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.