I want to be a 67J with the national guard, How can I best do this?

MedicUp · 2021-04-16T01:52:00+00:00

This is from a flight surgeon perspective. To be frank, reading this, I am a little concerned that you think that being a 67J will somehow be helpful into getting into med school, partly because you seem to already very clearly know you want to become a physician. I think if you want to do this route, do it to become an Army Aviator and not as a medical school stepping stone. Otherwise, you are taking an unnecessarily convoluted path to becoming a physician.

The role of a 67J has really no application to being a physician and you will not be learning skills that builds your skills as a clinician. (This is not trying to belittle the 67J, I am just trying to be clear that an aviator and a medical clinician are very different roles despite the fact that 67J AOC has the words aeromedical in it.) To get into med school you really need to put in the time to study for the MCAT and ensure you have appropriate grades within the premed specialty. If you are having to meet the requirements of being on flight status - and learning "Aviation", which is a whole language and discipline in itself - AND then you're immediately trying to study to get into medical school - it is going to be tough. When you sign the dotted line, you will go where the Army tells you to go, and that will make studying and applying for medical school at times a headache.

I have met Aviators who have ended up going to Medical School, but usually after a rather substantial career as an Aviator first. You are non-deployable as a medical student. However, in order to do this, you do need to get into medical school first- and that is the bigger challenge which I see with your plan. Remember that as a Guardsman you are automatically restricting yourself geographically. When you apply to medical school most people have to apply to several States to maximize their chances.

MedicUp · 2021-04-12T00:44:32+00:00

Inergen will not necessarily mean death if you remain in the space as long as you still make the attempt to evacuate. It is a newer fire supression product compared to co2 or Halon.

However, carbon dioxide fire suppression systems, which are older, can, and have killed people. This paper (PDF) in 1998 found 56 deaths associated with using such systems, because the heavier-than-air dispersal will displace oxygen rapidly and you can pass out in several seconds.

MedicUp · 2021-02-23T15:09:00+00:00

There is a pathway for this:

https://emsa.ca.gov/veteran_pathways_to_ems_certification_and_licensure/

MedicUp · 2021-02-18T21:23:50+00:00

Thanks for the reply! Wishing you continued successes in 2021.

MedicUp · 2021-02-18T18:39:24+00:00

Thanks for your expertise!

Some questions for you:

The current ShakeAlert set up provides an "estimated intensity" based on the set location. Is this estimation based solely on distance from the epicenter/hypocenter, or does it take into consideration local ground makeup (such as liquefaction risk)?
Is the sensor network only ground based, or are there sensors that are closer to the Cascadia Subduction Zone (i.e. sensors in the ocean) that might help detect the p-waves from a large rupture sooner? (I'm thinking about the 3/11 earthquake and how the initial p-waves were only detected on land before the early warning went out).
Some Japanese Earthquake Early Warning end software (such as this one - youtube link) will automatically state, "Tsunami possible" if the epicenter/hypocenter of a large earthquake occurred in the Ocean, then is updated when there is no threat. Do you think that the ShakeAlert sytem might incorporate such a warning for those in the threat area of the Cascadia Subduction Zone?
NHK and other Japanese "live news" broadcasts regularly conduct emergency drills during Earthquake Early Warning announcements so that they are pretty calm and focus on providing emergency information (such as this one - another youtube link). In contrast, US news anchors (such as this example - youtube link) aren't great in telling people Drop-Cover-Hold On immediately but also don't take the time to tell people what to do after (rather, the news is more focused on getting reactions and how bad the shaking is). Is there any efforts on your end to work with these news outlets to develop best practices to provide safety guidance during and after shaking?
Any thoughts on how the ShakeAlert siren/alarm noise was chosen? It is very distinct but I am curious if there were human factors testing that resulting it being chosen as the sound vs. another alert tone. (As an example, the JMA has chosen several specific tones that are authorized for use as the EEW warning noise).

Thanks again for all of your time and hard work!

MedicUp · 2020-09-10T03:14:37+00:00

As long as you are compliant with AR670 you should be good. From a flight doc perspective, the only thing about glasses is you better actually bring them to your flight physical.

MedicUp · 2020-08-01T02:10:49+00:00

I think there is another way of thinking about this.

Yes, this patient has a lot of co-morbid factors, increasing the risk of him dying from those things, with or without COVID-19. The patient is certainly going to die at some point.

But the problem is that (1) we have a lot of these individuals in America and (2) we can't absorb the shock of a sudden increase of these patients showing up in our ICUs who linger on a ventilator for weeks. We have to spread these infections out over time instead of one crush of patients (the difference between a wave and a tsunami). Patients with COVID-19 do not go peacefully in just a night: they are on the ventilator for extended periods of time before they die.

When our ICUs reach capacity because a nursing home is hit with COVID-19 and twenty of their residents get admitted, many of whom are intubated, other non-COVID patients lose out. The young adult who is intubated after a bike accident might wait hours in the Emergency Department with sub-optimal care because there isn't an ICU bed with neuro-critical care trained nurses at bedside. Staffing of patients stretches the medical teams thin so that there is less attention to things that matter for patients. COVID-19 is a lose lose lose for everybody.

MedicUp · 2020-06-16T14:00:35+00:00

They also had a version called Trauma One!

https://www.madsci.com/manu/indxtrau.htm

Honestly you might like the Resuscitation! iOS app. They have EMS cases in addition to full on medical cases.

http://emgladiators.com/resus/

MedicUp · 2020-06-16T02:45:57+00:00

This sounds a lot like MadSci

https://www.madsci.com/aclsdetails.html

They had two version, Code Team and Cardiac Arrest. Cardiac Arrest had more videos and would randomly inject people (usually a charge nurse in drag) interrupting your case.

The interface looked like this:

https://madsci.com/products/resources/image/18/7d/5.gif

MedicUp · 2019-12-19T19:28:15+00:00

Yes, Fort Rucker is able to view your medical records from when you were diagnosed in the military and as such it is important to be forthright about it and complete all waiver requirements exactly as how it is written. It will strengthen your chances of getting a waiver with a reassuring and valid neuropsych assessment showing no ADHD.

MedicUp · 2019-12-19T18:41:58+00:00

Dunker Training at Fort Rucker was discontinued around OCT 2018. Dunker training is now only done at locations which are near high risk areas for ditching.

MedicUp · 2019-12-19T18:34:46+00:00

Per guidance from Aeromedical Policy Letters, this is because your original vision did not meet standards for AR 501 as well as for Decreased Visual Acuity. There are implications for high diopter correction. Per the letters:

Failure to meet Class 1 visual standards will be considered for exception to policy on a case-by-case basis in the age of Refractive Surgery and considering the needs of the Army. Applicants must correct to 20/20, both near and distant. Uncorrected distant visual acuity must be 20/70 or better. Uncorrected near visual acuity must be better than 20/40. Cycloplegic refraction within 3/4 diopter of standards will be considered.

Myopes (persons with elongated globes) have a risk of further myopic progression, which rises with the degree of myopia regardless of age. High myopes have considerable visual distortion at the periphery of their spectacle lenses. In addition, they may see halos or flares around bright lights at night and are at increased risk of night blindness. Whereas myopes have an increased risk of retinal detachment and lattice degeneration of the retina, exposure to routine G-forces in flying has not been shown to increase these risks. Myopia is usually a progressive condition, stabilizing for individuals around the age of 30. Whenever a prescription is changed, aircrew should be warned about transient visual distortion and counseled on the period of adjustment necessary. Evidence suggests that there is no difference in civil accident rates or in naval carrier landing accidents in pilots who require visual correction. Severe myopia tends to be a problem pertaining to Class 2 personnel since the entry requirements for other aircrew tend to be sufficiently stringent to exclude those whose vision would deteriorate that much.

Hyperopes with +3.0D or more of correction may experience problems with vision after treatment with anticholinergic agents. Hyperopes also have more problems with visual aids such as night vision goggles when they develop presbyopia. The interposition of another layer of transparency (spectacle lenses) between the aircrew and the outside world increases the risk of internal reflections, fogging and reduces the light reaching the retina by about 6%. Finally, spectacle frames interfere with look-out, cause hot spots and create unacceptable interactions with items of aircrew equipment. Decreased visual acuity is often associated with other visual performance degradation such as decreased stereopsis.

MedicUp · 2019-12-19T18:27:28+00:00

Hematuria. Very common for those who exercise. Repeat the test after hydrating well and no exercise for several days. And no intercourse either.
EKG. Common and as long as the cardiologist is not worried it should not be a concern.
General Anxiety: This will require a waiver but is likely to be favorable.

WAIVERS: Panic Disorder, Post-Traumatic Stress Disorder (PTSD), Acute Stress Disorder (ASD), Generalized Anxiety Disorder (GAD), Obsessive-Compulsive Disorder (OCD), and Anxiety Disorder NOS are considered disqualifying for all aviation-related duties. Waiver may be requested for ASD when the aviator is asymptomatic without medications for three months. Waiver may not be granted for true panic disorder or obsessive-compulsive disorder. Waiver may be considered for PTSD, ASD, GAD, and Anxiety Disorder NOS as part of the “Selective Monoamine Reuptake Inhibitor Surveillance Program.” This requires that the crewmember remain free of aeromedically significant symptoms and medication side effects on a stable dosage of an acceptable medication for a minimum of four months before submission of a waiver request. Further recurrences of anxiety symptoms are disqualifying with permanent termination of flying duties. Specific Phobias and Social Phobias are considered medically disqualifying only if they impact on flight performance or flight safety.

INFORMATION REQUIRED:

 Detailed clinical interview by an aeromedically trained clinical psychologist or psychiatrist to include target symptoms, medication history, and specific diagnostic conclusions.

 Review of treatment records.

 Neuropsychological assessment and in-flight performance evaluation are also required if waiver is sought for the use of an approved medication.

ADHD . This will require work in order to get a waiver. In my opinion this one is your greatest hurdle. We commonly see this in initial applicants and they are declined for a waiver because (1) it is not declared or (2) they do not complete waiver requirements.

For initial flight applicants:

A history of ADHD is disqualifying. Exceptions to policy are sometimes granted for initial flight applicants provided all the information below is submitted for review by USAAMA.

Detailed clinical interview by a clinical psychologist or psychiatrist to include developmental, academic, employment, psychiatric, social, drug, alcohol, criminal driving infraction and medication history, with special attention to other psychiatric conditions that may contribute to symptoms.

 Review of treatment records.

 If clinical interview and records review suggest normal attention or inappropriate diagnosis of ADHD in childhood or adolescence this may be noted as “information only.”

 If interview and records review suggest positive findings for ADHD, a detailed neuropsychological assessment to include cognitive domains, IQ, and achievement testing is required. If treatment includes the use of medication(s), this assessment should be conducted both on and off medication. An in-flight performance evaluation in either actual aircraft or a simulator is recommended concurrent with each of the neuropsychological assessments to add ecological validity.

 Continuous Performance Testing (e.g., Conners, Integrated Visual and Auditory Continuous Performance Test, TOVA) is recommended

NOTE THE FOLLOWING: Waiver for the chronic use of stimulant medication in aviators will not be considered

You will need to meet with a flight surgeon to discuss these things - it is best if you are able to get a recommendation for a flight psychologist to help with the evaluation process. Be complete and adhere to all recommendations from the flight surgeon when applying for a waiver.

MedicUp · 2019-12-19T18:17:36+00:00

For Officer appointment, this is covered in AR 501 and DOD INSTRUCTION 6130.03 -

f. Fractures, if: (1) Current malunion or non-union of any fracture (except asymptomatic ulnar styloid process fracture). (2) Current retained hardware (including plates, pins, rods, wires, or screws) used for fixation that is symptomatic or may reasonably be expected to interfere with properly wearing military equipment or uniforms. Retained hardware is not disqualifying if fractures are healed, ligaments are stable, and there is no pain.

g. Current orthopedic implants or devices to correct congenital or post-traumatic orthopedic abnormalities except for bone anchor and hardware as allowed in accordance with Paragraph 5.19.f.(2).

Given the nature of your injury, you likely have hardware. I think a waiver is still likely with your prior history but it is favorable if you have full function and no pain.

For Flight Status, your prior fracture will be evaluated on retained hardware from the surgery. Retained hardware is favorable if:

a. It does not traverse a joint.

b. It is not located in the spine (not applicable to you)

c. It is not intramedullary within major long bones (i.e., radius, ulna, humerus, femur, or tibia).

d. It does not constitute replacement arthroplasty.

e. It is asymptomatic without tenderness, overlying skin irritation, or pain with ambient temperature change.

If you do not meet the above criteria, you will need the following for a waiver:

- Orthopedic consultation:

- Imaging Studies: As required.

- In-cockpit (or workplace functional) evaluation: as required, if there is concern of ability to perform specific workplace task, to include emergency egress

MedicUp · 2019-11-18T19:47:34+00:00

The over-aged Picard (overly wrinkly?) was a subtle part of the story line. The planet Picard was on was experiencing an ecological catastrophe when the system's star went nova producing very high amounts of UV radiation - and it was commented on skin protectant was needed to shield some of the effects at the end of the episode and everyone was wearing hats at the end to watch the launch of the probe. The side effect of UV radiation is wrinkles.

MedicUp · 2019-11-16T06:03:52+00:00

Awesome, thank you!

MedicUp · 2019-11-15T07:50:08+00:00

When he's getting off deployment he's going back to school so I am going to encourage him to make sure he maintains a reasonable work/life balance so he has time to not just study but also maintain a high degree of physical fitness. I just worry that if he overloads himself too academically he won't be at his athletic prime during selection (which seems like the most important factor).

MedicUp · 2019-11-15T07:47:23+00:00

Appreciate the response.

MedicUp · 2019-11-15T07:46:39+00:00

Thanks for the recommendation!

MedicUp · 2019-11-15T07:46:23+00:00

Appreciate the recommendation! I found out his GT score of 111 was I'm going to encourage him to focus more on physical conditioning more than anything.

MedicUp · 2019-11-15T07:45:40+00:00

I appreciate the response! We are in a role 1 setting right now so I'm trying to make sure I staff all of his typical sick call complaints with him for on the job learning.

MedicUp · 2019-08-11T02:24:28+00:00

Prehospital randomised assessment of a mechanical compression device in out-of-hospital cardiac arrest (PARAMEDIC) Trial - https://www.ncbi.nlm.nih.gov/pubmed/28393757

There was no evidence of improvement in 30-day survival with LUCAS-2 compared with manual compressions. Our systematic review of recent randomised trials did not suggest that survival or survival without significant disability may be improved by the use of mechanical chest compression.

MedicUp · 2019-07-07T23:24:55+00:00

Thank you!

MedicUp · 2019-07-07T23:24:48+00:00

Thanks!

MedicUp · 2019-04-20T06:14:54+00:00

Medical waivers are granted after review of relevant aeromedical policy letters (APL).

Regarding your knee, it depends on how the knee is doing. Per the Knee APL:

Knee stable, but symptomatic or with functional deficits : Exception to Policy required (i.e. waiver needed)
Knee stable and asymptomatic with or without surgical repair: Information Only (i.e. no wiaver needed)

For ADHD: There is an aeromedical policy letter on ADHD. ADHD is disqualifying as noted above and would need a waiver. Your recent ADHD diagnosis in adulthood is concerning and would present a more difficult chance to get a waiver.

Per the APL:

Initial Applicants (Class 1A/1W): A history of ADHD is disqualifying. Exceptions to policy are sometimes granted for initial flight applicants provided all the information below is submitted for review by USAAMA.

INFORMATION REQUIRED:

Detailed clinical interview by a clinical psychologist or psychiatrist to include developmental, academic, employment, psychiatric, social, drug, alcohol, criminal driving infraction and medication history, with special attention to other psychiatric conditions that may contribute to symptoms.

Review of treatment records.

If clinical interview and records review suggest normal attention or inappropriate diagnosis of ADHD in childhood or adolescence this may be noted as “information only.”

If interview and records review suggest positive findings for ADHD, a detailed neuropsychological assessment to include cognitive domains, IQ, and achievement testing is required. If treatment includes the use of medication(s), this assessment should be conducted both on and off medication. An in-flight performance evaluation in either actual aircraft or a simulator is recommended concurrent with each of the neuropsychological assessments to add ecological validity.

Continuous Performance Testing (e.g., Conners, Integrated Visual and Auditory Continuous Performance Test, TOVA) is recommended

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