Mass casualty training for prehospital and emergency providers in Kigali, Rwanda: a quasi-experimental pre–post educational study

Background A mass casualty incident (MCI) occurs when the number of patients exceeds available healthcare resources, placing significant strain on prehospital and facility-based emergency care systems, particularly in low- and middle-income countries (LMICs). An effective response to MCIs requires coordinated systems, targeted training, and clear communication across all levels of care. Although Rwanda experiences both natural and man-made disasters, formal training in mass casualty management for healthcare workers remains limited. Methods A two-part mass casualty training curriculum was developed for emergency physicians, nurses, paramedics, and community first responders in Kigali, Rwanda. The program combined asynchronous video-based modules with a half-day, simulation-based skills training. Participants completed a knowledge, attitudes, and practices (KAP) assessment prior to training, immediately after the simulation, and at 3- and 6-month follow-up intervals. Pre- and post-training scores were analyzed to assess changes in knowledge, confidence, and practices using tests of statistical significance. Results A total of 41 participants representing multiple levels of training completed the program during 2022. Most participants were male and aged 25–44 years, with limited prior experience in mass casualty management. Mean test scores increased significantly following the simulation and remained higher than baseline at 3- and 6-month follow-up. Participants also demonstrated significant improvements in confidence across key MCI-related skills. Conclusion This pilot study demonstrated that a multimodal mass casualty training curriculum was associated with improvements in knowledge and confidence among healthcare workers and community first responders in Kigali, Rwanda. These findings suggest the curriculum may be a promising approach to strengthening MCI preparedness in similar settings. Further studies with larger sample sizes are needed to validate its effectiveness and assess generalizability.