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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, 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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Kearney AS, Kabeja LM, George N, Karim N, Aluisio AR, Mutabazi Z, Uwitonze JE, Nyinawankusi JD, Byiringiro JC, Levine AC. Development of a trauma and emergency database in Kigali, Rwanda. Afr J Emerg Med 2016; 6:185-190. [PMID: 30456093 PMCID: PMC6234174 DOI: 10.1016/j.afjem.2016.10.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 09/26/2016] [Accepted: 10/04/2016] [Indexed: 01/21/2023] Open
Abstract
Introduction Injuries account for 10% of the global burden of disease, resulting in approximately 5.8 million deaths annually. Trauma registries are an important tool in the development of a trauma system; however, limited resources in low- and middle-income countries (LMIC) make the development of high-quality trauma registries challenging. We describe the development of a LMIC trauma registry based on a robust retrospective chart review, which included data derived from prehospital, emergency centre and inpatient records. Methods This paper outlines our methods for identifying and locating patients and their medical records using pragmatic and locally appropriate record linkage techniques. A prehospital database was queried to identify patients transported to University Teaching Hospital – Kigali, Rwanda from December 2012 through February 2015. Demographic information was recorded and used to create a five-factor identification index, which was then used to search OpenClinic GA, an online open source hospital information system. The medical record number and archive number obtained from OpenClinic GA were then used to locate the physical medical record for data extraction. Results A total of 1668 trauma patients were transported during the study period. 66.7% were successfully linked to their medical record numbers and archive codes. 94% of these patients were successfully linked to their medical record numbers and archive codes were linked by four or five of the five pre-set identifiers. 945 charts were successfully located and extracted for inclusion in the trauma registry. Record linkage and chart extraction took approximately 1256 h. Conclusion The process of record linkage and chart extraction was a resource-intensive process; however, our unique methodology resulted in a high linkage rate. This study suggests that it is feasible to create a retrospective trauma registry in LMICs using pragmatic and locally appropriate record linkage techniques.
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