Why do Flight Surgeons Fly?

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

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.

• ‘The History of Flight Medicine’ Featured Page on GFM. 

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

(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

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

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?

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.