• COVID-19
• INFECTIOUS DISEASES
• ACCIDENT & EMERGENCY MEDICINE

The COVID-19 pandemic led to a decrease in access to and use of healthcare services, exacerbating existing social disadvantages.1 Australia imposed border control measures to prevent the spread of COVID-19, with resources and staff diverted from normal activities to test and treat COVID-19. While this reduced infections and hospitalisations, the consequences of these public health measures are becoming apparent, especially for people with chronic diseases.

Here, we describe the volume and acuity of patients requiring aeromedical retrieval prior to and during the COVID-19 pandemic.1

Analysis of the Royal Flying Doctor Service (RFDS) database showed 13 827 aeromedical primary evacuations throughout the period of 1 July 2018–30 December 2021. In the 18 months prior to the pandemic (1 July 2018–30 December 2019), the RFDS conducted 6995 (50.6%) primary evacuations. In the 18 months during the pandemic (1 July 2020–30 December 2021), the RFDS conducted 6832 primary evacuations (49.4%). While this represented a reduction in overall activity, we found that critical, high dependency and serious patients increased from 3655 (52.3%) prior to the COVID-19 pandemic to 3956 (57.9%) during the COVID-19 pandemic (Table 1). There were significant increases in patient severity for diseases of the circulatory, digestive and genitourinary systems (Table 1). We observed a significant increase in priority 1 ‘life-threatening emergency’ primary evacuations during the pandemic (n=1255, 18.4%) compared with the prepandemic period (n=976, 13.95%).

Of concern is the increase in unmanaged chronic disease retrievals, such as poor management of diabetes mellitus during the restriction period. Our observations that circularity disease severity has increased during the pandemic is consistent with the literature demonstrating a significant increase in emergency calls for cardiac arrest, heart complaints, overdose/poisoning, pregnancy and stroke.2

The majority (n=11 601, 83.9%) of primary evacuations were from areas that did not have access to traditional emergency services (see Figure 1). Furthermore, we found that the majority of patients did not have access to chronic disease management services (n=11 186, 80.9%) or RFDS visiting general practitioner services (n=9057, 65.5%) within a 60 min travel time. This finding is consistent with the literature, which consistently highlights service accessibility and provision limitations in rural and remote Australia.3

• Download figure
• Open in new tab
• Download powerpoint

Figure 1

Aeromedical primary evacuation geographical locations (grey dots, scale 5–644 patients) and corresponding emergency department locations (orange diamond).

While the volume of retrievals was slightly reduced during the pandemic, patient acuity increased. The retrieval locations highly correlate to locations with limited access to healthcare exacerbated by COVID-19 restrictions and avoidance of medical facilities due to fears around COVID-19. This meant patients were not receiving regular care during social isolation, which caused acute emergency episodes.

While public health measures such as test–trace–isolate–quarantine are vital, the increases in unmanaged chronic disease during this period highlighted the importance of primary healthcare maintenance during social isolation. It is vital that future responses identify at-risk population groups and develop community informed chronic disease management plans specifically aimed at preventing downstream acute presentations.