What happens when you trade a fully-equipped resus bay for a vibrating King Air aircraft cruising thousands of feet above the Australian outback?
For Mina Arsanious, anaesthetic registrar, expedition medic and faculty on our Expedition & Wilderness Medicine course in Melrose, Australia, this isn’t a hypothetical, it’s just another day at work with the Royal Flying Doctor Service (RFDS).
Mina’s medical career has taken him from high-altitude expeditions on Kilimanjaro to trauma cases in the desert, but it’s aero-medical retrieval that has truly shaped his perspective on emergency care in extreme environments.
Now featured in a brand-new episode of our World Extreme Medicine Podcast, Mina shares a raw and insightful look at the realities of providing critical care mid-flight, drawing on lessons learned from years of flying into the unknown.
The Shift from Hospital to Aircraft
In retrieval medicine, the “resus room” might be the back of a plane.
“In a hospital, you have a large, well-equipped resuscitation bay,” Mina says. “In the back of a plane, you have a stretcher, two seats, and a couple of backpacks. Everything you do has to be streamlined and efficient.”
That means anticipating the patient’s needs before you ever take off. Space is tight, noise is constant, and turbulence can make even simple procedures feel impossible.
As Mina puts it, “The moment you take off, everything changes. There’s turbulence, pressure shifts, and G-forces, all things that don’t exist in a hospital setting.”
The Cases You Can’t Simulate
You might expect high-stakes trauma in retrieval medicine, but you probably don’t expect motorbike vs kangaroo.
In the Australian outback, that’s not unusual. Mina recounts a string of unusual cases:
“I’ve been to motorbike vs. goat, motorbike vs. emu, motorbike vs. kangaroo. You can’t simulate them… you just have to be ready for anything.”
It’s a reminder that remote medicine doesn’t follow a script. Fast thinking and adaptability are essential.
Critical Care in the Air: No Room for Error
From septic shock to infective endocarditis, retrieval teams deal with some of the most fragile patients, with no ICU in sight.
“You don’t have a cardiac output monitor or an ICU setup, just a portable ultrasound and clinical judgment,” Mina explains. “You have to make decisions fast, knowing that you’re 45 minutes from the nearest hospital.”
Every second counts. Pressure changes mid-flight can destabilise even well-managed patients, and equipment can fail without warning.
Heatwaves, Frostbite… and Failing Equipment?
Australia’s extreme climate isn’t just tough on people, it’s brutal on gear.
“In summer, our i-STAT machine kept overheating,” Mina says. “In winter, we had the opposite problem, it was too cold to work, so we kept the batteries warm in our pockets.”
More than just quirks, these are real potential barriers to life-saving care. Retrieval medics must be as resourceful as they are clinical, finding creative ways to adapt equipment in the field.
Communication as a Lifeline
In high-pressure environments, how you communicate can be as important as what you do.
“In retrieval medicine, you can’t afford miscommunication,” says Mina.
That means closed-loop feedback, clear read-backs, and pre-mission planning are non-negotiables.
But communication also means compassion.
“It’s easy to get frustrated when people aren’t communicating the way you want them to,” he says. “But you have to step back and recognise that they’re doing their best.”
Whether it’s a rural nurse with limited equipment or a stressed pilot dealing with weather conditions, Mina reminds us that everyone’s doing their part, and shared understanding saves lives.
Top Lessons from the Skies
For anyone curious about a future in retrieval medicine, Mina shares key principles that have helped him stay prepared:
→ Anticipate the worst-case scenario and have a response to the difference components
→ Plan for equipment failures (and carry backups!)
→ Keep critical tools within reach
→ Use closed-loop communication: always repeat and confirm
→ Stay adaptable: no mission ever goes exactly to plan
“You need a plan A, B and C… and sometimes you end up using plan D.”
From Outback Trauma to Expedition Teaching
Today, Mina isn’t just flying into remote emergencies, he’s also shaping the next generation of medics.
You can learn directly from him on our upcoming Expedition & Wilderness Medicine course in Melrose, Australia, where he’ll be joining our expert faculty to deliver hands-on teaching in pre-hospital care, trauma management, and the realities of medicine in remote and austere environments.
Listen to the Full Episode
Mina joins us on the World Extreme Medicine Podcast to dive deeper into his experience, share more patient stories, and offer candid reflections on life as an aero-medical doctor.
→ Click here to support the work of Mina and other doctors in outback NSW