Use of an innovative electronic communications platform (912Rwanda) to improve prehospital transport of injured people in Rwanda: protocol for a type 2 hybrid effectiveness-implementation interrupted time series study

Introduction Injury is a major cause of death in Rwanda, with many deaths occurring before hospital admission. Timely transport of injured patients to appropriate hospitals is crucial, ideally within an hour for severely injured patients. However, delays in reaching treatment facilities are common, with ambulance
services using inefficient mobile phone communication. This project aims to evaluate the effectiveness and implementation of an innovative electronic
communication platform (912Rwanda).

Methods and analysis The study will be conducted through the public ambulance service, Service d’Aide Médicale d’Urgence (SAMU), and receiving
health facilities in Kigali city and Musanze district in Rwanda. The 912Rwanda intervention will be rolled out in the two locations at different times.
The primary effectiveness outcome is the time from ambulance deployment to patient arrival at the health facility. Secondary effectiveness outcomes
include disaggregated times of the primary outcome and clinical outcomes, such as length of stay and
requirement for intensive care. These outcomes will be evaluated using an interrupted time series analysis, accounting for non-homogeneous variances,
auto-regressive errors and non-linear trends where appropriate. Implementation outcomes will be evaluated using the Reach, Effectiveness, Adoption,
Implementation, Maintenance (RE-AIM) Qualitative Evaluation for Systematic Translation (QuEST) framework. Cost-effectiveness will be evaluated using
a cost-consequence analysis with consequences as determined by the interrupted time series analysis.