Ambulance crews in Rwanda’s capital city could save more lives with the launch of a unique electronic system that could speed hospital transfers - reducing the likelihood of people dying unnecessarily from injuries caused by road traffic crashes, accidents, or violence, as well as other emergency condition.
The system is potentially revolutionary in low-resourced settings, such as countries in the Global South - using a single software system to enable faster location of the patient, guidelines-based assessment of their condition, and selecting the nearest facility that can treat their condition.
The first phase of 912Rwanda is rolled-out in Kigali and has been operational on nearly 4,000 journeys; it allows ambulance teams to locate patients quickly in areas where smartphone penetration and triangulation off cell phone masts is not possible.
The readiness of our programme also comes at a time when politicians in Rwanda have recognised that the numbers of people dying after injuries is in excess of what it should be and that ambulance services need to be more efficient.
Professor Justine Davies - University of Birmingham
Building on the successful launch of its first phase in late 2023, a second phase introduces an innovative Destination Decision Support Algorithm (DDSA). This promises to transform patient outcomes in critical situations with advanced logic ensuring a quick and accurate decision of which facility is the best match for the patient to be transported to.
Given issues faced in Rwanda are like those seen in other low-resourced settings, the system could help save lives in developing countries across the world, including in areas of conflict.
In many low- or middle-income countries, high housing density and poorly mapped streets challenge ambulance crews to quickly locate patients. Added to this, where resources are low, ambulance staff often lack experience in recognizing patient’s medical needs and facilities have varying supplies of staff or equipment. Meaning that, even when found, matching the patient to the facility that can treat their condition is difficult.
The 912Rwanda solution contains not only maps bespoke to Kigali, but an electronic decision support tool for ambulance staff to recognize the severity of patients, and an algorithm to match their severity with the facility which – on that day – has the staff and equipment to treat them.
This programme is backed by more than £3 million funding from the UK’s National Institute for Health and Care Research (NIHR) Research and Innovation for Global Health Transformation (RIGHT) programme and nearly $1 million from the United States National Institute of Health.
Universities of Birmingham, Rwanda, and Utah researchers partnered with colleagues at the Ministry of Health, local software firm Rwanda Build Program (RWBuild) and the Universities of Global Health Equity, York, and Aberdeen to develop, deploy, and evaluate the 912Rwanda system.
Justine Davies, Professor of Global Health Research at the University of Birmingham, and co-Principle Investigator of the NIHR funded project, commented: “Each one of these phases - finding the patient and then finding the right facility for that patient - is likely to dramatically reduce the time it takes for emergency patients to get to treatment at a hospital; in emergency care, minutes saved equals lives saved.
“The readiness of our programme also comes at a time when politicians in Rwanda have recognised that the numbers of people dying after injuries is in excess of what it should be and that ambulance services need to be more efficient.”
The 912Rwanda software and project has already had phenomenal success due to buy-in from the very highest leaders in the government of Rwanda as they look to transform their country into a leading power in the region and envision this work being an important part of that future.
Professor Sudha Jayaraman - University of Utah
Injuries in LMICs are common and their number is expected to increase, but death and disability after injury can be substantially reduced if people reach healthcare facilities in a timely manner.
Professor Sudha Jayaraman, Principal Investigator of the NIHR funded first phase of the project and Director of the Center for Global Surgery at University of Utah stated: "The 912Rwanda software and project has already had phenomenal success due to buy-in from the very highest leaders in the government of Rwanda as they look to transform their country into a leading power in the region and envision this work being an important part of that future.
“We are privileged and excited to partner with the leadership of Division of Emergency Medical Services, Dr Nepo Sindikubwabo and Mrs Jeanne d’Arc Nyinawankusi, as they create an international role model for such systems."
Dr Nepo Sindikubwabo agrees: “Our emergency medical service teams are happy to have helped design and implement the 912Rwanda software and look forward to the next steps of creating a coordinated system across all of our hospitals in Kigali city and expanding across to other parts of the country.”
Jean Claude Byiringiro, Associate Professor of Surgery and Former Dean of the School of Medicine and Pharmacy at University of Rwanda said: “We believe that the programme can make a significant impact in Rwanda, reducing the time it takes to get injured patients to hospital. Importantly, the project could play a key role in developing similar solutions in countries facing the same sort of problems.”
Rob Rickard, Director of Rwanda Build Program, highlighted the technical advancements in the project, stating, "Incorporating DDSA into 912Rwanda introduces a pivotal shift towards more precise and time-efficient emergency responses ensuring a decision of the facility is instant and accurate. Our collaborative efforts are setting new benchmarks in the realm of healthcare technology; the success of this project comes from the strength of all the partners dedication and the support of the SAMU division within the Ministry of Health and Rwanda Biomedical Center.”
Every year in Rwanda, injury causes 9% of deaths with 47% of these occurring before patients can reach hospital. Like many Low- and Middle-income Countries (LMIC), Rwanda experiences lengthy delays in getting patients to hospital as all communication between patients, ambulances, and hospitals are done using multiple phone-calls.
