Systemic Factors Influencing Pre-Hospital Medical Care Following Road Traffic Accidents Along Kenya's Nairobi-Mombasa Highway: A Mixed-Methods Study

Abstract

Road traffic injuries remain a leading cause of preventable mortality worldwide and disproportionately affect low- and middle-income countries where pre-hospital emergency medical services (EMS) are often underdeveloped. Kenya continues to experience a high burden of road traffic crashes, yet pre-hospital medical care remains fragmented and inconsistently coordinated. This study assessed the systemic factors influencing pre-hospital medical care following road traffic accidents along the Nairobi-Mombasa Highway (A109), Kenya. The study was guided by Emergency Management Theory, Systems Theory, and High-Reliability Organisation Theory and employed a descriptive cross-sectional mixed-methods design involving emergency medical personnel, traffic police officers, hospital administrators, community health volunteers, emergency-service providers, bystanders, and road traffic accident victims. Quantitative data were analysed using descriptive statistics, while qualitative data from key informant interviews and focus group discussions were analysed thematically. The findings identified six interrelated factors influencing pre-hospital medical care: incident command and leadership, communication and inter-agency coordination, human-resource capacity, transport and logistical readiness, governance and policy implementation, and continuity of care through referral and patient handover. Participants expressed strong support for an integrated EMS system, including a structured EMS model for the corridor, the adoption of standardised operational procedures, and strengthened coordination among emergency response agencies. The study concludes that strengthening pre-hospital medical care along Kenya’s principal transport corridor requires integrated emergency medical systems supported by coordinated governance, standardised operational protocols, competent emergency responder training, resilient logistics, interoperable communication systems, and continuous quality improvement. The findings inform EMS policy and trauma-system strengthening in Kenya and similar low-resource settings.