The State of Air Force Medicine

Lt. Gen. (Dr.) Mark A. Ediger discusses a wide range of medical issues affecting today's Airmen.

Fort Meade, MD --

Airman Magazine: What is the state of the Air Force Medical Service in terms of the current mission and what are your priorities?

Lt. Gen. Ediger: The Air Force Medical Service is strong. The men and women who serve our Air Force as medical professionals are actively engaged in the three main components of our mission and they are balancing them very well. Those three components are: supporting Air Force operations day to day wherever they occur, maintaining a ready medical force prepared to deploy, and then providing high-quality, safe health care with a good patient experience. Our priority is to advance mission success through a focus on four areas: full-spectrum readiness, integrated operational support, our Air Force Medical Home, and high reliability through Trusted Care.

Airman Magazine: How has the mission adapted to meet the current operations and how will you adapt in the future?

Lt. Gen. Ediger: As we know, Air Force capabilities are in high demand and the mission around the world is really requiring our Airmen across the Air Force to be innovative and adapt their capabilities to meet the operational challenges. As they do that, we in Air Force medicine must adapt with them to ensure that we are giving them the medical support they need to be fit and healthy and prepared to provide everything the mission requires.

That involves physical performance, as well as cognitive performance and the ability to have sustained attention to missions that require a great deal of vigilance and critical thought. So, as Airmen go to new locations and operate under new operational scenarios, we need to stay with them to ensure that we are giving them everything they need to be able to perform.

Then, should they have operations-related health issues that arise by virtue of the mission, we need to be there to give them the medical support they need to recover from either injuries or illnesses.

Airman Magazine: When you look back on the last 15 years of war in Iraq and Afghanistan, what kind of lessons have you learned at the AFMS that can be applied today?

Lt. Gen. Ediger: We have learned a great deal from the last 15 years of war and we have really learned those lessons as part of a joint team. The medical support in the extensive military operations over the last 15 years has been provided in a very joint manner.

We collaborated with the Army, the Navy, and the Marines to create the Joint Trauma System during that period of time. This Joint Trauma System has served us and those to whom we provide care very well, particularly in Iraq and Afghanistan, but also in current combat operations across North Africa and the Middle East.

By standing up the Joint Trauma System we have learned a great deal about how to adjust our trauma practices to save lives and salvage limbs. Those advances in trauma care have been adopted internationally and they have really advanced the art and science of trauma medicine around the world.

A lot of the things we have learned and the techniques we have applied to improve outcomes in combat support have become standard practice now in trauma centers, internationally. We have also learned that we can innovate and take techniques that formerly were only found in medical centers and take those into the operational environment. By doing so, we can apply medical interventions to disease and injury at an earlier point and improve outcomes.

That work continues; we know that is an effort that can never really stop. We must continue to ask our clinicians to innovate and take the best practices out of our medical centers and find ways to apply those in a field hospital, but also in an aircraft as we conduct aeromedical evacuation.

Airman Magazine: It sounds like we have come a long way since 2005, when someone would be wounded and taken to the field hospital at Balad, compared to what we have today.

Lt. Gen. Ediger: Yes. I think these innovations really started while we were operating in the trauma hub at Balad, Iraq, and they have progressed and continued in our operations in Afghanistan. We continue to operate the trauma hub at Bagram Airfield in Afghanistan.

I can give you one example, vascular surgery is a specialty that prior to these last 15 years of war we would not have really deployed.

Previously, an Airman or a service member would not have come under the care of a vascular surgeon until they had returned to a medical center in the U.S.. Our vascular surgeons did remarkable innovative work in taking new vascular techniques into the field hospital.

This started at Balad, but extends today to Bagram, where they now have the abilities to repair blood vessel injuries that previously would have resulted in an amputation in the field hospital setting and restore blood flow by using advanced techniques, thereby enabling the salvage of a limb.

Also, they have proven we can now stop a previously unsurvivable hemorrhage of large blood vessels within the abdomen and chest—in a field hospital setting.

That is the sort of innovation we see making a difference and will continue to make a difference as we identify more ways we can take advanced care further forward.

Airman Magazine: Could you explain what constitutes Invisible Wounds and what is the Air Force Medical Service’s role in IW research?

Lt. Gen. Ediger: When we use the term “Invisible Wounds” we’re really talking primarily about traumatic brain injuries and posttraumatic stress disorder and we call them invisible wounds because, while they are not outwardly evident to other people, they nonetheless impose some significant challenges for the Airmen who are dealing with those.

While, our primary focus is on injuries that are related to performing their duties as an Airman, we know we see a significant number of Airmen who develop traumatic brain injury or posttraumatic stress from exposures that occurred outside of duty, sometimes during sports activities, but also sometimes even prior to service.

So regardless of the original precipitating event, our focus is on developing the most effective processes to help those Airmen recover and to support them so that they can return to full function both personally but, especially, professionally as an Airman.

The Air Force is conducting several research trials on PTSD and Invisible Wounds with funding from the Defense Health Program’s Psychological Health & Traumatic Brain Injury Research Program.

Airman Magazine: What are your biggest challenges today and what kind of solutions are you finding to solve them?

Lt. Gen. Ediger: Our biggest challenge is always maintaining a ready medical force. As I have described, we are taking more advanced care into the operational environment than ever before and that requires us to have deployable teams with very sophisticated capabilities. Our challenge is to keep those teams current and ready to deploy at any given time.

In Air Force hospitals and clinics, we have a relatively healthy population that we support, so we have had to evolve our clinical practices to ensure we keep teams ready to manage trauma and critical care patients.

To do that, we have evolved into an open type of practice for our trauma, critical care, and emergency medicine specialists by leveraging partnerships. This gives our specialists the time and opportunity to take care of more complex patients than our population typically provides.

In some cases, those partnerships involve referral of patients from the VA [Veterans Affairs] to our hospitals. Sometimes those partnerships also involve sending our specialists to practice in trauma centers and academic institutions outside of the Department of Defense.

I believe this is our biggest challenge going forward in medical readiness; identifying the processes and partnerships to sustain a force with the kind of sophisticated medical capability that we know will make a difference in the future.

Airman Magazine: Gravity-induced loss of consciousness research by Air Force medical personnel has led to the adoption of a full coverage G-suit for our pilots. Is there research in other medical areas that we can expect with a similar impact on the health and safety of pilots and other personnel?

Lt. Gen. Ediger: We conduct a great deal of research focused on human performance and the safety of the operator.

As new weapons systems and capabilities evolve in the Air Force, our focal point for this research is the 711th Human Performance Wing at Wright-Patterson Air Force Base, part of the Air Force Research Lab (AFRL). They work within AFRL to conduct a variety of human performance-related research and actually develop products that can be transitioned into the operational environment.

They have been doing a great deal of work on oxygen systems in the new generation of fighter aircraft. They are also developing sensors that can be used to actually monitor the performance of the operator and the aspects important to the health of the operator: things like oxygen levels, level of alertness, and techniques for assessing and measuring visual performance.

The new generation of fighter aircraft have very advanced displays for the pilot. (The displays) give the pilot a much greater field of view and the ability to operate weapons by having displays, helmet-mounted in many cases. These displays are all color based so they really require that the pilot have a specific capability in terms of visual performance. They continue to do remarkable research in terms of developing the ability to assess the visual performance of a pilot of advanced aircraft.

These are just a couple of examples; the 711th has a lot of work in this area in progress.

Airman Magazine: In the area of vector-borne illnesses, are their specific things we have learned from mosquito surveillance programs in the Air Force that are helping us in fighting these diseases?

Lt. Gen. Ediger: Yes. Mosquito surveillance is something that the Air Force has always conducted, because we know vector-borne disease is a significant threat to health during deployed operations, but also, sometimes at home station. We have diseases of concern, such as West Nile (virus), that are transmitted in certain parts of the country.

We are using that capability to work with the Centers for Disease Control (CDC) to monitor the types of mosquitos present at Air Force installations and reporting the extent to which we are seeing the mosquitos that most commonly transmit the Zika virus in the endemic countries in this hemisphere. We know we have the Aedes aegypti mosquito prevalent across the southern portion of the United States and we are reporting the types of mosquitos we are trapping to the CDC.

We are also participating in testing the mosquitos that we trap for the Zika virus and reporting that to the CDC. That is an important part of the U.S.’s monitoring plan for Zika virus. As we saw in the latter part of 2016, mosquito- transmitted Zika virus occurred in parts of south Florida and south Texas. Monitoring efforts, coupled with targeted control measures, were essential to stop local transmission. Our installations are prepared to work with their local communities and take the same actions if, in fact, we see mosquitos carrying the Zika virus on or near Air Force installations in the U.S.

Airman Magazine: When we talked with Col. James A. Mullins, (the Surgeon General’s consultant on public health), he said one huge change from past years is that the focus has shifted from not just focusing on deployed troops, but to more stateside. What big changes has that shift brought about in the way you are fighting that battle?

Lt. Gen. Ediger: Well, we know the nature of the Air Force mission is such that we conduct Air Force operations every day from our installations within the U.S. So we have always had a focus on operational support at every Air Force hospital and clinic because of the nature of that mission.

Missions such as remotely piloted aircraft, intel ops centers, nuclear deterrence, global mobility – all of these are examples of missions conducted from installations within the U.S. that require good operational medical support.

In regard to Zika virus, this factors right in to our operational support mission from our medical groups at our installations. The fact that this particular infectious disease threat is actually of concern within the continental U.S. has enabled us to use our operational support capability at our installations and to advise installation commanders on the threat they may have locally.

Our public health experts in our medical groups do this in close coordination with local public health authorities in the communities where installations are located.

The fact that Zika is a concern in the U.S. has generated this kind of health concern, but I think our monitoring is robust and I think that will help us a great deal in terms of understanding if we see Zika virus transmitted by mosquitos on or near an Air Force installation in the U.S. Monitoring certainly was a useful tool in stopping the local transmission that occurred in south Florida and south Texas in 2016.

Airman Magazine: What measures are the AFMS employing to shift from an era defined by combat to more of a peacetime footing?

Lt. Gen. Ediger: We really feel like in Air Force medicine, just like the Air Force, that we are not really on a peacetime footing. Even though we see that the number of wounded we are moving and caring for from operations around the world has come down to a very low level, thankfully, we continue to have a high volume of Air Force operations being conducted around the world and from home station.

We have over 700 medical Airmen deployed today in support of combat operations. We also have a high tempo of global health engagement missions in progress around the world, such as the very large global health mission that recently finished in the Dominican Republic.

Maintaining our readiness and continuing to support operational medicine really doesn’t allow us to ever transfer to what we would consider a peacetime setting. We work day to day to balance operational support, our deployed operations, and provision of our day-to-day health care. The commanders of our hospitals and clinics work day to day to ensure that those three main components of our mission are all given appropriate priority.

We really believe that if we started to think about what we do as being either peacetime or wartime, we would put our own ability to support the mission at risk by diverting our focus from one of those three components.

Airman Magazine: How important is maintaining the connection with other federal medical institutions and medical research outside the Air Force?

Lt. Gen. Ediger: It is critical to our ability to meet our mission requirements in the future. The partnerships we have with civilian institutions are essential to our ability to maintain a ready force and essential to our innovative work in bringing more advanced capabilities into our deployed operations.

We have major partnerships where we have permanently embedded Air Force medical personnel with institutions such as Baltimore’s [R Adams Cowley] Shock Trauma Center, University of Cincinnati, St. Louis University, University of California-Davis, University of Nevada and University of Alabama-Birmingham. At each of these sites we have permanently assigned Air Force medical personnel, specialists in trauma and critical care, and they are part of the care teams at these institutions.

By having them there we gain the benefit of having teams that are practicing complex trauma medicine and critical care day to day and who are available to deploy. It also gives us the ability to cycle through Air Force clinicians before they deploy to refresh their trauma and critical care skills from our hospitals and clinics.

So you can go to Baltimore’s Shock Trauma today, one of the premier trauma institutions in the world, where they have three major trauma teams and one of those three teams has a substantial Air Force presence day to day.

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