fall1998nwsltr by hxtMEE65


									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: gamecockmd@aol.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

 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:    psteeves@pol.net
 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:   alsobel@sandia.gov
 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:   clloyd@teleport.com
 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
                                                                                                     580 Silhouette Way
 Thanks for the Opportunity,                                                                        Monument CO 80132
                                                                                                 Email: snyderq@alpa.org

                                                                                                    Newsletter Editor
                              Lt Colonel W. W. Dodson MD MPH                                   Col Gerald E. Harmon, SC ANG
                                                                                                    1075 N. Fraser Street
                                                                                                    Georgetown SC 29440
                                                                                               Email: gamecockmd@aol.com
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

                                                                      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
                                                                      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

 **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

    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: pat.nell@afrc.af.mil
    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

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: splashdoc@aol.com                      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

    integrity ( 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

                                                                   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.
   FAMILY-FRIENDLY LIFE                                                 Two Cents from the Editor…
   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:
                                                                       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

 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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