Kalpesh K. Purohit DO,MMS MAJ, MC, FS US Army Aerospace Medicine Resident
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Kalpesh K. Purohit DO,MMS MAJ, MC, FS US Army Aerospace Medicine Resident Discuss roles of Flight Surgeon in combat unit Discuss current state of Aviation Medicine in Iraq from BN Flight Surgeon Perspective Discuss aviation specific medical threats in Iraq Discuss aviation specific medical care in Iraq The comments and opinions expressed in this presentation are solely those of the author (Dr. Kalpesh K. Purohit) and do not represent those of the United States Army, DOD, or UTMB Could spend hours and days covering this topic General discussion of major clinical aspects Operational medicine from flight surgeon just returned from the field Previous operational assignment- Brigade Surgeon for 1st HBCT, 2ID Camp Casey, Korea- 10 miles from DMZ BN Surgeon (flight surgeon) for 3-4 AVN Regiment, 4th CAB, 4th ID from September of 2007 to June 2009 Deployed in support of OIF in June 2008-June 2009 Currently an Aerospace Medicine Resident in US Army 3-4 AVN Regiment, 4th CAB, 4th ID Fort Hood, Texas Blackhawk BN with 30 aircraft, 3 flight companies and over 400 personnel Mission: On order, 3-4 AVN REGT deploys to conduct air assault, air movement, and aviation tactical mission support across the spectrum of conflict. Deployed in support of OIF from June 2008 to June 2009 to Camp Taji, Iraq (Chemical Ali’s HQ) north west of Baghdad 0 aircraft lost, 0 fatalities in combat Flight Surgeon (1st Deployment) Aviation Physician Assistant (3rd Deployment) Medical NCO (3rd Deployment) Medics- 2 on hand Equipment Communication between team members essential especially when they have been deployed before Medical liaison with command Clinical Duties Administrative duties Safety Operations Medical training Routine primary care for all aviation and support personnel Maintain medical records on all personnel Ensure timely evaluation of aviation personnel who are medically disqualified Evaluate newly assigned aviation personnel for fitness to fly Up slips/down slips Monitor the physical and mental health of aviation personnel Liaison between medical and aviation elements acting as advocate for the Aviation Medicine Program Establish procedures for automatically grounding crewmembers when seen in other clinics Remind crew members to get their flight physical done Advise the commander on crew endurance crewmember interactions crewmember interface with equipment Crewmember interface with the environment Participate in unit level safety meetings Serve as an Accident Investigation Board member Monitor the ALSE program Monitor survival and physiologic training Advise the command of potential safety problems Promote the health and safety of aviation personnel by instituting a health education program Monitoring the conditions and hazards present in the work environment Assist the unit with annual occupational health and safety screening for non-crewmember personnel (e.g. fuel handlers) Participate in flight line operations Aeromedical Occupational inspections Monitor physical and psychological stresses Observe flight operations in order to monitor stresses contributing to human error in flight à field training exercises and unit day-today activities à frequent flight line visits Readiness and mobility support: Ensure the command considers medical aspects of all missions Assist in staff planning activities associated with operations Review operation plans (OPLANS) Advise the command on physiological and psychological factors affecting operations and crew endurance Conduct crewmember aeromedical training Level I- Combined Troop Aid Station for entire brigade (over 3000 personnel) 6 Doctors and 6 Physician Assistants, 30 Medics Connectivity 24-7 Continuous operations with continuous sick call Level II for X-ray and lab (on base) Level III- CSH (Med EVAC) Predeployment MASCAL/Accident preparation Flight Physicals/ Waivers Preventive Medicine Infections flare ups MRSA Allergic Reactions Supplement abuse Hydration/heat injury Psychiatric conditions Sports Injuries Chest Pain mTBI Fatigue Medical Readiness Profiles Rehearsing and working with medical section SRP Flight Physicals Medical Records Aid bags for sick call while in transit and in Kuwait (Pelican Case for Narcotics) Placement of Trauma Chests- Airfield, Dining Facility, Latrines Base wide Plan with monthly rehearsals History of Mortar attacks MASCAL plan rehearsed and updated constantly FDME and waivers using AERO for Army personnel Connectivity Some difficulty with personnel on flight status from other units- UAV operators (no record in AERO) Also Navy and Air Force flight physicals Garrison NOT field standards Bottled water Food sanitation Hand washing (station in front of dining facility) Carry out (stored at airfield) vs dining-in Fast food (BK, Popeye’s, Pizza Hut) Hygiene Laundry (done for us) Showers Unable to get cultures in time to make clinical decisions- results could take weeks to months. (Still getting results after re-deployment) Many infections treated empirically due to being deployed to less than sanitary conditions URI- Decongestant, antitussive, other supportive care .If patient needed for mission- given Azithromycin Sinus Infections- supportive care, Also started on Abx early- ie TMP SMX Diarrhea- Most often viral treated with supportive care (loperamide, Pepto). If no relief after a few days used Cipro. Culture results difficult to get Ultrasound was used to visualize and abscess Cellulitis and abscess- MRSA endemic TMP SMX Clindamycin If no improvement, treated with IV Vancomycin and med-evac’d to CSH for further care Initially treated with I and D, then started on Cephalexin No improvement so started on Clindamycin/TMP SMX Culture results came back 1 week later- MRSA Full return to duty- 2 weeks Many times- unknown triggers Food, medication, soap Utricaria, angioedema, Rhinoconjunctivitis, generalized anaphylaxis, dermatitis Epi, O2, NS IV, Continuous Vital Signs, Steroids, Benadryl Always ready for airway management- RSI, Glide Scope, Intubation- (did not occur) Allergist consult and testing done on redeployment Became a huge concern after 1 patient had to be evacuated to CSH with Renal Failure After return to duty, continued taking supplements and was evacuated again to CSH with hypokalemia Found supplements in his room for weight loss and body building including Xenadrine and Creatine Command Issue Formal Education program begun stressing common sense along with proper hydration Clinic visits to literally go over each and every supplement being taken Still sold in PX Heat fatigue mostly, with some heat exhaustion. Luckily no heat stroke seen Minimal- water was placed literally everywhere. High potential due to body armor, high temperatures, and high optempo Acclimatization Air conditioning Mental Health on base with on call Usually seen that day for initial consultation Few needed evacuation SSRI’s used- 4-6 month grounding after started and on stable dose Ankle Sprain Knee pain Back pain X-ray RICE, NSAIDS, Tylenol Physical Therapist on base initial work up and rule out by enzymes Flight crew members needed GXT Done in theater at CSH Routine Able to return flight crew back to full flying duty after return with normal results (usually 3-4 days) Used Military Acute Concussion EvaluationMACE questionnaire Evacuated to CSH for CT scan and work up along with Neurologist consult Continuous operations- 24/7 Someone is always sleeping during the day 8 hours of sleep sometimes difficult to attain Schedule changes happened frequently Ambien used most often, Lunesta less frequently(with commander approval) Stimulants were stored in clinic if needed for continuous operations, but luckily were not used, Modafinil, Dextroamphetamine (with commander approval) Aviation unit- could be completely different for an Infantry or Armor BN Not what was expected Connectivity is critical- communication, information, flight physicals Less trauma than was expected Infections treated with antibiotics empirically Fatigue and sleep issues need to be addressed continuously Flight line visits very important Be ready for anything Communication with commander
