ACC Command Surgeon on today’s, tomorrow’s medical operations Published Dec. 17, 2018 By Brig. Gen. Paul Friedrichs Command Surgeon, Headquarters Air Combat Command FALLS CHURCH, Va. -- Brig. Gen. Paul Friedrichs is the Command Surgeon, Headquarters Air Combat Command at Joint Base Langley-Eustis, Virginia. He organizes, trains, equips, and sustains combat-ready medical forces for rapid employment. He is responsible to the ACC Commander for the health care of 81,000 personnel located at 12 bases and more than 300 operating locations worldwide, as well as a comprehensive, community based health care system. He supports Combatant Command requirements as the Air Force's medical global force provider and serves as the Air Force Surgeon General’s readiness goal champion. Brig. Gen. Friedrichs, 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. You’re welcome, and thank you very much for this opportunity. Q. To begin, can you talk about your decision to become a doctor, and to do so in the Air Force? A. My parents tell anyone who will listen that I announced I wanted to become a doctor when I was five years old. When my mom tells the story, she insists that I said that it was because I wanted to learn where babies came from; maybe that is part of why I became a urologist. I knew that I wanted to serve not just my patients, but also our country. My dad was born in a farmhouse in Southern Louisiana in the late 1920s; his family struggled during the Depression and he began working when he was 8 years old. He later served in the U.S. Navy during World War II. He used his GI benefits to earn an engineering degree, and eventually designed aircraft carrier arresting cables at the Brooklyn Naval Shipyard. What a great country that allows people like my dad, who started life with almost nothing, to serve, contribute, raise families and become successful. My mom was born in Hungary and lost her parents in WWII. She fought in the 1956 Hungarian Revolution, was imprisoned, but escaped and reached Switzerland. There, she earned a degree in linguistics and trained to be a United Nations interpreter. She came to the USA to perfect her American English and met my dad, who proposed on their third date. After they married, she completed multiple advanced degrees and taught in high school and college. I grew up hearing about how bad a bad day can really be and, more importantly, how incredibly fortunate we are here in the USA, and knew that I wanted to give back to the nation that made so many things possible for my family. I chose the Air Force because aviation and space operations fascinate me, and I wanted to be a doctor who supported those missions. Q. The Secretary and Chief of Staff of the Air Force are revitalizing squadrons to improve readiness, morale, and align with operational requirements set for in the National Defense Strategy. How are ACC medical Airmen involved in this effort? A. ACC's amazing medics are directly involved in multiple efforts to revitalize readiness. The 366th Medical Group at Mountain Home Air Force Base, Idaho, has been part of a pilot that significantly improved readiness and access by consolidating all active duty medical care into an Operational Medicine Squadron. OMS primary care clinicians visit squadrons and meet regularly with leadership. This has allowed the OMS staff to understand what type of medical support is most appropriate for members of each squadron. At Seymour-Johnson AFB, members of the physical therapy staff are bringing their expertise to maintainers on the flight line, providing advice on how to prevent injuries, learning more about the work environment, and ultimately saving operators’ time. Here at Langley, the ACC Surgeon General staff is working with the ACC Manpower, Personnel and Services staff on a program to improve fitness opportunities for female Airmen who are pregnant and who choose to exercise safely during and after their pregnancy. Other members of our staff are collaborating with the F-35 Joint Program Office, the 711th Human Performance Wing, sister services and international partners to improve medical support to aviators and maintainers who operate and sustain this new aircraft. Q. What processes does ACC have in place to help the Air Force Medical Service on its zero harm journey? A. Each ACC Surgeon General division has a continuous process improvement board that communicates and synchronizes efforts. We focus on key activities at each home station medical group and encourage them to continue to improve. We also send our Trusted Care principles down-range, incorporating them into all of our training and assemblages. Trusted Care really is the foundation for all we do. It is a culture based on trust, respect for each other, and continuous improvement. The only way we will provide great care to America’s ill and injured down range is if we do it every day at home. Q. The Defense Health Agency is set to assume administrative control of military treatment facilities over the next several years. What do Airmen and patients in ACC need to know about this transition, and why? A. The most important thing for our patients to know is that they should expect to receive the same outstanding care as before. Medics will continue to do all we can to deliver high quality care anywhere, anytime. Many of the staff at the Defense Health Agency are active duty members from the services, or they served as military medics in a prior capacity. We are all focused on improving care to our patients. Q. As a flight surgeon, how do you see aeromedical evacuation improving in the future? What are you most excited about? A. It was a privilege to serve as the Command Surgeon for U.S. Transportation Command prior to coming to ACC. We have remarkable medics who care for our patients in the air as part of aeromedical evacuation crews, Critical Care Air Transport Teams, and other specialty patient movement teams. Thanks to partnerships between U.S. Transportation Command, Air Mobility Command and the Defense Health Agency, we are integrating our patient movement and patient safety system into the system used by the rest of the Military Health System. This will allow us, for the first time, to collect and analyze safety information on a patient from initial contact all the way through their care until they return to duty or transition to care in the Veteran's Administration or civilian sector. This partnership will help us at ACC as we learn from our past and present experiences and seek ways to continue to improve care. I am also excited that our patient movement teams will eventually use a version of the same electronic medical record that we are currently deploying to our home station facilities. This will improve our ability to share information accurately and quickly, and enable us to perform more detailed outcomes analyses. Innovation is enabling us to provide better care to patients in the air. The most exciting part about these efforts are the men and women who make up the patient movement enterprise and who keep finding new ways to improve. Q. One of the AFMS’s objectives is to enhance operational relationships in order to achieve full spectrum readiness. While ACC Airmen are conducting combat operations around the globe, how are your medics enhancing relationships and readiness? A. Our Expeditionary Medical Support has directly contributed to the very high survival rate of casualties in the recent low intensity conflicts, in part through collaboration with sister Services and allies. During last year’s hurricane responses, we deployed an Expeditionary Medical Support System, or EMEDS, to support Federal, state and local operations in Puerto Rico and we always have an EMEDS on call as part of the Global Response Force, ready to support any urgent requirements from Combatant Commands. As part of the Continental U.S. Patient Distribution Plan, EMEDS staff will partner with Department of Veterans Affairs, the Department of Health and Human Services, and the Department of Homeland Security to move large numbers of U.S. ill and injured patients from overseas contingencies back to the United States. EMEDS Airmen exercise with international partners every year so they are prepared to work together in future contingencies. Through these partnerships, they also learn and share best practices. We are also collaborating with military and civilian researchers to develop requirements for the next version of EMEDS, which will operate in contested, cyber-degraded environments. The new EMEDS will also provide enhanced ground medical capabilities to support care in environments where chemical, biological, and radiological or nuclear weapons are used. Another major initiative is revisiting the training requirements for our ground surgical teams. The National Defense Strategy forecasts that future wars will be transregional and multi-domain conflicts, so it is critical to train our medics for this environment. We are inviting our colleagues from the Army, Navy and the Defense Health Agency to collaborate with us to develop training that prepares our medics to work together and provide the best possible care for the Joint casualty stream during future conflicts. Q. What would you say to mid-level Air Force medics who are deciding whether to leave the Air Force or continue serving? A. Foremost, I would say "thank you" to everyone who has put on the uniform and served as a military medic. Whether you joined because you felt a call to serve, or because it was a way to pay for your training, I am grateful that you are a part of our Air Force Medical Service. Second, I would encourage anyone at that decision point to take some time to consider whether transitioning to the Air National Guard or the Air Force Reserves is the right next step. Third, I strongly encourage them to have some long talks with their family. My wife had to get out of the Army 20-plus years ago because we could not work out assignments together; since then, we both have continued to have successful careers, although she has had to be the "junior doc" in multiple jobs because of frequent moves. Moving our kids to new schools was not always smooth. You have to know how willing your family is to support the life that comes with serving in uniform in order to make the best decisions about career options. I caution colleagues that in today's health care environment, there is an increasing chance that any practice you join will be bought out, go out of business or otherwise change. There is no guarantee that civilian jobs are going to provide greater stability. Most importantly, in this era in which medical professionals are reporting ever-higher rates of burnout, it is important to be honest with yourself about what really motivates you. Many who stay in the military treasure the sense of purpose and mission that comes with being a military medic. While our bureaucracy can be challenging, I have never had a patient who was unable to receive the care they needed in our system. I have had the privilege of caring for patients above the Arctic Circle, at the South Pole, and just about everywhere in between. I've seen the joy brought by babies born to couples who tried for years to become parents and the relief when a family learns their loved one's cancer has been cured I’ve been knocked on my backside by bombs, and seen the best and worst that we humans can do to each other. Boredom has never been a problem. I will forever be grateful for having had the great privilege of caring for those who have chosen to serve, and the great pleasure of working with dedicated colleagues in all services, NASA, and other federal agencies who continue to motivate and inspire me.