You

1
Youre The Flight SurgeonARMA

• Colonel Brett A. Wyrick,
• USAF, MC, SFS, MPH

brett.a.wyrick.mil_at_mail.mil
2
One Day in the AOR

• Youre 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?

3
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.

4
The CCs 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

5
The Answer is D

• A nice open ended statement may encourage
  further conversation, and validation of a
  potential problem will further the conversation.

6
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

7
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.

8
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

9
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

10
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, Lets 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.

11
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.

12
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.

13
The Rest of the Story

• Predictably, our young aviator was Killed in
  action later that same evening after scoring
  three victories in aerial combat

14
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 Americas
  leading ace
• Fighter pilots still train at the base named in
  his honor, Luke AFB, AZ

15
Lt. Frank Luke, Jr

• ARMA SAT or UNSAT?