Royal Flying Doctor Service of Australia

A "Mantle of Safety" for the Outback

The Service began in 1928, originally as an experiment known as the Aerial Medical Service (AMS) which was to run for a single year. This experiment was based in Cloncurry, Queensland. It was formed by Reverend John Flynn, the first Superintendent of the Australian Inland Mission (AIM), a branch of the Presbyterian Church.

Flynn's missionary work involved the establishment of hospitals in bush communities. This, however, did not help those who lived far from any major community. In his public speaking he would often retell the tragic circumstances that had befallen several bush settlers. The fate of Jimmy Darcy was one of these stories.
:Darcy was a stockman in Western Australia. After being found injured by some friends, he was transported over 30 miles (12 hours), to the nearest town, Halls Creek. Here, Darcy was met by FW Tuckett, the Postmaster, and the only man in the settlement trained in first aid. Tuckett said there was nothing he could reliably do for injuries so serious, and tried unsuccessfully to contact doctors at Wyndham, and then Derby, by telegraph. He eventually got through to a doctor in Perth. Through communication by morse code, Dr Holland guided Tuckett through two rather messy bladder operations utilising the only sharp instrument available, a pen knife. Holland then travelled 10 days to Halls Gap on a boat for cattle transport, a Model T Ford, a horse drawn carriage, and even on foot, only to find that Darcy had died the day before. To rub salt in the wound, the operations had been successful, but the stockman had died from an undiagnosed case of malaria and ruptured abscess in his appendix.
It was from stories such as this that Flynn, and his following at the AIM, became inspired to develop a route of communications that could solve the problem of remoteness. However, no feasible technology seemed apparent.

Flight and Radio: The fusion of two fledgling technologies

Along with motorised flight, another new technology was being developed that could replace the complicated means of communication by telegraph. Together with Alfred Traeger, Flynn began experiments with radio in the mid 1920s to enable remote outposts to contact a centralised medical base. The pedal radio was the first result of this collaboration. These were distributed gradually to stationss, missions and other human residences around Cloncurry, the base site for a 50-watt transmitter.

By 1928, Flynn had gathered sufficient funds through fundraising activities to launch the experiment of the AMS on May 15. Its supporters included industrialist HV McKay, medical doctor George Simpson, and Hudson Fysh, one of the founders of Queensland and Northern Territory Air Service, the company which would go on to become QANTAS. QANTAS supplied the first aircraft to the fledgling organisation, a De Havilland model DH50, dubbed "Victory". On May 17, two days after inception, saw the service's first official flight departing from Cloncurry, 85 miles to Julia Creek in Central Queensland, where the plane was met by over 100 people at the airstrip. QANTAS charged two shillings per mile for use of the Victory during the first year of the project.

Success, and continued success

In 1932, the success from its operations in Cloncurry, and the increasing public awareness to this quite vital rural service, resulted in a push for a national network of flying doctors, hopefully with sponsorship from the government. In 1934, this was realised with the new Australian Aerial Medical Service opening up "Sections" across the nation. Bases were set up in Wyndham, Port Hedland, Kalgoorlie, Broken Hill, Alice Springs and Meekatharra. The Queensland experiment was expanded with two additional bases opening in Charters Towers and Charleville. An official Federal Council for the organisation was formed in 1936. In 1942 it was again renamed to Flying Doctor Service, with Royal being bestowed upon the service in 1955.
Sister Myra Blanche was one of the first nurses, known as "Flying Sisters", to join the service. She was key in the New South Wales Section operations during the 1940s and 50s, even though Flying Nurses didn't actually become regular until the 1960s. Today, 80% of emergency evacuations are performed with only a nurse and pilot being present in person, a doctor directing such actions from a remote location. Nurses have been responsible for two innovations to the service, the "medical chest" (1942), which was later to incorporate the RFDS official "body chart" (1951). The chart is an anatomical representation of a human being, with areas clearly numbered. With such a chart on the scene of a situation, a remote doctor can ask the patient "which number is the pain felt?" and receive an easily comprehendible reply. The medicines contained within the chest are similarily numbered for ease in the communications of specific medical instructions.

The service today

The service is still heavily reliant on community support for funding, and is well respected across the country as an organisation that has contributed so much to rural development. The service basically holds true to the original model set by John Flynn.

Its services include:

• on site emergency first aid
• safe transport to hospitals as needed
• radio advice to remote situations, although most communication these days is by telephone, using satellite-phones when necessary
• :taking advantage of technology, the RFDS is happily adopting video conference technology to improve its service
• transportation of a general practictioner for regular clinical visits to remote areas (usually a circuit visiting several communities and/or stations)
• consultation, communication, and support for rural and remote doctors across Australia
• inter-hospital transfer of patients

Aircraft

Most of the dedicated aeromedical evacuation aircraft used are either the Beechcraft Super KingAir B200 or the Pilatus PC-12. The internal configuration of these two aircraft varies in the different RFDS sections. Typically they are configured with two rear-facing seats which look onto two stretchers. In some aircraft, one stretcher can be removed quickly and two seats slipped into place instead.

Transport for primary health clinics is often in PC12s, or sometimes in smaller non-pressurised aircraft which may be chartered from local operators.

Both the KingAir and PC12 are pressurised and so can be used to safely transport patients who would not otherwise tolerate the decreased atmospheric pressures involved in non-pressurised aircraft. By flying at a lower altitude than usual, the internal cabin pressure can be maintained throughout the flight at sea level. This is important for patients critically sensitive to pressure changes.

In addition, pressurised aircraft can fly at a sufficiently high altitude in order to be above turbulent weather conditions. This is of great benefit in providing an environment safe for the patient and staff, and also limits complications of aeromedical tranport such as motion sickness and exacerbation of injuries such as unstable fractures.

Organization

The Service is broken up into four "Sections", each of which contains a number of bases from which the Service's aircraft are despatched. They are:

• Central Operations - with bases at Uluru (Ayers Rock), Alice Springs, Port Augusta, South Australia, and Adelaide.
• South East - Broken Hill, Dubbo, Bankstown, Melbourne, Essendon, and Launceston.
• Queensland - Mount Isa, Cairns, Townsville, Rockhampton, Brisbane, Bundaberg, and Charleville
• Western Operations - Derby, Port Hedland, Meekatharra, Perth, and Kalgoorlie

Statistics

According to the RFDS 2003 Annual Report the service owns 36 aircraft, operates 23 bases with 521 employees.

Each day, on average, the service: