Fergus W Gardiner

Royal Flying Doctor Service · Federation

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 cor...

Background: Inequalities in access to renal services and acute care for rural and remote populations in Australia have been described but not quantified. Aim: To describe: the coverage of renal disease management services in rural and remote Australia; and the characteristics of patients who had an aeromedical retrieval for renal disease by Aust...

Objectives: To assess the clinical effectiveness of faecal calprotectin (FC) testing for distinguishing between organic gastrointestinal diseases (organic GID), such as inflammatory bowel disease (IBD), and functional gastrointestinal disorders (functional GIDs). Study design: Studies that assessed the accuracy of FC testing for differentiating...

Objectives: To characterise the people retrieved by the Royal Flying Doctor Service (RFDS) for treatment of mental and behavioural disorders, and to assess mental health care provision in rural and remote areas. Design: Prospective review of routinely collected RFDS and Health Direct data. Setting, participants: RFDS aeromedical retrievals of patie...

We wished to describe the characteristics and disease profile of older persons living in rural and remote Australia who accessed the Royal Flying Doctor Service (RFDS), and to determine the services available to these populations. We believe many retrievals could have been limited with equitable distribution of medical testing and rehabilitation/ma...

Introducing Best for the Bush Despite some challenges, those in rural, regional and remote parts of our country report higher rates of life satisfaction than in our cities. It is critical for our society, our identity and our economy that we have populations in these areas farming our fibre, mining our minerals and tending our traditional lands....

Background Aeromedical emergency retrieval services play an important role in supporting patients with critical and often life-threatening clinical conditions. Aeromedical retrieval services help to provide fast access to definitive care for critically ill patients in under-served regions. Typically, fixed-wing aeromedical retrieval becomes the mos...

Objective Estimate impact of socioeconomic factors and remoteness from tertiary hospital on incidence/duration of Australian mental health admissions. Methods Retrospective analysis of incidence/duration of public mental health unit admissions (2018–19). Covariates included Indigenous population, potentially preventable hospitalisations (PPH) and...

Background Remote Australian women in labour often rely on retrieval services to allow birthing in specialist obstetric centres. However, there is currently debate over when not to transfer a woman in labour, for risk of an in-transit birth, associated with worse neonatal outcomes. Methods A scoping review methodology was undertaken, to define the...

In January 2022, as the COVID pandemic reached remote communities in Central Australia, The Northern Territory Health Central Australian Regional Health Service and the Royal Flying Doctor Service (RFDS) executed 'COVID on Country', a program designed to triage cases and to implement treatment and clinical review of individuals in their community w...

Introduction: The aim of this study was to describe the characteristics and outcomes of remote dwelling pregnant people with threatened labour referred for aeromedical retrieval to a regional birthing centre, as well as factors associated with birth within 48 hours. Methods: This was a retrospective observational study of all pregnant people in the...

Meeting the mental health needs of rural populations is challenging internationally, with few methods and scarce data available to inform site-specific planning. We developed a mixed methods approach that integrates Not-for-profit (NFP) organization data in a Geographic Information System (GIS) to explore interrelated understandings of mental healt...

Terence felt a massive, sudden, incredible pain in the back of his head. He knew something was very wrong. Terence, a train driver, was 58 years old when he experienced his stroke. He is not alone. About 100 strokes happen every day in Australia.

Background Understanding cultural differences between geographical regions is essential in delivering culturally appropriate healthcare. We aimed to describe the characteristics and outcomes of diverse clients using the Far North Mental Health and Wellbeing Service (FNS) and the Central West Health and Wellbeing Service (CWS). Methods We conducted...

Objective Women with threatened preterm labor in remote Australia often require tocolysis in the prevention of in-flight birth during air medical retrieval. However, debate exists over the tocolytic choice. Methods A retrospective analysis was undertaken on data containing women who required air medical retrieval for threatened preterm labor withi...

Stroke is the second most common cause of death and remains a persistent health challenge globally. Due to its highly time-sensitive nature, earlier stroke treatments should be enforced for improved patient outcome. The mobile stroke unit (MSU) was conceptualized and implemented to deliver the diagnosis and treatment to a stroke patient in the ultr...

Background We aimed to determine whether heart, stroke, and vascular disease (HSVD) prevalence and emergency primary evacuation (EPE), hospitalisation, and mortality differ by patient characteristics. Methods An Australian-wide incidence population based study, with prospective data collected form the 1 July 2019 to the 30 October 2020. Findings In...

Despite the high prevalence of mental illness, and high rates of suicide among young Australians, more than half (54%) of all people with mental health issues do not seek help. A new research report by the Royal Flying Doctor Service (RFDS) research team, in collaboration with the Australian Catholic University (ACU), found that a better understan...

Objective To guide the efficient and effective provision of mental health services to clients in Central West and Far North Queensland, we surveyed preferences for face-to-face or in-person contact. Methods A clinician-designed survey of contact preferences was offered to 248 clients of mental health services in Far North and Central West Queensla...

(Abstracted from Lancet Gastroenterol Hepatol 2021;6:547–558) Ursodeoxycholic acid (UA) is a common treatment for intrahepatic cholestasis of pregnancy (ICP), and its use is supported by the Society for Maternal-Fetal Medicine. However, evidence of the benefit of UA to fetal and neonatal outcomes in this patient population is unclear.

Acute stroke is one of the most common causes of disability worldwide and numbers are projected to increase. Modern and successful recanalizing treatments are available, but timely access to these treatments is most often restricted to urban populations. This disparity affects nearly half of the world’s population, particularly those living in rura...

Background Ursodeoxycholic acid is commonly used to treat intrahepatic cholestasis of pregnancy, yet its largest trial detected minimal benefit for a composite outcome (stillbirth, preterm birth, and neonatal unit admission). We aimed to examine whether ursodeoxycholic acid affects specific adverse perinatal outcomes. Methods In this systematic rev...

Background: Inequalities in the availability of maternity health services in rural Australia have been documented, but not the impact on aeromedical retrievals. This study aims to examine the prevalence of pregnancy-related aeromedical retrievals, the most common conditions (overall and in specific age groups), and their distribution according to...

Background: Limited access to obstetrics and gynaecology (O&G) services in rural and remote Australia is believed to contribute to suboptimal birth outcomes. Aims: To describe the characteristics of pregnancy aeromedical transfers, in-hospital outcomes, and patient access to O&G services, as compared to whole of Australia data. Materials and me...

Working as a regional psychiatrist in Western Australia requires work-time to be divided between clinical roles as a generalist psychiatrist within the public mental health system, and as a clinical academic focusing on research, advocacy, and teaching in psychiatry across rural and remote Australia. The challenge during 2020 has been ensuring clin...

Background Little is known on the trends of aeromedical retrieval during social isolation. Objectives To compare the pre, lockdown, and post‐lockdown aeromedical retrieval (AR) patient characteristics during a period of Coronavirus 2019 (COVID‐19) social isolation. Methods An observational study with retrospective data collection, consisting of A...

The aims of this article are to comment on pre–coronavirus disease 2019 (COVID-19) mental health activity in rural and remote Australia, including related air medical retrievals; to discuss how the current pandemic is likely to impact on this vulnerable population's mental health; and to provide potential solutions. The COVID-19 pandemic has result...

Rural and remote populations have poorer health outcomes and lower levels of access to healthcare. People living in these areas are frequently required to travel, sometimes significant distances, to inner regional areas and major cities to access comprehensive primary healthcare services. There has previously been little research that determines if...

Background: We aimed to compare the pre, lockdown, and post-lockdown aeromedical retrieval (AR) diagnostic reasons and patient demographics during a period of Coronavirus 2019 (COVID-19) social isolation. Methods: An observational study with retrospective data collection, consisting of Australians who received an AR between the 26 January to the 23...

Objective Adequate mental health service provision in rural and remote Australian communities is problematic because of the tyranny of distance. The Royal Flying Doctor Service provides air medical retrieval for people in rural and remote areas. The economic impact on both the Royal Flying Doctor Service and the public hospital system for mental he...

The Royal Flying Doctor Service (RFDS) provides medical care to populations without access to traditional health-care services. From 2014 to 2018 the RFDS conducted 6007 (≈1201/year) aeromedical retrievals for gastrointestinal (GI) disorders. More detailed research is needed to determine specific GI disorders that contributed to this caseload, and...

The current literature on the use of 2-octyl cyanoacrylate tissue adhesive as a dental splint is limited, especially during emergency management of avulsed permanent teeth. This article contributes by providing evidence-based clinical treatment of a patient with avulsed permanent teeth within aeromedical and emergency medicine. Key implications f...

Introduction There is a COVID-19 pandemic. We aimed to describe the characteristics of patients transported by the Royal Flying Doctor Service (RFDS) for confirmed or suspected Coronavirus disease 2019 (COVID-19), and to investigate surge capacity of, and operational implications for, the RFDS in dealing with COVID-19. Methods Prospective cohort s...

Objective To describe the characteristics of patients who used the Royal Flying Doctor Service dental clinics and determine Royal Flying Doctor Service and non‐Royal Flying Doctor Service dental service provision in mainland Australia. Design A prospective cohort study. Setting All Royal Flying Doctor Service dental clinics located throughout rur...

This report summarises insights from research undertaken to include the ‘hidden voices’ of people living in rural Australia that experience mental ill-health. It follows from a Phase 1 report that reviewed literature, policy and interviewed key stakeholders – with the goal of analysing current rural mental health need, services and service accessib...

Introduction: The aim of this paper was to describe the characteristics of paediatric patients who underwent an aeromedical retrieval within Australia (gender and Indigenous status) for suspected appendicitis between 1 July 2014 and 30 June 2018 (4 years). By understanding these trends, we hope to further justify the need for point-of-care ultraso...

Objective To study the effect of nurse‐led counselling on the anxiety symptoms and the quality of life following percutaneous coronary intervention for stable coronary artery disease. Design Randomised control trial. Setting Rural and remote China. Participants Rural and remote patients were consecutively recruited from a medical centre located...

A new RFDS research paper released today, details how cardiac rehabilitation services, if made available in the bush, could prevent as many as 80% of premature deaths from cardiac disease. One in five of the Royal Flying Doctor Service (RFDS) emergency flights are for heart attack and stroke. An average of 112 patients per-week, or 16 patients per...

Invited submission to MJA InSight.

Introduction: Patient self-management skills are an important part of heart failure (HF) management. However, there is a lack of knowledge about the effectiveness of nurse-led education on patient self-management and the associated clinical outcomes of rural Chinese patients with chronic heart failure (CHF). As such, this study was designed to eval...

Thousands of remote Australians aged over 65 are flown by aeromedical teams to hospitals with illnesses that could have been prevented through increased country health services. A Royal Flying Doctor Service (RFDS) study of 23,377 older remote residents transferred by air to hospital found heart, injury, and digestive illness triggered preventable...

Background To determine the prevalence and outcomes of intrahepatic cholestasis of pregnancy. Methods A review comparing intrahepatic cholestasis of pregnancy pregnancies to all other pregnancies in three tertiary care Australian hospitals over a 36-month period. Results There were 43,876 pregnancies. The prevalence of intrahepatic cholestasis of...

Objective: To determine patients’ perceptions of the benefits of participating in outpatient cardiac rehabilitation and the reasons why some decline to take part. Method: Data collected included patients’ responses to the self-administrated ‘Outpatient Cardiac Rehabilitation Program Evaluation’ form, after attending a cardiac rehabilitation program...

Intrahepatic Cholestasis of Pregnancy (ICP) is a medical condition characterised by pruritis in the absence of a skin rash and abnormal liver function tests in the absence of an alternative cause and resolution post partum. It is associated with increased maternal anxiety, depression1 and may increase stillbirth. ICP incidence varies between popula...

As celebrations of our 90th year of operation wind down, it is pertinent that the Royal Flying Doctor Service (RFDS) continue to look to the future, to ensure that our services remain competitive and efficient, optimally targeted and designed to meet the needs of a changing population in remote and rural Australia. The Australian population is esti...

As celebrations for the 90th year of Royal Flying Doctor Service (RFDS) operations wind down, it is pertinent that the RFDS continue to look to the future, to ensure that our services remain competitive and efficient, optimally targeted and designed to meet the needs of a changing population in rural and remote Australia. This paper seeks to inform...

Australia’s remote population is forecast to grow only marginally in a decade. Yet chronic illness will rise dramatically, with the burden of mental illness forecast to increase by a fifth, if action is not taken to halt current trends. Health service access in rural regions is also forecast to lag behind metropolitan areas, according to Royal Fly...

Introduction Preterm birth is a common cause of adverse neonatal and childhood outcomes. It is commonly associated with infection of the maternal-fetal interface. The relationship between periodontitis and preterm labour is controversial. Methods Control placental tissues from uncomplicated term births were compared with those from spontaneous pre...

Studies have identified that there are many barriers to treatment of mental health illnesses in military populations, including the negative-associated stigma. One such barrier includes perceptions of weakness, leading to concerns about leadership and competency and being seen as malingering. Furthermore, similarities can be seen in civilian health...

Introduction Young adult patrons are vulnerable to risk-taking behavior, including drug taking, at outdoor music festivals. Therefore, the aim of this field report is to discuss the on-site medical response during a music festival, and subsequently highlight observed strategies aimed at minimizing substance abuse harm. Method The observed outdoor...

A research paper entitled “Evaluation of the Royal Flying Doctor service and Australian Hearing Hearing Screening Trial” has been released. Hearing loss affects some 3.6 million Australians and is predicted to more than double by 2060 in line with Australia’s ageing population. In 2017, hearing loss was estimated to affect one in seven people in A...

There is a large number of patients with chronic kidney disease (CKD), diabetes mellitus (DM), and hypertension (HT) but whether the targets on blood pressure (BP) control in patients with DM and/or CKD are met is not clear. This narrative review therefore investigated evidence on services aimed at achieving desirable clinical results in patients w...

Objective The prediabetes and cardiovascular complications studies proposes to develop a screening protocol for diabetes cardiovascular risk, and strategies for holistic management amongst others. Over 500 participants were recruited in the first 2 years of rural community research screening. Specific for this report, various published findings wer...

Aims: To determine the extent to which targets for blood pressure (BP) (<140.90 mmHg) and random blood glucose level (BGL) (<7.7 mmol/L) control in patients with chronic kidney disease (CKD) are achieved; and the extent clinical inertia affects BP and glucose control in CKD and diabetes mellitus (DM). Methods: Data was collected from the 1st Jan...

Background: Diabetes education is believed to bring about sustained benefits in diabetes mellitus (DM) patient outcomes. These benefits have not been widely studied in an inpatient hospital setting, and as such the aim was to determine whether a hospital diabetes in-service, and specifically diabetes education, results in reduced blood glucose and...

Introduction: Obstetric cholestasis (OC) or intrahepatic cholestasis of pregnancy (ICP) is associated with increased pregnancy risk as well as anxiety and depression in the mother. This study therefore determined the prevalence of OC in the Australian Capital Territory (ACT) and the pregnancy outcomes associated with OC. Methodology: A retrospectiv...

Background: The sharing of a story, related to a co-worker or patient, is believed to lead to an increased personalisation of the empathy message. Previous clinical interventions aimed at improving empathy, primarily considered one stakeholder and were often patient-centric. Objective: The aim of this study was to test whether an intervention consi...

The sharing of a story, related to a co-worker or patient, is believed to lead to an increased personalisation of the empathy message. Previous clinical interventions aimed at improving empathy, primarily considered one stakeholder and are often patient centric. To promote a multidisciplinary approach, the researchers included patients (including t...

Aims: To review the epidemiology and the clinical evidence regarding achieving blood pressure (BP) and blood glucose control in patients with chronic kidney disease (CKD) and diabetes mellitus (DM), with emphasis on adherence and barriers within the context of Australian clinical guidelines. This article then considers Australian services aimed at...

Objective: To determine if the Cardiac rehabilitation (CR) program had positive effects on the patient medically as well as effects on pathological risk factors, functional capacity, and mental health; and the extent to which targets for blood pressure (BP) control in patients with hypertension (HT) and diabetes mellitus (DM) are achieved. Methodo...

Objective: To determine the patients’ perceived benefits or barriers in participating in a cardiac rehabilitation program and the various reasons for declining the program. Method: Data collected included patients’ responses to the self-administrated ‘Outpatient Cardiac Rehabilitation Program Evaluation’ form, after attending a cardiac rehabilitat...

Objective: To determine if the Cardiac rehabilitation (CR) program had positive effects on the patient medically as well as effects on pathological risk factors, functional capacity, and mental health; and the extent to which targets for blood pressure (BP) control in patients with hypertension (HT) and diabetes mellitus (DM) are achieved. Method...

This Grand Rounds presentation aimed to discuss the pathophysiologic mechanisms in the development of hypertension in diabetes mellitus patients, and its subsequent link to chronic kidney disease and cardiovascular disease. Furthermore this presentation aimed to communicate conference research results concerning the Hospital's Cardiac Rehabilitatio...

Background Stroke is one of the leading causes of disability and mortality. Patients who receive organized inpatient care in a stroke unit (SU) have better clinical outcomes. However, evidence on the cost analysis of an SU is lacking. The objective of this study was to assess the performance and analyze the cost-effectiveness of an SU. Methods A r...