Dispatch in disasters - a descriptive analysis of pre-hospital surge capacity in Rwanda's Emergency medical services

Emergency medical services (EMS) are essential to mass casualty incident (MCI) response, yet there is limited data from low-resource settings, where trauma is most prevalent. In Rwanda, trauma is the most common case seen by EMS, but the burden of MCIs remains unclear. This study aimed to describe EMS response to MCIs in Rwanda and to identify factors influencing ambulance dispatch.

A retrospective analysis was conducted using the Rwandan EMS call centre registry from July 1, 2018, to September 1, 2020. MCIs were defined as incidents with ≥3 injured individuals. Univariate analysis assessed MCI occurrence and ambulance dispatch by location (urban/rural) and time (day/night). Multivariate logistic and linear regressions examined predictors of ambulance dispatch and the number of ambulances sent. Results are presented as odds ratios (OR) and regression coefficients with 95% confidence intervals.

Of 18,059 entries, 9019 (49.9%) involved trauma. In total, 173 MCIs were described, including 770 injured individuals. Most MCIs occurred in Kigali (67.1%), and were road traffic accidents (96.0%). The median number of casualties per MCI was 3 (IQR 3-4). Injuries were mainly orthopaedic (65.3%) and moderate (46.2%). Ambulances were dispatched from the central command post in 67.7% of cases, whereas emergency teams were dispatched from nearby facilities in nearly 1/3. Most patients were transported to district hospitals. EMS dispatch was significantly more likely in Kigali (OR=60.4, p < 0.01), but not influenced by casualty count (OR=0.92, p = 0.36). However, higher casualty numbers did predict more ambulances sent (p < 0.01).

Rwanda experiences approximately 6.7 MCIs monthly across all healthcare levels. EMS dispatch was more likely in Kigali, though the number of ambulances correlated with the casualty count. Future research should explore the mortality knowledge gap and pre-hospital surge strategies, including EMS-hospital team collaboration, multi-patient transport, and on-site treatment of minor injuries.