mild TBI (Glasgow Coma Score [GCS] ≥ 13; 83.5%, n = 1,625). The most common interventions were provision of pain medications (71.0%, n = 1,429), placement of a cervical collar (53.6%, n = 1,079), and administration of intravenous fluids (48.7%, n = 979). In total, TBIs were involved in 67.0% of all mortalities seen by SAMU. CONCLUSION Currently, TBIs represent a large burden of disease managed in the prehospital setting of Kigali, Rwanda. These injuries are most often caused by RTIs and were observed in 67% of mortalities seen by SAMU. Rwanda has implemented several initiatives to reduce the incidence of TBIs with a specific emphasis on road safety. Further efforts are needed to better prevent these injuries. Countries seeking to develop prehospital care capacity should train providers to manage patients with TBIs.
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Affiliation(s)
- Ashley Rosenberg
- Division of Acute Care Surgery, Department of Surgery Virginia Commonwealth University School of Medicine, Richmond, Virginia USA
| | | | | | - Myles Dworkin
- Thomas Jefferson University School of Medicine, Philadelphia, Pennsylvania USA
| | - Vizir Nsengimana
- Department of Emergency Medicine, University Teaching Hospital of Kigali, Kigali, Rwanda
| | - Eugenie Kankindi
- Service d’Aide Medicale Urgente- Rwanda Ministry of Health, Kigali, Rwanda
| | | | | | - Ignace Kabagema
- Service d’Aide Medicale Urgente- Rwanda Ministry of Health, Kigali, Rwanda
| | - Theophile Dushime
- Service d’Aide Medicale Urgente- Rwanda Ministry of Health, Kigali, Rwanda
| | - Sudha Jayaraman
- Division of Acute Care Surgery, Department of Surgery Virginia Commonwealth University School of Medicine, Richmond, Virginia USA
- Program for Global Surgery, Department of Surgery Virginia Commonwealth University, VCU Health, Richmond, Virginia USA
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Rosenberg A, Uwitonze JM, Dworkin M, Kabagema I, Dushime T, Nkeshimana M, Riviello R, Jayaraman S. Fostering Trauma and Emergency Research Capacity in Rwanda Through Collaboration. J Surg Educ 2020; 77:1018-1023. [PMID: 32713743 DOI: 10.1016/j.jsurg.2020.03.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 03/27/2020] [Accepted: 03/31/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES Access to effective emergent care would prevent 45% of all deaths in LMICs, however, trauma and emergency care remain largely neglected. Our collaboration in Rwanda to build prehospital trauma care led us to create a research mentorship program to enhance the ability of the local team to evaluate their system. METHODS NIH grant funding had been previously obtained to establish standards for prehospital trauma care in Rwanda and build local research capacity. We created a research mentorship program that involved a surgical resident embedded locally tasked with 1) giving lectures on research, study design, interpretation, and writing, 2) providing mentorship for data interpretation and 3) supporting the development of abstracts, presentations, and publications. RESULTS Four research teams identified high priority areas for quality improvement research. Research group meetings were held and involved mentored literature searches, critical review of published works, basics of study design, abstract writing and manuscript development. Abstracts were submitted and accepted to three international conferences. At this time 3 manuscripts have been accepted and are in production, 2 abstracts and 1 manuscript has been published. Eleven staff enrolled in master's degree programs in critical and nursing, epidemiology, public health and global health equity across three institutions. CONCLUSIONS Responsive health care systems need capacity for ongoing quality improvement and research. This is especially true to address the massive global burden of disease of trauma and emergency conditions. US academic surgical collaborations have tremendous research expertise that can contribute to improving health system capacity globally. Such collaborations offer the opportunity to set up the foundations of future academic productivity.
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Affiliation(s)
- Ashley Rosenberg
- Division of Acute Care Surgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia.
| | - J M Uwitonze
- Service d'Aide Medicale Urgente, Rwanda Ministry of Health, Kigali, Rwanda.
| | - Myles Dworkin
- Thomas Jefferson University School of Medicine, Philadelphia, Pennsylvania.
| | - Ignace Kabagema
- Service d'Aide Medicale Urgente, Rwanda Ministry of Health, Kigali, Rwanda.
| | - Theophile Dushime
- Service d'Aide Medicale Urgente, Rwanda Ministry of Health, Kigali, Rwanda.
| | - Menelas Nkeshimana
- Department of Accident and Emergency, University Teaching Hospital of Kigali, Kigali, Rwanda.
| | - Robert Riviello
- Department of Surgery, Harvard University, Brigham and Women's Hospital, Boston, Massachusetts.
| | - Sudha Jayaraman
- Division of Acute Care Surgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia.
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Rosenberg A, Ntirenganya F, Bagahirwa I, Mbanjumucyo G, Rutayisire L, Muneza S, Nzeyimana I, Benimana E, Nahayo E, Bhengu B, Nuhu A, Muhumuza A, Uwitonze C, Umwali G, Nkeshimana M, Nyinawankusi JD, Krebs E, Uwitonze JM, Kabagema I, Dushime T, Byiringiro JC, Ndayisaba G, Jayaraman S. First Rwanda National Trauma Symposium 2019: Challenges and priorities. J Glob Health 2020; 10:010201. [PMID: 32257131 PMCID: PMC7100625 DOI: 10.7189/jogh.10.010201] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- Ashley Rosenberg
- Virginia Commonwealth University Department of Surgery, Richmond, Virginia, USA
- Joint first authorship
| | - Faustin Ntirenganya
- University Teaching Hospital of Kigali Department of Surgery, Kigali, Rwanda
- Joint first authorship
| | | | - Gabin Mbanjumucyo
- University Teaching Hospital of Kigali Department of Accident and Emergency, Kigali, Rwanda
| | - Lambert Rutayisire
- University Teaching Hospital of Kigali Department of Surgery, Kigali, Rwanda
| | - Severien Muneza
- University Teaching Hospital of Kigali Department of Surgery, Kigali, Rwanda
| | - Innocent Nzeyimana
- University Teaching Hospital of Kigali Department of Surgery, Kigali, Rwanda
| | | | - Ernest Nahayo
- Rwanda Military Hospital Department of Accident and Emergency, Kigali, Rwanda
| | | | - Assuman Nuhu
- University of Rwanda College of Medicine and Health Sciences, Kigali, Rwanda
| | - Arsene Muhumuza
- University of Rwanda College of Medicine and Health Sciences, Kigali, Rwanda
| | | | - Ghislaine Umwali
- Collaboration for Evidence-based Healthcare and Public Health in Africa, Kigali, Rwanda
| | - Menelas Nkeshimana
- University Teaching Hospital of Kigali Department of Accident and Emergency, Kigali, Rwanda
| | | | - Elizabeth Krebs
- Thomas Jefferson University, Sidney Kimmel Medical College, Philadelphia, Pennsylvania, USA
| | | | - Igance Kabagema
- Service d’Aide Medicale Urgente- Rwanda Ministry of Health, Kigali, Rwanda
| | - Theophile Dushime
- Service d’Aide Medicale Urgente- Rwanda Ministry of Health, Kigali, Rwanda
| | - Jean Claude Byiringiro
- University Teaching Hospital of Kigali Department of Surgery, Kigali, Rwanda
- University of Rwanda College of Medicine and Health Sciences, Kigali, Rwanda
| | - Gilles Ndayisaba
- Rwanda Biomedical Center, Department of Noncommunicable Diseases, Kigali, Rwanda
| | - Sudha Jayaraman
- Virginia Commonwealth University Department of Surgery, Richmond, Virginia, USA
- Virginia Commonwealth University Program for Global Surgery, Richmond, Virginia, USA
| | - on behalf of the participants for the first national Rwanda Trauma Symposium 2019 in Kigali, Rwanda
- Virginia Commonwealth University Department of Surgery, Richmond, Virginia, USA
- University Teaching Hospital of Kigali Department of Surgery, Kigali, Rwanda
- Rwanda Biomedical Center, Kigali, Rwanda
- University Teaching Hospital of Kigali Department of Accident and Emergency, Kigali, Rwanda
- Rwanda National Police, Kigali, Rwanda
- Rwanda Military Hospital Department of Accident and Emergency, Kigali, Rwanda
- University of Rwanda School of Nursing, Kigali, Rwanda
- University of Rwanda College of Medicine and Health Sciences, Kigali, Rwanda
- Rwanda Association for Biomedical Engineering, Kigali, Rwanda
- Collaboration for Evidence-based Healthcare and Public Health in Africa, Kigali, Rwanda
- Service d’Aide Medicale Urgente- Rwanda Ministry of Health, Kigali, Rwanda
- Thomas Jefferson University, Sidney Kimmel Medical College, Philadelphia, Pennsylvania, USA
- Rwanda Biomedical Center, Department of Noncommunicable Diseases, Kigali, Rwanda
- Virginia Commonwealth University Program for Global Surgery, Richmond, Virginia, USA
- Joint first authorship
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Dworkin M, Nsengimana V, Rosenberg A, Scott J, Riviello R, Krebs E, Umuhoza C, Ntaganda E, Uwitonze JM, Kabagema I, Dushime T, Jayaraman S. Prehospital epidemiology and management of injured children in Kigali, Rwanda. Emerg Med J 2020; 37:146-150. [PMID: 32001607 DOI: 10.1136/emermed-2019-208907] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 12/26/2019] [Accepted: 12/28/2019] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Paediatric injuries are a major cause of mortality and disability worldwide, yet little information exists regarding its epidemiology or prehospital management in low-income and middle-income countries. We aimed to describe the paediatric injuries seen and managed by the prehospital ambulance service, Service d'Aide Medicale d'Urgence (SAMU), in Kigali, Rwanda over more than 3 years. METHODS A retrospective, descriptive analysis was conducted of all injured children managed by SAMU in the prehospital setting between December 2012 and April 2016. RESULTS SAMU responded to a total of 636 injured children, 10% of all patients seen. The incidence of paediatric injury in Kigali, Rwanda was 140 injuries per 100 000 children. 65% were male and the average age 13.5 (±5.3). Most patients were between 15 and 19 years old (56%). The most common causes of injuries were road traffic incidents (RTIs) (447, 72%), falls (70, 11%) and assaults (50, 8%). Most RTIs involved pedestrians (251, 56%), while 15% (65) involved a bicycle. Anatomical injuries included trauma to the head (330, 52%), lower limb (280, 44%) and upper limb (179, 28%). Common interventions included provision of pain medications (445, 70%), intravenous fluids (217, 34%) and stabilisation with cervical collar (190, 30%). CONCLUSION In Kigali, RTIs were the most frequent cause of injuries to children requiring prehospital response with most RTIs involving pedestrians. Rwanda has recently instituted several programmes to reduce the impact of paediatric injuries especially with regard to RTIs. These include changes in traffic laws and increased road safety initiatives.
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Affiliation(s)
- Myles Dworkin
- Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Vizir Nsengimana
- Department of Emergency Medicine, University Teaching Hospital of Kigali, Kigali, Rwanda
| | - Ashley Rosenberg
- Department of Surgery, Virginia Commonwealth University, Richmond, Virginia, USA
| | - John Scott
- Department of Surgery, University of Washington, Seattle, Washington, USA
| | - Robert Riviello
- Division of Trauma, Burns, Surgical Critical Care and Emergency General Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Elizabeth Krebs
- Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Christian Umuhoza
- Department of Emergency Medicine, University Teaching Hospital of Kigali, Kigali, Rwanda
| | - Edmond Ntaganda
- Department of Surgery, University Teaching Hospital of Kigali, Kigali, Rwanda
| | - Jean Marie Uwitonze
- Service d'Aide Medicale Urgente, Republic of Rwanda Ministry of Health, Kigali, Rwanda
| | - Ignace Kabagema
- Service d'Aide Medicale Urgente, Republic of Rwanda Ministry of Health, Kigali, Rwanda
| | - Theophile Dushime
- Service d'Aide Medicale Urgente, Republic of Rwanda Ministry of Health, Kigali, Rwanda
| | - Sudha Jayaraman
- Department of Surgery, Virginia Commonwealth University, Richmond, Virginia, USA
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10
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Rosenberg A, Uwinshuti FZ, Dworkin M, Nsengimana V, Kankindi E, Niyonsaba M, Uwitonze JM, Kabagema I, Dushime T, Krebs E, Jayaraman S. The epidemiology and prehospital care of motorcycle crashes in a sub-Saharan African urban center. Traffic Inj Prev 2020; 21:488-493. [PMID: 32678676 PMCID: PMC7500827 DOI: 10.1080/15389588.2020.1785623] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 05/22/2020] [Accepted: 06/17/2020] [Indexed: 05/21/2023]
Abstract
OBJECTIVE Road traffic crashes (RTCs) are common among motorcyclists in Kigali, Rwanda. The Service d'Aide Medicale Urgente (SAMU), a prehospital ambulance service, responds to many of these crashes. We aimed to describe motorcycle-related RTCs managed by SAMU. METHODS SAMU clinical data including demographic information, injury characteristics, and management details were analyzed descriptively for all motorcycle crashes occurring between December 2012 and July 2016. RESULTS Every patient included in this study was injured. These patients all called the ambulance for their injuries after a motorcycle crash. There were 2,912 motorcycle-related RTCs over the study period, representing 26% of all patients managed by SAMU. The incidence of motorcycle crashes in Kigali was 258 crashes per 100,000 people over the 3.5-year study period. The average age was 30 years and 80% were males. The most common injuries were to the lower extremities (n = 958, 33%), head (n = 878, 30%), or upper extremities (n = 453, 16%). Injuries often resulted in fractures of extremities (n = 740, 25%) and external hemorrhage anywhere in the body (unspecified region; n = 660, 23%), yet few were severe based on the Kampala Trauma Score (n = 23, 2%) and Glasgow Coma Scale (n = 42, 1.5%). The most common interventions were provision of diclofenac (n = 1,526, 52.5%), peripheral intravenous (IV) access (n = 1,217, 42%), and administration of IV fluids (n = 1,048, 36%). CONCLUSION Motorcycle-related RTCs represent a large burden of disease for patients treated by SAMU in Kigali, Rwanda. Young men are most at risk of injury, which imposes a financial strain on society. Though injuries occurred frequently, critical trauma cases from motorcycle crashes were uncommon. This may be a result of several initiatives in Rwanda to improve road safety.
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Affiliation(s)
- A Rosenberg
- Division of Acute Care Surgery, Department of Surgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - F Z Uwinshuti
- Service d'Aide Medicale Urgente, Rwanda Ministry of Health, Kigali, Rwanda
| | - M Dworkin
- School of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - V Nsengimana
- Department of Emergency Medicine, University Teaching Hospital of Kigali, Kigali, Rwanda
| | - E Kankindi
- Service d'Aide Medicale Urgente, Rwanda Ministry of Health, Kigali, Rwanda
| | - M Niyonsaba
- Service d'Aide Medicale Urgente, Rwanda Ministry of Health, Kigali, Rwanda
| | - J M Uwitonze
- Service d'Aide Medicale Urgente, Rwanda Ministry of Health, Kigali, Rwanda
| | - I Kabagema
- Service d'Aide Medicale Urgente, Rwanda Ministry of Health, Kigali, Rwanda
| | - T Dushime
- Service d'Aide Medicale Urgente, Rwanda Ministry of Health, Kigali, Rwanda
| | - E Krebs
- School of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania
- Department of Emergency Medicine, Thomas Jefferson University School of Medicine, Philadelphia, Pennsylvania
| | - S Jayaraman
- Division of Acute Care Surgery, Department of Surgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia
- Program for Global Surgery, Department of Surgery, Virginia Commonwealth University, VCU Health, Richmond, Virginia
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11
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Rosenberg A, Uwinshuti FZ, Dworkin M, Nsengimana V, Kankindi E, Niyonsaba M, Uwitonze JM, Kabagema I, Dushime T, Jayaraman S, Krebs E. Data-driven prehospital training to decrease motorcycle crash deaths in a Sub-Saharan African urban center. Traffic Inj Prev 2019; 20:S207-S208. [PMID: 32296289 PMCID: PMC7158746 DOI: 10.1080/15389588.2019.1665438] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- A Rosenberg
- Virginia Commonwealth University Department of Surgery
| | - F Z Uwinshuti
- Service d'Aide Medicale Urgente- Rwanda Ministry of Health
| | - M Dworkin
- Thomas Jefferson University, Sidney Kimmel Medical College
| | | | - E Kankindi
- Service d'Aide Medicale Urgente- Rwanda Ministry of Health
| | - M Niyonsaba
- Service d'Aide Medicale Urgente- Rwanda Ministry of Health
| | - J M Uwitonze
- Service d'Aide Medicale Urgente- Rwanda Ministry of Health
| | - I Kabagema
- Service d'Aide Medicale Urgente- Rwanda Ministry of Health
| | - T Dushime
- Service d'Aide Medicale Urgente- Rwanda Ministry of Health
| | - S Jayaraman
- Virginia Commonwealth University Department of Surgery
| | - E Krebs
- Thomas Jefferson University, Sidney Kimmel Medical College
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