New Millennium, New Mind-Set: The Air Force Medical Service in the Air Expeditionary Era

Aerospace Power Journal, Winter, 2001 by Paul K. Lt Gen Carlton, Jr.

LT GEN PAUL K. CARLTON JR. (*)

Editorial Abstract: Diverse threats to our nation's security, both at home and abroad, challenge the Air Force's medical personnel to develop innovative solutions to provide medical support for a wide range of military operations. By using highly portable medical teams and modularizing deployable assets; commanders can tailor medical response to fit the unique features of each situation. Partnering with sister-service and coalition medical services achieves synergistic effectiveness.

AS COLD WAR scenarios fade from memory and dozens of small-scale contingencies around the world challenge deployed military medics, military medical services are rethinking their readiness philosophies to fit a new paradigm. Each service must prepare for a spectrum of operations much broader than the traditional wartime role. What are the diverse missions faced by the military medics who must support these operations? What are the readiness roles in these uncertain times?

The National Military Strategy of the United States, Joint Vision 2020, and Air Force Vision 2020 all point to continued global, proactive engagement by Air Force people. Because this cannot happen without effective medical support, the Air Force Medical Service (AFMS) is transforming itself in order to develop the necessary expeditionary culture.

My "vision" for the AFMS emphasizes that Air Force medical personnel must be able to support the Air Force mission throughout the full continuum of military operations in which airpower may be employed, as described in Air Force Doctrine Document 2, Organization and Employment of Aerospace Power 17 February 2000. To do this, medics must be able to provide support across three broad categories of deployment scenarios: humanitarian and civic assistance (HGA), medical response to disasters, and support of traditional wartime operations. These scenarios also directly support Air Force Vision 2020. For example, HCA missions demonstrate vigilance by promoting democracy, peaceful relationships (military-to-military and military-to-civilian), and economic vitality--a sort of "preventive medicine" against war. We demonstrate reach by responding promptly and appropriately to disasters when invited by an allied country and when called upon to augment disaster response by civil authorities at home. Both HCA and disaster- response missions create opportunities for our medical personnel to gain valuable experience during deployments that carry over to support wartime operations. Thus, they support power, our traditional readiness mission.

Medics face diverse and frightening challenges as our military increases its participation in nontraditional roles. Potential scenarios could involve weapons of mass destruction, natural disasters, and complex technological/political/natural crises. A regional or worldwide epidemic, such as the outbreak of influenza in 1918, could have enormous impact on all medical personnel. None of us need to be reminded of the recent tragic consequences of terrorism that put medical response to a severe test. Controlling such events can avert worldwide economic catastrophe and subsequent potential conflict.

Since each situation is unique, lessons learned from previous disasters will not solve all the problems of a new crisis. But one can learn general lessons and apply them to the development of generic plans for responding to different types of disasters. On the one hand, earthquakes, for example, can result in major surgical casualties, particularly in the first three days after the event. The need for intensive care and renal dialysis may overwhelm the civilian medical system's capability. On the other hand, a flood or hurricane may cause few surgical casualties but increase demand for emergency-room and public-health services as well as ongoing basic health-care needs, such as refilling prescriptions.

This scenario, combined with the potential loss of medical infrastructure, may overwhelm the local civilian medical system, as recently demonstrated when floods struck Houston, Texas, during Tropical Storm Allison. The Air Force deployed a 25-bed field hospital within 24 hours of receiving urgent requests from Texas and the Federal Emergency Management Agency. In such cases, the rapid insertion of lightweight, rapidly deployable, well-equipped surgical teams and field hospitals may prove critical to saving as many victims as possible while decompressing the civilian health-care system enough to give it a chance to recover. Most disasters create chronic needs for the local population that require long-term development work for full recovery. As the civilian health-care sector's ability to respond to sudden increases in casualties declines, senior government officials and citizens more than likely will expect military medics to assist quickly.

Medical-response missions could occur either just outside a domestic military base or overseas. Requests for domestic civil support would originate from local and state governments to appropriate federal agencies, which would then route the requests to the Defense Department. Overseas, these types of requests would come through the State Department, as they did after Hurricane Mitch struck Nicaragua in 1998 and floods swept through Mozambique.