By Col. Lee Harvis, Command Surgeon, Headquarters Pacific Air Forces
/ Published November 13, 2018
FALLS CHURCH, Va. -- Col. Lee Harvis is the Command Surgeon, Headquarters Pacific Air Forces, Joint Base Pearl Harbor-Hickam, Hawaii. As the senior medical advisor to the PACAF commander, Col. Harvis is responsible for nine medical groups, 3,900 personnel and a budget of $2.9 billion. His team supports three numbered air forces, patient movement across the Pacific, and oversees medical contingency planning, medical OPLAN support, and tri-service/international medical cooperative engagement activities. He also serves as the JTF-Support Forces Antarctica Surgeon. Col. Harvis is board certified in aerospace medicine, board eligible in occupational medicine, and is one of the Air Force’s few pilot-physicians. A command pilot and chief flight surgeon, he has more than 2,500 hours, including 80 combat hours in Afghanistan and Iraq.
Col. Harvis, thank you for taking the time to connect with us and share your personal and professional perspectives on Air Force life and military medicine.
A. Truly, it is my pleasure to share my personal and professional perspective on the many great things happening right now in Pacific Air Forces, the Air Force, and specifically in Air Force medicine. Keeping our Airmen informed is one of my highest priorities.
Q. To begin with, you are both a pilot and a physician, with more than 2,500 flight hours, including combat time. Why did you decide to become a physician, as well as a pilot, and how has being both been beneficial in your current capacity as a Command Surgeon?
A. From a very young age, I dreamed of becoming a pilot and a physician (and an astronaut). My father, who served for a short time in the Army, encouraged me to join the military and serve our country.
The first eight years of my career, I had the privilege to serve as a helicopter search and rescue pilot with the U.S. Air Force’s elite Pararescuemen. It was inspiring to wake up every morning to such a rewarding mission alongside this band of select medics. Nevertheless, I still aspired to further develop my passion for helping others. Medical school was the next step in that journey. After completing my internship, I was recruited into the pilot-physician corps and reassigned to a helicopter rescue squadron where I could leverage both skillsets.
My experiences in both the medical and flying worlds have made me realize just how many similarities exist in both communities. U.S. Air Force pilots are developed in a culture of safety, continuous process improvement, and focus on leadership and communication. In the medical community, we call this Trusted Care.
It has been my great fortune to be assigned as the Command Surgeon for PACAF and U.S. Air Force Special Operations Command, two highly operational commands. A Command Surgeon’s job entails being the principle advisor to the Major Command Commander on operational health service support, medical adaptive planning, expeditionary medical logistics, medical theater security cooperation, aeromedical evacuation, and force health protection. Recently, in light of the Defense Health Agency transformation, service components are refocusing on readiness. MAJCOM surgeons must ensure there is a comprehensive and effective medical readiness program to develop our Airmen and meet the needs of our warfighter. My dual career track has helped me cultivate a strong operational and readiness background to support the priorities of my commander and our Airmen.
Q. There has been a lot of news coverage about postponed military exercises in PACAF as the situation on the Korean peninsula changes. How does being near the demilitarized zone change how you ensure the continued readiness of medics?
A. PACAF is in full support of our diplomats and our Republic of Korea allies. The Department of Defense has suspended four joint exercises, allowing our government to negotiate a verifiable and complete denuclearization of the Korean Peninsula. Nonetheless, our military posture has not changed since the conclusion of the Singapore summit. Our medics and operators continue to train and maintain a high state of military readiness and vigilance.
Medical skills are perishable when not frequently used. Therefore, it is critical to provide in-theater training to keep our medics ready to ‘fight tonight’. Over the past year, we have deployed highly experienced medical instructors from the Air National Guard and Air Force Reserve to Korea and Japan to train more than 1,100 active duty medics. Some of the courses teach the medical effects of ionizing radiation, chemical and biologic medical response, advanced cardiovascular life support, advanced trauma life support, and the trauma nurse training course. The plan is to continue to bring trauma and CBRN training to our medics.
Our fixed and Collocated Operating Bases on the Korean Peninsula and throughout the Pacific are being recapitalized, allowing PACAF to exponentially increase training and medical logistics capabilities over the last 15 months, in preparation for any contingency.
Q. The Pacific Ocean is a large obstacle when moving patients, requiring prolonged care in the air. How do PACAF medics overcome this, or other, distance-related challenges?
A. The U.S. Pacific Command theater of operation covers a challenging 51 percent of the earth’s surface and spans the region from Alaska to Antarctica, and Hawaii to India. The International Date Line also affects our daily operations, requiring us to work with units 18 hours ahead of PACAF headquarters’ time zone and six hours behind D.C.
Fortunately, we have outstanding partners to assist with moving patients. U.S. Transportation Command’s Theater Patient Movement Requirements Cell – West, based at Hickam Air Force Base, Hawaii, oversees all urgent, priority, and routine patient movement. Movement is largely accomplished in three ways. First, TPMRC-W manages a weekly aeromedical evacuation aircraft, which allows the scheduled intertheater movement of any level of patient to the continental United States. If military air is not an option, TRANSCOM also coordinates with International SOS. Finally, TRANSCOM utilizes aircraft of opportunity as another alternative AE capability, which is called ‘in-system select’.
For urgent patient movements, PACAF maintains AE alert aircraft at various locations. In flight, patients are supported by AE crews and Critical Care Air Transport Teams, with 40 percent of CCATT missions originating in the Pacific. These CCATT teams, work hand-in-hand with AE teams.
Last year, these amazing medics moved more than 1,200 patients. This year, five Air National Guard or Air Force Reserve Command CCATTs augmented the active duty teams. The ANG and AFRC teams performed admirably and PACAF has requested additional man-days to continue this program.
Q. What are your thoughts on resiliency, and why is it important for Air Force medics to commit to it?
A. Resiliency is a very broad topic that covers physical, spiritual and mental health. Not only is there a strain on the Active, Reserve, Guard, and ‘civilian’ military members, but also on their families, whose lives are disrupted by frequent deployments, temporary duties (or TDYs), permeant change of station moves, geopolitical events, and natural disasters.
PACAF service members and their families have faced an array of stressors over the past year. Several intercontinental ballistic missiles fired from the Democratic People’s Republic of Korea over Japan caused the greatest amount of concern and uncertainty. In addition to job stressors, climate extremes at Elmendorf AFB, Eielson AFB, and Misawa AFB; family separation in Kunsan and Osan, Korea; and assignments to remote islands in the South Pacific are also challenging.
The Air Force has been boosting efforts to improve resilience in response to suicides, increase awareness of PTSD and other mental health issues. The Chief of Staff of the Air Force has instituted the Integrated Operational Support program and True North initiative. Both programs improve resiliency at the squadron level by placing mental health professionals, chaplains, physical therapists, and sports trainers into operational squadrons. Although medics are a cornerstone of the resiliency program, we must remember that the same stressors affect medics as all other Airmen.
Furthermore, PACAF understands that keeping families together improves resiliency and has committed to ensure as many family members can be cleared to join their active duty member. The PACAF Surgeon’s staff is modifying the Exceptional Family Member Program clearance process, developing telehealth capabilities to provide specialty care from afar, and providing access to online specialty medical advisors. This furnishes less-experienced primary care providers with online assistance for diagnosis and treatment options. I am proud to report that EFMP denials in PACAF have decreased from 33 percent in 2016 to 18 percent in 2017.
Q. Over the next several years the Defense Health Agency is scheduled to assume administrative control of military treatment facilities. What do you think Airmen and patients in PACAF need to know about this transition, and why?
A. Speaking of resiliency, there is significant stress associated with the Defense Health Agency transition, which began on October 1. I contend that most of the concern is because people simply do not like change. As the cost of healthcare continues to rise, we must consider that the goal of the DHA is to conserve limited medical resources, while providing better access to care.
Although PACAF medical groups are not scheduled to transition to DHA oversight until 2021, DHA policies and instructions are already being instituted across all DoD medical facilities. Keeping that in mind, Airmen at the squadron level and below should not see any significant changes to daily operations. Nor should DHA changes be visible to our patients, who should expect the same quality of care and no decrement in access.
Since a significant amount of my career has been in a joint environment, I recognize the potential benefits of building a joint medical organization, while maintaining our Service identities. Ultimately, as the DHA assumes clinical oversight, Service surgeons will be able to focus on their core readiness capabilities to support the warfighter and combatant commanders.
Q. The newest National Defense Strategy directs the U.S. military to renew its focus on great power conflicts, as opposed to the mostly counterinsurgency type conflicts that have defined American warfare since 2001. How is PACAF and Air Force Medicine changing to meet this requirement?
A. To support potential conflict with a near-peer adversary, PACAF medics have been revitalizing theater hospitals and renewing the focus on trauma skills. Joint Trauma System ‘lessons learned’ from 17 years of war in the Middle East have been instituted. Patient movement inventories have been increased to support higher casualty estimates. To augment patient movement capabilities, inter-fly agreements with several partner nations are being developed, such that respective AE crews can provide medical care interchangeably on each other’s airframes. A robust global health engagement program, interacting with more than 26 nations around the theater, counterbalances China’s increasing influence.
Q. The Air Force Medical Service’s three goals are to Drive AFMS Transformation, Strengthen the Joint Warrior Medic, and Achieve Full Spectrum Medical Readiness. Why are these goals important and how is PACAF supporting them?
A. Bottom line, the AFMS goals provide the blueprint for saving more lives in the event of any conflict. PACAF SG has focused on the readiness of our medics. It is imperative that Air Force medical personnel are agile and interoperable with our joint partners. They must be innovative and deliver the best medical care for our warfighters. “Readiness is priority number one” for the Air Force SG and the PACAF commander. This is especially critical in the PACOM area of responsibility with two near-peer competitors and the historically confrontational DPRK.
To achieve readiness, our medical groups have signed agreements with civilian institutions to augment the currency of perishable surgical skills. In the event of a conflict, the Air Force cannot solely manage the expected number of casualties and needs our Army and Navy counterparts to assist. We have outstanding joint partners and are constantly developing ways to increase joint capabilities in-garrison and at our COBs. PACAF SG has been focused on ensuring our medics arrive in-theater fully trained, followed by additional in-theater sustainment training throughout their assignment. Moreover, in order to ensure rapidly deployable medical capabilities, hundreds of tons of medical equipment have been pre-staged at COBs, as well as other regional logistic hubs. If a conflict breaks out, pre-staging limits competition for space on airlift that the warfighter needs. To this end, assigned COB commanders have led large-scale exercises at their respective deployment locations.
Q. What improvements do you foresee in battlefield medicine in 20 years? What are you most excited about?
A. Every day, I read articles about the Secretary and Chief of Staff of the Air Forces’ focus on innovation. The National Defense Strategy calls for Services to implement creative approaches, which will enhance our warfighting capabilities. It is exhilarating to see the Air Force rapidly integrating off-the-shelf technology. Before I describe expected improvements in battlefield medicine over the next 20 years, I want to say that we can save more lives today by using lessons learned, especially from the joint trauma system. All combatants need Tactical Combat Casualty Care training. Joint Base Elmendorf-Richardson Medical Group is a test platform for the new TCCC program. We also need the continued development of agile medical capabilities for austere environments.
I anticipate many exciting innovations. First, artificial intelligence and machine learning provide amazing opportunities in healthcare. Autonomous systems are already being tested that guide providers to accomplish lifesaving tasks. AI will one day repair spinal cord lesions or help read an ultrasound. I also expect improvements in blood products with stem cell researchers making critical advances now. I foresee greater progress in tissue engineering to treat burn patients. Scientists are recoding viruses and bacteria to fight disease and injuries. Along with improved treatments, I envisage advancements in unmanned aviation platforms, lighter and more effective body armor, and more rapid chemical and bio detection and treatment options. These will impact combat zone medicine through the prevention and treatment of trauma, ultimately leading to full recovery and rapid return to the battlefield.
Q. What would you say to a medical professional interested in joining the Air Force? Why should they consider the military, or the Air Force, as a career path?
A. Being a military medic is hands down the best job in the world. It provides opportunities that our civilian counterparts will never have. There are four medical career tracks, clinical, leadership, academic and operational. Over the course of a career, medics can move between each of these tracks. Every day and every assignment is different. There are opportunities to fly, work in disaster areas, treat patients in combat zones, embed in civilian institutions, and serve in locations around the globe. The Air Force encourages and funds medics to continue to train, to develop skills, and grow as medical leaders.