Developing Sustainable Prehospital Care for NCD Emergencies in Rwanda: A Collaboration between EMS, Ministry of Health of Rwanda, and Virginia Commonwealth University

Abstract

Introduction:

Every year, 71% of all deaths globally are due to NCDs. Over 85% of these deaths occur in low- and middle-income countries (LMICs), with 36% of all reported deaths in Rwanda attributed to NCDs. Approximately 24 million lives are lost each year in LMICs due to emergency medical conditions. The collaboration between VCU and the EMS Rwanda designed and implemented a pre-hospital medical emergencies training course and train-the-trainers program to address the rise of NCDs.

Methods:

During the course, pre and post 50 assessment questions were administered. Two cohorts participated 25 prehospital staff identified by EMS to form an instructor core and 19 emergency staff from public hospitals who are likely to respond to local emergencies in the community. A two-day EMCC was developed using established best practices. The Instructor core completed EMCC 1 and a one-day educator course and then taught the second cohort (EMCC2). Student’s t-test and matched paired t-tests were used to evaluate the assessments.

Results:

Mean score on EMCC 1 was 43% (SD: 20) compared to 85% (SD: 5) on post-course assessment. Pre-assessment failure rate was 88%. Mean scores for EMCC 2 were 45% (SD: 14) and 81% (SD: 10) on post-assessment. Pre-assessment score was low (50%). A paired t-test comparing pre-course to post-course assessment means demonstrated an increase by 42% (SD 30) for EMCC 1 (p<0.001) and 37% (SD: 14) for EMCC 2 (p<0.001) with 95% confidence. No items had to be removed from analysis based on the discrimination index (di).

Discussion:

NCDs often present as emergencies such as myocardial infarction and stroke. Effective management of these in the prehospital setting is essential to optimal outcomes. This study effectively implemented a training program in Kigali, Rwanda and created an instructor core to allow scale-up of effective pre-hospital services across the country.