Profile of the prehospital system in Madagascar

To delineate the present characteristics of emergency medical services (EMS) on the island of Madagascar.

This was a retrospective study of ambulance runs over a five-year period. The island covers 587,041 square kilometers with a population of 15 million, of whom 78% live in rural areas.

Madagascar has 0.13 EMS workers per 1,000 people in urban areas, compared with 0.001 EMS workers per 1,000 people in rural areas. The urban physician/population ratio is 1 per 8,160, while in rural areas the ratio is 1/30,000. There is no "911" dispatching system. The EMS system offers transport services in 90% of ambulance runs. Ambulance calls are dispatched by police and fire departments in 80% of cases and by private calls in the remaining 20%. Madagascar has a telephone/population ratio of 1 per 239. Each vehicle is staffed by two emergency medical technicians (EMTs) who are paid by local hospitals and clinics that operate under a medical director. Urban EMS covers an average radius of 100 km, in contrast to the community-based rural EMS that serves a radius of only 25 km. The EMS system receives critically ill patients in 35% of its runs, obstetrical emergencies in 30%, surgical emergencies in 25%, and pediatric emergencies in the remaining 10%.

This study shows that urban EMS is more organized, has a better-developed infrastructure, and has more personnel than its counterparts in rural areas. Future work will determine the impact of a rising population shift from rural to urban areas on this evolving EMS system.