Health & History, 2016. 18/2 121 Book Reviews Stephen Langford. The Leading Edge: Innovation, Technology and People in Australia’s Royal Flying Doctor Service (Crawley: UWA Publishing, 2015). ISBN: 9781742588148. 414 pp. All too often, accounts of Australia’s Royal Flying Doctor Service (RFDS) are dominated by the first letter of the alphabet: angels and apostles, adventure and adversity, aeroplanes and airwaves. I’m therefore pleased to report that although The Leading Edge is punctuated by humour and humility, it flies in the face of the populist ‘heart-warming’ genre. The text itself is a curious but valuable hybrid. Stephen Langford joined the Western Australian (WA) RFDS as a recently qualified doctor in 1983, and has risen through its ranks over the ensuing decades. Although it could be loosely described as his memoir, this book is more akin to an extended and carefully structured oral history than an autobiography. There is no doubt that Langford is central to each of the numerous short chapters, citing where appropriate his role in implementing changes in policy or practice. However, rather than focusing on his personal or clinical experiences, the author foregrounds technological developments within Australia’s aeromedical evacuation services over the past thirty-five years. The book’s title is therefore doubly apt: The Leading Edge indicates both the forward part of an aeroplane’s wing and innovation in a broader sense. As such it outlines interlinked developments in aviation, communications, information technology, education, and medical devices; as well as their corollaries in clinical care, servicing remote communities, staff development, and bureaucratic benchmarking. Each chapter is concise, generally spanning two to ten pages, and often illustrated by short narrative episodes detailing an event, case study or shift in practice. The book is engagingly written and can enjoyably be read over several sittings. Moreover, it will continue to serve as a concise reference regarding changes to inflight cardiac care, for instance, or the transition from wireless radio to smartphones in remotely assessing medical emergencies. Focused on WA operations and equipment, but standing in more broadly for Australia-wide developments, The Leading Edge has value beyond its primary subject. Certainly the text details the specifics of aeromedical evacuation, be it time-distance-weatherfatigue calculations or the clinical impact of altitude on pneumothorax 122 BOOK REVIEWS cases. What historians will particularly value, moreover, is the book’s pragmatic assessment of new technologies upon medical practice, from pulse oximetry to humidicribs. Regarding the latter, for instance, Langford remarks wryly that ‘Further monitoring was added as it became fashionable and then replaced when something new arose’ (p. 177). Ever open to ‘leading edge’ ideas, he is equally quick to admit their limitations or redundancy. Indeed, precisely because aerial ambulances are so tightly constrained by space, weight, and ergonomics, RFDS practitioners carefully evaluate the cost-benefit ratios of numerous emergency care innovations. Their choices may help us consider wider priorities in acute care, ambulance services, military medicine, obstetrics and neonatology—or even regional health screening and immunisation programmes. In this vein, I would have welcomed an appendix outlining the range of carefully numbered pharmaceuticals provided in remote-area medical chests. It’s not unusual, for instance, that a casualty with a broken limb will be advised during an RFDS teleconsult to self administer opiates while an aircraft is despatched. Allowing for shelf life and temperature sensitivity, this carefully structured pharmacopoeia could reveal much about how efficacy has been balanced against predictability in selecting essential medicines for non-prescriber administration. The Leading Edge is neither a technical manual nor an encyclopaedia, and is generally the better for it. One downside is that although nurses, midwives and Aboriginal people all appear within the narrative, their perspectives are largely marginalised. Conversely, Langford is quite specific about the choice, cost, and use of medical devices, aeroplanes, satellite phones, and software packages, including their operational idiosyncrasies. Such details can help us—both now and in the future—to reconstruct the embodied practices of late twentieth-century flying doctors and, to a lesser extent, the experiences of their patients. Likewise, sections on training, accreditation, record-keeping, and fundraising are important in understanding the wider systems necessary to sustain a complex health care entity such...