The Last Frontier: Flight Surgeon

Capt. Thomas White, senior health services officer, Coast Guard Air Station Sitka, stands next to one of the air station's MH-60 Jayhawk helicopters in Sitka, Alaska, Aug. 28, 2014. As a flight surgeon, White advises command center watchstanders during medevacs, provides medical training to rescue swimmers and corpsman aviation mission specialists, and crews helicopter missions to perform on-scene treatment of patients in critical condition. U.S. Coast Guard photo.

Capt. Thomas White, senior health services officer, Coast Guard Air Station Sitka, stands next to one of the air station’s MH-60 Jayhawk helicopters in Sitka, Alaska, Aug. 28, 2014. As a flight surgeon, White advises command center watchstanders during medevacs, provides medical training to rescue swimmers and corpsman aviation mission specialists, and flies with helicopter crews to provide treatment to patients in critical condition. U.S. Coast Guard photo.

In just the first seven months of 2014, Coast Guard 17th District crews performed 99 medevacs and non-maritime medical transports. No two of these vital rescue missions look the same. From skiffs, to cargo ships, to fishing boats, to small Southeast Alaska villages, the locations and platforms are as diverse as the ailments and injuries. Just as eclectic are the responding assets: one day an MH-60 Jayhawk helicopter crew, the next day a 45-foot Response Boat – Medium.

Anchorage-based emergency medical technicians transfer an Alaska Juris crewman from a Coast Guard Air Station Kodiak HC-130 Hercules airplane in Anchorage May 10, 2012.

Anchorage-based emergency medical technicians transfer an Alaska Juris crewman from a Coast Guard Air Station Kodiak HC-130 Hercules airplane in Anchorage May 10, 2012. U.S. Coast Guard photo.

The one element that ties all these rescue cases together is the decision-making teamwork taking place behind the scenes. When command center watchstanders receive a call involving a medical emergency, they reach out to the duty flight surgeon, a medical doctor with the knowledge to make a recommendation.

“Flight surgeons participate in a regional call schedule that supports the Coast Guard rescue coordination centers and deployed assets,” said Capt. Thomas White, senior health services officer, Coast Guard Air Station Sitka. “We also train air crews in aviation physiology and act as consultants for aviation life-saving equipment.”

White has served as a flight surgeon in Sitka, Alaska, since 2012. Among his many roles there is to work into the duty flight surgeon rotation with five other Pacific Northwest doctors to advise 17th District incident management personnel during medical emergencies.

When a flight surgeon gets a call from the command center, the decision-making process begins. Unlike in a hospital or clinic, where the next step is to treat the problem, a set group of important questions must be answered: What does the patient most likely have? What treatments are necessary? When does the patient need to be treated? What destinations can support the required treatment? Can the Coast Guard meet the window of opportunity?

Once answered, these questions provide an idea of how the Coast Guard would be able to assist in any particular situation, if at all.

“What we do has to matter,” said White. “We advise the command center on what we can expect to gain.”

The potential positive outcome is just one piece of the puzzle that watchstanders use to make a decision to launch on the case, but it’s a very important piece.

“Command center personnel do not have medical training, so when a medical situation occurs we contact the duty flight surgeon,” said Paul Webb, the 17th District command center supervisor.

Webb oversees the team that takes medical input and determines which assets to use in a response. In some cases there are no Coast Guard personnel in range, or a medevac isn’t necessary. That is when the duty flight surgeon becomes an advisor to the crew in need.

Coast Guard Air Station Kodiak and Kodiak Fire Department personnel carry an injured mariner from an MH-60 Jayhawk helicopter to a waiting ambulance in Kodiak, Alaska, July 19, 2014.

Coast Guard Air Station Kodiak and Kodiak Fire Department personnel carry an injured mariner from an MH-60 Jayhawk helicopter to a waiting ambulance in Kodiak, Alaska, July 19, 2014. U.S. Coast Guard photo.

“They provide medical advice to ships at sea who may have a medical situation on board that doesn’t require a medevac. These are called medicos,” said Webb. “They can also call upon other medical specialists in case we have a situation that requires a specialist to make a recommendation.”

The duty flight surgeon will work with a vessel’s crew to talk them through treating a patient, but there’s no such thing as a standard case.

“Sometimes it’s English, sometimes you’re speaking through an interpreter,” said White. “I’ve been in situations where there’s a merchant vessel at sea, they have a big medical locker, but there’s not someone there who has a lot of expertise. They’re wondering, ‘what medicine should I take, or how do I deal with this injury?’”

With only a handful of advanced care hospitals in the sprawling 3,853,500 square miles of the 17th District’s area of responsibility, timely medical advice is a critical need. The coordination required is on a scale unlike any other.

“The merchant vessels, cruise ships, remote Alaska villages that are around here, there’s no one who can get them from point A to point B in many cases,” said White, “so a lot of the time the Coast Guard is the vehicle of last resort.”

The hard work and expertise that go into providing medical advice for the vast range of emergency situations throughout Alaska often go unnoticed, just a checked box on a long list of steps to saving lives. The truth is, whether it’s picking up the phone and making expert recommendations in the middle of the night, providing medical training to rescue swimmers and corpsman aviation mission specialists, or even personally crewing a helicopter mission to perform on-scene treatment of a patient in critical condition, the Coast Guard’s flight surgeons are a crucial part of the team that guards the Last Frontier.

“I wake up every morning thinking that I get to go to work, not that I have to,” said White. “There’s never a boring day; every day offers a variety of challenges. I get to serve the people of Southeast Alaska. I get to serve my nation as a whole. I get to be a part of the great Coast Guard team. I get to work daily with the finest of professionals, completely dedicated to living out the core values of honor, respect and devotion to duty.”

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