Q&A: Brigadier General Bart O. Iddins
Written by Ted McKenna
MMT 2009 Volume: 13 Issue: 8 (December)
Command Surgeon
Air Force Special Operations Command
Iddins entered the Air Force as a veterinarian and public health officer. He earned his medical degree in 1991 and was assigned as a flight surgeon to the 352nd Special Operations Group at Royal Air Forces (RAF) Alconbury and RAF Mildenhall, U.K., where he served two tours. In 2000, he completed residency training and received specialty board certification. Iddins served as commander of the 377th Aerospace Medicine Squadron at Kirtland Air Force Base, N.M., and as commander of the 410th Expeditionary Medical Group at a forward deployed location during Operation Iraqi Freedom. Additionally, Iddins recently completed a 15-month tour as commander of Joint Task Force MED, Combined Joint Task Force- 82’s medical support brigade. Comprising more than 1,100 joint combined medical personnel, Joint Task Force MED provided direct command and control of echelon above brigade U.S., Egyptian, Jordanian and Korean medical forces deployed to Operation Enduring Freedom. Prior to assuming his current position, he graduated with highest academic distinction from the Air War College at Maxwell Air Force Base, Ala., and subsequently served as commander of the 42nd Medical Group at Maxwell. Iddins has extensive deployment experience and has worked extensively with foreign governments and militaries regarding health care infrastructure development and health care capacity building.
His academic background includes a doctorate in veterinary medicine from University of Tennessee College of Veterinary Medicine, a doctorate in medicine from Texas A&M University/University of Texas Health Science Center, and a master’s in strategic studies from the Air War College.
Major awards and decorations include the Legion of Merit with one Oak Leaf Cluster, Bronze Star Medal with one Oak Leaf Cluster, Defense Meritorious Service Medal, Meritorious Service Medal with three Oak Leaf Clusters, Air Medal with one Oak Leaf Cluster, Aerial Achievement Medal with four Oak Leaf Clusters, Joint Service Commendation Medal, Air Force Commendation Medal, Army Commendation Medal, Air Force Achievement Medal, Air Force Combat Action Medal, Combat Readiness Medal with one Oak Leaf Cluster, Afghanistan Campaign Medal and Humanitarian Service Medal.
Iddins was interviewed by MMT Editor Ted McKenna.
Q: How does Air Force Special Operations Command [AFSOC] employ its operational medical personnel?
A: AFSOC deploys its medical teams to support the full spectrum of special operations missions. The teams are rugged, modular, scalable, designed for maximum flexibility and are built into requirements- driven force packages in a building block approach. The Special Operations Forces Medical Element [SOFME] is the foundation building block and represents the cornerstone of AFSOC’s deployed medical capability. SOFME personnel have extensive medical training focused on combat health service support, trauma medical care, Special Operations Forces [SOF] casualty evacuation [casevac], aeromedical evacuation decision-making and bare base preventive medicine support.
Each SOFME consists of one AFSOC flight surgeon and two AFSOC combat medics. SOFME flight surgeons receive extensive SOF-specific training and advanced medical training related to trauma casualty management, health care engagement, tropical medicine and casualty evacuation. The SOFME enlisted combat medics are among the most highly trained enlisted medics in the U.S Air Force [USAF]. SOFME enlisted medics are fully trained independent duty medical technicians and nationally registered emergency medical technician-paramedics [EMT-P]. Additionally, these superb medics receive advanced training in casevac techniques and trauma casualty management.
Special Operations Surgical Teams [SOST] and Special Operations Critical Care Evacuation Teams [SOCCET] are AFSOC’s second medical capability building block. The SOST is a lightweight, rapidly deployable, far-forward, five-person surgical team that provides resuscitative surgical care and emergency trauma care to casualties in austere combat environments. The SOCCET comprises the core of AFSOC’s advanced critical care evacuation. This team provides advanced critical care casualty management in both the pre-operative and post-operative phases of casualty management, as well as aboard SOF aircraft or any other opportune ground or air transport platform. While SOST and SOCCET were designed to augment and/or operate in conjunction with one or more SOFMEs, each of these capabilities can be tasked independently as dictated by mission requirements.
AFSOC’s third and fourth medical capability building blocks are the Combat Aviation Advisory Medical Augmentation Team and the SOFME Medical Augmentation Team. These multidisciplinary teams add significant medical capabilities and depth to AFSOC’s deployed medical footprint. This modular building block approach allows AFSOC medical planners to rapidly increase or decrease medical resources and capability as dictated by changes in mission requirements or circumstances.
Q: Any notable training being done for AFSOC medics?
A: Death due to battlefield wounds is the lowest in history as the result of many factors, which include modern body armor, forward resuscitative surgery, rapid evacuation to higher levels of medical care and a trauma network that is integrated across all theaters of operation. However, training is the keystone to this unprecedented success. Consequently, training is at the forefront of AFSOC’s medical modernization efforts. For far too long AFSOC medical training has been inconsistent across the command. This inconsistency impeded and produced suboptimal medical interoperability between AFSOC medical units and other SOF medical units. As a result, a new SOF-specific medical training pipeline has been developed and is the product of a joint effort by the Air Force Special Operations Training Center [AFSOTC] and AFSOC Command Surgeon Directorate.
The medical training pipeline will train all medical personnel assigned to operational units. Newly assigned AFSOC medics progress through a 12- to 24-week curriculum—[the] length of training depends upon the specialty. Courses of instruction include orientation/introduction to the AFSOC/SOF culture, philosophy, missions, doctrine, tactics, techniques and procedures. Enlisted EMTs are upgraded to paramedic level as part of this training pipeline.
Additionally, the training pipeline includes survival, evasion, resistance, escape training; tactical combat casualty care; SOF casevac; irregular warfare; health care engagement; and SOF unique medical skills. The medical training pipeline culminates with additional tactical field skills training, comprising weapons skills, tactical urban operations, land navigation, tactical communication and convoy operations.
The AFSOC medical training pipeline leverages simulation technology and has incorporated advanced simulation manikins into all aspects of training, most notably the portions of training conducted in AFSOTC’s Tactical Operational Medical Skills Lab. In short, AFSOC medical training is now standardized and consistent across the command. This produces a highly trained AFSOC medical force that is completely interoperable with medics from all other SOF components.
Q: Any advances or trends you would note in the medical equipment/gear carried by AFSOC medics?
A: Portability is a critical consideration for AFSOC medical equipment. The need exists for smaller, lighter, more effective tools and equipment. Furthermore, the equipment must be user friendly and require minimal sustainment since resupply in austere forward operating locations can be problematic.
Consequently, we have a division, Expeditionary Healthcare Modernization Division [AFSOC/SGR], which is solely dedicated to medical research and technology advancements. This division executes a robust research and development program to examine new medical technology.
For instance, AFSOC Air Command medics utilize a backpack medical oxygen system, which provides approximately 15 liters per minute for two hours, or at lower flow rates, up to 10 hours. This small portable system is a major upgrade over standard oxygen systems due to decreased weight.
Additionally, AFSOC/SGR is actively engaged in equipping AFSOC medical teams with a wireless, active noise reduction intercom system in order to improve inter-team communication and operability during patient evacuation missions on aircraft and ground transportation platforms.
From a research and development standpoint, AFSOC/SGR is constantly exploring medical systems that minimize weight, enhance lifesaving capabilities, improve patient safety, and decrease maintenance and logistic requirements.
Q: Anything you would note about hearing and vision protection? Issues related to using night vision equipment, for example?
A: Hearing protection continues to be a high priority for AFSOC. We are very interested in technology that seamlessly integrates hearing protection and communication capability with lightweight ballistic helmets. AFSOC is also committed to laser eye protection issues regarding industrial laser exposure and lasers on the battlefield. We are, therefore, interested in technological and process innovations that serve to mitigate risks associated with lasers.
With regards to night vision goggles [NVG], AFSOC aircrews and operators rely heavily on this technology. SOFMEs, SOSTs and SOCCETs all train with, and utilize, NVG technology during flight and ground operations. The issues encountered with this technology are not unique to AFSOC. The newest generation NVGs are a substantial improvement over earlier generations; however, limitations still remain.
For example, even with the latest NVG technology, visual fields and peripheral vision are suboptimal, visual acuity is limited, albedo over water is virtually nonexistent, depth of perception/changes from near-to-far vision are problematic, and current NVGs are still too heavy. AFSOC/SGR is working directly with the 711th Human Performance Wing, the USAF School of Aerospace Medicine and USAF ophthalmologic consultants regarding vision protection—recently, new conformal ballistic eyewear for in-flight use with existing helmets has been approved.
Q: What is the state-of-the-art hemorrhage control at the moment? What do AFSOC medics use?
A: Hemorrhage control saves lives and is a top priority in casualty management. As a result, early use of tourniquets is of paramount importance to a casualty with a hemorrhaging extremity wound. Additionally, AFSOC medical personnel utilize QuickClot ACS+ and HemCon chitosan bandages to rapidly control battlefield wound hemorrhage. Furthermore, AFSOC SOSTs are specifically organized, trained and equipped to perform resuscitative/damage control surgery in the far-forward environment—early surgical intervention is superbly effective for controlling hemorrhage by repairing damaged arteries and vital organs.
Q: Are you having any issues with recruitment and retention?
A: Recruitment of high-quality AFSOC medical personnel has historically not been an issue—the AFSOC medical mission is unique, and morale is extremely high; as a result, AFSOC duty is highly desirable. Retention of AFSOC medics remains high despite heavy deployment commitments; however, staffing some specific specialties is challenging.
Q: Does AFSOC compete with other medical requirements?
A: Yes, medical resources are limited; therefore, each medic assigned to AFSOC is a medic who is not available to fill other USAF requirements. Nonetheless, the AFSOC medical footprint is small and provides extraordinary return on investment. AFSOC medics support AFSOC requirements, but are fully interoperable and likewise support other U.S. Special Operations Command [USSOCOM] service components and requirements.
Q: Does AFSOC work closely with counterparts from other services on tactics, training and procedures?
A: Yes, very closely. The fight is joint, the way we fight is joint, the way we train is joint and the way we function is joint. Consequently, joint cooperation, joint collaboration and joint interoperability are absolutely essential to success. AFSOC exchanges after-action reports and lessons learned with other USSOCOM components, medical training requirements are standardized across USSOCOM components, and USSOCOM medical personnel function as an integrated joint team. Furthermore, conventional force medical assets are critical SOF enablers.
Q: Are there any additional topics you would like to discuss?
A: While the focus of this interview is on modernization and technology, it is important for all of us to remember that in many cases, process modernization is more important than technological modernization, and as a “SOF Truth” states, “Humans are more important than machines!” ♦