The US Army has recognized the importance of meeting the health care needs of aviators, who must maintain a high standard of physical fitness, since creation of the Army Air Corps before WWII. The flight surgeon is a clinician whose primary responsibility is the health care of personnel on flight status. An aeromedical physician assistant (APA-C) is a clinician who can fill the role of flight surgeon.
The training program for flight surgeons is designed to develop the clinician's ability to recognize potential medical problems or the sudden incapacitation of an aviator. Flight surgeons also fly a minimum number of hours in order to understand the effects of fatigue, vibration, and noise on an aviator. This is my second tour to Iraq but my first tour "on flight status."
■ 2200 HRS
I am just back from flying a mission north of Baghdad. I am barely able to stand, and a wave of fatigue and nausea comes over me as I egress the Blackhawk helicopter. I am close to being a heat casualty after flying over the combat zone for 6 hours in 130-degree heat. I sit down on the edge of the runway and recall the events of the day, thankful to be back in familiar surroundings.
I remember one small forward operating base (FOB) we landed
at for a short stay; the FOB was located along the border of Iran. Like every other combat outpost, it was blanketed with dust and
surrounded by 15-foot-high cement walls.
I learned that the medics at this FOB were available only for sick call and emergent care issues. I walked around in an attempt to link up with the medics. A sergeant at the base heard I was there and asked me to help the medics evaluate incoming injured coalition troops who had been involved in a motor vehicle rollover. I was directed to the medic tent and waited for the patients. I quickly triaged the patients' injuries, and the medics got to work treating their wounds, which appeared to be non-life-threatening orthopedic injuries. Nonetheless, the patients were stabilized and packaged up for medevac. I waited for the medevac helicopters to circle above and handed the situation over to the FOB medics, as my crew was waiting for me. I could see the patients being loaded onto the medevac helicopters as we lifted off and circled above the base. Watching the scene below, I smiled to myself, knowing that I had really made a difference today.
■ 0800 HRS
Back at my base in southern Iraq, I've dragged myself out of my bunk and now I'm evaluating routine sick-call patients. Sick call includes almost everything you would see in the States, conditions as mundane as athlete's foot to a sprained ankle. I give the medics some quick on-the-go tips on everything from pathophysiology to pharmacology while evaluating patients, which works out great because the patients appreciate the education as well.
■ 1130 HRS
Before going to lunch, I double-check the list of soldiers given influenza immunizations. On arrival in Iraq, many soldiers were quarantined with flulike symptoms and subsequently tested positive for the flu. The remaining asymptomatic soldiers didn't want to get sick or be stuck in quarantine, so they all got their shots.
■ 1300 HRS
When I return from the chow hall, I check the afternoon patient schedule; only two patients require a flight surgeon. One is an unmanned aerial vehicle (UAV) operator/pilot, and the other is a crew chief. The UAV pilot is an easy flight physical; he is healthy and the evaluation is quick. Although pressed for time, I like to find out information, so I ask, "Anything interesting out there to see?" All the UAV pilots give the same answer: "No." I know they have to be pretty tight-lipped because of operational security, so I don't press the issue.
The crew chief presents for a recheck of what at first appeared to be some ulnar-nerve symptoms. I had initially inquired about his positioning in the Blackhawk, which included sitting at the side of the helicopter holding onto a machine gun while leaning on his elbows out a side window. He was advised to use elbow pads and attempt a different position, one that does not involve leaning on his elbows; now he is returning to let me know this seemed to help and his symptoms are improved.
The medic reminds me that I am scheduled to work the emergency room (ER) by myself, which supports a base with more than 7,000 soldiers, sailors, marines, and airmen. The ER is supported by an on-call forward surgical team (FST) capable of handling most trauma that comes through the door. Little did I know that this would be a night I would call for their help.