PRESIDENT™S COLUMN INSIDE THIS ISSUE - SoUSAFFS3).pdf · 2010-06-12 · PRESIDENT™S COLUMN Col Mark Ediger One rainy night in early September I flew in a formation of 14 MH-53

PRESIDENT�S COLUMNCol Mark Ediger

One rainy night in early September Iflew in a formation of 14 MH-53 PaveLows. Well, actually ours broke and Iwatched from the ramp as 12 othersdeparted. For those unfamiliar with PaveLows, they are big helicopters modifiedwith lots of computers and sensors, plus a few guns. Getting 12 offthe ground simultaneously on a rainy day is the maintenanceequivalent of hitting two grand slams in one inning.

I�ve become a huge fan of the Pave Low maintainers over thepast two years. Since we mostly fly at night in this Wing, I generallydon�t go trudging back to the office when the aircraft breaks�nowI tend to hang out on the ramp and watch the maintainers fix it. It�sa lot like medicine, really. Sometimes the crew detects an abnormalvibration and lands for some diagnostic work. How the crew feelsthese vibrations in the tempest of a running helicopter is a mysteryto me, but that�s another story. The �vibe� specialist comes ontothe running Pave Low, looking to be about 19 years old, plugs hislaptop into the avionics and downloads readings from vibrationsensors while the pilots hover. Then after landing, he or she will

run their hands over the skin of the aircraft while it idles, almost like a physician examining anabdomen. Somehow a diagnosis is pronounced and we either keep flying or we�re done for the night.

During a recent visit to the dorms where these Airmen live it was evident these young maintainersin whom we place so much faith are just one notch beyond teenager. From watching them andtalking with them I know they�re bright, well trained, and have some pretty unhealthy lifestyles andhabits. Self-reported tobacco use during cycle ergometry is showing us that the young folks are bigusers. Their interest in fitness seems to lag behind that of the Airmen we had only four years ago.I�m wishing we knew more about the health risks for our youngest members as affected by theirlifestyles and their jobs.

As we roll into population health those of us in aerospace medicine need to be pressing theoccupational aspect. We need active duty population data at each Wing specified by workplace,occupation, age, etc. The data needs to include occupationally related illness and injury as well ashealth risk factors. We all know how tough it is to get commanders to take the long view and takehealth promotion seriously. Population health data for specific workplaces continued on next page

Col Mark EdigerPresident

VOL. 16, NO. 3, Fall 2000

INSIDE THIS ISSUEPresident�s Column ............ 1View From the Top ............. 2The Forgotten CoreCompetency ....................... 3Letter to FlightLines ............ 4From the ACS ..................... 5Aviator & HCV .................... 7Executive Officer ................ 8FS Checklist Notice ............ 8Aerospace Medicine in......USAFA ............................ 9HCV Algorithm .................... 10From the Editor�s Desk ....... 11Information for Authors ....... 11Membership Information ..... 12

Col Ediger - continued - and occupations is a good start for showing commanders that prevention is away of taking care of their people.

I�d love to know more about the health of these Pave Low maintainers and everybody else workingat our Wing. To get there, we need to make sure population health and prevention extend to theoperational workplace and aren�t confined to a clinical focus. Having done a job in D.C., I�m awareof the alphabet soup of acronyms for information systems on the way or awaiting funding. Some saywe already have systems to do occupational epidemiology�we�ve found them too manpower intensivehere. I�ve got a feeling a simple tool dipping into systems we already have would be the 80%solution. We�ve got some great innovators on Team Aerospace�maybe somebody already has thistool and will spread it around. Let�s keep pressing for an evidence-based population focus in AirForce Aerospace Medicine! End

d e t a i l e dr e q u i r e m e n t sdocument thathas served as theblueprint forPhase II programd e v e l o p m e n t .P r o g r a md e v e l o p m e n tbegan in June2000 and isscheduled forcompletion inJanuary 2001.Alpha testing willbegin in lateAugust, and Beta testing in September. This testingperiod will be used to polish the program with userinput before it�s fully fielded. Along with theprogram deployment, complete user manuals and usertraining will be provided.

AIMWTS will allow base level users to identifyassigned individuals requiring waivers, view anindividual�s waiver history, write AeromedicalSummaries requesting new or renewal waiver actions,and electronically process waivers for review andcertification through a secure internet connection.The program will be prepopulated with ratedindividual demographics and historical medicalwaiver actions. With the touch of a button, reviewand certification authorities will be notified that newwaiver requests are waiting for their review. Whenthe review and certification authority takes finalaction, base level users are notified of the action thenext time they log into the program. All actionstranspire on the central database,and are tracked bythe system. The program allows users at any level tosee the status of a waiver being processed.

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VIEW FROM THE TOPCol Tom Travis

Aeromedical Information ManagementWaiver Tracking System (AIMWTS)

In January 2001, USAF Aerospace Medicine willcombine the traditional waiver processing and thetechnology of the new millennium with the deploymentof AIMWTS. AIMWTS is a fully automated systemthat will manage and track waiver and Exception toPolicy (ETP) actions for rated (flying) and specialoperational duty Air Force personnel. It will beaccessible through the Internet to users at severalfunctional levels: Medical Treatment Facilities at AFbases, Aeromedical Consult Service, Major AirCommand Surgeons (MAJCOM/SG), and Air Staff(AFMOA/SGOA). AIMWTS will manage waiverprocessing, from writing the initial AeromedicalSummary, requesting ACS evaluations, to finalcertification, all in one program, from anywhere in theworld. To ensure this program meets our needs,AIMWTS has been designed from the ground up bythe actual users.

This project is driven by a significant increase inETP requests over the last 3 years, and the CSAF asking�Do we track waivers for how over the history of ourAir Force we make the right/wrong call�. Meaning,did we make the correct decisions when approving ordenying ETP requests for these individuals? Since thereis no easy method to determine the merit and wisdomof granting these ETP waivers, we have been tasked tofind a solution to this problem. AIMWTS will allowus to track waivers over an aviator�s career. Thecentralized data will be made available to users fortracking and management purposes, and will assist inrefining future medical standards.

Phase I of the AIMWTS project was completed onSeptember 15, 1999, resulting in an extensive and

Col. Tom TravisHQ AFMOA/SGOA

Col Beek VanderbeekUSASAM Commander

�THE FORGOTTEN CORECOMPETENCY

Col Beek Vanderbeek

Important military medicine core competen-cies and initiatives are frequently espoused andenunciated in many of today�s forums:

�Medical Readiness��Full Spectrum Health Care��Force Health Protection��DCOM��Forward Casualty Care��Healthy Fit Force��Aeromedical Evacuation��Medicine without Walls��Primary Care Optimization��Disaster Response��International Health Liaisons��Global Health Surveillance��NBC & WMD Response��Humanitarian Response/Civic Support Actions��Put Prevention Into Practice��Light Lean &Lifesaving Medical Capabilities�

Yes, these are all relevant and important militarymedicine competencies or support tasks. BUT: In mymany travels, doctrine reviews, senior leaderencounters, newspaper and magazine reviews, Capstonecourse, health affairs strategy reviews, and missionsupport plans, I rarely if ever hear anyone discuss theessential core competency of aerospace medicine:

Human Performance Enhancement& Sustainment (HPE/S)

If you asked most folks who are working �FullSpectrum Health Care� or Force Health Protection(FHP) to show you their modules on things like�enhancing and sustaining aircrew performance in adirected energy hazard environment� or �maintainingsituational awareness in a complex air-to-airCol Travis - continued - AIMWTS represents atremendous leap forward in the service USAF FlightMedicine provides to our customers. Throughextensive user involvement and integration withexisting programs during development, we areconfident that AIMWTS promises to be the greatestadvance in waiver processing in the history of the AirForce. End

environment,� youwould assuredly seethe very big round-eyed deer-in-the-headlights syndrome(DITHS).

What bitter ironythat one of thefounding drivers formilitary medicine hasbecome so diminishedin value that it isessentially absent fromthe national militarymedicine dialog. It is instead left to engineers workingin program offices to decide how to apply the definingprinciples of our profession. We (RAMs, flightsurgeons) remain as the sole physician advocates forHPE/S; it is our duty; it is our core competency. Wefly in order to execute upon this core competency, andexecute we must.

The Force Health Protection (FHP) initiativecontains some elements of HPE/S, since �full spectrumprotection� does help sustain performance � but usuallyonly through the domains of physical protection frominjury or countermeasures for biomedical risks(immunization, personal protective gear..). But FHPfalls very short in strategies for operational performanceenhancement. This is an ever-growing deficiency. Inparticular, as we look at air, space, and informationdominance, and global standoff precision engagement,the predominant military war winning �system� is thehuman as he/she operates ever more complex militaryplatforms. Thus enhancement of the human weaponsystem (HWS) platform becomes paramount. Withcomprehensive operator performance enhancement andsustainment, there will be fewer Air Force personnelplaced at risk and fewer sent in harm�s way.

As we see �new platform� development diminishingand nearly absent (F-22, CV-22, maybe JSF), it is timefor the AFMS and the senior aerospace medicineleadership {*6 of our 10 MAJCOM/SGs are RAMs!*}to insert a wedge into AFMS strategy for HPE/S. Thiscan be approached as a �P3I� strategy (pre-plannedproduct improvement) for the human as a weaponsystem: �the wetware within the hardware andsoftware� environment, as The Iguana would say. Thisenvironment ranges from the F-22, to the C-17loadmaster, to the console operator of a UCAV or spacevehicle.

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2. Air Reserve Component (ARC) personnel whoare not eligible for elective treatment in the MHSmust obtain PRK at their own expense in the civiliansector. However, they still must obtain the sameinitial evaluation/referral and permission-to-proceedas the AD member. What this means is they musthave Sq/CC approval, they must be screened by themilitary Flight Surgeon and Optometrist, they mustobtain corneal topography if locally available (atown expense) and their screening/referralpaperwork must be sent to the PRK Registry forfinal review and permission-to-proceed. Uponreceipt of notification of permission-to-proceed, theARC member may schedule PRK at their ownexpense with the PRK surgeon of their choice. TheARC member must notify their Flight Surgeon andbe placed DNIF the day of the surgery. The ARCmember must obtain all the same required follow-up exams as AD members. The waiver and Returnto Status procedures are the same as for AD.3. Numbers of pilots and student pilots with PRKwaivers per year are limited (200/100 respectively)but the numbers in all other aviation and specialduty personnel are not limited.

As with any new program, this will evolve overtime. Be sure to refer to our PRK Web page for themost up-to-date information. There may even havebeen changes between the time this is written andpublication, so be sure to consult the online guidance.Parts of the PRK page are still under development.

Second, some common questions:1. Who are aviation and special duty personnel?Those who require an AF Form 1042, MedicalRecommendation for Flying and Special Duty2. Can aviation and special duty personnel just getPRK in the civilian sector at their own expense?No. All aviation and special duty personnel musthave the PRK done at WHMC (required for pilots)or any DoD Refractive Surgery for the WarfighterCenter.3. Who pays? Will the unit or member be chargedthe laser royalty fee? The TDY for treatment/follow-up is unit-funded. The royalty fee will notbe charged to the member or the unit.4. Is there a priority for treatment? For this policythere is prioritization for treatment. Priority 1: pilots(note that pilots must have their PRK at WHMC).Priority 2: WSO Navs, AFSOC other aircrew/special duty (CCT, aerial gunners, PJs). Priority 3:all other aviation and special duty personnel. (ed.note: most of us FSs fall in this last category)

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PRK POLICYCol Arleen Saenger

You have probably heard by now that PRK is nowwaiverable in aircrew and special duty operationspersonnel. There is a lot of interest in this program.And, a lot of questions have arisen. Each of you mustread and become familiar with your responsibilities inthis program (outlined in Atch 2 of the policy memo).These responsibilities are no different than anythingelse you do: educate your squadron, do clinicalscreening and referral, write and submit waivers, ensurethat required follow-up is accomplished. I want tobriefly review the program with you, answer somecommon questions and tell you how to get moreinformation if you need it. If you have questions, pleasecontact your MAJCOM. If the MAJCOM cannotanswer then they will contact us.

First, the program: A copy of the Aviation andSpecial Duty PRK Waiver and Surveillance Programis now available at our SGOA Home Page at http://sg-www.satx.disa.mil/moasgoa/index.cfm . The PRKWaiver and Surveillance Program applies to all aviationand special duty personnel, Active and ReserveComponents. It applies to current personnel and toapplicants to those career fields. The clinical criteria,scheduling, treatment and follow-up are the same forall. However, there are some differences in the policymemo that you need to be familiar with. The differencesare:

1. AD aviation and special duty personnel mustreceive their PRK in the Military Health System(MHS). Pilots must be done at WHMC. Non-pilotsmay be done at WHMC or any other DoD RefractiveSurgery Warfighter Center (more on Warfighter inanother Flightlines. We are not the POC forWarfighter but will provide you information once theprogram is finalized.)

Col Vanderbeek - continued - If a �P3I� strategy forthe HWS is developed, with a goal of continuouslyfostering HPE/S, then we will approach true �fullspectrum health care� for Air Force military medicine,with full spectrum protection and enhanced war-winning capability for the USAF.

We�ve got to keep advancing and leading in theareas of combat casualty care, force health protection,NBC defense, humanitarian and disaster response;BUT: It�s time to �walk the talk� and focus on theperformance of our most valuable Air Force weaponsystem...

THE HUMAN. End

PRK Policy - continued -5. What is the Refractive Surgery for the Warfighterprogram? Is this the same? The DoD RefractiveSurgery for the Warfighter program is separate fromthe AF Aviation and Special Duty PRK Waiver andSurveillance Program. Under �Warfighter� Army,Navy and Air Force will be performing refractivesurgery (PRK-only for the AF) on interested memberswho have been designated �warfighter� by theirservice. This is not meant to mean all active duty. Itapplies only to those for whom there is a real wartimeoperational advantage to reduce or eliminate the needfor corrective lenses. The AF Warfighter programwill include more than just aviation and special dutypersonnel. We are, however, the leading edge of theAF Warfighter program.

Third, how to get more information/answersto your questions: First, go to the PRK Web page. Ifyou can�t find the answer to your question there thencontact your MAJCOM. Please do not contact us atAFMOA directly. We are relying on the MAJCOMs togather and collate questions/inputs for us. We will postall new questions/clarification/information on the PRKWeb page. We really do rely on inputs from the field tofind the �things we didn�t think of,� so if you see some-thing �we didn�t think of� please pass it on to yourMAJCOM. End

HOT OFF THE PRESS!

MAY 2000, 6TH ED.FLIGHT SURGEON�S

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BROOKS AFB, TX 78235

FROM THE ACS: AdjustmentDisorder in a Student Pilot

John Patterson, PhDRoyden Marsh, MD

Brief case description up to the point of ACSevaluation: This 27 year old AF Academy graduate,Lt, communications officer was medically disqualifiedduring phase 2 of UPT for history of adjustment disorderwith depressed mood and suicidal gesture. He has 180TMFH, none of which has been in the last 6 months.He reports to the ACS for evaluation for possible FlyingClass I waiver recommendation.

The Lt reports that during the second phase of UPTin mid March, he recognized that his flying performancebegan to deteriorate due to stressors in his personal life.His parents, after several years and numerous cycles ofconflict and reconciliation, announced that they weredivorcing. This news came a few days after his fiancébroke their engagement. His parents had been in turmoilfor several years and his fiancé had, for the previousseveral weeks, started exhibiting unstable personalitytraits partly due to stopping her medication for manicdepressive disorder and further compounded by heavydrinking. Within days, he failed a check ride. Duringthis period, his flight commander gave him a monthoff to �work out his personal problems.� He was notdirected to the flight surgeon nor counseled to seekprofessional help dealing with his problems.Apparently, as his problems continued he was advisedto consider SIE from pilot training. He was quitedevastated at the final break up of his parents, the failureof his engagement, the failed check ride, anduncharacteristic academic problems. In late May hesaw his flight surgeon and reported tearfulness anddifficulty sleeping. He had seen his FS previously dueto stress-related complaints such as difficulty sleepingand depressed mood, but due to the marked worseningof his symptoms he was grounded and placed onZoloft®. He was told he would never fly again andwas eliminated from UPT. In spite of this, he quicklybegan feeling better, and began dating someone new.

In June, he decided to attend the selection/assignment party for his former UPT classmates andtook his new girlfriend. During the party she told himshe did not want to see him again. As the party wenton he, uncharacteristically, used more and more alcoholand began to focus on the failures of his family of origin,his own dating failures and failing in pilot training. Hebegan to consider and somewhat openly discuss suicideas the party went on. continued on next page

Adjustment Disorder- continued - As he and friendswere leaving, he found a piece of glass in the parkinglot and tried to scratch his wrist. Friends stopped himand called for help. He was transported to an ER,admitted and observed for two days and then released.He reports that when he awoke the next day, he wasappalled by what he had done. He denied any suicidalideation when sober. He continued in mental healthtreatment for a total of 21 sessions. Subsequently, theLt reports that things settled down in his life, with hisparents� divorce being finalized. In August he asked tostop taking Zoloft as he felt it wasn�t needed, but hewas told he should continue to take it. In spite of this,he discontinued the medication in September. In thefall he PCS�d and was reassigned as a communicationsofficer at his new duty station. He then began to explorepursuing a waiver and returning to flying.

Discussion of the clinical/aeromedical issues: Thiscase demonstrates a number of aeromedical psychiatryissues. First, with enough stress, each of us will beginto show performance decrements. In this case, anintelligent, accomplished young aviator began tostruggle in pilot training. Interestingly, neither he norhis flying supervisors took much action until after hehad failed a check ride even though his increasingstresses were known.

Issue two: Denial and intellectualization are aliveand well out there among most aircrew and their aircrewsupervisors. Aviator psychological defenses canoccasionally be the ultimate enemy of the oft-touted�compartmentalization.� Compartmentalization is theaircrew term that probably covers several defensemechanisms and is often used as an explanatory conceptto describe successful aviator coping. However, as inthis case, what does one do when the �compartments�are full to overflowing, other than fail?

Issue three: Aviators and their supervisors may notbe able to answer the question, �What, other thancompartmentalization, helps manage stress?� Taking�time off� seems to be one of the more enlightened, ifnot sophisticated, approaches to aviator stress overloadto the point of approaching failure. Not �Let�s talk tothe FSO,� or, even less likely, �Let�s see what MentalHealth has to say,� or the least likely, �Let�s get advicefrom MAJCOM or ACS.� FSOs must continue to earnthe trust of the line of the AF, so that Flight Medicine isone of the first resources a commander or aviatorconsiders when facing problems with stress.

Issue four: Not everyone understands the AFIs,much less aeromedical disposition. Did this aviatorneed to be permanently disqualified? Could he havebeen treated locally, kept on hold, and returned to

training? Absolutely. There are several approaches tosimilar case, but in these days of fiscal restraint ANDpilot shortage, it is important to not only do the rightthing, but also do the right thing in the best way.

Issue five: It is critical to fully evaluate and treatthe aviator and then assess aeromedical disposition.There are very few permanently disqualifyingpsychiatric diagnoses, and adjustment disorder, evenwith �suicidal� behavior, is not one of them. Howwould you assess this young man on the morning afterhis trip to the ER? He had way too much to drink, hehad at least three major psychological assaults (parent�sdivorce, failed engagement, failed UPT) in a few weeks,and while with his friends he began expressingsignificant discouragement and thoughts of ending hislife. On the way to the car he finds a piece of glass andwith his friends watching, scratches his wrist. Suicidalintention? Perhaps. Method? Hardly. Means?Doubtful. Lethality of attempt? Very limited. So, whatare we left with? A despondent young man who hadtoo much to drink during which his usual but alreadyflagging psychological defenses failed. Alcoholincident alone? Absolutely not. While alcohol playedan important role and should not be overlooked in theaeromedical treatment and disposition plan, to stop therewould not be best. It�s the adjustment disorder andprobable personality traits of dependency andinadequacy that will need attention before considerationfor return to fly. Otherwise, if not treated effectivelyand thoroughly, what�s the risk for recurrence the nexttime several relational conflicts occur in temporalproximity? Can medication help? Absolutely, if givencorrectly. Is medication alone sufficient? Usually not,particularly for waiver.

Issue six: We�re not paid to know everything, butwe�re paid to know who to call to solve problems thebest way possible: Know who to call. Can all suchcases be predicted or prevented? Not even the point.However, despite complications such as denial andrationalization from our aircrew and even commanders,often driven by stigma associated particularly withMental Health and perhaps even flight medicine, theFSO will continue to earn respect and credibility eachtime an aviator is �saved.� Sometimes the save isprevention; other times it�s return after disqualification,and even other times the save is in terms of not returningto fly, but rather returning to health and then on toanother career. So many cases in aerospace medicinedon�t fit neatly into convenient algorithms. But betweencolleagues, MAJCOM and ACS resources, no one hasto figure the tough ones out alone.

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Adjustment Disorder- continued - Case disposition:The Lt persistently and appropriately pursued the goalof returning to flying training for many months,culminating in MAJCOM approval for ACS evaluation.In the process of requesting return to flying, he wasevaluated and followed for several months at his localAFB Mental Health Clinic with the conclusion that hehad resolved his psychological adjustment difficulties.He experienced no recurrence of symptoms and localMental Health recommended return to flying. Anextensive ACS Neuropsychiatry evaluation concurredand waiver was recommended. AFMOA concurred andwaiver was granted. The Lt will begin UPT approx-imately 30 months after he was disqualified. End

WHAT DO YOU DO WITH THEAVIATOR WITH HEPATITIS C?

Lt Col Elizabeth Clark

I am writing this article for all those in the trenches,so to speak. When I came into the Air Force in 1989,Hepatitis C (HCV) was still referred to as Non-A Non-B Hepatitis. HCV was known to be transmitted bytransfusion but no virus had been identified. A specificvirus was eventually identified and the US Air Forcebegan testing with a rudimentary ELISA in 1992. Irecall vividly getting my first positive test result forHCV. I called Brooks AFB and asked for guidance.Back then you just watched the patient. Now we havereliable testing and hope with treatment. If you aren�tlooking for HCV you will not find it.

Hepatitis C is often a chronic and persistentinfection, which therefore requires waiver forcontinuance on flight status. Only 15% of those infectedwill clear the virus on their own. No protectiveimmunity is conferred. There is no Vaccine availableand due to the mutagenicity of HCV, and one may be along time in coming. It is an insidious disease, and 10-20% of chronically infected individuals developcirrhosis. Transplant may be required but isn�t alwayscurative since HCV is a systemic disease and may infecta transplanted organ.

It has been estimated that 1 in 50 US adults in theUS are currently infected with HCV, with the vastmajority unaware of the infection, such that precioustime to intervene is lost and the infection may continueto be spread to others. In our military, the risk is less,with studies showing about 0.3% infected.

HCV is contracted much the same way as HepatitisB, although Hepatitis B is much more easily spreadboth sexually and perinatally. HCV is also associatedwith intranasal cocaine use. Many of those discovered

with the infection will admit to no high-risk behavior,especially in our military population, so looking for arisk behavior may be a fruitless search. Although theCDC does not report an increased risk in those whohave tattoo�s, I suspect that our deployed populationobtaining tattoos from foreign sources may be at greaterrisk. Even though the tattoo artist may be using cleanneedles every time, many practitioners of the art do notdispose of the dye used for tattoos. The dye, which isre-used, may be a vehicle for infection. History iseverything and asking detailed questions may yield arisk for our military population.

What do you need to do? 1) Ask your flyersabout risk factors, and when they are present, check anHCV ELISA. IF HCV ELISA is positive then 2) con-firm this with a HCV RNA PCR. Positive PCR shouldlead to 3) further evaluation by ID or GI for consider-ation for liver bx and possibly treatment with ribavirinand interferon. 4) If the HCV ELISA is positive andthe PCR is negative I would check a RIBA in thesepatients. Some patients are only intermittently viremicwith HCV and may have a false negative PCR. 6) Geno-type of HCV may be important in determining whichkind and duration of therapy. However, treatment regi-mens are constantly changing. Look to your specialistfor the latest guidance. 7) Consider getting an imagingstudy early, usually ultrasound, (like while you arewaiting for the consultant to see the patient), to ruleout hepatocellular carcinoma. (See flowchart on page 10.)

All persons infected with HCV should have thefollowing interventions regardless of the transaminasesand biopsy results:

1. Immunization against both HBV &HAV2. Alcohol abstinence3. Healthy lifestyle4. In-depth discussion on risks of transmission andappropriate behavior modification.5. HIV testingWhy are we talking about this in Flight Lines? We

are talking about it because we have a population that,although at lower risk than the general population, maybe infected and may benefit from treatment. The rub isthey mostly are asymptomatic and the treatment couldput them DNIF and non-deployable for 6-18 months,depending on the treatment course. This is the time toput your doctor hat and discuss frankly with aviatorsthe risks of postponing treatment.

A useful flowchart is on page 10. Additional information isavailable from the Electronic Waiver Guide at the Rams Hornlocated on the Brooks AFB Home Page (http://quicksand.brooks.af.mil/af/afc/table.htm). The CDC also has anexcellent resource for disease information at www.cdc.gov . End

FROM THE EXECUTIVE OFFICERLt Col Rob Yoho

Greetings from the home office. Here now are a few interestitems from the business side of the house.

MEMBERSHIP: We have a new crop of Aerospace MedicinePrimary (AMP) course studs completing their training here at theSchool. Our parent organization, AsMA, graciously sponsored aluncheon for this class, as they do for each new AMP class. Thisgives our senior Society leadership in the local area a chance toenlighten the students on the virtues and privileges of professionalsociety membership. As a result, many of the students will join AsMAand the Society. As members of our Society, we ask that each of youtake a few minutes to talk with other flight surgeon associates to letthem know about AsMA and our Society. Show them the Blue Journal

and this FlightLines. Make sure they know about the annual AsMA Scientific Meeting, the Societysponsored Flight Surgeon Checklist and other �merchandise.� Your recruitment efforts are essentialto keeping the organization strong and capable of fulfilling its goals.

CHANGES OF ADDRESS: As soon as you know where you are (not so easy for some of us),please mail your changes of address to the Society PO Box listed on the back cover of FlightLines, orsimply e-mail the change to me at [email protected]. At the very least, please let your oldPost Office know where you are! If you left a forwarding address with your old Post Office, theyshould forward FlightLines to your new address and, for a charge to the Society, the Post Office givesus your new address. However, each quarter many issues of FlightLines are returned, for a charge, tothe Society with �no forwarding address.� I then change your status in our membership database to�LOST� resulting in no further issues of FlightLines being mailed to you until I receive a validchange of address. If you aren�t receiving your issues of FlightLines and you�ve recently moved, youmight suspect a problem with addressing�so get in touch. Then again, you probably won�t bereading this since you didn�t get it!

DUES: At the end of the calendar year, I root through the membership database and weed out allthe folks that are way overdue on their $15 per year dues. We cut you some slack, but I�m not sayinghow much! After a while, I must �retire� you from membership for not staying current on your dues.Before I �retire� you, I send out a personal notification to beg you to reconsider your membership.Please, pay your dues on time! It saves time and money. Refer to the �PAIDTHRU� line above yourname in the address label to check on your status. Remember to remit not only your current year�sdues, but also $15 for each year you have forgotten to pay. End

LTC Rob YohoExecutive Officer

READ NOTICE OF ERROR READDue to technical problems, the new 6th edition of the Society of USAF Flight Surgeons� Flight Surgeon�s CheckList contained errors in chapters I (Aerospace Medicine Operations) and V (Federal Aviation Administration). Ifyou purchased a copy of the Check List at the recent AsMA scientific meeting in Houston, Texas (14-19 May,2000), please contact Ms. Shelia Klein at the following address and give her your address for mailing the cor-rected version of these two chapters:

SHELIA KLEINBROOKS HERITAGE FOUNDATION, INC.

P. O. BOX 35362BROOKS AFB, TX 78235

Phone: (210) 531-9767 Fax: (210) 536 1565 e-mail: [email protected] Society of USAF Flight Surgeons apologizes for the inconvenience.

[Editor�s note: Well, a couple of MAJCOM SGPAs got firedup this quarter and wrote �tell all� exposés on what flightsurgeons do in their commands. The following two articlesmay or may not be the first in a series of articles discussingwhat each MAJCOM has to offer. Guess it depends on therest of you leader types, eh? So here goes!]

AEROSPACE MEDICINE IN...USAFA

Lt Col Beth HaselhorstUSAFA/SGP

The United States Air Force Academy�whatcomes to mind? The spires of the Cadet Chapelagainst the backdrop of the Rockies? The 18,000acres reminiscent of a national park? The chanceto watch 28 different intercollegiate sports, or hike,bike and ski? What should come to mind isAerospace Medicine at it�s finest. Let me tell youabout life as a flight surgeon in the smallest butmost unique and exciting command in the AirForce.

The United States Air Force Academy (USAFA)is recognized as one of the nation�s finest four-year institutions of higher learning. This fullyaccredited university provides cadets with a solidfoundation appropriate to an Air Force career,offering 31 academic majors with a faculty ofapproximately 530 professors and instructors.Before its graduates enter various flying andsupport specialties, the Academy trains them to be,first and foremost, Air Force officers. Of the morethan 28,600 cadets who have graduated from theAcademy, more than 53 percent are still on activeduty.

The 10th Medical Group serves the UnitedStates Air Force Academy; the 10 MDGcommander is dual hatted as USAFA CommandSurgeon. We serve over 64,000 beneficiaries andare responsible for the health care of four majorwings located at USAFA, Peterson AFB, CheyenneMountain Air Station and Schriever AFB.

The 10 Aerospace Medicine Squadron isresponsible for the Cadet Clinic, Space Medicine,Public Health, Bioenvironmental Engineering,Optometry, Health Promotions, MedicalReadiness, and Aerospace Physiology. As anassigned flight surgeon, you may do a flight line

visit at the Peterson operating location, evaluate aspace operator�s workstation in �the Mountain,�track rodents at Jack�s Valley or visit the falconrymews at the Academy. You may provide sick callfrom a tent during Basic Cadet Training or takecare of a Canadian satellite operator at the Petersonclinic. Let me tell you about some of our missions,our patient population and our aircraft.

The Cadet Clinic provides primary medicalservices for over 4,000 cadets, 400 aircrew and 100Preparatory School students. This busy universityhealth service, Flight Medicine office and PhysicalExaminations and Standards (PES) section handleover 17,000 outpatient visits per year and generatemore Flying Class I/IA physicals than any otherPES in the Air Force! Flight surgeons are thePrimary Care Managers to the Cadet Wingsupported by nurse practitioners. Full spectrumprimary care includes inpatient services to theCadets.

All flight surgeons work closely with PublicHealth and Bioenvironmental Engineering inpromoting a safe base-wide work environment.There is an active Occupational Health WorkingGroup at both USAFA and Peterson AFB. TheOptometry Flight maintains close ties with all flightsurgeons and provides primary oversight for theMedical Flight Screening program, the gateway forpilot training for all USAFA cadets.

The Aerospace Physiology Unit (APU) islocated at Peterson Air Force Base. The APUprovides annual training for over 2,200 studentsin a 13-state region. Four dive teams provide 24-hour on-call emergency coverage for the hyperbaricchamber co-located with the altitude chamber.Flight surgeons have the opportunity for hyperbarictraining and can serve as medical dive officers,earning hazardous duty pay in addition to flightpay.

Peterson AFB is the headquarters for the NorthAmerican Aerospace Defense Command, US SpaceCommand, AF Space Command and the 21st SpaceWing. The Space Medicine clinic at Peterson AFBprovides primary care services to over 3,200 aviators,space operators and other special duty personnel toinclude foreign military. Flight surgeons provide sitevisits inside Cheyenne Mountain and Schriever AFBas well as support to continued on next page

USAFA - continued - Independent Duty MedicalTechnicians at both locations.

Unique flying opportunities abound. Want tojump out of a perfectly good plane? The 98thFlying Training Squadron handles all training andflying associated with the USAFA parachutingprogram in which more than 20,000 jumps aremade each year. The basic course trains more than1,000 cadets each year. Active duty personnel haveopportunities to participate in basic jump programs.

The UV-18B aircraft provides the airlift supportfor the cadet parachuting program, the only threeTwin Otters owned by the Air Force. As a USAFA-assigned flight surgeon, you have the opportunityto fly with the UV-18B. Low level through theColorado Rockies � doesn�t get much better thanthat!

The Academy soaring program is the largest andmost active in the United States, with more than30,000 sorties a year. The location affords excellentmountain wave and thermal soaring conditionsenabling cadets to reach altitudes up to 25,000 feet.The 94th Flying Training Squadron handles thesoaring program. Their fleet includes motor

gliders (TG-7A and TG-4A) as well as sailplanesconsisting of 13 Air Force owned TG-4 trainers,three TG-3s, four aerobatic TG-9s and two Stemmehigh-performance motor gliders.

Our Peterson AFB flying squadron is the 84th

ALF. Their C-21 fleet has flights throughout theUS, primarily in support of Distinguished Visitorsto USAFA and SPACECOM. A reserve C-130 unitflies local and cross-country missions with plentyof room for flight surgeons.

The flying is fun, the patient population isfascinating, and the environment unparalleled. Forinformation on flight surgeon job opportunitieswith the 10 MDG and USAFA, please contact meat [email protected] or call DSN 333-7807. End

USAFA Mission Statement:TO INSPIRE AND DEVELOP OUTSTANDINGYOUNG MEN AND WOMEN TO BECOMEAIR FORCE OFFICERS WITH KNOWL-EDGE, CHARACTER AND DISCIPLINE,MOTIVATED TO LEAD THE WORLD�SGREATEST AEROSPACE FORCE IN SER-VICE TO THE NATION

Flow chart for Hepatitis C work up. (Continued from page 7)

FROM THE EDITOR�S DESK Lt Col Diane RitterWow, things never slow down, do they? First let me tell you about the match. In spite of the fact

that the Air Force has instituted new policy aimed at preventing folks from staying in past theircommitment without residency training, applications for GME were way down this year... EXCEPTfor applications to the Residency in Aerospace Medicine. This means you, flight surgeons, are steppingup to the plate to support our flyers. Good on ya.

Next I want to briefly tell you about my �summer vacation.� Ten of us from the third year RAMclass had the opportunity to attend the Military Tropical Medicine Course at Bethesda. This classincludes 4 weeks of incredible didactic learning and lab experience, followed by a 2-week medicalmission in a �tropical� environment. The didactics are taught by the guys that wrote the textbooks.The labs are challenging, requiring the students to actually identify unknowns from blood and stooleach day. I found its much easier to see stuff when you know ahead of time what the diagnosis is, butmuch harder when you don�t!

Finally, the field trip. I had the privilege of travelling to Peru. Upon arrival, we visited numeroushospitals in the capital city of Lima. We were both impressed by the knowledge and skill of thephysicians and medical students, and equally dismayed by, due to a paucity of resources, the lack ofavailability of standard medical therapies that we take for granted. Next, we traveled to some remoteareas of the country where we set up clinics to see indigenous peoples with little access to medicalcare. The problems we saw were a dramatic reflection of the failure of the local infrastructure tosupport the health of the population. Intestinal parasites are ubiquitous in rural Peru because thewater that flows through the towns is �multipurpose.� The water that might have been clean at thetop of the hill is quite filthy by the time it gets to the people at the bottom of the hill. Cysticercosis isepidemic due to the close proximity of pigs and people. Across from our hostel, we noted pigsplaying in the school playground with the children, and it was commonplace to see pigs in the yardsof homes.

Why am I telling you about this? Two reasons, really. The first is to remind everyone that whenwe send our troops to foreign lands, we put them at significant risk, and since we seldom see thediseases that are rampant in other places, we have to be extra vigilant in preventing them and indiagnosing them. Just as importantly, our team was profoundly reminded that health is criticallydependent on community infrastructure. Peru doesn�t have a lack of good doctors-they have a lack ofprioritization of engineering efforts to support good health. When we travel to areas where there isnot sufficient infrastructure we must bring that infrastructure with us or our troops will get sick. Ifthey get sick we will not be able to carry out the mission. History has proved this time and again. Sowhen we deploy, it is critical that we know what the infrastructure needs to look like and critical thatwe advocate for it. When we were in Peru, we felt somewhat used by the government: �See what weare doing for the people�bringing in the American doctors to see you.� Yet we knew that there waslittle we could do for these people�what they really needed was clean water. Not too glamorous, butmuch more effective than Albendazole. �Bunny�

The views expressed in this publication are those of the individual authors and not necessarily those of theSociety of USAF Flight Surgeons or any other rational group of intelligent individuals. The FlightLines news-letter is published quarterly. Material for publication may be submitted in most any format at the following fax,snail-mail, or e-mail addresses. The preferred method is e-mail of a Microsoft Word document. Although notmandatory, a non-returnable print or electronic picture (.tif or .jpg preferred at 300dpi) of yourself to be placedwith your article would be appreciated.Snail-mail: FlightLines Editors, Box 35387, Brooks AFB, TX 78235-5387E-mail: [email protected] Phone: (210) 536-2845 or DSN 240-2845Fax: Attention: FlightLines Editors (210) 536-1779 or DSN 240-1779

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