| Description |
Background: Timely pre-hospital emergency care significantly improves health outcomes. One substantial challenge delaying pre-hospital emergency care is in locating the patient requiring emergency services. The goal of this study was to describe challenges emergency medical services (EMS) teams in Rwanda face locating emergencies, and explore potential opportunities for improvement. Methods: Between August 2021 and April 2022, we conducted 13 in-depth interviews with three stakeholder groups representing the EMS response system in Rwanda: ambulance dispatchers, ambulance field staff, and policymakers. Semi-structured interview guides covered three domains: 1) the process of locating an emergency, including challenges faced; 2) how challenges impact pre-hospital care; and 3) what opportunities exist for improvement. Interviews lasted approximately 60 minutes, and were audio recorded and transcribed. Applied thematic analysis was used to identify themes across the three domains. NVivo (version 12) was used to code and organize data. Results: The current process of locating a patient experiencing a medical emergency in Kigali is hampered by: a lack of adequate technology, a reliance of local knowledge of both the caller and response team to locate the emergency, and the necessity of multiple calls to share location details between parties (caller, dispatch, ambulance). Three themes emerged related to how challenges impact pre-hospital care: increased response time, variability in response time 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 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 lowresource settings, there is an urgent need to implement locally relevant solutions to improve the timely location of emergencies. |
