Royal Flying Doctor Service of Australia

The Royal Flying Doctor Service of Australia (RFDS, informally known as The Flying Doctors) is an air ambulance service for those living in the remote inland areas of Australia. It is a not-for-profit organization which provides both emergency assistance and primary health care to people who cannot easily access a hospital or general practice due to the prohibitive distances of the Outback. The Service also assists with distance education.

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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 of Australia.

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 Creek 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

Victorian Lieutenant Clifford Peel, had heard Flynn's public speeches, and on being shipped out to France for World War I in 1917, sent Flynn a letter explaining how he had seen a missionary doctor visiting isolated patients utilising a plane. Assisted by costing estimates by Peel, Flynn immediately took the idea of using aircraft to incept his idea, and published Peel's idea in the church's newsletter. Sadly Peel died in combat in 1918, probably not even knowing the impact he had in the creation of an Australian icon.

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 stations, 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 15 May. 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 DH.50, dubbed "Victory". On 17 May, two days after inception, the service's first official flight departed 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

Within the first year of operations, the service flew approximately 20,000 miles in 50 flights, becoming the first comprehensive air ambulance service in the world. The service persisted through some very tough first few years, dealing with postwar Australia and the Great Depression of the 1930s. During its first few decades the service relied heavily on community fundraising, volunteer support and donations. This is still the mainstay of the services funding, but it benefits greatly from State and Federal Government funding programmes that have since been introduced. Until the 1960s the service predominantly hired aircraft, pilots and service technicians from contractors. After this point, the service moved on to purchasing its own equipment and employing its own pilots and mechanics.

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 Blanch 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 comprehensible reply. The medicines contained within the chest are similarly 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
• advice to remote situations via telephone, satellite-phones and portable video conferencing units.
• transportation of a general practitioner 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

The service also utilizes not just aircraft but also four-wheel drives and other utility land vehicles to aid in transportation and communications.

Aircraft

As of October 2007 the aeromedical evacuation aircraft used are either the Pilatus PC-12 or the Beechcraft King Air 200 series . 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.

Both the PC-12 and King Air 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 transport such as motion sickness and exacerbation of injuries such as unstable fractures.

Organisation

The Service is a loose federation of 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 Yulara (near Uluru (Ayers Rock)), Alice Springs, Port Augusta, South Australia, and Adelaide.
• South East - Broken Hill, Dubbo, Sydney, Bankstown, Melbourne, Essendon, and Launceston.
• Queensland - Mount Isa, Cairns, Townsville, Rockhampton, Brisbane, Bundaberg, and Charleville
• Western Operations - Derby, Port Hedland, Meekatharra, Perth(Jandakot Airport), and Kalgoorlie

Some bases have been closed, or moved, since inception. Stations at Carnarvon, Geraldton and Wyndham have closed, while the original base at Cloncurry was moved to Mount Isa in 1965 and the early base at Charters Towers moved to Cairns in 1972.

Statistics

According to the RFDS 2003 Annual Report the service owns 36 aircraft, and operates 23 bases with 521 employees. Each day, on average, the service:

• travels 38,550 kilometres by air
• performs 105 landings
• sees 582 patients
• performs 82 emergency evacuations
• conducts 161 telehealth sessions.

In the 2004 Annual Report, the daily averages are:

• 53,480 km flown
• 159 landings
• 577 patients
• 86 evacuations (this includes inter-hospital transfers)
• 158 telehealth sessions.

In 2004 there were 45 aircraft, 471 full time staff and 138 part time staff.

In the 2005 Annual Report, the daily averages are:

• 53,491 km flown
• 159 landings
• 643 patients
• 91 evacutaions (this include inter-hospital transfers)
• 202 telehealth sessions

At the end of 2005 there were 50 aircraft operating through 22 bases. The RFDS has 495 full time and 145 part-time staff members. Total operating expenses were Aus$ 31,017,289 of which $ 2,325,467 was funded by donations while the remainder came from Government and internal funding.

School of the Air

The School of the Air, which links outback students with centralised teachers, until recently used the same radio equipment as the RFDS. This has been surpassed with the availability of internet services.

Trivia

• On 22 October 1958, Holden car manufacturers donated their 500,000^th vehicle to the service in Melbourne.
• The RFDS was the subject of the TV drama series The Flying Doctors. The series followed the lives of an RFDS crew based in a fictional township called 'Coopers Crossing' and the members of the local population that they served.

References

• Ross J ed. (1999) Chronicle of the 20^th Century, Viking, Ringwood, Victoria, ISBN 0-670-88606-8
• Australian Inland Mission collection - digitised images from the National Library of Australia

• The Pedal Radio