Collaboration for preliminary design of a mobile health solution for ambulance dispatch in Rwanda
Authors:   Division of Acute Care Surgery, Department of Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA, USA, Rosenberg Ashley , Rickard Rob ,   RwandaBuild, Kigali, Rwanda, Uwinshuti Fraterne Zephyrin ,   Service d’Aide Medicale Urgente, Rwanda Ministry of Health, Kigali, Rwanda, Mbanjumucyo Gabin ,   Department of Emergency Medicine, University Teaching Hospital of Kigali, Kigali, Rwanda, Nkeshimana Menelas ,   Department of Emergency Medicine, University Teaching Hospital of Kigali, Kigali, Rwanda, Uwitonze Jean Marie ,   Service d’Aide Medicale Urgente, Rwanda Ministry of Health, Kigali, Rwanda, Kabagema Ignace ,   Service d’Aide Medicale Urgente, Rwanda Ministry of Health, Kigali, Rwanda, Dushime Theophile ,   Service d’Aide Medicale Urgente, Rwanda Ministry of Health, Kigali, Rwanda, Jayaraman Sudha ,   Division of Acute Care Surgery and Program for Global Surgery, Department of Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
Published: December 2020

The first 60 minutes after a trauma are described as “the golden hour.” For each minute of prehospital time, the risk of dying increases by 5% (Sampalis et al., 1999). Since 90% of the global burden of injuries occur in low- and middle-income countries and lead to 5.8 million deaths annually, addressing rapid access to emergency services is critical in these settings (Nielsen et al., 2012). In most low- and middle-income countries (LMICs), there are no formal trauma systems, and many lack organized prehospital care (Nielsen et al., 2012). Emergency medical dispatch and communication systems are a foundational component of emergency medical services (World Health Organization, 2005). Yet there are no established recommendations of creating these systems inLMICs.Rwanda, a country of over 12 million people, is a rapidly developing leader in East Africa. The Ministry of Health of Rwanda established the Service d’Aide Medicale Urgente (SAMU) in 2007, recognizing the need for public emergency medical services. SAMU’s national dispatch center receives roughly 3,000 calls per month through a national 912 hotline. It organizes regional transportation with 260 total ambulances located at hospitals throughout the country and provides prehospital emergency services in the capital city of Kigali with a fleet of 12 ambulances. In the city, each ambulance has a driver, nurse and anesthetist dispatched for every call. Emergency department nursing and anesthetist staff are dispatched from hospitals around the country to respond to regional emergencies. No formal prehospital cadre of the workforce exists although the SAMU staffhave extensive field experience in prehospital care. SAMU has several challenges to rapid prehospital emergency care including lack of addresses beyond the capital city, unclear location data in densely populated areas, complex communication processes with little information about health facility capacity, and no established electronic dispatch system. The average response time for SAMU ambulances was 59 minutes in 2018, but 39% of calls were not completed within the golden hour.