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Keywords:

  • emergency;
  • Indigenous health;
  • prehospital care;
  • remote area nursing;
  • service delivery to Indigenous population

Abstract

Objective: To understand the profile and impact of aeromedical evacuations in remote Indigenous communities.

Design: Descriptive study.

Setting: A primary health care centre in east Arnhem Land, Northern Territory, Australia.

Participants: Four hundred and ten evacuations from a total population of more than 2200 were analysed from February 2003 to August 2005.

Main outcome measures: Patient demographics, seasonal variations, diagnostic categories, utilisation of staff resources.

Results: On average 6.5% of the community were evacuated to hospital every year with an evacuation occurring every 2.2 days. Children aged under five years were 3.3-fold overrepresented in evacuations (comprising 37.7% of those evacuated versus 11.3% of the community, P < 0.001). Four diagnostic categories accounted for 61% of evacuations: respiratory disease (21%), obstetric conditions (15%), gastroenteritis (14%) and injury/poisoning (11%). Over the study period four patients required intubation at the clinic. Evacuation rates were higher in the monsoon season. Forty-seven per cent of evacuations occurred after hours. The waiting time for plane arrival ranged from one hour to 21 hours with a median wait-time of three hours.

Conclusion: Aeromedical evacuations place a heavy burden on primary health centres. Clinic staff are regularly required to provide hospital-level acute care, often for several hours at a time. Meeting this burden competes with primary prevention programs and regular clinic duties. The age and diagnostic profiles encountered in this study have significant implications for the range of skills required to provide an adequate acute care service. This study highlights the need for remote area health centres to be well resourced to meet these needs.