Quantitative Assessment of Surge Capacity in Rwandan Trauma Hospitals: A Survey Using the 4S Framework

Lotta Velin (), Menelas Nkeshimana, Eric Twizeyimana, Didier Nsanzimfura, Andreas Wladis and Laura Pompermaier
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Lotta Velin: Centre for Teaching & Research in Disaster Medicine and Traumatology (KMC), Department of Biomedical and Clinical Sciences, Linköping University, Johannes Magnus väg 11., 583 30 Linköping, Sweden
Menelas Nkeshimana: Department of Internal Medicine, Centre Hospitalier Universitaire de Kigali, KN 4 Ave, Kigali P.O. Box 655, Rwanda
Eric Twizeyimana: Center for Equity in Global Surgery, University of Global Health Equity (UGHE), Kigali Heights, KG 7 Ave, Kigali P.O. Box 6955, Rwanda
Didier Nsanzimfura: Emergency Department, Nyarugenge District Hospital, KN 247 St, Kigali P.O. Box 84, Rwanda
Andreas Wladis: Centre for Teaching & Research in Disaster Medicine and Traumatology (KMC), Department of Biomedical and Clinical Sciences, Linköping University, Johannes Magnus väg 11., 583 30 Linköping, Sweden
Laura Pompermaier: Centre for Teaching & Research in Disaster Medicine and Traumatology (KMC), Department of Biomedical and Clinical Sciences, Linköping University, Johannes Magnus väg 11., 583 30 Linköping, Sweden

IJERPH, 2025, vol. 22, issue 10, 1-16

Abstract: Surge capacity is the ability to manage sudden patient influxes beyond routine levels and can be evaluated using the 4S Framework: staff, stuff, system, and space. While low-resource settings like Rwanda face frequent mass casualty incidents (MCIs), most surge capacity research comes from high-resource settings and lacks generalisability. This study assessed Rwanda’s hospital surge capacity using a cross-sectional survey of emergency and surgical departments in all referral hospitals. Descriptive statistics, t -tests, Fisher’s exact test, ANOVA, and linear mixed-model regression were used to analyze responses. Of the 39 invited participants, 32 (82%) responded. On average, respondents believed that they could manage 13 MCI patients (95% CI: 10–16) while maintaining routine care, with significant differences between tertiary and secondary hospitals (11 vs. 22; p = 0.016). The intra-class correlation was poor for most variables except for CT availability and ICU beds. Surge capacity perception did not vary significantly by professional category, though less senior staff reported higher capacity. Significantly higher capacity was reported by those with continuous access to imaging ( p < 0.01). Despite limited resources, Rwandan hospitals appear able to manage small to moderate MCIs. For larger incidents, patient distribution across facilities is recommended, with critical cases prioritized for tertiary hospitals.

Keywords: surge capacity; mass casualty incidents; resource-limited settings; East Africa: advanced trauma life support care (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2025
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