In 2017, only one third of remote area nurs­es par­tic­i­pat­ing in a CRANAplus sur­vey had been offered good four-wheel dri­ve train­ing and most had not been required to demon­strate com­pe­ten­cy in bush dri­ving before com­menc­ing work.¹

This is despite the chal­leng­ing ter­rain RANs fre­quent­ly encounter – includ­ing soft sand, bull­dust, water cross­ings, flood­ed or flood-dam­aged roads, mud, cor­ru­ga­tions, wild ani­mals, and even snow and steep ter­rain in the high country.

These are cir­cum­stances that Laris­sa Laud­er has fre­quent­ly found her­self in – and emerged safe­ly from – since she start­ed to live and work in the bush in 2003. Laris­sa is a Charles Dar­win Uni­ver­si­ty (CDU) Lec­tur­er in con­ser­va­tion stud­ies and teach­es CDU’s Trav­el safe­ly in remote areas course, as well as oth­er 4WD courses. 

Sound deci­sion-mak­ing is the key to suc­cess, she says, and it requires sit­u­a­tion­al aware- ness. On one lev­el that means under­stand­ing the sea­son­al con­di­tions, but on a deep­er lev­el, it’s a ques­tion about your own skills. 

“Are you actu­al­ly fit to com­plete the task, at that point of time? Phys­i­cal­ly and men­tal­ly?” Laris­sa encour­ages dri­vers to ask themselves.

“You need to be con­fi­dent in your own abil­i­ty to per­form tasks and make decisions.”

This nugget of wis­dom echoes the thoughts of many mem­bers we talked with for this article:

• “Dri­ve to your capa­bil­i­ties not any­one else’s.” – Kel­ly, NT
• “Trust your gut, if you think the road will be impass­able for any rea­son (recent weath­er, etc) it prob­a­bly is.” – Joshua, NSW
• “Just take it slow, not worth risk­ing yours or your patients’ lives.”
• “Have a very low thresh­old for not trav­el­ling if weath­er or road con­di­tions aren’t good.”

To stay or go

RANs report find­ing them­selves in an ​‘eth­i­cal dilem­ma’, not know­ing what to do when faced with a retrieval in chal­leng­ing con­di­tions when help is far away, and when to pass the retrieval onto an out­side par­ty – such as RFDS, police or SES.

While it is dif­fi­cult to draw the line in the sand about when to make the call, the respon­si­bil­i­ty to decide should not rest on the shoul­ders of the remote health pro­fes­sion­al. Their deci­sion-mak­ing should and must be sup­port­ed by health ser­vice poli­cies and pro­ce­dures (as well as guid­ance from management).

To be effec­tive, poli­cies must be sup­port­ed in the field, says remote area nurse Rod Menere. Rod was involved in CRANAplus Nation­al Safe­ty and Secu­ri­ty Project in the late 2010s. He writes a blog called Remote Area Nurse Reflec­tions and has kind­ly allowed us to quote his two recent blog arti­cles on 4WDing.²⁺³

“New staff can be pres­sured to dri­ve accord­ing to the behav­iour or opin­ions of oth­ers,” he writes.

“Dri­ving safe­ty can also be dimin­ished in oth­er ways, espe­cial­ly if an employ­er expects staff to work out­side safe trav­el practices.

“Child health/​school health nurs­es or man­agers may be expect­ed to work Mon­day-Fri­day in one loca­tion, then dri­ve 300 to 600 kilo­me­tres over the week­end to com­mence work at anoth­er loca­tion the fol­low­ing Mon­day. RANs may be required to dri­ve 2+ hours to a clin­ic with­out full-time staff, work all day, then dri­ve home. That may be accept­able occa­sion­al­ly, but if it’s a reg­u­lar expec­ta­tion, it wears staff down and becomes a safe­ty issue.”

4WD train­ing

Skills are best learned in a tac­tile envi­ron­ment, such as a 4WD course, Laris­sa says. There’s a dis­tinc­tion in being famil­iar with poli­cies on 4WD use and main­te­nance, and first­hand expe­ri­ence in using a vehi­cle safe­ly and to its capabilities.

Nation­al­ly recog­nised 4WD cours­es include:

• FWPCOT3325 – Oper­ate a four-wheel dri­ve on unsealed roads
• RIIVEH305F – Oper­ate and main­tain a four-wheel dri­ve vehicle
• TLIC2025 – Oper­ate four-wheel dri­ve vehicle

Many remote area nurs­es report find­ing the cours­es they have under­tak­en use­ful. Some have gained their qual­i­fi­ca­tions through their employ­er, where­as oth­ers have self-fund­ed their atten­dance, or gained it via oth­er organ­i­sa­tions they are asso­ci­at­ed with (e.g. SES).

Pre­vi­ous CRANAplus con­sul­ta­tion has shown that many 4WD cours­es do not nec­es­sar­i­ly focus on man­ag­ing fatigue or dri­ving long dis­tances on dirt roads in vary­ing weath­er con­di­tions. They are more like­ly to focus on more chal­leng­ing aspects, such as vehi­cle recovery.

On top of for­mal train­ing, infor­mal train­ing or prac­tice in a low-risk con­text is also use­ful. Many remote ambu­lances are man­u­al, for starters, which can leave many new users ​‘kan­ga­roo-hop­ping’ around com­mu­ni­ties for the first few weeks – or poten­tial­ly putting petrol in a diesel engine.

If you’re used to dri­ving a small 2WD, a man­u­al 4WD can be a big change, says Rod – and big­ger doesn’t always mean safer, unlike many peo­ple assume.

“4WD vehi­cles are less sta­ble, they’re high­er and heav­ier,” Rod says. ​“Heavy sus­pen­sion and steer­ing mean they respond slow­ly in emer­gency sit­u­a­tions. They take a lot of get­ting used to.”

Prepar­ing pre-departure

4WD ambu­lances are typ­i­cal­ly equipped with var­i­ous fea­tures and acces­sories to enhance safe­ty. Some of these, like a bull­bar, are sim­ple ​‘set and for­get’ acces­sories that increase safe­ty just by being there. Oth­ers require the dri­ver to active­ly make use of them to increase safe­ty. These include:

• Recov­ery gear. Even if you don’t know how to use it, some­one else might. But there are risks to using it incorrectly.
• Spare tyres and jack. Work vehi­cles may be equipped with a bot­tle, trol­ley or high-lift jack. Oth­er acces­sories that may be use­ful, but not nec­es­sar­i­ly includ­ed, are tyre pres­sure mon­i­tors and punc­ture repair items/​kits (e.g. ​‘green goo’).
• Four-wheel dri­ve. This may also include low-range, which is a high-torque, low-speed set­ting use­ful in more extreme, slow-paced offroad situations.
• Aux­il­iary fuel tank. Expand­ing range out where the bowsers are few and far between.

The vehi­cle should also be equipped with var­i­ous com­mu­ni­ca­tion devices, includ­ing a satel­lite phone, UHF/VHF radio, and a Per­son­al Loca­tor Bea­con or In Vehi­cle Mon­i­tor­ing Sys­tems (IVMS).

You may wish to car­ry a list of UHF sta­tions and what they are used for.

“It can be real­ly dif­fi­cult to describe your loca­tion to emer­gency ser­vices or even to a col­league if you don’t know exact­ly where you are,” Laris­sa adds.

“[You can] prac­tise using your trip meter after major turn-offs or land­marks so you can say with rel­a­tive con­fi­dence that you are 56km past the iden­ti­fied creek crossing.”

It’s also essen­tial to com­mu­ni­cate with oth­er staff or com­mu­ni­ty mem­bers about your planned trav­el – as ought to be out­lined in work­place pol­i­cy. Once you’ve com­mu­ni­cat­ed a trav­el plan, stick to it.

As one Mem­ber told us, ​“I had a col­league fail to call in (as they had told me they would via a dodgy note), which sent me to dri­ve around the bush in soft sandy creeks look­ing for them, only for them to return sev­er­al hours lat­er fine and [not real­is­ing] I would take their call-in note seriously.”

Before depart­ing, it’s impor­tant to ensure all help­ful emer­gency gear is present, secured and eas­i­ly acces­si­ble. Items with­in 4WDs may be com­mon tar­gets for theft and there­fore removed to pre­vent theft day by day. Check that they’ve been put back in. Need­less to say, these checks, along with manda­to­ry safe­ty checks, are best car­ried out in advance of an emergency.

Dri­ving techniques

A gen­er­al rule of thumb Laris­sa dri­ves by is ​“Choose your tyre pres­sure, choose your gear, choose your path and com­mit.” Here are a few spe­cif­ic sce­nar­ios and how you might approach them.

Dri­ving on dirt or grav­el

Use 4WD gear­ing on loose dirt and grav­el. Scan ahead and to the sides and if you need to slow down to go through or over a bump, brake pri­or to the obsta­cle and then release your brakes so that the vehi­cle can use its full range of sus­pen­sion to han­dle the bump.

Roads of this kind may be cor­ru­gat­ed, mak­ing for unpleas­ant dri­ving. It can be tempt­ing to up the speed and ​‘float’ over cor­ru­ga­tions but beware of the impact this can have on your steer­ing.

Dri­ving on soft sand or mud

Deflate your tyres before you hit a soft sand patch – pro­vid­ed you have a means to rein­flate them (i.e. a com­pres­sor) to an accept­able lev­el for gen­er­al dri­ving. This will reduce the chance of bogging.

Approach­ing sand or mud, keep up your momen­tum and stay off the clutch. If the wheels start to spin, stop to avoid dig­ging your­self in deeper.

You can then try a few things: rock back­wards and for­wards in reverse and first gear, drop the tyres to a low­er pres­sure (e.g. 15psi), or place some­thing grip­py under the wheels – such as sticks or MaxTrax.

Water cross­ings

Laris­sa encour­ages dri­vers to ask them­selves these ques­tions: ​“How deep is the water? How fast is it flow­ing? What is the road like under­neath? Is it mud, sand, rock or con­crete? Is it dam­aged or does it have obstruc­tions? Are you con­fi­dent cross­ing at this time? If you get washed off or stuck, what are the con­se­quences – what is down­stream and are there like­ly to be croc­o­diles?”

She also rec­om­mends win­dows down dur­ing the cross­ing and using low range four-wheel drive.

Take care before going ​‘around’ a water cross­ing if that means going over untest­ed or poten­tial­ly soft, bog­gy ground.

Ani­mal strikes

If you see an ani­mal, be it a kan­ga­roo or a fer­al camel, it’s gen­er­al­ly advised that you should resist the temp­ta­tion to swerve. Swerv­ing risks you los­ing con­trol of the vehi­cle. Instead main­tain a straight line and brake.

Col­lab­o­rat­ing with oth­er road users

When approach­ing anoth­er vehi­cle on a dusty road, vis­i­bil­i­ty will usu­al­ly be dras­ti­cal­ly reduced, Laris­sa says.

If pos­si­ble, con­tact them on a two-way radio and have them acknowl­edge your pres­ence before over­tak­ing – you don’t want them to swerve to avoid a pot­hole just as you are going past.

“A gen­er­al prin­ci­ple is might has right,” Laris­sa adds. ​“If you are head­ing towards anoth­er vehi­cle and they are larg­er than you, give them more space. Also con­sid­er this for vehi­cles tow­ing as the trailers/​caravans can be dif­fi­cult to con­trol on unsealed roads.”

Tips from Members

• “Always ask the locals what road con­di­tions and water cross­ings are like well before you leave. Always, always car­ry lots of spare water and some food. Nev­er speed.” – Deb­o­rah, WA
• “Don’t dri­ve fast on roads you don’t know. An unex­pect­ed cor­ner or patch of bull­dust on the road can undo you. When dri­ving through sand make sure you tuck your thumbs in and hold the steer­ing wheel loose­ly and let the car do the major­i­ty of the work.” – Barb, NT
• “Dri­ve to con­di­tions. Don’t enter flood water if it’s mud­dy. Main­tain speed. Let peo­ple know where you’re going and when you get there con­tact them.” – David, NT
• “Ensure you can gen­uine­ly dri­ve a man­u­al vehi­cle. Prac­tice, prac­tice, prac­tice. I start­ed dri­ving in the pad­docks at about 8.” – Kel­ly, NT
• “Pack per­son­al or gear that can tol­er­ate weath­er in dry bags and put it on the roof. Because, even
  if you’re only trav­el­ing, you nev­er know if you get called to a job or come across one and now you have to trans­port a patient.” – Joshua, NSW
• “Online maps don’t cov­er very remote Aus­tralia. Look at a paper map and think about the con­tours and the water cours­es and which way water is like­ly to run or sit. Clay pans are decep­tive, very easy to stay bogged in them.”
• “Always check the gov­ern­ment road reports and the weath­er maps.”
  

Ref­er­ences

1. CRANAplus 2017. Remote Health Work­force Safe­ty and Secu­ri­ty Report: Lit­er­a­ture review, Con­sul­ta­tion and Sur­vey report. CRANAplus, Cairns
2. Menere, Rod (2024). ​‘29. RANs on & off the Road (1): Stay­ing alive in a 4WD’. Remote Nurs­ing Reflec­tions, May 5 2024. Avail­able at: https://remoteareanursereflections. word​press​.com/​2​0​2​4​/​0​5​/​0​5​/​2​9​-​r​a​n​s​-​o​n​-​o​f​f​-​t​h​e​-​r​o​a​d​-​1​-​s​t​a​y​i​n​g​-​a​l​i​v​e​-​i​n​-​a​-4wd/
3. Menere, Rod (2024). ​‘30. RANs on & off the Road (2): 4WD use, main­te­nance & trou­bleshoot­ing’. Remote Nurs­ing Reflec­tions, May 12 2024. Avail­able at: https://remoteareanursereflections.wordpress. com/2024/05/12/30-rans-on-off-the-road­‑2 – 4wd-use-maintenance-troubleshooting/