Project Summary/Abstract Globally, the burden of NCDs and injuries is substantial in low and middle income countries (LMICs) and economically devastating. The Disease Control and Priorities report by the World Bank reports in its second edition that nearly 45% of all deaths in LMICs are potentially addressable through effective EMS. However, very few LMICs have emergency medical service infrastructure. The Rwandan Ministry of Health created the Service d'Aide Medicale Urgente (SAMU) in 2007 to provide emergency medical services in the capital city of Kigali. The premise of this proposal is that by rigorously evaluating the services delivered by SAMU, we can ensure the delivery of high quality emergency care across diseases and conditions in Rwanda. In this exploratory grant, we hypothesize that by identifying index non-communicable diseases, injuries and other conditions through SAMU's unique electronic prehospital registry and implementing checklists to standardize prehospital emergency care, SAMU will be able to deliver consistently high quality prehospital emergency care across a wide range of conditions and life stages. This proposal offers a unique and innovative attempt at building health system capacity across disciplines in order to address the burden of non-communicable diseases and injuries and will establish a rigorous model for prehospital care that is much needed in LMICs. Comprehensive research proposals will then be developed to seek further NIH funding to standardize care across all communicable and non-communicable conditions and injuries, evaluate the impact on clinical outcomes, and scale up d ata collection and QI systems across the country in collaboration with the Ministry of Health.