Conversations

This is a place to congratulate, share conversations, sage advice, “chew the fat” and joust with good natured repartee, with the most recent comments first.

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Below are thoughtful comments and discussions which may prove instructive.  (Names  and phone numbers have been sometimes been redacted, if necessary to protect privacy, otherwise we do like to know who is commenting—WWP.

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Here is a great article from Eric “Beeper” Kendle:

Surfing at Water Survival…, New Leash on Life

Beeper with Manly Sized Board

It was a warm summer evening in June. I was catching some waves in the shorebreak off the beach of the Navy Lodge at Coronado Island. The waves were quick, a little steep but easy to get on due to the shallow water. Most of that day had been spent in the water. That’s why they called it water survival training. We practiced swimming and floating, finding our way out of parachute entanglements, donning and doffing flight gear, harnesses and parachutes all to be familiar with the techniques required to survive and be rescued from a water bailout or landing. We were a group of National Guard  F-16 pilots and Flight Docs accomplishing our annual water survival training. This also involved getting hooked to a coast guard or Navy chopper and being hoisted out of the water, which is one of the most disorienting experiences ever. Imagine being in the sea then intentionally swimming under a painful rotor wash that feels like sleet hitting hard all over your body then  looking up at the source of all that forced air and water knowing that if it fails, the whole thing falls on you. Then finding the tether, locking the hook onto your own gear and being violently hoisted out of the water up into that churning turbulence that keeps the chopper hovering above you.

 

Beeper Surfer

It was now post training playtime. Most of us were grilling out, cooking, eating or enjoying a beer with friends and family. I was working up a powerful hunger while honing my newbie surfing skills. Catching those easy waves seemed so easy.  I was thoroughly enjoying myself. I was by no means a good surfer but Surfing was one of the unexpected benefits of being a Citizen Airman in the Air National Guard. We often flew to Hawaii or San Diego to participate in flight training with other Squadrons. Dissimilar aircraft training (including dogfighting with other aircraft ) was a part of staying sharp. In my downtime over the years to these coastal locales I had taken up surfing. Not bad for a 40 year old man from the landlocked state of Arizona. So it was that I caught a steep wave, and came off my board that fateful evening in June. I remember the wave clearly getting steeper than I expected, I then took a half step back on my beautiful white and blue, 9ft Stewart longboard  when I realized I had departed controlled flight. I then did what I had been trained to do, kick the board away and land flat on my back to recover. This time the force of the wave somehow negated my backward motion and moved me toward the board impaling me on the fin of my board that was jammed into the sand nose first, fins facing up. I remember feeling some pain and the initial shock of my momentum stopping violently. It was almost surreal as I watched my arms pull the board out of my body only to note immediately that red stuff spurting out of my right thigh was my blood and it was pumping out quite forcefully!  Wow that looks arterial I thought, somewhat bemused by it all. Good thing I know what to do with that, or I could be Shark fodder. As an Air Force Flight Doc and Trauma Surgeon with 2 recent tours in Iraq my next move was to quickly put pressure on my femoral artery at the level of my inguinal crease. This is the shortest distance between the skin and the artery itself In most athletic individuals. I did that instinctively. No visible effect was seen on the arterial flow. I instantly knew it was a large artery possibly the main Superficial Femoral artery which could exsanguinate me very quickly without proper control. (A lethal event by the way. )The inability to control it with femoral pressure meant it was large and had great collateral flow.  All were good things, but not at this moment. My next thought was, I need to get out of this water. On the shore I can get help, better leverage and power on this groin pressure and if I pass out at least I won’t drown. Besides, there are sharks out here and they can pick up the scent of blood at one parts per million from up to a quarter mile away. So I quickly waded the remaining 30 yards to the beach then once on dry land I tried the manual pressure maneuver again. No effect! Alright this is getting real. Time to Trauma surgeon up…, on myself.  Alright.   About this time my now ex-wife came upon me and said, what’s wrong? I remember being concerned that she not panic and if for some reason I did not make it I did not want my last words with her to sound angry. So I smiled, as I said. Sweetheart I’ve been impaled by my board. I need you to run and get some help. The guys are over there. ( I pointed)  If ,I am not conscious when you return. I need a tourniquet on my leg and transport to a Level 1 trauma center. I smiled again as I said,  I Love You. She ran off and I realized I had one really great asset. My surfboard leash !! Yesssss!!!  my own attached tourniquet! There is a God. I quickly detached the leash, double wrapped it around my upper thigh at just below the inguinal crease and tied it as quickly and tightly as I could. My very own lifesaving tourniquet. The bleeding slowed. Thanks God.   Really…., Thank You. .

Beeper Sees his Life Flashback Before Him

I recall thinking as I tied the tourniquet around my right leg. I could be saying goodbye to my leg. I also thought yeah, but if you don’t, you just as well may die. So better to take my chances with the leg. About this time a middle aged man a bit younger than me came upon me and asked if I was alright? He looked at my tourniquet and said. You should really take that thing off. They might have to amputate your leg. I smiled a knowing smile as he said “I’m an EMT. ” I replied my friend, I am a trauma surgeon, the tourniquet stays, but if you want to help, I could use a stick and some pressure right here to control the back bleeding. (From those collaterals). He complied, handed me the stick, applied the pressure distally while I used the stick to make a prop that allowed me to tighten the femoral portion of the tourniquet even more. By the time the Bros (my squadron mate, pilot buddies arrived, the bleeding was well under control. They called the ambulance, used my board as a stretcher as they litter carried me off the beach to the parking lot and the soon to be arriving ambulance. Thank You, Viper pilots of the Arizona Air Guard.

Later that evening one of my colleagues the Chief of Trauma at UCSD Dr. Raul Coimbra saved my life definitively, by exploring my injury tying off the severed vessel and leaving me with a very cool scar on my leg. Life is good. Truly.

Beeper out.

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Responses to Beeper’s article have been witty and prompt—a portion of which repartee is shared below—WWP.

B….. Friends, for a little light hearted reading about our friend and previous Alliance President Eric Kendle, take a look at this…..

F…. Beeper’s article and his new “leash” on life, literally. When did this impalement happen? Recently? Or was this a recount of a long-ago event?….

B….. I am not sure when Beeper’s alleged incident occurred, but it sounds like it was a while ago. Of course, knowing flight docs and their penchant for exaggeration, maybe he was only bitten by a goldfish.

F…”Impaled” by surfboard fin?!   Ripped it out of his flesh, like He-Man, and without any hesitation, whatsoever?!

“Dashed 30 yards against crashing waves, while his “SFA” spurted arterial blood?!

And still had enough blood in his powerful, athletically fit, “just hoisted up violently by rescue helo during water survival training moments ago” incomparable body, to say “I love you” to his then (now-ex) wife, even after he had colored the ocean red?!

Did you notice he was quite proud of all the “collaterals” he had?!

And I always thought you only get collaterals if you had a “sickly” main artery.

All kidding aside, and being serious for a moment, Yes, Beeper was quite injured, and he saved himself by his quick mind, decisive action; and I/we are very glad he lived to tell his tale.

Thank you for printing such “GeeWhiz, there I was, and …..” stories, even if the “victim” and “hero” were one and the same, and in the first person.
Oh, ok, you may post it, but please include the part where I give him “credit” and say how happy/glad I/we are that he punched death in the nose and came out on top.

And please do not use my name, just sign it “a fellow flight surgeon and admirer”

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Kudos and appreciation from LtGen Ediger after the AANGFS Dinner.

“Thanks for the opportunity to attend last night.  The ANG has an amazing aerospace medicine team and I always enjoy the interaction.  I especially enjoyed hearing Gen Rice’s words for this group!”

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Medical Conditions Must be Reported to Medical Group in Timely Fashion

With the Authorized Use of Force Policy, the MDG must report potentially limiting conditions to the commander.  This can only be accomplished if the medication condition and/or medication are known by MDG.  This is done by the member’s self reporting.  Thanks to RJL for this timely, succinct note–WWP

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The AFI does not make it the responsibility of the MDG to be aware of the member’s health 24/7. The AFI clearly states this is the responsibility of the member’s unit commander (31-117, 4.2.1). I think this is a responsibility that we keep placing on ourselves then blame active duty for the self-flogging.

 There are examples through several AFI’s which delineate the service member’s responsibility (regardless of requirement to carry a firearm) to notify medical of a change in health within 72hrs. The problem is that the member’s unit commander don’t hold the member responsible. Hopefully, you will at least get some traction with the SF/CC.

 AFI10-203 15 JANUARY 2013

2.18. Airman.

2.18.1. The Airman must report any new medical condition, medical conditions that potentially affect deployability, or any change in medical status, to the appropriate medical provider at the time of onset. The Airman must also report all medical/dental treatment obtained through civilian sources to the appropriate military medical authority IAW AFI 41-210. See AFI 48-123 for additional guidance regarding ARC Airmen.

2.18.2. The Airman must meet scheduled medical appointments as directed and inform unit supervisor of required follow-up evaluations and appointments.

2.18.3. The Airman must make all attempts to resolve medical conditions in a timely manner. This includes, but is not limited to, attendance at all appointments, active participation in rehabilitation, and using medications as prescribed by their health care provider. Failure to meet this requirement as determined by an appropriate medical authority and the Airman’s Commander may result in MEB and resultant administrative separation from the AF, without medical disability compensation. See AFI 48-123 for additional guidance regarding ARC Airmen.

2.18.4. Upon receiving an AF Form 469 from a healthcare provider with FR or FAE, the Airman will immediately notify his/her UFPM who will in turn notify the installation EP (or ARC MLO) of the Airman’s restrictions and possible need for an exercise prescription (see paragraph 3.2.1.3. of this Instruction for guidance on exercise prescriptions). UFPM notification to the installation EP (or ARC MLO) follows locally developed processes.

 

AFI48-123 5 NOVEMBER 2013

2.12. Member. Meets scheduled medical appointments as directed. (T-2) Member should inform unit supervisor of required follow-up evaluations and appointments. Reports and submits all medical/dental treatment obtained through civilian sources and any medical condition that might impact utilization and readiness of personnel to the assigned Primary Care Element team or ARC medical unit. (T-1) See Chapter 10 for additional guidance regarding ARC members.

10.4. Responsibilities.

10.4.1. Commander or Supervisor. Each ARC commander or active force supervisor ensures an ARC member is medically qualified for WWD. Each commander and supervisor notifies the servicing medical facility when he/she becomes aware of any changes in an ARC member’s medical status.

10.4.2. ARC Member. Each ARC member is responsible for promptly (within 72hrs) reporting an illness, injury, disease, operative procedure or hospitalization not previously reported to his or her commander or supervisor, and supporting medical facility personnel IAW AFI 36-2910. Any concealment or claim of disability made with the intent to defraud the government results in possible legal action and possible discharge from the ARC.

  I hope this helps your units better educate their Wing,

 JRL 

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Aeromedical Evacuation Effect on Brain Injury Patients

Thanks to Col Mark “Kahuna” Auer for bringing this one to our attention because it is a topic of vital interest for our injured troops and  those who transport them.  The sensational Military Times headlines is certainly concerning “Injured warriors TBI may worsen with rapid air evacuations,”  though it is extrapolated form  a rat brain injury model study, Simulated Aeromedical Evacuation Exacerbates Experimental Brain Injury.  Although the applicability to current  practice is not delineated, it does raise interesting concerns regarding altitude, oxygen supplementation, altitude restrictions and timing of aeromedical evacuation–WWP

The rat model study concludes, “The present study demonstrates that hypobaric exposure (HB) during simulated air transport following traumatic brain injury (TBI) exacerbates neuroinflammatory secondary injury mechanisms, leading to
increased deficits in learning and memory, as well as hippocampal neuronal cell loss. The
present studies suggest possibilities for mitigating injury exacerbations by HB exposure
following TBI, including retaining patients at in-theater hospitals for longer periods prior
to transport; delaying the second aeromedical evacuation (AE); increasing cabin pressurization to reduce barometric effects or specialized enclosures for individual pressurization; and/or changes to the supplemental oxygenation protocols.”

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Flight Surgeon Flying Requirements and Flight Pay.

Thanks and kudos to Maj Ludtke, Col McPherson & TSgt Burns for chiming in on this enlightening discussion below which starts with the waiver 2016 Waiver for USAF FS Primary Aircraft Sortie Requirements, and then follows with a clarification of flying requirements.  The waiver applies for USAF flight surgeons, including those in theater (thanks to Col Wyrick, wishing you Godspeed in your endeavors).—WWP

Subject: 2016 Waiver for USAF FS Primary Aircraft Sortie Requirements
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Please see attached waiver extending waiver of USAF flight surgeons to perform
50% of flight requirements in primary aircraft.

Merry Christmas,
J. Rick Ludtke, Maj, USAF, MC, FS

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Rick,

The waiver applies to “USAF” flight surgeons but does not specifically mention
ANG. Our flying requirements for pay are different, but it specifies 4 hours a
month. My concern is that, if I show this waiver to Ops they will get confused
and likely dock me flight pay. Is there any way to have something specifically
for ANG flight surgeons that won’t confuse the issue? I, thankfully, have been
able to log all my hours, but not all of my docs have. I do, sometimes, have
difficulty getting enough sorties, however.

Scott

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Scott,

I guess I’m not sure that I understand yet how this waiver could dock you
flight pay, unless your SARM is doing something wrong.

The flying requirements to be eligible for flight pay are the same for all Air
Force flight surgeons, regardless of component. All flight surgeons are
required to obtain 4 hours flight time per month to be eligible.

This waiver is trying to address the issue where a FS is unable to meet the
“50% of requirements must be accomplished in primary aircraft” requirement.
This is most commonly an SME attached to an F-22, F-35, A-10, RPA or similar
unit where the only possibility to fly is “other than the primary assigned
aircraft”. This same waiver has been issued annually for the last several
years and is only being extended yet another year.

Rick

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Bill,

Is this correct? I thought ANG FS only needed 2 hours a month for flight pay.
That is the standard the Harm follows.

Scott

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Scott,

Some clarification would benefit the prior statement:
“The flying requirements to be eligible for flight pay are the same for all
Air Force flight surgeons, regardless of component. All flight surgeons are
required to obtain 4 hours flight time per month to be eligible. ”

1) Active Duty, Guard and Reserve flight surgeons are required to log 4 hours
per month when serving on active duty, e.g. when I, a Guardsman, was called to
Active Duty to serve on the Accident Board in August, I was required to log 4
hours of flight time per month.
2) However, Guard and Reserve without any Active Duty Time during the month
are required to log 2 hours per month.
* Some might argue that this is unfair for the Guardsman to receive
flight pay for 2 hours while the Active Duty is required 4 hours.
* However, Guardsmen do not receive flight pay for the entire
month–rather the flight pay is prorated for the number of duty days.
*This means that the Guardsman is required to log less time during a
month, but he/she is actually required to log more time per actual duty day
served.
*Since the flight pay is prorated, the Guard flight surgeon is actually
paid much less flight pay per day of duty.
**Active Duty flies 4 hours and receives flight pay for 30 days of
duty
**Whereas the Guardsman must fly 2 hours in a month and receive
flight pay for 3 days of duty (2 UTA days plus 1 day flying)

Thanks,
Bill
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Kandice,
Please let me know if the following response is factually accurate.
Doc Pond
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Col Pond,
All is accurate except for your first bullet. Even though you were on Active
Duty (title 10) orders, you were only on those orders for 20 days in August
and 5 days in September. Your flight hour requirements for August and
September was not 4.0 hours for each month, it was 2.7 Active duty hours and
0.7 hours of inactive duty needed in August. In September it was 0.7 hours of
Active duty and 1.7 of inactive duty hours needed. Attached is the DoD FMR Vol
7A Chapter 22 table 22-3, which shows how we figure out how much
active/inactive time is needed for each month. Please let me know if you have
any questions Sir. Merry Christmas.

V/r
Kandice “Kandi” N. Burns, TSgt

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TSgt Burns,

Thanks for keeping me honest.

I am glad you can keep track of and explain the intricate details of the process.

Merry Christmas.

Doc

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Thanks, Bill.  This is how I understood it, but I couldn’t recall a place to go to confirm it.  I knew you would have that info.
Scott

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A Little Good Natured Fighter Humor from Dean Winslow–
Good to hear from you & thanks for the chuckle, WWP
(Anyone need a gently used F-4?)

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Bill,

Not sure if you ever got in on the F-4 era.  (I have about 50 hours in the back seat of the Phantom– we had them in New Orleans until we got the Eagle in 1985…)  Anyway, see link below to funny video sent to me recently by Christina Olds (daughter of the legendary Brig Gen Robin Olds).  Hope you’re doing well.

(Unfortunately, the video is no longer available.)

Best,

Dean

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Thanks from MajGen Dunkelberger:
Bill,
MG D wishes to thank AANGFS.
Will you plz post her thank you (see copy and paste below) to the website?
Thanks.
fy
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Frank,
I would be happy to do so.  It was certainly a please and honor to have her in attendance.
Bill
+++++++++++++++++++++++
Excerpt from MG Dunkelberger’s email:
“Please pass on to the AANGFS my sincere appreciation for hosting LtGen Ediger and me for dinner this evening.  It was a lovely event, and we both really enjoyed ourselves.  I think the entire day was awesome.  Thank you for inviting me.”
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ANG Secure Medical Document Transfer

This conversation below highlights the need for a Guard friendly method of secure document transfer (read from the bottom up to get the chronological sense:

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Trying to get some push behind it. It is killing me as a CC also!
-Lisa

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Col Snyder.

Very eloquently said.

Bill

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Col Pond,

We are as frustrated as you are about the requirements that have restricted our ability to carry out off base communications with you and others. We thank you for taking care of these quickly. It is unfortunate that we carry out business by snail mail in an age of electronics, but we are bound by the regulations that are placed upon us and can, and will, continue to seek other solutions from those in control of these restrictions.

Thanks!

V/R

SWAT

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Chief

Thank you. I will take care of them within 24 hours of receipt.
What is the address to which the package was sent?
Do you have any thoughts on a less cumbersome way to transmit documents?
(In the private sector, password protection of the document with
encrypted transmission is approved for medical documents.

Thanks,

Doc

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Sir,

These have been sent by Fed Ex yesterday and you should receive them today.
We need to have them reviewed and your approval and/or disapproval
returned to us NLT Tuesday, 21 Jul 2015, via fax 812-877-5405.
There are other agencies on base that require the short suspense.
Please let me know if you have any questions or concerns. MSgt
Simmons is TDY this week, on leave next week, and TDY the following week. MSgt Carr is on leave next week as

Thank you

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April

I have been at Hoosier Youth Challenge this weekend, so I did not
have access to military email.  Although I can access military email
via the secure CAC card, CAC enabled webmail does not allow email
attachments to be downloaded to non-military addresses. I will be
happy to download the documents the next time I have access to an
ANG military computer which may be several week
Of interest, I was at Grissom ARB on Friday, but the military AF
computer system does not recognize the domain on the CAC card, so I
cannot get email at an Air Force military computer that is not a
Guard computer. Also note that Air Guard SharePoint is not
accessible from an Air Force military computer system.
If a quicker reply is desired, please send the documents to me by US
mail or by fax. (If the documents are large, remember that my fax
machine only has a 50 page reservoir)
I wonder, since you can upload documents for AIMWTS patients and I
can download them with a CAC card enabled computer, would it be
possible to create a patient named “test” and then upload and
download the documents in the “test” patient account. This would
meet the AF security requirements and then allow me to access the
documents from a secure, encrypted, CAC protected non-military
computer. It would simply be necessary that you notify me that the documents were there.

Thanks

Doc

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Subject: AGR, Transfers, and commissioning packages

Col Pond,

I have sent you multiple AGR, Commissioning and transfer
packages to your military email. I will be gone TDY for the next
three weeks and I leave at noon tomorrow. If you are able would you
please sign these and have them scanned to me tomorrow? If you are
not able to get them to me by noon would you please have them
scanned and sent to MSgt Carr. I appreciate all your help!

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Flight Surgeon Upgrade Training:

The Air Force instituted a drastic change to Flight Surgeon Upgrade Training several years ago and naturally hid it in the one place that none of us would find it… in the newly published AFI 48-149, Flight and Operational Medicine Program (the old SME regulation).

So what is the change? Flight surgeons actually have to get documented training before being upgraded to a 3-level. In fact, a flight surgeon isn’t supposed to be deployed until upgraded to a 3-level. My first reaction was “great, more stuff to do”… but to be honest, after looking at it, it really does make sense (shocking, I know). The numbers are reasonable, no more than 5 of a particular item and the requirements only cover the actual responsibilities of a flight surgeon on drill status. There’s nothing exotic here that only active duty can perform. To me, this is simply a formalization of what should already be happening at the local units… which means it was obvious to the powers above us that even the most basic training of flight surgeons wasn’t happening.

Upon graduation of AMP, a flight surgeon is awarded a 1-level (48X1). The local unit then provides the OJT to train and supervise the FS in actual performance of their duties (flight physicals, shop visits, writing an AMS, and actually flying). Upon completing all of the requirements, the AFI requires the MAJCOM to have oversight and approval authority before the flight surgeon is upgraded to a 3-level (48X3), so our office developed a checklist (Blank template for 48X3 Upgrade Training) a while ago and discussed it in the Heads-Up months ago to try and make it easy for units to request permission to upgrade a flight surgeon.

Remember, most all regulations are written in blood which means there had to be a long pattern of problems before someone considered it worth their time to write another regulation. Going all the way back to the first Desert Shield/Storm in the early 90s, there has been a huge problem with units deploying brand new flight surgeons to support the war without any seasoning training and there has been a problem with these brand new flight surgeons screwing up paperwork and causing pilots/aircrew to be grounded and out of the fight. Remember, most all of our deployed locations have only one or two flight surgeons assigned so there’s little ability There’s also been a big problem with flight surgeons not having previous flight experience and expecting to get tons of flight time while deployed but not understanding the military aviation community… so much of a problem that Operations Group Commanders have made several requests for permission to ground flight surgeons throughout CENTCOM. During my own deployment in 2011, a memorandum was circulated throughout the AOR reminding flight surgeons and ops group commanders why docs should be flying.

The past few months, several guard and active duty flight surgeons were deployed to CENTCOM without appropriately documented upgrade training. They’ve been grounded, denied the ability to fly and threatened to be sent home. My office has engaged to support the guard doc involved but this has caused a lot of unnecessary work for us and the local unit.

We as flight docs need to take this more serious and provide better training to the docs we recruit. We have to remember that we are sending people to war. At the Aerospace Medicine Conference a few weeks ago, it was explained that the Department of Defense has been fighting to remove flight pay from flight surgeons. We as flight docs have been making it look easy because we’re not training the new docs as to why aerospace medicine is a specialty in itself and the line officers have finally agreed that it’s so easy that we shouldn’t be flying.

We as the aerospace medicine community need to re-evaluate our perspective and the reasons why we’ve been trained as flight surgeons and take our responsibilities serious before they’re taken away. The fight is real and it’s on our doorstep. We need to be proactive about it now.

Please pass this on to your leadership and local flight surgeons.

Apologies for the wall of text,

Maj RL

(Thanks for the excellent commentary–WWP)

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Medical Treatment while on Title 32 Status:

In the past several months, we’ve been discussing the legal issues regarding providing medical treatment while on Title 32 status for various reasons, such as real world medical support of an exercise or civilian event. Several units had contacted me individually, each saying that the Army National Guard was able to provide this to their own and both the unit and their ARNG counterpart couldn’t understand why we were different.

Well, we happened to have a discussion with the Army National Guard Chief Surgeon last week, Col Mxxx who explained that the ARNG policy is the same as our own. He sent me the instructional policy published in 2013 which states that a member is not authorized to receive medical care unless they’re eligible for Tricare benefits (on orders for 30 days or more, or sustain an injury in the line of duty) and a healthcare provider cannot provide medical care unless privileged to do such at an active duty medical treatment facility. This means they’re not authorized to provide real world support either.

So I just wanted to give everyone real ammo to defend yourselves if you hear this from an ARNG unit again.  Maj RL

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Individual Medical Readiness (IMR) Statistics—USAF

” I understand everyone’s concern with the IMR stats, but when reviewing most units the largest number of 469s are related to code 31s and 37s (those being evaluated for and those undergoing DES processing).  It is important that we “follow the book” in identifying those members with potentially disqualifying or unfitting conditions for a number of reasons.  First we don’t want to “blow off” a diagnosis that if the member were to deploy would put them or the mission at risk.  Secondly, the COCOM/SG wants visibility of those members coming into their AOR to determine whether they can care for them or if it will increase the risk of requiring AE out of theater.  The 469/ALC process is used to identify members that require evaluation to deploy, but doesn’t necessarily mean they can’t deploy (especially for ALC-C1s).  We have discussed with AFMSA and AFMOA the possibility of not counting ALC-C1s against IMR numbers since most end up being able to deploy; however, since the decision belongs to the COCOM/SG (and every COCOM is different) they are not willing to change.

BL:  Try to get your DAWGs to really manage the AAC 31s and 37s.  Work with NGB/SGPM to keep the “ghosts” from counting against your flu (doesn’t work for the other immunizations).  Work with your Wing and Group/CCs to keep the rest of your IMR stats as minimal as possible.

We are in the process of developing a balanced scorecard/report card that looks at more than IMR…(i.e. Drug Demand Reduction testing rates, MRO overdue cases, ARTS/SORTS/DRRS, DOEHRS input, etc.) and weighting each to develop a MDG Score.  So that will take some of the pressure off of the 469s, but will mean that you have more than IMR to keep an eye on.  We met with BG Taheri last week and were able to get an UNFUNDED authorization for a full time medical provider at each of the GMUs.  The PDs are at NGB-J1TN for classification (I have no idea how long that will take), but you MDG/CCs need to engage with your Wing leadership and impress upon them the advantage of having a FT provider (most likely a mid-level) who can do a lot of the case management for your AAC 31 and 37s and work to get folks off 469s and back on the job.  I think they can pay for themselves based on reducing the amount of time folks are not available to work.  The ARC-CMD showed a 40% reduction in MEDCON days by actively managing cases (either returned to duty or processed into the DES).

V/r,

CXXX

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Dxxx,

IMR is really a Commander’s program.  It takes commanders holding people accountable for their “Individual” Medical requirements.  I think it really takes the MDG/CC and the SAS educating Wing and JFHQ leadership on the program.  It tends to be viewed as a medical issue, but really we provide the service…it is up to the member and their commander to ensure the program is successful.  Ultimately, the deployability of the unit (or at least the specific UTC) is dependent on all of the requirements being met.  That’s probably why there are no great ideas to solve this…it requires compliance and not a work around.

V/r,

Cxxx

———————

Cxxx

Thanks for the email. I appreciate your work on this.

I certainly understand the DLC/ALC process as I was recently deployed with my squadron and we were just at an EMEDS-basic with ER/hospital care more than an hour away.

As we have noticed, no one has given any great ideas to keep the other IMR stats up other than, as you noted, to work with the Wing/Groups to make sure everyone meet their requirements.

Thanks for the nuggets up re the possibility of full time provider at the GMUs.

v/r

Dxxx

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Subject: RE: Question: IMR Stats

All,

I agree the key is to focus on what is actionable versus hard broke. The National statistics per the cut/paste below show all of us having various degrees of profiles. I agree with Mike’s comments that commanders are essentially assuming the risk for their troops (and our collective IMR rates) when they recommend to retain. I also agree that we should not compromise with any leniency. The broken toys have an amazing way of finding another base for a PCS or causing more trouble at home if you don’t nip some of these things in the bud.

If anything, it is worthy to note that HHQ acknowledges both the reasons for high profile rates (OSA, PT testing, etc.) and the evaluation criteria/limfacs that tie our hands (Dental Class III, repetitive profile riders, etc.). (See comments in the center.)

Never miss a shot!

XXXXXXX

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Subject: RE: Question: IMR Stats

Bxxx, We, at Sxxxxx, are in a similar position.  We have pondered this quite a bit for quite some time with little avail.  We are a 1600 member wing.  We have about 8 full time AGR staff and 15 providers.  We have plenty of staff to see patients and complete packages efficiently but it doesn’t seem to matter.  We are at 88% in DCL’s and in the ninety range for all other categories with an overall rate of 73%.

In addressing #2 below, I think that the population is the same across the guard.  I would suspect that your members are similar to others in regard to recovering.  I do believe that the ALC codes are a problem.  We now have about 50 plus members on ALC codes and the number is growing every year.  It appears that the commanders want to retain their members even though they count against their IMR stats.  I think that part of the decision making process is that some of them have not reached the ability to retire and they would like to get the member past 20 years.  Also, many of the members are AGR or technicians and the commanders  don’t want to affect their full time employment if they have other options.  In addition, I think that most commanders are going to choose to retain someone despite them counting against their stats vs non-retaining members that often have years of corporate knowledge and that they have worked with and most likely befriended over 20 plus years. We have tirelessly tried to educate the wing in regard to this problem with little avail.  As far as ‘submitting more waivers’,  we also feel as though this could be why there are discrepancies between units.  We follow the book in regard to waivers and profiling and this may be working against us.  However, I am not willing to compromise in this area as I don’t think it would be ethical.  Unfortunately, I don’t have a great solution but also don’t think we should be more “lenient” or to “let things slide”.

In regard to ‘getting members to comply’, we have tried to rally the commanders at the wing meetings and this has helped to a certain degree.  I agree that this is very difficult problem and we are finding significant frustration as well.  I would certainly be open to hear if someone else has some best practice advice.

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ALCON

I have been thinking of IMR stats and have a few questions for you all. I realize I am airing “dirty laundry” by attaching our most recent IMR stats but would like your advice and I think the best way is to show you the numbers.

BLUF: I would like to know if any of you have higher %ages in each category than I have? If you do, how do you manage to do it?

My biggest concern are DLCs. There seems to be significant variability between units as to percent DLC/ALCs which results in the inability to actually affect the overall IMR stats.

A few thoughts:

1.) The xxxd’s overall IMR rate is low because 300+ have been deployed and we  weren’t able to send all of our DLC/ALC members with the 300. So instead of 67 DLC/ALC’s being compared to an adjusted population of 900+, it’s now being compared to and adjusted population of 561.

Notice that the xxx Maintenance GP has a AdjPop of 11 with 4 DLCs (no other deficiencies) so their total is only 63.6%.

2.) Our DLC/ALC %age is one the highest in the Guard. This means that either….

a.) our member population is much sicker or more injured than other Wings

b.) our members take longer to recover and come off DLCs

c.) our commanders are not discharging members with ALC codes or

d.) the MDG is submitting more waivers than other groups, more waivers than we need to

3.) Do you all have any suggestions as to how to get members to get their immunizations, dental, and WebHA’s completed?

4.) Maybe the xxxd MDG should not be submitting as many waivers? Could the xxxMDG providers be to “by the book and maybe we should be more “lenient” in interpreting the medical regs and we should be letting problems/issues”slide?” Maybe we should not submit waivers if we are expecting that some will be retiring within the next few years? Maybe we can justify not submitting waivers for other reasons?

Thoughts?

xxxx

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Col Pond,

Great program yesterday.  I am attaching a “Safety” brief that was a topic that came up in my squadron this year.  Cancer in the aviator.

I have the reference links in the notes sections.  Feel free to post as you feel appropriate.  I was able to give this in ~ 7 minutes.  A little longer than a fighter crowd would follow but the C-130 guys were a great and interested crowd.

Cheers,

JC

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John,

Thanks, I appreciate your willingness to share.  Your briefing has been posted to the Flight Safety Briefings.

Bill

One Response to Conversations

  1. Col William Rogers, Jr. says:

    I want to make sure that all of you are aware that when I leave Ramstein on
    August 16th with my team we will be leaving for good. The Air Force has decided
    to down size the CCATT foot print here (a logical decision concerning the much
    reduced demand) by closing the guard deployment leaving three active duty teams
    here(a not logical decision) this will have four major impacts on the
    Guard:

    1) We have a very important domestic mission with CCATT, when the next
    Katrina happens our 16 Guard CCATT teams have to be ready to deploy immediately
    to evacuate critical care patients from ICUs at damaged hospitals. The Katrina
    experience should not be forgotten, we just have to do better next time.

    2)
    CCATT teams have to revalidate at CSTARS every 24 months to remain deployable.
    CSTARS wont accept a CCATT member for revalidation unless she has a hard
    tasking. No more hard taskings for guard team members now that Ramstein is done
    so guess what? In 24 months no Guard CCATT team will be deployable, when the
    next Katrina happens is the plan to fly all the Guard teams to Cincinnati to
    revalidate for fourteen days then evacuate the ICUs?

    3) Impact on
    recruiting, we have the best clinicians in the Air Force, we work in busy places
    using cutting edge medical therapies. These are the docs nurses and RTs you want
    taking care of sick patients. Do we think they will join the guard to do CCATT
    knowing that the only clinicians deploying are the active duty? Newly recruited
    guard CCATT clinicians have the clinical stuff down when they join the Guard, to
    be effective as CCATT all they need is a chance to do a few real world missions,
    do the mission planning and logistical stuff and they are ready, their medicine
    (which is the important part of the CCATT job) is already rock solid and will
    remain so because they continue to work in busy civilian hospitals.

    4) impact on the active duty. This is my fifth time at Ramstein, I think every active duty person doing CCATT will admit that their clinical skills atrophy here now that the tempo is down, frankly even when we were busy this was no way to stay clinically broadly competent. You should almost never have to intubate as a CCATT doc, central lines in flight? And the list goes on. The active duty have a challenge remaining clinically busy at many MTFs as things are now and 6 months of CCATT at current op tempo doesn’t help at all. I would argue the Air Force should send the docs nurses and RTs who have been really busy clinically, a month or two without dropping a tube or optimizing a patient on inverse ratio
    will be a welcome break from the hectic clinical world that we live in.

    Any influence you could bring to bear to keep the Guard deployment going at Ramstein would be appreciated. We need to make sure that our 16 Guard CCATT teams are real assets, trained and current. The country has months to prepare for a war but hours to respond to a domestic event. If you need to reach me please don’t respond to my air force email since I can access it infrequently use either wrogers@cms.hhs.gov or drwilliamrogers@gmail.com thanks

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