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Q&A: Lieutenant General (Dr.) Thomas W. Travis

 

QA Travis

Pilot Doctor:
Pushing Air Force Medicine Forward
in a Constrained Environment

 

Lieutenant General (Dr.) Thomas W. Travis
Surgeon General
U.S. Air Force

 

Lieutenant General (Dr.) Thomas W. Travis is the surgeon general of the Air Force, Headquarters U.S. Air Force, Washington, D.C. Travis serves as functional manager of the U.S. Air Force Medical Service. In this capacity, he advises the secretary of the Air Force and Air Force chief of staff, as well as the assistant secretary of defense for health affairs, on matters pertaining to the medical aspects of the air expeditionary force and the health of Air Force people. Travis has authority to commit resources worldwide for the Air Force Medical Service, to make decisions affecting the delivery of medical services, and to develop plans, programs and procedures to support worldwide medical service missions. He exercises direction, guidance and technical management of a $6.6 billion, 44,000-person integrated health care delivery system serving 2.6 million beneficiaries at 75 military treatment facilities worldwide.

Travis entered the Air Force in 1976 as a distinguished graduate of the ROTC program at Virginia Polytechnic Institute and State University. He was awarded his pilot wings in 1978 and served as an F-4 pilot and aircraft commander. The general completed his medical degree from the Uniformed Services University of the Health Sciences School of Medicine, where he was the top Air Force graduate, and in 1987 he became a flight surgeon. For more than three years, Travis was chief of medical operations for the Human Systems Program Office at Brooks Air Force Base, Texas. He later served as the director of operational health support and chief of Aerospace Medicine Division for the Air Force Medical Operations Agency in Washington, D.C.

Prior to his current assignment, Travis served as deputy surgeon general, Headquarters U.S. Air Force, Washington, D.C. The general has commanded the U.S. Air Force School of Aerospace Medicine; 311th Human Systems Wing at Brooks AFB; Malcolm Grow Medical Center and 79th Medical Wing, Andrews AFB, Md.; and the 59th Medical Wing, Wilford Hall Medical Center, Lackland AFB, Texas. He also served as the command surgeon, Headquarters Air Force District of Washington, and command surgeon, Headquarters Air Combat Command, Langley AFB, Va. He is board certified in aerospace medicine. A command pilot and chief flight surgeon, he has more than 1,800 flying hours and is one of the Air Force’s few pilot-physicians. He has flown the F-4, F-15 and F-16 as mission pilot and the Royal Air Force Hawk as the senior medical officer and pilot.

Q: As surgeon general of the Air Force, what are your priorities?

A: My top priority, and that of the Air Force Medical Service, is focused on supporting the line of the Air Force mission—our ‘true north’—maintaining a medical force that is trained and ready to deploy at a moment’s notice, but also aligned with our wings in support of their operational missions. Our mission is to enable medically fit forces, provide expeditionary medics and improve the health of all we serve to meet our nation’s needs.

We have completed over 194,000 patient movements since 9/11, including transporting 7,900 critical care patients. We provided ‘care in the air’ to more than 5,000 patients in 2013 alone, including almost 300 critical care air transport team (CCATT) missions for the most seriously ill and injured.

In addition, we are now providing enhanced support for our ‘deployed in place’ airmen who man systems such as remotely piloted aircraft, or who are executing intelligence, surveillance and reconnaissance missions. These airmen are projecting air power in ways we have never done before. In different ways, our ‘outside the wire’ airmen, such as special operations forces and explosive ordnance disposal specialists, require a different type of prevention and care. The types of injuries or stresses—both visible and invisible—these members face are causing us to adapt and innovate to provide medical support in different ways than we have in the past to address the expanding definition of ‘operators’ and step up to our role as human performance practitioners, assuring airmen are always able to perform their missions effectively. Not only will access and care be customized for the mission, but so will prevention. We are now working to institutionalize how we are doing it now and how it will need to be done in the future.

Q: What are some challenges that the Air Force Medical Service currently faces?

A: The foremost challenge will be to stay ready, even as we come home from the current long war. Our military forces have benefited from the vast achievements Air Force, Army and Navy medics have made in deployed and en-route care since the beginning of the current war. Yet with this war winding down, even with fiscal challenges, we now have a clear responsibility to make sure military medics are well-trained and well-prepared for whatever contingency the future brings, to include combat operations, stability operations, humanitarian assistance or disaster relief.

To enhance our competency in the ground expeditionary and air evacuation missions, we must ensure that our providers continue to have robust opportunities to practice their skills and that we continue to pursue critical research and modernization initiatives for the future. We have very successfully leveraged civilian partnerships to maintain trauma skills readiness, and as this war subsides, I am convinced we will rely even more strongly on these relationships to help us train and to conduct research. Our Centers for the Sustainment of Trauma and Readiness (C-STARS) partnerships in Baltimore, Cincinnati and St. Louis provided critical trauma and critical care air transport team training to our deploying medics during the war and will remain significant platforms. We believe we will need to expand our training opportunities in the pause between hostilities to ensure all of our personnel remain ready and current.

To that end, we are transitioning to a layered, centrally managed platform emphasizing hands-on patient care, called Sustained Medical and Readiness Training, or SMART. This program establishes a three-tiered approach where personnel at facilities of all sizes will train with a standardized curriculum using organic training opportunities, local training affiliation agreements with partnering hospitals, and, when necessary, regional currency sites to ensure required skills are preserved and staff is sustained in a trained and ready status. We anticipate our first class at a regional SMART site to begin in September at Nellis Air Force Base, Nev.

With a focus on the future, we are involved in some amazing state-of-the-art research in our major thrust areas of en route care, force health protection, expeditionary medicine, human performance and operational medicine. As an example, we are collaborating with the Battlefield Health and Trauma Research Institute and the San Antonio University Health System to conduct research on spinal fractures, blood transfusions, sepsis, burns, hemorrhagic shock and compartment syndrome.

In support of human performance and en-route care, our C-STARS faculty and civilian partners are studying the timing of aeromedical evacuation on the clinical status of combat casualties to help medical teams determine the best timing of evacuation to optimize health outcomes. While we have been very proud of our success in quickly returning patients to higher levels of care when required, the decision of when to move a patient must be data-driven, and our experience in the current long war should help guide such decisions in the future.

Q: How is the Air Force Medical Service managing to maintain force health protection in this time of steep budget cuts?

A: As always, the focus of the AFMS is the readiness of our airmen. We continue to invest in prevention measures, such as immunizations, targeted routine health assessments and force health protection research initiatives. These will pay huge dividends down the road in keeping our airmen healthy. Additionally, we are committed to working with our sister services in shaping the newly established Defense Health Agency. We are hopeful that collaborations over the coming months and years will result in efficiencies, as well as cost savings, across our force health protection programs.

Q: Could you discuss some examples of Air Force Medicine’s role in providing expeditionary combat casualty care in support of joint operations?

A: Our CCATT have been a vital component during the war in saving lives by transporting stabilized patients to the next level of care. Our ‘care in the air team’ capability has been instrumental in advancing our practice of transporting only stable patients to a paradigm of en-route patient treatment that has become integral to health service support in joint doctrine.

As we strive for even greater survival rates, we’ve evolved our CCATT capability point-of-injury response. This gives us more capable care further forward and more sophisticated in-transit support. Our tactical critical care evacuation teams deliver damage control resuscitation on rotary wing, forward-deployed fixed wing, and tilt wing aircraft, and have accomplished more than 1,600 critical care patient movements since we began the program in June 2011, many from point of injury.

In addition to our CCATT capability, the expeditionary medical support health response teams are successfully deployed as a part of our continuous evolution in medical response capabilities anywhere in the world. They deliver immediate emergency care within minutes to hours of arrival—surgery and intensive critical care units in place within six hours, and full capability established within 12 hours of deployment arrival.

Working side by side with Army and Navy medics, we have executed joint en-route care that is historic in achieving unprecedented survival rates.    

Q: How does the Air Force Medical Service maintain the right workforce to deliver medical capabilities across the full range of military operations?

A: The AFMS prioritizes and funds our manpower requirements based on meeting the readiness mission we provide to the war-fighters. In addition to ensuring we have correctly funded the right manpower requirements, we take deliberate actions to maintain those skill sets.

In addition to this work, the AFMS faces keen human resource competition from the private sector and other federal agencies. To mitigate this challenge, we have pursued an aggressive two-pronged approach specifically targeting expanded education opportunities and enhancements to quality of life/practice to attract and retain qualified health professionals. Beginning in 2006, we expanded officer and enlisted education opportunities as a cornerstone of a ‘grow our own’ strategy. This included expanding the Health Professions Scholarship Program, funded residency training opportunities and instituting several new enlisted commissioning and certification programs such as the Enlisted to Medical Degree Preparatory Program (first selection board in fiscal year 2015).

By levying active duty service commitments to these programs, the AFMS was able to lengthen decision point timelines and guarantee a sustained force cohort for the future. These programs have proven to be the most successful avenue of accession for the AFMS.

In efforts to enhance quality of life and practice, we engaged clinical specialty consultants to balance the force and spread the deployment load more evenly among members. This effort continues to be key for high-demand, low-density medical specialties with high wartime deployment rates.

The successful implementation and execution of our two-pronged approach has resulted in a 10-year high in overall AFMS retention and average career lengths.

Q: Within Air Force Medicine, is there a growing trend towards more personalized care?

A: Yes, we are moving in that direction. As an example, we continue to embrace the principles of patient-centered medical home (PCMH) to improve patient care, access and outcomes. We have attained all-time-high levels of provider and team continuity throughout 2013, while reducing emergency room utilization rates. And we developed standardized support staff protocols to promote evidence-based practice, reduce variation and enhance reliability by using PCMH teams to their fullest capabilities. The protocols have also helped to improve currency of our medics while creating access opportunities for our patients.  

Likewise, we have achieved enhanced access through the continued deployment of secure messaging. This technology has now been launched throughout the AFMS and includes more than 305,000 enrolled users sending over 41,000 messages per month. This leading-edge communication tool provides an additional venue to meet patient needs without face-to-face appointments, and helps our patients partner with providers in the management of their care.

Q: Much has been made of the ‘tyranny of distance’ in the Pacific region. How does that impact Air Force Medicine?

A: In recent years, the Air Force has become accustomed to moving patients from Iraq and Afghanistan to definitive care in Germany and the United States relatively quickly, but the ‘tyranny of distance’ in the Pacific region does not allow that luxury. While we can depend upon the health care infrastructure of some Pacific countries to provide support to our patients, it is not available in all areas of the Pacific. Thus, the vastness of this region presents challenges to Air Force Medicine, most notably in our ability to provide rapid life-stabilizing care at dispersed operating locations, as well as responsive joint casualty evacuation from these locations to definitive care in the United States.

Additionally, potential adversaries in this region may prevent the access we have been accustomed to in recent wars, which could exacerbate the problem and result in even higher casualty rates. As the armed forces collaborate on new integrated war fighting concepts to ensure U.S. access and freedom of action in denied environments, Air Force, Navy and Army medics must also collaborate to ensure optimal warfighter performance and survival. Greater transport distances and times create a necessity for longer hold times for patients, which can increase the mortality rate for casualties.

Accordingly, the AFMS has partnered with Navy and Army medics to develop integrated solutions for medical operations in denied environments. New capabilities must employ lighter, more autonomous medical teams enabled by miniature medical devices and telemedicine, yet more resilient to survive during forward operations in a hostile environment. Our aeromedical evacuation system must be capable of moving casualties using integrated medical teams. An example is an ongoing Air Force-Navy collaboration to develop a way to move casualties from land to ship to land using integrated Air Force and Navy capabilities in support of hostilities in the Pacific. The Air Force and Navy are also exploring the potential use of unmanned aircraft for medical resupply and patient movement in denied environments.

We are also focusing on global health engagement activities to set the conditions for success in future wartime scenarios. We must give health engagement priority to the partner nations that play a critical role in our success in denied environments, first as a deterrent to war and second to ensure access to needed local infrastructure and resources in war. In order to quickly provide medical care, we must build relationships and share capabilities with partner countries in the region. The value of this type of engagement was recently proven in the Philippine tropical cyclone response. While U.S. Air Force medics were postured to support disaster relief efforts, the Philippine Air Force used training provided by Air Force medics to successfully move patients from the disaster area to receive medical care.

Q: How important are international partnerships to the Air Force Medical Service?

A: International collaboration is essential to our mission. International health specialists forge partnerships with nations around the globe, which help us address our critical challenges and meet theater combatant commanders’ end-state objectives. We are working to improve health conditions and regional stability to decrease the risk of conflict, and also to become more interoperable partners, able to effectively respond as a team across the full
spectrum of operations—from humanitarian disaster response to combat casualty care. As an example, we recently signed a terms of reference agreement with the Israeli Defense Force to reaffirm our mutual commitment to collaboration between our two organizations. The agreement will expand cooperation in such areas as aerospace medicine, mental health, training, academics and medical research.

Q: Are there any new special programs or initiatives within Air Force Medicine that you’d care to share with us?

A: I’m excited about the life-saving advancements in medicine—and the many initiatives now underway in the AFMS to ensure we remain on the leading edge into the future. I will give you a few examples.

We made history recently, when the lung team and one of our CCATTs transported the wife of a servicemember in need of a lung transplant on an Extracorporeal Life Support (ECLS) machine from Landstuhl, Germany to Joint Base Andrews, Md.—the longest-ever successful transport for a critically-ill patient on ECLS. Further research into use of the ECLS for the comprehensive treatment of combat casualties with single- and multi-organ failure is now underway at the Joint Battlefield Health and Trauma Institute by Air Force investigators.

In addition, last year we launched our telehealth initiative, called Project ECHO (extension for community health outcomes), with one specialty (complicated diabetes management) serving three military treatment facility pilot sites. Now in our second year, we have added chronic pain management, traumatic brain injury, behavioral health, dermatology, ear, nose and throat, and acupuncture for a total of seven live ECHO specialty series, and are on track to add four more specialty areas (addictions, infectious disease, neurology and dental) this coming year. We have expanded participation to include all services and the Department of Veterans Affairs. Added to this capability, continuing medical education accreditation was granted for six of the seven ECHOs. Participating provider response has been overwhelmingly positive, with a 17 percent increase in provider knowledge and confidence level in their management of these complicated patients, and an overall 95 percent approval rating in the ECHOs’ value to their practice. Project ECHO is postured for MHS-wide adoption under the new Defense Health Agency, which was established on October 1, 2014.

Q: Is there anything else that you would like to add?

A: During my 37-year career, I have never seen a time when it was more evident how important military medicine is to the operational capability of this nation. We have learned much and our medics have performed magnificently. The AFMS will continue to focus hard on providing operational support and high quality care around the globe, in-garrison and deployed, on the ground or in the air—that’s what we mean when we say ‘trusted care anywhere.’ I am honored to lead and serve with Air Force medics during this important time, and to partner with my Army and Navy colleagues as we move forward together to build an even better Military Health System. ♦

Last modified on Monday, 18 August 2014 10:30

Additional Info

  • Issue: 2
  • Volume: 18
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