Spring 2012
AANGFS
AFRFSA
1
Alliance of Air National Guard Flight Surgeons
Volume 24, Issue 1
The National Defense Au-
In this issue
NDAA
1
President’s Column
Lt Col Lisa Snyder
2
3
On the Glide Path
BGen Worthe S. Holt, Jr
4
Movie Review: Contagion 5
Thanks Fort Wayne!
6
The Doctor’s Corner
LOD Bullets
7
MRRFP
Col Gentry
8
Transfusion Support
Col Eisenbrey
9
BGen Chow comments
10
Joint Domestic Medical
Operations
Skin Cancer Concerns
Maj Latham
11
Tech Tips - Col Sotos
12
Editors 2 Cents
Book Review
Published by the AANGFS and on website: www.aangfs.com
13
Black Hawk Down
Speaker
AANGFS Dinner pics
14
BIFFS
SAS pics
Alliance Officers
15
Membership Application
16
Air Force Core Values:
Integrity first,
Service before self,
Excellence in all we do
thorization Act (NDAA) for
Fiscal Year 2012 for $662.4
B has passed both Houses of
Congress with final approval
by the Senate on December
15, 2011.
The bill is very long and complex; following is a summary
and highlights of those areas
of interest to the Guard and to
military medicine.
(Also contained in the bill was
a contentious provision regarding detainees: although
the Senate sponsors and
White House contended that
current law allows indefinite
detention of suspected terrorists, the NDAA codifies the
President’s authority to indefinitely detain terrorism
suspects, including American
citizens, without trial, a provision that has received attention from the American Civil
Liberties Union.)
Due to strong support from
Guard members and the
NGAUS, the NDAA includes
Chief of National Guard
Bureau as member of the
JCS and re-designates the
Director of the Joint Staff of
the National Guard Bureau as
the Vice Chief of NGB.
The End Strengths will be:
106,700 ANG; 71,400 AFR
Hostile fire and imminent
danger pay will be prorated
according to the number of
days spent in a qualifying area
rather than be paid on a
monthly basis.
Spring 2012
ber who is deployed in support of a contingency operaAir Force F-35 request retion at specified times before
duced from 19 airframes to
and after the deployment.
18. Navy and Marine Corps
Authorizes the Secretary of
receive full request, 7 and 6
Defense to provide members
respectively. The F-35 Low
of the reserve components per
Rate Initial Production Lot
-forming inactive duty train(LRIP) contracts are to be
ing during scheduled unit
negotiated at a fixed price.
training assemblies access to
mental health assessments
The Department of Defense
with a licensed mental health
may conduct offensive opera- professional.
tions in cyberspace subject to
the policy principles and legal Authorizes the Secretary of
regimens for kinetic capabili- Defense to provide an activeties, and the War Powers
duty service member with a
Resolution.
severe injury or illness with
rehabilitative equipment.
Of specific interest to military
medicine, the NDAA does
Requires the Secretary of Defense to prescribe improved
not prohibit TRICARE
regulations for commander
Prime enrollment fee increases in fiscal year 2012
and supervisor referrals for
and limits annual increases of mental health evaluations of
the fee to the amount equal to service members.
the percentage increase in retired pay beginning on Octo- Requires that, in determining
ber 1, 2012.
whether TRICARE network
providers are subcontractors
The NDAA prohibits the Sec for the purposes of the Federal Acquisition Regulations
-retary from proceeding
with restricting of the mili- or any other law, a TRICARE
tary health care system until support contract which inGAO assesses a report by the cludes a requirement to estabSecretary of Defense on oplish, manage, or maintain a
tions developed and considnetwork of providers shall not
ered for governance of the
be considered to be a contract
military health system. Aufor the performance of health
thorizes $31.8B for the Decare services or supplies.
fense Health Program. Does
not prohibit pharmacy copay- Limits funds for the future
ment changes.
electronic health records pro
-gram until the Secretary of
Requires the Secretary of De- Defense submits a report to
fense to provide person-toCongress on this program.
person mental health assessments for each service mem- - submitted by Col Bill Pond
Spring 2012
From the pen of the AANGFS president:
AANGFS
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ercise.
4. Don‘t choose your S & E medics to drive the
Medical Element‘s vehicles; the timing just doesn‘t work
out well for them to be there with the medical group after
There are many teams that have been doing this mission
successfully and impressively for a few years, so you might staging
wonder why I am writing this article. Well, that is a good
5. Pick a person (Grounds Master) to work with the
question, and I have a two part answer: First, after leaving
Decontamination
Element, after IC link up, who is really
the NGB/SGPA position and returning to the Indiana ANG,
good
with
spatial
visualization
and who can communicate
I was luckily and proudly assigned to the position of Mediwell. This interaction before set up is, I think, one of the
cal Element leader for the IN CERFP ( the first group to
most crucial events that happen in the exercise. If this
receive the dedicated 47- person package while executing
the shortest spin up time of all the new units) and second, I doesn‘t get set up correctly, note the problem with #6, # 8
and # 10. The Grounds Master needs to be the set up boss.
was asked to write this by one of the senior leaders in the
Too many people trying to run the show got messy (sound
ANG Medical Service. Like an obedient Lt Col, I said:
like the voice of experience? – it is). It is also confusing for
Yes Sir!
the team trying to figure out where to set up tents, etc if
there is more than one voice directing the set up.
As with any mission, there are many good ways to get the
job done efficiently and effectively; this is just a compila6. Keeping the distance between the Decontamination of information that helped the IN ANG CERFP Medition
tents
to triage (between Decon and Medical tents) to
cal Element succeed. Of course, the biggest contributor to
the
Medical
tent safe, but as close as the lines allow is imthe success is our members, and I have to say that the ANG
portant in order to eliminate increased patient transport
medical members from both units in the state of Indiana
time.
pulled together as a unified, well functioning machine.
Without their hard work, expertise, professionalism and
7. If at all possible assign tasks for Medical equipdedication – we would NOT have succeeded. Because of
ment
set
up, as this allows for repetitive best practice learnthem we passed our portion of the ex-eval in August after
ing,
decreased
set up time and importantly, decreased injujust 6 months of preparation. Exposure to a CERFP exerries and equipment breakage due to familiarity with the
cise and Ex-eval early on in the preparation further facilitated our success. I highly recommend a ―jump seat‖ on an equipment. Some examples include:
a. Stretcher and stretcher roller device assembly
ex-eval as a ―must do‖ for key members of the leadership
teams (both can cause injuries to fingers and
team, because that really sets up the big picture and allows
having a few ―specialists‖ worked out great).
time for questions concerning the details.
b. Identify members of tent 1 – 4 teams, each tent
team having an identified tent master so the
The list below contains ten ―lessons learned‖ which are
team‘s cues are consistent to the same people
listed in chronological order and not in order of importance:
executing set up each time (remembering to put
1. When selecting personnel to fill the 45 tradimembers on each team with varied vertical
tional positions, try to get both seasoned and new personmeasurements).
nel. As we hope this mission will stay for a while, it is
c.
Generator and HVAC assistant moving teams –
good to grow members in those positions and the seasoned
trying to set up in the same configuration each
members serve as excellent mentors.
time, if possible. Identifying this team allows
practiced, coordinated team lifting/moving tac2. When receiving the shipment of equipment,
tics. Unfortunately we assigned this team after
don‘t discard the boxes with the inventory identification
a back strain, a painful lesson learned.
codes; tracking the information later is very difficult and
d.
Med Toc team (we used MCC for Medical
labor intensive. Suggestion: have an established CERFP
Control Center) – sets up their own work space
logistics specialist with you at the time of receiving/packing
just the way they want it with a consistent plan.
the trucks.
e. Safety officer who will speak up and throw up
the flag when needed
3. Assign transportation spots in trucks, buses,
f.
Truck superintendent – for protocol of convoy,
vans etc. Accountability is much easier and there is less
maintenance and repair.
scrambling in the end. Identify (and get in writing) what
the requirements are required for drivers as it seems to vary
8. If you have ―stretcher set up specialists‖, they
by type of installation and state. It can be time-consuming
to catch up on requirements, if needed, right before the ex(Continued on page 3)
CERFP Lessons Learned
Spring 2012
AANGFS
(Continued from page 2)
can teach all team members, Army and Air, how to use
these correctly so none of the participants get dumped off
the litter. Our Army team members were a key as far as
manpower for moving patients and knowing how to work
this equipment was crucial. Most Medical Elements can
not sacrifice the personnel to move patients in and out of
tents/triage, etc. and if they can sacrifice the personnel, I
would argue it may not be the best use of their skills.
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and should have stated that to give the team members due
credit.
Working toward and passing the Ex-eval was an incredible
experience with an awesome team but could not have happened if the entire state leadership, including our TAG,
Chief of Staff, State Air Surgeon and both Wing Commanders and Medical Group Commanders, had not been
totally dedicated to supporting this mission. It is to them
and the team that the credit should be given. As this is a
9. Set up an expectant area / morgue close, but not joint mission, one more vital element should be mentioned
right at the back of the tent. It gets too cumbersome to con- in this success story, our Army team members and the
stantly walk around the area.
CERFP commander. Our chosen C2 leader, an impressive
Army LTC and an engineer by training, was able to me10. To ―pick up the patients,‖ select an ambulance thodically and skillfully put all of the moving parts together
and bus route that is feasible and close to the back of the
with the assistance of the full time team at the state level.
tent. Otherwise, a large amount of time is spent by someone moving patients a greater distance; you may get
Again, these are thoughts that I hope will be helpful as a
―dinged‖ for this, even if it is all pseudo - performed.
list of ―lessons learned‖, but admittedly, by far does not
represent the only way or even the ―best way‖ I am sure.
I have to brag on the team I was fortunate enough to work However, if you are feeling a bit lost, like I was in the bewith during this ex-eval. After having met once in April
ginning, hopefully this article will provide a few ideas as
when we received the equipment and only having worked you begin or continue your journey to the Ex-eval! Best
together for one exercise prior to the ex-eval, our time to
regards and good luck!
Medically Capable and ready to treat patients was….only
24 minutes. What does Medically Capable mean? For the Lt Col Lisa
TE & O‘s that we were tested IAW, it was defined as: the ―SWAT‖
main four tents set up and secured, power, lights and oxy- Snyder, MD,
gen in the tents with work stations set up to treat the sickest MPH
patient and a fully functional Medical Control Center. Us- Indiana Air
ing laminated TE & O‘s, I expressed our compliance with National
any remaining, unfulfilled items to the evaluators at any
Guard
available opportunity. That part is an open book test. Un- RAM 2008
fortunately, I did not express that even though the personnel all had specific assignments; many were cross trained
to other positions (such as generator set up/start up, etc)
This is
music??
After completing the Advanced Burn Life Support Course
at AMSUS, Col Robert “golden voice” St Clair leads the
band to the accolades of music critic, Col Clee Lloyd
The retirement ceremony for Col Reid Muller was held
on March 4, 2012 Hancock Field in Syracuse—
Congratulations, Reid, for a stellar career and dedicated
service to service men and women across the nation; the
nation is better because of you. We wish you the best.
AANGFS
The ONLY time you have too much fuel is when you're on fire.
It was a privilege and pleasure to attend the promotion
ceremony of Worthe S. Holt Jr., to the rank of Brigadier
General on October 29th, 2011. His remarks reflect well
upon the Guard and are instructional for us all, especially
our younger members. I am pleased that BGen Holt has
allowed us to share his remarks—WWP
I am thrilled to
have this opportunity, and
to share this ceremony with
so many of you here today.
I would like to acknowledge my wife, my two
sons, my in-laws, my parents, the Minnesota delegation, and all of you for participating today.
Over 30 years ago,
I joined the National Guard
because of a desire to fly
fighters. In a short period
of time, my motivation matured, and I developed a
profound sense of patriotism and commitment to our
country. I recall arriving at
Laughlin AFB, TX and
seeing the words ―Duty,
Honor, Country‖ painted
on the side of a building.
As you recall, General
Douglas MacArthur‘s address to West Point resonates continuously for all of us who have pledged to
serve. ―Yours is the profession of arms, the will to
win, the sure knowledge that in war there is no substitute for victory, that if you lose, the Nation will be
destroyed, that the very obsession of your public service must be Duty, Honor, Country.‖ I have never forgotten that, nor will I forget the driving force our Air
Force values have had upon me as a guide. Integrity
First, Service Before Self, and Excellence in All We
Do.
My presence here today is as much a story
about perseverance as it is about individual success.
Nothing that I have accomplished would have occurred were it not for the support and encouragement
of my family, friends, my Pilot brothers, and the airmen I have been so fortunate to work with. There
have been many important lessons along the way that
have been instrumental in helping me to grow as a
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4
person and prepare me for this next journey. I still
remember E.J. Bozarth dressing me down when I arrived in Aviano, Italy for oversleeping and missing
my F-4 launch the previous day. I remember Rock
Barchfeld grounding me for flying too low. Now I
guess, if you‘re going to get in trouble as a fighter pilot, it might as well be for going too fast or too low.
Nonetheless, those were
just two of many valuable experiences with
important lessons for
me about professionalism, responsibility, and
accountability. Teddy
Roosevelt said, ―Far
better is it to dare
mighty things, to win
glorious triumphs, even
though checkered by
failure, than to take rank
with those poor spirits
who neither enjoy much
or suffer much, because
they live in the gray
twilight that knows not
victory nor defeat. Despite the ups, downs and
challenges along the
way, my military career,
and in fact, my entire
life has been an incredible journey.
This celebration
today is also the result of participating on some exceptional teams. I have been fortunate to be a career long
member of the 113th Fighter Squadron, and the 181st
Medical Group, both within what is now the 181st Intelligence Wing in Terre Haute. I am now excited to
serve with the Minnesota National Guard, including
the 148th Fighter Wing and the 133rd Airlift Wing.
With such tremendous people and assets around you,
it is easy to succeed. It has been an exceptional privilege and honor to work and interact with all of you in
one capacity or another, and I pledge my service to
you in this new role. I won‘t let you down. Furthermore, as stated in the Airman‘s creed, I will not falter,
I will not fail, and I will leave no Airman behind.
Thank you
Every takeoff is optional. Every landing is mandatory.
It's always better to be down here, wishing you were up there, than to be up there, wishing you were down here
Spring 2012
Spring 2012
AANGFS
Movie Review: Contagion
(And why every Guard member should see it.)
By
Col William W. Pond, MD, SFS, MC
Indiana State Air Surgeon
Aside from portraying the Guard in a
humane, favorable
light and aside from
a gripping, realistic
story line, Contagion is a must see
for Guard members
who might be called
to deal with a pandemic disease outbreak.
Although World War
I claimed 9 million
soldiers and 7 million civilians, few
know or appreciate
the fact that the
1918 “Spanish flu”
pandemic claimed
even more civilians—50+ million died of flu associated illness! What if today another such pandemic
occurred with a strain that was just a little more
deadly with a larger population at risk and with jet age
mobility? Imagine morgues filled to capacity, hospitals able to accept only a fraction of those needing
care, schools and childcare closed, nurses remaining
at home to care for children, police and firemen
stretched to the limit, population rioting for food and
basic supplies…truly a scary situation with a desperate need for the Guard.
Without giving away too much of the suspense, intrigue and twists, I can say that the story is set in the
present and stars Matt Damon, Laurence Fishburne,
Kate Winslet and Jude Law who are closely involved
with the developing disaster and who cope in their
own ways. This pandemic starts hidden in the backdrop of the normal flu season which typically attacks 5
-20% of the population and which kills 3,000-49,000
in the US each year. But in Contagion, the damage
is far worse than 1918 with a flu that is believably and
only slightly more virulent with an attack rate surpassing the 1918 infection rate of 33% and mortality rate
of 10-20%. The movie does not postulate a nonbelievable 100% fatal, super bug like the Andromeda
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Strain; and therein lies the movie’s power because
the Contagion scenario is truly plausible. (The film’s
scientific consultant, W. Ian Lipkin is a brilliant physician, epidemiologist scientist, internationally recognized for his work on both the West Nile virus and
SARS.)
Influenza strains periodically
shift phenotypes when genetic viral material undergoes
reassortment usually with the
assistance of an intermediary
such as pigs; this surface antigen change may alter fundamental transmissibility and
lethality properties, such as
the ability to induce a
“cytokine storm” in the young
with their more robust immune system. (In 1918,
young patients were stricken with hemorrhage from
the mucous membrane, pneumonias, petechial hemorrhages or death) Although the source and history
of the 1918 flu are somewhat unclear, it is abundantly
clear that the new strain’s elevated attack rate and
lethality were intensified by a more mobile population.
The final results in 1918 were devastating and societally transformative.
Contagion is powerful because it realistically portrays
the disbelief, grief and frustration felt by families as
young, otherwise healthy people die. In our present
medical paradigm, we as a society, have come to expect that that only the old and the infirm succumb to
diseases; young healthy people die only in history
books—not so. A powerful realism resonates as physicians, scientists, Homeland Security, Center for Disease Control, Minnesota National Guard, police, fire,
physicians, nurses all work furiously to find a cure, to
treat the patients and to restore social order. The human suffering is reinforced by intertwined personal
story lines. Sun Tzu 孫子 would note that the “fog of
war” also applies to catastrophic societal disasters,
even in these days of instant communication with cell
phones, email, Twitter and CNN.
Although advanced planning may not prevent the outbreak, spread or even the development of a treatment, prior thought and preparation can significantly
decrease the devastating results. During the crisis is
not the time to decide the procedures for treating patients after the hospitals are filled to capacity, who will
pay for the coliseum, where cots and food will be obtained, who will deliver food or provide security, etc.
Continued on following page
Spring 2012
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Contagion by Pond continued from preceding page
Interestingly, Northeastern Indiana did conduct such
an exercise after 6 months of planning that involved
the Guard, police, fire, city and county government,
physicians, pharmacists, nurses,
lawyers, businesses, the Board Guard flight doc
of Health and the hospital staff often mistaken for
to address those items so Contagion movie
star, Matt Damon.
graphically portrayed in the
movie.
Contagion is now showing at the $3.00 theater; it
should be released on DVD on January 12, 2012, so
make sure you see it….and wash your hands.
WWP
 What is the Time of Useful Consciousness without oxygen at 30,000 feet above MSL?
 How long is one prohibited from flying after a hypobaric
chamber ride to 25,000 feet above MSL?
 How long is an aircrew member DNIFed after blood donation?
Flight surgeon Ken “Doc” Hanson participates in Pandemic Flu
exercise at the Memorial Coliseum with Board of Health staff.
Jeopardy Answers:
1-2 minutes, 12 hours, 72 hours
What are the Jeopardy questions? (see below)
for Category 1 CME (Continuing Medical 1 CME—a real value for Guard docs to
Education) if certain reasonable criteria are receive both required RSV training and
met:
CME.—WWP
Fort Wayne Medical Education CME
Program was just recertified for the maximum of 6 years with 15 commendations. 1) For the participants, they must show
attendance by a sign in roster, critique
the program, identify barriers to learning, and acknowledge commercial
bias.
2) For speakers and presenters, they must
identify any commercial interest or
bias, formulate educational presentations that endeavor to satisfy the requirements of adult learning principles, execute a written document of
With thanks to the AANGFS physicians
agreement, and provide the director
who completed the requisite records and
with copies of a resume and the presspeakers who made the Alliance program
entation.
the perfect example of a quality, jointly
3) For the director, he/she must assess
sponsored CME activity. {―Jointly Sponthe educational needs of the target
sored by the Fort Wayne Medical Educaaudience, assure that the above criteria
tion Program and the AANGFS (Alliance
are met, that attendance roster is mainof Air National Guard Flight Surgeons‖)}.
tained for 6 years, that hours of credit
are certified, certificates of attendance
Military medical education at Readiness
given and financial disclosure accomFrontiers is rigorous, thorough and profesplished.
sional in order to meet very specific military requirements clearly delineated by
In short, improved accountability requires
applicable regulations. Certain profesadditional work, but when accomplished,
sional medical education may be certified
the participants may be awarded Category
On behalf of Alliance President, LtCol
Lisa Snyder and MajGen Joseph Kirk
Martin, the Alliance of Air National
Guard Flight Surgeons presents its appreciation to Dr. James Buchanan and
Ms JeriSue Petrie, Director of Continuing Professional Development.
Spring 2012
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Specifically:
2.1. When on Title 10 or 32 or State Active
Medical Legal Aspects / CERFP
Duty orders, medics are authorized and afforded
medical legal coverage to treat victims and fellow
BLUF 1 -- No treat unless you are in 10,
CERFP members, including optional sick call clinics.
32, or State Active Duty, except emergency intervention to save life, limb,
2.2. When NOT on Title 10 or 32 or State Acsight.
tive Duty orders, routine sick calls and nonemergency treatments are not authorized and not
BLUF 2 -- If you start IV fluids, you
afforded medical legal coverage. Medics, however,
need to evac them.
are authorized to evaluate CERFP members for fitness for duty or evacuation (examples of authorized
1. All medics (physicians, physician assismedical acts af-forded medical legal coverage: evalutants, nurse practitioners, nurses, medical technicians, emergency medical technicians, paramedics) ate then return to duty, or evaluate then send to rest,
must meet requirements of a medical AFSC or MOS or evaluate then evacuate to off-site treatment faciland meet CERFP training requirements. In addition, ity).
The Doctor’s Corner
all medics whose particular career field is governed
2.3. No treatment is authorized or afforded
by licensure must possess current license in that field
medical
legal coverage when NOT on title 10 or 32 or
from a state or territory, but not necessarily Virginia.
State Active Duty orders, except emergency intervention to save life, limb, or sight.
2. All medical acts are afforded legal immunity and covered by Federal and Virginia Tort Laws,
whether these acts occur in or outside Virginia, as
long as such acts are conducted on Title 10 or 32 or
State Active Duty orders, within the medic’s scope of
practice and free of gross negligence and intental
torts.
Proposed by Col Frank Yang, VAANG SAS
Endorsed by Lt Col William Rogers VAANG SJAG
Endorsed by Col Thomas McCune VAARNG SARS
Previewed by BG Johnson, Col McCauley,
Col Mercer, Col Catrett, Col Preston
3..4.2.1.2. When the case involves service
aggravated EPTS medical conditions.
AFI 36-2910
3.4.2.1.3. When the medical condition involves a disease process such as coronary artery
This is in keeping with guidance from NGB/SG.
disease, cancer, diabetes mellitus, etc. or,
Going against the spirit (and letter) of these Member3.4.2.1.4. All cardiac conditions, including
favoring Regs is likely an invitation for Congressionheart attacks, rhythm disturbances, etc.
als) and possibly IG complaints.
3.4.2.1.5. When the member has been hospitalized.
In particular, I point out -3.4.2.1.6. When the member requires continu1.6. Presumption of LOD Status. An illness,
ing medical treatment or treatment in a civilian hospiinjury, disease or death sustained by a member in an
tal.
active duty status or in IDT status is presumed to
have occurred in the line of duty.
Col Frank Yang, VAANG SAS
LOD Bullets; based on NGB/SG input and
All, I spoke with NGB/SG Col. Wyrick regarding HQ guidance
on how we should view LOD requests. Below is a summary of
his guidance -- 1. MDG's role is limited to assessing the medical
record or Member to see if there has been a "pre-existing" condition or if a known pre-existing condition is "aggravated" while
on military status. 2. If no documented pre-existing condition,
then the first time Member became aware of symptoms should
be considered the start of the disease or injury. Example: even
though back trouble, diabetes, cardiac diseases can have long
lead time; the first time Member became aware of symptoms is
considered day one. 3. If documented pre-existing disease or
injury gets aggravated while on mil svc, this also qualifies as
LOD. Examples: Chronic back problem which gets worse while
in mil status working on a jet engine is a qualified LOD. Hypertension under control with medications becomes worse while on
AT and blood pressures remain high and requires more medications and more visits to doc is a qualified LOD. Previous chest
pain and known coronary disease that worsens into a heart attack
while on mil status is a qualified LOD. 4. When in doubt, err in
favor of the Member, to avoid the risk of "denying a Member
benefits the person deserves". In other words, official NGB/SG
guidance mirrors JAG approach, albeit SG's reason is "take care
of the Member", not necessarily based on avoidance of potential
litigation. Please feel free to forward this as you see fit.
FRANK Y. YANG, Col, MC, FS VAANG
Spring 2012
AANGFS
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The site for flight medicine: https://kx.afms.mil/kxweb/dotmil/kj.do?functionalArea=AerospaceMedicine
Medical Rapid Response
Force Package (MRRFP)
This article describes an initiative our
Northwest region is slowly rolling out
to allow our medical groups to respond
to a civilian mass casualty that overwhelms the domestic EMS system. It is
designed to be scalable and flexible to
allow our leadership to pull the trigger
in a more affordable, frequent and
timely manner, adding significantly to
our relevance as a medical surge force
in support of domestic operations.
The absolute cornerstone to the concept
is defining the equipment footprint as a
back-pack. By doing so it allows state
planners to get us out the door with a
minimum of logistical challenge. It is
this limited foot-print that simplifies
the challenge of get-ting us there in the
least amount of time when it counts the
most.
The second key element to the package
is the inclusion of food, shelter and water to be self supportive for the first
three days. This minimizes the support
requirements for the initial period,
again allowing planners to get us to
where we are needed with a minimum
footprint. Two man tents, MRE‗s (2 a
day), water filtration systems with col-
lapsible bags, sleeping bag and ground
pad in a 6,800 cu. cc. waterproof backpack make up some key aspects of the
equipment package.
A second pack which can be carried on
the chest or inside the backpack carries
medical supplies to enable a team of 25
to treat hundreds of patients. The total
weight of both packs combined is ~ 50
pounds. We anticipate wherever we are
assigned will require access by ground
and/or air to allow evacuation of our
critical patients and resupply, so no
significant walking will be required
with the packs.
The medical equipment list is a living
document with ongoing input on content. Medications are pre-contracted
with local chain pharmacies with no
cost or inventory issues. The contract
and cost is triggered when the meds are
picked up at the time of a disaster. We
are currently exploring civilian support
for this cost.
As a medical pickup team we can be
put to work triaging/treating walking
wounded patients in front of an overwhelmed civilian ER, joining a civilian
triage site, supplementing a CERFP in
non-CBNR settings, splitting up to
medically support refugee areas or providing triage independently. Med
groups from around the region can flow
teams into the disaster site in support of
civilian authorities.
A requirement to exercise with the
MRRFP equipment once every two
years as a part of an already AFI driven
mass casualty event would be sufficient
to maintain readiness.
In discussions with our state civilian
disaster response planners (our customers) the feedback is very supportive.
The medical surge capacity in the first
several days after the civilian EMS system is over-whelmed is a critical capability gap that this equipment package
can significantly address.
In summary, our belief is this equipment package leverages our med
Currently costs run $600 - 700 per bag groups in a significant way to provide a
(total $15,000) for the self-sufficiency very cost effective, scalable, flexible
capability that ensures our relevance in
supplies and another $23,600 for the
medical supplies for all 25 bags exclud- this budget challenged environment.
ing pharmaceuticals. The just in time
medications would run around $10,000. For more information:
SMSgt Jerod Taylor
The logistical requirements would be
Jerod.taylor@ang.af.mil
nil without the medications with very
few items having an expiration date.
Col Bob Gentry
Training for mass casualty incidents is mwittler@gmial.com
already a requirement and we have
enough (too much) on our plate as it is. Capt Anil Menon
anil@menon.com
Spring 2012
AANGFS
AFRFSA
9
Transfusion Support of the Trauma Patient
Arthur Bradley (Brad) Eisenbrey, Col, MC SFS
State Air Surgeon, Michigan
Massively bleeding patients present a unique combination of challenges to their rescuers and the physicians who intervene
to save them. Massive bleeding (other than the diffuse failure of coagulation in an otherwise intact patient) is primarily a
surgical problem supported by blood volume resuscitation. One of my mentors, Jay Shanberge, would argue that these
patients need ―factor 14‖ (suture) more than anything else since blood poured in just ended up on the floor if the holes
weren‘t closed. Advances in Self Aid/Buddy Care, including aggressive use of tourniquets, is making more of the previously exsanguinating events potentially survivable. The limiting factor in all massively bleeding patients, whether from
trauma, surgical mishap or large vessel wall rupture (GI bleed or aneurysm) is time to surgical intervention. The role of
transfusion (and the specialist in transfusion medicine) is to buffer the effects of the blood volume loss between the incident and surgical intervention, and to institute corrective measures to restore blood volume, oxygen carrying capacity and
the ability to form stable clots.
All laboratory tests are snapshots of the status of the patient at the time the sample was obtained. Hemoglobin concentration, platelet count, prothrombin time, and fibrinogen concentration changes must be interpreted in the context of what has
happened to the patient since the samples were drawn. Based on more than a decade of experience as a member of a
trauma team at a very large community teaching hospital/regional Level I Trauma Service, I established some ―factoids‖
to guide transfusion support for patients needing massive transfusion:

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

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
Obtain hemoglobin, platelet count, prothrombin time (PT) and fibrinogen concentration on arrival and monitor as frequently as practical.
Red cell mass is critical to coagulation. The ability to form a stable clot has a direct inverse relationship to
hemoglobin concentration below 10 g/dL.
Transfuse Fresh Frozen Plasma (FFP) early. The optimal ratio of FFP to packed red cells (PRBC) has not
been determined. I am most comfortable with one unit of FFP to every two units of PRBC, based on my experience and continual review of the literature.
Transfuse platelets early. Platelet function is negatively affected by almost every medication we give and by
changes in pH.
Consider transfusion of cryoprecipitate (CRYO) if more than one blood volume has been replaced. Transfuse
cryoprecipitate (2 units per 10 kg body weight) if fibrinogen is less than 100 mg/dL or if both the PT and activated partial thromboplastin time (aPTT) are prolonged (both require ≥100 mg/dL concentration of fibrinogen
to obtain a valid estimate of the function/concentration of the other clotting factors).
Look at the surgical field. Oozing means platelet dysfunction and/or thrombocytopenia: transfuse platelets.
Lack of clots means clotting factor deficiency: transfuse cryoprecipitate. Keep the one FFP:two PRBC ratio –
more FFP will not fix the problem. If there are clots and no oozing there is a hole that has been missed.
Catching up is much harder than staying caught up.
Whole blood transfusion should be restricted to the highly unusual emergency situations when modern blood
component therapy is not available due to access/logistical limitations.
Active trauma services should have ―trauma packs‖ available in their Blood Bank. I consider a trauma pack as six units of
group O negative PRBC, three units of thawed plasma and one unit of apheresis platelets. Pre-pooled CRYO should be
thawed and available as soon as a confirmed massively bleeding patient is admitted. Since most pre-pooled CRYO is distributed as pools of six, three pools will be needed for most adult trauma patients to approximate my two units per 10 kg
guideline. The Blood Bank should start assembling the next trauma pack immediately as the first leaves the door. Large,
active trauma services may consider having two trauma packs available: the thawed FFP can be transfused to other patients in the hospital before it expires and replaced with fresh thawed FFP.
Comment: I have not included the use of NovoSeven® in this discussion. I was an early adopter (I own no stock and have
received nothing from Novo Nordisk) for our trauma service and we obtained good results in both trauma and surgical
mishaps that did not respond to optimal blood component therapy. I saw the drug successfully used at the AFTH, Balad
AB, Iraq. It is not a panacea, and not a ―last ditch‖ intervention without optimal component therapy. I would not recommend its use without direct guidance from a specialist is Transfusion Medicine or a Hematologist with special expertise in
coagulation. Good luck finding a 48D3G in theater.
Spring 2012
AANGFS
Wisdom from Brig Gen Jim Chow
National Guardsmen were honored during halftime at the
University of South Carolina Military Appreciation Day
foot-ball game in November. After the ceremony, I met
with USC President, and Provost regarding USC students
who are serving in the Guard and Reserve. After 9/11,
there are many State and Federal legislations that cover
deploying service members' education status and financial
responsibility. It is crucial to develop and implement an
uniform and systematic approach to support National
Guard Soldiers Airmen and Reservists who are enrolled in
colleges and universities from the moment of notice of mobilization, through deployment and de-mobilization with
regards to their higher education.
AFRFSA
10
seamless on-going advice and assistance regarding sustaining plans for and access to higher education. Preparation
for return to academia upon de-mobilization should also be
priority.
Stage 3 - Post Deployment The school policy should include return to student status, as student transitions from
soldier/ warrior to civilian/student. Assistance should include all aspects of re-enrollment, re-integration, counseling, and advocacy by the schools. Our young returning
warrior Guardsmen need a uniform system to support and
provide guidance on their behalf.
University of South Carolina has
agreed to host a summit to bring
together all the colleges and universities in South Carolina to
Stage 1 - Pre-Deployment School administration needs a
develop an uniform and systemuniform policy and a practical protocol on behalf of its acatic policy on behalf of our
tivated students (ESGR would serve as a good model).
Guardsmen who are enrolled in
Once the student Guardsman, while matriculating in
higher education. There are no
school, is notified of mobilization, school support should
pre-existing uniform programs
include advocacy, representation, and assistance to transiout there according to J -1. This program may serve as a
tion from being a student to a Soldier/Airman. Transition
model for the rest of the country for our deserving young
support should include personal support and assistance admen and women.
dressing withdrawal from classes, academic standards,
residency status, as well as ad-dressing financial aid issues.
I welcome all suggestions and any information on all other
existing state programs.
Stage 2 - During Deployment Students should receive
support regarding education while deployed including supJim C Chow, Brig Gen, MC, CFS ANG Assistant to
port on behalf of Soldiers and Airmen pertaining to access
ACC SG Langley AFB, VA
to distance learning projects to satisfy academic requirements if practical or feasible. Policy should provide a
ANG SG office at the JFHQ was done.
The assessment revealed that there were not existing medical personnel available to fill the manning for the Joint Domestic Medical Operations Directorate construct. This required a response with solution sets recommending assigning the requirements for the Joint Medical Operations Directorate to fulltime medical planners in the HRF and
CERFP teams. The J1 was resilient in adding our recomSince the DoDD 5105.77 made official Joint Entities of
mendations to the draft document going out to the State
the 54 JFHQ‘s the J1‘s from the states during the Domestic JFHQ‘s but critical coordination between Major General
Operations Conference in Jan 2011 asked for a recomMartin, Col Riggins and the J1 prevailed and the J1 added
mended JTD a.k.a. (MTOE). The J1 at the NGB formed a 2 billets to the recommended JTD being sent to the State
WG consisting of representatives from all NGB JS Direc- JFHQ as the recommend Joint Manning Construct. Once
torates and Personal staffs to develop Joint Requirements, this document goes to the TAGs it will now be up to the
Functions, and Tasks derived from authority documents.
State JFHQ staff , Joint Director and TAG to determine if
Once that was constructed the NGB Service Directorates
there will be 2 Joint Medical Staff members on the JFHQ‘s
from the ARNG and ANG ICW the Joint Staff Directorates across the 54 states and territories.
convened and validated the requirements , functions and
tasks as Joint specific. Once that was completed an assess- Mr. Jim Engstrand
ment of required manning was executed and a review of
Senior Medical Operations Advisor
where that manning could be acquired from within the ex- NGB Joint Surgeon Office
isting fulltime medical personnel inside the ARNG and
The current status of the Joint Domestic
Medical Operations Directorate construct
for the Joint Table of Distribution and Allowances being provided to the 54 JFHQ’s
is as follows:
Spring 2012
AANGFS
AFRFSA
11
S K I N C ANCER CONCERNS
Maj. Phillip Latham, MD, Fellow AAD, ABD
Dermatology and Skin Surgery
Skin cancer rates are on the rise. Melanoma is now the most common form of cancer for young adults 25-29
years old and the second most common form of cancer for adolescents and young adults aged 15-29 years old. Rates are
rising faster in the 15-29 year old female population when compared the rate in the male population.
This is the population we see largely in our military practices. They are young, healthy, active,
outdoor working/living adults that in many instances ignore the risk factors that increase the risk for
these cancers. There was even a study of civilian airline pilots that demonstrated their risk of melanoma was over 25
times that of the non-flying population.
It is our job to remain vigilant for these cancers and cancer risk factors. We are obligated to educate our patients
regarding these risks and how to prevent and recognize these potentially fatal malignancies.
The following chart is an excerpt from the textbook Clinical Dermatology by Thomas Habif. It
lists the relative risk for melanoma development vs. those without the described risk factor.
Greatly increased Risk Status
risk
Relative risk
Personal history of atypical moles, family history of melanoma, greater than 75-100 moles
35
Previous non-melanoma skin cancer
17
Congenital nevus (giant, >20 cm)
5-15
History of melanoma
9-10
Family history of melanoma in parent, sibling, or children
Immunosuppression
8
6-8
Moderate increased risk
Clinically atypical nevi (2-9), no family history of melanoma/
sporadic atypical nevi
4.9-7.3
Large number of nevi, 51-100
3-5
Large number of nevi, 26-50
1.8-4.4
Chronic indoor tanning/UVA
5.4
Repeated blistering sunburns, 3
3.8
Repeated blistering sunburns, 2
3.0
Freckling
3.0
Fair skin, inability to tan
2.6
Red or blond hair
2.2
Clinically atypical nevi (1)
2.3
Modestly increased risk
These are certainly
the more obvious risk factors for cancer and many
are very significant for our
patients at risk. Other risk
factors for cancer not listed
above such as increased
exposure to ionizing radiation and circadian disruption are unique to pilots and
crew. Studies are ongoing
that suggest that these features of prolonged flying at
high altitude over long distances may yet be another
group of risk factors for
cancer development.
This information
can help us recognize and
educate those patients most
at risk which will contribute to preservation of a
healthy fighting force for
the future, free of this potentially deadly cancer.
Dr. Phillip “Lane” Latham is another outstanding physician and rising flight surgeon assigned to the 169th MDG in SC. He will be
busy filling the wing dermatology “consult service” void left by Brig Gen Jim Chow’s national commitments!! - DAR
Spring 2012
AANGFS
Tech Tips from the Digital Flight Surgeon
AFRFSA
12
(c) chapter 4 (i.e. DoDI 6130.03),
(d) chapter 5,
(e) chapter 13, and
(f) the various generic requirements for aviation-related
special duty.
I thought folks might be interested in a web site I put up to sort
through the USAF's 45 different physical standards (yes, 45, I
counted). The website is designed to work on smartphones -iPhone/ Android -- but will also work on a conventional comThe website combines all these parts into one, and then splits the
puter.
The following web page contains a link to the "smartphone pack- mass into easily-navigated single-organ-system pages. The website is still in Beta and still a bit shaggy. *** It is based on a notage": http://www.sotos.net/ang Or, shorter: sotos.net/ang
quite-current version of 48-123 *** I'd like to hear if you think it
Here in California we end up reviewing many types of physicals, would be useful or not. If so, I will update to the current AFI and
fix various bugs.
including: flying, space/missile, Predator pilot/sensor, pararescue, SERE, and CRO. I've found AFI 48-123 frustrating to use in By way of instructions, please note that
(a) everything is clickable,
the less common physical-types, because:
(b) the ABOUT -> INCLUSIONS page for each stan(a) the requirements are spread over several sections,
dard is particu-larly interesting, and
(b) it often requires digging to learn which sections per(c) if you tap on the text of any paragraph, you get helptain, and
ful links (except on the "Inclusions" page -- there is a
(c) the terminology can vary from section to section.
bug there).
Plus, DoDI 6130.03 is hanging out there, too.
Consider the physical standard for an aspiring flight surgeon. It
is the union of:
(a) section 6G FC2[initial] requirements,
(b) section 6K,
Editors 2 Cents
My fellow colleagues,
I have to admit I have no experience in
generating a newsletter! Col Bill Pond has
unselfishly devoted his time to produce an
outstanding AANGFS newsletter for years.
I am humbled by his generosity of time,
knowledge, computer savvy, and dedication to our organization. His contributions
to this issue with articles, advice and template can be easily recognized and are
greatly appreciated. Please recognize Bill
and thank him personally when you see
him. He is truly a remarkably talented,
energetic and innovative member of our
organization as well as a great Guardsman
and patriot. We need more like him.
I also must thank Col Richard Ando for his
diligence and patience in formulating the
newsletter since I have no acceptable skills
in manipulating a computer. I know he'll
say he was only cutting and pasting but it
took a lot of personal time. Many thanks
for all your help and volunteerism which
leads me to the body of my editorial.
Volunteerism is the heart and sole of our
foundation and history as Guardsmen and
women. Our force is recruited, retained
and sustained by our sense of giving of our
time for our nation, our families, our
John Sotos, Col, MC, CFS
CAANG SAS
Email: [[insert-here-the-last-name-of-the-first-president]]
@sotos.net
friends and our colleagues. I believe this
fundamental value generates extremely
strong bonds within our organizations and
fuels the cohesiveness that gives us our
conviction to duty.
Thanks BG Chow! As usual, your recognition of need and innovative thinking has
spurred a feasible solution for our deserving Guard members! I encourage Air and
Army Guard physicians and leaders to
Understandably, we have been asked to
lobby your Universities and Congressman
give more and more time to support conto support this initiative. It is a true void
tingencies around the globe and we conthat needs correction for our young memtinue to fulfill our commitments above and bers who have served our nation.
beyond the call of duty. How is that possible for men and women to forgo their per- Col Yang, thanks for the succinct but pertisonal commitments to their family and
nent bullets regarding Line Of Duty detercivilian jobs, time and time again to serve mination. Simplicity helps keep us out of
for months on end, potentially risking eve- the weeds and focused on the basic rearything including their lives? I believe that sons for the member's LOD disposition.
free choice hinges on the conviction of
volunteerism. We want to be involved. We Nice article on transfusion support Col
want to serve with our colleagues and our Eisenbrey! Thanks for the contribution.
fellow Guardsmen. And, we want to serve
for our fellow Guardsmen and families. No Thanks Maj (Lt Col select!) Latham for
one does it better than Guardsmen and
your reminder on the importance of evaluwomen and no one does it better than
ating the skin.
flight surgeons!
Col Sotos, you are always thinking of effiWith that, I encourage you all to be accient ways to make our life easier. Thank
tively engaged in your medical group, your you for all you do!
squadron, and your Alliance. The rewards
are more than gratifying, the friendships
Contributions from our colleagues proare genuine and the experiences are exhila- vides the body and soul of our newsletter.
rating.
Thanks very much to all contributors.
Please save your thoughts or experiences
Dana Rawl, Col, MC, CFS
on paper and submit articles for the next
SAS JFHQ SCANG
AANGFS Newsletter! - DAR
Editor
Spring 2012
AANGFS
Book Review: A Step Ahead of Death by
Scott McPherson
·
·
·
·
Paperback: 496 pages
Publisher: Comfort Publishing (August 1, 2011)
Language: English
Amazon Price: $18.99 paperback edition, $8.99 Kin
dle edition
· ISBN-13: 978-1936695003
A modern day family physician finds himself embroiled in murder
and mystery following a lunch time promenade intended to relieve
stress from his busy family practice. Jack Sharp‘s quiet life became a storm of innuendoes, suspicion, and violence after he dutifully engaged in his citizen responsibilities when he reported finding the body of a young woman. Old scars, that were emotionally
ravaging, were eventually ripped open through the course of the
investigation but through it all, Jack found spiritual guidance and a
love that he needed and deserved.
Perspectives from an evening with Mike Durant
If you weren‗t able to join us at the Alliance of Air National
Guard Flight Surgeon‗s dinner over Readiness Frontiers in San
Antonio, you missed an exceptional talk from Mike Durant.
Mr. Durant was the surviving pilot of a MH-60L Black Hawk
helicopter shot down over Mogadishu, Somalia on October 3,
1993. The events of the raid
were depicted in the movie
Black Hawk Down. His helicopter was struck in the tail
rotor by a rocket-propelled
grenade that caused the crash.
His helicopter crew of three
and two Delta Force snipers,
who volunteered for insertion
to suppress enemy advances,
were killed. Mr. Durant‗s injuries in the crash included a fractured femur and lumbar spine compression fractures. During his confinement for 11 days, he sustained a gunshot wound and a fractured jaw.
AFRFSA
13
Scott McPherson is a Nebraska Air
National Guard flight surgeon and family physician practicing in Lincoln. He
has done a superb job in presenting a
fast-paced novel that surpasses any CSI
storyline! His ability to weave the plot
and subplots provides the reader an
edge-of-your-seat intensity from the
first page to the last, culminating into
revelations not only for Jack Sharp but
other characters in the novel as well.
I found the novel a very entertaining
page-turner! I extend my hearty congratulations to my colleague and friend,
Scott McPherson, on his exceptional accomplishment. I wish him
the best of luck in the future. Maybe there will be a sequel?
Dana Rawl, Col, MC, CFS
SAS JFHQ SCANG
Of special interest to all of us as flight surgeons, I asked Mr. Durant what seemed to help him the most with his mental status and
health after he returned home and began months of rehabilitation.
His answer was what I expected. He felt welcomed by his unit. He
said that he met with his CO and was told his position in the
squadron would be waiting for him. Mike said that meant everything to him and he became determined to re-integrate into the
company and fly again. He did return to flying status and continued with the 160th Special Operations Aviation Regiment until his
retirement in 2001.
What strikes me in commentary is the fact that his comrades, his
buddies that he fought and flew with (not a mental health provider), supported him completely enabling him to over-come feelings of guilt, depression, and failure. I propose this is a large part
of the nature of our business as a flight doc – our integration into
the flying squadrons to be one with the pilots, to live and work
with them, to develop a bond of trust, friendship and respect.
Earning that kind of relation-ship is hard work and takes time but
is infinitely rewarding. Being a member in the society of flyers,
wearing the wings, allows you in but developing the necessary
camaraderie with the pilots is the foundation of being a fully functional flight surgeon. Let us all strive to minimize our administraMike‗s story of the events preceding the raid as well as the raid
itself and the aftermath were riveting. His opinions on the political tive bur-dens and dedicate more time to be fully functional in our
abilities as flight docs so we can perform our duties well and supdecision making affecting mission preparation, implementation
and outcome were piercingly critical and spot on. His interactions port our flyers accordingly.
with his captors and his intuitions for survival combined with his
Dana Rawl, Col, MC, CFS
training served him well and kept him alive. At one point he was
SCANG JFHQ SAS
even able to manipulate a situation to win favor with his captor,
which undoubtedly helped him through the incarceration.
Spring 2012
AANGFS
AFRFSA
14
A very enjoyable evening with
guest speaker, Mike Durant at
the AANGFS dinner.
Col Frank Yang, your AANGFS Treasurer; Col Dana Rawl, AANGFS
editor; Mike Durant; Col Bill Pond, ex-AANGFS editor (and current
editor mentor!); Maj Gen Kirk Martin; Col Worthe Holt
Col Brett Wyrick, the Air Surgeon; Lt Col Lisa ―Swat‖ Snyder, AANGFS president
Post dinner meeting - all we do is work, work, work! Is that Yellow Tail?
READINESS FRONTIERS 2012 AANGFS DINNER SATURDAY, 9 JUNE, 1800 SHOWTIME.
GREAT GUEST SPEAKER TBA. BE THERE!!
Spring 2012
AANGFS
BIFFS - Basic Info For Flight Surgeons

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


Quick-don masks do not have embedded Valsalva ports
since they are to be used in the event of an in-flight
emergency.
Narrow Panel Automatic Regular color is Green
Cabin altitude of a military transport at 30,000 feet MSL
is 7,000-8,000 feet MSL
Annual instrument refresher includes use of night vision
goggles, spatial disorientation, effects of fatigue.
Aircrew may not fly within 12 hours of hypobaric
chamber above 25,000 feet MSL (90% of DCS symptoms occur within 12 hours of leaving chamber.)
AFRFSA
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Warm fronts move from southwest to northeast.
Quick-Don masks are not found on dual seat fighter
aircraft (with ejection seats)
Aircraft pressurization include sealed and pressurized
cabins.
Time of Useful Consciousness at 30,000 feet MSL is 12 minutes.
HARM stands for Host Aviation Resource Management
office.
Guidance for minimum required aircrew training is
found in AFI 11-2022, vol. 1
Flyer is grounded for 72 hours after blood donation.
Col Biernacki making his point at the
Society of State Air Surgeons‘ meeting
Col Aiello receives
recruiting award.
Congratulations!
Letter of appreciation
from Col Pond
to Col Kindle.
Col Rawl presents letter of
appreciation to Col Guerdan.
Alliance Officers
President: Lt Col Lisa Snyder
567 Nauvoo Road
Lewisberry, PA
Email: lksn101@aol.com
Vice-President: Col Eric Kendle
1710 W. Avocado St.
Tucson, AZ 85704
E mail: beeperf16@juno.com
Treasurer: Col Brett Wyrick
3500 Fetchet Ave
Andrews AFB, MD 20762
Email: brett.wyrick@ang.af.mil
Secretary: Col Cassandra Howard
E mail: Cassandra.Howard@ang.af.mil
Newsletter Editor: Col Dana Rawl
2049 Bermuda Hills Rd
Columbia, SC 29223
Email: drawl@sc.rr.com
Program Committee: Col Eric Kendle,
Col Dana Rawl, Col Frank Yang
& Lt Col Lisa Snyder
Bylaws Committee: Col Buck Dodson
Historian: LtCol Brett Wyrick
Web site: vacant
15
 Articles and announcements for the next newsletter should be submitted by 1
August 2012 (but I will be happy to accept them anytime before then.)
 Avoid the last minute rush; submit your article today.
 Once again, authors, thanks for the great contributions - DAR, editor)
Alliance of ANG Flight Surgeons
The newsletter is published two or three times annually as able. Articles for inclusion are
solicited from members and guest authors. Material for publication can be sent to:
AANGFS Editor
Col Dana Rawl
2049 Bermuda Hills Rd
Columbia, SC 29223
Email: drawl@sc.rr.com
Viewpoints expressed in this publication do not necessarily represent official positions of the Alliance, the Air National Guard, the United States Air Force, or the Department of Defense. Letters may
be edited for grammar, spelling or length, but not content.
Dana A Rawl (DAR) Editor and Publisher
Spring 2012
AANGFS
AFRFSA
16
Membership Application---Alliance of ANG Flight Surgeons
_____ Member: Annual Dues $35 (____New or ____Renewal)
_____ Member: Life Dues $250 (for the true optimist)
Date:
Rank:
Last Name:
First Name:
MI:
Address:
City:
State:
Zip:
Aero Rating: FS SFS CFS
Position:
FS = Flight Surgeon
CC = Clinic Commander
CFM = Chief Flight Med
CAS = Chief Aeromed Services
SAS = State Air Surgeon
CCATT = Critical Care Air Transport Team
Mail to: Col Frank Yang
1300 Tribute Center Drive, Apt 364
Raleigh, NC 27612
Col Dana Rawl
2049 Bermuda Hills Rd
Columbia, South Carolina 29223
Unit:
Hours:
Years:
Active Flying: yes
Home Phone:
Work Phone:
Fax:
E-mail:
Civilian Specialty:
Academic Appt:
no
_______
_______
Member of Society of USAF FS: yes no
Member of AsMA: yes no
ACLS Certified: yes no Expires
ATLS Certified: yes no Expires
Trauma Med experience: yes no
Aeromedical Evac Experience: yes no
Comments:
When: 1800 social hour/ 1900 dinner
Saturday, 9 June, 2012
Where: Readiness Frontiers
Jacksonville, FL
Speaker: TBA
Don’t miss this opportunity