Page 1 AANGFS Newsletter Fall 1998 Alliance of Air National Guard Flight Surgeons Newsletter Volume 10, Number 2 Published two or three times annually by the AANGFS Fall 1998 President's Column Colonel Phil Steeves, CFS, MA ANG As flight surgeons--military physicians--we are members of two proud, ancient and honorable professions: the Profession of Healing and the Profession of Arms. This makes us unique in each community. Among our medical colleagues, we are the few who have any military and aerospace medicine experience. We are the ones they turn to for information about medical concerns for airline passengers (the handbook recently published by AsMA is an excellent reference). And they solicit our opinions on matters military in doctors’ lounge bull sessions. In this issue… We are also exceptional in the military community in many ways. We President's Column 1 are their healers, of course, and we frequently have privileged, sensitive information. However, there is another way in which we have too often been Col Janco's Thoughts 2 considered unique but in a negative sense--the oddballs who aren’t really military. For most of us, our commissions are reserve, not regular. On Alliance Officers 3 commissioning, we were given credit for our many years of professional raining, RAM Report-Buck Dodson 3 with the result that we walked around with shiny new captain’s bars, never having gone through AFA, ROTC, or OCS. The brief time at MIMSO (later MEB's Explained by SGP 4 COT, now AFOTS) can hardly bring us up to speed as military officers. In general, the line has forgiven us this deficiency (though they do double-takes at AMSUS Schedule 5 bare-chested captains!), excusing our limited military background. However, as Maj Gen Whinnery 6 the DOD draws down, and the senior rank structure thins out, I sense a diminishing tolerance of this anomaly. As military officers, we too should AANGFS Application 7 consider this unacceptable. Sustainment Course/ATLS 8 We can make up this shortcoming by obtaining professional military RAMblings from Col Falk 8 education (PME). As your president, I want to encourage all Alliance flight surgeons to complete the PME appropriate to their rank (and to their intended Letters to the Editor 9 future rank). This means SOS (Squadron Officer School) for O-3’s, ACSC (Air ACC/SG Asst-BG Higdon 10 Command and Staff College) for O-4/5’s, and AWC (Air War College) for anyone at or hoping to get to O-6. You will find the education to be very Core Values: Integrity 10 broadening: a combination of military history, current world events, leadership techniques, budgetary processes, and communications skills. Not only will it Media Reports/Retention 11 stand you in better stead when dealing with your military peers, commanders, Two Cents from Editor 11 and subordinates; I guarantee it will also improve your civilian skills in dealing with hospital administrators, HMO’s, etc. You write in your ESGR letters (you AME Web Site 11 commanders DO write those letters, don’t you!) that employers enjoy the benefit of their reservists’ getting military training that enhances their performance on the job. Well, you will find that PME will do the same for yourself. …continued on page 2 Page 2 AANGFS Newsletter Fall 1998 Continued from page 1… THOUGHTS AND OPINIONS ON How well are we already doing? Not very! Gen TRAINING, EXPEDITIONARY Higdon shared with me some numbers from recent promotion boards. At a recent Lt Col board, only 21% of FORCES, AND HOST WING medical corps applicants had any PME at all, compared to SUPPORT 62% of nurses, 91% of MSC’s, 85% of Optometrists. And for those meeting the O-6 board, only 19% of physicians Medical and AE squadron commanders must had completed AWC, compared to 67% of dentists, 100% juggle an extraordinarily complex array of competing of MSC’s, (though only 38% of nurses). training requirements, deployments, host wing support activities, immunizations, computerization/data tasks, and personnel issues. The list of course goes on and on. Yet These numbers are frankly embarrassing, and we in ANG medics are expected to be fully trained, 100% all the the Alliance should lead the way in correcting this. PME time, ready for rapid deployment. We're kidding can be completed by correspondence (and for many busy ourselves. It can't be done in most units. physicians, this is the only way). Many choose to do it by seminar, which takes a bit of coordination as well as a ADAF suffers a hemorrhage of pilots, largely due commitment to one evening every week for months. At to ops tempo. We may be facing a similar problem for least the camaraderie may add to the success rate. You will ARC medics as we are tasked to do more and more for find PME to be a win-win situation, improving your both our federal and state missions. Anthrax shots will be standing in both our professions--medical and military. no small task. Soon we will expand our roles in assisting civilian training and response to WMD. Friends, I see even more tasks coming down the pike. I suggest that the Alliance should consider developing a file that could assist its members in their PME. General Ryan's proposed solution to pilot losses is It could include papers written by Alliance flight surgeons to create air expeditionary forces that marry several units (not to copy, but to demonstrate possibilities), and for extended but less frequent deployments. We need to summaries of notes directed to the DLO’s (desired learning consider and, dare I say 'mirror,' that concept in planning objectives). Since the curriculum changes frequently, it our training with our AFRC and ADAF. We must begin to would have to be updated just as frequently. We are think of training with other units that we know we will looking for someone to coordinate this proposed project, deploy with. That training must be well integrated and soliciting volunteers from those who are recent graduates of designed to meet specific training requirements both for ACSC and AWC. Please contact me if you’re interested. the individual and for the medical/AE squadron. Novel solutions will be welcome. But where do we get the time? Colonel Phil Steeves, CFS, MA ANG While we explore integrated training for a medical expeditionary component, we need to realistically reassess our host wing support. What is truly essential for host support that cannot be done as efficiently elsewhere? Alliance of ANG Flight Surgeons When is outsourcing of routine tasks acceptable or not? Take immunizations for instance. Why can't flu shots be Newsletter done on a voucher system at local MD practices, occupational health departments at the workplace, or This newsletter is published two or three times annually by the public health departments? Just that alone would free up Alliance of Air National Guard Flight Surgeons. Articles for inclusion are always solicited from members and guest authors. Material for many man-hours for essential medical readiness training. publication can be sent to: Ditto anthrax and other 'routine' or regularly scheduled immunizations. Save the predeployment shots and other Col G. E. Harmon time-dependent shots for us. 1075 North Fraser Street Georgetown SC 29440 Let's hoist the sacred cow of physical exams for a FAX 843-527-4027 quick look. Not long ago when our existence as a reserve Email: email@example.com medical force was questioned, a brief study suggested that no one could accomplish our exam workload as efficiently Viewpoints expressed in this publication do not necessarily represent and cheaply as we could. Since then, we do fewer official positions of the Alliance, the Air National Guard, the United States Air Force, or the Department of Defense. physicals, we have shrunk in size, we have more training needs, and the health care industry has discovered Gerald E. Harmon, Col, CFS, SCANG managed care. TriCare has been deployed. Editor and Publisher …continued on page 3 Page 3 AANGFS Newsletter Fall 1998 Continued from page 2… Isn't it time to question the training value (sic) of routine physical exams in healthy individuals? Flight and occupational physicals notwithstanding, the routine physical can be accomplished elsewhere with equal quality and, I propose, lesser cost if contracted properly. We can still manage those individuals who are found to have potentially disqualifying or profiling disorders. Commanders: think of what you could do for training with those extra hours freed up from routine physicals. So what's my solution? Commanders need to speak up loudly and boldly both to their Wing Commanders and to our Assistants about our problems in juggling this array of tasks. As customers of ANGRC, we need to tell them what we can and cannot do in the field. We must reexamine how we allocate our precious UTA time, what our training goals should be, how we accurately and honestly measure and report our accomplishment of those goals, and distinguish which enabling tasks support our training goals from those that do not. What do you think? Bob Janco, Col, HQ TN ANG Bob.Janco@mcmail.vanderbilt.edu Greetings from Texas: Alliance Officers As a member of the Residency in Aerospace Medicine class of President 2000 (RAM 2000), it is my pleasure to report that this is one of the Colonel Phil Steeves, MA ANG largest recent classes at 21 physicians including 4 from the Army. All 4 Virginia Place of us spent last year in various Masters in Public Health (MPH) Wenham MA 01984-1129 programs throughout the US. The largest single group went to the University of Texas branch in San Antonio but many other schools Email: firstname.lastname@example.org were attended including Harvard and Johns Hopkins. It was a Vice-President challenging year since we had only a maximum of 12 months to Col Annette Sobel, NM ANG complete these programs which are designed for a 2-year P. O. Box 1507 enrollment; some of the programs, including UT also required the Tijeras NM 87059-1507 completion of a thesis. Typical courses included epidemiology, biostatistics, toxicology, project/program administration, Email: email@example.com environmental health, computer applications, and various electives. Treasurer Since I was the Air Guard sponsored student, I was on flying Lt Col Clee Lloyd, OR ANG status and obtained my hours flying mostly at Kelly or Randolph AFBs 24220 Skylane Drive here in San Antonio. Here at Brooks AFB, we are looking forward to this aerospace training year and the following occupational training Canby OR 97013-8746 year. Again, it will be a challenge since we all have to have Email: firstname.lastname@example.org completed PME by the end of this second year as well as a research Secretary project. This is indeed a great educational program and highly Lt Col Quay Snyder recommended. 580 Silhouette Way Thanks for the Opportunity, Monument CO 80132 Email: email@example.com Newsletter Editor Buck Lt Colonel W. W. Dodson MD MPH Col Gerald E. Harmon, SC ANG 1075 N. Fraser Street Georgetown SC 29440 Email: firstname.lastname@example.org Page 4 AANGFS Newsletter Fall 1998 test reports and a copy of ETT tracings. Finally, give the member’s duty title, and include information describing the impact of the illness on the member’s ability to Medical Evaluation Boards perform his or her position. Also mention the individual’s beliefs about his or her ability to continue in military Explained service. By The MEB makes recommendations on the individual’s ANG/SGP qualification for worldwide duty. The MEB does not make a determination as to whether the individual is fit to perform the duties of his/her office, grade, rank or rating. Capt (P) Phil Lanham, FS. USAF Nor does the board recommend a disability percentage rating. The next step in the MEB process involves sending the MEB to ANG/SGP for review. The MEB is reviewed for completeness and comprehensiveness of medical documentation. When the medical work-up is incomplete, or proper documentation is not submitted, the MEB package will be returned to the unit with a request for specific information. Sometimes the MEB must be What is a Medical Evaluation Board (MEB)? Speaking in returned to obtain the proper paperwork including general terms, it is a group of physicians, usually three, signatures. Once an MEB has been reviewed at the ANG, convening to discuss the details of a medical case on a a member’s medical disposition will be classified as: Service member. Based on the details of the member’s Certified medically fit for duty, deployable with waiver; case, the MEB decides whether or not the Service member is medically non-deployable, unfit for duty (Disqualified) medically qualified for Military Service. or; medically non-deployable, pending personnel action. Service members must meet an MEB in the following This last category is new (non-deployable, pending instances: 1) When they have a medical condition described personnel action) and is the Deployment Availability Code in AFI 48-123, attachment 2; 2) When a member has a (DAC) 42 process detailed in Log Letter 98-016. This condition for which he/she has been a 4T profile for 1 year; disposition allows members who are non-deployable to be 3) If in a commander’s opinion, a Service member has a retained, if their illness allows them to do their job and the medical condition which significantly interferes with the commander desires to retain them. These individuals are reasonable fulfillment of the individual’s employment in the placed in a non-mobility tasked position. If they are Military Service. In general, however, a MEB is completed retained in this category they are assigned a personnel if Military Service could seriously compromise the health or code DAC-42, continuing to do drill and gaining points well-being of an individual if they were retained. This may towards retirement. involve dependence on certain medications, appliances, severe dietary restrictions, frequent special treatments or a In the near future a listing of MEB and Waiver requirement for frequent clinical monitoring. For further Protocols will be available on the ANG web that discussion on this issue refer to DODI 1332.38 (The summarize the medical information ANG requires for the MEB/disability evaluation system process). most common diagnoses. These guidelines were recently reviewed by the Health Technician’s PAT and were well MEB documentation should include: a SF 88 (Physical received. Exam Form), a SF 93 (Medical History), an AF Form 618 (Medical Board Report) and a Narrative Summary. The SF Hopefully, this clarifies some issues on the MEB 88 and SF 93 should be from the most recent examination. process. If you think, nonetheless, you need our help, have (Currently MEBs on General Officers may incorporate the a question or need more information, contact us and we PHA (Preventive Health Assessment). In the future, all will try to assist you. You can contact anyone in our MEBs may utilize the PHA in place of SF Forms 88 and 93. section through our web site. Check it out: The AF Form 618 is completed at the time of the MEB and WWW.ANG.AF.MIL/SG/meddivisions/SGS/SGP.htm must include all signatures. The Narrative Summary must detail the history of the member’s illness and the complete Philip D. Lanham CAPT, USAF, MC, FS medical work-up, including annotation of specific laboratory Deputy Chief Aerospace Medicine and test findings. Other significant medical history should Office of The Air Surgeon Air National Guard be documented. Detail the medical treatment, the prognosis and any physical restrictions noted by the individual’s primary medical doctor (PMD). All pertinent PMD documentation will also be submitted to include copies of Page 5 AANGFS Newsletter Fall 1998 AMSUS Alliance of ANGFS Schedule of Events SATURDAY, 7 November 1998 TUESDAY, 10 November 1998 8:00 a.m. - Air National Guard Assistants, Advisors and 1:00 p.m. Alliance of ANG/AFRES Flight Surgeons State Air Surgeons Meeting 5: 00 p.m. Education Session #2 5:00 p.m. (Invitation Only) Program Chair - Col Annette Sobel, NMANG SUNDAY, 8 November 1998 1:00 p.m. Near Death Experience in Aviation 8:00 a.m. - Alliance of Air National Guard Flight Surgeons 2:00 p.m. Maj Gen James Whinnery, TXANG, MC 5:00 p.m. 2:00 p.m. Spinal Injury Patterns in Aircrew 8:00 a.m.- AANGFS Business Meeting 2:45 p.m. Lt Col William Drew, USAF, MC 9:30 a.m. Lt Col Phil Steeves, MAANG, MC 2:45 p. m. ENT Controversies in Aviation Medicine 9:30 a.m.- Break 3:15 p. m. Col Douglas Holmes, UAAFR, MC 10:00 a.m. 3:15 p.m. Assessment of Viral Hepatitides 10:00 a.m. - ANG Assistants' Briefings 3:45 p.m. Col Milton Mutchnik, OHANG, MC 11:00 a.m. Maj Gen James E. Whinnery, TXANG, MC 3:45 p.m. Break Brig Gen Dennis Higdon, TNANG, MC 4:00 p.m. Brig Gen Jackson Davis, DCANG, MC 4:00 p.m. Weaver Lecture: Perspectives of Aerospace Medicine 4:50 p.m. Maj Gen John Giller, USAFR, MC 11:00 a.m. - The Air Surgeon and ANG/SG Staff 12:00 p.m. Col James J. Dougherty, USAF, MC 4:50 p.m. Award Presentation Lt Col Carol Ramsey, USAF, MC 5:00 p.m. Maj Barry Holder, USAF 6:00 p.m. Alliance of ANG Flight Surgeons Banquet 12:00 p.m. - Lunch/Registration Location to be announced 1:00 p.m. WEDNESDAY 11November 1998 1:00 p.m Education Session #1 1:00 p.m. Alliance of ANG Flight Surgeons 5:00 p.m. Program Chair - Col Annette Sobel, NMANG,MC 5: 00 p.m. Education Session #3 Program Chair - Col Annette Sobel, NMANG, MC 1:00 p.m. - Cardiovascular Disease and the Aviator 1:45 p.m. Lt Col Quay Snyder, COANG, MC 1:00 p.m. Interactive Panel: LOD Determinations 1:50 p.m. Col Peter Hochla, NMANG, MC 1:45 p.m. - Evaluation of Orthopedic Injuries Col Edith Mitchell, MOANG, MC 2:30 p.m. Col Harry Robinson, MNANG, MC Lt Col Carol Ramsey, USAF, MC CMSgt Peter Braun, NMANG 2:30 p.m.- Focus on Preventive Medicine: GI Screening 2:45 p.m. Col Edith Mitchell, MOANG, MC 1:50 p.m. Trauma Prediction and Injury Management 2:45 p.m. Lt Col Tony Rizzo 2:45 p.m. Break 3:00 p.m. 2:45 p. m. Break 3:00 p. m. 3:00 p.m. - Controversies in Alternative Medical Therapy 4:00 p.m. Lt Col Carol Ramsey, USAF, MC 3:00 p.m. The Evolving Structure of OOTW Medical Lt Col Chuck Fisher, USAF, MC Management 3:45 p.m. Brig Gen Donna Barbisch, USAFR, NC 4:00 - p.m. Aerospace Medicine Lecture: Prevention of Col Annette Sobel, NMANG, MC Communicable Illness in 5:00 p.m. Commercial Airlines: TB, A Case Study 3:45 p.m. Break Dr Russell Rayman 4:00 p.m. 9:00 a.m. Executive Planning Session - State Air 4:00 p.m. Mirror Force Issues and the Guard and Reserves Surgeons 5:00 p.m. Lieutenant General Charles H. Roadman II, USAF, 12:00 p.m. Agenda to be distributed at time of meeting MC 5:00 p.m. State Air Surgeons Reception 7:00 p.m. (Invitation Only) MONDAY, 9 November 1998 12:00 p.m. - Air National Guard Awards Luncheon 1:30 p.m. Page 6 AANGFS Newsletter Fall 1998 Searching for Air Guard Medical Airpower Theory Maj Gen James E. Whinnery ANG Aisstant, USAF Surgeon General in time of peace. They must be adequate in time “In Time of Peace Prepare for War.” -George Washington of war to ensure victory. Now if this is our first order of battle, it In my opinion the words of George is easy to see that I am afflicted by what Carl Washington are intensely meaningful for the Nation Builder has called the “Icarus Syndrome.” I, like and directly applicable to the Air National Guard the USAF/ANG leadership under which I was Flight Surgeons (for that matter all flight surgeons). reared, have had a love affair with the airplane. I I have said this many times in terms of our primary therefore came by it from experience and it is wartime mission being accomplished in peacetime. difficultto break. To survive and thrive in these The primary mission is the preparation of our rapidly changing times, however, may require an warriors for war. It is the sum and substance of our evolution in the theory underlying Air Guard medical readiness. For, if we have failed to ensure medicine and its missions (including the order of the health of our force, optimized their protection, battle to a certain extent). If one observes the expanded their performance envelope, and made the active forces, both the line and medical service, absolutely ready to fight and win, we could lose the there are hints about how we might position war from the start. Our wartime clinical medicine ourselves more effectively. First from the line of skills may be for naught if our peacetime aeromedical the USAF, General Ryan have put forth the skills falter. We make the assumption that there will Expeditionary Aerospace Force (EAF) concept. be an extended conflict with numerous casualties so Many of the aspects of that concept indeed that we will need to employ our medical and surgical embrace the concepts we have previously skills. Judging from the most recent conflicts, this is advocated. These includes the call for a time- not the trend for the types of conflict we may phased readiness mode of operations so we can do experience in the future. This does not mean that we much more in the way of planning our lives and be can abrogate our clinical medicine readiness duties, it more ready and finely tuned at the precise simply means that we should understand what the moment we are called upon to serve. Such a mode medical order of battle actually is. The medical of operation will help our families, our civilian order of battle is aviation medicine first followed by professional lives and our employers. A focused the combat medicine (if necessary). When our training cycle with fewer but key inspections tied aircrew deploy, our aviation medicine duties must to our actual deployment. I very much agree with have been accomplished. Only if we have failed to these concepts. protect them adequately, only if we have failed to Now examine the rapidly evolving active ensure their health, only if we have failed to optimize duty medical service. Traditional clinical medicine their ability to perform in combat will we be called is being outsourced at every juncture possible, upon to use our medical skills to mend them. If we with true “blue suit” medicine being the final fail in our aviation medicine duties, we will need to be bastion we can secure. The large medical centers prepared to use our clinical medical skills. The and hospitals are disappearing or have physical examinations we perform, the immunizations disappeared. If a medical mission is not Air Force we administer, the safety briefings we give, the mission essential it is an endangered activity. I observations of our aircrew performance as we fly agree that this is the correct path to take. The with them, the defense against biological, chemical large medical complex of “white suit” medicine and nuclear weapons we devise for them, the G-suits that was built during the Cold War was an we develop, the oxygen masks we improve, and on and aberration and one we were essentially born with on. These are the aviation medical duties we perform following World War II. Healthy aviators and Page 7 AANGFS Newsletter Fall 1998 aerospace support personnel doing aerospace missions (us included) is what tomorrow appears to be bringing. Based on this scenario, does medicine still have the “Icarus Syndrome”? Maybe, but it surely does place the ANG Medical Service and its activities in a perfect position. If there were any group around that was more aviation oriented than the ANG Medical Service then I would like to have it proven to me. The ANG Medical Service is in the exactly the right position at the right time to lead military medicine. This will quickly change and we must decide how to evolve into the future. What about state missions? What about weapons of mass destruction used completely indiscriminately on US soil and US citizens (including our own loved ones right in Guard hometowns)? Have we integrated these threats into the underlying theory of Guard medicine? What are your thoughts on the theory of Air Guard medicine? “ A service that does not develop rigorous thinkers among its leaders and decision makers is inviting friction, folly and failure.” - I.B. Holley, Jr. MGen (ret), “Reflections on the Search for Airpower Theory,” in The Paths of Heaven: The evolution of Airpower Theory; Ed. P.S. Meilenger; Air University Press; Maxwell AFB, AL 1997. **Note: I would like to thank the following ANG Medical Service leaders that responded to the call for opinions in the last Newsletter. I will discuss their input on why they are in the ANG and why they joined and stay in the next issue. G. Harmon, SC ANG; T. Dolnicek, NE ANG; B. Janco and J. Witherspoon TN ANG; P. Steeves MA ANG; J. Lunn ID ANG; M. Hardy NH ANG; R. Andrews ME ANG. Page 8 AANGFS Newsletter Fall 1998 Flight Surgeon Sustainment Course with ATLS… Air Force Reserve Command (AFRC) sponsors a Flight Surgeon Sustainment Course at the Uniformed Services University of the Health Sciences (USUHS) each spring. This is an excellent refresher course for non-full time flight docs and for anyone who wants to update flight medical skills. This year Advanced Trauma Life Support (ATLS) is offered as part of the course. The dates are 16- 20 Mar 99 and costs are around $200 for the sustainment portion and $400 for the ATLS course. Contact ANG/SGP (LtCol Ramsey or Capt Lanham) or Col Patricia Nell, AFRC/SGP, DSN 497-1886, Comm 912- 327-1886, Fax 497-0610 and e-mail: email@example.com for details. RAMblings from Brooks Colonel Randy Falk Greetings from the 38th grade here in Alamo City. Having survived Fairchild (Combat Survival) and the best attempts Pensacola could make at drowning me, I am now officially a Phase III Resident in Aerospace Medicine (RAM). So far, the year has been quite challenging with rotations through both the State and City health departments. Some interesting electives in Occ Med/Prev Med and a rotation with American Airlines are yet ahead. My primary AANGFS function this year is arranging the annual Tuesday night extravaganza. Colonel Annie Sobel has put together a timely program highlighting the WWII Women's' Air Force Service (WASP). She has engaged the following three WWII era pilots: Ms. Elizabeth (Betty) Williamson Shipley Ms. Madge Leon Moore Ms. Dorothy Lucas They will describe the history of the Service Pilots (WASPs), significant mission profiles flown, the later integration of their roles into the larger USAF mission, and the progressive role of women in the military. These women are pioneering spirits of "High Flight"! DETAILS OF THE DINNER AND PROGRAM Date: 10 November 98 (Tuesday) Time: Cocktails (no-host bar) begin at 1800 hrs Location: HANGAR 9, Brooks AFB TX - the ONLY standing WWI hangar - now an outstanding museum of Air Force aviation history. In keeping with current fiduciary reforms, no military transportation will be available to Brooks AFB from the Convention Center. Team up, as much as possible, with folks who have rental cars. Alternatively, Brooks is only a 10 minute cab ride from the Convention Center...cab sharing should be quite inexpensive. Other transportation options are being investigated...more at registration Cost: $32.00 per person - information at registration on purchase Price includes Mexican Buffet Extravaganza - will exceed Riverwalk standards - & a piece of the "presentation brick - Alliance of Air National Guard Flight Surgeons" for the Hangar 9 terrace - a National Historic Site on the grounds of the home of Aerospace Medicine. Uniform: Casual civilian this year COME ONE...COME ALL!! THIS PROMISES TO BE A SUPERB EVENING OF HISTORY, EXCELLENT FOOD AND COMARADERIE! SEE YOU IN SAN ANTONIO. Page 9 AANGFS Newsletter Fall 1998 After reading the newsletter, I felt you may be Letters a good source of information. I have been a flight doc To The in the ANG for 10 years and plan on going the full 20, plus. As you know, it is now an absolute prerequisite Editor that any 05 complete the Air War College before promotion to 06 will be considered, at least in our neck of the woods/desert. I am a trauma/general surgeon in the largest practice in Tucson. Without exaggeration, I work 100- During AMSUS 1997, I had the opportunity to 110 hrs/week and have some type of call responsibility speak with fellow Flight Surgeons from around the 3 out of 4 weekends per month. My free weekend I country. Some of the conversations suggested a “less than dedicate to the guard. My areas of responsibility have optimal” relationship between the medical elements and done well in inspections and I maintain my flying the line officers. After returning home I discussed this with requirements without fail. Our pilots trust me. We several of the aviators in the Wing. My impressions were already feel we have too little time to accomplish all of confirmed by some of their stories from other units. I am the training required in a large med squadron, even not suggesting that all flying units have a poor relationship with 12 flight surgeons in our family. between the docs and the fliers, but it appears that we are Last year six of the docs attempted the War not fully developing as good a relationship as is possible. College in correspondence and in seminar. Within 6 We have all been asked many times “what is a flight months 5 dropped out due to the unrealistic surgeon?” After explaining we don’t actually operate in an expectations of the course, not to mention the unreal airplane but we do get to fly in operational aircraft, the time requirements needed to do just an average job. next question is “why?” Well, it is not just to fly. Part of The only doc to complete it was a physician who does our charter is to develop bonds with our aviators in hopes not have a clinical practice and subsequently much they will be willing to talk with us about physical, mental more time available to do the work. This is going to be or social problems that have the potential to adversely a problem guard-wide I suspect. If I cannot advance affect their flying or their general well-being. from here on out,my motivation to continue will be understandably less. Many of us do have excellent relationships with Maybe it's just sour grapes,but our active duty our pilots. My belief is we should all have the opportunity counterparts don't have private practices to worry to serve in a unit where the relationship is one of mutual about, much better time schedules, and can take the respect and willingness to help the other perform his course in residence if they desire. Not much of a mission. I would like members of the AANGFS to mirror force in my opinion. consider a mentor program. Those of us who feel we have I accomplish my PME every day at work. I am something to offer, can host recent graduates from the a leader at the hospital because my job demands it. Aerospace Course one weekend. The visiting Flight No pilot has ever worked as hard,at any duration of Surgeon can interact with the local Flight Surgeons to get a time as I, or my associates, ever have. I understand feel for how they work and how they perceive their the necessity for the PME and agree that it is mission. In addition, the visitor can speak with the aviators important, but writing a thesis on the Israeli Air War or of that unit and find out what a pilot wants in a Flight the Linebacker Campaigns is not going to help me lead Surgeon. Hopefully, these discussions will give the new a medical squadron. The flight surgeons in our Flight Surgeon a bit of insight not always available in the squadron are very discouraged. academic setting. Do you know of others who have shared other experiences? I am sure we are not unique in this The purpose of this discussion is not to point problem. There must be a solution. Otherwise, there fingers at anyone; it is to promote the improvement of will be a slow/steady attrition of an already scarce relationships between the medical elements and the aviator resource...quality flight docs. communities. I ask that you consider this and maybe we Your thoughts, even brief ones, would be can discuss this at AMSUS 1998. appreciated. JR “Splash” Walters, Col, SFS, SCANG Sincerely, 169 MDS/CC email: firstname.lastname@example.org Jim Balserak, MAJ, MC, SFS, AzANG (Tucson) e-mail: BladeF16@juno.com Page 10 AANGFS Newsletter Fall 1998 ACC/SG Assistant Brig General Dennis A. Higdon Reports ANG Assistant to ACC/SG I am pleased to report that I attended a significant major planning events. It is obvious to him that as the meeting at HQ/ACC. Following this summer's Air Force changes its way of life it will be impossible to "Warfighter" CORONA , General Ryan detailed the organize and manage the future without us. With our groundbreaking work the four-stars had accomplished deployment to Prince Sultan AB, and before, the Guard toward the development of our capabilities as an has proven it can do real missions. We will be at the Expeditionary Aerospace Force. General Hawley table to insure the active component includes the ANG (COMACC) immediately directed ACC staff to lead the Medical Service in ways that maximize our unique Air Expeditionary Force implementation planning effort. strengths as citizen-airmen. In response General Schafer (ACC/SG) organized a Two other significant points came from the meeting of the Combat Air Forces surgeons which was conference that might interest you. First, the active duty held at Langley AFB the second week in September. Air Force is having flight surgeon recruiting and This was the first meeting of the CAF/SGs in over five retention problems, too. They are currently staffed at years. What brought the command surgeons together 72% of authorized strength, and hurting. Second, this was a formidable agenda which included a review of winter's Form, Fit, Function Follow-on (F-4) will be at current theater medical CONOPS, development of Nellis AFB, NV. It will exercise and test the functional expeditionary medical support capability, theater capability of the modernized ATH and specialty sets. It surveillance, medical technology insertion/development, will be a Total Force event with ANG UTCs and Aerospace Medical initiatives. These subjects and participating. The exercise will be several weeks in others were briefed and discussed by the seven. What is length and will be managed by a cadre of 26 personnel. significant to you and me is that the ANG/SG, Col Col Mike Hayek, MOANG, has been tapped by General Dougherty, was one of them. Klaus Schafer is on target. Schafer to lead the cadre. The Mirror Force strategy is He automatically includes the Guard and Reserve in all working. Keep the faith. See you at AMSUS. CORE VALUES: INTEGRITY integrity ( in teg' ri tee) 1. The quality or state of being complete; unbroken condition; wholeness; entirety 2. The quality or state of being unimpaired; perfect condition; soundness 3. The quality or state of being of sound moral principle; uprightness, honesty, and sincerity. So that is the definition of integrity, but what does it mean to you and what does it mean to us? I ask what it means to us because we are all members of our medical units, the Air National Guard, and the Department of Defense. We need to realize that our actions not only affect our personal relations and us but also have an impact upon those people in our association. How many times at formation have we heard the phrase “reflects great credit upon your state, the Air National Guard, and the United States Air Force?” I ask each of you to consider this: your actions not only speak for you as an individual but for all of us in our medical squadrons and the Air National Guard. Most of us believe in a strong national defense. There are those who believe otherwise and whose right to disagree we serve to defend. Every time you smile in greeting someone, hold a door open or ask if you can offer assistance, you are spreading the word that we are a valuable force, willing to help others and ready to defend our country. Contrary to this, if our actions are not of sound moral principles, it reflects poorly on us all and limits our ability to achieve our mission. As you can see I haven’t answered the question “what is integrity?” This is a question we need to answer on our own. I challenge all of us to consider the effects of our actions not only upon ourselves but on those around us. Col John R. "Splash" Walters, MC, SFS, SC ANG Page 11 AANGFS Newsletter Fall 1998 The same is true for other high-tech jobs where Media Reports on Military military people are increasingly leaving in Retention and Recruiting midcareer. Article 3 of 422, Article ID: 9808020225 Published on 08/02/98, THE STATE (The following summaries are from articles in the HIGHEST BIDDER WOOS AWAY Columbia, SC, State newspaper:) MILITARY'S COMPUTER GURUS In the next few weeks, Senior Airman James Lowman will leave the Air Force for a job that will pay him $50,000 a year. If what corporate recruiters have told him is true, Article 1 of 422, Article ID: 9808020219 the 24-year-old computer database specialist will Published on 08/02/98, THE STATE more than double his income of $21,000 when he SKILLED MILITARY WORKERS joins the private sector after four years in the FLEEING FOR PRIVATE SECTOR service. THE LURE OF MORE MONEY, FAMILY-FRIENDLY LIFE Two Cents from the Editor… THREATENS AMERICA'S VOLUNTEER FORCE There's really not much to add to all of the In the Air Force, and increasingly in the other services, excellent articles in this edition of the people with technical skills are departing at an Newsletter. Besides, I found I had no room alarming rate into a booming civilian economy. left to write an editorial of substance. Tune in Some policy experts think the numbers herald the to the Alliance Home Page at biggest threat to the all-volunteer military since its www.telalink.net/~flitedoc and to the ANG/SG creation 25 years ago - an unprecedented exodus of Home Page at www.ang.af.mil/sg for lots of skilled workers. good poop. Article 2 of 422, Article ID: 9808020224 Published on 08/02/98, THE STATE Aviation Medical Examiners: EXODUS LEAVES FORCES WITH A good web site for you to visit is FLEDGLING PILOTS www.virtualfls.com (This is a site maintained The Air Force and other services might be able to replace hundreds of pilots who are leaving the military. for commercial pilots which provides medical But they can't give new pilots the experiences gained advice regarding aeromedical conditions and from years of flying. questions. Page 12 AANGFS Newsletter Fall 1998 Col Gerald E. Harmon, CFS, SCANG 1075 N. Fraser Street Georgetown SC 29440 Preparing for Weapons of Mass Destruction (WMD) Medical Consequence Management COL Annette Sobel, MC, SFS, NMANG We live in an exceedingly interconnected world in which the concepts of homeland defense and transnational threats (i.e., those respecting no geographic borders) are deeply intertwined. Local and state resources are critical components of our Nation’s defense strategy. Nunn-Lugar-Domenici legislation and PDD 39 are enabling legislation to support community preparedness and Guard and Reserve missions in response to acts of terrorism. DoD Directive 3025.15 provides the legal infrastructure for Military Assistance to Civil Authorities (MACA) and subsequent cooperative execution of response to the terrorist use of WMD. The Federal Response Plan (FRP) is a taxonomy and guide to federal support to state and local governments and assigns areas of responsibility to specific government agencies. For example, Mass Care is the primary responsibility of the American Red Cross; Health and Medical Services is the responsibility of the U. S Public Health Service. The Director of Military Support (DOMS) is charged with coordination of the DoD assets tasked with consequence management. With all this said, how will Air National Guard medical units, their command and control infrastructure and regional assets become and sustain readiness in the WMD-consequence management environment? Homeland Defense is not new to the Guard; it constitutes the roots from whence we’ve come. However, in the context of response to acts of terrorism, particularly those involving chemical and/or biological warfare, and overwhelming numbers of casualties at an unpredictable rate of onset, we are breaking new ground. We are in uncharted territories, as are our civilian counterparts. In fact, in many instances, we are our civilian counterparts in our full time jobs. This is the true dual nature of the Guard, and demonstrates the awesome power we have in support of our communities. I urge all State Air Surgeons, unit Commanders, and your executive staff to take inventory of the skills and talent you have indigenous to your units. Fire fighters, law enforcement officers, Urban Search and Rescue team members, communications and computer specialists have critical abilities transcending their medical AFSCs. Consider making some initial calls to introduce yourself to key personnel in your local community, i.e., the chief of your Disaster Medical Assistance Team (DMAT or MMST, Metropolitan Medical Strike Team), Fire Fighting/EMS Academy, Emergency Preparedness Liaison Officer (EPLO), etc. Get to know your Plans, Operations, and Military Support Officer (POMSO) and request and update briefing to understand your local and state response plan. Find out if the domestic preparedness training has already occurred in your community, and, if not, if you or your designee may attend. Invite civil (and other military) components to participate in readiness exercises, particularly in the command and control elements. Invite these folks to participate in sustainment training and perhaps as guest speakers. Those states with Care Force teams have a head start in the civil-military support process and mutual trust ensuing in each component’s abilities and assets brought to the table. Ultimately, effective consequence management involves the cross-disciplinary and integrated use of skilled personnel to support civil authorities and first responders in the mitigation process. A jump-start on preparedness is heightened awareness and integration with the local community on an individual level. This is an area in which the Guard excels.
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