A man lies in a paddock under the blazing sun, groaning and covered in blood with his left arm caught in a tractor loader.
Emergency services are on their way to free him with the jaws of life, but it will take them three hours to reach the remote property.
As time ticks by, the farmer loses blood, goes into shock and his pulse is weak.
A medic from the Royal Flying Doctor Service (RFDS) decides she must amputate the man's arm in the long grass of the makeshift outback operating room.
"You can't chop my arm off, how am I going to work?" the farmer cries, as he writhes on the ground.
With guidance from a senior colleague on the end of a satellite telephone, the doctor calmly operates and saves the man's life.
The farmer soon springs to his feet and dusts himself off with a laugh.
That's because the injured man is really an RFDS flight nurse nicknamed Cookie, who was using his years of experience to act out a common farm accident on a property outside Dubbo.
The simulation was part of a program preparing doctors for the real life-and-death decisions they will face while working with the aeromedical service.
These unique experiences are what drew critical care doctor Ingvild Lovaas from the frigid climes of Norway to the searing heat of western NSW to join the RFDS.
"I'm here because of the adventure," Dr Lovaas said, soon after completing the tractor simulation.
"I find extreme types of medicine very interesting, but I have only worked in a hospital, so this is an opportunity for me to take my skills out of the hospital."
The service's south eastern section has had its largest intake of doctors in over a decade, with 11 medics joining from around Australia, Germany and the UK.
Doctors' interest in working for the retrieval service has been so great, the Dubbo-Broken Hill branch had to knock back applicants.
The RFDS is able to attract doctors by offering a role with a valued lifeline for rural and remote Australians, along with far-flung travel and extraordinary cases.
Its training programs aim to give staff positive exposure to rural Australian life, which is a known factor for successfully recruiting and retaining medicos in the bush.
"It means people are more likely to stay, or extend or come back," the section's chief medical officer Shannon Nott told AAP.
"If you look back over the years, there's not been an insignificant number of doctors who started out with RFDS and who transitioned into the Australian environment.
"There is a broader net effect in being able to show people the care we can provide in rural and remote areas is needed, is valued."
Showing aspiring doctors the rewards and value of rural practice is behind a number of measures to boost the medical workforce outside the cities.
Rural health is shaping up as a key election issue, with a flurry of commitments and policy changes announced in recent months.
Rural generalists, who are GPs with additional training in areas like obstetrics, are set to be recognised as specialists, adding greater recognition to the profession.
Trials of single employer models have been expanded to give trainee doctors better pay and conditions while working across both hospitals and clinics.
An $8.5 billion federal government investment in Medicare for millions of extra bulk billed GP visits has been welcomed by rural medical groups, along with more scholarships for medical students.
But any progress contends with decades of inequity, with an annual $6.5 billion spending deficit on health in country Australia, according to financial modelling by the National Rural Health Alliance.
The alliance's annual rural health snapshot, released in February, showed 18,500 Australians do not have access to essential primary care within an hour's drive of their homes.
Avoidable deaths in the country are nearly four times higher than in metropolitan regions, with life expectancy up to 13 years shorter for people in very remote areas.
Medical practices in rural towns often run at a loss due to long consults for patients with complex conditions, alongside high operational costs, alliance chief executive Susi Tegen said.
"Many rural practices are already experiencing a thin or failed market, making it difficult to cover costs," Ms Tegen said.
"The newly announced government measures will do little to change that reality."
Gulgong, a NSW gold rush village of 2500 people, has been without a doctor for months, forcing people to travel to the few GPs in nearby Mudgee - or even to Sydney - for care.
A local campaign supported by the council and mining companies is offering a $45,000 incentive to retain doctors, while also investigating better housing and fly-in-fly-out options.
But despite the ongoing frustrations across healthcare in the bush there is growing interest in rural generalist studies, with places at medical colleges oversubscribed.
The Rural Doctors Association is calling for 200 extra Commonwealth-funded training places to build on the momentum.
Sally Bath, an emergency physician who moved from Sydney to work in Orange and is training with the RFDS in western NSW, has seen disparity in healthcare first-hand.
"I really wanted to come out ... and be a part of delivering critical care to a population that's quite under served," Dr Bath said.
That is part of what drives her to continue to treat people in the bush.
"Coming into a new community, you're in a very privileged position where you get treated with a lot of respect and people want to know you," Dr Bath said.
"It ... feels like you're an integral part of the community."
