You’re The Flight Surgeon ARMA

You’re The Flight SurgeonARMA Colonel Brett A. Wyrick, USAF, MC, SFS, MPH brett.a.wyrick.mil@mail.mil

One Day in the AOR… You’re the deployed Flight Surgeon for a fighter squadron at a forward operating base in combat zone. You come into the Ops area one morning, and the squadron commander says, “Hey Doc, do you have a minute to talk?” Your response is: • No way, I am late for my brief! • No, last time we flew I got no stick time. • Only if I get the next landing… • Sure, Boss- what is on your mind?

The Answer is D One of the primary duties of a Flight Surgeon is to act as an advisor and counselor for the commander. The assigned Flight Surgeon has a role in the squadron to know the emotional, psychological, and morale status of assigned aviators including the squadron commander.

The CC’s Tale… The Squadron CC pulls you aside into his office, and begins to speak in a low voice- “This is about one of the new guys, a 2nd Lieutenant, I am having problems with him, and I just do not know if he is going to work out.” Your response is: • This sounds like a personal problem • I am a Flight Doc, not a psychiatrist (Unless you are Jill Hendra) • I am just here to fly, and I do not want to get involved • Sounds like a problem, tell me more

The Answer is D A nice open ended statement may encourage further conversation, and validation of a potential problem will further the conversation.

The problem with the new guy… “He transferred in a few weeks ago, and he has been pretty much ostracized by the pilots. On his first combat mission, he turned tail and headed for home just about the time the triple A started popping- said his plane had mechanical issues. The guys gave him a hard time, and he has started acting pretty weird.” OK, this is different your working diagnosis is now: • Fear of Flying • Anti Social Personality Disorder • Cowardice • Mechanical Issues • Any of the Above

The Answer is E While this could be any combination of the above do not be to hasty to rush to judgment. You need more facts, and you say, “Please tell me more about this guy.”

A former ballroom dance instructor… He sits by himself most of the time and types up action reports for future combat missions. His only friend was killed in action a week ago, and he has been morose and combative, since. These two were closer than brothers, and we did not care too much for him either, they were both pretty strange. I am just not sure he is going to hack it here. Your working differential diagnosis should now include: • Adjustment disorder • Pathological grieving • PTSD • Suicidal Ideation • All of the above

“He has even been insubordinate to me…” OK, this is highly unusual behavior for any pilot, let alone a “Butter Bar”. There seems to be a problem here. Your next response should be- • I wonder where the nearest mental health unit is? B) Is this guy a danger to himself, or others? C) Maybe we should talk to this guy before he flies again. D) A DNIF might be in order here… E) All of these should be considerations

The Answer is, of course, E This really needs to be sorted out quickly, and you need to have safety in mind. Flight Safety, personal safety, and workplace violence must be considerations. You tell the squadron commander, “Let’s go talk to this guy before something happens.” The squadron commander looks down sheepishly at his feet, and says, “That might be difficult, he just took off on an unauthorized flight, and I have issued orders for his arrest when he lands.”

ARMA Adaptability Rating for Military Aviation is rated Satisfactory or Unsatisfactory. In the opinion of the Flight Surgeon, an Unsatisfactory adaptability rating for military aviation (ARMA) is made if maladaptive personality traits (not meeting diagnostic criteria for a personality disorder) or a pattern of maladaptive behavior is present that significantly interferes with safety of flight, crew coordination, or mission completion. Motivational issues are referred to administrative channels.

ARMA • “More flight surgeons are dissatisfied with the ARMA than are satisfied, and the regulation is perceived as unclear in the area of final disposition for candidates with equivocal ARMA's. A post-hoc analysis to rule out the influences of rank, gender, experience and residency training was performed. Residency training in Aerospace Medicine is beneficial in terms of doing an ARMA, when required, and covering recommended areas. Females and those with less than 1 year experience perform an ARMA more frequently than males and experienced flight surgeons. Despite the limitations of the current ARMA, it should not be abandoned. Recommendations to improve it are provided. Doing better ARMA's can lead to decreased illness, injury, accidents, and attrition.”

The Rest of the Story… • Predictably, our young aviator was Killed in action later that same evening… after scoring three victories in aerial combat

“Contemptuous disregard of danger…” • He was the only person to win the Medal of Honor while technically under arrest • 18 Victories in 14 days, 3 of which he did not fly • At the time of his death, he was America’s leading ace • Fighter pilots still train at the base named in his honor, Luke AFB, AZ

Lt. Frank Luke, Jr • ARMA: SAT or UNSAT?

You’re The Flight Surgeon ARMA