Medicinal thoughts - Flight Lines - Brief Article - Editorial

Aerospace Power Journal, Winter, 2001 by Eric Col Ash

WE USUALLY DON'T think about breathing until we can't. This literally involves one of the most important facets of war--medicine. Just as weaponry, reconnaissance, communications, and myriad other technologies have experienced phenomenal advancements, so too has military medicine progressed in quantum leaps of a revolutionary nature. Far removed from the era of Florence Nightingale during the Crimean War, military medicine now enjoys capabilities that translate into significantly increased comfort and prospects of survival for injured combatants on the battlefield or for innocent civilian victims of terrorist attacks or natural disasters.

Despite its critical importance and the dramatic improvements in practices, military medicine has remained an obscure topic in most professional military journals, including this one. In fact, a cursory glance at the history of Aerospace Power Journal (as well as that of its predecessor, Airpower Journal) reveals a paucity of attention afforded to aerospace medicine--until now. We are focusing on this important topic with several interesting pieces that suggest a new perspective on military medicine for most readers. Similar to aerospace superiority (another thing, like breathing, not to be taken for granted), military medicine is not only essential to mission success but can be the mission itself. Military medicine finds itself more closely linked to the very essence of our national policy in terms of engaging globally with humanitarian and disaster assistance and connecting with force protection--of paramount importance to military involvement worldwide.

As military medicine becomes increasingly involved with the total force, jointness, and coalition efforts with other nations and various organizations, it experiences the growing pains of new wineskins. Global engagement has tremendous implications for the Air Force Medical Service, and just as airmen--from fighter pilots to joint force air component commanders--have to accommodate the demands of timely decision making, so does the medical service find itself in an observe-orient-decide-act (OODA) loop in its worldwide challenges. Basically, the challenge calls for doing more things faster with a lighter, leaner medical force. The argument presented by Dr. Tom Hughes in one of our articles--that quicker may not always be better--has a perplexing application to military medicine, in which one measures the difference between life and death in seconds and heartbeats.

Threats to national security, vital national interests, and international stability are becoming increasingly complex and unpredictable. Similarly, military medicine is facing far more complicated challenges. But as some of the articles in this issue point out, Air Force medicine is up to the task. The piece by Lt Gen Paul Carlton Jr. highlights the current shift in emphasis on patient care to quicker, leaner, lighter, and essential-only systems that can react appropriately in support of the expeditionary Air Force. Brig Gen Bruce Green explores the same theme by looking at the history and current state of aeromedical evacuation--not just some peripheral issue but a "line of the Air Force" concern. In another article, Col James Dougherty points out the unique nature and "special" challenges of providing medical support to special operations forces. Finally, the Vortices opinion piece by Lt Col Stephen Howard attacks the rationale behind the drug-war efforts in South America, a topic with important medical con siderations for today's environment.

Air Force medicine is moving from the realm of the supporting to that of the supported--from the shaft to the tip of the spear. As such, it is increasing in its capability to respond and decreasing in size and response time. Integral to the overall effort is medical situation awareness on the part of the entire Air Force, including this journal. Hopefully, readers will understand this as they take their next breath and read on.