Systemic Barriers and Health System Fragmentation in Prehospital Emergency Preparedness Trauma Care Along Kenya’s Nairobi-Mombasa Highway: A Mixed-Methods Study

Abstract

This study evaluated the systemic barriers affecting prehospital emergency preparedness for road traffic accidents (RTAs) along Kenya’s Nairobi–Mombasa Highway (A109). A convergent parallel mixed-methods design was employed across the seven counties traversed by the highway. 226 respondents completed questionnaire surveys, selected through stratified random, purposive, and convenience sampling, including community first responders, healthcare professionals, ambulance personnel, fire-rescue personnel, police officers, and emergency operations staff. The study obtained qualitative data by interviewing key informants, conducting focus group discussions with service providers, administrators and RTA survivors, inspecting ambulances and undertaking field observations. Quantitative data were analysed descriptively, while qualitative data underwent thematic analysis, with findings integrated during interpretation. Respondents identified several interconnected barriers, including crash concentration at black spots (95.1%), particular vehicle types (97.4%) and nighttime (77.5%). Access to crash scenes was hindered by the absence of emergency lanes (85.9%) and traffic congestion (82.8%). Other challenges included poor coordination among emergency medical services, police and hospitals (81.4%), inadequate real-time communication (92.1%), shortages of emergency-trained personnel (68.6%), limited trauma training among police officers (79.6%), inadequate ambulance equipment (69.0%), insufficient dedicated funding (69.5%) and the absence of standardised guidelines (81.0%). Qualitative findings further revealed fragmented responses to entrapment incidents, staff exhaustion during mass-casualty events, inadequate blood reserves and ambulance downtime. The findings demonstrate that prehospital emergency preparedness is constrained by mutually reinforcing systemic weaknesses. Strengthening preparedness requires unified incident command, interoperable dispatch systems, certified responder training, effective ambulance maintenance, dedicated financing and improved road-safety enforcement, in alignment with Kenya’s Emergency Medical Care Policy 2020–2030.