Former Air Force surgeon general notes medical advances Published Dec. 17, 2010 By Mary Lou Gorny Hilltop Times editor HILL AIR FORCE BASE -- When Lt. Gen. (Ret.) P.K. Carlton, former surgeon general to the Air Force, had the opportunity to drop by the 75th Medical Group on Nov. 24 and talk with the clinic staff about the status of Air Force medicine, he noted the 10th anniversary of the International Health Specialist program. Also on his mind was the program he pushed hard to make a reality -- the medical evacuations injured service personnel receive as a regular standard of practice, which was not the case when the inclination some years back was to keep the injured at the first real hospital they reached until well on their way to recovery. IHS diplomacy Senior Master Sgt. Tracy Lewis, one of the team assembled for the briefing by Col. Donald Hickman, commander of the 75th MDG, talked later about her experiences as an International Health Specialist, during her stint at Hickham Air Force Base, Hawaii. Lewis spent three years there, and among many other IHS missions, helped assemble a first responder (Emergency Medical Service) program in Laos. "They asked for an EMT program," she said. "But the 120-hour training course was not sustainable." She recalled explaining to her Laos counterparts that the EMS program of 40 trained hours was an essential first step toward the eventual Emergency Medical Technician program the country wanted. Lewis has since received favorable reports Laos is well on its way toward sustaining the EMS program and has high hopes it will lead to the 120-hour EMT course first requested. "It is easy to give someone equipment but without training it is likely to become unusable," she said. Lewis echoed Carlton's remarks about the process of time some of these programs take as others really see what can be accomplished. "Sometimes it takes 10 to 15 years," she said. IHS members typically learn to become adept at approaching countries in a culturally acceptable manner. "I really 'got' this in Laos," Lewis said, of one of her deployments while with the IHS. "Although, the others I was meeting with there spoke English, it took awhile for them to warm up to me," she said. This was in great contrast to another team member who spoke some Thai. The people in this instance spoke three other languages: Lao, Thai and French. Lewis said the response to the team member speaking Thai was much warmer. "They assumed she was aware of at least some of the culture just by knowing the (Thai) language," she said. The IHS program can make a real difference in the lives of others in partnership countries. "When you take out a cataract in a grandmother's eye and she can see in the one eye, it makes a big impact in her family members' lives," Lewis said. The former Air Force surgeon general had noted in his earlier remarks how such actions can change the hearts and minds of others. "When you fix crossed eyes, a $6 fix, it makes a big difference to families," Carlton said. Some of these cosmetic fixes make huge individual impacts. Carlton noted that in some cases, an individual born with a cleft palate may go through life holding a hand in front of his or her face whenever interacting with others. Such a medical intervention, not just a cosmetic one, helps with eating and breathing as well. The will to live The Critical Care Air Transport Teams (CCATT), another program Carlton backed and helped kick off, has made a huge difference in current recovery rates of injured service members. "Get a patient back to his family and the will to live increases," Carlton said. Survivability rates for injured are much higher with a 97 percent to 98 percent survivability rate -- if medical personnel can get to the injured -- the highest percentage ever in the history of armed conflict. Lt. Col. Kerry Hesselrode, another member present at the briefing, spoke later about his own CCATT experiences. He agreed that CCATT has made a big difference in survival rates. "We've only lost two patients (in the history of the program) while in the air," he said. Patients are transported once they have reached a critically stable state -- expected to not need any emergency care en route to the next destination. Plans are made well in advance for such transport. "Doctors will move an arterial or central line to the other side for access to the patient, if that is the side of the plane they will need to be accessed from, if that's required before flight," he said as an example. In addition to loading 850 pounds of equipment needed for a transport flight, plans are made to anticipate any needs the patient might have, including pharmaceutical, plasma or other critical care issues. He said that CCATT members need to have the ability to work under high stress as typical transport conditions can include mortars going off all around them as the planes take off. While an average flight was 14 hours, he did serve on a flight that took 32 hours as a patient was transported from Germany to San Antonio, Texas. "You have to be able to problem solve," he said. "Once, we ran out of oxygen," he reported. Two of the respirators had locked up. "The respiratory therapist was able to jury-rig a fix," he said. "Each of us would carry a tool kit of typical things we think we might need of our favorite things to use," he said. In one particular instance, Hesselrode was contacted by a distant family member who knew of the reported injury of someone he was likely to transport to a particular location in the United States. The whole community had been supporting the family and many had formed prayer groups. The severely injured service member had a traumatic brain injury, broken jaw, lost his right leg and broken his other leg but had no chest injury. When Hesselrode did end up transporting the patient, he got a rare report on the patient's well-being later. While Hesselrode had not anticipated a full recovery after transport, it was reported the man had fully recovered other than the need for a prosthesis. "That was nice to know we were an integral part of this patient's recovery," he said. It is not something they usually found out -- the eventual recovery status of patients some time later. Positive experiences Both Hesselrode and Lewis reported their experiences were particularly satisfying. "I love my job," the colonel said of his involvement with CCATT. Lewis encouraged anyone with any language experience to report it so as to be able to be part of the pool of available personnel for disaster aid and IHS missions. "It made me a better teacher and supervisor," she said, as she reported having to consider the cultural background of each request and how to get things funded as she wrote funding proposals. She uses her cultural knowledge and insights into others' backgrounds in her new job assignments. "As we utilize those resources we do a lot of good," she said. Core functions SDLqThe CSAF has made 'Building Partnerships' one of twelve Air Force Core Functions. From its inceptions, Building Partnerships has been the IHS program's core mission," said Col. Mylene Huynh, HIS Program director, Office of the Air Force Surgeon General. "What may have changed over the past 10 years is the greater Department of Defense emphasis on non-kinetic or soft power and the recognition that global partnerships are best ways to achieve national security," she added. Huynh said that an average stint in an IHS position is similar to any other Air Force assignment. Right now the IHS has 65 fulltime positions. "In addition," Huynh said, "we have 300-plus personnel with IHS Special Experience Identifier (members who have demonstrated cross-cultural competency, have foreign language proficiency and understanding of interagency dynamics). The United States African Command (AFRICOM) is the latest Combatant Command (COCOM) to have the IHS personnel on staff in the last two years. Lewis was particularly hopeful and excited about potential changes that might come about there in medical care. Legacy of former surgeon general Hickman noted what an honor it had been for the 75th MDG to host Carlton, the 17th surgeon general of the Air Force: "Thousands of American Soldiers, Sailors, Airmen and Marines, as well as Allied and Coalition warriors, are alive today because of General Carlton's transformational vision at the turn of the millennium. "Warriors who would have died in Operation Desert Storm are alive today because the Air Force Medical Service transformed its deployed hospitals into light and modular systems suitable to today's fight and created critical care in the air -- an Air Force core competency."