USCG AEROMEDICAL UPDATE 2015 CAPT Kimberly Roman, MD, USPHS/USCG Chief Medical Officer, Personnel Service Center January 2015 Good morning. I am Kimberly Roman. I am a former Navy Flight Surgeon and am now a Coast Guard Flight surgeon. Assigned Duties Today I will giving the USCG Aeromedical Update. Please make sure your children know that we are Santa’s official guardian as he wings his way across the sky at Christmas so that makes us one of Santa’s helpers!

OBJECTIVES US Coast Guard What we do (briefly) What we do it with What we have been up to What’s new

ALL HAZARDS, ALL THREATS, ALWAYS READY: WHAT WE DO ALL HAZARDS, ALL THREATS, ALWAYS READY: SEMPER PARATUS We have talked before about the breadth of the things the CG does from Search and Rescue to Medevacs, Law Enforcement to Aids to Navigation (now that’s sexy) and any other homeland security or maritime request that comes our way. On a daily basis we will: Save 13 lives Board 193 ships and boats Assist 98 people in distress Escort over 20 larger passenger vessels, military outload vessels and High Interest Vessels Launch 164 aircraft missions, logging 317 hours Service 135 aids-to-navigation and correct 21 aids-to-navigation discrepancies (describe this briefly) Conduct 64 Search and Rescue Cases Interdict and rescue 10 illegal migrants Respond to 12 oil/chemical/HAZMAT spills Seize over 1,000 lbs of illegal drugs valued at $12.9M Complete 31 Port State Control safety and environmental exams on foreign vessels

AVIATION ASSETS HH-65 HC-144 Dolphin C-27 Spartan HH-60 Jayhawk HC-130 The CG recently acquired the C-27’s from the USAF as part of the NDAA of 2014. We stopped acquiring the HC-144 (have a total of 18), stopped the C-130H upgrades and have acquired 14 C-27s (most of which are still in storage). We also have the J model C-130. So, aeromedically, are there issues? We will have pilots retraining from other airframes. That will mean decreased pools for watch standing on the front and back side of this. It will mean more watches, more time away from family and home, longer hours, more missions and increased fatigue. Not to mention the logistics of standing up the new units, adapting the aircraft to CG missions, training mechanics…. It is a change. There is always increased stressors to deal with when this sort of change occurs. This will need to be monitored for and treated appropriately. C-27 Spartan HH-60 Jayhawk HC-130 Hercules

MEDICAL ASSETS To care for 43,500 AD members (approx 3000 aviation): 40 clinical physicians (including 28 flight surgeons) 38 clinical PAs (including 21 APAs) Losses/Gaps/Cross coverage Working in 35 Clinics Overseeing 62 Sick Bays afloat and 72+ Sick Bays ashore Most clinics are staffed by 1 Physician and 1 PA. Some of our bigger clinics (Academy, Cape May) may have multiple providers. All CG medical officers provide medical oversight to the sick bays in their respective AORs. Flight Surgeons share call for medevacs in their districts. I think it is interesting to point out that there are many pockets of CG men and women out there in what we call the “white space” where they have no direct oversight of a CG medical officer. This does not include aviators with the exception of those CG aviators receiving their care from DoD flight surgeons. The CG has regions covered by and IDHS who is responsible for ensuring that care received by civilian PCMs gets into the medical record, that any disqualifying diagnoses get back to the CG medical officer with regional oversight so that it can be dealt with appropriately. It is a very labor intensive process.

MEDICAL ASSETS Operational Medical Support Port Security Unit: 1 PA, 2 HSs Cutters/MSSTs: 1 IDHS Patrol Boats: 1 EMT-B Aircraft Fixed wing - no intrinsic medical support Rotary wing - 1 rescue swimmer (EMT-B) (Medevac/SAR) The CG has operational groups that deploy or are a part of deployable units. There are very few dedicated assets associated with these units. Many cutters do not have dedicated medical assets. The XO is the medical officer responsible for records, readiness, in conjunction with a regional type IDHS. Most have someone on board who is EMT certified. Fixed wing crews do not have dedicated medical assets other than their assigned flight surgeons. Some units have corpsmen who are considered Aviation Mission Specialists. Rotary wing – usually has 1 rescue swimmer assigned – training is EMT-B level. Occasionally paramedic but his is attained privately.

WHAT WE HAVE BEEN UP TO Overall Assets & Personnel: Deepwater Horizon Haitian Operation In the last few year, beside the usual, the CG has responded to the following: Haiti: Coast Guard was the first of the US Forces on-scene in Port Au Prince MEDEVAC > 120 critically injured Evacuated > 936 American citizens Deepwater Horizon: Overall Assets & Personnel: 48,000+ personnel 10,000 Vessels of Opportunity 125 aircraft 1000+ organizations Unaccompanied minors last summer (where they deployed, how many deployed, what they did) The Coast Guard deployed 12 medical personnel to SW TX from 24May14-20Jun14. These members screened 24,721 and saved DHS over $4 million.   Ebola involvement (number of corpsmen sent to airports, number of airports, how long, mission). The Coast Guard deployed 20 HS’s to 5 airports (New York, Newark, Chicago, Atlanta, & DC). The mission was from 07OCT14-30OCT14. Over 600 screenings were conducted. Ebola Unaccompanied Minors

LEADERSHIP CHANGES USCG CHANGE OF COMMAND JUNE 2014 We have also had leadership Changes. Admiral Papp Admiral Zukunft

AVIATION MEDICINE RETIRED From Greenland to… So, after having traveled the globe, ended many a Salmon’s trip upstream, played with polar bears and fell into a crevass in Greenland, flown in every airframe in the CG, taken part in too many mishap boards and trained many new CG flight surgeons, CAPT Ken Harman decided it was time to sit on his dock, drink Moose Drool and tool around on his boat and let the rest of us fend for ourselves. We thank him for his service and wish him well – most of the time….. RETIRED

AVIATION MEDICINE ON DECK Whether because they were really desperate or my bribe worked, I have been selected to replace CAPT Harman as the AMSO this summer. I have done as much damage as they can stand in the beltway so I will wind my way back down her and see how much havoc I can stir up. I look forward to working with each and everyone here! Talk about the Duck Hunt – JPAC, joint mission, all aviation from CG!, Frozen In Time – Mitch Zuckoff

WHAT’S COMING Integrated heath information System #1 Goal: Eliminate Silos of Health Information – Better Manage Healthcare So, what’s coming up for the CG in the next year. The big thing I believe is our long awaited new EMR. But it has become more than just an EMR. It is an Integrated Health Information System, IHIS, which will sort of wrap everything up in a single – well – I don’t know – but it is an integrated health management system. No more PGUI (or AHLTA for you) plus MRRS, plus OMSEP databases, plus mishap data bases, DENCAS…….. It will all be handled with IHIS. This means a program we have all come together on will be phased out by the CG. Tricare Safety Medical Dental Readiness Deployment Occupational Work-Life

Member/Patient Engagement – myIHiSPortal Unit/Command Engagement – Unit Safety Portal Mishap & Injury Reporting Available to All Post Injury & Exposure Monitoring Available to members to monitor requirements Surveillance Tools

IHiS Occupational Health Screening & Surveillance OMSEP Aviation/Dive Physicals PHAs System is HIPAA compliant Member’s entire record is able to be exported or shared with the VA or DoD as appropriate or required AERO will be replaced by a program on EPIC. It will have many of the same features as AERO including an electronic 2808 and 2807 and waivers will be trackable through the system also. At this time, however, it does not appear that the data from EPIC will flow into AERO or vice versa. This may cause some confusion when doing cross service physicals and is something that we will want to address in the next several months. Another positive is that for the last many years, CG has had hard records and since CG PGUI did not interface with AHLTA, unless there was a hard copy record present, DoD could not see a CG member’s information. EPIC will have the ability to export data to both the VA or DoD as necessary.

IHiS For further information, contact: CAPT Trent Janda, DO US Coast Guard (CG-114) 2703 Martin Luther King Jr Ave SE Washington DC 20593-7907 trenton.a.janda@uscg.mil This is quite a complex issue and I have now told you about as much as I know. If you have any other questions concerning this expanding and every changing topic, please contact CAPT Trent Janda. If it is IT and EMR, I don’t know too many others who know more than he does.

QUESTIONS? Thank you.