Aeromedical Retrieval for Stroke in Australia

Abstract

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.

Aeromedical retrieval diagnostic trends during a period of Coronavirus 2019 lockdown

“…26 The vast majority of aeromedical retrievals come from rural and remote areas of Australia. 13 These areas are characterised as having healthcare workforce shortages, coupled with higher social and economic disadvantage and higher rates of chronic disease, including cardiovascular 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.…”

“…The vast majority of aeromedical retrievals come from rural and remote areas of Australia 13 . These areas are characterised as having healthcare workforce shortages, coupled with higher social and economic disadvantage and higher rates of chronic disease, including cardiovascular and respiratory disease 27 .…”

“…During the COVID‐19 pandemic, the Royal Flying Doctor Service (RFDS) was tasked with transferring confirmed and suspected COVID‐19 patients throughout Australia, in addition to its normal activity of 30 000–35 000 aeromedical transfers per year 12 . Australia spans 7.69 million square kilometres, with the majority of the 2018 Australian population ( n = 24 992 860) residing in major cities ( n = 18 003 544; 72.0%) or inner‐regional areas ( n = 4 445 356; 17.8%), with the remainder living in outer‐regional ( n = 2 052 366; 8.2%), remote ( n = 291 213; 1.2%) and very remote ( n = 200 381; 0.1%) areas 13 . With a fleet of 74 aircraft the RFDS provides extensive aeromedical retrieval for patients requiring treatment in inner‐regional or major city hospitals 14…”

Aeromedical retrieval diagnostic trends during a period of Coronavirus 2019 lockdown

“…During the COVID-19 pandemic the Royal Flying Doctor Service (RFDS) was tasked with transferring confirmed and suspected COVID-19 patients throughout Australia, in addition to its normal activity of 30,000-35,000 aeromedical transfers per year 12 . Australian spans 7.69 million square kilometres, with the majority of the 2018 Australian population (n = 24,992,860) residing in major cities (n = 18,003,544; 72.0%) or inner-regional areas (n = 4,445,356; 17.8%), with the remainder living in outer-regional (n = 2,052,366; 8.2%), remote (n = 291,213; 1.2%), and very remote (n = 200,381; 0.1%) areas 13 . With a fleet of 74 aircraft the RFDS provides extensive aeromedical retrieval for patients requiring treatment in inner-regional or major city hospitals 14…”

Mental Health Care for Rural and Remote Australians During the Coronavirus Disease 2019 Pandemic

“…10 The RFDS services the majority of Australia's landmass (7.69 million square kilometers), 11 with rural and remote populations (N = 2,543,960, 10.2%) comprising the majority of people accessing RFDS services. 12 From July 2014 to June 2018, the RFDS conducted 105,147 air medical retrievals, 13 with respiratory system and mental and behavioral disorders comprising 7,697 (7.3%) and 3,230 (3.1%) of the retrievals, respectively.…”