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Mass casualty training for prehospital and emergency providers in Kigali, Rwanda: a quasi-experimental pre-post
Oriane Longerstaey1, Rafael Davis2, William Mullen2
1Department of Emergency Medicine, The Warren Alpert School of Medicine of Brown University, Providence, RI, USA.
Background:
A mass casualty incident (MCI) occurs when the number of patients exceeds available healthcare resources, placing significant strain on prehospital and facility-based emergency care systems, particularly in low- and middle-income countries (LMICs). An effective response to MCIs requires coordinated systems, targeted training, and clear communication across all levels of care. Although Rwanda experiences both natural and man-made disasters, formal training in mass casualty management for healthcare workers remains limited.
Methods:
A two-part mass casualty training curriculum was developed for emergency physicians, nurses, paramedics, and community first responders in Kigali, Rwanda. The program combined asynchronous video-based modules with a half-day, simulation-based skills training. Participants completed a knowledge, attitudes, and practices (KAP) assessment prior to training, immediately after the simulation, and at 3- and 6-month follow-up intervals. Pre- and post-training scores were analyzed to assess changes in knowledge, confidence, and practices using tests of statistical significance.
Results:
A total of 41 participants representing multiple levels of training completed the program during 2022. Most participants were male and aged 25-44 years, with limited prior experience in mass casualty management. Mean test scores increased significantly following the simulation and remained higher than baseline at 3- and 6-month follow-up. Participants also demonstrated significant improvements in confidence across key MCI-related skills.
Conclusion:
This pilot study demonstrated that a multimodal mass casualty training curriculum was associated with improvements in knowledge and confidence among healthcare workers and community first responders in Kigali, Rwanda. These findings suggest the curriculum may be a promising approach to strengthening MCI preparedness in similar settings. Further studies with larger sample sizes are needed to validate its effectiveness and assess generalizability.
