EMERGENCY-MEDICINE EDUCATION INTERVENTION IN RWANDA

Study objective: To describe the effectiveness of an emergency medical education program in a postwar developing country. Methods: A prospec tive, nonrandomized interrupted time-series study was conducted in an emergency department at a national referral hospital in Rwanda immedia tely after the 1994 civil war. Participants included 11 medical person nel staffing the ED comprising physicians, nurses, and medical assista nts. International medical relief workers in the ED identified deficie ncies by directly observing routine clinical practices. On the basis o f this assess ment, formal training programs in trauma resuscitation, airway management, wound care, and blood/fluid precautions were conduc ted. Subjects were then observed 1 week and 2 months after the educati onal programs and scored on a standardized data-collection form. Score s before and after intervention were compared with the use of Fisher's exact test to determine program effectiveness. Results: Educational i nterventions with statistically significantly longer term effects incl uded wound management principles and blood/fluid precautions (before v ersus after intervention, P < .05). Interventions with the least susta ined effect included advanced airway interventions and procedures rela ted to trauma resuscitation. Conclusion: Educational seminars proved t o have the greatest sustained effect on those behaviors requiring mini mal equipment and noncomplex medical decisionmaking.