The RFDS in WA
Behind the Scenes
Dealing with your flight request
When you call on our 1800 number, it is identified in our Coordination Centre communications system as an evacuation or medical advice request and will be answered as quickly as possible. During the middle of the day we may have large numbers or calls occurring which could cause a brief delay. During the night we have less staff on duty and a sudden surge in calls may also cause short delays.
The Coordinator who initially answers your call is not clinically trained but experienced in the logistics of tasking and coordinating aero medical flights. They will ask you if your call is just for medical advice, or a definite flight request (we handle hundreds of medical advice calls from remote settings every week).
If your call is a flight request, they will ask for eight core pieces of information. These include who you are and where you are calling from (so we can call back). They will also ask for basic details about your patient to assist in identifying them (name, age and a rough diagnosis), their weight (important for loading), their location and destination (if known).
Transfer to Retrieval Doctor
The Coordinator will then transfer your call to the Duty Doctor at the base which is most likely to undertake the flight. As a minimum there is always one doctor available at any time at each of our five operating bases. Ideally it will be the base closest to you which will handle the request and will be tasked to transport your patient. However, if aircraft are out on long flights or duty medical staff are caught up with other flight requests, you may be put through to a retrieval doctor at another nearby base.
Our goal is to ensure that you can make a single call, and provide all of the information in that call to arrange transfer of your patient.
Call us Early!
There are usually multiple flight requests being handled at any one time. Therefore the earlier you call us and provide all the necessary clinical information, the more promptly we can arrange the transfer.
If you call us early, we are more likely to allocate your patient to an evacuation flight which may be planned or already underway in your region. A delay of merely 30 minutes can mean an aircraft departs on a flight in the opposite direction and will not return for 4-6 hours. Or it may mean that we depart from within your region with only one patient on board and will be unable to return for perhaps 6-12 hours.
We can carry two stretchered patients on most flights but the RFDS State-Wide Coordination Centre can only arrange this if we know about your patient.
Assessing the flight request
During your discussion with our retrieval doctor, we will liaise with you on a number of aspects of the request.
Air Transport Criteria
We are generally only able to allocate our aircraft and teams to patients who require long distance stretcher transport with medical or nursing care during the trip. If your patient can travel by other means (for example road ambulance, private vehicle, public transport, commercial flights) then we may have to decline your request.
Your patient will be assigned to one of three broad priority categories. We will liaise with you on this and the approximate time frame for transfer. If you believe the time frame is not suitable for your patient you have the opportunity to negotiate this with our medical staff based on clinical grounds.
Government funding arrangements and our resource limitations require patients to be transferred to the nearest suitable hospital able to provide care, not just to a hospital of choice. We ask you to justify the requested destination if it is not the nearest suitable hospital, or does not normally have the capacity to manage cases such as yours.
Our medical staff will make an assessment of the crew required to transfer the patient. Many cases such as acute surgical, obstetric and mental health will be transferred with a Flight Nurse alone. However unstable, undifferentiated or complex patients with acute cardiac, respiratory, paediatric or critical care requirements, or major trauma, will normally have a retrieval team comprising doctor and flight nurse.
During your call we will be evaluating what special equipment, drugs or other items might be required for the transport. This may include bringing blood products, anti-venoms or antidotes.
During your call our medical staff will be deciding whether it is better to collect your patient at the airport or come in to your hospital. Coming in to the hospital enables us to undertake more procedures and "package up" your patient in better facilities. However, it adds at least 1 ½ to 2 hours to the retrieval and so for time-critical cases it may be better to collect the patient at the airport and get them to their destination much more quickly.
Coming into a hospital also ties up a crew for longer, causing delays for other patients waiting to be transferred across the state. As a routine, most patients are collected at the airport and the referring hospital is responsible for getting them to the airport, with an escort and handing over.
Our clinical staff will decide on a number of other operational parameters. These include whether we need sea level cabin pressurisation, whether a multiple sector flight is appropriate, or we need a straight through flight with over-nighting of the crew.
We need to consider which other patients can be carried on the same aircraft, considering clinical and workload factors. In the case of certain infectious patients, we may not be able to carry other patients on the same flight, particularly if they are immunocompromised.
Very large patients, who are too wide to fit on an ambulance or aircraft stretcher, require special arrangements. In some cases we may not be able to transport them at all. Patients who are able to fit on a stretcher but are very heavy (to around 180kg) may be carried on some aircraft. We need an accurate weight in advance and the case will need to be discussed with our retrieval doctor and extra lifting assistance provided at the airstrip.
After your call, the retrieval doctor will notify our Coordination Centre of the priority of the flight and many of these special arrangements. They will then liaise on any operational issues which preclude a straightforward transfer from occurring.
Dealing with Multiple Requests
Is it not uncommon for there to be multiple requests of similar urgency all pending. During daytime hours, a Clinical Coordinator (RFDS retrieval doctor) is available in the Coordination Centre to overview outstanding cases and determine the most appropriate order of transport, based on clinical grounds. After hours, this role is undertaken by the individual duty doctors at each base.
Tasking the Flight
The most appropriate crew will be tasked taking into account all other patients awaiting transport and the current distribution and workload of each base. Many factors are involved including aircraft hours and serviceability status, pilot duty hours and limitations, staff shifts and rostering limitations and other patients to be collected. Weather forecasts, airstrip conditions, payload and fuel requirements also influence which teams can be used and when.
The Coordinator will call the pilot, flight nurse and doctor and allocate a particular aircraft. Arrangements are made for fuelling to meet the specific needs of the flight and preliminary notifications may be made to hospitals about estimated arrival times (ETA's) – especially if it is a relatively short flight. In some locations the time taken for a road ambulance to get the patient to the airport is longer than the 25 minutes to fly 200km! Calls may be necessary to arrange airstrip lighting and strip checks for livestock and roos.
See what happens next: Conducting a Flight