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Why do Flight Surgeons Fly?

By In Aerospace Medicine, Blog, Flight Medicine, History, . . . On November 02, 2014


Jay Flottmann, USAF Pilot & Flight Surgeon

Jay Flottmann, USAF Flight Surgeon & F-22 Pilot

In the United States, Flight Surgeon is the title used by the military (and NASA) to designate a medical doctor who has completed specialized training in aerospace medicine and has been awarded an aeronautical rating.  This contrasts with the term Aviation Medical Examiner (AME) used by the Federal Aviation Association (FAA).  AME’s lack the flying requirement that flight surgeons currently enjoy.  The name’s history dates back to the earliest days in aviation medicine, but is a present day misnomer as a surgeon is now commonly recognized as a particular type of physician who performs surgical procedures.

 

 

 

 

 

 A BRIEF HISTORY OF FLIGHT DOCS IN FLIGHT

WWII Flight Surgeon Wings

WWII Flight Surgeon Wings

It is uncertain exactly when flight surgeons began to fly with the flying units whom they cared for.  There is evidence that flying quickly became an encouraged and frequently practiced duty shortly after the flight surgeon position was created in 1918 during World War I.

In a 1920 report published in the Journal of American Medical Association

USAF Flight Surgeon Wings

USAF Flight Surgeon Wings

(JAMA), the lead author Maj W.L. Sheep states that  “…of 48 flight surgeons on active duty, 29 were on flight status, 7 of whom were qualified pilots, with 5 more taking instruction.”  It seems that the question of flight surgeons on flying status was contentious in those

early days.  In 1921, all flight surgeons were removed from flying status but then reinstated to rated flying duties in 1922.  In the years between World Wars I & II, many positions for flight surgeons remained vacant and the military had

US Navy Flight Surgeon Wings

US Navy Flight Surgeon Wings

difficulty finding physicians to train as new flight surgeons.  As a consequence of the decades of peace, both military aviation and flight medicine suffered an identity crisis and in 1935, flight surgeons were again removed from flying status.  In 1940, American military flight surgeons regained their wings for good and a board published their standardized ratings requirements.  On 3 March 1942, the Flight Surgeon rating received its own distinctive gold badge.   In order to avoid confusion with naval aviation badges, however, this badge was

USAF Astronaut Wings

USAF Astronaut Wings

changed in 1944 to the standard oxidized silver wings still used today.  The flight surgeon wings display the familiar snake and staff medical symbol on the shield.

Military aviation began as a branch within the Army known as the Army Air Service.  Aviation also became a part of the U.S. Navy prior to WWI.  In 1947, the U.S. Army Air Corps becomes its own separate service, the United States Air Force.  The U.S. Coast Guard’s history in aviation also predates WWI, and rotary wing aircraft later became a critical asset in their mission.   With the onset of the space age, a new aeronautical rating for astronaut was created.  Within each of these organizations, the flight surgeon enjoys an aeronautical rating with a flight requirement.

 

WHY ARE FLIGHT SURGEONS REQUIRED TO FLY?

Top Knife F-16 Flight Doc Course

Top Knife Patch

To civilians and even military members not acquainted with the flying mission, the role or rationale that flight surgeons play during flying duties may be difficult to understand.  I can’t count the number of times a young crew chief asks me why a fighter squadron uses one of the pilots as a doctor or inquires how I provide medical care to the pilot during flight in an F-16.  There are 3 primary reasons that a flight doc is required to log a minimum number of hours performing flying duties monthly and annually.

  1. Aerospace Physiology & Pathology – Flight surgeons are expected to provide education to their flyers on issues of aerospace physiology and pathology.  They also diagnose and treat unique medical conditions that occur only to those exposed to the rigors of military aviation.  In order to truly appreciate the consequences of flight, it is critical that the flight surgeon not only study aerospace physiology academically, but it is imperative that they experience the environment first hand.
  2. Unique Demands of  the Aircraft & Flying Mission – Each airbase, aircraft, and individual flying unit has a unique and specialized mission.  In order for the successful flight surgeon to fully appreciate the nuances of his patients’ special duty, it is critical that he participate in the specific flying mission of the flyers.  Ultimately, aerospace medicine is a branch of occupational medicine.  In order for a flight surgeon to make the appropriate aeromedical disposition for an injury, medical condition, or prescription medication; an intimate knowledge of the physical and cognitive demands placed on aircrew for the particular aircraft is vital.
  3. Trust – It has long been recognized that pilots and other aircrew seek medical care with a certain degree of underlying anxiety about how a particular medical condition may affect their flying or special duty status.  For this reason, it is of utmost importance that the flight surgeon gain the trust of his or her flyers.  An individual flyers must know that their flight doc has their best interests at heart and aims to keep them safe during flight rather than arbitrarily taking their wings away.  Much of the trust that develops between flyers and their doc is thru the flight doc’s willingness to become familiar with the flying mission by participating in flying duties.

The words of otologist and early aerospace medicine pioneer Dr Isaac Jones writing in the 1930’s still ring true today in regards to why flight surgeons absolutely must fly:

“In order to know and understand the flying personnel and their reaction patterns, tendencies, and capabilities, the flight surgeon must cultivate the social contacts open to him. The most valuable information about the pilot is gathered by seeing him in his element, the air, in the pe. formance of his real tasks. Therefore, the flight surgeon should, whenever the occasion presents, fly with his associates under all conditions.”

 

The Pilot-Physician

The U.S. Armed forces have derived such value from flight surgeons taking flight that they have created highly specialized programs that allow selected individuals to become dual qualified as military pilots and doctors.  The US Navy has a handful of individuals that wear both flight surgeon and pilot wings.  Additionally, the USAF utilizes the pilot-physician program.  Some of these individuals are first doctors then return to military pilot training and others are military pilots who gain acceptance to medical school, but ultimately once selected into this highly competitive program, the USAF provides a new duty code and expects this small group of qualified pilot-physicians to maintain currency in both professions.

 

MAJ (DR) PATRICK HSIEH: FLIGHT SURGEON DUTIES IN THE USAFR

 

REFERENCES

1. Clement.  The Role of USAF Flight Surgeons During The Vietnam Conflict.  1987.
2. USCG History of Aviation.
3. Sheep.  The Flight Surgeon.  JAMA.  1929.
4. Jones GI. The flight surgeon. Aero. Dig. 1932.


  • Mark Filgerleski

    Major Jedick,

    Very intersting piece. I often wondered this myself- I briefed a flight surgeon once (WX) and we chatted for a bit. Stellar officer, and an even finer person. Anyways, I asked him, but, as he was running short on time, he bascially told me “We fly to understand the rigors of flight itself.” That’s the explanation I gave any young Airman wondering the same.

    Now, it’s even clearer- Thank you, sir!

  • CalSailor

    How do flight surgeons reconcile Geneva Convention status issues? As medical officers, they are non-combatants; as pilots, they definitely ARE. (As a Chaplain that issue came up in re: enlisted Marines who were to provide safety for Chaplains, and the fact that the Marine is a combatant and the Chaplain is not.)

    Pr Chris

    • Actually chaplains and doctors both have a duty to chose between conscientious objector and form two personnel.

      Flight surgeons almost always fall under form two personnel as sure the thunder birds are non combat personal but most missions that call for a F-16 of F-15 (blue angles) are not training missions thus have to be flown by combat rated personnel.

      There is this book called the universal code of military justice that explains in detail what a conscientious objector is and when the decision has to be made by personnel. I am an ordained knight in the catholic church and that came up more often than I liked because I was how I resolved the conflict of taking lives with being a priest. Every time I had to look at the person and say to a catholic knight is not about taking lives but with protecting those who are endangered by others. I wore my chaplain’s braid on one mission of mercy to rescue a bunch of hostages. The stupid thing is still bloody, most of it washed out but I kept it to remember that even a chaplain pulling soldiers out of the line of fire is still not as pure and pristine of focus as priest that simply offers mass. It is why I don’t belive that if you are in uniform you could even be a non-combatant.

      So if you see the religious brain usually a pure white braid for Catholics, other faiths have different colors those are usually going into harms way with the idea of helping people but have chosen to wear military braid representing not a non combant but understanding they are advancing the solider’s countries goal even by simply saving combatants that might go to war later on or might kill people. So while I understand that chaplains have the right of being conscientious objectors, they should be in vestments not a military uniform in that case. I am rated as a flight surgeon in the USAF and I remember when I was running flight medicine at McGuire AFB the flight doctor told me that if we got any space related injuries I would have to treat them being space rated. When congress moved the personnel from USAF Space Command I was transferred over and I laughed because I was only in space command because of training requirement needed be filled the base commander thought the F104 was an old piece of junk. He had his engine maintenance class rebuild it as their training project, and he laughed he offered to race me with a B1 Lancer. Much larger air frame much more fuel. The thing is it uses jet fuel, while the F104 uses a methane gas. So as a flight surgeon when I got to McGuire AFB I could explain the concept of how much large gravitates impact the body having flown at stupid speeds, the problems that a flight suit can cause leaving welts on the arms and legs that indent the body looking like I was strapped to a table or something. When the pilots came in asking about them I can hold up my own arm if wearing a tshirt and say the indents fade. A regular flight surgeon might not know. Having to know that you have to stand up until you pass out prevents blood clots. Knowing that the pressure cuffs might prevent the fingers and toes from being blown off due to blood pressure is something regular flight surgeons know but when a pilot wants to know so what happens when they go faster. I can tell them that slowing down their breathe decreases the pressure on the cuffs even at much higher gee force. But hyperventilating will cause you to black out and likely crash and die. I know from books but I also know from having flown.

      Last the funny thing I have to point out about the USAF might be the other services too, but if you rate as a parachutist and a pilot you only get to wear the pilot wings even if you rated higher as a parachutist. Then when you get your astronaut wings you have to replace even a master aviator with journeyman astronaut pilots wings. Those rating require a certain number of missions. So just because you see a journeyman flight surgeon they may have a thousand jumps but only a two or three flights.