The first medical jet aircraft for the Royal Flying Doctor Service

TO THE EDITOR: The Royal Flying Doctor Service (RFDS) has provided aerial emergency services to patients in the remote Kimberley and Pilbara regions of Western Australia since 1935. Until the 1980s, most evacuations were regional, and only small numbers of patients were transferred to Perth. Demand for longdistance transfers from northern WA has increased as a result of economic growth, improved resuscitation of the seriously ill, advances in treatment only available in major cities, and community expectations of more equitable access to tertiary care. In the Kimberley, a ha dful of specialists service an area twice the size of Victoria, confronting substantial health problems in the predominantly Indigenous population. The Pilbara, an even larger region (two and a half times the size of Victoria) and the epicentre of massive economic development in mining and energy, is also covered by only limited numbers of specialists and a single regional hospital. During the 12 months to 30 June 2009, the RFDS transferred 1018 patients from the Kimberley and Pilbara regions to Perth, up to 2200 kilometres away, and a similar number were evacuated to facilities within the regions, or to Darwin, up to 1500 kilometres away (Box 1). These patients routinely endure some of the longest medical retrievals anywhere in Australia, if not the world. With turboprop aircraft, retrieval times can be up to 12 hours. Pilot flight-time limitations over such distances mean that 93% of Kimberley patients require multiple aircraft and crews to achieve transfer (Box 2). Patient handovers increase transport time and clinical risk, and require considerable coordination. In October 2009, the RFDS in WA launched a fast long-range medical retrieval jet, available to all of the community, irrespective of their capacity to pay. The aircraft, a Hawker 800XP mediumsized jet, has been funded by corporate sponsorship from the mining company Rio Tinto, as well as by public fundraising and cost recoveries. The aircraft has been exclusively outfitted for its aeromedical role. It has the capacity to retrieve two patients in need of critical care with two medical retrieval teams on board, non-stop from the most distant locations in WA, and can carry a third stretcher patient if necessary. Although they are more expensive to purchase and operate, the use of pure jet aircraft can substantially reduce transport times for patients with complex or timecritical conditions, and thus improve clinical outcomes. This is the first jet in the history of the RFDS, and represents a quantum step forward from the “DH50 machine” referred to in the Journal in 1927, or the pressurised turboprop aircraft adopted in the 1980s. Flying times for patients will be effectively halved. The aircraft, designated “Rio Tinto Life Flight”, will be integrated into the existing RFDS state-wide retrieval service in WA, which coordinates and operates 14 turboprop aircraft from five centres. This is a significant initiative to improve access and equity to tertiary care for Indig1 Trends in Royal Flying Doctor Service long-distance medical retrieval from and within the Kimberley and Pilbara regions of Western Australia