Air Force Surgeon General eyes modernizing capabilities for joint commanders (Part 2) Published May 23, 2022 By Shireen Bedi Air Force Surgeon General Public Affairs FALLS CHURCH, Va. -- Since assuming his role of Air Force Surgeon General, Lt. Gen. Robert Miller has worked to advance the Air Force Medical Service’s capabilities, ensuring it is ready for an evolving joint fight. One of his stated priorities is enhancing combatant commander capabilities, which focuses on modernization at every level of care, and increasing global health engagements. “The combat environment will not be static,” said Miller. “As a result, we cannot assume we will always have air superiority…, [so medics may need] to hold and treat patients longer and closer to the front lines. Deployed capabilities and medical technology need to meet this potential new reality.” Aeromedical Evacuation Aeromedical evacuation has remained a staple life-saving capability since World War II and has grown to save more lives through humanitarian support, and amid a global pandemic. However, future conflicts will present new, unprecedented challenges. “We have to be ready for… increasingly dispersed operations in challenging, contested environments,” said Col. Marilyn Thomas, Division Chief, En Route Medical Care, Air Mobility Command. “We may find ourselves having to move what we call ‘unregulated patients.’ That means when we have an aircraft approved for aeromedical evacuations and we are able to land, we may not know the exact number of patients or their exact diagnoses. Preparing for unregulated patient movement impacts the makeup of our teams and how we train.” U.S. Air Force Airmen assigned to the 86th Aeromedical Evacuation Squadron perform advanced life support training at Ramstein Air Base, Germany, March 14, 2022. U.S. Air Force Capt. Adam Olligschlager, left, 86th Airlift Wing plans and programs action officer, was celebrated as Airlifter of the Week, March 10, 2022, for his outstanding organization and execution of the Secretary of Defense Dispersal Plan. When Olligschlager isn’t working as an action officer, he assumes regular duties as a flight nurse evaluator at the 86th Aeromedical Evacuation Squadron. (U.S. Air Force photo by Airman 1st Class Jared Lovett) Photo Details / Download Hi-Res KC-46A Pegasus, which completed its first aeromedical evacuation mission on July 10, 2020. “The idea is we can adapt to almost any cargo or tanker aircraft, so wherever patients move, if we have an aircraft, we can team up with aeromedical evacuation crews,” said Lt. Col. Sarah Morton, Chief, Aeromedical Evacuation Standardization and Evaluation, Air Mobility Command. “What we are doing now is making sure we can integrate on whatever the next approved aeromedical evacuation aircraft will be.” Air Mobility Command, which leads the aeromedical evacuation and critical care air transport missions, is continuously working to optimize equipment to become smaller and modular. Additionally, AMC is reviewing medical specialties to right size the makeup of AE and CCAT teams. “We know patient loads could be larger in future conflicts, so we are taking another look at what type of clinicians and clinical support we need,” said Thomas. “We are looking at what the right mix of medical attendants would be to augmented support.” U.S. Air Force Staff Sgt. Kyuree Rose, 86th Medical Squadron surgical technician, applies a tourniquet to a simulated patient during a joint 86th Medical Group Ground Surgical Team and U.S. Army 160th Medical Detachment Forward Resuscitative Surgical Team exercise at Breitenwald Training Area, Landstuhl, Germany, March 9, 2021. The exercise was used to demonstrate the ability to provide emergency care of injured or critically ill patients in a joint environment outside of established support. (U.S. Air Force photo by Senior Airman John R. Wright) Photo Details / Download Hi-Res Deployed ground capabilities Miller has also directed a closer look at ground medical capabilities, including care delivered at the point of injury and in deployed medical facilities. “The end goal is to provide commanders with greater flexibility and range of options that can bring advanced care that is highly mobile and ready to operate in the most demanding environments,” said Miller. One of those options is the Air Force’s Ground Surgical Team, or GST, a six-member surgical team who can work in austere environments to provide damage control resuscitation, surgery, and critical care. “Trauma care in austere, deployed environments is different than from trauma care in hospitals,” said Lt. Col. Christopher Mahoney, the GST consultant to the Air Force Surgeon General. “Resources and personnel are limited, and you often have little backup or access to a fully staffed, modern facility. GST members are trained for that environment to give patients the best chance of survival.” Airmen from the 378th Expeditionary Medical Squadron received a shipment of supplies and new tents at Prince Sultan Air Base, Kingdom of Saudi Arabia, Oct. 3, 2020. Volunteers helped build the medical tents to increase the overall footprint and medical capabilities offered on base. (U.S. Air Force photo by Staff Sgt. Cary Smith) Photo Details / Download Hi-Res deployment in 1999, the EMEDS has played a critical role in every conflict and many humanitarian responses. However, as the nature of warfare changes, so to must EMEDS. “Our EMEDS will need to become increasingly modular to function in contested, cyber-degraded environments for tans-regional, all-domain conflicts,” said Paul Clark, Expeditionary Medical Policy and Operations acting director, Office of the Air Force Surgeon General. “To meet these demands we are developing ways to modernize.” The AFMS is working to increase the facility’s capacity to hold patients longer, or indefinitely, in degraded operational environments, as well as to grow relationships with partner nations. Strengthening alliances Being medically ready for the future fight extends beyond the AFMS. The Air Force, along with the entire Department of Defense, relies on Global Health Engagement to strengthen partnerships with other nations. GHEs improve mutual capabilities through health-related exchanges and furthers interoperability with partner nations during contingency operations. U.S. Air Force Airmen assigned to the 86th Aeromedical Evacuation Squadron and Royal Moroccan Air Force AE team members share tactics, techniques and procedures during a multinational casualty evacuation training exercise during exercise African Lion 21, June 16, 2021. African Lion maintains combat readiness by ensuring the ability to provide superior airpower capabilities in support of U.S. and partner interests in the region. (U.S. Air Force photo by Tech. Sgt. Devin Nothstine) Photo Details / Download Hi-Res GHE training programs and platforms are already evolving to ensure International Health Specialists who develop and execute GHE programs have the expertise necessary to continue strengthening partnerships. This includes creating a tri-service GHE orientation course, increasing training in security cooperation, and setting up a fellowship program set to begin this summer. “Increasing the effectiveness of Air Force global health engagement is critical to supporting national security policies,” said Miller. “As a strategic goal of the Air Force Medical Service, it is important our internationally minded Airmen execute long-term, sustainable, and impactful medical security cooperation.” Editor’s Note: This article is part two of a three part series highlighting Lt. Gen. Robert Miller’s priorities for the future of the Air Force Medical Service.