In less than 80 years, the Royal Flying Doctor Service (RFDS) has developed from an idea and a 2-seater bi plane to over 60 state of the art flying mobile intensive care aircraft, including a latest version jet. It now operates the largest flying doctor service of its type in the world. Spanning the Australian continent, it serves Christmas Island to Norfolk Island and the world’s largest waiting room in between.

However, as a not for profit NGO faced with growing demands for its services within a climate of increasing regulatory laws, government competitive tendering for aeromedical services and changing donor and society expectations, the RFDS cannot – and has not – sat on its laurels.

Traditionally it is probably best known for its “swoop and scoop” rescue missions in emergency evacuations. The service is constantly reviewing ways to meet health needs around Australia. While “responses” to emergency calls provides one form of medical intervention, a focus on “prevention” has seen the greatest concentration of RFDS effort over recent times.

The flying in of doctors, nurses and allied health professionals to remote locations to conduct over 14,000 clinics annually has  seen access to medical advice greatly enhanced in the targeted areas. For some, it’s the only access to healthcare available!

Health promotion programs such as RFDS “On the Road” in remote Western Australia and health promotion Field Days in outback Queensland deliver education to indigenous communities, remote schools, and community groups. Also, the provision of thousands medical chests - a pharmacy in a box - allows for remote self-medication “by numbers” under instruction by phone from a medico back at base.

But it has been the advance in technological services that has seen a surge in diagnostic and delivery efficiency. A portable blood testing unit which transmits results to medical staff from isolated locations and direct from the air provides instant information for our medical staff to better treat patients “on the spot”. More recently, the introduction of portable ultrasound units has enabled obstetric ultrasound during antenatal checks at the remote clinics. The ultrasound units, the size of a briefcase, have also enhanced the emergency function of abdominal scans in trauma, the better diagnosing of pneumothorax, and the location of arterial lines in difficult circumstances.

Video conferencing and video diagnosis are revolutionising the ability for medical staff to discuss medical challenges in real time and to speak and “see” patients face-to-face.

The enhanced broadband capability will enable the RFDS to develop its “on-line health service” delivery where a “tele-doctor” or a “video-doctor” will be able to make patient visits without leaving the surgery, thus enabling more consultations without the delay of travel. In 2010, over 85,000 tele-health consultations to remote locations were conducted. The more people connected to a broadband capability, the higher reach of this vital service. Further enhancement of technology will enable scans and monitoring to be taken and analysed centrally. The “flying doctor” will be able to fly across the airways instantly to a patient. Electronic patient records will be accessible by medical staff via a central database enhancing consistent treatment whatever the patient’s location within Australia. This is vitally important as we serve more people who travel as tourists or workers across the country.

However with all the advances in technology, sick and injured people still need to be transported. So the introduction of RFDS’ most expensive “innovation” - jet aircraft - has reduced travel time to respond to calls for assistance by two thirds. In the recent “Dash through the Ash” in June 2011, a three-month-old baby from Perth was flown thousands of kilometres by an RFDS jet to the Royal Children’s Hospital in Melbourne below the volcanic ash cloud, which had grounded commercial aircraft. This enabled life-saving heart surgery within hours of the desperate need.

While advances in transportation, medical equipment and information technology will continue to provide leaps in patient care, it is the commitment and connection of highly professional staff that is the hallmark of the RFDS service. Accordingly, we have increased our efforts in primary health care through our mental health workers, art therapists (to assist with community building) and the innovative visiting Rural Women’s GP Program which provides women with confidential consultations in remote locations.

From its traditional accident or trauma services, the RFDS is innovatively responding to the need to provide preventative and primary health care. Health education, screening and community development all impact on the health of all Australians.

The future need for RFDS is growing, with increasing demand for its services in health education and primary health services. An aging population is seeing an increase in demand across all emergency and non-emergency transport and retrieval services. However, increased demand does not guarantee growth of RFDS.

With government departments moving towards competitively tendering traditional service contract on the open market, RFDS must now compete on a commercial basis – a challenging shift from a service focus to a business focus. In addition, as with many charitable service organisations, the deliberate investment in commercial enterprises to supplement the cost of service provision will also require brave consideration as an income source. The ability to align with private enterprises and provide economic measures on their “social investment” return will also have implications for the management skillset within the organisation. These innovations in leadership and business models are exciting opportunities for the service as it continues to evolve and build on its unique and iconic history.

The other major challenge for RFDS is the recruitment of medical and allied health professionals into rural and remote locations. And we are not alone in this challenge. RFDS is working closely with rural health networks to determine future models of delivery into remote areas - we are moving to work more with tele-health and e-health to provide remote self-diagnosis and treatment.

This is an exciting and challenging time for RFDS to further innovate to meet the changing needs of rural and remote communities across vast areas of Australia. And if it is to succeed in this work, RFDS needs the support of companies, governments and all Australians!

Scott Chapman, Chief Executive, Victoria