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Tue Mar 3 05:29:42 GMT 2009

Whilst waiting for someone from RFDS (Royal Flying Doctor 
Service) to be a bit more accurate I will provide some 
information for this discussion gleaned from my experience 
in doing aeromedical retrievals on their airframes here in 
Australia to help out the discussion on fixed wing 
aeromedical retrieval.

They fly both King Airs and Pilatus PC 12 depending on 
which state in Australia you are in.  They do land on 
highways, which in the remote parts of Australia have been 
widened with parking bays and windsock off to the side. 
 They also land on bush dirt strips as required.  Given 
Australia's geography and wide spread population some of 
whom are many many many hundreds kilometres from any 
medical resources (I suspect similar to areas of Canada) 
the service does undertake a proportion of primary 
retrievals where the first medical help on scene will be 
in the form of the Doctor and Nurse working on the fixed 
wing.  This is especially the case for remote farming 
stations and minesites as well as for adventurers and 
travellers taking on Australia's outback.  This is often 
trauma related but may be medical or obstetric.  They have 
been operating nationally since the mid 1930s (I think) 
but where established in 1928.  During that time they have 
established an exemplary safety record and in recent times 
(last 10 years) I am aware of only one "incident" with the 
airframes with, I believe, no fatalities.

Again, given the geography there are a significant number 
of rotary wing aeromedical retrieval services also.  As 
Ian has already stated, weather, terrain, distance from 
airstrip to hospital and availability allowing, the 
generally accepted knowledge is that a fixed wing will be 
quicker for retrievals over 250-300kms away from recieving 
hospital (i.e. there and back) with helo used between 
50-100 up to 250 kms.  This is being looked at again with 
the advent of AW 139s into some helo services offering 
quicker flying time and longer range in those with extra 
tanks fitted but this is yet to be clarified.  I think it 
is important not to overvalue the speed there and back, as 
in many instances getting the medical retrieval team there 
quickly is what is required, at which stage definitive 
care can be instigated.  It is also not uncommon 
(especially in New South Wales) for retrieval teams to get 
to the scene quickly (by helo) provide medical assistance 
and intervention and then accompany the patient by road to 
the nearest appropriate hospital.  This is most likely in 
cases of entrapment and prolonged extrication.

Whilst enjoying the robust discussion on the value or 
otherwise of aeromedical retrieval services I would 
encourage people to think about specifics of geography, 
weather, population densities etc (particularly outside 
the US) before making sweeping statements in support or 
condemnation of there use (caveats often apply, on both 
sides of the debate).

On a seperate note the forum has been somewhat quiet with 
regard to interest in the recent bush fire disaster(s) in 
Victoria, Australia.  A recent article in the National 
press here has given some details of how major hospitals 
and EMS undertook there roles in this event but it would 
be great if anyone on the list was able to expand so that 
lessons learnt could be gained by all.

Cheers
Stefan

Emergency and Retrieval Physician
CareFlight Medical Services

On Wed, 25 Feb 2009 12:13:29 -0500
  Stephen Richey <stephen.richey at gmail.com> wrote:
> I would look at the success (and safety record) of the 
>Royal Flying Doctor
> Service in Australia.  They actually  have been known to 
>land their
> fixed-wing aircraft (King Airs if memory suffices) on 
>roads to access
> patients.
> 
> My main point with there being a greater utility in the 
>use of fixed wing
> aircraft in rural areas (and I mean REALLY 
>rural....Wyoming, New Mexico,
> northern Maine, western Kansas, North Dakota, Alaska, 
>etc....not "Look!
> There's corn!" rural) is that they are faster over 
>exceedingly long
> distances (once you get past a couple hundred miles as 
>is the case when your
> closest trauma center may be Albuquerque, Denver, Salt 
>Lake City, Portland
> or Anchorage.  In this way, they actually save time. 
> The secondary point to
> all of this is the reduction in the number of people 
>unnecessarily flown
> from scenes.  It is this sort of cowboy tactic that gets 
>crews and patients
> killed.
> 
> Interhospital transfer by fixed wing aircraft- if it is 
>taken seriously and
> implemented properly (which is currently is not in many 
>places because of
> the reliance on helicopters)- can be an extremely 
>effective means of moving
> the minority of patients who really need aeromedical 
>evacuation as quick as
> possible.   Also patient care in the back of a 
>helicopter is not easy and
> the added "comfort" of a more stable and roomy cabin 
>offered by a fixed wing
> aircraft allows for advanced procedures to be carried 
>out quicker and
> easier.
> 
> On Wed, Feb 25, 2009 at 12:01 PM, p.bjorn at netzero.net
> <p.bjorn at netzero.net>wrote:
> 
>>
>>
>> Begs the question: how useful ARE fixed wing services in 
>>EMS?  Even in my
>> experience (rural Maine), the circumstances which at 
>>once suggest and
>> tolerate airplane transfer during the primary treatment 
>>phase are
>> exceedingly rare.  You're adding at least two vehicles 
>>and maybe three teams
>> to the transfer process.  That consumes time and 
>>shatters continuity.
>>
>> Pret
>>
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> 
> 
> 
> -- 
> Stephen L. Richey, CRT
> --
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