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.
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