'Mantle of safety'--aero-medical service in Central Australia.SS David
Department of Emergency Medicine, Alice Springs Hospital NT 0870, Australia., Australia
Keywords: Air Ambulances, organization &administration,Australia, Emergency Medical Services, standards,trends,Human, Safety, Support, Non-U.S. Gov′t,
“Safety ... safety ... ‘a mantle of safety’. We shall cast our mantle of safety over the Inland.” These were the famous words of Reverend John Flynn, founder of the Flying Doctor Service (RFDS). He began his Christian missionary work in 1911 at a time when there were only two doctors serving an area of 15,00,000 square kilometres in the Northern Territory. Flynn realised that the problems of distance and communication resulted in people dying from lack of prompt medical attention. Two essential commodities- air transport and radio were needed to conquer the isolation.
Rev. Flynn saw potential in this development along with Lieutenant Clifford Peel, a young Australian medical student who had an interest in aviation. Unfortunately, Peel did not live to see his dream come true- he was killed in action during World War I. But his remarkable vision lives on today in the RFDS.
The Aerial Medical Service was established and the first flight was made on 17 May 1928, using a De Havilland model DH50 aircraft, hired from a small local airline, Queensland and Northern Territory Aerial Service, later to become Qantas. The aircraft was single-engined, fabric-covered and was capable of carrying the pilot and four passengers at a cruising speed of 80 miles per hour. In the first year, 50 flights were made, 18,000 miles were flown and 225 patients treated for various illnesses and injuries. It became a non-denominational honorary body and was granted the name of the Royal Flying Doctor Service by the Queen of England in 1955.
Basic telephone and telegraph links existed only near larger towns, radio communication was unknown and neighbours could be hundreds of miles away. What was needed at the outstations was a portable, cheap and reliable two-way radio, with a range of 500 Km. It also needed to be simple enough to be operated by an untrained person and have its own power source. Alfred Traeger of Australia invented the ingenious two-way radio set which was powered through pedals. The pedal sets were installed in Outstations to provide communication with the Flying Doctor Bases. Today, most isolated communities are accessible by telephones.
It is significant that the Flying Doctors have maintained an excellent safety record, despite very difficult conditions. The first Flying Doctor pilot, Arthur Affleck, had no navigational aids, no radio and only a compass. He navigated by landmarks such as fences, rivers, riverbeds, dirt roads or just wheel tracks and telegraph lines. He also flew in an open cockpit, fully exposed to the weather. In the early days of the service, airstrips were hastily modified cattle enclosures and there was no airstrip lighting. Flights were mostly during daylight hours. Fuel supplies were also carried on board, since refuelling was not possible in the remote areas.
The earliest constitution of the RFDS was prepared in 1933. Its objectives were to provide medical and communication service to isolated Australians irrespective of race, industry, political affiliation or economic status. It specifically addressed the needs of Aboriginal people. In essence, these remain the objectives of the Service today. RFDS now operates from 19 bases all over Australia. Each RFDS base is a non-profit, non-denominational organisation and is autonomous in its administration.
Medical aid is provided by the RFDS free of charge to those who live, work and travel in Australia’s Outback. Each year, the Service provides medical attention to approximately 100,000 people in the remote areas of Australia, including aerial evacuation of about 9000. The fleet of 40 aircraft makes about 40,000 flights a year, flying more than 13 million kilometres and evacuation of about 21,000 patients.
Central Australia occupies about 10,00,000 square kilometres of semi-desert country. The total population of Central Australia would be approximately 40,0000, one third being Aboriginals. Rural population is fragmented into over 100 settlements, the vast majority of which are Communities of 200 people or less.
About 43% of the Aboriginal population are children and the birth rate is about 50% higher than non-Aboriginals. The Aboriginal infant mortality rate (26.4 per 100 live births) has improved over the past decade but is still approximately three times that of non-Aborigines (9.6 per 1000). Although greatly improved since the early 70s, the morbidity and mortality statistics of Central Australian aborigines is still poor. They have a variety of medical illnesses, which differ in incidence and severity from elsewhere in Australia. This sector of Australian society, which has the greatest health care needs, is the worst serviced by health care practitioners. Medical practitioners in Australia do not work with Aborigines by choice. Few are employed by Aboriginal Medical Services, and those who locate themselves permanently in areas with large Aboriginal population, are exceptional.
The Alice Springs RFDS base, established in 1939, covers Central Australia. It covers a total area of nearly one million square kilometres; the average radius is 600 kilometres, the size comparable to Great Britain. There are in total 39 Outstations and Clinics, operating in 16 areas. Current medical staffing includes six doctors, six nurses, six pilots, and 3 aircraft.
When a Flying Doctor Communications Officer receives an emergency call, they can be in contact with a doctor, nurse and pilot within 30 seconds and an aircraft can be airborne within 45 minutes. There are three types of flights: Emergency, Mercy and Routine Care Clinic flight. Emergency flights are made in case of serious illness or accident with the objective of providing immediate medical attention and possible evacuation to a hospital, usually the Alice Springs Hospital. Direct medical consultation is also available through the Accident & Emergency Department of the Alice Springs Hospital. A Mercy flight is carried out under conditions, which may compromise normal air safety standards. This is at the discretion of the pilot, whom could decide to take a calculated risk to save a life. Routine Health Care Clinics are conducted at isolated communities, homesteads and mine sites. People travel hundreds of kilometres to attend these Clinics. One of the RFDS nurses always flies with the plane even on apparently routine flights, as there is possibility of diversion to pick up a sick patient.
Most Aboriginal patients presenting to the Clinic have already consulted a Nunkara (traditional healer) and may have received herbal or physical treatment. The relationship between the Nunkaras and RFDS personnel is one of cordiality and professional respect.
Contact occurring between the RFDS and patients is as follows:
a) Radio consultations - The nursing sister, or Aboriginal Health Worker at an Aboriginal settlement can radio the RFDS doctor at the base for medical consultation and advice.
b) Routine clinic work when the RFDS doctor visits missions and communities. Here they act as the general practitioner for the community. However, they do not seem to have time for primary health care (water, sanitation, health eduction and health promotion) or research.
c) Emergency medical consultations, in which the doctor provides immediate medical help outside clinic hours. These consultations are often the results of trauma, motor vehicle accidents, premature labour and sick infants.
d) Aero-medical evacuation to a regional hospital – usually the Alice Springs Hospital.
Since 1928, the RFDS of Australia has grown into one of the most respected organisations in the world. Covering an area equivalent to Western Europe, it now operates from 19 Bases, operating over approximately 80 per cent of the Australian continent.
The Service recently undertook a soul-searching evaluation of its structure, operations and goals. Although providing emergency medical services would continue, it may refocus efforts on cost efficiency, health promotion and prevention.
The development of the RFDS is woven into the fabric of past and contemporary life in outback Australia. No longer is the Service just for the people of the outback; it is becoming involved with the ever-increasing number of tourists visiting Australia’s remote locations. Today, Flynn’s dream of a “Mantle of Safety” continues to be there for all. Countries such as India, werein health services are not easily accessible at distant places, may also benefit from such services, especially so during major calamities, natural as well as man-made.
The author wishes to acknowledge the support and assistance rendered by The Aero-Medical Services of Remote Health Department, Northern Territory Health Services, Alice Springs, Australia.