56 Challenges Locating the Scene of Emergency: A Qualitative Study of the EMS System in Rwanda

Faculty Mentor: Sudha Jayaraman (Surgery, University of Utah)

Introduction: Efficient pre-hospital emergency care can significantly improve healthcare outcomes. One significant challenge that contributes to inefficiency in pre-hospital care is difficultly locating the patient requiring emergency care. The goal of this study was to describe challenges emergency medical services (EMS) teams face in Rwanda locating emergencies, and to explore potential opportunities for improvement.

Methods: Between August 2021 and April 2022, we conducted 21 in-depth interviews with four stakeholder groups representing the EMS response system in Rwanda: ambulance dispatchers, ambulance field staff, receiving hospital staff, and policymakers. Semi-structured interview guides covered participants’ perspectives on the challenges EMS systems face in locating an emergency, how challenges impact quality of pre-hospital care, and what opportunities exist for process and tool development. Interviews lasted 30-90 minutes each, and were audio recorded and transcribed. Applied thematic analysis was used to identify themes across three domains: the process of locating an emergency, impacts of challenges, and opportunities for processes and tools. NVivo (version 12) was used to code and organize data.

Results: The current process of locating a patient experiencing an emergency in Kigali is hampered by a lack of supportive technology, depends on knowledge of both the caller and the response team to locate the emergency, and requires multiple calls to share location details between parties (caller, dispatch, ambulance). Three themes emerged related to the impact of challenges in locating an emergency: increased time response, inconsistencies in response based on both the caller and dispatcher staff’s individual knowledge of the area, and inefficient communication between the caller, dispatch, and ambulance. Three themes emerged related to opportunities for processes and tools to improve the location of emergencies: technology to geolocate an emergency accurately and improve time response, improvements in communication to allow for real-time information sharing, and better location data from the public.

Conclusion: This study has identified challenges faced by the EMS system in Kigali, Rwanda in locating emergencies and identified opportunities for intervention. Timely EMS response is essential for optimal clinical outcomes. As EMS systems develop and expand in low-resource settings, there is an urgent need to implement locally relevant solutions to improve the efficient location of emergencies.