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CareFlight chief pilot Richard Sandford was flying to Epenarra station, about 150 kilometres as the crow flies south-east of Tennant Creek, when a straightforward mission became a marathon.

Like many places in Central Australia, heavy rainfall at the end of 2016 had flooded roads and made Epenarra's airstrip unusable, so when CareFlight's Darwin headquarters received a call for help the helicopter was the only option.

The patient was a 29-year-old woman in urgent need of surgery but the community's health clinic only had one nurse on hand.

The plan was simple on paper and so CareFlight set out to transfer her to the Tennant Creek Hospital.

"The weather generally looked OK at the time, but after two or three hours of flying south it started to deteriorate around the Tennant Creek area," Mr Sandford recalled.

"We ended up having to do a lot of avoiding the weather, and with that you have to recalculate and rethink out the strategy with fuel."

To compromise, a fuel distributor came to meet the team where they eventually landed at a highway rest stop 30 kilometres north of the town.

But the trouble didn't end there.

"Once we got past that issue and picked up the patient, the weather then deteriorated into Tennant Creek," Mr Sandford said.

"It became obvious after a conversation with air traffic control that the weather had got to a point where we probably wouldn't get into Tennant Creek, so we then elected just to take the patient all the way down to Alice Springs."

The marathon helicopter mission from Darwin to Alice Springs was a 10-and-a-half-hour return trip, or "a very long day with a lot of flexibility" as Mr Sandford described it.

That kind of agile thinking can often mean the difference between life and death in the horror stories that frequently unfold in the far-flung corners of Northern Territory.

In the jurisdiction's top half, the government contracts CareFlight to run its aeromedical services; its pilots might transfer patients from Gove to Darwin one day and avert tragedy in croc-infested fishing spots the next.

But the Top End's notoriously stormy wet season poses a number of challenges to the fleet of five fixed-wing planes and a helicopter.

"The art of flying in this weather is to avoid it," Mr Sandford said.

"It's just that there's sometimes so much around you can't avoid it."

Flexibility, concentration, no fear of lightning

Mr Sandford has a diverse skillset and many, many hours of flight time, meaning he can pilot both types of CareFlight's aircraft.

This is important when, say, a remote runway becomes too waterlogged to permit the landing of a 7.5-tonne plane, but a football field has ample space for a helicopter.

"Whenever speed and distance are the issue and there's a runway at the other end, we'll always use the airplane. They're the workhorses," general manager Craig Gibbons said.

"But when access is the problem in areas like the national parks ... in the areas off the coast where there's a lot of fishing and boating, and even motor vehicle accidents and other incidents that happen on the highways, that's when the helicopter comes into its own."

Mr Sandford said flexible thinking was key being a CareFlight pilot in the Top End.

"If they come from a very structured background like airline flying, it can take quite a while to understand the complexities of being happy and comfortable to just change the plan," he said.

At other times it takes endurance; helicopter-led search and rescue missions over water can be like searching for a comparative speck in vast swathes of sea.

"It takes a certain way of making sure you're still concentrating because it is routine and can get quite boring, but you just keep focused on the task at hand," Mr Sandford said.

Then there is the issue of flying through areas with a high frequency of lightning strikes.

Mr Sandford said plane strikes were common enough, but aircraft were designed to withstand them as long as routine maintenance was carried out afterwards.

"You can have short events where the electronics of the aircraft might be disturbed, but quite often we find that lightning strikes occur on the aircraft and pilots are not necessarily aware that they occurred."

Clinicians performing vital work on bumpy rides

Last year CareFlight carried out 3,404 patient retrievals across the Top End and occasionally beyond — an average of roughly nine each day.

But that average was far from evenly spread.

"Some days we had one or two, and we've had a few days last year where we did more than 20," Mr Gibbons said.

"Those days where we do more than 20 put us at the absolute limit of our resourcing."

During these operations aircraft effectively become small intensive care units, housing clinical staff as they perform difficult work in occasionally turbulent conditions.

"It is a cramped operating environment. It's a little different to an ICU in the hospital," Mr Gibbons said.

"You can't walk around a bed, you can only approach the patient generally from one direction.

"Sometimes the circumstances mean the clinicians have to be strapped into their seat if they're flying through turbulence."

He said only the most extreme weather events would put a halt to their missions, and even then generally only for a short period of time.

"A lot of the job is about saving lives and protecting people. It has to be with a great degree of compassion."

ABC