How does one become a USAF Flight Surgeon you may ask?
The recipe is simple.
Step 1: Meet the appropriate licensing requirements to practice medicine.
Step 2. Join the USAF as a commissioned officer.
Step 3. Complete the USAF Aerospace Medicine & Aircrew training requirements.
Below is an article detailing the current aerospace medicine training required of USAF Flight Surgeon candidates, written by none other than the current lead instructor for all of the Aerospace Medicine Primary (AMP) Courses aka “The AMP Daddy”, Lt Col Bryant ‘THUNDA’ Martin:
A BRIEF HISTORY OF THE FLIGHT SURGEON
Since the term “flight surgeon” was coined at Hazelhurst Laboratory on March 11, 1918, and the first three physicians graduated, flight surgeons have been the widget called upon in times of crisis and change. As my AMP Daddy would readily say of the flight surgeon, “Break glass in case of war.” As the field of medicine grows and the expectation of the U.S. Air Force for excellence continues, the role of the flight surgeon continues to expand to meet the demand. Today, the battle call is one for readiness. Hearing that call, USAFSAM has been working feverishly to meet that demand.
Maj Louis H. Bauer took over flight surgeon training in 1919 and established the first permanent course of instruction as a 2-month-long training curriculum at Mitchel Field, Long Island. The Medical Research Laboratory and School for Flight Surgeons has continually produced the world’s foremost flight surgeons ready to serve and protect those in harm’s way. Over the last 100 years, the school’s name has changed, the location has changed, the people have changed. What hasn’t changed is the dedication to excellence and the desire to continually evolve the educational process, ensuring that our flight surgeons have the best training available as they go forth to serve our Airmen. With that in mind, we are very proud to introduce the newly minted 2-month-long Aerospace Medicine Primary (AMP) course that will be kicking off with the spring 2020 courses.
THE HISTORY OF AMP
For those unfamiliar with the current process (or old enough like me to remember the days of a single direct AMP course), let me summarize how it has been. AMP has been broken up into four courses of 2-3 weeks duration known as AMP 101, 201, 202, and 301. Five years ago, the then Surgeon General of the USAF directed all medical students to attend AMP 101. This policy change had a direct impact on what could feasibly be taught in this course, as the now majority of the students do not ever go on to serve as flight surgeons. AMP 301 has been problematic, as it occurs after graduation and its intent has been multipurposed and evolving over the years.
Going forward, AMP will continue to be a four-course process, with each iteration being 2 weeks long. The major change will be dropping AMP 301 and replacing it with a new pre-graduation 2-week course. The first two courses in the series have been renamed Air Force Operational Medicine (AFOM) 101 and 102 and will replace AMP 101. The final two courses retain the name Aerospace Medicine Primary 201 and 202. For now, these four courses will serve as the core curriculum for flight medicine providers to the USAF. As you can surmise by the name change, the Aerospace Medicine Education Branch and USAFSAM are positioning themselves for potential growth and changes, with developments being seen in the Operational Medicine Readiness Squadrons and the newly termed Warfighter Operational Medicine Clinics. Let’s take a moment and break down each course, and you’ll begin to better understand the vision of how we believe this new curriculum will match the demand signal.
AFOM 101: INTRODUCTION TO USAF MEDICINE (2 weeks)
AFOM 101 is the evolution of the previous AMP 101 course with the emphasis built around introducing the new provider to the role of the medical provider in the Air Force Medical Service (AFMS) and the role of the AFMS in the USAF. The intent is to educate newly minted medical officers in the dynamic world they are now an integral part of and introduce them to a different thought process foreign to most of our training. The course focuses on the many capabilities of the USAF and how the medical missions within those areas differ. The students will be introduced to new concepts such as a broad overview of the aeromedical evacuation platform and capabilities, physiological aspect of continuous operations, concept of occupational and preventive medicine in light of force sustainment, and aviation fundamentals, to mention a few. The students will continue to spend a day at the local airport being introduced to aviation and experiencing small aircraft flight. This course will continue to serve as an introduction to medical students and be the first course in the pipeline for flight surgeon training.
AFOM 102 is technically the new course in the series, but is so by name only. The majority of the curriculum has been reshuffled from AMP 101 and AMP 201 to form this course. The intent of this course is to provide the building block for a competent occupational primary care provider for the Air Force – someone who can actually function in a primary care clinic for active duty service members. To train flight surgeons all these years, we’ve had to be proficient on all skills that now fall under the BOMC umbrella. We’ve always taught special exams, MEB/IDES, profiling, SHPE, and so on. These are skills that we have taught and have been expected to master in the field. AFOM 102 brings all of these non-aviation, Air Force occupational skills under one course. As we looked at what skills also made us competent occupational providers for the Air Force that weren’t aviation-based, we found additional items. Many of the concepts in occupational medicine found in AMP 201 and the Occupational Medicine Symposium have been built in such as shop visits, special exams, fitness for duty determination, arming use of force, and PRP. AFOM 102 includes blocks of instruction designed to teach a clinician how to prepare a patient to enter the aeromedical evacuation system. In other words, if a provider was to be at an EMEDS, what could he or she do to better understand the process of AE and how could he or she prepare the patient medically so the handoff to the clearing flight surgeon is that much smoother for the patient and the AE team? Additionally, if a mass casualty were to occur on base such as a bus accident, it would be all hands on deck for response. AFOM 102 includes a block of instruction introducing disaster response, the Incident Command System, and concepts of working with the local EMS. The 2-day medical response to CBRN training previously found in AMP 301 has been incorporated here.
EXPEDITIONARY MEDICAL SUPPORT (EMEDS):
AMP 201 has been the bread and butter course for teaching clinical competency for flight medicine since its inception. The problem – there hasn’t been enough time to meet the stated goal. With this new curriculum model and the movement of the non-aviation material to AFOM 102, the table has been cleared for a conceptionally different approach. Throw out what you remember of AMP, the big lecture hall, the long hours of Charlie Brown’s teacher. We promise better. AMP 201 is limited to a class size of 36 students. Each class will be organized into 6 flights (flight Ellsworth, flight Eglin, etc.) of 6 students. Each student will be given a case study on day one such that each member of each flight will have one of the six different case studies. The goal is for each baby flight surgeon to carry his or her Airman through his or her entire career from initial flying class physical to SHPE with every bump along the way, be it deployment, waiver, toxic exposure, etc. The course is designed to only include a few hours of lecture each day, with the remaining time divided between laboratory time and small group work. An example of a typical day is as follows.
In the morning all students would receive 2 hours of lectures on AFI 48-123 and the Medical Standards Directory (for USAF Aeromedical Standards) to thoroughly understand their pur- pose and function. During the remaining 2 hours of the morning, each baby flight surgeon from the six flights with the same case study will meet to work through the scenario given that day. In other words, all six flight docs from the six different flights assigned TSgt Snuffy as their case study on day one will meet to discuss the new scenario: TSgt Snuffy is trying to become an aerial gunner who happens to have poor depth perception and is seeking a waiver for an initial flying class physical. Once the team comes to a working solution, they will have the opportunity later in the day to reconvene with their own flight and present their case while listening to the other five members present theirs. Sound familiar? Hopefully, you’ve been attending your FOMWG meetings! The power of this approach is that members must use the resources available to search for the answers, the process is designed to demonstrate all the parts of flight medicine in a sequential manner, and the FOMWG reinforces normal clinical practice while introducing breadth of experience.
Interspersed throughout the AMP 201 experience is a myriad of additional learning opportunities independent of the case study. The course will kick off with hypobaric chamber (hypoxia) training previously held in AMP 202.
HYPOXIA TRAINING IN THE HYPOBARIC CHAMBER:
It will also include the reintroduction of aircrew life support equipment familiarization and aircrew meals! The new AMP curriculum is built on the concept of drawing a continuous development model from course to course. Aeromedical evacuation training is a perfect example of this. AFOM 101 introduces the student to the USAF capability of AE. AFOM 102 teaches the provider how to prep a patient for AE more efficiently. The plan for AMP 201 is to train all flight surgeons to be competent clearing flight surgeons and meet Air Mobility Command’s expectations for deployment readiness. Working with TRANSCOM, we are incorporating training from the Advanced Clinical Concept in Aeromedical Evacuation Symposium and the Clearing Flight Surgeon’s Handbook.
AMP 201 will continue to include in-depth discussion on aviation physiology from our experts at the Aeromedical Consult Service. The spatial disorientation trainer previously taught in AMP 101 has been moved to this course and the education section consolidated to include human factors and the reintroduction to Initial Safety Board response. Needless to say, AMP 201 is really the “new” course in the flight surgeon pipeline and the one we’re most excited to introduce.
AMP 202 has been the capstone experience for flight surgeon training since it began when USAFSAM moved to Wright-Patterson Air Force Base. It will continue to be so and will continue to improve. The course is a collaborative effort with Greene County Airport and MacAir.
USAFSAM HIGH G-FORCE CENTRIFUGE TRAINING:
The students will start the course with the physiologist and complete their centrifuge training during the first 2 days before transitioning to Greene County. The remaining 8 days will be dedicated to a brief ground school and safety training followed by a series of eight flights. Each flight is designed to introduce the baby flight surgeon to a different aeromedical aspect of aviation. Six of the flights are completed in the Cirrus aircraft, one in a high-performance acrobatic aircraft, and one in a private helicopter.
The entire experience from the day they enter to the moment they leave has been scripted to resemble that of an active duty fighter squadron. All of the pilot instructors selected to teach the course are retired generals, graduated wing commanders or group commanders, with tens of thousands of hours between them. Each day is conducted with squadron briefings. The students are expected to memorize Bold Faces of which they must pass written tests and can be called upon to present orally as emergency procedures of the day at any time. Each flight ends with a pilot-student debrief to review the flight. DO NOT BE MISTAKEN. We are not training pilots and that is not the intent of this course. Each flight is designed to introduce an aeromedical concept. What would it be like to have a physician determine driving privileges on a patient when the physician doesn’t drive? We know the argument! We make the argument. Why does a flight surgeon fly? Each flight and each debrief is followed by an aeromedical decision-making case study. Our senior-most flight surgeons attend each day, ready to catch each baby flight surgeon and conduct their own debrief. For an hour or so the students work through case studies based around the aviation principle they just experienced in flight. For example, after flying a 1.2-hour sortie in a two-ship Cirrus formation and being wing tip to wing tip, the students and the USAFSAM flight surgeon discuss visual acuity, depth perception, and visual fields and review case studies and the impact of waivers for certain airframes vs. other airframes.
In addition to the debriefs, there are a number of refresher aeromedical briefs included during the ground training and safety briefings designed to reinforce the concepts introduced in previous AMP courses. The new curriculum plans to leave AMP 202 wholly intact, but promises to continually improve the case studies and tighten up the learning process.
THE FATE OF AMP 301
The current version of AMP 301 has been a bundling of previously individual courses. Going forward the following will occur:
- Aircraft Mishap Investigation Primary course will return to its prior status as a stand-alone course that will be offered twice annually in the spring and fall.
- Advanced Trauma Life Support (ATLS) will continue to be offered immediately following the conclusion of AMP 202 and will be open to all registrants with priority to pipeline AMP students.
- CBRN training has been included in AFOM 102.
- Centrifuge training has been included in AMP 202.
WHAT HAPPENED TO THE CHIEF OF AEROSPACE MEDICINE (SGP) SYMPOSIUM?
As you may have noticed, we pulled the SGP Symposium offline a few years back, as it had become a bit long in the tooth and was due for some revitalization. This past spring the new course was launched, and feedback from the end-of-course evaluations was off the charts in support of the new direction. The schoolhouse asked us to take the course in a different direction and, in doing so, asked for a new name to come along. AOMED, or the course formerly known as the SGP Symposium, stands for Aerospace and Operational Medicine Executive Development (not my first title choice but it was the one that survives Public Affairs scrutiny). The name change leaves the door open for the course to someday include the presence of senior flight and operational medical technicians who work side by side with the SGP to deliver on the six programs of the Aeromedical and Operational Enterprise.
The course is 5 days long and is structured around two blocks of education. The first 2 days focus on career and professional development to prepare an individual for the role of an SGP. It explains the key concepts and interactions of the enterprise and how to deliver the products the line of the Air Force demands. The first block lays out expectations for the SGP from the different community members, such as wing commanders, emergency response personnel, hospital commanders. It also aids the SGP in understanding the top-down approach to the AOME by gaining a larger perspective regarding emerging topics from the AFMS and core mission programs.
The final block of instructions breaks down the six core programs of the AOME as outlined in AFI 48-101 that the SGP is responsible to deliver to the med group commander via the Aeromedical Council (AMC). Each program is seen from an oversight perspective and then detailed to the significant players and products that work together to deliver the final report. Finally, each program is discussed based on the intended final product or report that must be generated to fulfill the AMC requirements. The intent is for each participant to leave with a clear sense of the breadth of responsibility placed on the SGP as a starting point and with tools to begin to tackle the assignment. The class concludes with round-robin sessions on topics that are too brief to need a full lecture but serve as quick primers or reminders for the new SGP – how to complete a COHERS, what is the science behind the audiology exam and interpretation, what are the appropriate action steps for dealing with a confirmed HIV positive lab result, etc.
The course will be offered twice annually in September and April of each year and is intended for those who have met the SGP selection board, just arrived as a new SGP, and realized somewhere along the way as an SGP that they still have no clue as to what they’re doing.
As you can tell, this is a major undertaking by a small but dedicated group of staff who are committed to the continued delivery of excellent flight surgeons. As with every aspect of our military life, change is in the air. While the drive to produce is forever at our back pushing harder each day, the resources seem to vanish as mysteriously as my youth and good looks. That said, we are focused on building the next level of this house started 101 years ago by the ancestors who left us this charge, “Volanti Subvenimus.” You support the flyer and we support you!
THE FIRST THING ANY USAF FLIGHT SURGEON SHOULD BOOKMARK ON ANY NEW COMPUTER: