A flight surgeon is a military medical officer assigned to duties in the clinical field variously known as aviation medicine, aerospace medicine, or flight medicine. (Although the term "flight surgery" is considered improper by purists, it may occasionally be encountered.[1])
Flight surgeons are medical doctors, either MDs or DOs who are primarily responsible for the medical evaluation, certification and treatment of aviation personnel — e.g., pilots, USN and USMC Naval Flight Officers, USAF navigators/Combat Systems Officers, astronauts, air traffic controllers, UAV operators and other aircrew members. They perform routine, periodic medical examinations ("flight physicals") of these personnel. 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 on flight status (i.e., they log flight hours), but are not required to be rated or licensed pilots. 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). Though 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), many are less extensively trained.
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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.[2][3] The term is especially associated with Col. (later Brig. Gen.) Theodore C. Lyster (the first Chief Surgeon, Aviation Section, U.S. Signal Corps, U.S. Army), and with Maj. Isaac H. Jones. These two officers proposed the organization of a “Care of the Flier” unit in June 1918.[4]
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.
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 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.[5]
This position requires additional specialized training. It 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 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/flight 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 service:
In the U.S. Air Force, most flight surgeons have received initial training in the form of the Aerospace Medicine Primary (AMP) course, an eight week training program that involves aeromedical topics as well as aircrew and survival training.
Some 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. Consequently, a RAM has some actual piloting experience and some training toward initial qualification, although the rating of pilot is not awarded.
In the U.S. Navy, initial flight surgeon training is significantly longer and involves a version of MOFFT, so that all Navy flight surgeons have some formal pilot training. Naval Flight Surgeons may also attend a three year RAM training program that is distinct from the Air Force program. A small number of Naval Flight Surgeons are also "dual-designated" as Naval Aviators, having either been former unrestricted line officer pilots who attend medical school and transfer to the Navy's Medical Corps, or previously designated Naval Flight Surgeons selected to attend flight training as Student Naval Aviators. These officers are awarded Naval Aviator insignia, but remain in the Medical Corps as "dual designator" officers, qualified as both a Naval Aviator and a Naval Flight Surgeon. Such officers are often assigned as research pilots.[6]
The U.S. Army, which has more Flight Surgeons than the U.S. Air Force, has a combined training program. Most Army Flight Surgeons graduate from a basic course of 6 weeks taught at the US Army School of Aviation Medicine at Fort Rucker, Alabama and are then assigned to their units. After some experience in the field, Army physicians are then eligible to participate in a RAM program as described above-- In the past, most Army RAMs have participated in the USAF program, but currently most take part in the USN program, while a few study in the only US civilian RAM program, at Wright State University. RAM training is the equivalent of other specialty residency training in the US, and a graduate of the program can take board certification tests and is then considered a fully-fledged specialist.
The training requirements in other nations than the US are different -- for example, in the United Kingdom, Aviation Medicine is considered a sub-specialty of Occupational Medicine rather than a fully separate specialty. Thus, Royal Air Force, Royal Navy and British Army specialists in Aviation Medicine are usually required to be specialists in Occupational Medicine before undertaking the specialised training in Aviation Medicine.
During World War II, the head of the Army Air Forces, General of the Army 'Hap' Arnold, directed all flight surgeons in the U.S. Army Air Forces to fly regularly with their patients in order to better understand the aviation environment. Consequently, in the U.S. military, flight surgeons are rated aircrew members who receive flight pay and who are required to fly a certain number of hours monthly.