Improving prehospital trauma care in Rwanda through continuous quality improvement: an interrupted time series analysis

Scott, John W.; Nyinawankusi, Jeanne D’Arc; Enumah, Samuel; Maine, Rebecca; Uwitonze, Eric; Hu, Yihan; Kabagema, Ignace; Byiringiro, Jean Claude; Riviello, Robert; Jayaraman, Sudha

doi:10.1016/j.injury.2017.03.050

Cited by 40 publications

(43 citation statements)

References 21 publications

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“…There are 42 district and four referral hospitals; the referral hospitals also serve as teaching hospitals 17 . Prehospital emergency medical services, known as the Service d'Aide Médicale Urgente (SAMU), were established by the Ministry of Health in 2007 18 . Prehospital emergency medical services, known as the Service d'Aide Médicale Urgente (SAMU), were established by the Ministry of Health in 2007 18 .…”

Section: Methodsmentioning

confidence: 99%

Epidemiology of paediatric injuries in Rwanda using a prospective trauma registry

et al. 2020

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Background: Child survival initiatives historically prioritized efforts to reduce child morbidity and mortality from infectious diseases and maternal conditions. Little attention has been devoted to paediatric injuries in resource-limited settings. This study aimed to evaluate the demographics and outcomes of paediatric injury in a sub-Saharan African country in an effort to improve prevention and treatment.Methods: A prospective trauma registry was established at the two university teaching campuses of the University of Rwanda to record systematically patient demographics, prehospital care, initial physiology and patient outcomes from May 2011 to July 2015. Univariable analysis was performed for demographic characteristics, injury mechanisms, geographical location and outcomes. Multivariable analysis was performed for mortality estimates.Results: Of 11 036 patients in the registry, 3010 (27⋅3 per cent) were under 18 years of age. Paediatric patients were predominantly boys (69⋅9 per cent) and the median age was 8 years. The mortality rate was 4⋅8 per cent. Falls were the most common injury (45⋅3 per cent), followed by road traffic accidents (30⋅9 per cent), burns (10⋅7 per cent) and blunt force/assault (7⋅5 per cent). Patients treated in the capital city, Kigali, had a higher incidence of head injury (7⋅6 per cent versus 2⋅0 per cent in a rural town, P < 0⋅001; odds ratio (OR) 4⋅08, 95 per cent c.i. 2⋅61 to 6⋅38) and a higher overall injury-related mortality rate (adjusted OR 3⋅00, 1⋅50 to 6⋅01; P = 0⋅019). Pedestrians had higher overall injury-related mortality compared with other road users (adjusted OR 3⋅26, 1⋅37 to 7⋅73; P = 0⋅007).Conclusion: Paediatric injury is a significant contributor to morbidity and mortality. Delineating trauma demographics is important when planning resource utilization and capacity-building efforts to address paediatric injury in low-resource settings and identify vulnerable populations.

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Section: Methodsmentioning

confidence: 99%

Epidemiology of paediatric injuries in Rwanda using a prospective trauma registry

et al. 2020

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“…The capabilities have been previously described. 12 Patients use the service through a public 912 toll-free number, which accesses the country's central ambulance dispatch center in Kigali. There is no formal paramedic training program in Rwanda, but a portion of SAMU nurses and non-physician anesthetists receive short courses in emergency trauma, medical, pediatric, obstetric, and neonatal care, as well as Advanced Cardiac Life Support (ACLS) and Basic Life Support (BLS) certification.…”

Section: Study Context and Settingmentioning

confidence: 99%

The Initial Prehospital Management of Traumatic Brain Injuries in Kigali, Rwanda

Rosenberg

Mukeshimana

Uwamahoro

et al. 2020

Prehosp. Disaster med.

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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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“…Further, the implementation of a continuous quality improvement programme (63,64) and pain protocols or guidelines as well as removing the need to obtain medical control authorisation (13) have likewise improved the provision of prehospital analgesia.…”

Section: Knowledge and Attitudes Regarding Painmentioning

confidence: 99%

Acute pain assessment and management in the prehospital setting, in the Western Cape, South Africa: A Knowledge, Attitudes and Practices Survey

Lourens

Hodkinson

Parker

2020

Preprint

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Background: Acute pain is frequently encountered in the prehospital setting, and therefore, a fundamental aspect of quality emergency care. Research has shown a positive association between health care providers’ knowledge of, and attitudes towards pain and pain management practices. This study aimed to describe the knowledge, attitudes, and practices of emergency care providers regarding acute pain assessment and management in the prehospital setting, in the Western Cape, South Africa. The specific objectives were to, identify gaps in pain knowledge; assess attitudes regarding pain assessment and management; describe pain assessment and management behaviours and practices; and identify barriers to and enablers of pain care. Methods: A web-based descriptive cross-sectional survey was conducted among emergency care providers of all qualifications, using a face-validated Knowledge, Attitudes and Practices of Pain survey. Results: Responses of 100 participants was included in the analysis. The survey response rate could not be calculated. The mean age of respondents was 34.74 (SD8.13) years and the mean years’ experience 10.02 (SD6.47). Most respondents were male (69%), employed in the public/government sector (93%) as operational practitioners (85%) with 54% of respondents having attended medical education on pain care in the last two years. The mean percentage for knowledge and attitudes regarding pain among emergency care providers was 58.01% (SD15.66) with gaps identified in various aspects of pain and pain care. Practitioners with higher qualifications, more years’ experience and those who did not attend medical education on pain, achieved higher scores. Alcohol and drug use by patients were the most selected barrier to pain care while the availability of higher qualified practitioners was the most selected enabler. When asked to record pain scores, practitioners were less inclined to assign scores which were self-reported by the patients in the case scenarios. The participant dropout rate was 35%. Conclusion: Our results suggest that there is suboptimal knowledge and attitudes regarding pain among emergency care providers in the Western Cape, South Africa. Further, gaps in pain knowledge, attitudes and practices were identified. Some barriers and enablers of pain care in the South African prehospital setting were identified but further research is indicated.

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Improving prehospital trauma care in Rwanda through continuous quality improvement: an interrupted time series analysis

Cited by 40 publications

References 21 publications

Epidemiology of paediatric injuries in Rwanda using a prospective trauma registry

Epidemiology of paediatric injuries in Rwanda using a prospective trauma registry

The Initial Prehospital Management of Traumatic Brain Injuries in Kigali, Rwanda

Acute pain assessment and management in the prehospital setting, in the Western Cape, South Africa: A Knowledge, Attitudes and Practices Survey

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