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Australia’s remote population is forecast to grow only marginally in a decade. Yet chronic illness will rise dramatically, with the burden of mental illness forecast to increase by a fifth, if action is not taken to halt current trends.
Health service access in rural regions is also forecast to lag behind metropolitan areas, according to Royal Fly...
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Citations
... Indigenous peoples, while comprising only 3.2 % of the total population, account for nearly half of the population in very remote areas (major cities 1.8 %; remote 15.3 %; very remote 40.6 %) (Australian Bureau of Statistics, 2021b). Located in Australia's North, Queensland has the second-highest Indigenous population, with the leading non-Indigenous ancestry being English, Irish, Scottish, and Chinese (Gardiner et al., 2018). ...
... This study includes data for vaccines given to remote and very remote Australian residents, as defined by the Australian Statistical Geography Standard (ASGS) (13). Remote and very remote Australia has low population concentrations distributed over vast distances with limited or no service provision, including healthcare, for hundreds of kilometers (14,15). ...
Background
The Royal Flying Doctor Service of Australia (RFDS) established a unique SARS-CoV-2 vaccination program for vaccinating Australians that live in rural and remote areas. This paper describes the preparation and response phases of the RFDS response.
Methods
This study includes vaccinations conducted by the RFDS from 01 January 2021 until 31 December 2021 when vaccines were mandatory for work and social activities. Prior to each clinic, we conducted community consultation to determine site requirements, patient characteristics, expected vaccination numbers, and community transmission rates.
Findings
Ninety-five organizations requested support. The majority (n = 60; 63.2%) came from Aboriginal Community Controlled Health Organizations. Following consultation, 360 communities were approved for support. Actual vaccinations exceeded expectations (n = 70,827 vs. 49,407), with a concordance correlation coefficient of 0.88 (95% CI, 0.83, 0.93). Areas that reported healthcare workforce shortages during the preparation phase had the highest population proportion difference between expected and actual vaccinations. Areas that reported high vaccine hesitancy during the preparation phase had fewer than expected vaccines. There was a noticeable increase in vaccination rates in line with community outbreaks and positive polymerase chain reaction cases [r (41) = 0.35, p = 0.021]. Engagement with community leaders prior to clinic deployment was essential to provide a tailored response based on community expectations.
... Health professionals who work in remote communities understand the barriers to provision of health services, but limited • failure of health services to engage and codesign with consumers including young people [59,60] Access to effective health services. Accessing health services for remote-living families often means travelling long distances to reach health care, relying on the Royal Flying Doctors Service, or waiting for outreach health services to visit remote communities [61][62][63]. For instance, families must travel long distances to access allied health services for children in remote settings, notably paediatric speech pathologists [64,65]. ...
In Australia, there is a significant gap between health outcomes in Indigenous and non-Indigenous children, which may relate to inequity in health service provision, particularly in remote areas. The aim was to conduct a scoping review to identify publications in the academic and grey literature and describe 1) Existing health services for Indigenous children in remote Australia and service use, 2) Workforce challenges in remote settings, 3) Characteristics of an effective health service, and 4) Models of care and solutions. Electronic databases of medical/health literature were searched (Jan 1990 to May 2021). Grey literature was identified through investigation of websites, including of local, state and national health departments. Identified papers (n = 1775) were screened and duplicates removed. Information was extracted and summarised from 116 papers that met review inclusion criteria (70 from electronic medical databases and 45 from the grey literature). This review identified that existing services struggle to meet demand. Barriers to effective child health service delivery in remote Australia include availability of trained staff, limited services, and difficult access. Aboriginal and Community Controlled Health Organisations are effective and should receive increased support including increased training and remuneration for Aboriginal Health Workers. Continuous quality assessment of existing and future programs will improve quality; as will measures that reflect aboriginal ways of knowing and being, that go beyond traditional Key Performance Indicators. Best practice models for service delivery have community leadership and collaboration. Increased resources with a focus on primary prevention and health promotion are essential.
... Typically, tertiary retrieval involves the step-up transfer of patients between secondary and higher-level tertiary hospital care for more advanced ongoing clinical support. Tertiary retrieval may also involve the transfer of patients to less acute medical settings, also known as repatriations or back transfers, where health care is stepped down for ongoing support prior to medical discharge [4,10]. ...
Background
Aeromedical emergency retrieval services play an important role in supporting patients with critical and often life-threatening clinical conditions. Aeromedical retrieval services help to provide fast access to definitive care for critically ill patients in under-served regions. Typically, fixed-wing aeromedical retrieval becomes the most viable transport option compared with rotary-wing aircraft when distances away from centres of definitive care extend beyond 200 kms. To our knowledge, there are no studies that have investigated fixed-wing aeromedical services in the member countries of the organisation for economic cooperation and development (OECD). A description of the global characteristics of aeromedical services will inform international collaboration to optimise clinical outcomes for patients.
Aim
In this scoping review, we aimed to describe the features of government- and not-for-profit organisation-owned fixed-wing aeromedical retrieval services in some of the member countries of the OECD.
Methods
We followed scoping review methodology based on the grey literature search strategy identified in earlier studies. This mostly involved internet-based searches of the websites of fixed-wing aeromedical emergency retrieval services affiliated with the OECD member countries.
Results
We identified 460 potentially relevant records after searching Google Scholar (n = 24) and Google search engines (n = 436). After removing ineligible and duplicate information, this scoping review identified 86 government-and not-for-profit-operated fixed-wing aeromedical retrieval services as existing in 17 OECD countries. Concentrations of the services were greatest in the USA followed by Australia, Canada, and the UK. The most prevalent business models used across the identified OECD member countries comprised the government, not-for-profit, and hybrid models. Three-quarters of the not-for-profit and two-fifths of the hybrid business models were in the USA compared to other countries studied. The government or state-funded business model was most common in Australia (11/24, 46%), Canada (4/24, 17%), and the UK (4/24, 17%). The frequently used service delivery models adopted for patients of all ages included primary/secondary retrievals, secondary retrievals only, and service specialisation models. Of these service models, primary/secondary retrieval involving the transportation of adults and children from community clinics and primary health care facilities to centres of definitive care comprised the core tasks performed by most of the aeromedical retrieval services studied. The service specialisation model provided an extra layer of specialist health care dedicated to the transportation of neonates and paediatrics. At least eight aeromedical retrieval services catered solely for children from birth to 16 years of age. One aeromedical service, the royal flying doctor service in Australia also provided primary health care and telehealth services in addition to primary retrieval and interhospital transfer of patients. The doctor and registered nurse/paramedic (Franco-German model) and the nurse and/or paramedic (Anglo-American model) configurations were the most common staffing models used across the aeromedical services studied.
Conclusions
The development and composition of fixed-wing aeromedical emergency retrieval services operated by not-for-profit organisations and governments in the OECD countries showed diversity in terms of governance arrangements, services provided, and staffing models used. We do not fully understand the impact of these differences on the quality of service provision, including equitable service access, highlighting a need for further research.
... Routine screening for dementia is limited, despite known benefit of early detection and intervention on quality of care and patient outcomes, this again particularly evident in regional and rural communities [4]. Dementia healthcare services have become increasingly managed by specialist services, with the World Alzheimer Report 2016 calling for primary and community care services to play a more prominent role in diagnosis and management [5]. ...
Background
Dementia is a major international health issue with high impact on the patient, relatives, and broader society. Routine screening for dementia is limited, despite known benefit of early detection and intervention on quality of care and patient outcomes. Screening is particularly limited in rural and regional areas, despite high burden and projected growth of dementia in these populations. The current study aimed to implement a new general practitioner (GP) led, multidisciplinary, model of care providing dementia detection and referral pathway to a community-based specialist clinic across six regional general practices.
Methods
Cross-sectional analysis of dementia screening and referral characteristics in the St Anthony Family Medical Practices group based in the regional area of Loddon-Mallee, Victoria. Data were collected on demographics and relevant medical history. Cognitive state was assessed using the Mini-Mental State Examination (MMSE), GP Assessment of Cognition (GPCog), and Geriatric Depression Scale (GDS). Referrals and referral outcomes were recorded for geriatrician, psycho-geriatrician, or both.
Results
Eight hundred and eighteenth patients over 65 years were screened, accounting for approximately 24.2% of 65 and over presentations for the practice network. Of those screened, 68.9% were indicated for referral and 30.3% of these were successfully referred. Of the indicated patients who received referrals, 34.2% declined. Many who declined referral had intermediate scores on the cognitive assessments utilized.
Conclusion
Standardised models of care, integrated within community services, are necessary to improve access to early detection, referral and quality management of dementia. The St Anthony Memory Service model will be invaluable in informing future service development, and in particular the development of services for people living with dementia in rural and regional communities.
... The concept involves an airplane or helicopter Air-MSU equipped identically to a MSU road ambulance with multimodal imaging capabilities, a point-of-care laboratory, and a telemedicine connection to a stroke specialised centre so that stroke patients in remote regions could obtain diagnosis and treatment at the emergency site. The large Victorian Stroke Telemedicine project, a state-wide programme to establish access to acute stroke thrombolysis in non-specialised regional hospitals has demonstrated that the delivery of acute remote stroke specialist support can be safely implemented [31] . ...
Acute stroke is one of the most common causes of disability worldwide and numbers are projected to increase. Modern and successful recanalizing treatments are available, but timely access to these treatments is most often restricted to urban populations. This disparity affects nearly half of the world’s population, particularly those living in rural and remote areas, and most often affects people with indigenous background. We provide information on this disparity in acute stroke care between rural, remote, and urban areas. We discuss potential new management strategies which could facilitate the timely delivery of acute stroke care to those residents beyond the better serviced urban areas. We focus on the concept of a mobile stroke unit (MSU), especially an Air-MSU. This aircraft solution could provide an imaging capability and immediate clinical expertise via linked telemedicine to diagnose and treat acute stroke patients at the emergency site. The Air-MSU is not only envisioned to allow intravenous thrombolysis in the field but also to allow pre-hospital triage to comprehensive stroke centres through use of contrast imaging to diagnose large vessel occlusion, facilitating endovascular thrombectomy. Moreover, issues regarding optimal operating environment as well as novel imaging and diagnostic devices, which could facilitate the implementation of an Air-MSU are discussed. Innovative health care solutions are urgently needed to close the treatment gap for stroke patients living in rural and remote regions worldwide.
... and respiratory disease. 27 A potential contributor to the higher relative rates of retrievals for cardiovascular disease could be associated with limitations in these population groups able to access telehealth services, as traditional face-to-face services during the lockdown period were limited. As many remote Australian communities have limited access to COVID-19 testing and management facilities, coupled with higher chronic disease risk factors, it is likely that during mass infection many of these patients will require air ambulance transfer to inner-regional and major city hospitals. ...
Background
Little is known on the trends of aeromedical retrieval during social isolation.
Objectives
To compare the pre, lockdown, and post‐lockdown aeromedical retrieval (AR) patient characteristics during a period of Coronavirus 2019 (COVID‐19) social isolation.
Methods
An observational study with retrospective data collection, consisting of AR between 26 January and 23 June 2020.
Results
There were 16981 ARs consisting of 1983 (11.7%) primary evacuations (PEs) and 14998 (88.3%) inter‐hospital transfers (IHTs), with a population median age of 52 years (interquartile range [IQR] 29.0–69.0), with 49.0% (n= 8283) of the cohort being male and 38.0% (n= 6399) being female. There were six confirmed and 230 suspected cases of COVID‐19, with the majority of cases (n=134; 58.3%) in the social isolation period. As compared to pre‐restriction, the odds of retrieval for the restriction and post‐restriction period differed across time between the major diagnostic groups. This included, an increase in cardiovascular retrieval for both restriction and post‐restriction periods (OR 1.12 95% CI 1.02‐1.24 and OR 1.18 95% CI 1.08‐1.30 respectively), increases in neoplasm in the post restriction period (OR 1.31 95% CI 1.04‐1.64), and increases for congenital conditions in the restriction period (OR 2.56 95% CI 1.39‐4.71). Cardiovascular and congenital conditions had increased rates of priority 1 patients in the restriction and post restriction periods. There was a decrease in endocrine and metabolic disease retrievals in the restriction period (OR 0.72 95% CI 0.53‐0.98). There were lower odds during the post‐restriction period for a retrievals of the respiratory system (OR 0.78 95% CI 0.67‐0.93), and disease of the skin (OR 0.78 95% CI 0.6‐1.0). Distribution between the 2019 and 2020 time periods differed (p<0.05), with the lockdown period resulting in a significant reduction in activity.
Conclusion
The lockdown period resulted in increased AR rates of circulatory and congenital conditions.
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... Additional, and unprecedented, stresses caused by the COVID-19 pandemic will lead to anxiety, burnout, depression, and increased sick and personal leave within our clinical workforce. 21 These health care providers are already in short supply in rural and remote Australia 14 ; as such, we need clinical and general population policy and practice interventions aimed at supporting these clinicians and the public they service. However, the best way to support mental health during pandemics such as COVID-19 remains unclear. ...
The aims of this article are to comment on pre–coronavirus disease 2019 (COVID-19) mental health activity in rural and remote Australia, including related air medical retrievals; to discuss how the current pandemic is likely to impact on this vulnerable population's mental health; and to provide potential solutions. The COVID-19 pandemic has resulted in significant air medical activity from rural and remote Australia. COVID-19 and the necessary public health and socioeconomic interventions are likely to significantly compound mental health problems for both the general public and the mental health workforce servicing rural and remote communities. However, the COVID-19 crisis provides a window of opportunity to develop, support, and build novel and sustainable solutions to the chronic mental health service vulnerabilities in rural and remote areas in Australia and other countries.
... Within rural and remote Australia, the rates of specialist doctor provision (including gastroenterologists) is 27 per 100 000 population, well below suggested benchmarks of 100 per 100 000 population. 2 The Royal Flying Doctor Service (RFDS) conducts extensive aeromedical retrievals for patients in rural and remote areas. However, it is unclear how many RFDS patients receive an aeromedical retrieval for GI conditions. ...
The Royal Flying Doctor Service (RFDS) provides medical care to populations without
access to traditional health-care services. From 2014 to 2018 the RFDS conducted 6007
(≈1201/year) aeromedical retrievals for gastrointestinal (GI) disorders. More detailed
research is needed to determine specific GI disorders that contributed to this caseload,
and in particular inform whether the establishment of a GI specialist service is justified.
... For example, when Central Operations (CO), which provides services to South Australia and the Northern Territory, has 6 operational aircraft, it is able to meet demand 87.5% of the time at benchmark. However, if COVID-19 cases were to increase by n=8 priority 1 and n=4 priority 2 patients per day, Central Operations would need to increase its serviceable aircraft to [8][9][10][11][12][13][14][15] to meet demand. This is consistent throughout the RFDS Sections and Operations, with results detailed in Figure 3. Figure 4 indicates that under most scenarios, priority 1 patient demand is met under 6 hours, however at the expense of priority 2-3 (as these are prioritised after priority 1 patients). ...
... Rural and remote areas (especially remote areas) have significant workforce shortages. 12 This includes limitations in recruiting and retaining general practitioners, nurses, and allied health professionals. 12 During this pandemic we have had volunteer pilots offer their services. ...
... 12 This includes limitations in recruiting and retaining general practitioners, nurses, and allied health professionals. 12 During this pandemic we have had volunteer pilots offer their services. ...
Introduction
There is a COVID-19 pandemic. We aimed to describe the characteristics of patients transported by the Royal Flying Doctor Service (RFDS) for confirmed or suspected Coronavirus disease 2019 (COVID-19), and to investigate surge capacity of, and operational implications for, the RFDS in dealing with COVID-19.
Methods
Prospective cohort study. To determine the characteristics of patients transported for confirmed or suspected COVID-19, we included patient data from 02 February 2020 to 06 May 2020. To investigate surge capacity and operational implications for RFDS in dealing with COVID-19, we built, and validated, an interactive operations area level discrete-event simulation decision support model, underpinned by RFDS aeromedical activity data from 2015 to 2019 (4-years). This model was subsequently used in a factorial in silico experiment to systematically investigate both the supply of RFDS aeromedical services and the increased rates of demand for these services, for diseases of the respiratory system.
Results
The RFDS conducted 291 patient episodes of care for confirmed or suspected COVID-19. This included 288 separate patients, including 136 males and 119 females (gender missing=33), with a median age of 62.0 years (IQR=43.5-74.9). The simulation decision support model we developed is capable of providing dynamic and real-time support for RFDS decision-makers in understanding the system's performance under uncertain COVID-19 demand. With increased COVID-19 related demand, the ability of the RFDS to cope will be driven by the number of aircraft available. The simulation model provided each aviation section with estimated numbers of aircraft required to meet a range of anticipated demands.
Conclusion
Despite the lack of certainty in the actual level of COVID-19 related demand for RFDS services, modelling demonstrates that robustness of meeting such demand increases with the number of operational and medically staffed aircraft.
