Mackney S1
1CareFlight
Biography:
Dr Sarah Mackney, is the Deputy Medical Director of CareFlight Northern Territory and an Emergency Physician at Royal Darwin Hospital. She relocated to Darwin in 2013, where she lives with her husband and three children. She has developed a broad clinical practice spanning emergency medicine, pre-hospital care, and critical care retrieval.
Working across both CareFlight and Royal Darwin Hospital, she has extensive experience delivering healthcare in geographically isolated and resource-limited settings. Dr Mackney provides clinical leadership in aeromedical operations and contributes to clinical governance and service development, with a focus on improving outcomes for remote and First Nations communities.
Abstract
Aim:
To describe the complexity of obstetric aeromedical retrieval in the remote Top End of Northern Australia and highlight the challenges of managing time-critical maternal emergencies in geographically isolated settings.
Methods:
A retrospective review of obstetric retrievals undertaken by CareFlight NT during 2025 was performed. Retrieval activity data were analysed to characterise workload and indications for transfer. Three representative cases were examined: a patient presenting in labour with severe hypertension and unknown gestation at a remote clinic, and two cases of catastrophic postpartum haemorrhage (PPH) requiring urgent aeromedical response from a regional hospital.
Results:
In 2025, CareFlight NT conducted 385 obstetric retrievals, including 150 cases of preterm labour, and was involved in 25 births occurring prior to team arrival. Communities across the Top End include large Aboriginal populations with higher rates of preterm birth and pregnancy-related complications. Long distances and limited access to specialist maternity and neonatal services frequently necessitate urgent aeromedical transfer. The cases demonstrated the complexity of balancing maternal and foetal risk, managing severe maternal illness in resource-limited environments, and coordinating culturally safe care across geographically distant teams. The PPH cases required aggressive resuscitation, blood product administration, emergency surgical intervention, and retrieval support to facilitate transfer for definitive obstetric, surgical, and intensive care management.
Conclusions:
Obstetric emergencies represent a significant component of aeromedical retrieval workload in the Top End. Safe outcomes rely on early recognition, timely escalation, structured risk assessment, and effective collaboration between remote clinicians, retrieval services, and tertiary obstetric teams. These experiences highlight the critical role of aeromedical retrieval in supporting remote maternity care and may inform preparedness, training, and clinical pathways for severe obstetric emergencies in remote Australia.