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Journal of Postgraduate Medicine
Medknow Publications and Staff Society of Seth GS Medical College and KEM Hospital, Mumbai, India
ISSN: 0022-3859 EISSN: 0972-2823
Vol. 46, Num. 3, 2000, pp. 245-246
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Journal of Postgraduate Medicine, Vol. 46, No. 3, July-September, 2000,
pp. 245-246
Technology Review
`Mantle of Safety' - Aero-Medical Service
in Central Australia
SS David
Department of Emergency Medicine, Alice Springs Hospital NT 0870, Australia.
Code Number: jp00084
"Safety ... safety ... `a mantle of safety'. We shall cast
our mantle of safety over the Inland." These were the
famous words of Reverend John Flynn1, 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.
Air Transport
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.
Communication
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.
Hardships of the early RFDS
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.
Logistics
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
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.
Central Australian RFDS
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.
Operations
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.
The Future
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.
Conclusion
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.
SS David
Department of Emergency Medicine,
Alice Springs Hospital NT 0870, Australia.
Acknowledgment
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.
Reference
- McPheat WS. Flynn. J. Apostle to the inland. Sydney: Hodder and Stoughton,
1963: 64-69.
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Copyright 2000 - Journal of Postgradate Medicine
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