Developing sustainable prehospital trauma education in Rwanda

Ashley Rosenberg; Ignace Kabagema; Basil Asay; Jean Marie Uwitonze; Stephanie Louka; Menelas Nkeshimana; Gabin Mbanjumucyo; Luke Wolfe; Catherine Valukas; Theophile Dushime; Sudha Jayaraman

doi:10.1016/j.afjem.2020.07.015

Developing sustainable prehospital trauma education in Rwanda

Afr J Emerg Med. 2020 Dec;10(4):234-238. doi: 10.1016/j.afjem.2020.07.015. Epub 2020 Nov 2.

Affiliations

¹ Department of Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA, USA.
² Service d'Aide Medicale Urgente (SAMU), MOH, Kigali, Rwanda.
³ HCA Healthcare, Richmond, VA, USA.
⁴ Department of Emergency Medicine, Virginia Commonwealth University School of Medicine, Richmond, VA, USA.
⁵ Department of Emergency Medicine, University Teaching Hospital of Kigali (CHUK), Kigali, Rwanda.
⁶ Department of Surgery, Northwestern University School of Medicine, Chicago, IL, USA.

Abstract

Introduction: Every year, >5 million people worldwide die from trauma. In Kigali, Rwanda, 50% of prehospital care provided by SAMU, the public prehospital system, is for trauma. Our collaboration developed and implemented a context-specific, prehospital Emergency Trauma Care Course (ETCC) and train-the-trainers program for SAMU, based on established international best practices.

Methods: A context-appropriate two-day ETCC was developed using established best practices consisting of traditional 30-minute lectures followed by 20-minute practical scenario-based team-driven simulation sessions. Also, hands-on skill sessions covered intravenous access, needle thoracostomy and endotracheal intubation among others. Two cohorts participated - SAMU staff who would form an instructor core and emergency staff from ten district, provincial and referral hospitals who are likely to respond to local emergencies in the community. The instructor core completed ETCC 1 and a one-day educator course and then taught the second cohort (ETCC2). Pre and post course assessments were conducted and analyzed using Student's t-test and matched paired t-tests.

Results: ETCC 1 had 17 SAMU staff and ETCC 2 had 19 hospital staff. ETCC 1 mean scores increased from 40% to 63% and ETCC 2 increased from 41% to 78% after the course (p < 0.001 using matched pair analysis). A one-way ANOVA mean square analysis showed that regardless of the baseline level of training for each participant, all trainees reached similar post-course assessment scores, F (1) = 15.18, p = 0.0004.

Discussion: This study demonstrates effective implementation of a context-appropriate prehospital trauma training program for prehospital staff in Kigali, Rwanda. The course resulted in improved knowledge for an instructor core and for staff from district and provincial hospitals confirming the effectiveness of a train-the-trainers model. This program may be effective to support capacity development for prehospital trauma care in the country using a qualified local source of instructors.

Keywords: Africa; Education; Prehospital; Rwanda; Trauma.