Air Ambulance and Emergency Retrieval Services in Western Australia: Caseload Analysis Over 5 Years

The Royal Flying Doctor Service Western Operations (RFDSWO) provides critical care transfer and retrieval services across 2.5 million km2 to a population of 2.58 million people, providing both primary and secondary retrievals across Western Australia. Flying on average 26 million km/y, retrievals are undertaken with the use of rotary and fixed wing aircraft. Our current fleet includes 16 Pilatus PC-12NGs turboprops, 2 Pilatus PC-24 jets, and access to 1 helicopter (Bell 412). A Hawker XP800 Jet was retired in 2019 after 10 years of service. Our retrieval teams are formed of either a doctor and a nurse or a nurse only on fixed wing missions and a doctor and critical care paramedic for helicopter emergency medical services missions. We present our experiences and caseload statistics over the past 5 years. We performed an analysis of our retrieval database looking at the workload from January 1, 2012, to December 31, 2016. This included the number of patients, age, ethnicity, type of retrieval, priority, diagnosis, and distances covered. Forty-three thousand forty-one patients underwent Royal Flying Doctor Service air transfer over a 5-year period. Aboriginal patients comprise around 3.1% of the Western Australian population but accounted for 33% of RFDSWO retrieval missions. There was a mean transfer rate of 8,608 patients per year, which was relatively consistent across the study period. The modal age was 55 to 59 years, but Aboriginal patients were younger with a mean age of 36.5 years (Aboriginal) versus 49.7 years (non-Aboriginal). The types of retrieval undertaken were as follows: primary (17.3%), secondary (81%), and repatriation (1.7%). The urgency/priority of missions was as follows: immediate (7.3%), urgent (54.5%), and semiurgent (38.1%). The 3 most common diagnosis (International Statistical Classification of Diseases, 10th Revision) categories were trauma/injury (22.9%), cardiovascular (22.3%), and gastrointestinal (10.5%). The modal distance flown was 700 km per mission. RFDSWO has 1 of the largest retrieval workloads in the world, covering a landmass comparable with Western Europe. This brings with it a variety of challenging cases and complex logistics, often in extremely harsh and remote environments. We bring a wide breadth of experience in the area of retrieval medicine, and our aim is to share these experiences with other teams.