The RFDS in WA
Priorities are set to ensure that conflicting flight requests are dealt with in order of medical need and to allow operations coordinators to task aircraft and crews in the most efficient means possible to meet these needs.
Priority systems categories patients according to the urgency of the case; that is, how quickly the patient must be attended. This is not necessarily the same as the severity of the patient's illness. Some patients have a high level of urgency but may not be critically ill, for example, advanced pre-term labour. Other patients may be critically ill but relatively stable and the level of care during transport is therefore more important than speed.
Our priority system grades flights according to performance benchmarks. These relate to the delay between receipt of the call to the departure of the aircraft incorporates delays in the RFDS (Western Operations) system, including the time taken to assess the flight and assign a priority, the time taken to task the crew, and the time taken for the crew to prepare for the flight and take off. Time from take off to arrival is primarily dependent on the patient's location and distance from the nearest base over which we have little control. However the time can be improved by diversion of aircraft in the area or lengthened by resource issues which require the tasking of a crew from a base which is not the nearest.
Arrival time is important medically, particularly for locations with limited resources, and is the most obvious performance parameter in the eyes of the referring centre. In determining the priority, a judgement of the flight times involved also needs to be made, especially for patients requiring transport over long distances.
The RFDS priorities used are:
Priority 1: "life threatening emergency"
Flight departs in the shortest possible time (subject to weather and essential safety requirements).
Priority 2: "urgent medical transfer"
Flight departs promptly (within performance criteria) with flight planning requirements met on the ground.
Priority 3: "elective transfer"
Flight tasked to make best use of resources and crew hours. Once tasked, departs within performance criteria set.
Priority 1 and 2 flights cover those emergency and retrieval flights where time is an important factor in the patient's management. Priority 3 relates to routine air medical transport operations where urgency is not a key factor.
Note: there is no formal stand-by category. We define these patients as not warranting a special flight. They will be carried on an opportunity basis only, in which case they should be recorded as Priority 3 in flight documentation. This includes most returning patients.
Priority 1: accident where no medical attention is available
eg. roadside, mine, station
Potentially life-threatening problem without adequate facilities
eg. heart attack, epiglottis, meningitis, respiratory failure or premature neonate in a nursing post or small hospital
Time Critical Condition
eg. arterial occlusion, aortic aneurysm, ruptured ectopic pregnancy, imminent delivery, uncontrolled haemorrhage
Priority 2: urgent medical problem where some stabilisation and treatment is possible locally but patient must be moved promptly
eg. cardiac failure, acute abdomen, pre-eclampsia, pneumonia, unstable angina, term infant with early respiratory distress, compound fractures, penetrating eye injury
Priority 3: elective inter-hospital or clinic transfer. Patient is in a stable condition with reasonable resources available
eg. conditions for investigation, patients from clinics, returning patients
May include seriously ill where time is not critical
eg. stable ventilator-dependent patient, transferred due to staff shortages
An acceptable delay period may be added to give a better indication of time frame
eg. 'within 12 hours, 24 hours, or 48 hours' or 'today or tonight'
These patients are non-urgent, being transported for specialist review, admission for confinement (from a clinic) or may be returning patients. Alternative means of transport should be strongly considered.
Priorities are only a tool for tasking aircraft and some discretion should be used if specific needs cannot be accommodated under the definitions outlined. The priority should be set on the medical need and not to suit our operational capabilities.
Departs in the shortest possible time, from the nearest base, to provide the quickest response on site. Response time from initial request to departure to be less than one (1) hour.
Departs promptly. Only delays to accomplish priority 1 flights. Response time objective four (4) hours maximum from initial call to departure.
Time is not critical. Departs promptly once tasked but may be delayed to achieve greatest efficiency in aircraft use. Limited time guidelines may be provided to Coordination Centre eg. within 12, 24 or 48 hours.
Response Time Definitions
The following definitions have been in long-standing use in our aero medical service.
Time from receipt of the first call regarding a patient transfer to departure (doors closed) time of the aircraft.
Time from receipt of the first call regarding a patient transfer to arrival and first contact with the patient.
Time from arrival and first contact with the patient to departure (doors closed) with the patient.
Time from arrival and first contact with the patient the arrival (doors open) at the destination airport.
Time from receipt of the first call regarding a patient transfer to arrival (doors open) at the destination airport.
A time agreed with the assessing RFDS doctor and Coordination Centre on the latest time when the aircraft and crew will depart for a patient. Times exceeding this must be notified to the assessing RFDS doctor.