title: [Aeromedical evacuation of critically ill patients in developing countries A retrospective study on 244 patients in Djibouti].
abstract: BACKGROUND
  The pratice of intensive care in Africa is marked by a wide variety of health care delivery. Only a few centers offer specialized intensive care units, as cardiac or neurological units. That may explain the need for aeromedical evacuations for patients whose condition exceeds local capacity. Our objective was to assess whether the proportion of patients admitted to intensive care and evacuated had increased between 1997 and 2013 in a developing country, Djibouti.
  
  
  METHODS
  We examined the activity register of Bouffard Hospital intensive care unit in Djibouti to determine the number and characteristics of patients evacuated by air ambulance during a 16 years period.
  
  
  RESULTS
  From January 1997 to December 2013, a total of 244 patients were evacuated. The evacuation rate was 5.74ù of the patients admitted to the entire duration of the study. The rate of patients evacuated was not different between 1997 and 2013 (5,69ù versus 8,33ù respectively, p = 0,269). However, the rate of djiboutian evacuated patients was statistically different between 1997 and 2013 (0,96ù versus 4,46ù, p = 0,02). The main causes were severe trauma injuries, cardiovascular diseases and neurological diseases.
  
  
  CONCLUSIONS
  The aeromedical evacuation of a critically ill patient in a developing country is a process requiring heavy logistics and depending on the medical skills available in the area, and financial resources that can be implemented for the patient. Our study shows that medical evacuations in favor of Djiboutian patients are marginal but are increasing over the past decade.
authors.affiliation: Hôpital d'instruction des armées Sainte-Anne, boulevard Sainte-Anne, 83800 Toulon, France, Service d'anesthésie réanimation, hôpital médico-chirurgical Bouffard, Djibouti Ville, Djibouti.
authors.forename: J
authors.initials: J
authors.lastname: Bordes
authors.affiliation: Anesthésie réanimation, hôpital d'instruction des armées Desgenettes, Lyon, France.
authors.forename: D
authors.initials: D
authors.lastname: Loheas
authors.affiliation: Service d'anesthésie réanimation, hôpital médico-chirurgical Bouffard, Djibouti Ville, Djibouti.
authors.forename: A
authors.initials: A
authors.lastname: Benois
mesh_terms: D000328:Adult; D017732:Air Ambulances; D003422:Critical Care / Q000706:statistics & numerical data*; D016638:Critical Illness; D003906:Developing Countries; D015730:Djibouti; D006801:Humans; D007362:Intensive Care Units; D012189:Retrospective Studies
keywords: Djibouti; aeromedical evacuation; developing countries; intensive care