Introduction: Rural, remote, and Indigenous stroke patients have worse stroke outcomes than urban Australians. This may be due to lack of timely access to expert facilities. Objectives: We aimed to describe the characteristics of patients who underwent aeromedical retrieval for stroke, estimate transfer times, and investigate if flight paths corresponded with the locations of stroke units (SUs) throughout Australia. Methods: Prospective review of routinely collected Royal Flying Doctor Service (RFDS) data. Patients who underwent an RFDS aeromedical retrieval for stroke, July 2014-June 2018 (ICD-10 codes: I60-I69), were included. To define the locations of SUs throughout Australia, we accessed data from the 2017 National Stroke Audit. The main outcome measures included determining the characteristics of patients with an in-flight diagnosis of stroke, their subsequent pickup and transfer locations, and corresponding SU and imaging capacity. Results: The RFDS conducted 1,773 stroke aeromedical retrievals, consisting of 1,028 (58%) male and 1,481 (83.5%) non-Indigenous and 292 (16.5%) Indigenous patients. Indigenous patients were a decade younger, 56.0 (interquartile range [IQR] 45.0-64.0), than non-Indigenous patients, 66.0 (IQR 54.0-76.0). The most common diagnosis was "stroke not specified," reflecting retrieval locations without imaging capability. The estimated median time for aeromedical retrieval was 238 min (95% confidence interval: 231-244). Patients were more likely to be transferred to an area with SU and imaging capability (both p < 0.0001). Conclusion: Stroke patients living in rural areas were younger than those living in major cities (75 years, Stroke Audit Data), with aeromedically retrieved Indigenous patients being a decade younger than non-Indigenous patients. The current transfer times are largely outside the time windows for reperfusion methods. Future research should aim to facilitate more timely diagnosis and treatment of stroke.

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. This article is protected by copyright. All rights reserved.

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Background Inequalities in the availability of maternity health services in rural Australia have been documented, but not the impact on aeromedical retrievals. This study aims to examine the prevalence of pregnancy-related aeromedical retrievals, the most common conditions (overall and in specific age groups), and their distribution according to operation area and demographic characteristics. Methods Cross-sectional study using administrative data from the Royal Flying Doctors Service (RFDS) including all pregnant women aged 15–49 years retrieved by the RFDS between 2015 and 2019. All pregnancy-related aeromedical retrievals were classified according to the International Classification of Diseases, Tenth Revision (ICD-10, chapter XV). The distribution of pregnancy-related conditions was presented overall and stratified by age group (i.e. < 20 years, 20–34 years and 35+ years). Retrieval and receiving sites were geographically mapped with Tableau mapping software® based on postcode numbers of origin and destination. Results A total of 4653 pregnancy-related retrievals were identified (mean age 27.8 ± 6.1 years), representing 3.1% of all RFDS transfers between 2015 and 18 and 3.5% in 2018–19 (p-value 0.01). The highest proportion of pregnancy-related retrievals (4.8%) occurred in Western operation. There was an apparent increase in pregnancy-related retrievals in South Australia and the Northern Territory (Central Operation) in 2018–19. Preterm labour/delivery was responsible for 36.4% of all retrievals (40.7% among women aged 15–19 years) and premature rupture of membranes for 14.9% (19.4% among women aged 35–49 years). Inter-hospital transfers represented 87.9% of all retrievals, with most patients relocated from rural and remote regions to urban hospitals; most retrievals occurred during the day, with a median distance of 300 km. Adolescents and Aboriginal and Torres Strait Islander were overrepresented in the sample (four and eight times higher than their metropolitan counterparts, respectively). Conclusions The proportion of pregnancy-related aeromedical retrievals varies geographically across Australia. Overall, one-third of retrievals were related to preterm/delivery complications, especially among adolescents. Most retrievals performed by the RFDS are susceptible to public health strategies aimed at improving antenatal care and preventing unintended pregnancies among adolescents and Aboriginal and Torres Strait Islander women. Greater capacity to manage pregnancy conditions in rural hospitals could reduce the requirement for aeromedical inter-hospital transfers.