Around the Air Force President's Column

17 Pages·2012·3.77 MB·English

Vol. 25, No. 2 Winter 2012
Around the Air Force
President’s Column

Timothy Robinette, Col, USAF, MC, CFS Inside This Issue
Command Surgeon, HQ AFSOC
President’s Column 1
Happy 2012 New Year; don’t From the Editor 3
believe the Mayans! This
newsletter is focused upon
what we flight surgeons do Around the Air Force

in our jobs; some duties are
Flight Surgeons Wanted –
routine bread and butter aero-
space medicine and others Grey Beards Need Apply 4
define our future during a
revolutionary period. Telewarfare: A New Human Performance
Frontier 5
Maj Geoffrey “Rock”
Ewing’s article on disability
Advancing En Route Medical Care Through
prevention and manage-
International and National Partnerships 7
ment highlights how work-
related illnesses and injuries
have decreased while the Air Evacuation Comes Back to
number of lost work days has Wilford Hall Again 8
increased. Flight surgeons as profile officers are an integral part of the
AFMS disability process. Additionally, flight surgeons participate in Physiology Training and Research at
the entire process: at the beginning as the provider, in the middle at the
Brooks City-BaseAcceleration and
DAWG, and potentially again at the end with Medical Evaluation Boards
Research Center 9
or aeromedical waiver for special duty personnel. With so many points
of contact with these processes, flight surgeons must understand their
impact on a member’s ability to return to duty. Effects of Air Force Operations on the
Psychological Health of
Lt Col Dan “Danger” Mirski’s article titled “Air Force Color-Deficiency Remotely Piloted Aircraft Operators 11
Testing Standards in 2012” updates a previous article written in the
Winter 2011 FlightLines. As you are all aware, color discrimination in TAir Force Color-Deficiency
the cockpit has become critical as we have progressed to glass cockpits
Testing Standards in 2012 13
and overlapping displays, often distinguished by color. This article talks
about use of new technology in a few test sites that will help better screen
Research....Friend or Foe? 14
for cone color deficiencies in each of the three primary colors.
Remotely piloted aircraft (RPA) use has rapidly proliferated within the Disability Prevention and Management:
military since 9/11. Uses of RPAs in warfare are a revolutionary change The Physician’s Role 15
in war fighting. With this revolution has come concern and potential
evidence of increased work-family conflicts. The operators fight the
war at work and return home to their family at the end of the work day.
Lt Col Laura Brodhag’s article entitled “Effects of Air Force Operations
on the Psychological Health of Remotely Piloted Aircraft Operators”
discusses a USAFSAM study that addressed the impact on operators
FLIGHTLINES | 1
Notice!
involved in these missions. One recommendation was to assign opera-
tional psychologists to RPA units. Not addressed in this article, HQ
Call for Content
AFSOC has embedded operational psychologists in our RPA units for a
couple years. Additionally, HQ ACC has recently done similarly. This
scientific study validated what was hypothesized, and these corrective What makes FlightLines great is that it connects us with the rapid
changes and variety of expertise that exists in USAF flight medicine.
measures have been instituted.
Send us news that affects us all, teach us about your area of exper-
tise, and share with us your “There I was…” stories from the field.
Wilford Hall has stood up a contingency aeromedical staging facility.
(Include your pictures!)
See Lt Col Howard Givens’ brief discussion of the stand up of this
operation. While discussing aeromedical evacuation issues, Col Sarady Submission guidelines:
“Toucan” Tan wrote an article titled “Advancing En Route Care through 500-3000 words
International and National Partnerships.” This shows AMC’s outreach to Pictures 300 dpi or better in .tif or .jpg
the joint and combined environment in air evacuation.
Send your articles, news, suggestions, or comments to :
What will you do when you separate or retire from the AFMS? As
most of you know, the AF is short of flight surgeons. To fill some of [email protected]
the vacancies, retired AF flight surgeons (mostly RAMS) have been [email protected]
contracted or hired in GS positions. Col (ret) Bryan “Gerbil” Funke’s [email protected]
article, “Flight Surgeon Wanted – Grey Beards Need Apply,” is an excel- [email protected]
lent overview of the highlights of his job. Life is “all good” except he [email protected]
can’t fly. But, he gets to live the life of a Capt Flight Surgeon one more
time. Enjoy it Gerbil!
Information Update!
Speaking of grey beards, Col Joe “Bugs” Ortega’s article, “Telewarfare:
A New Human Performance Frontier,” continues on the previous discus- Moving, need your FlightLines sent to another email address?
sion of RPA operations. Bugs gives a great history of the evolution of
flying, the communications revolution, and the impact both have had 1. FlightLines distribution email update –
on providing health care in the midst of multiple revolutionary changes Send to [email protected]
in a relatively short time. For the grey beards reading this, the learning
curve just got steeper.
2. Society membership information update –
http://www.sousaffs.org/default.php --> Login --> Edit Profile
New technology is allowing aircraft to fly autonomously, haul cargo,
and fly aeromedical evacuation missions. The impact these will have on
flight surgeons remains to be seen. However, a human is always in the
chain somewhere. As historic flight surgeons performed in many new
SoUSAFFS Officers and
environments (altitude, speed, dive, flight, space, etc.), with these new
operational environments flight surgeons must stay engaged and inserted Board of Governors
in the mission. Keep ‘em flying!
President and Chairman ...........................Col Timothy Robinette
Vice-President ............................................Col Kenneth Knight
Secretary .....................................................Lt Col Tess Goodman
FlightLines
Treasurer ...............................................................Col Sarady Tan
Executive Officer .............................................Maj William Hayes
Editorial Staff Air Force National Guard Representative ...............Col J. Karen
Klingenberger
Air Force Reserve Representative ....................Col Joel Bogner
Executive Editor Maj Geoffrey Ewing Honorary Board Advisors ............................Lt Gen Bruce Green,
Maj Gen Tom Travis, Maj Gen Douglas Robb
Editors Lt Col Laura Brodhag Elected Members
Lt Col Dan Mirski 2011 .....Lt Col Cheryl Lowry, Col Tom Clarke, Col Mark Mavity
Maj Patricia Pankey 2010 ..........................Lt Col Alden Hilton, Lt Col Sparky Matthews,
Lt Col Robert York
Technical Editor Sandy Kawano Past Presidents ............Col Timothy Jet, Col Margaret Matarese,
Brig Gen Daniel Wyman, Maj Gen Douglas Robb
Business Editor Lt Col Rob Craig-Gray Committee Chairs
Awards ..................................................Lt Col Kathryn Hughes
FlightLines: Vision and Mission Program ................................................Lt Col Duncan Hughes
Membership ...................................................Maj Justin Tingey
Nominating .........................................Lt Col Devin Beckstrand
Our vision: FlightLines is the written forum for the Society
Resolutions .................................................Col Mark Coakwell
of United States Air Force Flight Surgeons. We help facilitate
History and Archives ................................Capt Jason Cromar
top-to-bottom, bottom-to-top, and horizontal dialogue within the Constitution/Bylaws ...................................Lt Col Mark Nassir
Flight Surgeon community. Reinartz Ed & Training ...............Lt Col Christopher Borchardt
Information Systems ..................................Lt Col Robert York
Our mission: We provide a vehicle to pass the vector and tools
Scientific Chair .....................................Col Richard Bachmann
to Flight Surgeons so they can do their jobs effectively and effi-
Webmaster .......................................................Lt Col Rob York
ciently as current and future leaders within Team Aerospace.
Merchandising Subcommitee ....................Lt Col Jeff Lawson
2 | FLIGHTLINES
From the Editor
Maj Geoffrey “Rock” Ewing, USAF, MC, SFS
Omega RAM 11
Welcome to another issue of FlightLines! Consistent with the mission Operational Flight Surgeon Safety Award
of FlightLines to educate and inform the flight surgeon community, this This award was established by the Society of USAF Flight Surgeons
issue should not disappoint. At the outset of this issue I want to highlight Board of Governors to recognize outstanding safety achievements of
some key notices. operational flight surgeons assigned to a medical group or squadron
medical element. The award is given to an individual who has made
COMMITTEES significant contributions to safety over the preceding calendar year.
SoUSAFFS is a dynamic organization with frequent staff position This award encompasses all areas of safety that may include, but are
changeovers. This keeps the work fresh and current and allows enough not limited to, identification, investigation, and mediation of hazards;
opportunities that any flight surgeon who wishes to be involved has a creation of effective prevention programs; insightful mishap investiga-
place at the table. SoUSAFFS’s committees are a great place to get “on tion; and innovative safety program management.
the inside” and help shape the organization’s work and build new profes-
sional relationships. Contact a committee chair to get involved. Howard R. Unger Award
This award was established by the Society of USAF Flight Surgeons
Nominating Committee – Lt Col Devin Beckstrand – Nominee selec- Board of Governors to encourage and reward publication of original
tion for board members work by USAF flight surgeons. The award goes to the best paper
written by a USAF flight surgeon published in Aviation, Space, and
Constitution and By-Laws Committee – Lt Col Mark Nassir – Environmental Medicine during the previous year. Originally called
Compliance with AsMA and USAF requirements the Best Paper Award, it was renamed in 1988 to honor Major General
Howard R. Unger, Chief Flight Surgeon, and former President of the
Membership Committee – Lt Col Tess Goodman – Member recruitment Society.
and management
Julian E. Ward Award
Awards Committee – Lt Col Kathryn Hughes – Solicits and manages This award was established and sponsored by the Society of USAF
SoUSAFFS’s annual awards Flight Surgeons in memory of its first member to have lost his life in an
aircraft accident and to honor all flight surgeons whose lives were lost
Programs Committee – Lt Col Duncan Hughes – Society growth and in the pursuit of flying activities relating to the practice of aerospace
annual business meeting medicine. The award is given annually for superior performance and/or
outstanding achievement in the art and science of aerospace medicine
Reinartz Education and Training Committee – Lt Col Christopher during residency training.
Borchardt – Education, training, and medical student outreach
Olson-Wegner Award
History and Archives Committee – Open – Updates the Society’s This award was established by the Society of USAF Flight Surgeons
history and teaches USAF history to members to recognize aeromedical enlisted personnel for their contributions to
the Air Force Aerospace Medicine Program. It is awarded to the most
Resolutions Committee – Col Mark Coakwell – Consensus statements outstanding Aeromedical Technician in the Air Force. This award is in
Information Systems – Lt Col Rob York – Operates SoUSAFFS’s memory of Master Sergeant Gary J. Olson and Airman Shane D. Wegner,
website who lost their lives in a helicopter accident 25 October 1991.
Scientific Committee – Col Richard Bachman – Promotes scholarly George E. Schafer Award
field research This award was established and awarded by the Society of USAF Flight
Surgeons Board of Governors in honor of Lieutenant General George
Merchandising – Lt Col Jeff Lawson – Sales and promotion of E. Schafer, Chief Flight Surgeon, and former President of the Society.
SoUSAFFS’s products General Schafer’s distinguished career ranged from squadron flight
surgeon to Air Force Surgeon General and epitomizes the purposes and
AWARDS principles of the Society of USAF Flight Surgeons. The award is given
A call for our annual SoUSAFFS’s awards nominations is on the radar. in his name to a United States Air Force Medical Corps officer who has
Don’t let good work go unnoticed. Who would you nominate for a made long-term significant contributions to the mission effectiveness
SoUSAFFS award? of the United States Air Force and to the vitality of the specialty of
Aerospace Medicine.
Malcolm C. Grow Award
This award was established by the Society of USAF Flight Surgeons to Everyone’s contributions to FlightLines and SoUSAFFS are rewarding
recognize an individual thought to exemplify the “ideal” flight surgeon and appreciated. Regardless of the size of the contribution, the combined
at the operational level. Selection is based on exceptionally effec- effect is what makes FlightLines and SoUSAFFS such a benefit to its
tive support of a flying organization and superior rapport with flying members and the USAF. We hope you enjoy the articles submitted for
personnel. this issue.
FLIGHTLINES | 3
Flight Surgeons Wanted – Grey Beards Need Apply
Bryan “Gerbil” Funke
RAM ‘99
When I retired from the Air Force I never dreamed I would work for the family stress and illness. Prior to my arrival, flight medicine patients
Government or live in Sumter, but retirement came a bit sooner than I were continuously shuttled to different PCMs due to turnover, deploy-
had anticipated, and after 14 PCS assignments my family didn’t want to ments, and manning shortages. Having the patients enrolled to the
move again. As luck would have it, the Air Force was facing a shortage “civilian” has provided our patients the continuity and quality of care
of flight surgeons and Shaw AFB was one of those bases not getting any they deserve. Taking care of the families and the flyers who retired from
new AMP graduates. The job seemed like a good match so I applied. I our office is also a key part of keeping the trust. As the civilian flight
sent my CV to the contractor who had won the Shaw contract, and after doc, I see my role as a facilitator, freeing our SMEs and blue-suit flight
a bit of negotiating we arrived at a mutually agreeable offer so I accepted docs to do operational medicine and flying – a big win for all.
the position.
As a civilian I also attend many of the same meetings as my active duty
Probably the most difficult task was getting credentialed as a contractor. counterparts such as AMC, OEHWG, Grounding Management, and
The Air Force contract specified applicants must be board certified in DAWG. Because I’m the PCM for all our patients, I usually have direct
either aerospace medicine or family practice and have recent clinical knowledge of their DNIF/DNIC, waiver, and IMR status and can answer
flight medicine experience as well as current BLS, ACLS, and PALS questions at the meetings. In my office we divide the workload when it
certifications. The contract also required the contractor to submit comes to waivers, MEBs, and RILOs—each of us gets a fair share, and
credentials and privileges list. Although my last six assignments were when someone deploys we cover for him/her. I also visit industrial shops
command or headquarters positions, I had seen patients regularly and and brief at the wing flying safety meeting. As the greybearded old guy
my clinical credentials were current, which greatly simplified the I can sometimes provide expert advice on programs and how to get the
process. Amazingly, the contractor seemed overwhelmed by the USAF mission done. Frequently I’m also the guy with the different perspective
credentialing process, so I filled out the AF forms and sent them to him asking why we are doing it that way.
with detailed instructions on submitting the package. I cannot empha-
size enough the importance of maintaining your clinical privileges and My contract and Air Force policy initially specified some things that I
currency if you want to be a contractor or civilian flight surgeon after could not do – fly, make aeromedical dispositions, and respond to flight-
your Air Force career. line emergencies to name a few. When I started at Shaw, we had five
other flight surgeons in the office, but over time they all left the Air Force
Although the medical group wanted to fill the position right away, I without being replaced. For a time I was the only flight surgeon in the
could not start working until all the paperwork was submitted by the office, necessitating that I do unforeseen things like respond to inflight
contractor and approved by the Air Force, which caused a delay of about emergencies and mishaps. Initially I had to have all my AF 1042s
10 days. The MDG commander wisely decided that I should partici- cosigned, but this policy has also changed. I really do miss the flying,
pate in the unit newcomer’s orientation. This gave me the opportunity and hopefully one day civilian flight docs can again take to the air in
to meet my new colleagues and to accomplish the many checklist and USAF aircraft. I now have three recent AMP graduates in the office, and
computer-based training items while familiarizing myself with the local I spend a lot of time teaching and mentoring. Our young flight docs are
network and MDG procedures. bright, motivated, and great physicians who’ve hit the ground running,
so I know the future of our Air Force is bright.
I found a familiar environment in the FSO and immediately felt at home
in clinic. I really enjoyed getting back to full time clinical medicine. Recently I converted to a GP-0602 civilian position. As NSPS positions
At first, my active duty flight surgeon colleagues seemed a little uneasy are phased out, GP positions are created, providing competitive salaries
and unsure how to deal with this retired colonel in the office, but after for physicians and dentists. These GP positions offer the stability and
a few reminders that I was now simply a team member, they began to benefits of other civil service categories such as leave, temporary duty,
address me as Gerbil (my call sign) or Bryan. It felt great to be a high and retirement.
paid “captain” again.
Will I remain in flight medicine forever? I don’t know, but I can say
My patients are great and the cases I’ve seen are interesting enough and with certainty that my job is rewarding and meets my family’s current
clinically challenging to keep me motivated and satisfied. I honestly needs. I rate being a civilian flight doc two thumbs up! Any SoUSAFFS
believe we see higher acuity patients in the FSO now than we did 30 members looking at their upcoming transition can call me if they want
years ago when I was a newbie flight surgeon. I’m not sure why that more information about Air Force civilian flight surgeon positions.
is—perhaps because we have two large headquarters with older patients Clear skies and tailwinds…always check six!
at my base. Perhaps the very high deployment ops tempo contributes to
4 | FLIGHTLINES
Telewarfare: A New Human Performance Frontier
Col H.J. “Bugs” Ortega
AF ISR Agency/SG
We live in a moment of history where change is so speeded up that we Warfare, too, has evolved over the course of time, from the Bronze Age
begin to see the present only when it is already disappearing. to the Iron Age to gunpowder to firearms to the Industrial Revolution to
R.D. Laing aviation. The communications age illustrated in my opening vignette
has led to networked military operations via RPAs and distributed opera-
The goal today is for you all to take a bit of time to ponder some strategic tions (Ortega, 2009), and robotics will lead to even more drastic changes
ramblings from an old flight surgeon. So strap in! For you oldsters out (Singer, 2009). While that simple comparison of the same place over 20
there, think about how remote a Korea assignment was in the 1980s. years illustrates how things changed over time for Kunsan, the point is
(MGen Anderson, you can think about it in the 70s, sir.J) Some of you that it can be really difficult to see those changes and their impacts from
colonels were in the USAF at the time – I was a young captain in 1987 the trenches in which we all live, work, and fight every day.
at the Kun. It was $5 a minute to phone CONUS. Snail mail was $0.22
per letter. The internet was dominated by mainframes and terminals. So let’s step back and look at our history. In 1903, the Wright Brothers
The PC was just beginning. Patient logs were kept on a triple nickel flew. In 1907, the Aeronautical Branch was established in the U.S.
– SF555. The World Wide Web wasn’t even invented yet. When I Army’s Signal Corps. In 1914, the first military aviator medical stan-
returned to Kunsan in 2006, the communications environment was very dards were introduced. Col Theordore Lyster argued in 1918 that the
different—the internet, the web, emails, smart phones, Facebook, Skype, “medical problems of flying were in their infancy.” There were only 32
$0.05/min to the States, a stamp at $0.39! It wasn’t nearly as remote a papers in the medical literature of the day on the problems encountered
feeling as in the 80s. The rest of the experience had only minimally in aviation… in 15 years! Technology and capability leapt ahead over
changed J, and it still rocked for an operational flight doc! the next two to three decades, and after WWII, the USAF was born (Link
et al., 1955). Now, take a look at this chart from a 2008 USAF briefing
on RPA programs and way ahead.
FLIGHTLINES | 5
For the entire 21st century (so far), we’ve been fighting a unique kind
The changes depicted over the life of our Air Force up to now are stun-
of war. Many of you know nothing else. RPAs, cyber, and intel are
ning. While no one knows the future, the trends become clearer in this
now doing warfare from home station, via the communications advances
graphic, and the implications for all flight docs, and even the specialty
I’ve already mentioned. This “combat from a distance” requires a name
of Aerospace Medicine, are similarly stunning.
– and I dub it “telewarfare.” (See insert definition.) Most of you have
heard this cliché about military operations: “hurry up and wait.” But
Today’s RPA operations, thanks to the communications revolution, are
military operations have changed. Lt Gen Lord, the AF CIO, recently
not quite to the green “near future” box but close. Currently we operate
described this rapidly changing operational world as “warfare at the
one RPA crew to one vehicle, but MAC or multi aircraft control is rapidly
speed of light.” The USAF has aligned the 24th AF cyber fighting
approaching, and autonomous “swarm” technology is not too far behind.
NAF under AF Space Command. The AF has taken the first steps in
The chart describes two areas of rapid and significant change that will
defining new medical standards for these operations, like RPA standards
be intensely emotional and difficult for the world of USAF Aerospace
and Space Command’s Cyber operator standards, which initially closely
Medicine to navigate. One is USAF aviator culture, and the second is
match SMOD requirements. As cyber operations move into more promi-
traditional flight doc populations and duties. Let’s take the latter first.
nence, I believe we have a turbulent ride coming. I’m sure this is simply
the beginning.
Professionally speaking, the main item here for us flight docs is that
the crew no longer require PPE – no G-suit, no ATAGS, no helmet, no
“There is nothing more difficult to take in hand, more perilous to
Nomex® (gasp!). Okay, they still have Nomex®, but the other stuff is
conduct, or more uncertain in its success, than to take the lead in the
now OBE. But the trend is again unmistakable – fewer humans in the
introduction of a new order of things.”
harsh environment of traditional aviators – low pressure, low oxygen,
— Niccolo Machiavelli, The Prince (1532)
low temperature, high vibration, challenging inertial loads, high stress
interpersonal communication, human factors, etc. As the group of
Change is coming. Most of you have been steeped in the AF culture
humans who actually “slip the surly bonds of earth” shrinks, the impor-
of AEF cycles, air operations, EMEDS, a rapid AE chain, stabilization
tance of physical requirements will concomitantly wane. As most of
surgery, CCATTS, and international health specialists. Strap in folks.
you know, many of the traditional items that were important in the past
Just like my story about the remoteness of Kunsan, these concepts
for AF flight docs are not so significant in today’s age – take in-depth
were not invented back in 1987. The coming world of RPA, cyber, and
ophthalmologic knowledge as an example. What does this trend portend
robotics is around the corner and may happen in some of you young
for ENT issues, like Eustachian tube dysfunction or Valsalva, or sudden
flight docs’ careers. The world of military operations will continue to
incapacitation risk? What does it do to “pilot selection” standards?
morph and change and adapt to our nation’s needs. Will our AF adapt
and evolve? I think so, and we flight surgeons will be there to help
Now, who should flight surgeons take care of? Aviators have always
guide this transition, focusing, like always, on ensuring the highest level
been the actual “warriors” for the Air Force, and astronauts are an
of human performance of our nation’s warfighters. Keep ‘em flyin’ and
obvious population as well (really slipping the surly bonds). But given
fightin’!
the trends, who is that group of the future USAF? What distinguishes
this group from other AF personnel? What duties are mission critical
References:
for the USAF to accomplish? These are open questions, but they rely
on a completely different perspective from traditional hypobaric, hypo-
Link MM, Coleman HA. Medical support of the Army air forces in
thermic, hypoxic, inertial thinking. You might even start thinking that
World War II. Washington, DC: Office of the Surgeon General, USAF;
Aerospace Medicine is lost! But I believe we’ll be required to stick
1955.
with our traditional mission-oriented and human performance focus to
include clinical medical knowledge. How will we support the USAF
Ortega HJ. A new combat paradigm: distributed ops. FlightLines 2009
and mission accomplishment? Who are the critical players in bringing
Fall; 23(3):15.
AF capabilities to the nation? Who will be the AF’s combatants of the
future? Is it RPA? Is it space? Is it cyber? Is it computer programmers
Singer PW. Wired for war: the robotics revolution and conflict in the 21st
who are developing artificial intelligence routines for weapons? Who
century. New York: The Penguin Press; 2009.
should we focus on? If everyone is special then no one is special. We
could reach the long-touted goal of “flight medicine for everyone,” but
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no one will be actually flying. That leads into the other area of change
tel·e·war·fare Show Spelled [tel-uh-wawr-fair]
derived from the chart – USAF culture.
noun
The USAF has a long tradition intertwined with aviation. Since 1903
1. the process of armed conflict between enemies conducted in
this culture has developed and grown into what we have today. Helmets,
part or in whole via control of vehicles, devices or weapons from
leather jackets, and flight suits were all derived from operational and
a distance
human performance needs. Squadron ready rooms, squadron heritage
2. the production of kinetic combat effects via a remotely controlled
rooms (formerly “bars”), RMOs, flight leads, debriefings, and check-
vehicle or weapon
lists were developed over the years from the unique experiences and
3. the remote control use of weaponry and/or sensors from home
needs of “those who fly and fight.” We applied selection standards and
station in direct support of military units in a distant area of opera-
rigorous screening that resulted in a subpopulation of individuals who
tions, to include real time intelligence, surveillance, reconnaissance,
could perform in the environment, and they have thrived over the years
and attack operations via ground, air, sea, space or cyberspace
into the leadership of our service – in no small part due to their rigorous
selection, difficult training process, and arguably because of their combat
Related forms
function. But what does the chart portend for the coming age? This is
tel·e·com·bat
much harder to discern, but USAF Aerospace Medicine is up to the task.
tel·e·war·ri·or
As a matter of fact, USAFSAM has been at the forefront of studying the
tel·e·com·ba·tant
human effects of this new environment and characterizing the risks. It
Also called: combat engaged airmen, employed in place operations,
is what we flight docs do.
deployed in place personnel, distributed operations, reach-back
operations, remotely piloted vehicle operations
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6 | FLIGHTLINES
Advancing En Route Medical Care
Through International and National Partnerships
Colonel Sarady “Toucan” Tan, USAF, MC, SFS
Chief, Aerospace Medicine Division, HQ AMC/SG
On the 20th and 21st of July 2011, General Raymond E. Johns, Jr.,
commander of the Air Mobility Command (AMC), and Brigadier
General Bart O. Iddins, AMC Surgeon General (SG), hosted interna-
tional and civilian partners in the inaugural International Aeromedical
Evacuation (AE) and En Route Medical Care Conference. The confer-
ence was held in conjunction with the 2011 biennial Air Mobility
Rodeo competition at McChord Field, Washington. The purpose of this
multinational consortium was to allow nations to share experiences and
advances in en route medical care and patient transport. Clinical manage-
ment guidelines, clinical and aircrew training platforms, new technology
to support en route patient care, and research initiatives were presented at
lectures, poster sessions, panel discussions, and demonstrations.
The 2-day symposium of presenters included doctors, nurses, medics,
developers, and researchers from both the military and civilian sectors
representing 29 nations which included Canada, Germany, Japan,
Jordan, New Zealand, and Pakistan. Many experiences, stories, and General Johns and Lieutenant General Green
lessons learned were shared that forged new friendships and professional
conversed between plenary sessions. - Tan
networks. Some notable attendees included Dr. Jonathan Woodson
(Assistant Secretary of Defense for Health Affairs); Lieutenant General
Charles B. Green (USAF Surgeon General); Lieutenant General (R) Dr.
Paul K. Carlton, Jr. (former USAF SG); Major General Kimberly A. culminated with eight poster presentations, aircraft static displays, and
Siniscalchi (Assistant Air Force Surgeon General, Nursing Services); equipment demonstrations from 28 various vendors. Some aircraft on
Major General Byron C. Hepburns (59 MDW/CC); Air Commodore hand for display included the C-17, KC-135, UH-1 (Huey U.S. Army
Wilcox (UK); Brigadier General Daniel O. Wyman (ACC/SG); Brigadier Dust Off), and a civilian fixed wing air ambulance. Equipment and
General John D. Owen (IMA to AMC/SG); Major General Frederick H. technology demonstrations encompassed new patient litters/lifts/isola-
Martin (AMC/A3); and Chief Master Sergeant (CMSgt) Charles R. Cole tion units, medical monitors, and Critical Care Air Transport Team/Air
(USAF Chief, Medical Enlisted Force). Force Special Operation Command’s medical equipment sets as well as
medical tents/shelters.
General Johns launched the conference with a presentation on “Meeting
Global Demand with International AE Partnerships,” which highlighted Lieutenant General Green and CMSgt Cole initiated the conference’s
the impacts AE has had in saving lives through medical care delivered second day with a presentation on “Advancing the Art & Science of Air
to airmen, sister services, civilians, and coalition partners throughout Evacuation.” In the brief, they envisioned future AE will provide interop-
the en route care system. A few other topics discussed on the first day erable medical services across the continuum of care, negate stresses of
included the “Royal Air Force Medical Services Aeromedical Evacuation flight, expand the range of patient delivery, and deliver seamless state-
Capability” by Squadron Leader Simon Lynn from the United Kingdom, of-the-art medicine in the air and on the ground. They were followed by
“Pain Management During Aeromedical Evacuation” by Major (Dr.) Dr. William Beninati (Colonel-retired), whose meticulous review of the
Tim Sveinbjornson from Canada, and “Hoisting to a Higher Level” “History of the Critical Care Air Transport Program” provided insights
(civilian helicopter medical transport) by Dr. Frank Thomas from Utah. into some of the challenges he, Dr. P.K. Carlton, and other early USAF
The Afghanistan Armed Forces’ aeromedical evacuation and tactical critical-care-in-the-air pioneers overcame as they developed and fielded
Army aeromedical evacuation in Operation Enduring Freedom presen- this revolutionary capability. Lieutenant Colonel (Dr.) Raymond Fang
tations wrapped up the afternoon plenary session. The first day event then introduced the audience to a unique critical care capability and
equipment set called the Acute Lung Rescue Team (ALeRT). His team
at the Landstuhl Regional Medical Center has employed ALeRT over
the last few years to manage and transport patients with severe lung
failure out of Operations Enduring Freedom, Iraqi Freedom, and New
Dawn. The rest of the second day plenary sessions featured speakers
from Japan, Jordan, New Zealand, and Pakistan. Lastly, Dr. Woodson
closed out the International AE and En Route Medical Care Conference
with a speech on “Wartime Medical Advances: Benefits for the Military
and Society” during the dinner social.
Overall, the 2-day event narrowed gaps in the en route medical care
continuum both locally and internationally. Interoperability among
international military services was also highlighted and synergized for
future cooperation. Conference participants expressed overwhelmingly
positive feedback on the benefit of exchanging en route medical care
ideas, which enhanced international military and civilian partnership. As
a result of the success of this inaugural symposium, AMC leaders plan
to offer the next International Aeromedical Evacuation and En Route
Brigadier General Wyman and Colonel Tan Medical Care Conference in conjunction with the 2013 Air Mobility
between plenary sessions. - Tan Rodeo. So plan now and join AMC in shaping future international en
route medical care. See you in Seattle next year!
FLIGHTLINES | 7
Air Evacuation Comes Back to Wilford Hall Again
Howard Givens, Lt Col, USAF, MC, SFS
Commander, 559 AMDS
559th CASF patient transport by K loader - Givens
The 59th Medical Wing at Lackland AFB began receiving patients aircraft to waiting ambulances, with anyone needing inpatient care taken
through the global air evacuation (AE) system in July 2011 through a directly to San Antonio Military Medical Center by contract ambulance.
contingency aeromedical staging facility (CASF) located at Wilford Hall All other patients are transported to the 559 CASF located at WHASC,
Ambulatory Surgical Center (WHASC). The CASF team is made up of where they typically remain for 24 hours but possibly as long as 72 hours
active duty, Air National Guard, and Air Reserve medics deployed to San awaiting follow-on transportation. The usual process involves several
Antonio for 6-month rotations, with the primary mission of providing inbound missions per week matched to an outbound mission the next
medical care between AE flights. Current operations require that flight day (where the CASF team reverses the process to get all patients safely
surgeons assess the patient movement request for each patient transiting situated on the aircraft under the care of the in-flight nursing team).
San Antonio to determine whether the patient will need or is likely to Occasionally, however, a “tail-to-tail” changeover will take place that
need inpatient care. The CASF team meets all patients at the arriving involves moving patients directly from the inbound flight to an outbound
aircraft, which allows the nursing staff to communicate directly with aircraft waiting to take the patient further along the AE chain. Overall,
the in-flight nursing staff, and the flight surgeon reassesses each patient the CASF mission is a challenging but rewarding addition to the 59th
to determine whether any changes have occurred in-flight to warrant a Medical Wing.
higher level of care. The CASF team then moves all patients from the
8 | FLIGHTLINES
Physiology Training and Research at Brooks City-Base
Acceleration and Research Center
Richard Sumrall, Lt Col, USAF, MC, CFS
be initiated at the discretion of the commander following an in-flight
The report of my death was an exaggeration. Gz-induced loss of consciousness (GLOC) incident, to improve an
-Mark Twain individual’s anti-G straining maneuver performance, or as a confidence
builder. The flight surgeon should be in this process to provide medical
Despite recent reports, there are still a few active duty Air Force evaluation and head-up display (HUD) tape review.
personnel at Brooks City-Base. With the recent move of USAFSAM
to Wright-Patterson AFB, you may have questions on the status of
centrifuge and altitude chamber operations. This article updates current
USAFSAM centrifuge and altitude chamber operations at Brooks City-
Base (BCB) as of October 2011.
Continued Operations at Brooks City-Base
The unit at BCB is designated the Acceleration and Research Center and
falls under the USAFSAM Aerospace Medicine Department, Aerospace
Physiology Division (FEEP) at WPAFB. Assigned at BCB are 3 aero-
space physiologists, 12 aerospace physiology apprentices, and a flight
surgeon. Contract personnel are a physician assistant, technicians, and
several contract research scientists. Another scientist is assigned to
USAFSAM as a civil servant. The main contractor continues to be Wyle
Laboratories.
Operations continue to be in buildings 160 and 170 on the “Hill” at BCB.
Figure 1. Number of Centrifuge Students Trained
The facilities have been rented by Wyle Laboratories from the City of
San Antonio as of 1 July 2011; previously, the facilities were rented by
the AF.
From AFI 11-404, Centrifuge Training for High-G Aircrew, paragraph
Centrifuge Training 1.1., “…an effective anti-G straining maneuver (AGSM) is the aircrew’s
most significant weapon against the potentially incapacitating effects of
The centrifuge at WPAFB will be operational no earlier than December G, adding an average of 3.5 G to aircrew resting G-tolerance. Centrifuge
2012, and the centrifuge at Holloman AFB was shut down in September training has proven to be our best device for teaching the proper AGSM,
2009, so the Air Force’s only centrifuge is at BCB. The other DoD as well as providing the opportunity for teaching the physiology of high-
centrifuge is at Naval Air Station Lemoore, CA. This centrifuge will be G flight and an awareness of the factors that affect an aircrew’s G-toler-
decommissioned in 2012, and Navy acceleration training will be accom- ance from day to day.”
plished jointly at WPAFB. Up to 1,000 aircrew are trained annually in
the centrifuge (Figure 1). Prior to September 2009, all aircrew training GLOC is still a threat to SHGA aircrew. During FY01-08, there were 4
was performed at Holloman AFB. F-16 Class A mishaps, 43 F-16 Class E events, 14 F-15 Class E events,
1 fatal Class A T-37 mishap, and 158 T-37 Class E events due to GLOC;
AF centrifuge training is outlined in AFI 11-404, Centrifuge Training for the most recent fatal GLOC mishap was 28 June 2011. Flight surgeons
High-G Aircrew. Initial training is for Specialized Undergraduate Pilot continue to play an integral role in preventing GLOC by flying in SHGA,
Training students in the T-38 track. Qualification training is for pilots reviewing HUD tapes with SGHA, and counseling aircrew on lifestyle
and aircrew going to a sustained high-G aircraft (SHGA) (T-38, F-15, measures to optimize Gz tolerance. AFPAM 11-419, G-Awareness
F-16, F/A-22, F-35). Refresher training is for aircrew who are more for Aircrew, details this program. Do not take acceleration forces for
than 3 years removed from an SHGA assignment or are converting from granted; continue your vigilance with G-awareness.
a non-SHGA aircraft.
Do you know the procedure if notified of a GLOC Class E physiologic
Flight surgeons being newly assigned to an SHGA must complete event? (AFMAN 91-223, 6.3.6.) When was the last time you reviewed
qualification training; if they are more than 3 years removed from an AFPAM 11-419, G-Awareness for Aircrew? Are you flying on SHGA
SHGA platform, they must complete refresher training. Flight surgeons and conducting HUD tape reviews?
and other SHGA aircrew would call the ARC at the numbers below for
training date. Centrifuge Research
Commander-directed acceleration training is 3-day training to evaluate USAFSAM continues to conduct acceleration research in the centrifuge.
and improve an aircrew member’s performance under G. It would Studies include evaluating new anti-G suits, pressure breathing, and
FLIGHTLINES | 9
electrical muscle stimulation. Subjects are active duty members in the we all remember – instead now call 210-292-3483 (CYA-DIVE), after
local area and receive hazardous duty incentive pay for the months they duty hours DSN 554-5990, 210-292-5990. The “Panama” chamber is
participate in centrifuge training or testing as a subject. still at BCB; plans are for it to be put into a museum, but specifics are
pending. The hyperbaric chambers at BCB have been used for research
Altitude Research but have been “quiet” for many months now.
No AFI 11-403 altitude chamber training is conducted at BCB, and there Contact Us
are no operational training altitude chambers at BCB. Altitude physi-
ology training (for aerospace physiologists and apprentices and local We do not have DSN access; all numbers are 210-998- unless otherwise
aircrew such as flight surgeons) is performed at WPAFB. noted. The scheduling cell phone is 382-8719. Primary centrifuge
schedulers are SSgt Cubeddu at -4082 or Lt Bradley at -4078. Maj
The research altitude chambers at BCB are still operational and busy. Gonzalez is the flight commander and lead aerospace physiology officer
Ongoing testing projects include patient warming blanket systems, at -4093. The flight surgeon is Lt Col Richard Sumrall at 598-2824. If
Joint Strike Fighter advanced helmet-mounted display and ejection seat you live in the local area, are active duty, and are interested in becoming
testing, and new aircrew chemical agent mask systems. Other studies a centrifuge or altitude chamber research subject, contact TSgt Taylor for
ongoing or planned include workload measurement at altitude, on-board centrifuge at -4096 or SSgt Cubeddu for the altitude chamber at -4082.
oxygen generating system (OBOGS) testing, and a neurologic decom-
pression sickness study. Finally, if you are in San Antonio and are nostalgic for Brooks City-
Base, contact Dr. Sumrall for a visit to these facilities, at least through
Spatial Disorientation December 2012. We are still alive and well at Brooks!
The Gyroflight Sustained Operations Simulator (GSOS) spatial disori- Brooks’ Centrifuge Information
entation trainer was moved to WPAFB in August this year. It is mainly
used for testing. A recent project using the GSOS was evaluating visual The centrifuge at Brooks City-Base was built and installed by Rucker,
techniques with LCD display spectacles to help aircrew recognize and Inc. in the early 1960s. It has trained many tens of thousands of aircrew
overcome spatial disorientation. personnel since then. It can spin up to 67.8 rpm generating 30 Gs, the
axis depending on the seat orientation. Its max G-onset rate is 6 G/s. It
Hyperbaric Operations is powered by four 250-hp electric motors and has regenerative braking,
so it was green long before “green” was hip! Because it is inseparable
As a side note, clinical hyperbaric operations moved to Wilford Hall from the building, it has belonged to the City of San Antonio since 2001
Medical Center in March 2008, now called Wilford Hall Ambulatory and is currently leased by Wyle Laboratories.
Surgical Center. The emergency phone is NO LONGER LEO-FAST as
The History of the RAM Patch
The background of red and blue represents the
Col Tom Travis (RAM 92-93), who was then
USAF School of Aerospace Medicine and the
USAFSAM/CC, requested a design for a
birthplace of all RAMs.
RAM graduate patch in 2002. Maj Dan
“Hawkeye” Shoor (RAM 03) submitted
The USAF symbol represents the people we
an initial round design. Upon review, Lt
support, the entire USAF family.
Gen Charles Coolidge, Jr., then AFMC/CV,
declared that the RAM program was the
The RAM’s cranium is the traditional
“Weapons School of Flight Medicine.”
symbol of flight surgeons with residency
At his recommendation, the patch was
in aerospace medicine. Three stars fly
edited into the format of the USAF
above the RAM representing three fields
Weapons School graduate patch. The
of training (aerospace medicine, occupa-
RAM graduate patch became standard
tional medicine, and general preventive
wear in 2003. They will be available at
medicine) and the three main roles in flight
AsMA from the SoUSAFFS.
medicine, bioenvironmental engineering, and
public health.
10| FLIGHTLINES