NOTICE: This publication is available digitally on the AFDPO WWW site at:

http://www.e-publishing.af.mil.
COMPLIANCE WITH THIS PUBLICATION IS MANDATORY
BY ORDER OF THE
SECRETARY OF THE AI R FORCE
AI R FORCE I NSTRUCTI ON 48-101
19 AUGUST 2005
Aerospace Medicine
AEROSPACE MEDI CI NE OPERATI ONS
OPR: HQ USAF/SGOP (Col Arne Hasselquist) Certified by: HQ USAF/SGO
(Maj Gen Joseph E. Kelley)
Supersedes AFI 48-101, 11 July 1994 Pages: 59
Distribution: F
This instruction implements AFPD 48-1, Aerospace Medical Program. It provides guidance and estab-
lishes procedures for conducting the multidisciplinary aspects of the aerospace medical program (AMP).
It describes the key aerospace medicine mission effect areas that support the operational aerospace mis-
sion: Ensure a Healthy and Fit Force, Prevent Casualties, Restore Health and Optimize and Enhance
Human Performance. This Instruction addresses the requirement for development of Team Aerospace
Personnel. This instruction interfaces with Air Force 10-, 11-, 36-, 40-, 41-, other 48 series, and 90- series
publications. Any organizational level may supplement this instruction. Send comments and suggested
improvements on AF IMT 847, Recommendation for Change of Publication, through channels to: Direc-
tor, Aerospace Operations, Air Force Medical Support Agency (AFMSA/SGP), ATTN: Col Charles
Fisher, 110 Luke Avenue, Suite 400, Bolling AFB DC 20032-7050. Ensure that all records created as a
result of processes prescribed in this publication are maintained in accordance with AFMAN 37-123,
Management of Records and disposed of in accordance with the Air Force Records Disposition Schedule
(RDS) located at https://webrims.amc.af.mil/.
SUMMARY OF REVI SI ONS
This publication has been significantly revised and must be completely reviewed. Chapter 3, Chapter 4,
Chapter 5, and Chapter 6 outline AMP responsibilities for the four key mission effect areas derived
directly from AFPD 48-1. This is a brisk, and intentional departure from the current AFI 48-101 that was
organized according to functional areas, meant to recognize and foster integrated Team Aerospace solu-
tions to AMP challenges. Furthermore, this document is not meant to replace innumerable other AFIs that
are specific to the management of a particular AMP element, but rather to fill in the gaps that may exist in
current AMP guidance. For that reason, certain functional areas may receive greater emphasis within this
document as their roles and responsibilities are not reflected elsewhere in other, current guidance.
2 AFI48-101 19 AUGUST 2005
TABLE OF CONTENTS
Chapter 1 RESPONSIBILITIES 3
1.1. This instruction implements AFPD 48-1, Aerospace Medical Program (AMP). ....... 3
1.2. Specific Organizational Responsibilities ................................................................... 3
Chapter 2 AMP ORGANIZATION AND MANAGEMENT 11
2.1. The AMP will be organizationally aligned IAW AFI 38-101,
Air Force Organization ............................................................................................. 11
2.2. Other Meetings: ......................................................................................................... 13
Chapter 3 ENSURE A HEALTHY AND FIT FORCE 16
3.1. The AMP will provide specific specialty care required to ensure the success
and safety of specific operators and missions .......................................................... 16
Chapter 4 PREVENT CASUALTIES 22
4.1. The AMP (AMP) provides activities and expertise crucial to casualty prevention
and optimizes the safety and health of USAF personnel ......................................... 22
Chapter 5 RESTORE HEALTH 29
5.1. The AMP will provide operational health care that includes, (but is not limited to) .. 29
Chapter 6 OPTIMIZE AND ENHANCE HUMAN PERFORMANCE 36
6.1. The AMP becomes a force multiplier by aspiring to create a health-optimized
Air Force. ................................................................................................................. 36
Chapter 7 DEVELOPMENT OF TEAM AEROSPACE PERSONNEL 42
7.1. Squadron commander ensures a robust education, training, and development
program to fully employ Team Aerospace members ................................................. 42
Chapter 8 MEASURING SUCCESS OF AEROSPACE MEDICINE ACTIVITIES 45
8.1. Aerospace Medicine Activities: ................................................................................. 45
Attachment 1 GLOSSARY OF REFERENCES AND SUPPORTING INFORMATION 47
Attachment 2 CAPABILITY GAP ANALYSIS WORKSHEET 55
Attachment 3 EXAMPLE TEMPLATE: AMC MEETING AGENDA 57
Attachment 4 EXAMPLE TEMPLATE: OHWG MEETING AGENDA 59
AFI48-101 19 AUGUST 2005 3
Chapter 1
RESPONSIBILITIES
1.1. This instruction implements AFPD 48-1, Aerospace Medical Program (AMP). It provides guidance,
responsibilities, and procedures for conducting the multidisciplinary aspects of the AMP. The successful
execution of the AMP requires a Team Aerospace approach from all the disciplines involved in the myr-
iad aspects of the AMP. Team Aerospace (TA), is comprised of personnel and activities that include, but
may not be limited to, Flight Medicine (FM), Public Health (PH), Bioenvironmental Engineering (BE),
Aerospace Physiology (AP), Health Promotion (HP), Air Evacuation (AE), Medical Readiness, Optome-
try, and Hyperbaric Medicine as well as education, research and development activities related to the suc-
cessful accomplishment of this program. Medical treatment facility (MTF) AMPs are represented for the
purposes of planning and programming by the AFMS corporate structure within the Aerospace Opera-
tions panel.
1.1.1. Responsibilities for elements of the AMP are outlined in subsequent chapters in describing the
specific effects of each.
1.2. Specific Organizational Responsibilities
1.2.1. Office of the Secretary of the Air Force.
1.2.1.1. SAF/IE. The Assistant Secretary of the Air Force for Installations, Environment, and
Logistics (SAF/IEE) will provide overall policy pertaining to the formulation, review and execu-
tion of Environment, Safety and Occupational Health Programs to include related AMP plans,
policies and budgets.
1.2.1.2. SAF/AQ. The Deputy Assistant Secretary of the Air Force for Acquisition (SAF/AQ)
establishes liaison with HQ USAF/SG to ensure humanmachine interface issues are addressed
in weapon system acquisition. Moreover, this liaison identifies and assesses the occupational
health risks impact associated with new systems as early as possible in the development and acqui-
sition process.
1.2.2. HQ USAF.
1.2.2.1. HQ USAF/XO. The Deputy Chief of Staff for Plans and Operations establishes require-
ments and policies for flying personnel and squadron operations.
1.2.2.1.1. The Director of Operations (AF/XOO) prescribes the operational qualification
requirements for flight surgeons.
1.2.2.1.2. Sets policies on physical and physiological qualification for flying personnel.
1.2.2.1.3. Sets pharmacological fatigue countermeasures policy.
1.2.2.2. HQ USAF/ILE. The Office of the Civil Engineer develops construction plans and speci-
fications that meet health and welfare standards established by the office of the AF Surgeon Gen-
eral.
1.2.2.3. HQ USAF/SG. Provides strategic guidance, resources, and policies and procedures to
execute the AMP.
4 AFI48-101 19 AUGUST 2005
1.2.2.3.1. HQ USAF/SGO. Provides policy and regulatory guidance necessary to success-
fully execute the AMP.
1.2.2.3.1.1. Oversees strategic planning and programming activities.
1.2.2.3.1.2. Maintains liaison with Department of Defense (DOD) agencies for aircrew
health, disease prevention, occupational health, environmental quality and crew perfor-
mance issues.
1.2.2.3.1.3. Advises AF/XOO on physical standards and physiological training require-
ments for aircrew and special duty personnel.
1.2.2.3.2. HQ USAF/SGR provides guidance and programming to support AMP moderniza-
tion including Research, Development Test & Evaluation (RDT&E) activities. USAF/SGR
will also:
1.2.2.3.2.1. Develop a human weapon system (HWS) modernization program to meet
requirements of the battle space.
1.2.2.3.2.2. Review technology requirements to enhance human performance and coordi-
nate with Line of the Air Force (LAF) processes to ensure relevant solutions are incorpo-
rated into the Department of Defense (DOD) RDTE&A programs.
1.2.2.3.2.3. Support field identification of Human Systems needs, and advocate their
insertion into the capabilities requirements and program objective memorandum (POM)
processes.
1.2.2.3.2.4. Provide direct interface with 311th Human Systems Wing (HSW), Defense
Advanced Research Projects Agency (DARPA), and other military and civilian develop-
ment agencies to ensure USAF AMP modernization priorities are executed in concert with
Joint development where possible.
1.2.3. AFMSA/SGP will:
1.2.3.1. Chair the Aerospace Operations panel in development of programming recommendations
to support strategic guidance of HQ USAF/SG.
1.2.3.2. Develops, plans and programs, provides consultative services, and executes AMP in sup-
port of and at the direction of HQ USAF/SGO.
1.2.3.2.1. Ensure integration and coordination of AMP initiatives and policy with line Air
Staff entities when appropriate.
1.2.3.3. Provide consultants in all Team Aerospace disciplines on behalf of HQ USAF/SG to
MAJCOM, HQ USAF, and other agencies.
1.2.3.4. Interface with all MAJCOM SGPs to facilitate successful execution of all aspects of the
AMP.
1.2.3.5. Lead the Team Aerospace Corporate Board (TACB) and ensure at least one combined
meeting per year.
1.2.3.5.1. The Team Aerospace Corporate Board voting membership will include at a mini-
mum:
1.2.3.5.1.1. AFMSA/SGP (Chair)
AFI48-101 19 AUGUST 2005 5
1.2.3.5.1.2. MAJCOM/SGPs
1.2.3.5.1.3. TA Enlisted Career Field Managers
1.2.3.5.1.4. AO Panel voting members
1.2.3.5.1.5. TA Associate Corps Chiefs or equivalent (if not otherwise included above)
1.2.3.5.2. The TACB will set strategic direction and communicate to AO panel and senior
leadership recommendations for policy and priorities on behalf of team aerospace.
1.2.3.6. Maintain liaison with other Services and Federal agencies.
1.2.3.7. Oversee execution of USAF medical readiness activities in support of USAF/SGO and
AFMOA/CC (Medical Operations Center).
1.2.3.8. Appoint an AFMSA-assigned 48A4 as the casualty management officer point of contact
(POC) for Chemical, Biological, Radiological, Nuclear, and Explosive (CBRNE) policy develop-
ment and implementation.
1.2.3.9. Develop objective metrics to measure the success of the AMP.
1.2.4. The MAJCOM/SG will:
1.2.4.1. Organize, train and equip personnel to support aerospace medical program execution
within their command.
1.2.4.2. Appoint a Chief of Aerospace Medicine (MAJCOM/SGP), and provide appropriate MAJ-
COM staff to successfully execute the AMP.
1.2.5. The MAJCOM/SGP will:
1.2.5.1. Develop guidance to assist subordinate installation medical units to properly execute all
aspects of the AMP.
1.2.5.2. Identify personnel and resource requirements and establish resource and manpower prior-
ities for successful execution of the AMP throughout the command.
1.2.5.3. Use AFMSA derived objective measures (metrics) to gauge success of AMP at each facil-
ity.
1.2.5.4. Collects human weapon systems Capabilities Analysis from all field units in the MAJ-
COM. Forward these products to 311 HSW/YA.
1.2.6. 311 HSW. The commander, 311th Human Systems Wing provides support for all aspects of
USAF AMP requirements. Through its organizations the 311 HSW will:
1.2.6.1. Provide education and training for specific Team Aerospace and related disciplines.
1.2.6.1.1. Establish and maintain the single point-of-service website that integrates all appli-
cable online resources for the AMP at the USAF School of Aerospace Medicine (USAFSAM).
1.2.6.2. Provide technical consultation in all disciplines of the AMP.
1.2.6.3. Conduct RDT&E in support of LAF requirements and objectives.
1.2.6.4. To best meet operational requirements, YA shall meet with AF/SGR and /or LAF repre-
sentatives semiannually to review and prioritize human system and performance enhancement
6 AFI48-101 19 AUGUST 2005
RDT&E initiatives, based upon submitted Human Weapons System Capability Analysis reports
per para.1.2.5.5. (See also para. 1.2.9.7.3.7. and Attachment 2).
1.2.6.4.1. Aerospace Medicine research projects should be chosen from this list of RDT&E
requirements.
1.2.7. The MDG/CC. (Wing/CC for ARC Units) will:
1.2.7.1. Provide resources, personnel and guidance to ensure successful execution of the AMP at
their installation.
1.2.7.2. Ensure AMP personnel are properly trained and resourced to successfully execute the
AMP at deployed locations.
1.2.7.3. Appoint in writing the most qualified flight surgeon as the Chief, Aerospace Medicine
(SGP).
1.2.7.3.1. The SGP will be the most qualified flight surgeon. Depending upon rank and capa-
bility, this will typically be an Aerospace Medicine Specialist (AFSC 48AX) whenever one is
assigned; or, when no 48AX is assigned, the SGP will typically be the senior flight surgeon,
(AFSC: 48XX).
1.2.7.4. Appoint a Bioenvironmental Officer or NCO as:
1.2.7.4.1. NBC medical defense officer (NBC MDO) IAW AFI 41-106, Medical Readiness
Planning and Training.
1.2.7.4.2. Representative to the Disaster Control Group (or similar function IAW pending
National Response Plan guidance).
1.2.7.5. Appoint in writing a Public Health Officer as Medical Intelligence Officer.
1.2.8. Squadron/CC. The responsibilities of the squadron commander under whose command the
AMP resides include the following:
1.2.8.1. Leadership. The squadron commander:
1.2.8.1.1. Serves as a member of the medical treatment facilitys Executive Council/Commit-
tee.
1.2.8.1.2. Ensures execution of aerospace medicine activities using an integrated team
approach through the Aerospace Medicine Council.
1.2.8.1.2.1. The Squadron/CC may appoint the most qualified TA member as the AMC
Chair. Typically this will be the SGP.
1.2.8.2. Planning/Programming.
1.2.8.2.1. Ensures the formulation of plans, policies and procedures for delivering health care
services and health care support for operational missions.
1.2.8.2.2. Ensures availability of medical support to meet operational requirements.
1.2.8.2.3. Ensures coordination of AMP activities within the medical treatment facility and
other medical activities.
AFI48-101 19 AUGUST 2005 7
1.2.8.2.4. Reviews, coordinates, and negotiates, when necessary, host tenant support agree-
ments, memorandums of understanding, inter-service support agreements, letters of agree-
ment, etc. Taking into account that the specific support dictated is within the capabilities and
resources of the unit, and it is realistic.
1.2.8.2.5. Ensures contingency support requirements for squadron assets are codified and are
properly executed.
1.2.8.3. Funding/Financial Oversight.
1.2.8.3.1. Directs squadron financial budget and execution activities.
1.2.8.3.2. Ensures fiscal accuracy and responsible stewardship within the squadron.
1.2.8.3.2.1. Projects and advises medical treatment facility and higher headquarters lead-
ership of financial requirements for mission accomplishment.
1.2.8.4. Manpower Personnel Programs.
1.2.8.4.1. Leads squadron personnel to meet training requirements as described in Chapter 7.
1.2.8.4.2. Identifies new personnel requirements to meet mission needs and ensure their
proper communication to higher authority.
1.2.8.4.3. Evaluates and rates subordinate personnel.
1.2.8.4.3.1. See AFI 48-149, Squadron Medical Elements, for SME personnel rating poli-
cies.
1.2.8.4.4. Ensures squadron personnel participation in unit and personnel recognition pro-
grams.
1.2.9. The Medical Treatment Facility/SGP:
1.2.9.1. Is appointed IAW paragraph 1.2.7.3. and if he/she is not the aerospace squadron CC will
be aligned directly subordinate to the Aerospace Medicine (AMDS/ADOS) squadron commander
(or flight/CC in Medical Operations squadrons). Dual duty as SGP and squadron/CC, flight/CC, or
as element/CC if Aerospace Medicine is only a flight, is acceptable.
1.2.9.2. Will serve as the medical treatment facility and installation authority, consultant, and sub-
ject matter expert in the medical specialty of aerospace medicine and will be a member of the
medical treatment facility Executive Committee as the Aerospace Medicine subject matter expert.
1.2.9.3. Must be a flight surgeon with sufficient experience and formal training; optimally includ-
ing a Masters degree in Public Health (MPH); to be facile in all aspects of clinical aerospace med-
icine, AMPs and execution, and must be an active participant in supported unit operational
activities.
1.2.9.4. Maintain clinical currency in the practice of Aerospace Medicine.
1.2.9.5. Is responsible for developing a strong relationship with the LAF to facilitate the effective-
ness of the AMP.
1.2.9.6. Completion of the USAFSAM SGP Course is highly encouraged either before first
assignment as the SGP, or as soon as possible thereafter.
1.2.9.7. The responsibilities of the medical treatment facilitys SGP include:
8 AFI48-101 19 AUGUST 2005
1.2.9.7.1. AMP Oversight: Will provide medical specialist oversight in the development, inte-
gration, delivery and quality of clinical and operational AMPs and services.
1.2.9.7.1.1. Through the AMC, develop an integrated approach to disease and injury pre-
vention; performance enhancement; health surveillance activities; sound aviation, ground
and weapons human performance enhancement and sustainment training; operational
safety efforts and occupational health programs.
1.2.9.7.1.2. Oversee effective clinical practice of Aerospace Medicine by all AMP medi-
cal staff.
1.2.9.7.1.2.1. Will review and certify aeromedical waiver products as authorized by
parent MAJCOM.
1.2.9.7.1.2.2. With SGH, will establish/monitor standards of practice for flight sur-
geons.
1.2.9.7.1.2.3. Oversee aerospace medicine clinical utilization of non-Defense Health
Program (DHP) aeromedical assets (SME, IDMT, air evacuation); ensure personnel
meet professional standards and are provided training / utilization to retain currency.
1.2.9.7.1.2.4. Will advise/assist the SGH with Aerospace Medicine Credentialing/
Privileging.
1.2.9.7.1.2.5. Oversee medical aspects of installation Health Promotion/Prevention
activities.
1.2.9.7.1.2.6. Oversee medical aspects of physiological training activities, hyperbaric
treatment activities, and performance enhancement activities for aircrew, ground sup-
port personnel, and others who impact mission effectiveness.
1.2.9.7.1.3. Establish preventive medicine/performance enhancement requirements for
physiologically stressed/operationally oriented career fields, such as aircrew, missileers,
fire fighters, et al.
1.2.9.7.1.4. Provide medical oversight for the occupational health program and ensure
medically appropriate risk assessment and medical surveillance activities are conducted.
1.2.9.7.1.5. Provide or oversee Team Aerospace training for medical treatment facility
staff to support the AMP where required.
1.2.9.7.1.6. Will provide medical oversight of aircrew life support issues.
1.2.9.7.1.7. Oversee installation preventive health activities.
1.2.9.7.1.8. Provide or designate medical oversight and training for the installation fitness
program IAW AFI 10-248, Fitness Program.
1.2.9.7.2. Aeromedical Consultancy. The medical treatment facility SGP will serve as the
installation Aerospace Medicine Consultant for:
1.2.9.7.2.1. Provider and staff responsibilities for aircrew and special operational duty
personnel health activities.
AFI48-101 19 AUGUST 2005 9
1.2.9.7.2.2. Physician consultant for medical and Line of the Air Force (LAF) leadership
for aerospace/operational medicine, preventive medicine, occupational health, deploy-
ment/re-deployment, and environmental issues including:
1.2.9.7.2.3. Occupational Medicine (unless an occupational medicine specialist is avail-
able).
1.2.9.7.2.4. Human Factors and Aviation, Ground, Space and Weapons Safety programs.
1.2.9.7.2.5. Operational Medicine activities.
1.2.9.7.2.6. Human performance enhancement and sustainment programs.
1.2.9.7.2.7. Clinical Aspects of aeromedical evacuation.
1.2.9.7.2.8. Preventive Medicine (to include Population Health) activities.
1.2.9.7.2.9. USAF Fitness Program (See AFI 10-248 for program administration).
1.2.9.7.2.10. Disease Surveillance and prevention activities (tuberculosis (TB), Rabies,
sexually transmitted disease (STD), etc).
1.2.9.7.2.11. Risk assessment/communication on occupational/environmental quality mat-
ters.
1.2.9.7.2.12. Subject matter expert in the clinical practice of aerospace medicine, the final
decision authority on the application of military physical standards, and the performance
of occupational Fitness-for-Duty determinations.
1.2.9.7.2.13. Base operations and mobility planners to optimize the human weapon system
and incorporate preventive medicine and performance enhancement activities into the war
mobilization plan.
1.2.9.7.2.14. Senior Profile Officer for the MTF.
1.2.9.7.3. Operational Enhancement. The SGP will:
1.2.9.7.3.1. Serve as a liaison for medical support of LAF operational requirements.
1.2.9.7.3.2. Coordinate with operational commanders on contingency medical support
programs.
1.2.9.7.3.3. Serve as the clinical consultant for operational risk management activities.
1.2.9.7.3.4. Advise leadership in medical and operational activities to enhance warfighter
effectiveness.
1.2.9.7.3.5. Serve as Aerospace Medicine physician representative in operational medical
planning and execution activities.
1.2.9.7.3.6. Ensure active and effective rapport and communication between operational
agencies and the base medical treatment facility.
1.2.9.7.3.7. Identify, collect, and forward to MAJCOM, the human weapon system (HWS)
capability gap analysis for all installation/base operational missions. See paragraph
1.2.6.4. and Attachment 2 of this instruction.
10 AFI48-101 19 AUGUST 2005
1.2.9.7.3.7.1. Mentor installation flight surgeons and team aerospace personnel on
HWS capability gap analysis.
1.2.9.7.3.7.2. Forward the HWS capability gap analysis to MAJCOM/SGP not less
than annually, preferred semi-annually, in order to meet AF/SG-ROCC requirements
review and validation. Identify in the analysis potential solutions that require science
and technology, developmental efforts, or off-the-shelf potential resolutions to the
capability gaps.
1.2.10. Consultative and Analytical Services
1.2.10.1. At times, the need for TA expertise will exceed the abilities of the base level AMP. TA
personnel in various centralized reach-back organizations have developed specialized skills for
very specific mission needs. Some common TA consultation agencies are:
1.2.10.1.1. The Aeromedical consultative Service, United States Air Force School of Aero-
space Medicine, Brooks City-Base, TX. This agency provides focused expertise in the Medi-
cal Flight Screening program, before rated crewmembers are permanently DNIFd for medical
reasons.
1.2.10.1.2. The Air Force Institute for Operational Health (AFIOH), Brooks City-Base, Texas.
This agency provides focused TA expertise and specialization, beyond those capabilities typi-
cally found at base level. Services offered include environmental and occupational health con-
sultation, focused occupational and environmental health surveillance and sample analysis.
1.2.10.1.3. The Air Force Research Laboratory (AFRL) provides research on the human
weapon system. Team Aerospace personnel are assigned to provide aeromedical expertise to
the process. Maintain and enable research and development efforts that are responsive to
emerging threats.
1.2.10.1.4. The 311
th
Human Systems Wing provides commanders and supervisors advice
concerning aeromedical problems related to aircraft equipment, mission plans, human systems
interface, occupational health, and environmental stress that affect mission completion.
1.2.10.1.5. 311 HSW/YA ensures fully integrated life support system program development
that is compatible with and optimized for the human and effectively controls hazards.
AFI48-101 19 AUGUST 2005 11
Chapter 2
AMP ORGANIZATION AND MANAGEMENT
2.1. The AMP will be organizationally aligned IAW AFI 38-101, Air Force Organization, and the current
medical group guidance within whatever construct is utilized at an installation, (e.g. aerospace medicine
squadron, aeromedical-dental squadron or medical operations squadron.) Regardless of organization, a
number of essential elements and activities will be present at all USAF home station or deployed medical
treatment facilities.
2.1.1. The Aerospace Medicine Council (AMC)
2.1.1.1. The Aerospace Medicine Council is a collaborative decision making body responsible for
the functional oversight of the AMP, and as such, is directly responsible to the medical group com-
mander (MDG/CC).
2.1.1.2. Key functions of the AMC will include:
2.1.1.2.1. Establishing AMP objectives.
2.1.1.2.2. Planning and coordinating all AMPs.
2.1.1.2.3. Regular review of operational support activities to the installation and review of
compliance with outcome measures directed by this instruction.
2.1.1.2.4. Review any changes to operational, occupational and community health-based
immunizations and chemoprophylaxis recommended by Public Health.
2.1.1.2.5. Review, evaluate, solve, or up-channel, problems referred to the AMC.
2.1.1.2.5.1. Elevating issues referred to the AMC, that cannot be resolved without
change(s) in doctrine, tactics, policy, or instruction will be done using a standard memo-
randum format, and will be signed by the AMC Chair.
2.1.1.2.5.1.1. Subject Line will read: Aerospace Medicine Action Letter.
2.1.1.2.5.1.2. A one page brief description of the issue, suggested resolution and
interim action(s) imposed (if any) while awaiting MAJCOM/SGP reply. Additional
background information can be forwarded as attachment(s).
2.1.1.2.5.1.3. MAJCOM/SGP or delegated action officer will have 30 days from date
of letter to provide an interim response to the submitting AMC Chairman. Total resolu-
tion may require higher review or implementation; MAJCOM/SGPs must make rea-
sonable attempts to provide feedback to the submitting base.
2.1.1.2.6. Identify and execute opportunities to improve the AMPs support to the installation;
to create the desired effects through enhancing the capabilities of Team Aerospace, and the
local mission.
2.1.1.2.7. Exist as a separate entity from squadron staff meetings dealing with leadership and
management issues such as AMP-specific resources, personnel, and training.
2.1.1.2.8. The AMC should convene on a monthly basis, but not less than quarterly.
12 AFI48-101 19 AUGUST 2005
2.1.1.2.9. AMC is the reviewing/approval authority for Occupational Health Working Group
minutes.
2.1.1.2.10. AMC minutes will be reviewed/approved by the medical group executive commit-
tee.
2.1.1.2.11. All functional areas will develop standard agenda items representative of major
program areas, to include key AMP metrics that will be presented and analyzed for trends as
part of a comprehensive preventive AMP (Attachment 3).
2.1.1.2.12. New Business items relevant to current AMP issues will be brought to the AMC
for discussion and decision-making.
2.1.1.2.13. All Open items generated by New Business issues or trend analysis of Standard
Agenda items will be tracked and worked to closure.
2.1.1.2.14. The AMC will typically be chaired by the SGP (see para. 1.2.8.1.2.1.). However,
the squadron/CC may appoint the most qualified member of Team Aerospace to chair the
AMC.
2.1.1.2.15. The AMC membership, at a minimum, will include the SGP, OICs or NCOICs of
Aerospace Physiology, Bioenvironmental Engineering, Flight/Missile Medicine, Health Pro-
motion, Optometry, Public Health, all assigned Flight Surgeons (SMEs included), and a Den-
tal representative. Attendance by both OICs and NCOICs of each Team Aerospace functional
area is recommended.
2.1.1.2.15.1. Inviting guests to lend support to specific issues or assist with problem solv-
ing, as well as fostering good working relations is encouraged.
2.1.2. Occupational Health Working Group (OHWG)
2.1.2.1. The Occupational Health Working Group provides guidance for the installation Occupa-
tional Health Program. Key functions of the OHWG are effectively detailed in AFI 48-145, Occu-
pational Health Program.
2.1.2.1.1. Membership of the Occupational Health Working Group will include:
2.1.2.1.1.1. Chairperson will be the medical treatment facilitys SGP or Occupational
Health physician.
2.1.2.1.1.2. Representatives from Bioenvironmental Engineering, Flight Medicine, Public
Health, and Aerospace Physiology (if assigned), in the membership as detailed in this AFI
and AFI 48-145.
2.1.2.1.2. The Occupational Health Working Group should meet on a monthly basis, but not
less than quarterly.
2.1.2.1.3. Occupational Health Working Group minutes will be reviewed and approved by the
AMC.
2.1.2.1.4. Occupational Health Working Group representatives will develop standard agenda
items representative of major occupational health program areas to include key metrics that
will be presented and analyzed for trends as part of a comprehensive occupational health pro-
gram (Attachment 4).
AFI48-101 19 AUGUST 2005 13
2.1.2.1.5. New Business items relevant to current Occupational Health Program issues will be
brought to the Occupational Health Working Group for discussion and decision-making.
2.1.2.1.6. Track all open items generated by New Business or trend analysis of Standard
Agenda items to closure.
2.1.3. Flight Medicine Grounding Management Meeting
2.1.3.1. The SGP, all available Flight Surgeons, the NCOIC, other key Flight Medicine personnel,
and a representative from Public Health will attend a weekly meeting that will address:
2.1.3.1.1. Review and recommend action on cases recorded on AF IMT 1041, Medical Rec-
ommendation for Flying or Special Operational Duty (Special Operational Duty) Log.
2.1.3.1.1.1. AF IMT 1041, Medical Recommendation for Flying or Special Operational
Duty Log will be kept on file for five years, and then destroyed. Reference: Air Force
Records Disposition Schedule (RDS) located at https://webrims.amc.af.mil/
2.1.3.1.2. Review required actions on AIMWTS workflow data to include new aircrew/spe-
cial operational duty waivers, waiver renewals, and waiver cases due for interim follow-up
studies.
2.1.3.1.3. Review open Initial Flying/Special Operational Duty physical examinations as pre-
sented by Public Health.
2.1.3.1.4. Review and follow-up open referrals of flying/special operational duty personnel to
the local network for medical evaluation and care.
2.1.3.1.5. Documentation of the above weekly reviews will be maintained for a period of two
years.
2.2. Other Meetings: Team Aerospace members will attend other meetings that directly support the
AMP or resultant services provided by the AMP or its members.
2.2.1. At the MDG/CCs discretion, the SGP is highly encouraged to attend various wing executive
forums.
2.2.2. Environmental, Safety, and Occupational Health (ESOH) Council.
2.2.2.1. Occupational Health Working Group Chair will ensure attendance to provide oversight
and professional expertise regarding Occupational health issues.
2.2.2.2. A Bioenvironmental Engineering representative will attend to present metrics detailing
industrial hygiene surveillance and as subject matter expert on recognition, evaluation, and control
of occupational and environmental hazards to include related risk management/risk communica-
tion.
2.2.2.3. A Public Health representative should attend to present metrics detailing occupational
health medical exam compliance rates and address issues relevant to this program.
2.2.3. Full Spectrum Threat Response (FSTR) Working Group
2.2.3.1. The SGP and/or Bioenvironmental Engineering will attend as the installation NBC med-
ical defense officer and as the subject matter experts regarding initial response, evaluation, and
control of risks associated with CRBNE events.
14 AFI48-101 19 AUGUST 2005
2.2.3.2. Public Health will attend to provide relevant medical intelligence information and pro-
vide consultation regarding public health aspects associated with Chemical, Biological, Radiolog-
ical, Nuclear and Explosives (CBRNE) events.
2.2.3.3. Bioenvironmental Engineering will provide sampling, analysis and monitoring support,
in conjunction with Civil Engineering (CE), and advise on human health and environmental expo-
sure hazards, as part of any incident response.
2.2.4. Wing/Squadron Flight Safety Meetings
2.2.4.1. Flight Surgeons and Aerospace Physiologists will attend as aircrew members and aero-
medical consultants. Each will periodically brief topics of aeromedical relevance for the flying
community.
2.2.5. Integrated Delivery System Meeting/Health Promotion Working Group/Community
Action Information Board
2.2.5.1. Health Promotion as subject matter experts, must actively participate in the commu-
nity-based organizations such as the CAIB and IDS.
2.2.5.2. In addition, Health Promotion will facilitate the Health Promotion Working Group
(HPWG) for the wing commander (or his/her designee) who will chair it.
2.2.5.3. Public Health may attend the HPWG as epidemiology consultant in support of commu-
nity health issues.
2.2.6. Health Consumer Advisory Council
2.2.6.1. Attended by the squadron/CC and SGP, and, when necessary, other flight surgeon(s)
required to address community concerns regarding AMP issues.
2.2.7. Executive Committee
2.2.7.1. Squadron commander will attend as responsible agent for all squadron activities/pro-
grams.
2.2.7.2. SGP will attend as MDG/CC's appointed consultant for professional oversight issues
related to the AMP.
2.2.8. Medical Readiness Staff Function
2.2.8.1. The squadron/CC should attend as responsible agent for squadron readiness activities/
requirements.
2.2.8.2. The SGP (or designate if he or she is not available), will attend as MDG/CC's appointed
consultant for professional oversight issues related to the AMP.
2.2.8.3. The Medical Intelligence Officer (an appointed Public Health Officer or NCO) will attend
to provide and receive medical intelligence information.
2.2.8.4. Bioenvironmental Engineering will attend as the CBRNE medical defense officer respon-
sible for medical CBRNE issues.
2.2.9. Medical Professional Staff Meeting
2.2.9.1. All available Flight Surgeons, including SMEs, will attend.
AFI48-101 19 AUGUST 2005 15
2.2.9.2. Flight Surgeons will brief; on a rotational basis; AMP related topics as developed and
scheduled by the SGP. Documentation will be maintained for a period of two years.
2.2.9.2.1. All Team Aerospace members may be required to address the Professional Staff at
various times to support mission and facility needs.
2.2.10. Population Health Working Group
2.2.10.1. The SGP will attend as the MTF preventive medicine consultant/champion.
2.2.10.2. Public Health will attend as the epidemiology consultant to help formulate questions
regarding population health issues and provide meaningful analysis of resulting data.
2.2.10.3. Health Promotion will attend as the subject expert and responsible agent for commu-
nity-based prevention efforts.
2.2.10.4. BE will attend as the subject expert for occupational and environmental health issues
impacting personnel.
2.2.11. Installation Restoration Program-Restoration Advisory Board
2.2.11.1. Attended by the SGP and Bioenvironmental Engineering to address community con-
cerns associated with installation restoration and clean-up programs.
16 AFI48-101 19 AUGUST 2005
Chapter 3
ENSURE A HEALTHY AND FIT FORCE
3.1. The AMP will provide specific specialty care required to ensure the success and safety of specific
operators and missions including, but not limited to, aviators, astronauts, missileers, air traffic controllers
and certain weapons systems operators. This expertise will further include investigation and safety activ-
ities for those weapons systems and programs. Additionally, in promoting a healthy and fit force, as
defined in Air Force Doctrine Document (AFDD 2-4.2), the AMP will ensure USAF personnel are
afforded optimal benefit through healthy behavior, immunization, chemoprophylaxis and health protec-
tive devices as appropriate and will develop programs to educate and motivate members to utilize tools,
techniques and lifestyle to enhance safety and performance.
3.1.1. Preventive Health Activities
3.1.1.1. Health Promotion and Lifestyle Modifications
3.1.1.1.1. Evidence-based and targeted health promotion, education and intervention activities
are determined and directed by the Health Promotion Flight Chief / Element Leader IAW AFI
40-101, Health Promotion Program.
3.1.1.1.2. Flight Medicine will provide brief point-of-service education on lifestyle modifica-
tion and refer active duty members requiring lifestyle-related prevention education and inter-
vention to the health and wellness center (e.g. fitness assessment/prescription, tobacco
cessation, cholesterol reduction). Reservists are encouraged to attend health education pro-
grams at a host HAWC on a space available basis.
3.1.1.1.3. Team Aerospace will provide aircrew with health and lifestyle information that
impact in-flight performance and reduces tolerances of other flight stresses, (Reference: See
AFI 11-403 for training requirements). Where assigned, Aerospace Physiologists will assist
Flight Surgeons with aircrew lifestyle education in operational flying wings.
3.1.1.1.4. Where assigned, Aerospace Physiologists will assist Health Promotion with life-
style education for installation personnel, at home station and deployed locations.
3.1.1.2. Physical Fitness Programs
3.1.1.2.1. The commander-driven physical fitness program is conducted at the unit-level IAW
AFI 10-248, Fitness Program.
3.1.1.2.1.1. Health Promotion maintains equipment and location for units to conduct cycle
ergometry testing for members medically excused from the 1.5 mile run.
NOTE: Consult applicable MAJCOM/SGP for unique application to ARC personnel.
3.1.1.2.2. Health Promotion operations provides exercise, nutrition, and behavior modifica-
tion programs and resources IAW AFI 10-248.
NOTE: Consult applicable MAJCOM/SGP for unique application to ARC personnel.
3.1.1.2.2.1. Aerospace Physiologists and Flight Surgeons assist in healthy lifestyle educa-
tion and fitness training consultation for special operational personnel to improve perfor-
mance and reduce injury potential.
AFI48-101 19 AUGUST 2005 17
NOTE: Consult applicable MAJCOM/SGP for unique application to ARC personnel.
3.1.1.3. Immunization Program
3.1.1.3.1. Public Health will review standard military/mobility immunization requirements
based on Advisory Committee of Immunization Practices (ACIP), protocols, AFJI 48-110,
Immunizations and Chemoprophylaxis, and other applicable guidance and make recommenda-
tions for changes to the Executive Committee, through the Aerospace Medicine Council, as
required. Public Health provides consultation to the medical staff regarding prevention and
control of diseases of community health importance.
3.1.1.3.2. Public Health will review and monitor immunization status of active duty personnel
by unit and report currency to unit commanders monthly, with a report for the wing com-
mander at least quarterly.
3.1.1.3.3. Clinical care staff, including Flight/Missile Medicine personnel (including attached
non-Defense Healthcare Program (DHP) assets) may administer immunizations at point of
service or on deployment processing lines IAW AFJI 48-110.
3.1.1.3.4. Personnel administering immunizations must comply with all USAF, MAJCOM,
and local training directives, and will document immunizations in applicable databases, and
also immunization records, if required.
3.1.2. Clinical Preventive Services
3.1.2.1. General Clinical Preventive Services
3.1.2.1.1. Flight Medicine performs professional and paraprofessional clinical aspects of fly-
ing, special operational duty, and occupational health exams, IAW AFI 44-102, Community
Health Management and AFI 48-123, Medical Examinations and Standards.
NOTE: Consult applicable MAJCOM/SGP for unique application to ARC personnel.
3.1.2.1.1.1. Flight Medicine maintains an effective grounding management program (see
Ch 5).
3.1.2.1.1.1.1. Flight Medicine initiates, tracks, and conducts follow-up procedures,
reviews, and tasks for all flying and Special Operational Duty waivers, to include entry
into Aeromedical Information Management Waiver Tracking System (AIMWTS).
3.1.2.1.1.2. Flight Medicine will screen and monitor medical requirements on enrolled
members for security clearance and PRP, and interface with the medical treatment facil-
itys PRP Competent Medical Authority as required by AFI 36-2104, Nuclear Weapons
Personnel Reliability Program.
3.1.2.1.2. The squadron commander ensures an appropriate number of flight surgeons and
4N0X1 technicians are certified by the Federal Aviation Administration (FAA) Regional Sur-
geon to conduct FAA Class 2 and 3 physical examinations to support unique training require-
ments for AD flyers and Special Operational Duty, as well as base Aeroclubs (when present).
3.1.2.1.2.1. The default FAA examination provided will be Class 3 Student Pilot, or
Class 3 Private Pilot.
3.1.2.1.2.2. Commercial FAA Class 2 examinations should only be conducted when a
unique USAF training requirement exists for the beneficiary.
18 AFI48-101 19 AUGUST 2005
3.1.2.1.2.3. USAF providers are not authorized to perform FAA Class 1 examinations at
any medical treatment facility.
3.1.2.1.3. Public Health:
3.1.2.1.3.1. Public Health will serve as the office of primary responsibility (OPR) within
the medical treatment facility for questions regarding administrative aspects of Preventive
Health Assessment Individual Medical Readiness (PIMR) issues.
3.1.2.1.3.2. Public Health will review appropriate physical examinations, 4T profiles,
and clearances to ensure proper administrative requirements are achieved before these
documents are forwarded or leave the facility (except routine PHAs and MEBs, which will
be handled by the appointed Physical Evaluation Board Liaison Officer IAW AFI 41-210,
Patient Administration Functions).
3.1.2.1.3.3. Public Health will inform medical treatment facility leadership, Primary Care
Elements, unit health monitors, unit commanders, and unit deployment managers, of Pre-
ventive Health Assessment-Individual Medical Readiness (PIMR) currency (to include
Occupational Health Examinations) requirements and current status.
3.1.2.1.3.4. Public Health will serve as the initial point of service for all non-enrolled
patients requiring physical examinations and will capture/enter demographic and general
non-clinical data into various web-based programs or software applications. However,
since Public Health will not complete the clinical portions of the exams, local MDG lead-
ership must identify to which Primary Care Element Public Health will refer these patients
to complete the clinical portions of the exam, as well as entering of findings and results
into the web-based and/or software applications.
3.1.2.1.3.5. Public Health provides education on administrative aspects of physical exam-
inations, profiles, occupational health, and PIMR to the professional staff and Primary
Care Elements at least annually.
3.1.2.1.3.5.1. Maintain documentation of training for a period of two years.
3.1.2.1.3.6. Ensure Primary Care Elements are informed of patients requiring clinical fol-
low-up for communicable disease, occupational health, deployment surveillance, and
other related programs. Moreover, Public Health will provide Primary Care Elements with
consultant support, assist in the development of clinical practice guidelines, and provide
recurring training as needed.
NOTE: Consult applicable MAJCOM/SGP for unique application to ARC personnel
3.1.2.1.3.6.1. Maintain documentation of training for a period of two years.
3.1.2.1.4. Flight Medicine and Public Health will provide travel medical services, as needed
for all DOD beneficiaries.
3.1.2.2. Occupational Health
3.1.2.2.1. The Occupational Health Working Group develops medical surveillance require-
ments based upon the Bioenvironmental Engineering workplace survey results, and in compli-
ance with federal (Occupational Safety and Health Administration) and Air Force
AFI48-101 19 AUGUST 2005 19
Occupational Safety and Health (AFOSH) standards and applicable clinical practice guide-
lines.
3.1.2.2.2. Public Health, Bioenvironmental and Flight/Occupational Medicine staff, will pro-
vide education and training on the Occupational Health Program, to include rationale for
examination requirements and monitoring, to Flight Medicine providers. (See also paragraph
2.1.2. of this instruction.)
3.1.2.2.3. Flight/Occupational Medicine will accomplish the required clinical aspects of occu-
pational health exams for military and assigned civilian workers. Unless contract services are
in place to provide examinations, Flight/Occupational Medicine will perform occupational
health medical exams (OHME) for all civilian government employees and other occupational
groups as defined by the Occupational Health Working Group.
3.1.2.2.4. Bioenvironmental Engineering will:
3.1.2.2.4.1. As the installation radiation safety Officer (RSO): establish the radiation
safety program and procedures to minimize associated health risks and ensure compliance.
3.1.2.2.4.2. Perform hazard risk assessment and provide advice to supervisor or com-
mander regarding hazard mitigation.
3.1.2.2.4.3. Accomplish special surveillance (as identified in AFI 48-145) IAW applicable
program requirements (Example: Radiofrequency Radiation program accomplished IAW
AFOSH Standard 48-9).
3.1.2.2.5. Public Health will:
3.1.2.2.5.1. With Flight/Occupational Medicine, and Aerospace Physiology, provide hear-
ing protection education to support the Hearing Conservation Program.
3.1.2.2.5.2. Accomplish illness prevention education when human performance or human
factors have been identified. May be assisted by Aerospace Physiology (when assigned).
3.1.2.2.5.3. Report occupational health exam completion rates to the Occupational Health
Working Group.
3.1.2.2.5.4. Update Flight Medicine providers and industrial shops on changes to occupa-
tional health exam requirements and as approved by the Occupational Health Working
Group and recorded in the current Occupational Medicine database.
3.1.2.2.5.5. Update and train FSO and Primary Care Elements on PIMR software and
application changes.
3.1.2.2.5.6. Inform Primary Care Elements and the Occupational Health Working Group
on the results of any trend analysis, or occupational illness or injury investigations when
necessary.
3.1.2.2.5.7. Accomplish occupational screening audiograms in support of the Hearing
Conservation Program and refer patients with significant threshold shifts to Flight Medi-
cine for evaluation.
3.1.2.2.5.7.1. Public Health personnel will not perform diagnostic audiograms result-
ing from patient complaints of possible hearing related problems. Where no clinical
20 AFI48-101 19 AUGUST 2005
Audiology staff is available in the medical treatment facility, referral to a Hearing Con-
servation Diagnostic Center (HCDC), for testing is appropriate.
3.1.2.2.6. Flight Surgeons and Aerospace Physiologists will provide aircrew with health and
lifestyle information and counseling that may impact in-flight performance and reduce physi-
ological tolerances to flight stresses.
3.1.2.2.7. Review occupational health medical exams to assess compliance and address dis-
crepancies.
3.1.2.2.8. Optometry will perform occupational laser eye exams when required.
3.1.3. Deployment Preventive Health Services
3.1.3.1. Bioenvironmental Engineering, Public Health, Health Promotion, and Flight/Occupa-
tional Medicine will execute primary deployment health and occupational medicine program
activities while at home station and when deployed, unless DOD or contract occupational medi-
cine services are in place.
3.1.3.1.1. Primary Care Element teams will play an active role in pre and post deployment
activities for the installation.
3.1.3.1.2. Public Health is the point of contact for deployment surveillance requirements.
3.1.3.1.3. Public Health will track completion of the Deployment Health Programin both
pre- and post-deployment phases.
3.1.3.1.4. Bioenvironmental Engineering will determine occupational and environmental
health survey (OEHS) requirements for deployed site (if known) prior to deployment and pro-
vide consultation to providers during post-deployment health assessments and follow-up
encounters.
3.1.3.1.5. Bioenvironmental Engineering will conduct quantitative fit testing (QNFT) IAW
AFMAN 32-4006, Nuclear, Biological, and Chemical (NBC) Mask Fit and Liquid Hazard
Simulant Training, and other evaluations for use of personal protective equipment (PPE) to
meet deployed occupational health requirements.
3.1.3.1.6. Public Health will serve as the initial point of service for the installation on medical
deployment issues. Public Health will work with Primary Care Elements and other medical
treatment facility departments to ensure personnel are medically qualified to deploy.
3.1.3.1.7. Public Health is the medical treatment facility liaison for unit deployment managers
(UDM), installation deployment officers (IDO), unit health monitors (UHM), Primary Care
Elements, squadron commanders/first sergeants and other base leadership to answer queries
pertaining to medical deployment processing.
3.1.4. Aircrew Health
3.1.4.1. Flight Medicine performs professional and paraprofessional clinical aspects of PHAs and
exams for flying and special operational duty personnel, IAW AFI 48-123, Medical Examinations
and Standards, AFI 44-102,Community Health Management, and this instruction.
3.1.4.1.1. Enter into AIMWTS all aircrew/special operational duty personnel presenting with
conditions requiring aeromedical waiver IAW AFI 48-123, Medical Examinations and Stan-
dards.
AFI48-101 19 AUGUST 2005 21
3.1.4.1.1.1. Review open waiver cases weekly to ensure timely aeromedical disposition.
3.1.4.1.2. Review AIMWTS weekly to identify cases with existing waivers that require
interim evaluations and initiation of waiver renewal actions to preclude waiver expiration.
Reviews should also include emphasis or discussion on any clinically interesting or complex
cases underway.
3.1.4.1.3. Identify aircrew/special operational duty personnel on waivers during installation
in-processing and out-processing to ensure proper processing at gaining and losing bases.
3.1.4.2. Flight Surgeons will perform in-flight evaluations and functions when indicated to
include; evaluate/observe members in duty setting, i.e. cockpit, aircrew-seating position,
unmanned aerial vehicle (UAV) or unmanned combat aerial vehicle (UCAV) control positions,
missile silos, etc.
3.1.4.2.1. Flight Medicine and Aerospace Physiology will assess, monitor, and mitigate the
physical, psychological and physiological stress factors of aircrew/special operational duty
personnel respectively. This does not prohibit referral to appropriate clinical specialists when
warranted.
3.1.4.2.2. Flight Medicine will advise flying commanders on their aviators fitness status daily
and when their status changes. Additionally, Flight Surgeons will address medical qualifica-
tion for flying activities (e.g. waivers, initial exams, et al), as needed or requested.
3.1.4.3. Optometry accomplishes eye examinations in support of flight or special operational duty
physical examinations IAW requirements of AFI 48-123 or higher headquarters direction (e.g.
waivers and Aeromedical Consultation Service).
22 AFI48-101 19 AUGUST 2005
Chapter 4
PREVENT CASUALTIES
4.1. The AMP (AMP) provides activities and expertise crucial to casualty prevention and optimizes the
safety and health of USAF personnel in the performance of their duties in any circumstance or location.
The modern workplace can be a complex environment that poses a variety of health risks to Air Force
members and their families. Risk can be encountered in the workplace, at home, in the community and
when deployed. Team Aerospace personnel will conduct threat analysis and incorporate this information
to advise leadership, educate members, and assist with planning of medical employment. Team Aerospace
personnel will employ specific programs to identify and mitigate health risks, including but not limited to
those associated with food and water, environment, physical factors, fatigue, disease transmission, injury
and chemical, biological, radiological, nuclear or explosive (CBRNE) exposures and to document poten-
tial exposure to those risks. Additionally, Team Aerospace personnel will oversee and execute an effective
occupational health and industrial hygiene program, to include specific screening and examinations, that
enhance protection of USAF employed personnel from illness or injury related to their workplace.
4.1.1. Ensure Safety of Food and Water Supplies
4.1.1.1. Bioenvironmental Engineer (BE) will implement a safe drinking water program to ensure
health of the consumers and compliance with stipulated requirements IAW AFI 48-144, Safe
Drinking Water Surveillance Program, for home station locations and AFMAN 48-138, Sanitary
Control and Surveillance of Field Water Supplies, for field conditions or deployed locations. BE
will conduct water vulnerability assessments to ensure the integrity and security of home station
and deployed water distribution systems.
4.1.1.2. Public Health (PH) will collaborate with base agencies to execute a food safety and secu-
rity program at their installation and at deployed location IAW AFI 48-116, Food Safety Program,
most recent Food and Drug Administration (FDA) Food Code, DOD, Federal, State, and local
guidelines, and applicable 10-series AFIs. Flight Medicine will assist Public Health in facility
evaluations, health surveillance, and disease outbreak investigations.
4.1.2. Conduct Medical Threat Analysis
4.1.2.1. Flight Medicine, Public Health and Bioenvironmental Engineering will research, com-
pile, and analyze real-time medical threat data, and communicate threat assessment to responsible
authorities and deploying personnel IAW AFI 10-403, Deployment Planning and Execution, and
AFI 41-106, Medical Readiness Planning and Training.
4.1.2.2. Flight Surgeons perform operational flying duties for the purpose of enhancing their abil-
ity to understand the flight environment to enable them to make sound aeromedical recommenda-
tions regarding aircrewmembers fitness to fly, to evaluate physiological threats in the high
altitude and/or combat flying environment, as well as to research and identify design performance
enhancements. Flight surgeons are assigned as squadron medical elements IAW AFI 48-149,
Squadron Medical Elements, to facilitate improved human systems interface at the squadron level,
in addition to providing care for aviators in a deployed setting.
4.1.2.3. Public Health will coordinate with local and host nation government/nongovernmental
agencies to supplement medical intelligence information to assess health risks/threats.
AFI48-101 19 AUGUST 2005 23
4.1.2.4. Bioenvironmental Engineering will conduct various vulnerability assessments (VA) to
include water, NBC, and Toxic Industrial Chemicals/Toxic Industrial Materials VAs.
4.1.3. Conduct Disease Surveillance and Analysis
4.1.3.1. Bioenvironmental Engineering and Public Health will conduct surveillance, capitalizing
on interconnected global databases, to establish symptom/disease baselines and provide real-time
detection of adverse health trends due to endemic/natural or intentional causes.
4.1.3.2. Public Health will provide disease vector surveillance and recommendations for preven-
tion and control of insect vectors IAW AFI 48-102, Medical Entomology Program.
4.1.3.3. Public Health and Flight Medicine will conduct epidemiological investigations and
reporting of communicable disease outbreaks.
4.1.3.4. Public Health conducts disease and pest vector surveillance and provides appropriate rec-
ommendations for disease vector prevention and control.
4.1.3.5. Collectively, Team Aerospace accomplishes effective risk communication, and must
ensure personnel, workers and commanders are made aware of potential risks, and recommend
measures and countermeasures to mitigate or eliminate risks.
4.1.4. Conduct Operational Risk Management (ORM)
4.1.4.1. Team Aerospace will assist in developing and implementing ORM Programs. This may
include:
4.1.4.1.1. Providing deployed commanders with human performance information to apply to
theater risk management decision-making models.
4.1.4.1.2. Integrating ORM programs into aviation and wing support community such as air
traffic control, aircraft maintenance, etc. Aerospace Physiology provides ORM training.
4.1.4.1.3. Facilitating safety programs and investigating hazards.
4.1.4.2. Team Aerospace provides lifestyle/health risk education and counseling for installation
personnel, at home station and deployed locations, within their respective scope of education and
training.
4.1.4.3. Team Aerospace will assess and advise on the health risk of the threat of chemical, bio-
logical, radiological, nuclear, and/or high-yield explosives (CBRNE) IAW several directives.
Among these are AFI 10-2501, Full Spectrum Threat Response (FSTR) Planning and Operations;
AFMAN 10-2503 (in development); and AFTTP 3-42.32, Home Station Response to Chemical,
Biological, Radiological, Nuclear and Explosives (CBRNE) Events, and AFMAN 10-2602,
Nuclear, Biological, Chemical, and Conventional (NBCC) Defense Operations and Standards.
4.1.4.3.1. The Bioenvironmental Engineer as NBC medical defense officer, provides Weap-
ons of Mass Destruction program oversight and/or guidance.
4.1.4.4. Provide operational risk management (ORM) consultation to workplace supervisors and
commanders to facilitate appropriate health risk management. Bioenvironmental Engineering will
serve as the office of primary responsibility.
4.1.4.5. Conduct education and training. Team Aerospace members will provide worker and
workplace training IAW specific AFOSH Standards and AFIs for worker health protection (air-
24 AFI48-101 19 AUGUST 2005
crew, food facility, respiratory protection). Training will be conducted by the appropriate subject
matter experts as determined by training topic(s) and required learning objectives.
4.1.4.5.1. Public Health will provide annual food safety training to facility supervisors IAW
AFI 48-116, Food Safety Program.
4.1.4.5.2. Team Aerospace will inform supervisors that they are required to train, give them
the tools and remind them to annotate the AF IMT 55, Employee Safety and Health Record.
4.1.5. Conduct Environmental Surveillance and Assessment
4.1.5.1. BE will maintain proficiency for and conduct Environmental Health Site Assessments to
provide home station and deployed commanders with health-based risk assessments to directly
support mission capabilities.
4.1.5.1.1. Bioenvironmental Engineering will collaborate with Flight Medicine, Public
Health, and other wing organizations, interact with regulators, government agencies, and the
public, via Public Affairs officials to communicate health risks associated with affected popu-
lations and the environment.
4.1.5.1.2. Bioenvironmental Engineering recommends management and control practices, to
include elimination and substitution that reduces hazardous materials and wastes (pollution)
and risks to health and/or the environment.
4.1.5.2. Bioenvironmental Engineering serves as the installation point of contact for all Agency
for Toxic Substance and Disease Registry (ATSDR) activities.
4.1.5.3. When/If required, Public Health reports all pediatric blood lead screening data, and con-
ducts blood lead toxicity investigations. They will also assist community lead poisoning preven-
tion education programs.
4.1.5.4. Team Aerospace performs epidemiological investigations of environmental and occupa-
tional problems.
4.1.5.5. Bioenvironmental Engineering participates in installation Environmental Protection
Committee or Environment, Safety and Occupational Health Council.
4.1.5.6. Bioenvironmental Engineering participates in Environmental Compliance and Manage-
ment Program (ECAMP) or Environmental, Safety, and Occupational Health Compliance and
Management Program (ESOHCAMP).
4.1.5.7. Bioenvironmental Engineering supports the installations pollution prevention goals
through a hazardous material user authorization process that improves control and reduces risks
through analysis and consultation.
4.1.6. Provide Specialized Clinical Care for Flying and Special Operational Duty Populations
4.1.6.1. Flight Medicine will provide preventive services for flying and special operational duty
personnel and their family members.
4.1.6.2. See Chapter 5 for detailed descriptions in scope of practice and responsibilities to this
unique category of beneficiaries.
AFI48-101 19 AUGUST 2005 25
4.1.6.3. Flight Medicine will provide the same level of clinical preventive services to their empan-
elled population as any other Primary Care Element. Clinical preventive care will be IAW estab-
lished local policies and priorities as outlined by the Population Health Working Group.
4.1.7. Integrate Team Aerospace into Research, Development, Test, Evaluation and Acquisition
(RDTE&A) Processes
4.1.7.1. Incorporate Team Aerospace assets into the RDTE&A process as early in the develop-
ment as possible and throughout the process.
4.1.7.2. Identify, quantify and evaluate potential occupational and environmental hazards in the
weapons systems and technologies process during systems RDTE&A.
4.1.7.3. Identify hazards for potential elimination, substitution, and engineering control.
4.1.8. Medical Readiness Activities
4.1.8.1. A unit level medical readiness officer (MRO), medical readiness NCO (MRNCO) or
medical readiness manager (MRM), will be appointed in writing by the medical treatment facility/
unit commander, and will serve as the medical readiness advisor to the medical unit and wing
leadership.
4.1.8.2. Appointed persons shall attend the Medical Readiness Planners course IAW AFI 41-106,
Medical Readiness Planning and Training. Upon course completion and return to home station,
appointed personnel will:
4.1.8.2.1. Lead the medical treatment facility through planning, developing, training, and
implementing appropriate medical response plans to accomplish assigned missions.
4.1.8.2.2. Coordinate Warning, Alert, and Execution orders for expeditionary/deploy-
ment operations through the MAJCOM and base/wing installation deployment officer (IDO)
or equivalent.
4.1.8.2.3. The MRO will serve as a medical treatment facility consultant for medical unit indi-
vidual mobilization augmentee (IMA) liaison.
4.1.8.2.4. Review and coordinate deployment taskings in operations plans, designed opera-
tional capability (DOC) statement and medical resource letter (MRL).
4.1.8.2.5. Provide analysis of the MRL unit type codes (UTCs) readiness requirements to
medical unit commander.
4.1.8.2.6. Provide oversight for appointing personnel to assigned UTCs.
4.1.8.2.7. Coordinate mobility preparation and training IAW AFI 10-403, Deployment Plan-
ning and Execution, and AFI 41-106.
4.1.8.2.8. Manage all after action reports IAW AFI 10-206, Operational Reporting.
4.1.8.2.9. Develop or refine pre-existing plans. Include peacetime and wartime disaster and
contingency plans.
4.1.8.2.10. Manage the preparation, coordination and publication of the medical contingency
response plan (MCRP) or emergency management plans (EMP) and medical input to other
applicable base level plans. (MCRP not applicable to the AFRC).
26 AFI48-101 19 AUGUST 2005
4.1.8.2.11. Serve as the functional area plans representative for base/installation mission plan-
ning documents.
4.1.8.2.12. Provide the medical information needed for base-level mission planning docu-
ments. Team Aerospace provides planners an understanding of the potential outcomes of
exposure to identified hazards at selected sites.
4.1.8.2.13. Coordinate medical input for base/installation support plans.
4.1.8.2.14. Establish MOUs and MOAs with civilian/non-federal and DOD/federal agencies
as required.
4.1.8.2.15. Operate and manage assigned National Disaster Medical System (NDMS) respon-
sibilities IAW DOD Directive 6010.22, when so designated.
4.1.8.2.16. Accomplish readiness assessments and reporting.
4.1.8.2.16.1. Prepare reports that substantiate unit effectiveness in organizing training and
equipping. Major validating systems include but not limited to Medical Readiness Deci-
sion Support System (MRDSS), Status of Resources and Training System (SORTS), Med-
ical Report for Emergency, Disasters and Contingency (MEDRED-C), AEF Reporting
Tool (ART), web-based validating systems, and after action reports (AAR).
4.1.8.2.16.2. Consolidates reports identifying units effectiveness to operational response.
4.1.8.2.16.3. Advises the Medical Readiness Staff Function (MRSF) on all medical readi-
ness issues that impacts organizations ability to meet assigned wartime, humanitarian
assistance, homeland security/defense, and disaster response missions.
4.1.9. Deployed Medical Operations
4.1.9.1. The Medical Readiness Office will prepare and coordinate expeditionary/deployment
operations for MDG personnel.
4.1.9.2. Team Aerospace, via Preventive Aerospace Medicine (PAM) and Global Reach Laydown
(GRL), will execute ADVON missions to identify potential hazards, conduct site selection for
medical facilities, establish medical operations, food and water services, etc.
4.1.9.3. Deploying Team Aerospace members must ensure effective information transfer from
GRL to PAM team when GRL precedes PAM arrival at deployment location IAW GRL/PAM UTC
CONOPS, Theater Policy, MAJCOM Policy, and AFI 48-102, Medical Entomology Program.
4.1.9.4. Plan for and resolve, deployed force bed-down health issues.
4.1.9.4.1. Team Aerospace personnel will employ force bed down upon deployment IAW
UTC CONOPs and BOS personnel.
4.1.9.4.2. Personnel and equipment lay down procedures and planning will be optimized IAW
UTC concept of operations (CONOPs), available space and opportunity.
4.1.9.5. Team Aerospace will provide commanders an understanding of the potential outcomes of
exposure to identified health hazards to enhance operational risk management decisions through-
out the deployment, employment, and redeployment phases.
AFI48-101 19 AUGUST 2005 27
4.1.10. Environmental and Occupational Disease Prevention
4.1.10.1. Team Aerospace will provide specific consultation on deployed installation occupa-
tional health programs and risk communication IAW AFI 48-145, Occupational Health Program.
In addition to the above, Team Aerospace will:
4.1.10.2. Provide food, water, vectorborne disease surveillance and mitigation capability
IAW AFI 48-102, Medical Entomology Program; AFI 48-116, Food Safety Program; DOD
4145.19-R-1, Storage and Material Handling, NATICK Guide to the Salvage of Foods Exposed to
Refrigeration Failure, Guidelines of Evaluation and Disposition of Damaged Canned Food Con-
tainers, and local treatment facility CONOPS.
4.1.10.3. Accomplish risk communication and mitigation to include:
4.1.10.3.1. Provide post response health consequence management capability for the full
spectrum of threats.
4.1.10.3.2. Accomplish drinking water assessments and surveillance IAW AFI 48-144 Safe
Drinking Water Surveillance Program, AFMAN 48-138 Sanitary Control and Surveillance of
Field Water Supplies.
4.1.10.4. The installation radiation safety officer is the wing commanders representative for all
radiation related matters (ionizing and non-ionizing radiation, radioactive material permits and
contractor use of radioactive material on the installation).
4.1.11. Aerospace Physiology Training and Support
4.1.11.1. Aerospace Physiology, including Human Performance Training Teams (HPTT), will
offer physiological training programs IAW AFI 11-403, Aerospace Physiological Training Pro-
gram, and AFI 11-404, Centrifuge Training for High-G Aircrew, to meet the regional aircrew,
cadet, parachutists, operational support personnel and passenger training requirements.
4.1.11.2. Where assigned, Aerospace Physiologists will conduct simulator-based physiology
training for combat air forces aircrew as authorized in AFI 11-403, and provide academic training
to meet refresher course requirements.
4.1.11.3. Aerospace Physiology provides in-flight physiological support for unpressurized air-
drop missions scheduled above FL180 IAW AFI 11-409, High Altitude Airdrop Mission Support
(HAAMS), and respective 11-2 mission design series (MDS) AFIs.
4.1.11.4. Human performance enhancement (HPE) training.
4.1.11.4.1. Team Aerospace assists operational leadership, engineers, and other subject matter
experts in identifying and recommending countermeasures to human performance and safety
threats.
4.1.11.4.1.1. Countermeasures may take the form of personal protective equipment, med-
ical interventions, to include pharmacological medications, combinations of these and
other yet-to-be developed and approved countermeasures.
4.1.11.5. Team Aerospace will provide HPE training for all appropriate military personnel to
reduce occupational injuries, accidents, and loss of life or resources.
28 AFI48-101 19 AUGUST 2005
4.1.11.6. Human Performance Training Teams (HPTT), where assigned or available will:
4.1.11.6.1. Assist other members of Team Aerospace in identifying hazards and risks to
human performance and assists with development and implementation of training solutions to
enhance readiness and combat capability.
4.1.11.6.1.1. Coordinate and incorporate human factors and human performance training
into existing programs, look for training gaps, and augment current programs.
4.1.11.6.1.2. Assist the SGP, line commanders, and supervisors in human factors analysis,
assessment, and investigation.
4.1.11.6.1.3. Where available, their training objectives will include HPE and flight safety
training to aircrew and the HPE training to non-aircrew to reduce occupational injuries,
accidents, and loss of life/resources that negatively impact combat capability.
4.1.11.7. Aerospace Physiology provides physiological support for U-2 reconnaissance opera-
tions including pressure suit/life support preflight, and U-2 pilot integration into suit and cockpit
at Beale AFB and deployed locations.
4.1.12. Installation Safety Program
4.1.12.1. SGP serves as a liaison to the installation Safety office.
4.1.12.2. Bioenvironmental Engineering and Aerospace Physiology will maintain an open dia-
logue with Flight and Ground Safety and serve as the primary medical interface to promote inte-
grated safety and occupational health risk management and solutions.
4.1.12.3. Flight Surgeons and Aerospace Physiologists will ensure current mishap trends or les-
sons learned are briefed to flight crew at quarterly flying safety meetings, IRC briefings and other
applicable forums.
4.1.12.4. Team Aerospace will develop strategies to address unfavorable human performance
trends in all disciplines. Aerospace Physiology will report flight/ground/weapons mishap trends to
the SGP at the AMC.
4.1.12.5. Flight Surgeons will serve as Safety Investigation Board members IAW AFPAM
91-211, USAF Guide to Aviation Safety Investigation..
4.1.12.6. Team Aerospace members other than flight surgeons may serve as consultants in support
of the flight surgeon member of safety investigation boards at the discretion of the board president
and flight surgeon member, IAW AFPAM 91-211, USAF Guide to Aviation Safety Investigation.
4.1.12.7. BE will provide training for disaster team members and work with responsible com-
manders to ensure they are equipped as responders to provide primary environmental and occupa-
tional surveillance and risk assessment expertise IAW AFI 10-2501, Full Spectrum Threat
Response (FSTR) Planning and Operations.
AFI48-101 19 AUGUST 2005 29
Chapter 5
RESTORE HEALTH
5.1. The AMP will provide operational health care that includes, (but is not limited to), Casualty Care and
Management (AFDD 2-4-2), routine health care, and clinical services for families under any circumstance
required of the mission, and in compliance with Air Force Policy Directive 44-1, Medical Operations.
The AMP will provide specific expertise in the planning and execution of medical responses to mishaps,
operational incidents and mass casualties, and it will provide professional expertise to ensure the safety
and appropriateness of aeromedical evacuation of patients.
5.1.1. Scope of Clinical Services
5.1.1.1. Population. Flight Medicine will provide primary and preventive medical care for eligi-
ble aircrew and special operational duty personnel, and their families.
5.1.1.2. Service Access. Flight Surgeons will provide medical care and consultation through the
combination of sick call, scheduled clinical appointments and consultations of opportunity in both
clinical and non-clinical settings. The SGP will determine the optimal appointment template plan
to ensure Flight Surgeons are best able to meet all clinical and nonclinical tasks.
5.1.1.3. Disposition. Flight Surgeons will review all medical care provided outside the Flight
Medicine Clinic within 24 hours to render timely aeromedical dispositions. Document all aero-
medical dispositions in the members outpatient medical record.
NOTE: Consult applicable MAJCOM/SGP for unique application to ARC personnel.
5.1.1.3.1. To ensure appropriate aeromedical followup, Flight Medicine will develop local
policies to identify Flight Medicine patients seen elsewhere within the MTF, as well as ensur-
ing timely follow-up for consultations and care delivered outside the MTF.
5.1.1.3.2. Flight Surgeons will ensure medical, dental, and support staff are aware of aviation/
operational medicine requirements when dealing with aircrew and special operations person-
nel.
5.1.1.3.2.1. Flight Medicine will establish an annual schedule of aeromedical topics on
which to brief the provider medical staff on a monthly basis.
5.1.1.3.2.2. Documentation of this training will be maintained for a period of two years.
5.1.1.3.3. Flight Surgeons will consult with other health care specialists to deliver optimal
clinical care and expedite aeromedical dispositions.
5.1.1.3.3.1. As part of the delivery of total medical care, Team Aerospace professionals
will provide advice relevant to the unique elements of aeromedical exposures that might
influence consultants diagnosis and treatment.
5.1.1.3.3.2. Flight Surgeons should consult with their SGP for complex aeromedical dis-
position cases. MAJCOM/SGPA, AFMSA/SGPA, and/or the Aeromedical Consult Ser-
vice will also be available for consultation, as required.
5.1.1.3.4. Flight Surgeons will monitor the care of flyers, special operational duty personnel
and their families when hospitalized. Moreover, they must ensure proper aeromedical disposi-
30 AFI48-101 19 AUGUST 2005
tion and follow-up after the discharge of hospitalized aircrew, special operational duty person-
nel, and other empanelled patients.
5.1.1.3.4.1. Active duty MTF Flight Medicine practices will establish procedures to obtain
and review Admissions and Disposition logs on a daily basis from the medical facility as
well as proximate civilian inpatient facilities.
5.1.1.3.5. Flight Medicine will provide clinical support to Flight Medicine patients enrolled in
communicable disease programs IAW AFI 48-105, Surveillance, Prevention, and Control of
Diseases and Conditions of Public Health or Military Significance. Flight Medicine and Pub-
lic Health will also provide consultative services in support of the above programs to other Pri-
mary Care Elements.
5.1.1.3.6. Flight Surgeons will serve as a liaison between flying and special operation duty
personnel/units, and all available medical services.
5.1.1.3.7. Optometry will deliver clinical eye care to TRICARE Prime beneficiaries and other
enrollees on a space available basis.
5.1.1.4. Empanelment to the Flight Medicine group practice (FMGP) is limited to aviators, other
special operational duty personnel whose duties require AF IMT 1042 action, and their family
members.
5.1.1.4.1. All deviations from paragraph 5.1.4. require MAJCOM/SGPA approval before
enacting, and may be cause for resource reallocation. Such deviations may include enrollment
of other operational support groups such as Life Support, Aircraft Maintenance, and high-risk
occupational groups, as submitted for approval and determined by the SGP to be necessary for
the successful completion of the local aeromedical or installation mission.
5.1.1.4.2. Flight Surgeons and support staff not directly assigned to the medical unit will sup-
port the activities of the overall Flight Medicine group practice when at home station and fall
under operational control of the SGP. The relationship of squadron medical elements is specif-
ically addressed in AFI 48-149, Squadron Medical Elements.
5.1.1.4.2.1. Flight surgeons and support staff not directly assigned to the medical facility
are not included in the medical units resourcing model and do not drive additional empan-
elment.
5.1.1.4.3. Non-empanelled patients may be seen for operational, occupational, and special
purpose examination requirements described in this AFI, including work-related injuries or ill-
nesses as discussed below.
5.1.1.5. Clinical Occupational Medicine:
5.1.1.5.1. Flight/Occupational Medicine will provide clinical occupational medicine services
for civilian employees and perform fitness for duty and disability evaluations IAW AFI
48-145.
5.1.1.5.1.1. Flight/Occupational Medicine and Optometry will provide outpatient and
inpatient medical care within the MTF, at government expense, for non-TRICARE eligible
civilian federal employees suffering job related injury or illness according to the Federal
Employees Compensation Act.
AFI48-101 19 AUGUST 2005 31
5.1.1.5.1.1.1. The AFMS will not manage a non-TRICARE eligible civilian
employees non job-related injury or illness or abnormal finding during a medical
examination. However, AFMS providers will provide emergency care, or first aid and
minor symptom relief if the treatment would enable the employee to return to work and
complete the current work shift.
5.1.1.5.1.1.2. For non-work related cases, AFMS providers will refer the employee to
their personal medical provider when care is needed.
5.1.1.5.1.2. Flight Surgeons (or Occupational Medicine providers) will provide treatments
requested by civilian medical practitioners for civilian employees (if resources permit)
when reasonably necessary to keep the employee on the job, and only as they pertain to
job-related illness/injury.
5.1.1.5.1.3. Installation supervisory personnel, medical providers, and each worker will
ensure Public Health is informed promptly about each job-related illness or injury. The
installation Safety (SE) office will also be informed of work-related injuries.
5.1.1.5.1.4. Public Health, Bioenvironmental Engineering, and Flight Medicine will per-
form epidemiological investigations and occupational illness/injury surveillance of envi-
ronmental and occupational problems IAW USAF and OSHA guidelines to identify
disease/injury trends, identify etiologies/causative agents, and develop intervention strate-
gies and preventive measures to reduce lost work time. AFIOH and the Air Force Safety
Center will provide epidemiological and industrial hygiene consultation as required.
5.1.1.5.2. Flight/Occupational Medicine will provide occupational medicine consultative sup-
port to the MTF professional staff, as well as local civilian providers caring for civilian
employees.
5.1.2. Specialized Aeromedical Care for Specific Populations
5.1.2.1. Flight Medicine will provide medical support for all in-flight emergencies during normal
clinic hours and (at least) on-call availability to support base emergency response services
after-hours.
NOTE: Consult applicable MAJCOM/SGP for unique application to ARC personnel.
5.1.2.1.1. Flight Medicine will develop local policies to ensure that a Flight Surgeons and
Flight Medicine Technician are on-call 24/7, and able to provide aeromedical support within a
reasonable period as defined by the SGP. Copies of this on-call schedule will be distributed to
Flight Safety, the Command Post, and the Emergency Room or other after-hours POC for the
medical facility if one exists.
5.1.2.1.2. The MDG/CC may determine which MTF functional area will be responsible for
providing emergency flightline ambulance response (Ambulance Service versus Flight Medi-
cine), based upon mission requirements.
5.1.2.2. Flight Surgeons will provide immediate support and appropriate treatment to manage all
physiological incidents and in-flight exposures resulting in injury/illness.
5.1.2.2.1. Flight Surgeons will establish procedures and local directives for the management
of DCS attributable to flying, diving, or altitude chamber exposure.
32 AFI48-101 19 AUGUST 2005
5.1.2.3. Flight Medicine will coordinate with Aerospace Physiology to provide medical support
for hypobaric and hyperbaric chamber operations IAW AFI 11-403, Aerospace Physiological
Training Program and AFI 148-112, Hyperbaric Chamber Program.
5.1.2.3.1. During all chamber flights, designated Flight Surgeons must be able to respond by
telephone within two minutes of notification and get to the chamber within 15 minutes.
5.1.2.3.2. In no case will emergency care and transport by qualified emergency response per-
sonnel be delayed to await the FSOC or a Flight Medicine team.
5.1.2.3.3. A Flight Surgeon will serve as the medical member of any clinical hyperbaric com-
pression therapy team IAW AFI 48-112, Hyperbaric Chamber Program. Current
USAF-approved indications for clinical hyperbaric therapy are listed in Section B.
5.1.2.3.4. Aerospace Physiology technicians will function as Inside Observers on multi-place
chamber treatment dives to assist with patient management. Flight Medicine 4N0X1, Aero-
space Medicine Technicians assist with medical support for hyperbaric chamber operations
when indicated and approved by the SGP.
5.1.2.4. During centrifuge operations, the flight surgeon on call (FSOC) will be notified if an
emergency or non-routine medical treatment is required. The FSOC will be available to provide
support to the centrifuge training center within five minutes, unless approved in advance by the
MDG/CC. When indicated, Flight Medicine or appropriate emergency medicine transport team
provides patient transport to the MTF or other appropriate facility.
5.1.2.4.1. In no case will emergency care and transport by qualified emergency response per-
sonnel be delayed to await the FSOC or a Flight Medicine team.
5.1.2.5. Flight Medicine will provide NASA Space Medicine and Space Shuttle Medical
Response support for contingency landings (Modes) at designated primary and alternate shuttle
landing sites. Shuttle medical support activities will be coordinated through Department of
Defense Manned Spaceflight Support (DDMS) IAW the NASA/DOD memorandum of under-
standing.
5.1.3. Deployed Medical Care and Casualty Management
5.1.3.1. Flight Medicine will:
5.1.3.1.1. Provide clinical care of deployed forces to include trauma management.
5.1.3.1.2. Partner with International Health Specialists to establish networks/liaisons with
local host nation medical facilities and government health agencies.
5.1.3.1.3. Manage combat stress casualties in conjunction with available Life Skills providers.
5.1.3.1.4. Medically evaluate repatriated POWs IAW current Air Force and DOD Repatriation
of Prisoners of War Plan.
5.1.3.1.5. Provide medical care in conjunction with humanitarian relief missions and other
military operations other than war (MOOTW).
5.1.3.1.6. Provide care to multi-national forces as established in memorandums of agreement
or understanding (MOA/MOU), North Atlantic Treaty Organization Standard Agreements
(NATO STANAG), or combatant commander (COCOM) directives.
AFI48-101 19 AUGUST 2005 33
5.1.4. Disaster Response
5.1.4.1. Team Aerospace will ensure that personnel and equipment are prepared to provide aero-
medical support IAW AFI 10-2501, Full Spectrum Threat Response (FSTR) Planning and Opera-
tions, for airborne emergencies, aircraft mishaps, mass casualties, natural disasters, CBRNE
events, HAZMAT releases, and other disasters. Moreover, Flight Medicine will ensure:
5.1.4.1.1. Ambulances and all on-board equipment are in good repair, inspected daily, and are
ready for emergency response.
5.1.4.1.2. Procedures have been established and local directives published for the initial
response and management of casualties generated in aviation mishaps and other disasters.
5.1.4.1.3. Disaster response and mishap investigation kits are prepared and immediately avail-
able for quick response.
5.1.4.1.3.1. Initial response, mass casualty and mishap investigation kits are inspected and
inventoried on a quarterly basis. Maintain documentation of inspections for two years.
5.1.4.1.4. Disaster response medical crews are trained and exercised regularly. Consult with
the Medical Readiness Staff Function (MRSF), for annual exercise requirements.
5.1.4.2. Medical response will be coordinated IAW the National Incident Management System
(NIMS) and the National Response Plan to facilitate compliance with Homeland Security Presi-
dential Directive 5 to properly interface with other base agencies, as well as off-base local and fed-
eral emergency response agencies to optimize response and pre-hospital emergency care IAW AFI
10-2501, and supporting manual(s).
5.1.4.3. Outbreak Investigation. In the aftermath of disasters, Flight Medicine and Public Health
will conduct outbreak investigations to expedite the diagnosis of causative agents and implemen-
tation of intervention and possible prevention strategies. They will also coordinate with national
response agencies as required.
5.1.4.4. Flight Medicine will, upon request, assist Life Skills providers in delivering critical inci-
dent stress management (CISM) intervention following mishaps and disasters.
5.1.4.5. In the event of WMD scenarios, Team Aerospace may augment other AFMS assets in
decontamination and treatment of NBC casualties.
5.1.4.5.1. BE will detect, identify, and quantify hazards and perform health risk assessments
to determine operational and medical impacts.
5.1.4.5.2. Bioenvironmental Engineering will assist in recommending appropriate protective
equipment and procedures to the decontamination team and determining the effectiveness of
patient decontamination.
5.1.4.5.3. Flight Medicine will provide expertise/care to diagnose and manage NBC casual-
ties.
5.1.5. Air Evacuation (AE)
5.1.5.1. Flight Surgeons will coordinate with theater surgeons and AE personnel to assist in clini-
cal aspects of peacetime and operational AE.
5.1.5.2. Flight Surgeons will screen patients and attendants for contra-indications to AE flight.
34 AFI48-101 19 AUGUST 2005
5.1.5.2.1. Flight Medicine will review records, AE requests and/or evaluate patients and
non-medical attendants prior to flight.
5.1.5.2.2. Flight Surgeons will ensure proposed enroute treatment is appropriate and compat-
ible with the stresses of flight, IAW HQ AMC guidance.
5.1.5.3. Flight Medicine will provide/assist with the delivery of enroute stabilization and critical
patient care. TA support may also include the loaning of personnel or equipment to expedite the
AE mission during contingency operations. Other support functions include:
5.1.5.3.1. Flight Medicine will work in conjunction with AFMS air evacuation and critical
care medical assets to provide seamless care and transport.
5.1.5.4. Flight Medicine will ensure patients are entered into available air evacuation information
system databases to provide accurate means of tracking/visibility of patients during transfer.
5.1.5.5. Flight Surgeons will aeromedically and clinically support Aeromedical Staging Facilities.
5.1.5.6. Training and support to Air Force Special Operations Command (AFSOC) operational
medical and pararescue personnel, charged with providing initial stabilization in combat search
and rescue and mass casualty incidents.
5.1.5.6.1. AFSOC provides medical personnel and aircraft to support casualty evacuation of
Special Ops forces (SOF) and U.S. and coalition partners where SOF are the only available
assets in the AOR, or to trans-load patients between pararescue crews and established AE
assets.
5.1.6. Consequence Management
5.1.6.1. Flight Medicine will ensure DNA Registry samples are collected for 100% of the military
members of their empanelled population, and that such data is appropriately reflected in appropri-
ate Individual Medical Readiness (IMR) database(s).
5.1.6.1.1. In the event of fatalities requiring confirmatory identification, Flight Medicine will
work with Services (mortuary affairs) to ensure security of remains and collection of tissue
samples for comparison against available DNA registry samples.
5.1.6.2. Flight Surgeons may be required to provide medical support as part of a Death Notifica-
tion team for peacetime or wartime fatalities.
5.1.6.3. Team Aerospace will engage in the identification of requirements and the RDT&E of new
technologies/capabilities that facilitate the diagnosis and treatment of injuries and illnesses, espe-
cially in deployed austere environments.
5.1.6.4. Flight Medicine and other members of Team Aerospace as appropriate, will provide feed-
back to line commanders regarding mission impact due to prevalent injuries/illnesses.
5.1.6.4.1. Flight Surgeons will advise flying/special operational duty commanders regarding
fitness and qualification for flying/special operational activities IAW AFI 48-123, Medical
Examinations and Standards.
5.1.6.4.2. Flight Medicine will report AF IMT 1042 actions to flying units on a daily basis by
the most expeditious and reliable means possible.
AFI48-101 19 AUGUST 2005 35
5.1.6.4.3. Flight Medicine will actively review the AF IMT 1041 Grounding Management
Log on a weekly basis to ensure timely aeromedical dispositions.
5.1.6.4.4. Documentation of this weekly review product will be maintained for a period of
five years IAW Air Force Records Disposition Schedule (RDS) located at https://
webrims.amc.af.mil/.
5.1.6.4.5. BE will utilize health risk assessments to determine potential operational/medical
impacts and advise on CBRNE outcomes and persistent threats so appropriate risk-based man-
agement decisions can be made.
36 AFI48-101 19 AUGUST 2005
Chapter 6
OPTIMIZE AND ENHANCE HUMAN PERFORMANCE
6.1. The AMP becomes a force multiplier by aspiring to create a health-optimized Air Force. The AMP
will employ scientifically sound principles of preventive medicine and health promotion to improve over-
all physical, psychological and social health and performance of individuals to enhance quality of life,
increase effectiveness, and ultimately prolong healthy life. Furthermore, the AMP must research and
employ objective occupation selection criteria, evidenced-based medical standards, and the tools and
techniques necessary to achieve fully optimized levels of individual physical performance, cognition, and
employment, thus creating the human weapon system, (HWS).
6.1.1. The AMP will participate in all phases of the system acquisition cycle, providing consultation
and design expertise to ensure the interface between the human and the system is safe and effective.
The AMP will provide expertise to educate workers and leadership, and to optimize work practices
and solutions to ensure worker safety, community health and environmental protection during devel-
opment and employment of new systems.
6.1.2. Human performance enhancement (HPE) activities.
6.1.2.1. Altitude Chamber Training
6.1.2.1.1. Aerospace Physiology will provide original, refresher, and cadet physiological
training programs IAW AFI 11-403, Aerospace Physiological Training Program.
6.1.2.1.2. Flight Surgeons will ensure students are medically prepared for altitude chamber
training, provide medical supervision of the training, and respond and treat any adverse cham-
ber reactions.
6.1.2.2. High G Force (Gz) Training
6.1.2.2.1. Aerospace Physiology will provide initial, qualification, and refresher centrifuge
training, as well as training to optimize performance in the sustained positive High G (Gz)
environment IAW AFI 11-404, Centrifuge Training for High-G Aircrew.
6.1.2.2.1.1. Flight Surgeons ensure students are medically prepared for centrifuge train-
ing, provides medical supervision of the training, and responds and treat any centri-
fuge-related injuries or physiological incidents.
6.1.2.2.1.2. Flight Surgeons evaluate any fighter aircrew having difficulty performing in
the High G (Gz) environment. Flight Surgeons may refer to Aerospace Physiologists for
additional instruction when it may be beneficial.
6.1.2.2.1.3. Flight Surgeons and Aerospace Physiology instruct fighter aircrew on physi-
cal fitness program elements or exercises that can enhance High G (Gz) tolerance IAW
AFPAM 11-419, G-Awareness for Aircrew.
6.1.2.2.1.4. Aerospace Physiology instructors will conduct Fighter Aircrew Conditioning
Program IAW applicable MAJCOM instructions. Aerospace Physiology will provide con-
ditioning protocol and fitness consultation for any student who does not successfully com-
plete the Fighter Aircrew Conditioning Test evaluation.
AFI48-101 19 AUGUST 2005 37
6.1.2.2.1.5. Flight Surgeons, assisted by an Aerospace Physiologist, will conduct in-flight
and Head Up Display (HUD) video review of anti-G straining maneuver (AGSM) IAW
AFI 11-2 F-15/F-16/F/A-22/A-10 V1s and AFPAM 11-419, G-Awareness for Aircrew.
Aircrew with deficiencies will receive corrective feedback from the Flight Surgeons and a
referral to formal AGSM training by Aerospace Physiology when indicated.
6.1.2.3. Night Vision Goggle (NVG) Program Support
6.1.2.3.1. AFI 11-202V1, Aircrew Training, defines Air Force-wide training requirements for
the use of NVGs. Mission related Flight Surgeons and Aerospace Physiologists will become
certified as part of the training team, assisting in initial and refresher training. Weapons spe-
cific training and operational requirements are contained in the applicable AFI 11-2 series doc-
uments.
6.1.2.3.2. Flight Medicine must screen the records of personnel who use NVGs initially and
periodically thereafter to confirm vision requirements are met IAW AFI 48-123, Medical
Examinations and Standards, A8.7, Duty Requiring the Use of Night Vision Goggles (NVG).
6.1.2.3.3. Flight Surgeons and Aerospace Physiologists will advise commanders on defining
appropriate NVG use.
6.1.2.3.4. Aerospace Physiology will develop NVG training programs for non-aircrew sup-
port personnel who require NVG use during night mission operations.
6.1.2.4. Reducing Spatial Disorientation (SD) And Expanding Situational Awareness (SA)
6.1.2.4.1. Flight Surgeons and Aerospace Physiology instructors will provide initial academic
training on weapon system specific human performance enhancement, spatial disorientation,
visual illusions, and situational awareness.
6.1.2.4.2. Flight Surgeons and Aerospace Physiologists will provide weapon system specific
human performance enhancement training in operational flying wings.
6.1.2.4.3. Flight Surgeons and Aerospace Physiologists will present SD and related SA topics
during instrument refresher course IAW AFMAN 11-210, Instrument Refresher Course (IRC)
Program.
6.1.2.4.4. Aerospace Physiologists will incorporate SD/SA mishap scenarios into simula-
tor-based physiology training for appropriate aircrew.
6.1.2.5. Crew/Cockpit Resource Management (CRM)
6.1.2.5.1. Aerospace Physiology instructors will provide initial academic training on CRM.
6.1.2.5.2. When trained, the Aerospace Physiologists and Aerospace Physiology technicians
are authorized to function as a qualified CRM facilitator IAW AFI 11-290, Cockpit/Crew
Resource Management Training Program.
6.1.2.5.3. Aerospace Physiology and/or Flight Surgeons will attend, participate in, and moni-
tor CRM training. Deficiencies in CRM training are reported to the local SGP.
6.1.2.5.4. Where assigned, Aerospace Physiology provides team training to appropriate
non-flying teams, as required.
38 AFI48-101 19 AUGUST 2005
6.1.2.6. Airsickness Prevention. The SGP ensures Aerospace Physiology and Flight Medicine
provide a viable Airsickness Management Program. This program has demonstrated its effective-
ness in assisting UPT/UNT students to overcome airsickness. Although this program was designed
for UPT/UNT students, it may be beneficial for an experienced aircrew having difficulty with air-
sickness, especially those transitioning to a new weapon system.
6.1.2.6.1. Individuals should continue primary training/regular flight duties while participat-
ing in any phase of the Airsickness Management Program.
6.1.2.6.2. The program consists of the following four phases:
6.1.2.6.2.1. Phase 0: Education provided by Aerospace Physiology during initial physio-
logical training.
6.1.2.6.2.2. Phase I: Following airsickness episode #1, education is reinforced and the
Flight Surgeon should consider pharmacological intervention with Scop/Dex.
6.1.2.6.2.3. Scopolamine 0.5 mg and Dextroamphetamine Sulfate 5.0 mg (Scop/Dex)
given 1 to 2 hours prior to flight for three consecutive flights, one flight per day.
6.1.2.6.2.3.1. Note: Pilots undergoing treatment for airsickness will not fly solo while
using pharmacologic medications.
6.1.2.6.2.4. Phase II: Following airsickness episode #2, provide relaxation training from
Life Skills and continue pharmacologic therapy at the discretion of the flight surgeon.
6.1.2.6.2.5. Phase III: Following airsickness episode #3 and higher, the Flight Surgeon
will focus further evaluation upon the individuals motivation to fly, to include the possible
diagnosis of Manifestations of Apprehension, and possible subsequent elimination from
flying duties.
6.1.2.6.2.5.1. Aircrew able to continue to perform effectively with either active or pas-
sive airsickness without the need for intervention from an instructor or other crew-
member, should also be entered into Barany chair physiologic adaptation training
conducted by Aerospace Physiology.
6.1.2.7. Endurance Management
6.1.2.7.1. Flight Surgeons and Aerospace Physiologists provide Fatigue Countermeasures
training to commanders, supervisors, and schedulers. The SGP will advise wing leadership of
organizational fatigue countermeasures strategies and provide fatigue prevention and sleep
hygiene to shift workers and other applicable personnel.
6.1.2.7.2. Team Aerospace personnel will identify fatigue issues during shop visits and report
their findings to AMC to develop mitigating strategies or training. Team Aerospace personnel
will assist squadron medical elements in counter-fatigue strategies for their units when
requested.
6.1.2.7.3. Team Aerospace will evaluate fatigue management strategies for long duration,
including Remotely Piloted Aircraft Operators (unmanned platforms), night operations and
high ops tempo sorties. Flight Surgeons will participate in unit mission planning when indi-
cated by unique airframe AFI or requested by flying unit commanders.
AFI48-101 19 AUGUST 2005 39
6.1.2.7.4. Flight Medicine will establish a program to ground test, dispense, and control phar-
macological agents for alertness management IAW AFI 48-123, Medical Examinations and
Standards, AFI 11-202V3, General Flight Rules, and current USAF/XO and USAF/SG policy.
6.1.2.8. Human Performance Evaluations.
6.1.2.8.1. Team Aerospace personnel will actively look for ways to improve workplace per-
formance as part of scheduled shop visits. Supervisors and commanders will be informed of
potential performance improvements they can implement as part of the shop visit out brief.
6.1.2.8.2. Flight Surgeons, as one of their primary flight duties, must evaluate specific human
performance capability challenges, analyze gaps in capability, and make suggestions for
improvement or resolution through the AMP as a Human Weapon System (HWS) Capabili-
ties Gap Analysis submission (See also, paragraphs 1.2.5.5., 1.2.6.4., and 1.2.9.7.3.7.).
6.1.2.8.3. Flight Surgeons and Aerospace Physiologists will brief appropriate known
counter-measures for identified performance challenges, to mitigate gaps in human perfor-
mance and mission capabilities, during squadron/wing academics. Potential briefing topics:
situational and spatial awareness, visual illusions, fatigue, task management, and mission haz-
ards.
6.1.2.9. Flight Surgeons inspect life support facilities quarterly IAW AFI 11-301V1, Aircrew Life
Support Program, and assist Wing Life Support, as requested by OSS/CC. Aerospace Physiology
personnel will advise life support personnel on physiological and performance issues pertaining to
personal protective equipment and deployed theater requirements. Maintain document these
inspections for a period of two years.
6.1.2.9.1. Flight Medicine and Aerospace Physiology representatives participate as members
of wing level Aircrew Protection Working Group IAW AFI 11-301V1, Aircrew Life Support
Program.
6.1.2.10. Vision Enhancement.
6.1.2.10.1. Optometry fits and provides aircrew and special operational duty personnel requir-
ing corrective lenses with USAF Aircrew eye frames.
6.1.2.10.2. Optometry fits and provides aircrew and special operational duty personnel with
soft contact lenses and conducts all required periodic follow-up exams IAW the USAF Air-
crew Soft Contact Lens (SCL) program.
6.1.2.10.3. Optometry provides initial evaluations and follow-up optometric care for aircrew/
special operational duty personnel electing to undergo corneal laser refractive surgery IAW the
most current and up-to-date USAF guidelines.
6.1.2.10.4. The Aeromedical Consultation Service is responsible for recommending policy
and the immediate pre- and post-operative management of aircrew receiving corneal refractive
surgery.
6.1.2.10.5. Optometry provides pre- and post-operative care for active duty members electing
to participate in the PRK/LASIK for the Warfighter (non-aircrew) program.
6.1.3. Optimizing the Human-Machine Interface: Team Aer ospace wi l l addr ess t hat t he
human-machine interface is accounted for in the RDTE&A of emerging systems and technology
40 AFI48-101 19 AUGUST 2005
insertion programs for existing systems. RAMs, pilot-physicians and physiologists, BE will provide
expertise to optimize work practices and solutions.
6.1.3.1. Enhancing System Design. Team Aerospace is charged with the responsibility to enhance
human performance through improved systems design. During the design phases of new systems
development, RAMs will evaluate the impact of key factors to ensure optimal design for total sys-
tem performance, and will advise on ergonomics and the unique human-machine interface in the
systems development process. This includes the advancement of technology for operational vision
programs to the warfighter. Pilot physicians will take a lead role in the development of require-
ments and design optimization for human interface IAW AFI 11-405, The Pilot-Physician Pro-
gram.
6.1.3.1.1. RAMs, pilot physicians, and aerospace physiologists will participate in system
development at program offices to facilitate successful human weapon system integration.
Projects, research, and development shall follow capability review and risk assessment
(CRRA) and functional area working group (FAWG) direction. Pet projects that do not have
the support of the Line of the Air Force developers and CRRA goals are discouraged and
should not proceed without AFMS Aerospace Panel approval.
6.1.3.1.2. Bioenvironmental Engineers participate in weapons system design to minimize
health risks secondary to design and related processes.
6.1.3.2. Acquisition and Test. Team Aerospace members assigned to monitor the acquisition and
test process are responsible for developing and improving requirements to enhance human perfor-
mance through improved human-machine interface design. These TA members evaluate potential
improvements by assessing interface issues through formal requirements channels. Ideas for
improvements include current systems (modification) as well totally new requirements that drive
new research and development for incorporation into future systems.
6.1.3.3. System Operator Education. During system operation and deployment, Team Aerospace
will advise about possible performance enhancement techniques and process or equipment use to
ensure the best possible human-machine interface.
6.1.3.4. Industrial Applications. Flight Surgeons and/or Aerospace Physiology provide human
factors consultation to workers and commanders to improve worker performance. Human factors
support may be provided for all industrial processes, at home station, and while deployed.
6.1.3.5. Removal from Service. Team Aerospace will advocate for appropriate safeguards and pro-
cedures are in place to protect personnel during removal of weapons systems from the AF inven-
tory. This includes proper disposal of controlled/hazardous materials associated with these
systems. Bioenvironmental Engineering will monitor and advise on appropriate safeguards IAW
the Code of Federal Regulations, OSHA and USAF directives, and other related industrial direc-
tives are carefully applied to each. This closes the cradle to grave loop of involvement for Team
Aerospace in optimizing Human Performance.
6.1.4. 311th Human Systems Wing (311 HSW): The 311 HSW seeks to produce an overwhelm-
ingly effective warfighter through cutting-edge human performance and global health. Located at
Brooks City-Base, Texas, the 311th Human Systems Wing is the major USAF agency tasked with
oversight, development, and training for the operational aspects of the Human Weapons System.
AFI48-101 19 AUGUST 2005 41
6.1.4.1. There are three major units in the 311 HSW heavily involved with HWS issuesthe
USAF School of Aerospace Medicine (USAFSAM), the Air Force Institute for Operational Health
(AFIOH), and the Human Systems Program Office (YA).
6.1.4.1.1. Education. USAF School of Aerospace Medicine provides aerospace education and
training for Team Aerospace through courses in Flight Medicine, Flight Nursing, Aerospace
Physiology, Bioenvironmental Engineering, and Public Health, as well as the Advanced Aero-
space Medicine for International Medical Officers course.
6.1.4.1.2. Clinical. The Force Enhancement Department within USAFSAM provides consul-
tation and integration on the clinical aspects of Aerospace Medicine, including aeromedical
consultation, aeromedical standards, hyperbaric medicine, and performance enhancement.
AFIOH promotes global health and protects USAF warriors and communities by enhancing
readiness and effectiveness. AFIOH develops creative solutions to operational health prob-
lems using numerous tools including environmental and health surveillance, risk analysis, pro-
cess re-engineering, consultation and technological innovations.
6.1.4.1.3. Acquisition. The 311 HSW/YA is the USAFs Human Systems Program Office. YA
acquires equipment, services, and systems to support the human in the loop for all weapon sys-
tems. This office interfaces with all other weapon systems program offices, USAF major com-
mands, and sister services, and allied air forces. It ensures procured items will support the
HWS in the operational environment.
6.1.4.1.4. Research. 311 HSW collaborates in HPE research to develop new equipment and
training that improves the human-machine interface in areas such as the following:
6.1.4.1.4.1. Major weapon system acquisition such as the F/A-22 Raptor, F-35 Joint Strike
Fighter, and Remotely Piloted Aircraft (issues such as life support and pilot-vehicle inter-
face).
6.1.4.1.4.2. In collaboration with the Air Force Research Laboratory, research in accelera-
tion, spatial disorientation countermeasures, and fatigue countermeasures, including phar-
macological interventions.
6.1.4.1.4.3. Human issues in command and control, information management, deci-
sion-making, and net-centric warfare.
6.1.4.1.4.4. Medical standards and selection criteria.
6.1.4.2. Team Aerospace members in operational assignments requiring assistance in HPE issues
can contact 311 HSW/XP, the Wing focal point for receipt of requests for operational analyses, in
conjunction with HQ USAF/SGOP, HQ AFMSA/SGP, and HQ AFMC/SGP.
6.1.4.3. 311 HSW will collaborate with AF/SGR to resolve gaps in capability, as defined by the
HWS Capabilities Gap Analysis, generated by installations and units, and staffed through MAJ-
COM/SGPs for prioritization and potential funding and programming via the SGROCC.
42 AFI48-101 19 AUGUST 2005
Chapter 7
DEVELOPMENT OF TEAM AEROSPACE PERSONNEL
7.1. Squadron commander ensures a robust education, training, and development program to fully
employ Team Aerospace members in order to maximize synergy, and meet deployment and home station
mission needs. To deliver the desired effects as noted in previous chapters, the squadron commander will
ensure training in the following areas for all assigned and attached AMP personnel as indicated within
each reference.
7.1.1. Each AMP Air Force Specialty Code (AFSC) (officer, enlisted, and civilian) has a unique
career path. The squadron commander must ensure members are aware of their unique potential career
paths, and provide career guidance as applicable. Enlisted career paths are spelled out in the AFSC
Career Field Education and Training Plan (CFETP). AF Enlisted Career Field Managers (AFCFM), as
well as MAJCOM and installation AFSC Functional Managers will ensure enlisted personnel
assigned to the AMP meet CFETP requirements commensurate with duty location and mission
responsibilities. The Air Force Personnel Center web site contains officer career path pyramids for
each Corps.
7.1.1.1. Home Station (Routine) Support and Daily Operations.
7.1.1.1.1. Each member will meet or exceed training requirements for his or her AFSC IAW
respective directives and local requirements to perform primary home station missions.
7.1.1.1.2. All Team Aerospace enlisted personnel will complete upgrade training require-
ments as specified in the applicable CFETP and maintain currency.
7.1.1.1.3. Unless superseded by military/mission requirements, Team Aerospace personnel
will complete Professional Developmental Education, to include professional military educa-
tion (PME), IAW established program guidelines. The local functional manager or appropriate
higher authority may approve mission specific delays. See AFI 36-2301, Professional Military
Education.
7.1.1.1.4. Team Aerospace personnel will complete advanced training commensurate with
certain positions. (e.g. medical readiness officer, and Hearing Conservation Certification
courses, et al).
7.1.1.1.5. Team Aerospace personnel must accomplish recurring certification training, such as
periodic recertification training for AFSC-required certifications (4B0X1-HAZWOPER;
4E0X1 Hearing Conservation, etc.). Any lapses in required certification training must be
tracked by the commander until resolved.
7.1.1.1.6. Continued Medical Education (CME) training. The AMDS or equivalent unit must
budget for at least one CME training course per officer (including SMEs) per year. The squad-
ron commander will ensure good stewardship of government funds to prevent approval
requests for training to more expensive venues when closer, less expensive training opportuni-
ties exist.
7.1.1.1.6.1. Personnel assigned to squadron medical elements may also receive CME
funding from their parent unit, as well as other non-defense health program (DHP) funding
sources.
AFI48-101 19 AUGUST 2005 43
7.1.1.1.7. Mission Unique Training (e.g. Physiological Training Unit Support, et al.): Squad-
ron commander.
7.1.1.1.8. Flight Surgeons will secure Top Knife and similar professional short courses as
funding permits and as required by program office of primary responsibility. Top Knife atten-
dance for projected assignments will be funded by the gaining unit, and should be completed
prior to PCS, or PCS enroute to minimize costs during overseas moves
7.1.1.1.9. ATLS, ACLS, IDMT Recurrent Training, PALS, etc. will be attended and com-
pleted as recommended when the training is accessible and required to meet credentialing and
UTC or special mission training requirements.
7.1.1.1.10. Many advanced training opportunities exist for Team Aerospace skill set sustain-
ment. These opportunities should be exploited to fully enable Team Aerospace capabilities.
Many of these training opportunities lead to industry certifications, which greatly increase
Team Aerospace capability.
7.1.1.2. Disaster Response Operations
7.1.1.2.1. Disaster team training will be driven by base/wing requirements. Each AFSC will
train IAW respective directives and identified vulnerabilities/threats and planned responses
(e.g. Base Support Plan, Readiness Skills Verification Program (RSVP), medical contingency
response plan, et al).
7.1.1.2.2. Team Aerospace disaster team chiefs will identify training requirements and
develop an annual training plan. Training will be documented for all participants and reported
to the Medical Readiness Office.
7.1.1.2.3. Disaster Response training will be conducted and documented IAW all National,
USAF, State and local directives, protocols, and memoranda.
7.1.1.2.4. Disaster training may include, but not limited to:
7.1.1.2.4.1. Locally developed/AFSC specific training programs.
7.1.1.2.4.2. Medical unit readiness training (MURT), IAW AFI 41-106, Medical Readi-
ness Planning and Training.
7.1.1.2.4.3. HAZMAT and HAZWOPER Training (to required level) IAW AFI 10-2501,
Full Spectrum Threat Response (FSTR) Planning and Operations.
7.1.1.2.4.4. Advanced Air Force and civilian training courses commensurate with disaster
team responsibilities (e.g. AF formal training courses, Federal Emergency Management
Agency (FEMA) courses, and emergency care courses).
7.1.1.3. Unit Type Code (UTC)/Deployment Training
7.1.1.3.1. Each UTC and AFSC will train IAW respective directives prior to deploying. UTC
formal training (those with a valid course number) must be accomplished every other AEF
training cycle, unless otherwise directed IAW AFI 41-106, Medical Readiness Planning and
Training.
7.1.1.3.1.1. Individuals assigned to the Medical Nuclear Biological Chemical (Medical -
NBC) team, Preventive Aerospace Medicine (PAM) team, and Global Reach Laydown
44 AFI48-101 19 AUGUST 2005
(GRL) UTCs, and the Decontamination team chief must attend training prior to UTC
assignment.
7.1.1.3.1.2. IAW AFI 41-106, Medical Readiness Planning and Training, formal course
attendance is not waiverable.
7.1.1.3.2. AFSC-specific sustainment training must be completed to ensure individuals main-
tain adequate skills to perform duties in a deployed/employed setting.
7.1.1.3.2.1. Additional training may be required IAW respective CFETPs, deployment
guides or deployment location instructions.
7.1.1.3.2.2. Medical personnel assigned to deployable UTCs will complete field training
in addition to UTC formal courses and AFSC-specific training IAW AFI 41-106, Medical
Readiness Planning and Training, to be considered fully trained for Status of Resources
and Training System (SORTS) reporting purposes and the AEF Reporting Tool (ART).
7.1.1.3.3. Team Aerospace members are required to support the LAF at home station and
while deployed.
7.1.1.3.4. SGP will ensure 4NOX1s assigned to SME positions are trained IAW AFI 48-149,
Squadron Medical Elements.
AFI48-101 19 AUGUST 2005 45
Chapter 8
MEASURING SUCCESS OF AEROSPACE MEDICINE ACTIVITIES
8.1. Aerospace Medicine Activities: AMP activities encompass multiple disciplines and endpoints of a
spectrum that make it impractical to prescribe single suitable outcome measures of success. Nonetheless,
the processes described in this document should be monitored for efficiency and effectiveness and such
monitoring should be used to improve the processes themselves.
8.1.1. Measures of Efficiency: These will primarily be resource-based evaluation of processes. Most
measures of time to process, manpower utilized, or money spent on a process fall into this category;
and these measures are useful management tools, but are of limited use in measuring success of the
program.
8.1.2. Measures of Effectiveness: Effectiveness measures are usually based on the outcome of a pro-
cess. Examples of Aerospace Medicine outcome measures of effectiveness include those predicated
on health outcomes, mission preparedness, or improved safety or performance.
8.1.3. Designing Measures of Success
8.1.3.1. The AMP must be, at least in large part, in control of the outcome or process measured.
8.1.3.2. The results of the measurement must be linked to a resultant action (e.g. a process
improvement), and not collected simply to report.
8.1.3.2.1. Trigger values, targets, and objectives should be designed into the measure.
8.1.3.2.2. Pre-determine threshold actions to be taken when possible.
8.1.3.3. Collection of data will not drive disproportionate workload as compared to the process or
activity the measure the data intends to reveal.
8.1.3.4. Applicable guidance for privacy and confidentiality will be followed while collecting
data.
8.1.3.5. Measurement data should be formatted to identify and display trends.
8.1.4. Minimum Prescribed Measures of Success : Each of these outcomes will be measured by the
AMP and followed and acted upon primarily at the AMC. Additional efficiency and effectiveness
measures should be accomplished as appropriate.
8.1.4.1. Healthy Fit Force
8.1.4.1.1. Unit and base rates of Individual Medical Readiness.
8.1.4.1.2. Unit and base rates of occupational health medical exam compliance.
8.1.4.1.3. Effectiveness of the Health Promotion program will be measured by tracking:
8.1.4.1.3.1. Health and fitness improvement of members referred for fitness and wellness
instruction.
8.1.4.1.3.2. Sustained tobacco cessation among tobacco users referred for assistance.
8.1.4.1.4. Effectiveness of preventive health programs:
46 AFI48-101 19 AUGUST 2005
8.1.4.1.4.1. Completion of recommended clinical preventive services for AMP empan-
elled patients
NOTE: Although health outcome measures would be more accurate measures of effectiveness, collec-
tion of this sort of data will usually be impractical at an installation level. AFMS-wide evaluation may be
appropriate.
8.1.4.2. Prevent Casualties
8.1.4.2.1. Installation specific rates of illness or injury due to human factors or threats that can
be avoided or mitigated by effective AMP activity should be monitored and thresholds for
review established.
8.1.4.2.2. Completion of industrial hygiene surveys for category 1 and category 2 workplaces.
8.1.4.2.3. As a measure on workplace risk management, BE shall report the total number of
new, completed and open items from the workplace monitoring plan for all risk levels, and
shall report the number of open high risk items.
8.1.4.3. Restore Health
8.1.4.3.1. Aircrew and Special Operational Duty medical mission ready measures. AMP will
monitor the percent of medically qualified active aircrew, by unit and rating not less than
weekly. Greater than 90% of active aircrew in any given unit should be medically mission
ready at all times.
GEORGE PEACH TAYLOR, LT GEN, USAF, MC, CFS
SURGEON GENERAL
AFI48-101 19 AUGUST 2005 47
Attachment 1
GLOSSARY OF REFERENCES AND SUPPORTING INFORMATION
References
AFDD, 2-4.2, Health Services
AFPD 11-4, Aviation Service
AFPD 40-1, Health Promotion
AFPD 40-2, Radioactive Materials (Non-Nuclear Weapons)
AFPD 41-3, Worldwide Aeromedical Evacuation
AFPD 48-1, Aerospace Medical Program
AFPD 91-2, Safety Programs
AFI 10-206, Operational Reporting
AFI 10-248, Fitness Program
AFI 10-403, Deployment Planning and Execution
AFI 10-2501, Full Spectrum Threat Response (FSTR) Planning And Operations
AFI 11-202V1, Aircrew Training
AFI 11-202V3, General Flight Rules
AFI 11-290, Cockpit/Crew Resource Management Training Program
AFI 11-301V1, Aircrew Life Support Program
AFI 11-401, Aviation Management
AFI 11-403, Aerospace Physiological Training Program
AFI 11-404, Centrifuge Training for High-G Aircrew
AFI 11-405, The Pilot-Physician Program
AFI 11-409, High Altitude Airdrop Mission Support Program
AFI 32-7080, Pollution Prevention Program
AFI 36-2104, Nuclear Weapons Personnel Reliability Program (PRP)
AFI 36-2301, Professional Military Education
AFI 37-138, Records Disposition - Procedures and Responsibilities
AFI 38-101, Air Force Organization
AFI 40-101, Health Promotion Program
AFI 40-201, Managing Radioactive Materials in the US Air Force
AFI 41-106, Medical Readiness Planning and Training
AFI 41-210, Patient Administration Functions
48 AFI48-101 19 AUGUST 2005
AFI 44-102, Community Health Management
AFI 48-102, Medical Entomology Program
AFI 48-105, Surveillance, Prevention, and Control of Diseases and Conditions of Public Health or Mili-
tary Significance
AFJI 48-110, Immunizations and Chemoprophylaxis
AFI 48-112, Hyperbaric Chamber Program
AFI 48-116, Food Safety Program
AFI 48-117, Public Facility Sanitation
AFI 48-119, Medical Service Environmental Quality Programs
AFI 48-123, Medical Examinations and Standards
AFI 48-125, The US Air Force Personnel Dosimetry Program
AFI 48-135, Human Immunodeficiency Virus Program
AFI 48-144, Safe Drinking Water Surveillance Program
AFI 48-145, Occupational Heath Program
AFI 48-148, Ionizing Radiation Protection
AFI 48-149, Squadron Medical Elements
AFMAN 10-2602, Nuclear, Biological, Chemical, And Conventional (NBCC) Defense Operations And
Standards
AFMAN 11-210, Instrument Refresher Course (IRC) Program (IRP)
AFMAN 32-4006, Nuclear, Biological, And Chemical (NBC) Mask Fit And Liquid Hazard Simulant
Training
AFMAN 36-2105, Officer Classification
AFMAN 36-2108, Enlisted Classification
AFMAN 37-123, Management of Records
AFMAN 48-138, Sanitary Control and Surveillance of Field Water Supplies
AFPAM 11-419, G-Awareness for Aircrew
AFPAM 48-133, Physical Examination Techniques
AFPAM 91-211, USAF Guide to Aviation Safety Investigation
AFTTP 3-42.32, Home Station Response to Chemical, Biological, Radiological, Nuclear and Explosives
(CBRNE) Events
DOD 4145.19-R-1, Storage and Material Handling
DODD 6010.22, National Disaster Medical System (NDMS)
AFI48-101 19 AUGUST 2005 49
Abbreviations and Acronyms
Abbreviation/AcronymDefinition
AARafter action report
ACLSAdvanced Cardiac Life Support
ADOSaeromedical-dental squadron
ADVONadvanced echelon
AEaeromedical evacuation
AEFAir and Space Expeditionary Force
AFDDAir Force Doctrine Document
AFIAir Force Instruction
AFIOHAir Force Institute of Operational Health
AFMANAir Force Manual
AFMOAAir Force Medical Operations Agency
AFMSAir Force Medical Service
AFMSAAir Force Medical Support Agency
AFOSHAir Force Occupational Safety and Health
AFPAMAir Force Pamphlet
AFPDAir Force Policy Document
AFRLAir Force Research Laboratory
AFSCAir Force specialty code
AFSOCAir Force Special Operations Command
AFTTPAir Force Tactics Techniques and Procedures
AGSManti-G straining maneuver
AIMWTSAeromedical Information Management Waiver Tracking System
AMCAeromedical Council
AMDSaerospace medicine squadron
AMPaerospace medical program
AORarea of responsibility
APAerospace Physiologist or Aerospace Physiology
ARCair reserve component
ARTAEF Reporting Tool
ATLSAdvanced Trauma Life Support
50 AFI48-101 19 AUGUST 2005
ATSDRAgency for Toxic Substances and Disease Registry
BEBioenvironmental Engineering
BOSbase operating support
CAIBCommunity Action Information Board
CBRNEchemical, biological, radiological, nuclear or explosive
CCcommander
CFETPCareer Field Education and Training Plan
CISMcritical incident stress management
CMEcontinuing medical education
CMOcasualty management officer
COCOMcombatant commander
CONOPSconcept of operations
CRMcockpit/crew resource management
CRRAcapability review and risk assessment
DCSdecompression sickness
DDMSDepartment of Defense Manned Spaceflight Support
DHPdefense health program
DNIFduties not to include flying
DOCdesigned operational capability
DODDepartment of Defense
ECAMPEnvironmental Compliance and Management Program
EMPemergency management plan
ESOHCAMPEnvironmental, Safety, and Occupational Health Compliance and Management Program
FAAFederal Aviation Administration
FAWGfunctional area working group
FDAFood and Drug Administration
FEMAFederal Emergency Management Agency
FMFlight Medicine
FMGPFlight Medicine group practice
FSOflight surgeons office
FSOCflight surgeon on call
FSTRfull spectrum threat response
AFI48-101 19 AUGUST 2005 51
GRLGlobal Reach Laydown
HAAMShigh altitude airdrop mission support
HAWChealth and wellness center
HAZMAThazardous materials
HAZWOPERhazardous waste operations emergency response
HCDCHearing Conservation Diagnostic Center
HPHealth Promotion
HPEhuman performance enhancement
HPTTHuman Performance Training Team
HPWGHealth Promotion Working Group
HSWHuman Systems Wing
HUDhead-up display
HWShuman weapon system
IAWin accordance with
IDMTindependent duty medical technician
IDOinstallation deployment officer
IDSintegrated delivery system
IMAindividual mobilization augmentee
IMRindividual medical readiness
IRCinstrument refresher course
LAFLine of the Air Force
LASIKlaser in-situ keratomileusis
LEPlaser eye protection
MAJCOMmajor command
MCRPmedical contingency response plan
MDGmedical group
MDOmedical defense officer
MDSmission design series
MEBmedical evaluation board
MEDRED-CMedical Report for Emergency, Disasters, and Contingency
MOAmemorandum of agreement
MOOTWmilitary operations other than war
52 AFI48-101 19 AUGUST 2005
MOUmemorandum of understanding
MPHmasters degree in public health
MRDSSMedical Readiness Decision Support System
MRLmedical resource letter
MRMmedical readiness manager
MRNCOmedical readiness NCO
MROmedical readiness officer
MRSFMedical Readiness Staff Function
MTFmedical treatment facility
MURTmedical unit readiness training
NASANational Aeronautics and Space Administration
NATO STANAGNorth Atlantic Treaty Organization Standard Agreement
NBCnuclear, biological, chemical
NCOnoncommissioned officer
NCOICNCO in charge
NDMSNational Disaster Medical System
NIMSNational Incident Management System
NVGnight vision goggles
OEHSoccupational and environmental health survey
OHMEoccupational health medical examination
OHWGOccupational Health Working Group
OICofficer in charge
OPRoffice of primary responsibility
ORMoperational risk management
OSHAOccupational Safety and Health Administration
PALSPediatric Advanced Life Support
PAMPreventive Aerospace Medicine
PCSpermanent change of station
PHPublic Health
PHAPreventive Health Assessment
PIMRPreventive Health Assessment, Individual Medical Readiness
PMEprofessional military education
AFI48-101 19 AUGUST 2005 53
POCpoint of contact
POMprogram objective memorandum
POWprisoner of war
PPEpersonal protective equipment
PRKphotorefractive keractectomy
PRPPersonnel Reliability Program
QNFTquantitative fit test
RAMresidency [trained] aerospace medicine [specialist]
RDSrecords disposition schedule
RDT&Eresearch, development, test, and evaluation
RDTE&Aresearch, development, test, evaluation, and acquisition
RSOradiation safety officer
RSVPReadiness Skills Verification Program
SAsituational awareness
SAFSecretary of the Air Force
SCLsoft contact lens
SDspatial disorientation
SESafety
SGSurgeon General
SGHChief of Hospital/Clinic Services
SGPChief of Aerospace Medicine
SMEsquadron medical element
SOFspecial operational forces
SORTSStatus of Resources and Training System
STDsexually transmitted disease
TATeam Aerospace
TBtuberculosis
UAVunmanned aerial vehicle
UCAVunmanned combat aerial vehicle
UDMunit deployment manager
UHMunit health monitor
USAFSAMUSAF School of Aerospace Medicine
54 AFI48-101 19 AUGUST 2005
UTCunit training code
VAvulnerability assessment
WMDweapons of mass destruction
WRMwar readiness materiel
YAHuman Systems Program Office
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Attachment 2
CAPABILITY GAP ANALYSIS WORKSHEET
TeamAerospace Human Weapon SystemCapability Gap Analysis
Base: [Base Name] [Date]
Submitted By: [Organization]
[Name/Rank of SGP]
Recommendation Categories to Address/Close the Capability Gap
1.1 A B C D E F G H
Capability Categories
(Not all Inclusive)
Existing
Capability
Gap
Desired
Endpoint
Capability
Scientific
Research Develop New
Technology
Procure
Off-the-Shelf
Technology
Develop/
Refine Existing
Technology
Test
&
Analysis
Training
Policy
or
Guidance
Other
1. Task / Mission
Management (and
distracters)
-- Predictive Battlespace
Awareness
-- Spatial Awareness
2. Information Management
-- Displays/information
transfer/decision-
making interfaces
-- Command/Control/
Communication:
(Intel/ Surveillance/ Recon
Data Transfer)
3. Cockpit/Workplace/
Console (design/displays/
interfaces/life support
ensemble/life support
integration/positioning/
ergonomics)
-- Human Systems Integration
--- HSI domains:
manpower, personnel,
training, human factors,
safety, environmental,
occupational health,
habitability, and
personnel survivability
-- System Design
-- Protective Systems: escape;
evade; LEP; anti-trauma;
anti-exposure; noise;
altitude; anti-G; temperature
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Instructions:
1. Fill in data for Base, Reporting Organization/SGP, and Date.
2. For each applicable Capabilities Category, identify any currently Existing Capability Gaps that potentially impact upon mission suc-
cess.
3. Define the Desired Endpoint Capability to be achieved by addressing/closing the Existing Capability Gap.
4. Make specific recommendations (can be more than one) of how to address/close the Existing Capability Gap. Preface each recommen-
dation with the letter (A-H) at the top of the form to indicate the corresponding Recommendation Category.
Send this report at least annually to MAJCOM/SGP, per paragraph 1.2.9.7.3.7.
4. Vigilance
5. Cognitive Performance
-- Cognitive Demands for
Mission Requirements
6. Visual and Perceptual
-- Vision Performance
-- Night/Low-Light Vision
7. Physiologic Performance
-- Physiologic Demands for
Mission Requirements
--- Sustained Operations
8. Selection, Screening, or
Occupational Standards
-- Match Capabilities to
Mission Performance
Requirements
9. Other
AFI48-101 19 AUGUST 2005 57
Attachment 3
EXAMPLE TEMPLATE: AMC MEETING AGENDA
Agenda: Aerospace Medicine Council
Time:
Place:
1. Attendance:
2. Review of Minutes:
a. Executive Committee Approval of AMC Minutes
b. AMC
c. Occupational Health Working Group
3. Standard Agenda:
a. Health Promotion:
i. Fitness Program:
ii. Tobacco Cessation:
b. Dentistry:
i. Dental Readiness Rates:
c. Flight Medicine:
i. Grounding Management:
ii. Access/Productivity:
iii. Shop Visits/Briefings:
iv. Optometry/SCL Program:
d. Human Performance/Physiology:
i. Shop Visits/Briefings:
ii. Flight/Ground/Weapons Safety Trends and/or Lessons from Other Locations
e. Public Health:
i. Sanitation Program Report:
ii. Communicable Disease Report:
iii. Food Safety Report:
iv. Occupational Health Report (Quarterly Report) (Jan, Apr, Jul, Oct):
v. PIMR Status Report:
vi. Profiling Report (Quarterly Report) (Feb, May, Aug, Nov)
58 AFI48-101 19 AUGUST 2005
f. Bioenvironmental Engineering:
i. Industrial Mask Fit Testing and QNFT:
ii. Quarterly ALARA Review (Mar, Jun, Sep, Dec):
iii. Occupational Health Management Information System (OH-MIS)--
CCS/DOEHRS-IH:
iv. Process/HAZMAT Authorization Report
v. Radiation Safety (Mar, Jun, Sep Dec)
vi. Water Vulnerability Assessment and Routine Monitoring Reports:
vii. Confined Space Permit Issues/Construction Approval Reviews:
4. Old Business:
5. New Business:
6. Adjournment/Next Meeting:
AFI48-101 19 AUGUST 2005 59
Attachment 4
EXAMPLE TEMPLATE: OHWG MEETING AGENDA
1. Case Files
2. Approve minutes.
3. Place/Date and Time of Meeting:
4. Attendance:
5. Standard Agenda Items:
5.a. Hearing Conservation Program OPR: PH
5.b. Status of Occupational Illness Investigations OPR: PH
5.c. Status of Occupational Injury Investigations OPR: SE
5.d. Status of Industrial Hygiene Surveys OPR: BE
5.e. Pregnancy Profile Completion Times OPR: PH
5.f. Annual Occupational Exam Compliance Rates OPR: PH
5.g. Ergonomics OPR: BE
6. Special Surveys:
6.a. As Required
7. Old Business:
8. New Business:
9. Adjournment: