· web viewcontinued from page 2… page 12 aangfs newsletter fall 1998. in this issue…...

AANGFS Newsletter Fall 1998

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.

We are also exceptional in the military community in many ways. We are their healers, of course, and we frequently have privileged, sensitive information. However, there is another way in which we have too often been 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 commissioning, we were given credit for our many years of professional raining, 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 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 bare-chested captains!), excusing our limited military background. However, as 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 consider this unacceptable.

We can make up this shortcoming by obtaining professional military 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 future rank). This means SOS (Squadron Officer School) for O-3’s, ACSC (Air 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 broadening: a combination of military history, current world events, leadership techniques, budgetary processes, and communications skills. Not only will it stand you in better stead when dealing with your military peers, commanders, 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 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

Alliance of Air National GuardFlight Surgeons Newsletter

In this issue…

President's Column 1Col Janco's Thoughts 2Alliance Officers 3RAM Report-Buck Dodson 3MEB's Explained by SGP

4AMSUS Schedule 5Maj Gen Whinnery 6AANGFS Application 7Sustainment Course/ATLS 8RAMblings from Col Falk

8Letters to the Editor 9ACC/SG Asst-BG Higdon 10Core Values: Integrity 10Media Reports/Retention 11Two Cents from Editor 11

President's ColumnColonel Phil Steeves, CFS, MA ANG

Volume 10, Number 2 Published two or three times annually by the AANGFS Fall 1998


Continued from page 1…

How well are we already doing? Not very! Gen Higdon shared with me some numbers from recent promotion boards. At a recent Lt Col board, only 21% of medical corps applicants had any PME at all, compared to 62% of nurses, 91% of MSC’s, 85% of Optometrists. And for those meeting the O-6 board, only 19% of physicians had completed AWC, compared to 67% of dentists, 100% of MSC’s, (though only 38% of nurses).

These numbers are frankly embarrassing, and we in the Alliance should lead the way in correcting this. PME can be completed by correspondence (and for many busy physicians, this is the only way). Many choose to do it by seminar, which takes a bit of coordination as well as a commitment to one evening every week for months. At least the camaraderie may add to the success rate. You will find PME to be a win-win situation, improving your standing in both our professions--medical and military.

I suggest that the Alliance should consider developing a file that could assist its members in their PME. It could include papers written by Alliance flight surgeons (not to copy, but to demonstrate possibilities), and summaries of notes directed to the DLO’s (desired learning objectives). Since the curriculum changes frequently, it would have to be updated just as frequently. We are looking for someone to coordinate this proposed project, soliciting volunteers from those who are recent graduates of ACSC and AWC. Please contact me if you’re interested.

Colonel Phil Steeves, CFS, MA ANG

Alliance of ANG Flight SurgeonsNewsletter

This newsletter is published two or three times annually by the Alliance of Air National Guard Flight Surgeons. Articles for inclusion are always solicited from members and guest authors. Material for publication can be sent to:

Col G. E. Harmon1075 North Fraser StreetGeorgetown SC 29440

FAX 843-527-4027Email: [email protected]

Viewpoints expressed in this publication do not necessarily represent official positions of the Alliance, the Air National Guard, the United States Air Force, or the Department of Defense.

Gerald E. Harmon, Col, CFS, SCANGEditor and Publisher

THOUGHTS AND OPINIONS ON TRAINING, EXPEDITIONARY FORCES, AND HOST WING

SUPPORT

Medical and AE squadron commanders must juggle an extraordinarily complex array of competing training requirements, deployments, host wing support activities, immunizations, computerization/data tasks, and personnel issues. The list of course goes on and on. Yet ANG medics are expected to be fully trained, 100% all the time, ready for rapid deployment. We're kidding ourselves. It can't be done in most units.

ADAF suffers a hemorrhage of pilots, largely due to ops tempo. We may be facing a similar problem for ARC medics as we are tasked to do more and more for both our federal and state missions. Anthrax shots will be 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.

General Ryan's proposed solution to pilot losses is to create air expeditionary forces that marry several units for extended but less frequent deployments. We need to consider and, dare I say 'mirror,' that concept in planning our training with our AFRC and ADAF. We must begin to think of training with other units that we know we will deploy with. That training must be well integrated and designed to meet specific training requirements both for the individual and for the medical/AE squadron. Novel solutions will be welcome. But where do we get the time?

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? When is outsourcing of routine tasks acceptable or not? Take immunizations for instance. Why can't flu shots be done on a voucher system at local MD practices, occupational health departments at the workplace, or public health departments? Just that alone would free up many man-hours for essential medical readiness training. Ditto anthrax and other 'routine' or regularly scheduled immunizations. Save the predeployment shots and other time-dependent shots for us.

Let's hoist the sacred cow of physical exams for a quick look. Not long ago when our existence as a reserve medical force was questioned, a brief study suggested that no one could accomplish our exam workload as efficiently and cheaply as we could. Since then, we do fewer physicals, we have shrunk in size, we have more training needs, and the health care industry has discovered managed care. TriCare has been deployed.

…continued on page 3

mailto:[email protected]


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 [email protected]

Greetings from Texas:

As a member of the Residency in Aerospace Medicine class of 2000 (RAM 2000), it is my pleasure to report that this is one of the largest recent classes at 21 physicians including 4 from the Army. All of us spent last year in various Masters in Public Health (MPH) programs throughout the US. The largest single group went to the University of Texas branch in San Antonio but many other schools were attended including Harvard and Johns Hopkins. It was a challenging year since we had only a maximum of 12 months to complete these programs which are designed for a 2-year enrollment; some of the programs, including UT also required the completion of a thesis. Typical courses included epidemiology, biostatistics, toxicology, project/program administration, environmental health, computer applications, and various electives.

Since I was the Air Guard sponsored student, I was on flying status and obtained my hours flying mostly at Kelly or Randolph AFBs here in San Antonio. Here at Brooks AFB, we are looking forward to this aerospace training year and the following occupational training year. Again, it will be a challenge since we all have to have completed PME by the end of this second year as well as a research project. This is indeed a great educational program and highly recommended.

Thanks for the Opportunity,

BuckLt Colonel W. W. Dodson MD MPH

Alliance Officers

PresidentColonel Phil Steeves, MA ANG

4 Virginia Place

Wenham MA 01984-1129

Email: [email protected]

Vice-PresidentCol Annette Sobel, NM ANG

P. O. Box 1507

Tijeras NM 87059-1507


TreasurerLt Col Clee Lloyd, OR ANG

24220 Skylane Drive

Canby OR 97013-8746


SecretaryLt Col Quay Snyder

580 Silhouette Way

Monument CO 80132


Newsletter EditorCol Gerald E. Harmon, SC ANG

1075 N. Fraser Street

Georgetown SC 29440








What is a Medical Evaluation Board (MEB)? Speaking in general terms, it is a group of physicians, usually three, convening to discuss the details of a medical case on a Service member. Based on the details of the member’s case, the MEB decides whether or not the Service member is medically qualified for Military Service.

Service members must meet an MEB in the following instances: 1) When they have a medical condition described in AFI 48-123, attachment 2; 2) When a member has a condition for which he/she has been a 4T profile for 1 year; 3) If in a commander’s opinion, a Service member has a medical condition which significantly interferes with the reasonable fulfillment of the individual’s employment in the Military Service. In general, however, a MEB is completed if Military Service could seriously compromise the health or well-being of an individual if they were retained. This may involve dependence on certain medications, appliances, severe dietary restrictions, frequent special treatments or a requirement for frequent clinical monitoring. For further discussion on this issue refer to DODI 1332.38 (The MEB/disability evaluation system process). MEB documentation should include: a SF 88 (Physical Exam Form), a SF 93 (Medical History), an AF Form 618 (Medical Board Report) and a Narrative Summary. The SF 88 and SF 93 should be from the most recent examination. (Currently MEBs on General Officers may incorporate the PHA (Preventive Health Assessment). In the future, all MEBs may utilize the PHA in place of SF Forms 88 and 93. The AF Form 618 is completed at the time of the MEB and must include all signatures. The Narrative Summary must detail the history of the member’s illness and the complete medical work-up, including annotation of specific laboratory and test findings. Other significant medical history should 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

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 perform his or her position. Also mention the individual’s beliefs about his or her ability to continue in military service.

The MEB makes recommendations on the individual’s 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. 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 returned to obtain the proper paperwork including signatures. Once an MEB has been reviewed at the ANG, a member’s medical disposition will be classified as: Certified medically fit for duty, deployable with waiver; medically non-deployable, unfit for duty (Disqualified) or; medically non-deployable, pending personnel action.

This last category is new (non-deployable, pending personnel action) and is the Deployment Availability Code (DAC) 42 process detailed in Log Letter 98-016. This disposition allows members who are non-deployable to be retained, if their illness allows them to do their job and the commander desires to retain them. These individuals are placed in a non-mobility tasked position. If they are retained in this category they are assigned a personnel code DAC-42, continuing to do drill and gaining points towards retirement.

In the near future a listing of MEB and Waiver Protocols will be available on the ANG web that summarize the medical information ANG requires for the most common diagnoses. These guidelines were recently reviewed by the Health Technician’s PAT and were well received.

Hopefully, this clarifies some issues on the MEB process. If you think, nonetheless, you need our help, have a question or need more information, contact us and we will try to assist you. You can contact anyone in our section through our web site. Check it out: WWW.ANG.AF.MIL/SG/meddivisions/SGS/SGP.htm

Philip D. Lanham CAPT, USAF, MC, FSDeputy Chief Aerospace MedicineOffice of The Air Surgeon Air National Guard

Medical Evaluation BoardsExplained

ByANG/SGP

Capt (P) Phil Lanham, FS. USAF

http://WWW.ANG.AF.MIL/SG/meddivisions/SGS/SGP.htm


SATURDAY, 7 November 19988:00 a.m. - Air National Guard Assistants, Advisors and

State Air Surgeons Meeting5:00 p.m. (Invitation Only)

SUNDAY, 8 November 19988:00 a.m. - Alliance of Air National Guard Flight Surgeons5:00 p.m.

8:00 a.m.- AANGFS Business Meeting9:30 a.m. Lt Col Phil Steeves, MAANG, MC

9:30 a.m.- Break10:00 a.m.

10:00 a.m. - ANG Assistants' Briefings11:00 a.m. Maj Gen James E. Whinnery, TXANG, MC

Brig Gen Dennis Higdon, TNANG, MC

Brig Gen Jackson Davis, DCANG, MC

11:00 a.m. - The Air Surgeon and ANG/SG Staff12:00 p.m. Col James J. Dougherty, USAF, MC

Lt Col Carol Ramsey, USAF, MCMaj Barry Holder, USAF

12:00 p.m. - Lunch/Registration1:00 p.m.

1:00 p.m Education Session # 1 5:00 p.m. Program Chair - Col Annette Sobel, NMANG,MC

1:00 p.m. - Cardiovascular Disease and the Aviator1:45 p.m. Lt Col Quay Snyder, COANG, MC

1:45 p.m. - Evaluation of Orthopedic Injuries2:30 p.m. Col Harry Robinson, MNANG, MC

2:30 p.m.- Focus on Preventive Medicine: GI Screening2:45 p.m. Col Edith Mitchell, MOANG, MC

2:45 p.m. Break3:00 p.m.

3:00 p.m. - Controversies in Alternative Medical Therapy4:00 p.m. Lt Col Carol Ramsey, USAF, MC

Lt Col Chuck Fisher, USAF, MC

4:00 - p.m. Aerospace Medicine Lecture: Prevention of Communicable Illness in

5:00 p.m. Commercial Airlines: TB, A Case StudyDr Russell Rayman

9:00 a.m. Executive Planning Session - State Air Surgeons

12:00 p.m. Agenda to be distributed at time of meeting

5:00 p.m. State Air Surgeons Reception7:00 p.m. (Invitation Only)

MONDAY, 9 November 199812:00 p.m. - Air National Guard Awards Luncheon 1:30 p.m.

TUESDAY, 10 November 19981:00 p.m. Alliance of ANG/AFRES Flight Surgeons5: 00 p.m. Education Session #2

Program Chair - Col Annette Sobel, NMANG

1:00 p.m. Near Death Experience in Aviation2:00 p.m. Maj Gen James Whinnery, TXANG, MC

2:00 p.m. Spinal Injury Patterns in Aircrew2:45 p.m. Lt Col William Drew, USAF, MC

2:45 p. m. ENT Controversies in Aviation Medicine3:15 p. m. Col Douglas Holmes, UAAFR, MC

3:15 p.m. Assessment of Viral Hepatitides3:45 p.m. Col Milton Mutchnik, OHANG, MC

3:45 p.m. Break4:00 p.m.

4:00 p.m. Weaver Lecture: Perspectives of Aerospace Medicine

4:50 p.m. Maj Gen John Giller, USAFR, MC

4:50 p.m. Award Presentation5:00 p.m.

6:00 p.m. Alliance of ANG Flight Surgeons BanquetLocation to be announced

WEDNESDAY 11November 19981:00 p.m. Alliance of ANG Flight Surgeons5: 00 p.m. Education Session #3

Program Chair - Col Annette Sobel, NMANG, MC

1:00 p.m. Interactive Panel: LOD Determinations1:50 p.m. Col Peter Hochla, NMANG, MC

Col Edith Mitchell, MOANG, MCLt Col Carol Ramsey, USAF, MCCMSgt Peter Braun, NMANG

1:50 p.m. Trauma Prediction and Injury Management2:45 p.m. Lt Col Tony Rizzo

2:45 p. m. Break3:00 p. m.

3:00 p.m. The Evolving Structure of OOTW Medical Management

3:45 p.m. Brig Gen Donna Barbisch, USAFR, NCCol Annette Sobel, NMANG, MC

3:45 p.m. Break4:00 p.m.

4:00 p.m. Mirror Force Issues and the Guard and Reserves 5:00 p.m. Lieutenant General Charles H. Roadman II, USAF,

MC

AMSUS Alliance of ANGFS Schedule of Events


“In Time of Peace Prepare for War.” -George Washington

In my opinion the words of George Washington are intensely meaningful for the Nation and directly applicable to the Air National Guard Flight Surgeons (for that matter all flight surgeons). I have said this many times in terms of our primary wartime mission being accomplished in peacetime. The primary mission is the preparation of our warriors for war. It is the sum and substance of our medical readiness. For, if we have failed to ensure the health of our force, optimized their protection, expanded their performance envelope, and made the absolutely ready to fight and win, we could lose the war from the start. Our wartime clinical medicine skills may be for naught if our peacetime aeromedical skills falter. We make the assumption that there will be an extended conflict with numerous casualties so that we will need to employ our medical and surgical skills. Judging from the most recent conflicts, this is not the trend for the types of conflict we may experience in the future. This does not mean that we can abrogate our clinical medicine readiness duties, it simply means that we should understand what the medical order of battle actually is. The medical order of battle is aviation medicine first followed by the combat medicine (if necessary). When our aircrew deploy, our aviation medicine duties must have been accomplished. Only if we have failed to protect them adequately, only if we have failed to ensure their health, only if we have failed to optimize their ability to perform in combat will we be called upon to use our medical skills to mend them. If we fail in our aviation medicine duties, we will need to be prepared to use our clinical medical skills. The physical examinations we perform, the immunizations we administer, the safety briefings we give, the observations of our aircrew performance as we fly with them, the defense against biological, chemical and nuclear weapons we devise for them, the G-suits we develop, the oxygen masks we improve, and on and on. These are the aviation medical duties we perform

in time of peace. They must be adequate in time of war to ensure victory.

Now if this is our first order of battle, it is easy to see that I am afflicted by what Carl Builder has called the “Icarus Syndrome.” I, like the USAF/ANG leadership under which I was reared, have had a love affair with the airplane. I therefore came by it from experience and it is difficultto break. To survive and thrive in these rapidly changing times, however, may require an evolution in the theory underlying Air Guard medicine and its missions (including the order of battle to a certain extent). If one observes the active forces, both the line and medical service, there are hints about how we might position ourselves more effectively. First from the line of the USAF, General Ryan have put forth the Expeditionary Aerospace Force (EAF) concept. Many of the aspects of that concept indeed embrace the concepts we have previously advocated. These includes the call for a time-phased readiness mode of operations so we can do much more in the way of planning our lives and be more ready and finely tuned at the precise moment we are called upon to serve. Such a mode of operation will help our families, our civilian professional lives and our employers. A focused training cycle with fewer but key inspections tied to our actual deployment. I very much agree with these concepts. Now examine the rapidly evolving active duty medical service. Traditional clinical medicine is being outsourced at every juncture possible, with true “blue suit” medicine being the final bastion we can secure. The large medical centers and hospitals are disappearing or have disappeared. If a medical mission is not Air Force mission essential it is an endangered activity. I agree that this is the correct path to take. The large medical complex of “white suit” medicine that was built during the Cold War was an aberration and one we were essentially born with following World War II. Healthy aviators and

Searching for Air GuardMedical Airpower Theory

Maj Gen James E. WhinneryANG Aisstant, USAF Surgeon

General


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.


RAM blings 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 ShipleyMs. 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 hrsLocation: 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 registrationCost: $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.

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 protected] for details.



After reading the newsletter, I felt you may be a good source of information. I have been a flight doc in the ANG for 10 years and plan on going the full 20, plus. As you know, it is now an absolute prerequisitethat 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 100-110 hrs/week and have some type of call responsibility 3 out of 4 weekends per month. My free weekend I dedicate to the guard. My areas of responsibility have done well in inspections and I maintain my flying requirements without fail. Our pilots trust me. We already feel we have too little time to accomplish all of the training required in a large med squadron, even with 12 flight surgeons in our family.

Last year six of the docs attempted the War College in correspondence and in seminar. Within 6 months 5 dropped out due to the unrealistic expectations of the course, not to mention the unreal time requirements needed to do just an average job. The only doc to complete it was a physician who does not have a clinical practice and subsequently much more time available to do the work. This is going to be a problem guard-wide I suspect. If I cannot advance from here on out,my motivation to continue will be understandably less.

Maybe it's just sour grapes,but our active duty counterparts don't have private practices to worry about, much better time schedules, and can take the course in residence if they desire. Not much of a mirror force in my opinion.

I accomplish my PME every day at work. I am a leader at the hospital because my job demands it. No pilot has ever worked as hard,at any duration of time as I, or my associates, ever have. I understand the necessity for the PME and agree that it is important, but writing a thesis on the Israeli Air War or the Linebacker Campaigns is not going to help me lead a medical squadron. The flight surgeons in our squadron are very discouraged.

Do you know of others who have shared other experiences? I am sure we are not unique in this problem. There must be a solution. Otherwise, there will be a slow/steady attrition of an already scarce resource...quality flight docs.

Your thoughts, even brief ones, would be appreciated.

Sincerely,

Jim Balserak, MAJ, MC, SFS, AzANG (Tucson)e-mail: [email protected]

During AMSUS 1997, I had the opportunity to speak with fellow Flight Surgeons from around the country. Some of the conversations suggested a “less than optimal” relationship between the medical elements and the line officers. After returning home I discussed this with several of the aviators in the Wing. My impressions were confirmed by some of their stories from other units. I am not suggesting that all flying units have a poor relationship between the docs and the fliers, but it appears that we are not fully developing as good a relationship as is possible. We have all been asked many times “what is a flight surgeon?” After explaining we don’t actually operate in an airplane but we do get to fly in operational aircraft, the next question is “why?” Well, it is not just to fly. Part of our charter is to develop bonds with our aviators in hopes they will be willing to talk with us about physical, mental or social problems that have the potential to adversely affect their flying or their general well-being.

Many of us do have excellent relationships with our pilots. My belief is we should all have the opportunity to serve in a unit where the relationship is one of mutual respect and willingness to help the other perform his mission. I would like members of the AANGFS to consider a mentor program. Those of us who feel we have something to offer, can host recent graduates from the Aerospace Course one weekend. The visiting Flight Surgeon can interact with the local Flight Surgeons to get a feel for how they work and how they perceive their mission. In addition, the visitor can speak with the aviators of that unit and find out what a pilot wants in a Flight Surgeon. Hopefully, these discussions will give the new Flight Surgeon a bit of insight not always available in the academic setting.

The purpose of this discussion is not to point fingers at anyone; it is to promote the improvement of relationships between the medical elements and the aviator communities. I ask that you consider this and maybe we can discuss this at AMSUS 1998.

JR “Splash” Walters, Col, SFS, SCANG169 MDS/CCemail: [email protected]

LettersTo TheEditor




I am pleased to report that I attended a significant meeting at HQ/ACC. Following this summer's "Warfighter" CORONA , General Ryan detailed the groundbreaking work the four-stars had accomplished toward the development of our capabilities as an Expeditionary Aerospace Force. General Hawley (COMACC) immediately directed ACC staff to lead the Air Expeditionary Force implementation planning effort. In response General Schafer (ACC/SG) organized a meeting of the Combat Air Forces surgeons which was held at Langley AFB the second week in September. This was the first meeting of the CAF/SGs in over five years. What brought the command surgeons together was a formidable agenda which included a review of current theater medical CONOPS, development of expeditionary medical support capability, theater surveillance, medical technology insertion/development, and Aerospace Medical initiatives. These subjects and others were briefed and discussed by the seven. What is significant to you and me is that the ANG/SG, Col Dougherty, was one of them. Klaus Schafer is on target. He automatically includes the Guard and Reserve in all

major planning events. It is obvious to him that as the Air Force changes its way of life it will be impossible to organize and manage the future without us. With our deployment to Prince Sultan AB, and before, the Guard has proven it can do real missions. We will be at the table to insure the active component includes the ANG Medical Service in ways that maximize our unique strengths as citizen-airmen.

Two other significant points came from the conference that might interest you. First, the active duty Air Force is having flight surgeon recruiting and retention problems, too. They are currently staffed at 72% of authorized strength, and hurting. Second, this winter's Form, Fit, Function Follow-on (F-4) will be at Nellis AFB, NV. It will exercise and test the functional capability of the modernized ATH and specialty sets. It will be a Total Force event with ANG UTCs participating. The exercise will be several weeks in length and will be managed by a cadre of 26 personnel. Col Mike Hayek, MOANG, has been tapped by General Schafer to lead the cadre. The Mirror Force strategy is working.

Keep the faith. See you at AMSUS.

ACC/SG AssistantReports

Brig General Dennis A. HigdonANG Assistant to ACC/SG

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


Article 1 of 422, Article ID: 9808020219Published on 08/02/98, THE STATE SKILLED MILITARY WORKERS FLEEING FOR PRIVATE SECTORTHE LURE OF MORE MONEY, FAMILY-FRIENDLY LIFE THREATENSAMERICA'S VOLUNTEER FORCE In the Air Force, and increasingly in the other services, people with technical skills are departing at an alarming rate into a booming civilian economy. Some policy experts think the numbers herald the biggest threat to the all-volunteer military since its creation 25 years ago - an unprecedented exodus of skilled workers. Article 2 of 422, Article ID: 9808020224Published on 08/02/98, THE STATE EXODUS LEAVES FORCES WITH FLEDGLING PILOTS The Air Force and other services might be able to replace hundreds of pilots who are leaving the military. But they can't give new pilots the experiences gained from years of flying.

The same is true for other high-tech jobs where military people are increasingly leaving in midcareer.

Article 3 of 422, Article ID: 9808020225Published on 08/02/98, THE STATE HIGHEST BIDDER WOOS AWAY 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, the 24-year-old computer database specialist will more than double his income of $21,000 when he joins the private sector after four years in the service.

Media Reports on MilitaryRetention and Recruiting

(The following summaries are from articles in the Columbia, SC, State newspaper:)

Two Cents from the Editor…

There's really not much to add to all of the excellent articles in this edition of the Newsletter. Besides, I found I had no room left to write an editorial of substance. Tune in to the Alliance Home Page at www.telalink.net/~flitedoc and to the ANG/SG Home Page at www.ang.af.mil/sg for lots of good poop.

Aviation Medical Examiners:A good web site for you to visit is www.virtualfls.com (This is a site maintained for commercial pilots which provides medical advice regarding aeromedical conditions and questions.

http://www.ang.af.mil/sg

http://www.telalink.net/~flitedoc

http://www.virtualfls.com/


Preparing for Weapons of Mass Destruction (WMD) Medical Consequence ManagementCOL 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.

Col Gerald E. Harmon, CFS, SCANG1075 N. Fraser StreetGeorgetown SC 29440

· web viewcontinued from page 2… page 12 aangfs newsletter fall 1998. in this issue…...

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