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Document created: 20 August 02
Air & Space Power Journal - Fall 2002
Editor’s Note: PIREP is aviation shorthand for pilot report. It’s a means for one pilot to pass on current, potentially useful information to other pilots. In the same fashion, we intend to use this department to let readers know about aerospace-power items of interest.
The International Health Specialist
Col Jane B. Ward, USAF, Retired, MC, FS*
Col Kerrie G. Lindberg, USAF, NC
Maj Daniel S. McNulty, USAF, MSC, CAAMA
Maj Mona P. Ternus, USAFR, NC
*Colonel Ward is the former director and Colonel Lindberg is manager of the International Health Specialist Program, Major McNulty is administrator of the Surgeon General’s Tactical Action Team, and Major Ternus is an individual mobilization augmentee (IMA) on that team. The authors wish to acknowledge the valuable assistance of the following people, who added their valuable insight to the writing and preparation of this article: Col Richard Hersack, Col Stephen Waller, Lt Col Yolanda Jimenez, Lt Col Luis Morales, and TSgt Jesse S. Moreno.
Now that the Cold War has ended, the national security of the United States requires effective leadership overseas to promote global stability. Paralleling this trend, the Department of Defense’s (DOD) roles and missions have evolved in complex and nontraditional ways. One finds both an ever-increasing emphasis on transforming the nation’s military into expeditionary forces and a growing discussion over military personnel taking on more direct roles as “ambassadors in uniform.”1
The 2001 Quadrennial Defense Review Report proposed a national military strategy that emphasizes the importance of such dynamic international relationships as assuring allies, deterring aggression, dissuading opponents, and decisively winning any military engagement.2 Although these are not radically new concepts to military leaders and military planners, they nevertheless underscore the importance of military functions beyond traditional war fighting. Assumption of a diplomatic role that requires direct interactions with partners from other countries will facilitate successful military engagement around the globe in increasingly complex, nontraditional military operations.
Our military has always had the “tools” to participate directly in shaping the international environment through nontraditional means. But these tools are usually regarded as support functions to war fighters. An editorial in a recent issue of Aerospace Power Journal noted that military capabilities traditionally considered support functions (e.g., medicine, logistics, civil engineering, etc.) might become supported functions in future nontraditional military operations.3 In support of global engagement, the Air Force Medical Service (AFMS) is transforming itself to develop the necessary expeditionary culture. Lt Gen Paul K. Carlton Jr. and others stated that the “ ‘vision’ for the AFMS emphasizes that Air Force medical personnel must be able to support the Air Force mission throughout the full continuum of military operations in which airpower may be employed.”4 This global vision is embodied in the AFMS core competency of “interfac[ing] with the world healthcare system”—a key component to the AFMS’s support for global engagement.5 One finds this new AFMS core competency in the international health specialist (IHS) program.6
The Air Force’s IHS program, developed by General Carlton, focuses on building medical partnerships with other countries in peacetime, before they need assistance. IHS members are educated in the language, culture, and politics of their specific areas of responsibility (AOR). Teams support the combatant commander’s theater engagement plans, create partnerships with medical colleagues from nations within their region, facilitate military-to-military and military- to-civilian interactions, and support medical-planning operations and deployment execution within their AOR. These skill sets reflect the notion that Air Force medics often represent the “tip of the spear” as instruments of national policy.7
The Air Force’s foreign area officer (FAO) program, which cultivates a pool of officers with “foreign language competency and regional expertise for effective interactions with foreign militaries and organizations,” serves as a model for the IHS program.8 The FAO program places officers educated in political-military affairs and proficient in both the regional culture and appropriate language in positions as military diplomatic advisors, as well as in DOD international jobs to support the theater combatant commanders.9
Similarly, the IHS program seeks to establish a cadre of medics fully qualified in their primary role as either AFMS health-care providers or support staff who have (1) additional language and cultural competency, (2) expertise in regional medical threats and infrastructure, (3) knowledge of joint and interagency coordination processes, and (4) the ability to build medical “bridges” to support coalition partnerships. As in the FAO program, IHS team members would act as advisors to the regional combatant commander for medically related issues in his or her theater engagement plan and as advanced-echelon personnel for exercise and real-world site surveys; they also would facilitate humanitarian assistance, disaster response, and traditional contingency operations and missions in their assigned region of expertise.
As of April 2002, the Air Force had 47 IHS team members aligned with four unified commands (European Command [EUCOM], Pacific Command [PACOM], Central Command [CENTCOM], and Southern Command [SOUTHCOM]) and in academic positions at the Uniformed Services University of the Health Sciences (USUHS) in Bethesda, Maryland, as well as the USAF School of Aerospace Medicine (USAFSAM) at Brooks AFB in San Antonio, Texas. These team members will instruct future DOD and Air Force medical leaders in global medical issues and groom them as staff liaisons with Special Operations Command, the Air National Guard (ANG), and Air Force Reserve Command (AFRC).
IHS teams consist of medics of any rank and Air Force specialty code. The typical team includes eight members who represent the five medical officer corps (medical, dental, nursing, biomedical services, and medical services) and enlisted career fields, thus encompassing a wide variety of backgrounds.10 Most members are experts in the culture and language in their AOR and have a wealth of experience in humanitarian assistance and disaster response. Many of them are well versed in the linguistic, cultural, political, military, medical, and economic issues of their AOR at the time of first assignment. Others receive training in these areas through Air Force or civilian courses.
In addition to full-time IHS staff and team members, the IHS program has compiled a database of over 300 volunteer AFMS members with a variety of linguistic, cultural, and deployment experience who may be called on a case-by-case basis for selected missions. The combined exper-tise of these subject-matter experts provides 49 different foreign languages for military commanders. Of these members, 114 officers and 23 enlisted personnel have received a special-experience identifier for Air Force–wide utilization.
The IHS program has also partnered with the Air Force’s FAO office to support and explore language-training opportunities—a collaborative effort to have medics meet and sustain the chief of staff of the Air Force’s goal of having 10 percent of all officers proficient in a second language by 2005. The program has also extended its language-training opportunity to enlisted personnel through the Base Education Office Tuition Assistance program. Furthermore, IHS team members have enthusiastically participated in the FAO Language Area Studies Immersion program.
The IHS program directly supports the Air Force’s transformation to an expeditionary force. Regional teams have linguistic and cultural competency, expertise in regional medical threats, understanding of the joint coordination processes, and the capability to build effective international medical partnerships. These skills are invaluable for theater commanders in the era of global engagement and the expeditionary air and space force.
Only one year from start-up, IHS teams have been actively engaged within their AORs, optimizing military-to-military and military-to-civilian partnerships. Building upon the AFMS’s traditional readiness strengths in war-winning operations, the IHS focuses on humanitarian/civic assistance and disaster response to meet the challenges of the new millennium. By improving interoperability among the AFMS, sister services, and coalition nations’ medical systems, we enhance our focused logistics capability, a tenet of Joint Vision 2020.11 The diverse cultures, competing interests, and differing priorities of each local organization have made the development of unity of effort within each AOR a challenge—one that IHS teams have successfully met.
June 2001 saw the establishment of the first IHS team in support of SOUTHCOM. Part of the 59th Medical Wing at Lackland AFB, Texas, this team has the goal of becoming the focal point for all international activities tasked to the wing, including critical-care air-transport team missions, joint/combined exercises, humanitarian/civic assistance missions, humanitarian assistance missions, National Disaster Medical System taskings, and implementation of Expanded International Medical Education and Training (E-IMET) courses in SOUTHCOM’s AOR. Other roles include serving as liaisons and translators for host nations and deployed teams, as well as participating in readiness planning, deployment processing, and other operations.
Based in San Antonio, this team has deployed seven humanitarian/civic assistance missions and two humanitarian assistance missions to Latin America in its first year. Operationally, the team has facilitated the deployment of Air Force active duty personnel from multiple medical centers and US Army reservists in support of E-IMET courses to Bosnia, Chile, El Salvador, Russia, Turkey, and Czechoslovakia. Recognized for their cultural, regional, and deployment expertise, team members have joined the teaching cadre of the Combat Casualty Care Course at the Defense Medical Readiness Training Institute as lecturers and group facilitators for the Humanitarian Field Exercise. Most recently, SOUTHCOM’s command surgeon has tasked the team to assist with the development of exportable courses in air and space medicine and site visits, as well as participate in the annual update of the theater engagement plan.
Located at Headquarters United States Air Forces in Europe (USAFE), Ramstein AB, Germany, the IHS team in support of European Command—the next team to reach operational status—has actively engaged in training, supporting international engagements, and conducting embassy briefings. It is the point of contact for USAFE working groups regarding training and medical engagements. Team members have served as faculty members and support officers for E-IMET courses and the EUCOM Training Program Management Review; they also have participated in four major total-force and triservice exercises, including Medflag and Medical Central and Eastern Europe (MEDCEUR).
The team aligned with PACOM has members forward-deployed throughout the Pacific at the unified-command and numbered-air-force levels, Headquarters Pacific Air Forces, Hickam AFB, Hawaii; soon they will be at the Center of Excellence in Disaster Management and Humanitarian Assistance in Honolulu as well. This team has responsibility for the IHS Unit Type Code Manpower and Equipment Force Packaging System, ensuring that the IHS program is visible to the AOR combatant commanders. The most successful engagements to date have occurred with our allies in Japan and Russia. Over 200 joint-service medics have participated in the Russia Far East program in the past five years. Team members have briefed internationally in Guam, at the 24-country Asia-Pacific military-medical conferences in New Zealand and Malaysia (serving as the lead for an international-health breakout session), and at other international medical conferences throughout the region.
CENTCOM’s IHS team works in the command’s surgeon general directorate in close contact with the J-5’s (plans and policy) Humanitarian Assistance Branch. Developing a five-year regional medical-engagement program that meets the objectives of CENTCOM’s commander, the team introduces DOD medical personnel to varied cultures of medicine in the AOR and conducts activities that benefit the host country’s medical infrastructure—a “win-win” situation for all. The CENTCOM command surgeon’s Engagement Branch has oversight for component and joint medical-engagement projects and coordinates host-nation medical agreements and exchanges. The branch also promotes remote-care, managed-care programs and leads cooperative defense initiatives in weapons of mass destruction and consequence management. The command’s IHS members were key workers in the Coalition Medical Operations Planning Conference in Tampa, Florida, sponsored by the Engagement Branch in December 2001. To improve the quality and efficiency of health care in the theater of operations, medics from coalition nations supporting Operation Enduring Freedom worked together during this meeting to set ground rules for interoperability relative to medical standards, logistics, and aeromedical evacuation.
ANG’s IHS program focuses on enhancing the existing international state-partnership program. One major task involves restructuring the overseas annual-training program to promote international exposure and interactions. Having the overall goal of promoting the total-force concept, the ANG program will formalize and coordinate the Guard’s engagement in active duty and Reserve exercises and responses. To enhance mission continuity, ANG is developing a template for its humanitarian deployments and international exercises, eventually to be shared with the total force. The IHS team also formally tracks ANG’s international activities for increased visibility.
A training plan is being developed to train ANG personnel for IHS participation. Plans also call for development of a database—interactive with active duty and Reserve databases—to track ANG members with IHS qualifications. Furthermore, qualified guardsmen have received special-experience identifiers that ensure their identification as IHS members.
As with ANG, the main focus of AFRC’s IHS program concerns the development of an interactive database, establishment of the IHS special-experience identifier, and development of IHS training opportunities. Promoting the total-force concept, the Reserve IHS program also identifies training and exercises that will combine ANG, Reserve, and active duty efforts. For example, AFRC provides Air Force planners for Exercise Medlite in Tunisia, which combines didactic instruction on planning responses to disaster situations and international standards of trauma medicine, executes a mass-casualty field-training exercise, and provides medical support for Exercise Atlas Drop conducted by the Joint Chiefs of Staff. This exercise produces improved host-nation capability and many lessons learned in interoperability.
Uniformed Services University of the Health Sciences includes an international health program office led by the academic director of the IHS program. This office has developed an elective track in international health, now an approved focus of study for the Master of Public Health degree program. Plans are under way for IHS personnel and international partners to access specifically designed international-health courses available through multiple advanced distributed-learning modules, exportable worldwide. These courses, which will focus on humanitarian assistance, disaster response, and air and space medical topics, are designed to “train the trainer” and will help cement relationships between our future medical officers and their counterparts from various host nations. USUHS’s IHS office also serves as a hub for networking with civilian government and nongovernment international-health agencies, academic programs, and other US military international-health programs.
The Air Force’s School of Aerospace Medicine provides medically oriented training for our international allies’ military medical personnel as well as US Air Force personnel. USAFSAM’s IHS chief also serves as program director for the six-month-long course entitled Advanced Aerospace Medicine for International Medical Officers, offered annually and attended by 15 or more international flight surgeons who are rising stars in their home nation’s military. USAFSAM’s IHS office is developing exportable courses as well as an IHS core curriculum to enhance its team members’ international-partnering skills. Students attending formal training courses at USAFSAM receive informational briefings about the IHS program and have the opportunity to meet members of an IHS team. Lastly, the team offers briefings to medical dignitaries from other nations who frequently visit USAFSAM; these sessions address how the IHS program can improve interoperability with their countries. Both USUHS and USAFSAM ease the process of establishing medical partnerships with foreign countries, civilian academic health centers, and sister services.
Never before has the AFMS found itself in a position to directly support the Air Force mission of global engagement so profoundly as through the expression of its core competency of using international health specialists to interface with the world’s health-care system. IHS teams provide the Air Force with additional capability for global reach that directly affects AFMS support across the entire spectrum of military operations, including peacetime humanitarian assistance and disaster response.
Exercises and real-world responses have proven the value of the IHS program in establishing and building international coalition partnerships, facilitating disaster-preparedness training among allied nations, and developing effective disaster-response systems on a regional level. As individuals with IHS skill sets become increasingly valuable to theater commanders, the IHS program will mature as part of the Air Force culture and as an exciting career track for many AFMS personnel. The IHS program serves as a cornerstone, ensuring that the AFMS can carry out its diverse expeditionary medical services and engage the full spectrum of military operations now and in the future.
1. Several articles and books deal with the diplomatic role performed by military members. Some of the most recent include the following: Charles C. Moskos, John Allen Williams, and David R. Segal, eds., The Postmodern Military: Armed Forces after the Cold War (New York: Oxford University Press, 2000); Jocelyn Coulon, Soldiers of Diplomacy: The United Nations, Peacekeeping, and the New World Order, trans. Phyllis Aronoff and Howard Scott (Toronto: University of Toronto Press, 1998); Lt Gen Paul K. Carlton Jr., “New Millennium, New Mind-Set: The Air Force Medical Service in the Air Expeditionary Era,” Aerospace Power Journal 15, no. 4 (Winter 2001): 8–13; and William L. Dowdy, Expeditionary Diplomacy: POL-MIL Facilitation of AEF Deployments, ARI Paper 2001-02 (Maxwell AFB, Ala.: Airpower Research Institute; College of Aerospace Doctrine, Research and Education, June 2001), on-line, Internet, 13 June 2002, available from http://research. maxwell.af.mil/papers/special_collection/arr/2001-02.pdf.
2. Donald H. Rumsfeld, Quadrennial Defense Review Report, 30 September 2001, on-line, Internet, 13 June 2002, available from http://www.defenselink.mil/pubs/qdr2001.pdf.
3. Col Eric Ash, “Medicinal Thoughts,” Aerospace Power Journal 15, no. 4 (Winter 2001): 5–6.
4. Carlton, 9.
5. The Air Force surgeon general recently approved five AFMS core competencies: fixed-wing aeromedical evacuation, medical care in military operations, interface with world health care, human-performance sustainment and enhancement, and population health. A revision of Air Force Doctrine Document (AFDD) 2-4.2, Health Services, 13 November 1999, is incorporating these core competencies into operational-level doctrine. Although not doctrine per se, core competencies enable doctrine to achieve objectives. The AFMS core competencies should flow from and support the Air Force core competencies outlined in AFDD 1, Air Force Basic Doctrine, 1 September 1997. The IHS program is an application of the AFMS core-competency interface with world health care.
6. For more information related to the IHS program, see United States Air Force International Health Specialist (IHS), on-line, Internet, 13 June 2002, available from https://www.afms.mil/afihs.
7. Carlton, 12.
8. Air Force Instruction (AFI) 16-109, Foreign Area Officer Program, 1 June 1998, 3, on-line, Internet, 13 June 2002, available from http://afpubs.hq.af.mil/pubfiles/af/16/afi16-109/afi16-109.pdf.
10. The Medical Corps is composed of physicians of many specialties. The Dental Corps includes dentists; the Nurse Corps includes nurses; and Biomedical Sciences encompasses a variety of professionals such as optometrists, psychologists, lab officers, social workers, pharmacists, bioenvironmental engineers, health physicists, and public health officers. The Medical Service Corps includes specialists in health-care administration, manpower, and resourcing.
11. Joint Vision 2020 (Washington, D.C.: Joint Chiefs of Staff, 2000), 30–32, on-line, Internet, 13 June 2002, available from http://www.dtic.mil/jv2020/jv2020.doc.
The conclusions and opinions expressed in this document are those of the author cultivated in the freedom of expression, academic environment of Air University. They do not reflect the official position of the U.S. Government, Department of Defense, the United States Air Force or the Air University.
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