A deployed U.S. Navy flight surgeon performs a shipboard exam in the Persian Gulf in 2004.
A flight surgeon is a military medical officer practicing in the clinical field of aviation medicine. Although the term "flight surgery" is considered improper by purists, it may occasionally be encountered.[1]
Flight surgeons are physicians (MDs or DOs) who serve as the primary care physicians for a variety of military aviation personnel on special duty status — e.g., pilots, Flight Officers, navigators/Combat Systems Officers, astronauts, missile combat crews, air traffic controllers, UAV operators and other aircrew members, both officer and enlisted. In the United States Department of Defense, the Army, Navy, and Air Force all train and utilize flight surgeons. In addition to serving as primary care for military members on special duty status and their families, the U.S. Department of Defense uses flight surgeons for a variety of other tasks.
Aviation medicine is essentially a form of occupational medicine and flight surgeons are tasked with the responsibility of maintaining the military's strict medical standards, especially the even stricter standards that apply to those on flying, controlling or jump (airborne) status. In the U.S military, flight surgeons are trained to fill general public health and occupational and preventive medicine roles, and are only infrequently "surgeons" in an operating theater sense. Flight surgeons are typically rated aviators on flight status (i.e., they log flight hours in military aircraft as a crewmember), but are not required to be rated or licensed pilots, naval flight officers, or navigators/CSOs. They may be called upon to provide medical consultation as members of an investigation board into a military or NASA aviation or spaceflight mishap. Occasionally, they may serve to provide in-flight care to patients being evacuated via aeromedical evacuation, either fixed wing or rotary wing.
The civilian equivalent of the flight surgeon is the Aviation Medical Examiner (AME). Some civilian AMEs have training similar to that of military flight surgeons, and some are either retired military flight surgeons or actively serving flight surgeons in a military Reserve Component.
History
The roots of aviation medicine extend back to the earliest scientific discoveries of gas laws and the makeup of Earth's atmosphere as these factors relate to the human body. As aviation progressed from lighter-than-air balloons to fixed wing controlled flight to spaceflight, the disciplines of medicine and physiology were required to track with each technological advance. Physicians and physiologists, such as John Jeffries (1745-1819) and Paul Bert (1833-1886), conducted experiments on humans in flight and documented the body's response to these physiologic stressors.[2] However, it would not be until airplanes were first used in war that the office of the first flight surgeon was established.
World War I
The term "flight surgeon" originated in the early months of 1918 when the U.S. Air Medical Service of the U.S. Army collaborated with two civilian aviation organizations—the Aero Club of America and the Aerial League of America—to manage problems of medical screening and standards for U.S. military aviators.[3][4]
The original intent was for the military and the Surgeon General to understand what was causing the high flight mishap rate. Shortly after the appointment of the first flight surgeons, research and experience led to a dramatic improvement in aircrew health as well as a significant raising of the entry medical standards for all aircrew. The early flight surgeons found that the Army's practice of assigning officers to flight duty who were not physically qualified for infantry or cavalry duty was improper. Because of the G-forces, risk of spatial disorientation, and risk of hypoxia encountered in the aviation environment, among other challenges, early flight surgeons found that aviation personnel must be scrupulously healthy and well trained in the basics of aerospace physiology.
World War II
The role of flight surgeons continued to mature and expand as the U.S. faced World War II. The 1941 movie Dive Bomber, although focused on Naval Aviation, highlighted the role of the flight surgeon just prior to the attack on Pearl Harbor, and demonstrated how solving the problems of hypoxia at altitude would reduce the aircraft mishap rate.
Strict racial segregation in the U.S. Army required the development of separate black flight surgeons to support the operations and training of the Tuskegee Airmen in 1941 and continued in the U.S. Army Air Forces throughout World War II.[6] Following the establishment of an independent U.S. Air Force and the racial integration of all the U.S. armed forces following World War II, this separation was discontinued.
Cold War
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Flight Surgeons were still utilized but only in garrison environments.[citation needed]
During the Vietnam War, USAF flight surgeons were utilized on flights.[7]
Today
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Training
The position of flight surgeon requires additional specialized training beyond traditional medical school; training which is both military and medical in nature. Flight Surgeon training was created as distinct from other medical professionals in the armed forces because of the special, and often higher, minimum standards of fitness and physical requirements required by the extremely high responsibility positions of aviators and ancillary aviation personnel. For example, some routine treatments, such as certain antihistamines, when administered to aviation personnel, are cause for temporary grounding (loss of flying privileges) until the therapy and its effects are completed. Further, the whole "mindset" of aviation medicine practitioners is different from that of non-aviation physicians. Most medical problems on the ground are "an abnormal response to a normal environment", while in aviation the clinician must consider the "normal response to an abnormal environment."
Flight surgeon training varies depending on the branch of military service:
U.S. Air Force
In the U.S. Air Force, most flight surgeons receive initial training at the U.S. Air Force School of Aerospace Medicine (USAFSAM) at Wright-Patterson AFB, Ohio.[8] The entry curriculum is known as the Aerospace Medicine Primary (AMP) Course, a two-week curriculum that involves aeromedical topics as well as aircrew and survival training. AMP is a combination of didactic and laboratory experiences designed to prepare USAF medical officers for basic mission qualification to perform duties in support of the objectives of the USAF Aerospace Medicine Program.[9]
Some Air Force Flight Surgeons ultimately move on to the Residency in Aerospace Medicine (RAM), a three-year program involving a Master of Public Health, a year of aerospace medical training, and a year of either occupational or preventive medical training. Graduates of the RAM are eligible to be double-boarded in Aerospace Medicine and either Occupational or Preventive Medicine, and are generally assigned to supervise other flight surgeons or medical units. The RAM also involves Medical Officer Flight Familiarization Training (MOFFT), during which the flight surgeon receives abbreviated ground school and some basic pilot training in the T-6 Texan II. Consequently, a RAM has some actual piloting experience and some training toward initial qualification, although the aeronautical rating of USAF Pilot is not awarded.[10]
A limited number of USAF Flight Surgeons may also perform duties as Pilot-Physicians (Air Force Specialty Code 48VX). Pilot-Physicians initially begin their USAF service as line officer pilots, later transferring to the USAF medical corps in order to attend medical school. The purpose of pilot-physicians is to provide "integrated operational and aerospace medicine guidance" in the research, development, testing, and evaluation of Air Force systems and missions to realize the greatest effectiveness and cost savings.
Pilot-physicians were previously assigned only to an operational flying squadron in their respective aircraft, with their main assignment as a pilot, but also with clinical duties seeing patients, usually the aviation medicine clinic, depending on the pilot-physician's medical specialty. On 21 April 2011 the USAF Pilot-Physician Program (PPP) was completely revised to make "... the most of the special resources of Air Force officers who are simultaneously qualified both as pilots and flight surgeons...", with a senior pilot-physician selected by the Air Force Surgeon General to be Program Director, and assignment of designated command, staff, research, training, and education billets as well as duty in operational units. A P48VX Air Force Specialty Code (AFSC) is assigned to those medical officers on aeronautical orders as a pilot-physician and assigned to one of these designated PPP billets. Pilot-Physicians are entitled to conditional flight pay (i.e., Aviation Career Incentive Pay or ACIP), that is, only if assigned to an active flying position and flying a prescribed number of hours monthly.
In addition to being a rated pilot and a rated flight surgeon, a pilot-physician must have completed at least three years of operational flying and one year as an operational flight surgeon, with a provision for assigning applicants without flight surgeon operational experience to a base where they would likely become a "first assignment pilot-physician".[11] The revised program allows flight surgeons access to undergraduate pilot training and remotely piloted aircraft (RPA) pilot training (one slot per year); allows participation of flight surgeons with prior experience as USAF Combat Systems Officers/Navigators/Electronic Warfare Officers/Weapons Systems Officers, RPA sensor operators, and flight test engineers as navigator-physicians or flight test-physicians; and authorizes pilot-physicians to compete for assignment to the USAF Test Pilot School.[12]
Pilot-physicians are defined by four core competencies to achieve program objectives: (1) Providing expert guidance through the synthesis of operational and medical experience; (2) Conducting research by applying operational insights to studies, basic and applied science, relevant research, development, test & evaluation (RDT&E), and operational test & evaluation (OT&E); (3) Teaching aircrew, senior Air Force leaders, and medical personnel on subjects of particular expertise, and (4) Conducting analysis to provide recommendations for operational systems, environments, and mishaps; and solutions to human performance problems.[13]
Pilot-physicians are eligible for advanced ratings as both flight surgeons and pilots. They may apply toward advanced pilot ratings any USAF pilot years of aviation service, months of operational flying duty, and total flying hours accrued before achieving flight surgeon status. After attaining status as a pilot-physician, all hours flown as a pilot, and months of operational flying duty credit accrued as a pilot, are "dual-credited" toward both advanced pilot and flight surgeon ratings as long as the officer is on aeronautical orders as an active pilot-physician.[14]
USAF Flight Surgeons hold three different rating levels, Flight Surgeon, Senior Flight Surgeon and Chief Flight Surgeon, contingent upon years of service as a flight surgeon and total flight hours logged. Air Force Flight Surgeons serve throughout the flying activities of the U.S. Air Force, to include flight surgeons in the Air Reserve Component who serve in the Air Force Reserve Command (AFRC) and the Air National Guard (ANG).
Air Force Flight Surgeon insignia
U.S. Navy
Medical debriefing of Lt. Colonel John H. Glenn, Jr., USMC (center) after orbital flight of Friendship 7 on 20 February 1962 aboard the aircraft carrier USSRandolph(CVS-15). The debriefing team for Lieutenant Colonel Glenn was led by Commander Seldon C. "Smokey" Dunn, MC, USN (FS) (RAM-qualified) (far right w/EKG in hands)."Best regards and many thanks for all the help, 'Smokey' John H. Glenn Jr Mercury Astronaut a good date -- 20 February 62"
In the U.S. Navy, initial flight surgeon training is conducted via the Flight Surgeon Primary Course at the Naval Aerospace Medical Institute (NAMI) at NAS Pensacola, Florida. The Flight Surgeon Primary Course is significantly longer than its USAF counterpart and involves a lengthier and more robust version of MOFFT for all candidates, so that all Navy flight surgeons have some formal pilot training in the T-6 Texan II aircraft, up to the "safe for solo" point in training as well as 5 flights in the Navy TH-57 training helicopter. Naval Flight Surgeons may also attend a three-year RAM training program that is distinct from the USAF program. Following training, nearly all Naval Flight Surgeons will be assigned to a deployable Navy or Marine Corps combat aviation squadron in the Fleet (USN) or Fleet Marine Force (USMC). More senior flight surgeons will later be assigned to the staff of a Naval Air Force or Marine Aircraft Wing, carrier air wings, functional/type air wings, Marine Aircraft Groups, the Medical Departments of aircraft carriers or amphibious assault ships, or the staff of Naval Hospitals or Naval Branch Clinics aboard Naval Air Stations, Marine Corps Air Stations and Naval Air Facilities. Naval Flight Surgeons are also eligible command Naval Hospitals, Naval Branch Clinics and the Medical contingent aboard naval hospital ships.
A small number of Naval Flight Surgeons are also "dual-designated" as Naval Aviators or Naval Flight Officers, having either been former unrestricted line officer pilots or NFOs who transferred to the Navy's Medical Corps, attended medical schools, and later qualified as Naval Flight Surgeons; or previously designated Naval Flight Surgeons were selected for a full flight training as Student Naval Aviators. These latter officers are also awarded Naval Aviator insignia, but remain in the Medical Corps as "dual designated" officers, qualified as either a Naval Aviator or Naval Flight Officer and as a Naval Flight Surgeon whom wear both insignia. Such officers are often assigned as research pilots.[15]
A small number of Naval Flight Surgeons—including two dual-designated Naval Aviators/Naval Flight Surgeons: CAPT David M. Brown, MC, USN (FS) and CAPT Joseph P. Kerwin, MC, USN (FS) -- have also qualified as astronauts. CAPT Kerwin flew in 1973 as Science Pilot aboard Skylab 1, becoming the first U.S. physician to fly in space. Two of these officers, CAPT Brown and CAPT Laurel Blair Salton Clark, MC, USN (FS) were both killed during the Space Shuttle Columbia disaster, mission STS-107, in 2003.
Since the separation of the U.S. Army Air Force from the Army as the U.S. Air Force in 1947, Army flight surgeons have primarily focused on the health and fitness of the Army's rotary wing aviators. Most Army flight surgeons graduate from a basic course of 6 weeks taught at the U.S. Army School of Aviation Medicine at Fort Novosel, Alabama, and are then assigned to their units. After some experience in the field, Army flight surgeons are then eligible to participate in a RAM program as described above. In the past, most Army RAMs have participated in the USAF program, but many take part in the USN program, while a few study in the only US civilian RAM program, located at Wright State University. RAM training is the equivalent of other specialty residency training in the United States, and a graduate of the program can take board certification tests and is then considered a fully-fledged specialist. Like their USAF counterparts, Army flight surgeons also hold three different rating levels, Flight Surgeon, Senior Flight Surgeon and Master Flight Surgeon, contingent upon years of service as a flight surgeon and total flight hours logged. Army flight surgeons support all active duty Army Aviation units and personnel, as well as those in the Army Reserve and Army National Guard.
Army Flight Surgeon insignia
Other countries
The training requirements for military flight surgeons in countries other than the United States are different—for example, in the United Kingdom, Aviation Medicine is considered a sub-specialty of Occupational Medicine rather than a fully separate specialty. Thus, Royal Air Force, Royal Navy and British Army specialists in Aviation Medicine are usually required to be specialists in Occupational Medicine before undertaking the specialised training in Aviation Medicine.[16]
The United States Astronaut Badge is a badge of the United States, awarded to military and civilian personnel who have completed training and performed a successful spaceflight. A variation of the astronaut badge is also issued to civilians who are employed with the National Aeronautics and Space Administration as specialists on spaceflight missions. It is the least-awarded qualification badge of the United States military.
The Observer Badge is a military badge of the United States armed forces dating from the First World War. The badge was issued to co-pilots, navigators, and flight support personnel who had received a variation in the training required for the standard Pilot's Badge. The Observer Badge survived through the Second World War and into the 1950s, at which time the concept of an Observer Badge was phased out in favor of the modern Aircrew Badge and Navigator-Observer Badges. In addition to wings for Naval Aviators and Naval Flight Officers, the United States Navy still maintains an "Observer Badge" which is issued to flight-qualified mission specialists, such as a select number of meteorologists and intelligence officers in both the U.S. Navy and U.S. Marine Corps. The U.S. Air Force awards its USAF Observer Badge, which is identical to the USAF Navigator Badge, to Air Force officers who have qualified as NASA Space Shuttle Mission Specialists, have flown an actual mission aboard the shuttle and/or the International Space Station and who are otherwise not previously aeronautically rated as an Air Force pilot or navigator.
A United States Aviator Badge refers to three types of aviation badges issued by the United States Armed Forces, those being for Air Force, Army, and Naval aviation.
The Navigator Badge is a military qualification badge of the United States Air Force which was first created during the Second World War. The current USAF badge is designated by Air Force Instructions as the Navigator/Observer Badge and is issued to rated officers in both rating categories. In 2009, it was renamed as the Combat Systems Officer badge.
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The Flight Surgeon Badge is a military badge of the United States Armed Forces which has existed to designate Flight Surgeons since the Second World War.
Naval Air Station Pensacola or NAS Pensacola, "The Cradle of Naval Aviation", is a United States Navy base located next to Warrington, Florida, a community southwest of the Pensacola city limits. It is best known as the initial primary training base for all U.S. Navy, Marine Corps and Coast Guard officers pursuing designation as naval aviators and naval flight officers, the advanced training base for most naval flight officers, and as the home base for the United States Navy Flight Demonstration Squadron, the precision-flying team known as the Blue Angels.
The Air Force Specialty Code (AFSC) is an alphanumeric code used by the United States Air Force to identify a specific job. Officer AFSCs consist of four characters and enlisted AFSCs consist of five characters. A letter prefix or suffix may be used with an AFSC when more specific identification of position requirements and individual qualifications is necessary. The AFSC is similar to the Military Occupational Specialty Codes used by the United States Army and the United States Marine Corps or enlisted ratings and USN officer designators and Naval Officer Billet Classifications (NOBCs) used by the United States Navy and enlisted ratings and USCG officer specialties used by the United States Coast Guard. The United States Space Force equivalent is known as the Space Force Specialty Code (SFSC).
The Aircrew Badge, commonly known as Wings, is a qualification badge of the United States military that is awarded by all five branches of armed services to personnel who serve as aircrew members on board military aircraft. The badge is intended to recognize the training and qualifications required by aircrew of military aircraft. In order to qualify as an aircrew member and receive the Aircrew Badge, such personnel typically undergo advanced training in aircraft in-flight support roles.
A naval aviator is a commissioned officer or warrant officer qualified as a crewed aircraft pilot in the United States Navy or United States Marine Corps. United States Coast Guard crewed aircraft pilots are officially designated as "Coast Guard aviators", although they complete the same undergraduate flight training as Navy and Marine Corps crewed aircraft pilots, and are awarded the same aviation breast insignia.
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Air Reserve Technicians, commonly referred to as ARTs, are a nucleus of full-time uniformed U.S. Air Force leaders, managers, operators, planners and trainers in what is known as the Air Reserve Component (ARC) of the United States Air Force, the ARC consisting of both the Air Force Reserve and the Air National Guard.
U.S. Air Force aeronautical ratings are military aviation skill standards established and awarded by the United States Air Force for commissioned officers participating in "regular and frequent flight", either aerially or in space, in performance of their duties. USAF aeronautical badges, commonly referred to as "wings" from their shape and their historical legacy, are awarded by the Air Force in recognition of degrees of achievement and experience. Officers earning these badges and maintaining their requirements are classified as rated officers and receive additional pay and allowances.
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The Flying/Aviation Cadet Pilot Training Program was originally created by the U.S. Army to train its pilots. Originally created in 1907 by the U.S. Army Signal Corps, it expanded as the Army's air assets increased.
The RAF Centre of Aviation Medicine is a medical organisation run by the Royal Air Force and based at RAF Henlow in Bedfordshire. It is the main organisation conducting aviation medicine research in the UK.
A squadron in an air force, or naval or army aviation service, is a unit comprising a number of military aircraft and their aircrews, usually of the same type, typically with 12 to 24 aircraft, sometimes divided into three or four flights, depending on aircraft type and air force.
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George E. Schafer was a lieutenant general in the United States Air Force who served as surgeon general of the United States Air Force from 1975 to 1978.
The United States Air Force School of Aerospace Medicine (USAFSAM) is the United States Air Force (USAF) organization focused on education, research, and operational consultation in aerospace and operational medicine. USAFSAM was founded in 1918 to conduct research into the medical and physiologic domains related to human flight, and as a school for medical officers trained to support military aviation operations, later coined as flight surgeons. The school supported early military aviation from World War I through the evolution of aviation and into the modern era. USAFSAM conducted medical research and provided medical support for the initial US space operations beginning in 1947 through the establishment of NASA in 1958. After the creation of NASA, USAFSAM continued to actively support civilian and military manned space missions through clinical and physiologic research. USAFSAM is one of the oldest continually operating school for flight surgeons and other operational medical personnel of its kind in the world. USAFSAM is located in Dayton, Ohio at Wright-Patterson Air Force Base, and is part of the 711th Human Performance Wing and the Air Force Research Laboratory (AFRL).
References
↑ Department of the Army, Army Regulation 616–110, Selection, Training, Utilization, and Career Guidance for Army Medical Corps Officers as Flight Surgeons, 19 March 1986, page 4. The "Glossary" [Section II, "Terms"] of this official Army regulation defines "Flight Surgery" as "A nonexistent term". It also distinguishes "Flight Medicine" as a specialty practiced by USAF flight surgeons, whereas "Aviation Medicine" is one practiced by US Army flight surgeons.
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