Flying Doctor at 80

“Who would have thought that such a humble beginning would have culminated in such a large organisation, with operations right across the country,’’ says John Lynch, chief executive of the RFDS Central Operations.

“John Flynn’s vision was amazing. ’’ So are the modern figures. Last year, the RFDS fleet of 47 pressurised aircraft flew 21. 7 million kilometres servicing an area of 7. 15 million square kilometres and attending to 252,547 patients in remote and rural Australia.

The national statistics show the RFDS attended an average of 665 patients a day, including 96 medical evacuations a day. And all this with 705 staff, including 155 part-time casuals.

“When it all started, it was an experiment and no-one knew where it would lead,‘’ Lynch says.

Under John Flynn’s guidance, and with the crucial 1927 invention by Alfred Traeger of the pedal wireless to provide the key communications network, the Presbyterian Church’s Australian Inland Mission developed its proposal for the Aerial Medical Service, which was proclaimed on May 15 1928. Two days later the first flight took off from Cloncurry in Queensland to Julia Creek Station, 136km away.

The aircraft was a single-engine De Havilland DH. 50, capable of carrying four passengers and cruising at about 80 miles an hour. It was chartered from the fledgling Queensland and Northern Territory Aerial Service, whose founder – Hudson Fysh – was an enthusiastic supporter of Flynn’s concept.

Within four years, 10 little hospitals had been established across the Outback, served by the flying doctor, but the Great Depression had begun and the Australian Inland Mission was struggling to keep the service going, despite federal government assistance, and the operation was handed over to a new organisation, the Australian Aerial Medical Service, in

“When it all started, it was an experiment and no-one knew where it would lead. ‘’

1934.

Through the 1930s, two new bases were established in Queensland, at Charters Towers and Charleville, together with bases at Broken Hill, Alice Springs, Kalgoorlie, Meekatharra, Wyndham and Port Hedland.

The organisation was renamed the Flying Doctor Service in 1942 and gained its Royal charter from the Queen in 1955.

The modern organisation, under its national board, is split into four relatively autonomous operating regions comprising Western Australia, Central – combining South Australia and the Northern Territory, Queensland and South-Eastern Australia, which covers New South Wales, Victoria and Tasmania.

South-Eastern Section has six bases and the largest Beechcraft fleet – 14 King Air B200s, with a 15th now coming into service at the Broken Hill base after an extensive modification and medical fit-out by Hawker Pacific at Bankstown and Total Aerospace Solutions.

The region’s business development manager, Alan Tippett, said the work represented a milestone in the development of aeromedical aircraft. The design was groundbreaking and would make the service more effective and efficient, he said.

The fit-out included patient oxygen, power systems, stretcher loading and mounting devices as well as “state-of-the-art medical equipment which qualifies our aircraft as fully operational flying intensive care units’’.

The Queensland Section has eight bases and 14 aircraft – 11 Super King Airs and three Pilatus PC-12s – and a territory covering 1. 73 million square kilometres, with more than 1000 landing strips. The latest two King Airs are coming into service now, after being bought last year and extensively modified. The region also has ordered two smaller Cessna Caravans for its Far North Queensland service, to replace charter aircraft.

Western Operations, formed from the merger of the WA and Eastern Goldfields divisions last year, has five bases, a fleet of six PC-12s and five King Airs, with a seventh PC‑12 on order and due for delivery in August, and covers an area of 2. 5 million square kilometres. Last financial year, its own aircraft flew 5. 14 million kilometres and chartered aircraft added another 450,000km.

As it clears a debt of $17 million for previous aircraft purchases, the chief executive of Western Operations, Tim Shackleton, told the ABC last year there were plans to replace the ageing King Airs and the present aim was a fleet of 12 PC-12s. But the division has not announced a timetable for the acquisitions yet.

Central Operations, with 10 PC-12s and an 11th coming on line now, and with eight medical officers, 35 nurses and 32 pilots, clocked up 4. 5 million kilometres of flying and made more than 51,000 patient contacts, including 7600 evacuations and hospital transfers, last year.

Central Operations incorporates the heartland of the RFDS – Alice Springs – where the organisation is preparing to spend $1. 5 million to upgrade its airport base and the popular museum and tourist centre in the town, which received about 70,000 visitors last year and acts as a national and global shopfront for the organisation. Tourism activities generated important revenue of almost $1. 4 million last financial year.

The proposed improvements at Alice Springs will follow recent expenditure of $3 million to upgrade the Port Augusta base in South Australia, where all components including administration, communications, flight operations and medical services were brought

The modern organisation is split into four relatively autonomous operating regions.

under one roof. The new base, opened in November last year, coordinates all communications, 24 hours a day, and serves as the after-hours tasking coordinator for Alice Springs and after-hours communications link for the Broken Hill base of the RFDS South Eastern Section across the border in New South Wales.

The communications centre is named after pedal wireless inventor Alfred Traeger.

And the service recently upgraded its Adelaide Airport facilities, including an area to load and unload patients under cover instead of carrying out that work on the tarmac, as well as providing improved accommodation for flight operations management and crews.

The Central Operations organisation expanded its operations to run the Marree health service at the bottom of the Birdsville Track in South Australia in 2006, took over the general medical practice at Tennant Creek in the NT in January this year and operates the Ayers Rock medical centre at Uluru in central Australia, where the role includes running a road ambulance.

It also conducts extensive “telehealth‘’ consultations over the telephone and its radio network –13,795 in all last year.

At the region’s Adelaide headquarters, John Lynch says those additional roles typify the way the RFDS has grown from an emergency medical service for isolated communities into a comprehensive primary healthcare service for remote and rural Australia.

While a key role remains emergency flights for accident and illness victims, the service runs regular clinics for Outback communities, with teams of doctors, nurses and specialists such as physiotherapists, occupational therapists, mental health workers and an Aboriginal health coordinator.

It also provides emergency medicine training programs for rural and regional doctors and health professionals, first aid training for people living in remote communities and a Commonwealth funded national GP service for rural women.

And it has started a “healthy living’’ health education program to tackle the growing problem of illnesses caused by poor diet and lack of exercise. This partnership with the Hong Kong-based Li Ka Shing Foundation – associated with the majority Hong Kong owner of Australian electricity group Spark Infrastructure – will conduct a 10 year program aimed at promoting lifestyle changes to reduce the incidence of such illnesses as heart disease and diabetes.

So the original “mantle of safety’’ mission for people in the outback has become “a mantle of healthcare services, saving and improving the lives of all in rural and remote Australia’’.

And the mission goes beyond that expanded vision, for the RFDS and its medically equipped aircraft also operate between capital cities, ferrying patients from Adelaide to specialist medical services in Melbourne, for instance.

The wider role has brought moves towards a national – and nationally funded – organisation to replace what Wikepedia describes as “a loose federation’’ of RFDS operations. The Howard government had sought cooperation in establishing a new national funding scheme for recurrent grants and re-introduced capital grants. A new funding model based on service delivery has been agreed in principle and is expected to lead to increased federal grants.

But there are some stumbling blocks to producing a national operations system, not least because different states and territories have different emergency service requirements, regulations and specifications.

As one small example, when an Adelaide based aircraft arrives at Adelaide Airport from a South Australian centre, the stretchers and stretcher loaders are compatible with the SA Ambulance Service and patients can be transferred directly and rapidly from aircraft to ambulance.

But the NT authorities have different emergency service specifications to the SA government, resulting in a different loading system, and a patient being flown from Alice Springs to hospital in Adelaide must be unloaded from the NT-based aircraft at Adelaide Airport, manually moved on to another stretcher and then loaded into the waiting ambulance.

A bit like the former, time-consuming change-of-gauge procedures on the railways, John Lynch agrees.

Apart from lost time, the different requirements also add to the cost in fitting out aircraft, and costs are a major concern.

The RFDS receives Commonwealth, state and territory grants, but it also relies heavily on corporate backing, customer receipts and donations to keep aloft.

The Central Operations balance sheet for 2006-2007 shows that government grants slipped from $12. 95 million to $11. 78 million, but income from customers rose from $8. 7 million to $10. 2 million on improved recoveries, and revenue from donations, legacies and bequests almost doubled from $5. 09 million to $9. 85 million.

Although operating costs for the region increased from $16. 3 million to $18. 7 million, including a $1 million jump to $3 million in the fuel bill and higher employee costs of $11. 3 million, Central Operations booked a surplus of $12. 4 million on total revenues of $35. 6 million for the last financial year.

A healthy surplus – but one which must be set against proposed forward capital investment of about $40 million over the next five years for the region, so that fundraising – as in the early days of the flying doctor – remains a crucial activity.

The capital costs will include medical equipment and the start of a replacement program for the early PC-12s for Alice Springs, Adelaide and Port Augusta from 2010.

The Adelaide based section of the organisation was a launch customer for the Pilatus PC-12 turbine single, receiving its first two aircraft in March 1995 and a total of four during that inaugural year.

Barrie Hocking, general manager of aviation operations for the CentralJohn Flynn gained his first taste of outback isolation when he was sent to the Beltana Mission in the northern Flinders Ranges as a missionary in 1911.

The following year he was made the first superintendent of the Presbyterian Church’s Australian Inland Mission, and began his quest to bring health services to the Outback, establishing bush hospitals and hostels.

But distance from medical help for the seriously ill and accident victims was a major problem, and led to deathes among outback people.

A key catalyst for developing the flying doctor service was a young medical student from Robe in South Australia, Clifford Peel, an aviation enthusiast who wrote to Flynn from a troopship on his way to the battlefields of France in November 1917.

Peel advanced a vision of using aircraft and missionary doctors to span the outback distances and bring medical help quickly to stations and isolated communities.

He even provided Flynn with some cost estimates for aircraft operations.

The young lieutenant did not live to see his idea become a reality – he was killed while flying over German lines near the end of the war – but Flynn and a former military airman, Hudson Fysh, industrialist H V McKay and a young Melbourne doctor, George Simpson, worked together to develop the concept.

Their work – and Alfred Traeger’s pedal wireless – provided the foundation for the flying doctor service.

And one of Fysh’s aircraft, a De Havilland DH. 50, operated the first Aerial Medical Service flight from the Queensland and Northern Territory Aerial Service’s base at Cloncurry on May 17 1928, at a charter cost of two shillings (20c) a mile. The infant Qantas also provided maintenance, with the Commonwealth government meeting half the cost.

The DH. 50 flew 110,000 miles for the AMS until 1934, when it was replaced with a DH. 83 Fox Moth.

The DH. 50 was sold to the Rockhampton Aerial Service in that year. In 1935, while operating a newspaper run, the aircraft crashed into the sea off Caloundra, north of Brisbane, and lost. But the pilot was rescued by the local lifesaving club. region, says the Pilatus was chosen to replace the region’s twin-engine Super King Airs – with the last of those aircraft sold four years ago – because of the fuel efficiency of its single engine, very good payload and all-strip capabilities.

“It does the job very well for us,’’ Hocking said. Last year the fleet of 10 – ahead of the latest aircraft delivery – clocked up 11,000 flying hours.

The new arrival, costing $6 million fully equipped and destined for the Alice Springs base, has a slightly higher takeoff weight of 4740kg, up by 220kg on previous models.

At the service’s preferred cruising speed of 255kt, compared with peak performance of about 270kt, the aircraft has a range of 1540nm with full reserves.

Peter Randell, chief pilot and SA operations manager for Central Operations, says the increased takeoff weight translates to another 250 litres of fuel, increasing the effective range for an aeromedical flight with crew and patients to 1150nm.

The PC-12 has a roomy, pressurised cabin, and a large rear door for easy stretcher access for air ambulance work. Pilatus says the standard turboprop aircraft includes a complete IFR avionics installation, EFIS instruments, auto-flight system and full de-icing equipment.

As launch customer, the RFDS has helped to guide some modifications, including a flat floor, a large rear door and ergonomics for singe pilot operation. The PC-12’s original large winglets were reduced to improve handling, after RFDS pilots found they were blanketing air flow across the ailerons.

The head of Pilatus Australia, Sebastian Lip, says the PC-12 operates as an aerial ambulance for several organisations, including the Red Cross in South Africa, the Royal Canadian Mounted Police (which has 13) and the Native Air Ambulance service in Arizona.

But the RFDS has “the only fully-dedicated aeromedical aircraft”, with much of the equipment including patient oxygen supply fitted at the factory in Switzerland.

Only the stretchers, stretcher loaders and cabinets are installed locally, he says.

The aircraft has proved popular with other Australian emergency services, with the WA and NT Police each operating two and the SA police one, while five PC-12s are serving as executive aircraft, carrying six to eight passengers.

Central Operations carries out its own maintenance with a team of eight aviation engineers, and has succeeded in keeping costs under tight control for the past year. John Lynch says the service has not experienced problems in keeping either maintenance staff or pilots so far – although he fears the national and international shortage of pilots is likely to have a future impact.

Attracting sufficient doctors and nurses to remote areas is another story, and the RFDS has introduced several initiatives including orientation programs for medical and nursing students as well as nursing scholarships to assist recruitment.

Dr John Setchell, general manager of health services for Central Operations, says several medical students have been lined up to work at Port Augusta, Ayers Rock and Tennant Creek under an elective program arranged through the medical schools at the University of Adelaide and Flinders University.

Dr Setchell says the RFDS has a responsibility to help to overcome doctor and nurse shortages in remote and rural Australia as part of its national health care brief.

As part of its 80th anniversary celebrations, the RFDS will hold open days at all its 22 bases across the country on May 18 as well as staging special events during the year. It’s achievements are certainly worth celebrating.

The PC-12 has a roomy, pressurised cabin, and a large rear door for easy stretcher access for air ambulance work.