Lived Experiences of Prehospital Care Among Road Traffic Accident Survivors in Rwanda: A Qualitative Descriptive Study

Lived Experiences of Prehospital Care Among Road Traffic Accident Survivors in Rwanda: A Qualitative Descriptive Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Lived Experiences of Prehospital Care Among Road Traffic Accident Survivors in Rwanda: A Qualitative Descriptive Study Liberatha RUMAGIHWA, Priscille Musabirema, Gerard Urimubenshi, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8965241/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 18 Apr, 2026 Read the published version in BMC Emergency Medicine → Version 1 posted 11 You are reading this latest preprint version Abstract Introduction Globally, road traffic accidents(RTAs) are reported as a major cause of death and disability in low- and middle-income countries(LMICs). Although effective prehospital care can reduce these outcomes, such services remain insufficient in many LMICs. Improving prehospital care requires an understanding of RTA survivors’ experience, which is the aim of this study. Methods A qualitative descriptive study with purposive sampling explored RTA survivors’ experience of prehospital care. A sample size of eighteen participants from urban and rural hospitals was determined by data saturation. Semi-structured, face-to-face interviews were conducted in August 2025 using an interview guide written in Kinyarwanda. Interviews were audio-recorded, transcribed verbatim, and analyzed thematically using ATLAS.ti 24. Results Three main themes emerged from participants’ experiences. First, community awareness, encompassing activation of emergency services, bystander first aid, and post-RTA decision-making, highlighted both the potential and limitations of community involvement. Second, ambulance availability and response time revealed frequent delays and unavailability of ambulances. Third, professional prehospital care, including care provided at the scene, during transport, and decisions regarding the receiving health facility, varied in quality and consistency across cases. Conclusion Insights from RTA survivors’ experiences indicate that Rwanda’s prehospital emergency care is constrained by delays in seeking and receiving care, particularly in rural settings. Policymakers should consider these findings when designing strategies to ensure equitable and sustainable prehospital services. Qualitative research patient’s experience Emergency medical services prehospital care road traffic accidents survivors Rwanda Figures Figure 1 Introduction The mortality rate from road traffic accidents (RTAs) is a major worldwide public health concern. Approximately 1.19 million people die globally in traffic accidents each year, with 92% of these deaths occurring in low- and middle-income countries (LMICs); additionally, 20–50 million people suffer non-fatal injuries, which disproportionately affect men and people in economically productive age groups[ 1 ]. Furthermore, projections indicate that by 2030, global RTA deaths could rise by 30%, reaching 1.85 million annually, possibly making RTAs the seventh leading cause of death worldwide[ 2 ]. Africa has the highest rate of traffic fatalities, with about 26.6 deaths per 100,000 people[ 3 ]. Despite Africa having only 3% of all global vehicles, it accounted for 225,482 deaths in 2021, representing 19% of fatalities worldwide[ 4 ]. Cyclists and pedestrians are vulnerable road users and account for 44% of all global RTA deaths [ 2 , 5 ]. The burden is especially severe in Sub-Saharan Africa, where children and young adults are disproportionately affected. In Rwanda, a sub-Saharan African nation, the number of RTA nearly doubled from 5,611 in 2018 to 10,334 in 2022 (NISR, 2023). Most of the patients transported by ambulances in Rwanda presented with RTA related injuries[ 6 ]. Additionally, over half of deaths occurred before arrival at the hospital[ 7 ]. Traffic-related orthopedic injuries cause significant disability and reduce functioning[ 8 ]. Appropriate prehospital care, can prevent many RTA related deaths and injuries. Prehospital emergency care (PHEC) includes medical treatment provided before arriving to emergency department[ 2 , 9 ]. WHO emphasizes that immediate medical care and transportation save lives, reduce disability, and improve long-term outcomes[ 10 ]. Trauma patients who receive early care have higher survival rates and better functional outcomes [ 9 ]. Despite its proven benefits, PHEC remains fragmented, underfunded, poorly standardized and understaffed, resulting in delays and reliance on private transportation and poor patient’s outcomes [ 10 – 14 ]. In Rwanda, PHEC has been provided for the nearly two decades in urban and rural areas; however little is known about the RTA survivor’s experience with PHEC. Therefore, this study aims to explore RTA survivors’ experience of prehospital care. Aim, Design and study settings This study used a qualitative descriptive design to explore the prehospital experiences among RTA survivors in Rwanda. Qualitative description is a strong methodological approach for healthcare designers, practitioners, and researchers, as it generates detailed, participant-driven accounts of their experiences[ 15 ]. The study was conducted at Centre Hospitalier Universitaire de Kigali (CHUK) from urban and Ruhengeri Level 2 Teaching Hospital (RL2TH), from rural areas. Among Rwanda's four referral hospitals in the urban area, CHUK is the main public and referral teaching hospital with a variety of special care services, receiving numerous trauma patients from across the country at its emergency department[ 16 ]. Statistics of Service d’aide medicale d’urgence (SAMU), which is the main prehospital service provider in Rwanda, demonstrated its patient flow capacity, as nearly half (42.5%) of the 92% of road traffic accident patients evacuated following motorcycle-related RTAs were transported to CHUK, Rwanda's largest trauma center[ 17 ]. RL2TH is administratively located in Musanze, the most populous district in the northern province, with a population density of 1157 people per square kilometer, and is classified as rural area[ 18 ]. Furthermore, the Northern Province, where Musanze is located, was identified in the SAMU strategic plan as a location with mountainous terrain and limited infrastructure such as roads and bridges, limiting ambulance access in rural regions[ 19 ]. Figure 1 depicts study settings across Rwanda. Sample size, sampling strategy, and period This study included 18 adult survivors of RTAs from both urban and rural settings in Rwanda. The sample size was determined using qualitative research approaches, which emphasize depth over breadth, and data saturation occurred when no new insights surfaced during interviews[ 20 ]. Purposive sampling was used to recruit participants who were 18 years or older, conscious post RTA, sustained RTA within the previous one to three months, and still hospitalized at CHUK or RL2TH during data collection period. Accident locations were also considered either Kigali city(urban) or Musanze district(rural) in order to capture variation in experiences related to geographic context. The data were collected from August 7th to August 28th, 2025. Data Collection Procedures The interview guide was developed in English with input from qualitative research experts. It was then translated into Kinyarwanda and piloted with two RTA survivors hospitalized at CHUK to refine the tool before data collection for the study. Face to face interviews were conducted at the patient's bedside at a time that was convenient for each participant. Written informed consent was obtained before participation. Surrounding curtains were closed to ensure privacy, confidentiality and minimize interruptions during the interview. All interviews were audio recorded and then uploaded to the lead researcher's secure personal computer for verbatim transcription and translation back into English. Each interview with participants lasted 10 to 15 minutes. Data Analysis and Trustworthiness Transcribed data were loaded into ATLAS.ti version 24 and analyzed thematically following Braun and Clarke’s six-step approach [ 21 ]; to discover main themes and sub-themes. The analysis followed an iterative process that involved repeated reading of the transcripts for familiarization, generating initial codes, grouping similar codes to develop themes inductively, and identifying and addressing any overlap. To establish trustworthiness in this study, we ensured data credibility, dependability, confirmability, transferability, and reflexivity [ 22 ]. Credibility was established by asking participants to clarify and elaborate on their responses during the interviews, ensuring that the lead researcher understood their experiences correctly. Furthermore, the lead researcher had sufficient opportunity to interact with participants and observe their verbal communication. The lead researcher kept an audit log of all coding decisions, theme development, and interpretation adjustments throughout time to ensure dependability. Additionally, the same interview guide and the same interviewer used for all participants[ 15 ]. Peer debriefing was conducted through regular talks within the study team, which included local and international experts, to challenge assumptions and explore alternate interpretations, hence increasing confirmability. To facilitate transferability, detailed descriptions of participants' experiences and the context of care were provided. Reflexivity was maintained during the study through journaling, memo writing, and team reflection, allowing researchers to evaluate how their own experiences, attitudes, and viewpoints can influence interpretation while maintaining participants' voices at the forefront. Results Participant Characteristics A total of 18 participants were included in the study. Most participants were aged 18–45 years, while two were 46 years or older. The sample was predominantly male. Most participants had attended primary school, a smaller number had completed secondary education, and only a few had pursued higher education. Motorcyclists were predominant, followed by bicyclists, pedestrians, and lastly car drivers. (Table 1 summarizes participant characteristics.) Table 1 Participants’ characteristics Demographic Description Frequency Percentage Age(years) 18–45 16 88.8 ≥ 46 2 11.1 Gender Male 17 94.4 Female 1 5.5 Education level At least primary school attended 10 55.5 Secondary school 6 33.3 Higher education 2 11.1 Categories of road users Motorcyclists 8 44.4 Bicyclists 5 27.7 Pedestrians 3 16.6 Car drivers 2 11.1 Community Awareness Participants showed mixed awareness of the national ambulance service. While few participants agreed that they knew the universal access number, “ Yes, I know it, 912 ” (P14, urban), others were confusing it with other numbers or totally acknowledged that they do not know it, “Not sure if it is 111 , is it correct ?” (P 15, urban), I do not know the number to call (P18, rural). Some participants thought that only Rwanda National Police officers are the ones to activate ambulances. “ I thought it was only the traffic police who should call ambulances” (P17, rural); and some of the calls were made by police officers, as this participant affirms, “A police officer called an ambulance; he was directing lights as traffic lights were off. (P6, urban). Some participants inform their family members immediately after having a RTA without notifying prehospital services first: “ I asked another motorcyclist to call my mother and brother, who is also a motorcyclist .” (P16, Urban). Fear of delays often obliged some participants to look for another means of transport. “ I thought the easiest thing was to come immediately to the hospital… waiting for an ambulance could take too long ” (P7, urban). Some participants received care immediately post-RTA, and others did not. One participant was helped by a knowledgeable bystander: “He said that he had knowledge and skills from Rwanda Red Cross trainings” ( P16, urban), and another said, “ People nearby helped me immediately; one even stopped the bleeding using a cloth .” (P1, urban). Several participants did not receive any help: “ Nothing was done for me; I might have died” (P5, urban). In rural areas, participants also shared that nothing was done by those who were surrounding the scene: “ No, nothing was done” (P 17, rural). One participant said that the taxi that hit them, immediately took them to RL2TH without activating an ambulance: “The taxi that hit us immediately took us to Ruhengeri level two teaching hospital ”(P18,rural). Ambulance availability and response time Participants stated diverse experiences regarding the time it takes an ambulance to reach on the scene of accident. “The ambulance arrived first in less than 10 minutes” (P1, urban). “Right after the accident, once the vehicle had overturned, we stayed there for about 20 minutes. ( P17, rural ) . For some cases, there was an extended time for the ambulance to reach to the RTA scene, “Ambulances take long to reach accident victims; I had the accident at 2:30 a.m., the ambulance reached me at 3:30 a.m.” (P 13, urban). Participants identified ambulance shortages or prioritizing issues as factors contributing to delays. For example, one participant shared; “The ambulance personnel told us that, the ambulance was far, and my fellow motorcyclist took me to the hospital” (P5, urban); while another shared “one ambulance came, and they saw that my case was not as severe as others, and advised me to take a motorcycle to CHUK” (P 6, urban). Professional prehospital care Participants expressed diverse experiences with prehospital care provided at the scene and during transport. Some benefited from professional prehospital care stating “ The ambulance staff gave me IV fluids and applied protection to my legs until we reached the emergency department” (Participant 2, urban). Whereas others did not receive prehospital care, “ No, they just put me in the ambulance and brought me ” (P 17, rural). Another participant added, “In the ambulance? No, they did not provide additional care” (Participant 11, urban). Some participants received care during transport, “They treated me while we were on the way. They continued giving me treatment for pain” (Participant 1, urban). Participants also shared their experiences regarding the choice of receiving facility by health care providers and its impact on recovery time. “ I was supposed to be brought to CHUK, but the beds were full, so they ended up taking me to Nyarugenge District Hospital (P 16, urban). Another participant added, “ I was at the emergency department of Ruhengeri hospital. They told me my back was broken”. If they had referred me right away to the right place, I could have received surgery and perhaps recovered faster(P17 , rural). Table 2 presents a summary of the main themes and sub-themes identified through thematic analysis of interviews with road traffic accident survivors, along with their operational definitions to clarify the meaning and scope of each sub-theme. Table 2 Summary of main themes, sub-themes, and their definitions Main Theme Sub-themes Definitions Community awareness Activation of emergency services This sub-theme refers to different actions taken by injured individuals or bystanders to initiate contact with formal prehospital care systems. Provision of first aid This sub-theme refers to the care provided to injured individuals at the scene of a road traffic incident before the arrival of formal emergency services. Decision-making post-RTA This sub-theme indicates choices made by injured individuals or bystanders immediately after a road traffic accident, including whether to seek help, whom to contact, how urgently to act, and what steps to take before emergency services arrive. Ambulance availability and response time Delayed ambulances This sub-theme describes the period between when a road traffic accident occurs and when suitable help reaches the scene Unavailability of ambulance This sub-theme refers to situations in which ambulances were not readily available when needed after a road traffic accident. Professional prehospital care Immediate care at the scene This sub-theme refers to the initial assistance provided to injured individuals at the site of a road traffic accident by prehospital care providers Care during transport This sub-theme refers to different procedures which were provided to RTA survivors on the way to the receiving facility. Choice of receiving facility The sub-theme refers to decisions made by prehospital care providers to choose the right receiving health facility. Discussion This study explored the lived experiences of RTA survivors in Rwanda. Three main themes emerged: community awareness, ambulance availability and response time, and professional prehospital care. The majority of participants were male and between 18 and 45 years old, with most having a primary education level. Motorcyclists and bicyclists accounted for most injuries, followed by pedestrians and car drivers. These findings align with regional evidence showing that young adult males using two-wheeled vehicles are disproportionately affected by RTAs in Rwanda and across sub-Saharan Africa[ 6 , 7 , 23 , 24 ]. Increasing awareness of accident prevention and teaching first aid among this vulnerable population may contribute to accident reduction and faster response post RTA. The findings of our study evidenced limited community awareness of first aid and the universal access number as a persistent barrier. Unawareness of the ambulance universal access number was previously shown by [ 25 ], who revealed that 67.8% of the Rwandan population was unaware of the 912 EMS number. These findings demonstrate the critical need for providing public first aid and increasing awareness of 912 universal access number to guarantee prompt prehospital care activation and quick interventions post RTA in Rwanda. Many participants reported that bystanders hesitated to provide first aid due to lack of training fear of causing harm, a finding that is supported by previously conducted studies in LMICs [ 26 ]. Untrained bystanders could unintentionally worsen injuries, or lack empathy during care and inadequately stabilized victims[ 27 – 29 ].Sociocultural barriers further hindered immediate care by laypersons[ 23 ]. Expanding first responder community programs that address social culture influence could improve the timeliness and quality of prehospital care. Participants verbalized delayed or absent ambulance response, often resulting in reliance on alternative means of private transport. These challenges mirror widespread EMS shortages and delays described in LMIC literature[ 11 – 13 , 23 ]. Timely response is critical for trauma survival; addressing ambulance scarcity remains a core priority. Care provided on the scene and during transport varied widely. Some participants received splinting, wound care, pain management, and IV fluids, while others reported minimal or no treatment. Pain management, in particular, was frequently inadequate. Similar inconsistencies in prehospital care have been reported in LMIC studies, which highlight equipment shortages and training gaps [ 11 , 29 , 30 ]. Previous evidence shows that effective prehospital analgesia significantly improves patient comfort and reduces pain severity upon hospital arrival[ 31 ]. Provision of training for prehospital care providers and enough medication in ambulances would be a solution to this gap. Though the study revealed the strengths and gaps in Rwanda’s prehospital care, some limitations should also be acknowledged. Inclusion of only adult survivors of road traffic accidents who were conscious may have excluded the perspectives of more severely injured individuals, unconscious patients, or younger victims. Moreover, venue for interviews could have affected the patient’s privacy and confidentiality. Underrepresentation of rural areas reflects an important contextual challenge, as it was indicated that 59.3% of deaths occur at the community level in rural areas compared to 38% in urban areas[ 32 ]. Conclusion Despite current findings, persistent gaps remain in community awareness, ambulance availability and response times, and the quality of care provided at the scene and during patient transport. To strengthen strategies for equitable and sustainable prehospital care, policymakers responsible for emergency services in Rwanda should consider the above gaps revealed by participants of this study. Future studies should explore additional factors contributing to prehospital deaths and long-term disabilities following RTAs. Declarations Ethics approval and consent to participate This study was conducted in accordance with the principles of the Declaration of Helsinki and received ethical approval from the University of Rwanda Institutional Review Board (Approval No. 585/CMHS IRB/2025), the Ethics Committee of CHUK (Approval No. EC/CHUK/116/2025), and the RL2TH (Approval No. 918/RL2TH/DG/2025). Written informed consent was obtained from all participants, who were free to withdraw at any time. Confidentiality was ensured through the use of unique participant codes, with no personal identifiers recorded. Eligible participants were conscious road traffic accident survivors who had been hospitalized for one to three months. The study findings aim to inform improvements in prehospital care in Rwanda and similar contexts. Consent for publication A consent for publication is not applicable for this manuscript. Competing interests The authors declare no competing interests. Funding This study is part of PhD studies that are funded by the Rwanda Right 912 project. The funding had no influence on the study design, data interpretation, or conclusion drawn. Author Contribution LR contributed to the conception and methodology of the study under the guidance of PM, GU, IC, and JCB. LR also contributed to data collection and data analysis with guidance from PM, GU, IC, and JCB. All authors (LR, PM, GU, IC, and JCB) critically reviewed the manuscript. Acknowledgments The authors extend their sincere gratitude to the leaders of CHUK and RL2TH for fruitful collaboration during data collection. The Rwanda Right 912 project is also acknowledged for funding this study as part of PhD studies. Prof. Jeanne B. Jenkins for her editorial contribution to this manuscript. Data Availability The qualitative datasets generated and analyzed during the current study are not publicly available due to ethical restrictions and the sensitive nature of the interview data, which may compromise participant confidentiality. Data may be made available from the corresponding author upon reasonable request. References WHO. (2023) Global status report on road safety 2023. https://iris.who.int/bitstream/handle/10665/375016/9789240086517-eng.pdf?sequence=1 accessed on August 2025. World Bank. (2021) The State of Emergency Medical Services in Sub-Saharan Africa. State Emerg Med Serv Sub-Saharan Africa. https://doi.org/10.1596/35175 accessed on July 2025 https://doi.org/10.1596/35175 Africa development bank group. 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Cite Share Download PDF Status: Published Journal Publication published 18 Apr, 2026 Read the published version in BMC Emergency Medicine → Version 1 posted Editorial decision: Revision requested 26 Mar, 2026 Reviews received at journal 22 Mar, 2026 Reviewers agreed at journal 17 Mar, 2026 Reviews received at journal 15 Mar, 2026 Reviewers agreed at journal 13 Mar, 2026 Reviewers agreed at journal 07 Mar, 2026 Reviewers invited by journal 06 Mar, 2026 Editor invited by journal 03 Mar, 2026 Editor assigned by journal 28 Feb, 2026 Submission checks completed at journal 28 Feb, 2026 First submitted to journal 25 Feb, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8965241","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":603716270,"identity":"a3d827dc-d5fb-49e6-a5d5-c010f0bfb590","order_by":0,"name":"Liberatha RUMAGIHWA","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA0ElEQVRIiWNgGAWjYBACPijNY8DAwPiAKC1sSFqYDUjSwgBUziZBpBbeZ1I3amplzCWSn1Xz7mGQ52/gfYZXLxsDu5l0zrHjPJYz0sxu8zxjMJxxgN2MgBY2NukctmM8BrcTgFoOMDBuAIrcIKzlH0hL+rdioBZ74rTkttUAteSYMQO1JBLWwszGbJ3bd4DH4P6bYsk5BySSZxxmY/+BTws/exvj7ZxvdfYGZ45v/PDmgI1tf3sbgQhiBpOHYVwJmAhBUEecslEwCkbBKBiZAAA4Rzpv4jxCiAAAAABJRU5ErkJggg==","orcid":"","institution":"University of Rwanda","correspondingAuthor":true,"prefix":"","firstName":"Liberatha","middleName":"","lastName":"RUMAGIHWA","suffix":""},{"id":603716274,"identity":"d697106b-a47a-411c-ba24-a6a017e68105","order_by":1,"name":"Priscille Musabirema","email":"","orcid":"","institution":"University of Rwanda","correspondingAuthor":false,"prefix":"","firstName":"Priscille","middleName":"","lastName":"Musabirema","suffix":""},{"id":603716276,"identity":"61ca6a3a-da91-4bb4-8636-3609e4ead793","order_by":2,"name":"Gerard Urimubenshi","email":"","orcid":"","institution":"University of Rwanda","correspondingAuthor":false,"prefix":"","firstName":"Gerard","middleName":"","lastName":"Urimubenshi","suffix":""},{"id":603716277,"identity":"54dcbf54-c480-47cd-b9bb-cfa8c62a083f","order_by":3,"name":"Isabelle Coetzee-Prinsloo","email":"","orcid":"","institution":"University of Pretoria","correspondingAuthor":false,"prefix":"","firstName":"Isabelle","middleName":"","lastName":"Coetzee-Prinsloo","suffix":""},{"id":603716279,"identity":"8fd24f59-0f3d-436f-a4ad-0227cabecfdc","order_by":4,"name":"Jea Claude Jean Claude Byiringiro","email":"","orcid":"","institution":"University of Rwanda","correspondingAuthor":false,"prefix":"","firstName":"Jea","middleName":"Claude Jean Claude","lastName":"Byiringiro","suffix":""}],"badges":[],"createdAt":"2026-02-25 08:38:28","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8965241/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8965241/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12873-026-01588-7","type":"published","date":"2026-04-18T15:59:32+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":104413761,"identity":"61f73592-ee24-4a7b-8934-5e23e28276b5","added_by":"auto","created_at":"2026-03-11 13:05:25","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":178379,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eStudy settings\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8965241/v1/42463a8130df1bd57b54ee06.jpeg"},{"id":107350839,"identity":"2195ef82-a4f6-445c-8c66-618e483235a3","added_by":"auto","created_at":"2026-04-20 16:05:32","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":452117,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8965241/v1/b0a56d59-bc2e-401b-b7f6-606ebc1a8a84.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Lived Experiences of Prehospital Care Among Road Traffic Accident Survivors in Rwanda: A Qualitative Descriptive Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe mortality rate from road traffic accidents (RTAs) is a major worldwide public health concern. Approximately 1.19\u0026nbsp;million people die globally in traffic accidents each year, with 92% of these deaths occurring in low- and middle-income countries (LMICs); additionally, 20–50\u0026nbsp;million people suffer non-fatal injuries, which disproportionately affect men and people in economically productive age groups[\u003cspan class=\"CitationRef\"\u003e1\u003c/span\u003e]. Furthermore, projections indicate that by 2030, global RTA deaths could rise by 30%, reaching 1.85\u0026nbsp;million annually, possibly making RTAs the seventh leading cause of death worldwide[\u003cspan class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAfrica has the highest rate of traffic fatalities, with about 26.6 deaths per 100,000 people[\u003cspan class=\"CitationRef\"\u003e3\u003c/span\u003e]. Despite Africa having only 3% of all global vehicles, it accounted for 225,482 deaths in 2021, representing 19% of fatalities worldwide[\u003cspan class=\"CitationRef\"\u003e4\u003c/span\u003e]. Cyclists and pedestrians are vulnerable road users and account for 44% of all global RTA deaths [\u003cspan class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e5\u003c/span\u003e]. The burden is especially severe in Sub-Saharan Africa, where children and young adults are disproportionately affected.\u003c/p\u003e \u003cp\u003eIn Rwanda, a sub-Saharan African nation, the number of RTA nearly doubled from 5,611 in 2018 to 10,334 in 2022 (NISR, 2023). Most of the patients transported by ambulances in Rwanda presented with RTA related injuries[\u003cspan class=\"CitationRef\"\u003e6\u003c/span\u003e]. Additionally, over half of deaths occurred before arrival at the hospital[\u003cspan class=\"CitationRef\"\u003e7\u003c/span\u003e]. Traffic-related orthopedic injuries cause significant disability and reduce functioning[\u003cspan class=\"CitationRef\"\u003e8\u003c/span\u003e]. Appropriate prehospital care, can prevent many RTA related deaths and injuries.\u003c/p\u003e \u003cp\u003ePrehospital emergency care (PHEC) includes medical treatment provided before arriving to emergency department[\u003cspan class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e9\u003c/span\u003e]. WHO emphasizes that immediate medical care and transportation save lives, reduce disability, and improve long-term outcomes[\u003cspan class=\"CitationRef\"\u003e10\u003c/span\u003e]. Trauma patients who receive early care have higher survival rates and better functional outcomes [\u003cspan class=\"CitationRef\"\u003e9\u003c/span\u003e]. Despite its proven benefits, PHEC remains fragmented, underfunded, poorly standardized and understaffed, resulting in delays and reliance on private transportation and poor patient’s outcomes [\u003cspan class=\"CitationRef\"\u003e10\u003c/span\u003e–\u003cspan class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn Rwanda, PHEC has been provided for the nearly two decades in urban and rural areas; however little is known about the RTA survivor’s experience with PHEC. Therefore, this study aims to explore RTA survivors’ experience of prehospital care.\u003c/p\u003e"},{"header":"Aim, Design and study settings","content":"\u003cp\u003eThis study used a qualitative descriptive design to explore the prehospital experiences among RTA survivors in Rwanda. Qualitative description is a strong methodological approach for healthcare designers, practitioners, and researchers, as it generates detailed, participant-driven accounts of their experiences[\u003cspan class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe study was conducted at Centre Hospitalier Universitaire de Kigali (CHUK) from urban and Ruhengeri Level 2 Teaching Hospital (RL2TH), from rural areas. Among Rwanda's four referral hospitals in the urban area, CHUK is the main public and referral teaching hospital with a variety of special care services, receiving numerous trauma patients from across the country at its emergency department[\u003cspan class=\"CitationRef\"\u003e16\u003c/span\u003e]. Statistics of Service d’aide medicale d’urgence (SAMU), which is the main prehospital service provider in Rwanda, demonstrated its patient flow capacity, as nearly half (42.5%) of the 92% of road traffic accident patients evacuated following motorcycle-related RTAs were transported to CHUK, Rwanda's largest trauma center[\u003cspan class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eRL2TH is administratively located in Musanze, the most populous district in the northern province, with a population density of 1157 people per square kilometer, and is classified as rural area[\u003cspan class=\"CitationRef\"\u003e18\u003c/span\u003e]. Furthermore, the Northern Province, where Musanze is located, was identified in the SAMU strategic plan as a location with mountainous terrain and limited infrastructure such as roads and bridges, limiting ambulance access in rural regions[\u003cspan class=\"CitationRef\"\u003e19\u003c/span\u003e]. Figure\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e depicts study settings across Rwanda.\u003c/p\u003e\u003ch2\u003eSample size, sampling strategy, and period\u003c/h2\u003e\u003cp\u003eThis study included 18 adult survivors of RTAs from both urban and rural settings in Rwanda. The sample size was determined using qualitative research approaches, which emphasize depth over breadth, and data saturation occurred when no new insights surfaced during interviews[\u003cspan class=\"CitationRef\"\u003e20\u003c/span\u003e]. Purposive sampling was used to recruit participants who were 18 years or older, conscious post RTA, sustained RTA within the previous one to three months, and still hospitalized at CHUK or RL2TH during data collection period. Accident locations were also considered either Kigali city(urban) or Musanze district(rural) in order to capture variation in experiences related to geographic context. The data were collected from August 7th to August 28th, 2025.\u003c/p\u003e\u003ch3\u003eData Collection Procedures\u003c/h3\u003e\u003cp\u003eThe interview guide was developed in English with input from qualitative research experts. It was then translated into Kinyarwanda and piloted with two RTA survivors hospitalized at CHUK to refine the tool before data collection for the study. Face to face interviews were conducted at the patient's bedside at a time that was convenient for each participant. Written informed consent was obtained before participation. Surrounding curtains were closed to ensure privacy, confidentiality and minimize interruptions during the interview. All interviews were audio recorded and then uploaded to the lead researcher's secure personal computer for verbatim transcription and translation back into English. Each interview with participants lasted 10 to 15 minutes.\u003c/p\u003e\u003ch3\u003eData Analysis and Trustworthiness\u003c/h3\u003e\u003cp\u003eTranscribed data were loaded into ATLAS.ti version 24 and analyzed thematically following Braun and Clarke’s six-step approach [\u003cspan class=\"CitationRef\"\u003e21\u003c/span\u003e]; to discover main themes and sub-themes. The analysis followed an iterative process that involved repeated reading of the transcripts for familiarization, generating initial codes, grouping similar codes to develop themes inductively, and identifying and addressing any overlap. To establish trustworthiness in this study, we ensured data credibility, dependability, confirmability, transferability, and reflexivity [\u003cspan class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eCredibility was established by asking participants to clarify and elaborate on their responses during the interviews, ensuring that the lead researcher understood their experiences correctly. Furthermore, the lead researcher had sufficient opportunity to interact with participants and observe their verbal communication. The lead researcher kept an audit log of all coding decisions, theme development, and interpretation adjustments throughout time to ensure dependability. Additionally, the same interview guide and the same interviewer used for all participants[\u003cspan class=\"CitationRef\"\u003e15\u003c/span\u003e]. Peer debriefing was conducted through regular talks within the study team, which included local and international experts, to challenge assumptions and explore alternate interpretations, hence increasing confirmability.\u003c/p\u003e\u003cp\u003eTo facilitate transferability, detailed descriptions of participants' experiences and the context of care were provided. Reflexivity was maintained during the study through journaling, memo writing, and team reflection, allowing researchers to evaluate how their own experiences, attitudes, and viewpoints can influence interpretation while maintaining participants' voices at the forefront.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eParticipant Characteristics\u003c/h2\u003e \u003cp\u003eA total of 18 participants were included in the study. Most participants were aged 18\u0026ndash;45 years, while two were 46 years or older. The sample was predominantly male. Most participants had attended primary school, a smaller number had completed secondary education, and only a few had pursued higher education. Motorcyclists were predominant, followed by bicyclists, pedestrians, and lastly car drivers. (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e summarizes participant characteristics.)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eParticipants\u0026rsquo; characteristics\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDemographic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDescription\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercentage\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAge(years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18\u0026ndash;45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e88.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e11.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e94.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eEducation level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAt least primary school attended\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e55.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecondary school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e33.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHigher education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e11.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eCategories of road users\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMotorcyclists\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e44.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBicyclists\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e27.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePedestrians\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e16.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCar drivers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e11.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eCommunity Awareness\u003c/h2\u003e \u003cp\u003eParticipants showed mixed awareness of the national ambulance service. While few participants agreed that they knew the universal access number, \u0026ldquo;\u003cem\u003eYes, I know it, 912\u003c/em\u003e\u0026rdquo; (P14, urban), others were confusing it with other numbers or totally acknowledged that they do not know it, \u003cem\u003e\u0026ldquo;Not sure if it is 111\u003c/em\u003e, \u003cem\u003eis it correct\u003c/em\u003e?\u0026rdquo; (P 15, urban), \u003cem\u003eI do not know the number to call\u003c/em\u003e (P18, rural). Some participants thought that only Rwanda National Police officers are the ones to activate ambulances. \u0026ldquo;\u003cem\u003eI thought it was only the traffic police who should call ambulances\u0026rdquo;\u003c/em\u003e (P17, rural); and some of the calls were made by police officers, as this participant affirms, \u0026ldquo;A \u003cem\u003epolice officer called an ambulance; he was directing lights as traffic lights were off.\u003c/em\u003e (P6, urban).\u003c/p\u003e \u003cp\u003eSome participants inform their family members immediately after having a RTA without notifying prehospital services first: \u0026ldquo;\u003cem\u003eI asked another motorcyclist to call my mother and brother, who is also a motorcyclist\u003c/em\u003e.\u0026rdquo; (P16, Urban). Fear of delays often obliged some participants to look for another means of transport. \u0026ldquo;\u003cem\u003eI thought the easiest thing was to come immediately to the hospital\u0026hellip; waiting for an ambulance could take too long\u003c/em\u003e\u0026rdquo; (P7, urban).\u003c/p\u003e \u003cp\u003eSome participants received care immediately post-RTA, and others did not. One participant was helped by a knowledgeable bystander: \u0026ldquo;He \u003cem\u003esaid that he had knowledge and skills from Rwanda Red Cross trainings\u0026rdquo; (\u003c/em\u003eP16, urban), and another said, \u0026ldquo;\u003cem\u003ePeople nearby helped me immediately; one even stopped the bleeding using a cloth\u003c/em\u003e.\u0026rdquo; (P1, urban). Several participants did not receive any help: \u0026ldquo;\u003cem\u003eNothing was done for me;\u003c/em\u003e I might have died\u0026rdquo; (P5, urban). In rural areas, participants also shared that nothing was done by those who were surrounding the scene: \u0026ldquo;\u003cem\u003eNo, nothing was done\u0026rdquo;\u003c/em\u003e (P 17, rural). One participant said that the taxi that hit them, immediately took them to RL2TH without activating an ambulance: \u0026ldquo;The \u003cem\u003etaxi that hit us immediately took us to Ruhengeri level two teaching hospital\u003c/em\u003e\u0026rdquo;(P18,rural).\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eAmbulance availability and response time\u003c/h3\u003e\n\u003cp\u003eParticipants stated diverse experiences regarding the time it takes an ambulance to reach on the scene of accident. \u003cem\u003e\u0026ldquo;The ambulance arrived first in less than 10 minutes\u0026rdquo;\u003c/em\u003e (P1, urban). \u003cem\u003e\u0026ldquo;Right after the accident, once the vehicle had overturned, we stayed there for about 20 minutes. (\u003c/em\u003eP17, rural\u003cem\u003e)\u003c/em\u003e. For some cases, there was an extended time for the ambulance to reach to the RTA scene, \u003cem\u003e\u0026ldquo;Ambulances take long to reach accident victims; I had the accident at 2:30 a.m., the ambulance reached me at 3:30 a.m.\u0026rdquo;\u003c/em\u003e (P 13, urban).\u003c/p\u003e \u003cp\u003eParticipants identified ambulance shortages or prioritizing issues as factors contributing to delays. For example, one participant shared; \u003cem\u003e\u0026ldquo;The ambulance personnel told us that, the ambulance was far, and my fellow motorcyclist took me to the hospital\u0026rdquo;\u003c/em\u003e (P5, urban); while another shared\u003cem\u003e\u0026ldquo;one ambulance came, and they saw that my case was not as severe as others, and advised me to take a motorcycle to CHUK\u0026rdquo;\u003c/em\u003e (P 6, urban).\u003c/p\u003e\n\u003ch3\u003eProfessional prehospital care\u003c/h3\u003e\n\u003cp\u003eParticipants expressed diverse experiences with prehospital care provided at the scene and during transport. Some benefited from professional prehospital care stating \u0026ldquo;\u003cem\u003eThe ambulance staff gave me IV fluids and applied protection to my legs until we reached the emergency department\u0026rdquo;\u003c/em\u003e (Participant 2, urban). Whereas others did not receive prehospital care, \u0026ldquo;\u003cem\u003eNo, they just put me in the ambulance and brought me\u003c/em\u003e\u0026rdquo; (P 17, rural). Another participant added, \u003cem\u003e\u0026ldquo;In the ambulance? No, they did not provide additional care\u0026rdquo;\u003c/em\u003e (Participant 11, urban). Some participants received care during transport, \u003cem\u003e\u0026ldquo;They treated me while we were on the way. They continued giving me treatment for pain\u0026rdquo;\u003c/em\u003e (Participant 1, urban).\u003c/p\u003e \u003cp\u003eParticipants also shared their experiences regarding the choice of receiving facility by health care providers and its impact on recovery time. \u0026ldquo;\u003cem\u003eI was supposed to be brought to CHUK, but the beds were full, so they ended up taking me to Nyarugenge District Hospital\u003c/em\u003e (P 16, urban). Another participant added, \u0026ldquo;\u003cem\u003eI was at the emergency department of Ruhengeri hospital. They told me my back was broken\u0026rdquo;. If they had referred me right away to the right place, I could have received surgery and perhaps recovered faster(P17\u003c/em\u003e, rural).\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e presents a summary of the main themes and sub-themes identified through thematic analysis of interviews with road traffic accident survivors, along with their operational definitions to clarify the meaning and scope of each sub-theme.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSummary of main themes, sub-themes, and their definitions\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMain Theme\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSub-themes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDefinitions\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eCommunity awareness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eActivation of emergency services\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eThis sub-theme refers to different actions taken by injured individuals or bystanders to initiate contact with formal prehospital care systems.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eProvision of first aid\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eThis sub-theme refers to the care provided to injured individuals at the scene of a road traffic incident before the arrival of formal emergency services.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDecision-making post-RTA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eThis sub-theme indicates choices made by injured individuals or bystanders immediately after a road traffic accident, including whether to seek help, whom to contact, how urgently to act, and what steps to take before emergency services arrive.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAmbulance availability and response time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDelayed ambulances\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eThis sub-theme describes the period between when a road traffic accident occurs and when suitable help reaches the scene\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnavailability of ambulance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eThis sub-theme refers to situations in which ambulances were not readily available when needed after a road traffic accident.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eProfessional prehospital care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eImmediate care at the scene\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eThis sub-theme refers to the initial assistance provided to injured individuals at the site of a road traffic accident by prehospital care providers\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCare during transport\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eThis sub-theme refers to different procedures which were provided to RTA survivors on the way to the receiving facility.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChoice of receiving facility\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eThe sub-theme refers to decisions made by prehospital care providers to choose the right receiving health facility.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study explored the lived experiences of RTA survivors in Rwanda. Three main themes emerged: community awareness, ambulance availability and response time, and professional prehospital care.\u003c/p\u003e \u003cp\u003eThe majority of participants were male and between 18 and 45 years old, with most having a primary education level. Motorcyclists and bicyclists accounted for most injuries, followed by pedestrians and car drivers. These findings align with regional evidence showing that young adult males using two-wheeled vehicles are disproportionately affected by RTAs in Rwanda and across sub-Saharan Africa[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Increasing awareness of accident prevention and teaching first aid among this vulnerable population may contribute to accident reduction and faster response post RTA.\u003c/p\u003e \u003cp\u003eThe findings of our study evidenced limited community awareness of first aid and the universal access number as a persistent barrier. Unawareness of the ambulance universal access number was previously shown by [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e], who revealed that 67.8% of the Rwandan population was unaware of the 912 EMS number. These findings demonstrate the critical need for providing public first aid and increasing awareness of 912 universal access number to guarantee prompt prehospital care activation and quick interventions post RTA in Rwanda.\u003c/p\u003e \u003cp\u003eMany participants reported that bystanders hesitated to provide first aid due to lack of training fear of causing harm, a finding that is supported by previously conducted studies in LMICs [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Untrained bystanders could unintentionally worsen injuries, or lack empathy during care and inadequately stabilized victims[\u003cspan additionalcitationids=\"CR28\" citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e].Sociocultural barriers further hindered immediate care by laypersons[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Expanding first responder community programs that address social culture influence could improve the timeliness and quality of prehospital care.\u003c/p\u003e \u003cp\u003eParticipants verbalized delayed or absent ambulance response, often resulting in reliance on alternative means of private transport. These challenges mirror widespread EMS shortages and delays described in LMIC literature[\u003cspan additionalcitationids=\"CR12\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Timely response is critical for trauma survival; addressing ambulance scarcity remains a core priority.\u003c/p\u003e \u003cp\u003eCare provided on the scene and during transport varied widely. Some participants received splinting, wound care, pain management, and IV fluids, while others reported minimal or no treatment. Pain management, in particular, was frequently inadequate. Similar inconsistencies in prehospital care have been reported in LMIC studies, which highlight equipment shortages and training gaps [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Previous evidence shows that effective prehospital analgesia significantly improves patient comfort and reduces pain severity upon hospital arrival[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Provision of training for prehospital care providers and enough medication in ambulances would be a solution to this gap.\u003c/p\u003e \u003cp\u003eThough the study revealed the strengths and gaps in Rwanda\u0026rsquo;s prehospital care, some limitations should also be acknowledged. Inclusion of only adult survivors of road traffic accidents who were conscious may have excluded the perspectives of more severely injured individuals, unconscious patients, or younger victims. Moreover, venue for interviews could have affected the patient\u0026rsquo;s privacy and confidentiality. Underrepresentation of rural areas reflects an important contextual challenge, as it was indicated that 59.3% of deaths occur at the community level in rural areas compared to 38% in urban areas[\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e].\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eDespite current findings, persistent gaps remain in community awareness, ambulance availability and response times, and the quality of care provided at the scene and during patient transport. To strengthen strategies for equitable and sustainable prehospital care, policymakers responsible for emergency services in Rwanda should consider the above gaps revealed by participants of this study. Future studies should explore additional factors contributing to prehospital deaths and long-term disabilities following RTAs.\u003c/p\u003e"},{"header":"Declarations","content":" \u003cp\u003e \u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e \u003cp\u003e This study was conducted in accordance with the principles of the Declaration of Helsinki and received ethical approval from the University of Rwanda Institutional Review Board (Approval No. 585/CMHS IRB/2025), the Ethics Committee of CHUK (Approval No. EC/CHUK/116/2025), and the RL2TH (Approval No. 918/RL2TH/DG/2025). Written informed consent was obtained from all participants, who were free to withdraw at any time. Confidentiality was ensured through the use of unique participant codes, with no personal identifiers recorded. Eligible participants were conscious road traffic accident survivors who had been hospitalized for one to three months. The study findings aim to inform improvements in prehospital care in Rwanda and similar contexts.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication\u003c/strong\u003e \u003cp\u003e A consent for publication is not applicable for this manuscript.\u003c/p\u003e \u003ch2\u003eCompeting interests\u003c/h2\u003e \u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThis study is part of PhD studies that are funded by the Rwanda Right 912 project. The funding had no influence on the study design, data interpretation, or conclusion drawn.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eLR contributed to the conception and methodology of the study under the guidance of PM, GU, IC, and JCB. LR also contributed to data collection and data analysis with guidance from PM, GU, IC, and JCB. All authors (LR, PM, GU, IC, and JCB) critically reviewed the manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgments\u003c/h2\u003e \u003cp\u003eThe authors extend their sincere gratitude to the leaders of CHUK and RL2TH for fruitful collaboration during data collection. The Rwanda Right 912 project is also acknowledged for funding this study as part of PhD studies. Prof. Jeanne B. Jenkins for her editorial contribution to this manuscript.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe qualitative datasets generated and analyzed during the current study are not publicly available due to ethical restrictions and the sensitive nature of the interview data, which may compromise participant confidentiality. Data may be made available from the corresponding author upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWHO. 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(2023) Serbian Statistical Yearbook 2023. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://alpha.statistics.gov.rw/statistical-publications/statistical-yearbook/rwanda-statistical-yearbook-2023\u003c/span\u003e\u003cspan address=\"https://alpha.statistics.gov.rw/statistical-publications/statistical-yearbook/rwanda-statistical-yearbook-2023\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e accessed August 2025.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-emergency-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"emmd","sideBox":"Learn more about [BMC Emergency Medicine](http://bmcemergmed.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/emmd","title":"BMC Emergency Medicine","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Qualitative research, patient’s experience, Emergency medical services, prehospital care, road traffic accidents, survivors, Rwanda","lastPublishedDoi":"10.21203/rs.3.rs-8965241/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8965241/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eIntroduction\u003c/h2\u003e \u003cp\u003eGlobally, road traffic accidents(RTAs) are reported as a major cause of death and disability in low- and middle-income countries(LMICs). Although effective prehospital care can reduce these outcomes, such services remain insufficient in many LMICs. Improving prehospital care requires an understanding of RTA survivors\u0026rsquo; experience, which is the aim of this study.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA qualitative descriptive study with purposive sampling explored RTA survivors\u0026rsquo; experience of prehospital care. A sample size of eighteen participants from urban and rural hospitals was determined by data saturation. Semi-structured, face-to-face interviews were conducted in August 2025 using an interview guide written in Kinyarwanda. Interviews were audio-recorded, transcribed verbatim, and analyzed thematically using ATLAS.ti 24.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThree main themes emerged from participants\u0026rsquo; experiences. First, community awareness, encompassing activation of emergency services, bystander first aid, and post-RTA decision-making, highlighted both the potential and limitations of community involvement. Second, ambulance availability and response time revealed frequent delays and unavailability of ambulances. Third, professional prehospital care, including care provided at the scene, during transport, and decisions regarding the receiving health facility, varied in quality and consistency across cases.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eInsights from RTA survivors\u0026rsquo; experiences indicate that Rwanda\u0026rsquo;s prehospital emergency care is constrained by delays in seeking and receiving care, particularly in rural settings. Policymakers should consider these findings when designing strategies to ensure equitable and sustainable prehospital services.\u003c/p\u003e","manuscriptTitle":"Lived Experiences of Prehospital Care Among Road Traffic Accident Survivors in Rwanda: A Qualitative Descriptive Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-11 12:04:18","doi":"10.21203/rs.3.rs-8965241/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-03-26T05:01:34+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-22T04:53:24+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"144749836071633620932638251502630226475","date":"2026-03-17T11:12:57+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-16T03:32:13+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"212818412012655701876921667334709261927","date":"2026-03-13T05:39:06+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"191275647956372196111967494662582825756","date":"2026-03-07T20:12:53+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-03-06T09:56:19+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-03-03T06:19:51+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-02-28T11:25:54+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-02-28T11:23:39+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Emergency Medicine","date":"2026-02-25T08:25:22+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-emergency-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"emmd","sideBox":"Learn more about [BMC Emergency Medicine](http://bmcemergmed.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/emmd","title":"BMC Emergency Medicine","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"af90e982-89ae-46ea-b8d2-feae45b1d1bb","owner":[],"postedDate":"March 11th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-04-20T16:02:46+00:00","versionOfRecord":{"articleIdentity":"rs-8965241","link":"https://doi.org/10.1186/s12873-026-01588-7","journal":{"identity":"bmc-emergency-medicine","isVorOnly":false,"title":"BMC Emergency Medicine"},"publishedOn":"2026-04-18 15:59:32","publishedOnDateReadable":"April 18th, 2026"},"versionCreatedAt":"2026-03-11 12:04:18","video":"","vorDoi":"10.1186/s12873-026-01588-7","vorDoiUrl":"https://doi.org/10.1186/s12873-026-01588-7","workflowStages":[]},"version":"v1","identity":"rs-8965241","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8965241","identity":"rs-8965241","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}