NIHR RIGHT 4: A Communications platform to improve pre-hospital transport of injured people in Rwanda A UK and low-and-middle-income-country (LMIC) partnership that aims to improve the management of pre-hospital transport for injured people in
Rwanda. In Rwanda, injury causes 9% of deaths; 47% of these deaths happen before the patient has reached hospital. Similar to many LMICs, Rwanda experiences long delays in getting patients to a hospital which is suitable to treat their injuries, with all communication between patients, ambulances, and hospitals done using multiple phone-calls. In this project, we will develop and test Rwanda912, a novel electronic communication tool for use in ambulances in low resource settings. Rwanda912 uses an ambulance Destination Decision Support Algorithm (DDSA) which matches injured patients with the nearest hospital that can treat their injuries. It does this based on information from hospitals on availability of staff and equipment, and from the ambulance crew on patient status. In collaboration with the Rwandan Ministry of Health, Rwandan ambulance services, and local and international academics, this project will test whether Rwanda912 reduces time from injury to arrival at hospital and improves clinical outcomes such as death, length of stay in hospital, and need for an intensive care unit. Our study will be done in one urban and one rural setting. The aim of the study is to improve the management of pre-hospital transport for injured people in Rwanda. The objectives of the study are as follows;
1. Finalise development of Rwanda912’s Ambulance Destination Decision Support Algorithm (DDSA) and user interfaces. The Rwanda912 concept has been designed and the initial version approved for rapid development to give a testable prototype. The basic software foundations for this prototype has been developed in another grant, funded by the US National Institute of Health. In this NIHR grant, the prototype will be iteratively improved by repeated user testing until a final Rwanda912 product, that accurately matches patients with facilities, is ready for implementation.
2. Develop training materials and train staff to use the Rwanda912 app. This will occur in 2 stages. The first stage is the rapid development of training materials. The second stage is the delivery of training and user testing.
3. Do mock field-trials and roll out the intervention to ensure the app will work well under “real world” conditions, Rwanda912 will be tested under controlled conditions in the field during mock trauma scenarios using dummy patients (actors who will act
out different injury scenarios) at different locations in the study sites. The complete pathway from calling for an ambulance to arriving at a facility will be tested.
4. Testing the application in the real world. We will collect baseline data on time that injured patients take to get to hospital and other study outcomes (like death, length of stay in hospital, and admission to the intensive care unit) for a period of over one1 year, whilst objectives 1-3 are being completed. This data collection will be done in both the rural and urban site. We will compare outcomes from after deployment of Rwanda912 to those collected before deployment of Rwanda912. This comparison will show us whether Rwanda912 has improved outcomes.
5. In addition to the outcomes mentioned above, we will also collect information which will help us to find out why Rwanda912 worked or didn’t work. These “implementation outcomes” will include costs, acceptability, and use of the Rwanda912 app.