Australia’s aeromedical retrieval infrastructure and practices celebrate a long and proud history but a new push could see airborne healthcare taken to new heights.
Independent body Aeromedical Innovation Australasia’s (AIA) chairman Dr Paul Adams said the disparity existing in retrieval capabilities between urban and rural areas was concerning.
“I used to be a paramedic in South East Queensland and subsequently moved to Mt Isa as a doctor and I noticed issues almost immediately,” he said.
“They do have a helicopter in Mt Isa but it’s only useful to get patients from rural health posts back to Mt Isa Hospital- Townsville hospital is another 900km away if that patient needs intensive care.
“Fixed wing aircraft like those operated traditionally by the RFDS need runways or roads to take off and therefore aren’t able to land on the scene of many rural emergencies.
“Tiltrotor technology is predominantly used by the US military however soon there will be a civilian option. I began taking an interest in how tiltrotors might apply to aeromedical retrievals in Australia with our vast landscapes and low density populations in remote areas.”
Dr Adams said despite aeromedicine providers’ attempt to provide timely care, the motto “every minute counts” faced great irony in rural and remote areas.
"Don't get me wrong, we are very lucky to have the high quality services that currently exist and the amazing people within these organisations - it's just that new technology is coming at a rate that will make implementation really challenging,” he said.
“I once had a patient come in to Mt Isa mid- afternoon needing intensive care in Townsville. The first available aeromedical assistance couldn't launch from Townsville until evening so they weren't at the patient’s bedside until at least six hours after we called.
“It took over ten hours to get the patient to ICU and that is extremely different to what you would expect at Goondiwindi or somewhere in range of a rescue helicopter.”
Dr Adams suggests tiltrotor aircraft may be the answer, but AIA is taking a holistic approach to investigating different options.
In development for 50 years, the tiltrotor is best described as a combination of a helicopter and an aeroplane.
Dr Adams said the AW609 civilian tiltrotor was on track for Australia and could fly like a conventional fixed wing plane and achieve vertical takeoff and landing like a helicopter.
“It can also hover whilst operating a winch or hoist. It has normal wings and on the end of the wings are engines with big propellors to power the aircraft forward like an aeroplane, or they can rotate to lift it vertically like a helicopter,” he said.
“This transitions once the aircraft is in flight to achieve wing borne flight like that of a turbo prop aeroplane so you can achieve speeds and ranges far in excess of a helicopter.”
Not only does tilt rotor technology remove accessibility barriers and improve timeframes for optimum patient care, it is also making headway with cabin pressurisation.
Due for American Federal Aviation Administration (FAA) certification in 2018, D Adams said the AW609’s capabilities were unique.
“Tiltrotor aircraft are ideal for any injury or illness where the patient may deteriorate with an increase in altitude - cases needing a combination of cabin pressurisation, speed and point to point helipad transport are the niche it fills, overcoming a lot of shortcomings of modern helicopters,” he said.
"Tiltrotors could operate hospital to hospital and free up ambulances normally required to move patients between the hospital and the airport. "
Dr Adams said he created project thunderbird to accelerate the tiltrotor’s introduction to Australian aeromedicine.
“We’re not trying to make something happen that wouldn’t otherwise, we’re just pushing the process along quicker for the sake of better patient care,” he said.
“We face a number of challenges. We’re a very small team trying to facilitate change in an industry that has multiple competing agendas and people who might not listen to you if you haven’t got credibility.
“We’re a not for profit organisation and so far we have no funding. Essentially we’re crashing together two different worlds- fixed wing and helicopters, so there’s opposition to that to begin with.
“The industry is also very fragmented, a mosaic of different styles and Government arrangements- there are many reasons why patient care can get lost.”
Queensland RFDS head of flying operations Shane Lawrey said the organisation was aware of tiltrotor technology and would monitor its development and safety record in the coming years.
“The RFDS encourages research and development in the aeromedical field,” he said.
“Patient care is our number one priority and we welcome any advancement in technology that would allow us to reach a person in need faster and deliver them to hospital safely.”
Dr Adams said a population based approach to aeromedicine in Australia was not good enough.
“If you look at helicopter emergency medical coverage down the coast it covers about 97 per cent of the population but that’s not helpful if you’re at Longreach or Mt Isa,” he said.
“There is a continuing theme of rural people being the vulnerable minority and aeromedicine is about providing equity- the greatest good for the greatest number doesn’t cut it for me in this instance.”
Currently the New South Wales director of neonatal and paediatric emergency transport, Dr Andrew Berry has spent a great deal of time in rural and remote areas of Queensland and said he now sees the world from the perspective of people living in isolated areas.
“Queensland has helicopters scattered up and down its coastline and planes operating in rural areas but the two more or less work independently due to their restrictions,” he said.
“The tiltrotor bridges those technologies and potentially eliminates a certain amount of existing infrastructure.”
Dr Adams said project thunderbird was a long term commitment with clear goals and measurable outcomes.
“We’re advocating for a state-of-the-art support facility and a trial for tiltrotor aeromedicine at Wellcamp Airport, Toowoomba, and the early discussion stages are looking promising,” he said.
“It seems that you could use a Toowoomba AW609 to get an injured cattle farmer from a remote paddock in South West Queensland to a Brisbane Hospital in half the time it currently takes. Also, from Wellcamp we could reach the patient before the Roma helicopter, while altogether using half the number aircraft to do these rescues."
Dr Adams said he was not trying to create trouble by suggesting that the systems currently in place were inadequate but encouraged industry representatives and the general public to seek improvement.
“People are doing an awesome job with what they’ve got but we shouldn’t be content to say if it’s not broken don’t fix it,” he said.
“We need to constantly evaluate gap closing options and in doing so we might become known as pioneers and innovators.
“I strongly believe we should be the ones to demonstrate to the rest of the nation and the world the application of this new technology for a good cause and not just for generating revenue.”
