Graphic: Loading a patient aeromedical transfer
In 2011, 669,881 Australians or 3% of the Australian population identified as Aboriginal and/or Torres Strait Islander (Indigenous) Australians. The 2011 Census data demonstrated that 142,900 Indigenous Australians, or 21% of the Indigenous population, lived in remote and very remote areas. A central purpose of the Royal Flying Doctor Service (RFDS) is to provide health services to those who live in remote and very remote areas. Accordingly, this research considers the health of Indigenous Australians living in remote and very remote areas. It details illness and accident demand for aeromedical retrievals of Indigenous Australians by the RFDS from remote and very remote Australia.
In 1989, the National Aboriginal Health Strategy Working Party affirmed the term Aboriginal health means not just the physical wellbeing of an Indigenous person but also the social, emotional and cultural wellbeing of the whole community in which each individual is able to achieve their full potential as a human being. Indigenous Australians’ decisions about when and why to seek health services, treatment acceptance, adherence and follow-up, and the success of prevention and health promotion, is accordingly influenced by culture. Indigenous Australians’ health outcomes are poorer than non-Indigenous Australians in relation to chronic and communicable diseases, mental health, infant health, and life expectancy. Indigenous Australians are 1.2 times as likely as non-Indigenous Australians to die from cancer and 1.5 times as likely as non-Indigenous Australians to die from cardiovascular disease (CVD). Indigenous Australians are 1.8 times as likely to die from an injury as non-Indigenous Australians and twice as likely as non-Indigenous Australians to be hospitalised for an injury. Indigenous Australians are twice as likely to die as a result of self-harm (suicide) than non-Indigenous Australians and three times as likely to die from chronic lower respiratory diseases. Indigenous Australians are three times as likely to die of digestive conditions and five times as likely as non-Indigenous Australians to die from endocrine, nutritional, and metabolic conditions such as diabetes. There is no biomedical reason to explain any of these disparities.
The substantial difference in health outcomes between Indigenous and non-Indigenous Australians is known as ‘the Gap.’ Reducing the gap between Indigenous and non-Indigenous Australians underpins much of Australia’s policies about Indigenous health.
Within national hospital statistics, data are reported on the care of Indigenous Australians who attend hospital for any reason. The outcomes for Indigenous Australians who arrive at hospital from remote or very remote Australia via an aeromedical retrieval are also captured in these data. However, not all components of care provided to Indigenous Australians, who are transported via an RFDS aeromedical retrieval, are reported in the national dataset. Specifically, the number of Indigenous patients transported by the RFDS for any reason, their primary diagnosis prior to arrival at hospital, and demographic data have not been previously reported. This research reports this data for the first time, using the International Statistical Classification of Diseases and Related Health Problems, 10th Edition, Australian Modification (ICD-10-AM) service data recorded by the RFDS in the period between 1 July 2013 and 31 December 2015.
Between July 2013 and December 2015, the RFDS conducted 75,763 aeromedical retrievals, equivalent to 83 aeromedical retrievals per day. Indigenous status was recorded for 62,528 patients. Patients whose Indigenous status was unknown were excluded from further data analysis. Of the 62,528 retrievals, 17,606 (28.2%) aeromedical retrievals were of Indigenous Australians from remote and very remote Australia. The current report considers the reasons for these healthcare interventions, to inform policy actions on what might prevent the future need for these episodes of care. When Indigenous aeromedical retrieval data were analysed using the 22 categories of ICD-10-AM, plus an additional category for unknown or ill-defined conditions, the RFDS was able to identify the most significant illnesses impacting the Indigenous Australians it serves. The sociodemographic characteristics of the population were also identified. The data revealed that: Indigenous females (53.8%) were 1.2 times as likely as Indigenous males (46.2%) to undergo an aeromedical retrieval; the average age at which an Indigenous Australian underwent an aeromedical retrieval was 30–34 years; Indigenous children aged 0–4 years (14.1% of Indigenous aeromedical retrievals) were the group of Indigenous patients most likely to undergo an aeromedical retrieval; and the largest volume of aeromedical retrievals originated in central Australia, the north of Western Australia, and the north of Queensland.
Indigenous Australians were most likely to require an aeromedical retrieval for injury, poisoning and other consequences of external causes: 17.9% of all Indigenous aeromedical retrievals. Diseases of the circulatory system, such as heart attacks or stroke, were the second most common reason for an aeromedical retrieval: 14.3% of all Indigenous aeromedical retrievals. Diseases of the respiratory system, such as a respiratory infection, influenza, and pneumonia, were the third most common reason for an aeromedical retrieval of Indigenous Australians: 12.8% of Indigenous aeromedical retrievals. Together, injury, poisoning and other consequences of external causes, diseases of the circulatory system, and diseases of the respiratory system accounted for almost half (45.0%) of all RFDS aeromedical retrievals of Indigenous Australians. Other illnesses impacting Indigenous Australians that triggered an aeromedical retrieval included: diseases of the digestive system, including the oesophagus, stomach, appendix, liver, and diseases associated with dental caries (7.8% of Indigenous aeromedical retrievals); pregnancy, childbirth and the puerperium (7.2% of Indigenous aeromedical retrievals); symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (6.5% of Indigenous aeromedical retrievals); diseases of the genitourinary system, such as renal failure (5.5% of Indigenous aeromedical retrievals); diseases of the skin and subcutaneous tissue (5.1% of Indigenous aeromedical retrievals); ill-defined conditions (4.5% of Indigenous aeromedical retrievals); mental and behavioural disorders (4.0% of Indigenous aeromedical retrievals); infectious and parasitic diseases (2.7% of Indigenous aeromedical retrievals); diseases of the musculoskeletal system and connective tissue (2.3% of Indigenous aeromedical retrievals); diseases of the nervous system, such as meningitis, Parkinson or Alzheimer disease (2.2% of Indigenous aeromedical retrievals); and endocrine, nutritional and metabolic diseases (2.1% of Indigenous aeromedical retrievals).
Unsurprisingly, some diseases only required emergency health transport in the most acute circumstances. These included: conditions originating in the perinatal period (1.5% of Indigenous aeromedical retrievals); neoplasms, or abnormal tissue growth (1.0% of Indigenous aeromedical retrievals); diseases of the blood and blood-forming organs and disorders involving the immune system (0.5% of Indigenous aeromedical retrievals), diseases of the eye and adnexa (0.2% of Indigenous aeromedical retrievals); diseases of the ear and mastoid process (0.2% of Indigenous aeromedical retrievals); and congenital malformations, deformations and chromosomal abnormalities (0.2% of Indigenous aeromedical retrievals). For Indigenous Australians between the ages of five and 39 years, injury, poisoning and certain other consequences of external causes was the leading reason for an aeromedical retrieval, accounting for around 30% of retrievals for each 5-year age group up to 34 years and around 20% for Indigenous Australians aged 35–39 years. A previous RFDS report on injuries in remote and rural Australia called for the development of a new national injury prevention plan incorporating evidence-based strategies aimed at reducing injuries (Bishop, Gale, & Laverty, 2016). The current report reiterates this call for a new national injury prevention plan, and
recommends such a plan incorporates specific, evidence-based, culturally appropriate strategies to reduce injuries amongst remote and rural Indigenous Australians.
The age pattern of Indigenous aeromedical retrievals showed that remote and rural Indigenous children, aged 0–4 years, accounted for the greatest proportion of all aeromedical retrievals, with around one in seven Indigenous aeromedical retrievals for a child under five years of age. More specifically, 22.6% of Indigenous Australians that underwent an aeromedical retrieval for diseases of the respiratory system were under one year of age. The overrepresentation of young Indigenous children in aeromedical retrievals, compared with other age groups, suggests that illness and injury prevention and intervention messages that target young children, their parents or carers, and health professionals serving these communities, may be helpful in reducing the incidence, or mediating the impacts of, illnesses and injuries for young Indigenous children. Specific, culturally appropriate, evidence-based illness and injury prevention strategies should be reviewed, developed, adopted, and evaluated for remote and
rural Indigenous Australians, taking into account the state-based services in areas where Indigenous Australians reside.
Organisations providing health care to Indigenous Australians, such as the RFDS, also have an important role to play in improving health outcomes for Indigenous Australians. There is strong evidence that inequitable access to quality healthcare, based on ethnicity, contributes to health disparities for Indigenous Australians. Consequently, better health outcomes are achieved when services and providers are culturally competent. There exists the potential for cultural competencies expected of health workers providing clinical care to Indigenous Australians in mainstream health settings to be articulated in a new national framework, designed and overseen by Indigenous lead clinical experts, as a measure to contribute to better Indigenous health outcomes. Such a framework would ideally provide evidence-based recommendations on the development of culturally appropriate services, and promote culturally appropriate face-to-face service delivery by healthcare professionals serving
Bishop, L., Laverty, M., and Gale, L. (2016). Providing aeromedical care to remote Indigenous communities. Canberra: Royal Flying Doctor Service of Australia.