Newsletters

POSTED: June 25th, 2024
POSTED IN: 2024 Quarter 2, EM Pulse - The Official Newsletter of MOCEP,

By Jason Wagner, MD, FACEP; Washington University in St. Louis

“I feel the need – the need for SPEED!”

If you’re of a certain age, this iconic line from the movie Top Gun may bring back memories. For me, it brings me back to the inception of my interest in joining the military. As a high schooler in the ’80s I must have seen Top Gun a dozen times in the theater; no streaming back then kids. It prompted me to apply to the Naval Academy, only to be rejected after they informed me that I applied a year too early. The next year, I re-applied and was accepted! While being a fighter pilot was a dream, much to my mom’s chagrin, I declined the academy (and its “free” education) for a wrestling scholarship at the University of Minnesota. A series of events too long for this article found me a couple of years later enlisted in the Army as an infantryman with the 2nd Ranger Battalion, 75th Ranger Regiment, where I joined a peace-time Army only to leave for basic training the day Iraq invaded Kuwait. My time in the Army was followed by finishing my undergraduate degree at the University of North Dakota and my MD at the University of Colorado Health Sciences Center. In 2001, I began residency in Emergency Medicine at Washington University in St. Louis. During my residency, I realized that getting into the cockpit of a fighter jet was still a possibility when I learned about the role of a Flight Surgeon (FS). Spoiler alert, they do NOT do surgery in the back of a plane. Rather, they are more like a team doctor for a group of high-performing athletes (at least as it pertains to fighter pilots), and I was lucky enough to have an F-15 squadron in my backyard at Lambert Airfield in St. Louis, MO. I enlisted into a peace-time Air Force, joining the Missouri Air National Guard in 2001 just days before 9-11.

My initial role in the 131st Med Group consisted of performing physical exams and preparing for field medical care in mobile hospitals. During my three of four-year stint of residency training, I was able to attend the two-month Air Force Flight Surgeon Course. Eight hours a day of classroom instruction on what was basically a crash course on primary care was only occasionally interrupted by practical courses. I experienced loss of color vision during hypoxia training, vomited more times than I can recall after barely passing centrifuge training, flexed my infantry skills during water-safety and survival school, and finally got my first flight in fighter-trainer. Graduating from the course, it was back to resident life but with the added benefit of spending a few days a month doing Basic Fighter Maneuvers (BFM or Dogfighting) in the back of an F-15 with some of the most experience pilots in not only the USAF, but the world. The first pilot I flew with scored the first confirmed kill in Desert Storm/Shield and had the most cumulative hours in an F15 of any pilot in the world.

As a FS for a fighter squadron, you care for the flyers, the aircraft maintainers, and their families. It’s a bit like being a FP with some Sports Med experience. The biggest benefit is that you are incorporated into their family of flyers as a full member with a different area of expertise. You hold the power to keep a flyer in or out of the cockpit, so they often tread lightly during clinic visits. It’s the quiet moments where you get the truth; sharing a beer at the bar or flying back to base after an afternoon of BFM is when they confess to you that they are starting to experience back pain when they pull more than 6 G’s, or they ask you to look at the mole on their arm that turns out to be melanoma. This is one reason why you are integrated into the team. The other is to get a sense of what the job requires. You need to experience the demands of BFM in a high-performance platform to truly understand the impact of medical issues on their ability to do their jobs.

My first concept to what flying in an F-15 might be like came from the aforementioned Top Gun film, where they basically set a camera on a saw mount to make it jiggle and called it “high-G flight.” Maverick and Goose make shooting the breeze in a high-G turn look way too easy. Watch Top Gun – Maverick if you want a better sense of what an 8-G turn looks and (might) feel like. Grunting and straining to keep fresh blood in your brain is a hell of a workout! Even worse, from the back seat (there’s always a pilot flying up front) you don’t have a solid sense of how many G’s your pulling, or for how long you might be doing it. Work too hard and you’ll tire out. Relax too much and you’ll G-lock (pass out). After earning my call-sign, I was able to fly the plane to and from the area where we “fight”, eventually earning my way to flying during some BFM training. BFM is all about physics and conservation of energy. I like to refer to it as a ballet of physics. The less graceful your flying, the more energy you bleed, and the more rapidly your opponent gets an angle to shoot you down. The pilots I flew against always knew when “Doc” was flying the plane. I was an easy target.

After 10 years as an F-15 FS, our aircraft was re-distributed to units across the Air Force, and the 131st went from F-15’s to the B-2 Bomber at Whiteman Air Force Base. While the B-2 is the most advanced air-based weapons platform in the world, it goes without saying that supporting the B-2 was not nearly as fun as the F-15. Firstly, the B-2 does not do BFM. Instead, they do 24-hour missions. Secondly, it wouldn’t matter if they did BFM, because they also don’t let doctors take one of their 2 seats, pilots only! My time supporting B-2 bombers lasted only a few years, because my medical group became one of the first Air Guard units in the country to support a Critical Care Air transport Team (CCATT). CCATT consists of one physician (critical care or emergency medicine trained), one registered nurse, and one respiratory therapist. This 3-person team is equipped to care for up to six critical care patients at a time in the back of an aircraft (still not doing surgery in the back of an aircraft, but it’s a step closer). A team can support up to three ventilated patients (more with augmentation) along with three more seriously wounded or ill. CCATT also has the ability to perform nearly all stabilizing procedures you could do in an ED or ICU. This includes airway management, central venous and arterial lines, chest tubes, POCUS, pressers, blood products, etc.

CCATT was used heavily during our conflicts in Iraq and Afghanistan to transport patients from hospitals near the point of injury to higher levels of care and eventually back to hospitals in the US and Germany. CCATT’s capability of taking relatively unstable patients to the levels of care needed for life-saving surgeries is partially credited with the high survival rates of individuals injured in our more recent conflicts. Currently, this concept is being pushed even further with teams performing missions in areas of active conflict to secure patients at the point of injury and rapidly transferring them to highly capable surgical teams near active areas of combat.

After serving in the military since 1990, I will retire in June 2024 as a Lieutenant Colonel. My time in the Missouri Air National Guard, while time-consuming, was extremely fulfilling as well. As an EP, it can be especially challenging, because most units do drill during weekends, which means you’ll spend one of you coveted two weekends off on military duty. That said, I was able to serve locally, nationally, and internationally helping my neighbors in Missouri along with foreign nationals across the world. I’ve proved care and training in over a dozen countries, while getting a chance to break the sound barrier over the North Atlantic near Iceland. My service consumed a lot of weekends and cost me months of being away, I could not have done it without an understanding spouse who supported me and my family throughout, while still growing her own career as a PhD. Thanks to my wife Kristen and my kids Amanda, Jadee, and Drew for giving part of their time with me to their country.