flight surgeon flight surgeon a flight surgeon is a military medical officer practicing in the clinical field of aviation medicine. although the term "flight surgery" is considered improper by purists, it may occasionally be encountered. a deployed u.s. navy flight surgeon performs a shipboard exam in the persian gulf in 2004. flight surgeons are physicians (mds or dos) who serve as the primary care physicians for a variety of military aviation personnel on special duty status — e.g., pilots, flight officers, navigators/combat systems officers, astronauts, missile combat crews, air traffic controllers, uav operators and other aircrew members, both officer and enlisted. in the united states department of defense, the army, navy, and air force all train and utilize flight surgeons. in addition to serving as primary care for military members on special duty status and their families, the u.s. department of defense uses flight surgeons for a variety of other tasks. aviation medicine is essentially a form of occupational medicine and flight surgeons are tasked with the responsibility of maintaining the military's strict medical standards, especially the even stricter standards that apply to those on flying, controlling or jump (airborne) status. in the u.s military, flight surgeons are trained to fill general public health and occupational and preventive medicine roles, and are only infrequently "surgeons" in an operating theater sense. flight surgeons are typically rated aviators on flight status (i.e., they log flight hours in military aircraft as a crewmember), but are not required to be rated or licensed pilots, naval flight officers, or navigators/csos. they may be called upon to provide medical consultation as members of an investigation board into a military or nasa aviation or spaceflight mishap. occasionally, they may serve to provide in-flight care to patients being evacuated via aeromedical evacuation, either fixed wing or rotary wing. the civilian equivalent of the flight surgeon is the aviation medical examiner (ame). some civilian ames have training similar to that of military flight surgeons, and some are either retired military flight surgeons or actively serving flight surgeons in a military reserve component. history the roots of aviation medicine extend back to the earliest scientific discoveries of gas laws and the makeup of earth's atmosphere as these factors relate to the human body. as aviation progressed from lighter-than-air balloons to fixed wing controlled flight to spaceflight, the disciplines of medicine and physiology were required to track with each technological advance. physicians and physiologists, such as john jeffries (1745-1819) and paul bert (1833-1886), conducted experiments on humans in flight and documented the body's response to these physiologic stressors. however, it would not be until airplanes were first used in war that the office of the first flight surgeon was established. world war i the term "flight surgeon" originated in the early months of 1918 when the u.s. air medical service of the u.s. army collaborated with two civilian aviation organizations—the aero club of america and the aerial league of america—to manage problems of medical screening and standards for u.s. military aviators. the term is especially associated with colonel (later brigadier general) theodore c. lyster (the first chief surgeon, aviation section, u.s. signal corps, u.s. army), and with major isaac h. jones. these two officers proposed the organization of a pioneering "care of the flier" unit in june 1918. the original intent was for the military and the surgeon general to understand what was causing the high flight mishap rate. shortly after the appointment of the first flight surgeons, research and experience led to a dramatic improvement in aircrew health as well as a significant raising of the entry medical standards for all aircrew. the early flight surgeons found that the army's practice of assigning officers to flight duty who were not physically qualified for infantry or cavalry duty was improper. because of the g-forces, risk of spatial disorientation, and risk of hypoxia encountered in the aviation environment, among other challenges, early flight surgeons found that aviation personnel must be scrupulously healthy and well trained in the basics of aerospace physiology. world war ii the role of flight surgeons continued to mature and expand as the u.s. faced world war ii. the 1941 movie dive bomber, although focused on naval aviation, highlighted the role of the flight surgeon just prior to the attack on pearl harbor, and demonstrated how solving the problems of hypoxia at altitude would reduce the aircraft mishap rate. during world war ii, the head of the u.s. army air forces, general of the army (later general of the air force) henry 'hap' arnold, directed all flight surgeons in the army air forces to fly regularly with their patients in order to better understand the aviation environment. consequently, to this day, their successor u.s. air force flight surgeons are considered "aeronautically rated" aircrew members who receive flight pay and who are required to fly a certain number of hours monthly. the same policy applies to army flight surgeons and to naval flight surgeons, the latter who are considered "aeronautically designated" officers like their naval aviator and naval flight officer counterparts. strict racial segregation in the u.s. army required the development of separate black flight surgeons to support the operations and training of the tuskegee airmen in 1941 and continued in the u.s. army air forces throughout world war ii. following the establishment of an independent u.s. air force and the racial integration of all the u.s. armed forces following world war ii, this separation was discontinued. cold war flight surgeons were still utilized but only in garrison environments. during the vietnam war, usaf flight surgeons were utilized on flights. training the position of flight surgeon requires additional specialized training beyond traditional medical school; training which is both military and medical in nature. flight surgeon training was created as distinct from other medical professionals in the armed forces because of the special, and often higher, minimum standards of fitness and physical requirements required by the extremely high responsibility positions of aviators and ancillary aviation personnel. for example, some routine treatments, such as certain antihistamines, when administered to aviation personnel, are cause for temporary grounding (loss of flying privileges) until the therapy and its effects are completed. further, the whole "mindset" of aviation medicine practitioners is different from that of non-aviation physicians. most medical problems on the ground are "an abnormal response to a normal environment", while in aviation the clinician must consider the "normal response to an abnormal environment." flight surgeon training varies depending on the branch of military service: u.s. air force in the u.s. air force, most flight surgeons receive initial training at the u.s. air force school of aerospace medicine (usafsam) at wright-patterson afb, ohio. the entry curriculum is known as the aerospace medicine primary (amp) course, a two-week curriculum that involves aeromedical topics as well as aircrew and survival training. amp is a combination of didactic and laboratory experiences designed to prepare usaf medical officers for basic mission qualification to perform duties in support of the objectives of the usaf aerospace medicine program. some air force flight surgeons ultimately move on to the residency in aerospace medicine (ram), a three-year program involving a master of public health, a year of aerospace medical training, and a year of either occupational or preventive medical training. graduates of the ram are eligible to be double-boarded in aerospace medicine and either occupational or preventive medicine, and are generally assigned to supervise other flight surgeons or medical units. the ram also involves medical officer flight familiarization training (mofft), during which the flight surgeon receives abbreviated ground school and some basic pilot training in the t-6 texan ii. consequently, a ram has some actual piloting experience and some training toward initial qualification, although the aeronautical rating of usaf pilot is not awarded. a limited number of usaf flight surgeons may also perform duties as pilot-physicians (air force specialty code 48vx). pilot-physicians initially begin their usaf service as line officer pilots, later transferring to the usaf medical corps in order to attend medical school. the purpose of pilot-physicians is to provide "integrated operational and aerospace medicine guidance" in the research, development, testing, and evaluation of air force systems and missions to realize the greatest effectiveness and cost savings. pilot-physicians were previously assigned only to an operational flying squadron in their respective aircraft, with their main assignment as a pilot, but also with clinical duties seeing patients, usually the aviation medicine clinic, depending on the pilot-physician's medical specialty. on 21 april 2011 the usaf pilot-physician program (ppp) was completely revised to make "... the most of the special resources of air force officers who are simultaneously qualified both as pilots and flight surgeons...", with a senior pilot-physician selected by the air force surgeon general to be program director, and assignment of designated command, staff, research, training, and education billets as well as duty in operational units. a p48vx air force specialty code (afsc) is assigned to those medical officers on aeronautical orders as a pilot-physician and assigned to one of these designated ppp billets. pilot-physicians are entitled to conditional flight pay (i.e., aviation career incentive pay or acip), that is, only if assigned to an active flying position and flying a prescribed number of hours monthly. in addition to being a rated pilot and a rated flight surgeon, a pilot-physician must have completed at least three years of operational flying and one year as an operational flight surgeon, with a provision for assigning applicants without flight surgeon operational experience to a base where they would likely become a "first assignment pilot-physician". the revised program allows flight surgeons access to undergraduate pilot training and remotely piloted aircraft (rpa) pilot training (one slot per year); allows participation of flight surgeons with prior experience as usaf combat systems officers/navigators/electronic warfare officers/weapons systems officers, rpa sensor operators, and flight test engineers as navigator-physicians or flight test-physicians; and authorizes pilot-physicians to compete for assignment to the usaf test pilot school. pilot-physicians are defined by four core competencies to achieve program objectives: (1) providing expert guidance through the synthesis of operational and medical experience; (2) conducting research by applying operational insights to studies, basic and applied science, relevant research, development, test & evaluation (rdt&e), and operational test & evaluation (ot&e); (3) teaching aircrew, senior air force leaders, and medical personnel on subjects of particular expertise, and (4) conducting analysis to provide recommendations for operational systems, environments, and mishaps; and solutions to human performance problems. pilot-physicians are eligible for advanced ratings as both flight surgeons and pilots. they may apply toward advanced pilot ratings any usaf pilot years of aviation service, months of operational flying duty, and total flying hours accrued before achieving flight surgeon status. after attaining status as a pilot-physician, all hours flown as a pilot, and months of operational flying duty credit accrued as a pilot, are "dual-credited" toward both advanced pilot and flight surgeon ratings as long as the officer is on aeronautical orders as an active pilot-physician. usaf flight surgeons hold three different rating levels, flight surgeon, senior flight surgeon and chief flight surgeon, contingent upon years of service as a flight surgeon and total flight hours logged. air force flight surgeons serve throughout the flying activities of the u.s. air force, to include flight surgeons in the air reserve component who serve in the air force reserve command (afrc) and the air national guard (ang). air force flight surgeon insignia u.s. navy medical debriefing of lt. colonel john h. glenn, jr., usmc (center) after orbital flight of friendship 7 on 20 february 1962 aboard the aircraft carrier uss randolph (cvs-15). the debriefing team for lieutenant colonel glenn was led by commander seldon c. "smokey" dunn, mc, usn (fs) (ram-qualified) (far right w/ekg in hands). "best regards and many thanks for all the help, 'smokey' john h. glenn jr mercury astronaut a good date -- 20 february 62" in the u.s. navy, initial flight surgeon training is conducted via the flight surgeon primary course at the naval aerospace medical institute (nami) at nas pensacola, florida. the flight surgeon primary course is significantly longer than its usaf counterpart and involves a lengthier and more robust version of mofft for all candidates, so that all navy flight surgeons have some formal pilot training in the t-6 texan ii aircraft, up to the "safe for solo" point