Citation Information :
Wojick M, McHargue C, d Arc Nyinawankusi J, Rosenberg A, Dworkin M, Sharma V, Uwitonze JM, Kabagema I, Dushime T, Jayaraman S. Standardization of Prehospital Care in Kigali, Rwanda. Panam J Trauma Crit Care Emerg Surg 2020; 9 (1):32-37.
Background: Injury in the prehospital setting is a leading cause of death worldwide, and noncommunicable diseases (NCDs) and injuries substantially burden low- and middle-income countries (LMICs). Timely and effective prehospital emergency care improves outcomes, and these systems of care have been recommended by the World Health Organization (WHO). However, there is a gap in the literature on strategies to support effective prehospital care in LMICs. Through our collaboration with Service d'Aide Medicale d'Urgence (SAMU), the prehospital emergency medical service (EMS) in Kigali, Rwanda, we aimed to develop and implement standardized checklists and protocols for commonly encountered emergencies and assess the initial implementation. Study design: The eight most common conditions treated by SAMU were identified through a previously established electronic registry. Protocols and checklists were drafted using established and publicly available resources from a regional EMS body in Virginia and customized using stakeholder analysis to fit the resources and setting in Rwanda. The metrics for each condition were incorporated into a single ambulance run sheet, and a 1-month pilot trial tracked checklist use and metric adherence. Results: We aimed to create eight protocols and checklists. We focused on the eight most common conditions including extremity injury, traumatic brain injury (TBI), altered mental status (AMS), hyperglycemia, hypoglycemia, postpartum hemorrhage, adult acute respiratory distress, and pediatric acute respiratory distress. Initial results showed variability in prehospital care across the different complaints and highlighted the benefits of using checklists. Subsequently, the Rwanda Ministry of Health (MOH) approved the checklists as the national standard for prehospital care. Implementation is in its initial stages with additional data to come in a later publication. Conclusion: Standardization of prehospital care is important in order to ensure patients receive optimal, evidence-based care. The program described in this study demonstrates how protocols and checklists can be implemented in the prehospital setting.
The top 10 causes of death. https://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death.
Krug EG, Sharma GK, Lozano R. The global burden of injuries. Am J Public Health 2000;90(4):523–526. DOI: 10.2105/ajph.90.4.523.
Callese TE, Richards CT, Shaw P, et al. Trauma system development in low- and middle-income countries: a review. J Surg Res 2015;193(1):300–307. DOI: 10.1016/j.jss.2014.09.040.
WHO, | Prehospital trauma care systems. (2014).
WHO Guidelines for Safe Surgery 2009: Safe Surgery Saves Lives. (World Health Organization, 2013).
Haynes AB, Weiser TG, Berry WR, et al. A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med 2009;360(5):491–499. DOI: 10.1056/NEJMsa0810119.
Ramsay G, Haynes AB, Lipsitz SR, et al. Reducing surgical mortality in Scotland by use of the WHO surgical safety checklist. Br J Surg 2019;106 10.1002/bjs.11151.
Kerner T, Schmidbauer W, Tietz M, et al. Use of checklists improves the quality and safety of prehospital emergency care. Eur J Emerg Med 2017;24(2):114–119. DOI: 10.1097/MEJ.0000000000000315.
Chen C, Kan T, Li S, et al. Use and implementation of standard operating procedures and checklists in prehospital emergency medicine: A literature review. Am J Emerg Med 2016;34(12):2432–2439. DOI: 10.1016/j.ajem.2016.09.057.
Epiu I, Tindimwebwa JVB, Mijumbi C, et al. Working towards safer surgery in Africa; A survey of utilization of the WHO safe surgical checklist at the main referral hospitals in east Africa. BMC Anesthesiol 2016;16(1):60. DOI: 10.1186/s12871-016-0228-8.
Scott JW, Nyinawankusi JD, Enumah S, et al. Improving prehospital trauma care in Rwanda through continuous quality improvement: An interrupted time series analysis. Injury 2017;48(7):1376–1381. DOI: 10.1016/j.injury.2017.03.050.
Africa:: Rwanda — The World Factbook - Central Intelligence Agency. https://www.cia.gov/library/publications/the-world-factbook/geos/rw.html.
Enumah S, Scott JW, Maine R, et al. Rwanda's model prehospital emergency care service: a two-year review of patient demographics and injury patterns in Kigali. Prehosp Disaster Med 2016;31(6): 614–620. DOI: 10.1017/S1049023X16000807.
Regional Documents/Forms. Old Dominion EMS Alliance, Inc. https://odemsa.net/regional-documents/(2018).
Razzak J, Usmani MF, Bhutta ZA. Global, regional and national burden of emergency medical diseases using specific emergency disease indicators: analysis of the 2015 global burden of disease study. BMJ Glob Health 2019;4(2):e000733. DOI: 10.1136/bmjgh-2018-000733.
McCaul M, de Waal B, Hodkinson P, et al. Developing prehospital clinical practice guidelines for resource limited settings: Why re-invent the wheel? BMC Res Notes 2018;11(1):97. DOI: 10.1186/s13104-018-3210-3.
Dizon JM, Machingaidze S, Grimmer K. To adopt, to adapt, or to contextualise? the big question in clinical practice guideline development. BMC Res Notes 2016;9(1):442. DOI: 10.1186/s13104-016-2244-7.
Lang ES, Spaite DW, Oliver ZJ, et al. A national model for developing, implementing, and evaluating evidence-based guidelines for prehospital care: evidence-based ems guidelines. Acad Emerg Med 2012;19(2):201–209. DOI: 10.1111/j.1553-2712.2011.01281.x.