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

Sudha Jayaraman,Paulin Banguti,Menelas Nkeshimana,Elizabeth Krebs,Jean Claude Byiringiro,Eric Uwitonize,Theophile Dushime,Rebecca Maine,Jeanne D’Arc Nyinawankusi,Ignace Kabagema,Patrick Kyamanywa,Faustin Ntirenganya,Robert Riviello,Jean Marie Uwitonze,Kenneth L Williams,Irene Bagahirwa,Stephen Rulisa,Ashley Rosenberg

doi:10.5334/aogh.3324

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.

Highlights

Surgical capacity building has gained substantial momentum
Long-term research capacity development included Masters’ Degree support for 11 staff. This collaboration was highly productive in empowering staff and leadership, standardizing clinical service delivery in emergency medical system (EMS), and investing in systems and infrastructure
This can be a useful model for trauma and EMS system capacity development in other low-and-middle-income countries (LMICs)

Summary

Introduction

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. Access to surgical services world-wide is poor – an estimated five billion lack reliable surgical care with the majority of this unmet need in low-and-middle-income countries (LMICs) [1, 2]. LMICs bear the brunt, especially for childhood deaths from trauma [5].

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