Induction of Flight Physicians to Combat Aircraft

(This article was first published as part-1 in Issue 5:06 of this magazine and a part-2 was to be published having comments/opinions of the ex-IAF top brasses. However, the response received was not worthy of publishing as a separate issue hence, added in part-1 itself to make it complete.)

Introduction

It is a great opportunity for the Aerospace Medicine community to know that the Air HQs is considering inducting doctors to the flying training courses in their Fighter, Transport and Helicopter streams. This news was broken by none other than Lt Gen Daljit Singh, Director General of Armed Forces Medical Services (DGAFMS). It has not come as a surprise as efforts have been on from the IAF Medical Services for some time projecting the need and the top brasses acknowledging it too. The Govt notification is yet to be announced though.

It must be appreciated that doctors do get trained to fly combat aircraft in some countries. USA has been training them for decades and also encourages them to carry out Op tasks in their AF, Navy and Army aircrafts. Op flying in military aircraft makes them appreciate the various challenges of aviation stresses much better than anyone else. Any Av Med Specialist with Op flying skills will be much better in imparting aviation-stress training to other pilots in combat operations. They will also be better skilled to decide on the issues of aircrew fitness for flying as well as in undertaking Aeromedical research associated with various flight Ops. Today, USA is rich with such expertise to the extent that the entire world Av Med Community benefits from. The present initiative by the IAF will undoubtedly boost the knowledge and skills in these spheres. Actually, Air Mshl J K Gupta, ex-DGMS (Air) vividly recounted that the British too had adopted the concept of training doctors in flying Hunters to help some of the pilots overcome air sickness.

Problems of the Past

The present initiative could also be a revival of similar exercises of the late 1960s when Med Offrs (along with Technical Offrs) of the IAF were given the option to join the flying stream. A signal used to be sent by the Air HQs seeking volunteers from Med & Tech Branches. If they passed PABT and cleared medical fitness tests, they joined the Flying Training Course along with other trainees at AFA. They had to go through the entire common training schedules for 1st, 2nd and 2A/3rd phases of flying, to graduate for the Flying Wing. Doctors joining Flying Training courses were often at odds vis-à-vis NDA cadets owing primarily to the age factor. The doctors joined flying training courses at ~24 yrs of age if not older, against the NDA cadets who were 4-5 yrs younger. Although this age difference didn’t appear worrisome, an iconic doctor-pilot of yesteryears Wg Cdr Bhupinder Singh (Retd) feels this difference as significant in terms of the ability to learn flying skills and comparatively a slower reaction time in monitoring & handling controls. “We lost many of our colleagues in accidents” he mentions; adding that in one’s career, such doctor-pilots often felt disillusioned, in choosing whether to continue as a flyer or a doctor with totally divergent courses of actions ahead. In those times, there was no concept of performing dual roles.

After graduating, the doctor-pilots were posted to the squadrons for purely operational flying and there laid a problem. The Commanding Officer of the squadron wanted him to comply with all operational tasks that hardly left any time for him to be useful for the medical duties. On the other hand, if such F(P) doctor was posted by the Med Dte to a Stn, the SMO would like him to carry out his primary duties of Med Offr in the MI Room/SMC and then only spare him for the Op tasks in the squadrons. Often the doctor flyer found his legs in two different boats. As a young doctor/flyer, one often found it hard to satisfy two different bosses having entirely different objectives. Unfortunately, dual utility as a doctor fully experienced in Op flying or a Flyer as a full-fledged doctor were seldom utilised for the benefit of both specialised faculties of Flying and Medical.

Adopting a New Approach Now?

Those were the situations 50 yrs back when Aviation Medicine in India was in its infancy, with limited scopes for utilising the skills of a doctor-pilot in Human Engg, Human Factors, rendering design inputs in aircrew-aircraft interface and inflight evaluations of Life Support Aviation Equipment or any other specialised tasks. It can be hoped that now when doctors will be taken up for flying training again, they could be used optimally and gainfully on both objectives. Today in the high proficiency tasks of flying and Aeromedical Research, a doctor-pilot trained in Aviation/Aerospace Medicine may become a high-end facilitator in letting HF be integrated into flying task as well as Flying experience be incorporated in better realising the Aeromedical concerns of a pilot. As a Specialist in Aerosp Medicine, the author is tempted to think that a Flyer doctor could be a better Specialist in Aviation Medicine with the full knowledge of aviation stresses having had their actual experiences. However, as a pilot, one may be reluctant to assume that a doctor flyer could be a better Human Factor specialist.

Todays’ Institute of Aerospace Medicine (IAM) is very high-tech “Op-Training Estt” with a Dynamic Flight Simulator, a Disorientation Simulator, imparting aircrew Op-training programs like OPTRAM; running NVG lab with modern goggles; Training programs for Human Space Missions; dwelling on various issues of Aircrew-Aircraft Compatibility, rendering design inputs in new aircraft and so on. Besides IAM, there are two Aeromedical Training Centres (AMTCs) too that impart Aircrew with aeromedical training to the aircrew. All these institutions are co-located with Flying Establishments where doctor-pilot specialists in Aerospace Medicine (or Flight Physician) could be best utilised on both Op tasks and Aeromedical research. Doctor-Pilot Av Med Specialist could also be a better person to test and evaluate the Life Support and other Aircrew Safety Systems/Equipment designed & developed by our scientists often with their inputs. Thus there could be a new approach in the Task Profiles of the newer Doctor-Pilot resources, much larger and wider than the earlier either Pilot or Medical roles. This will also give much needed job satisfaction to the new Doctor-Pilot specialists (or Flight Physicians) having undergone gruelling training of medicine, Op-flying as well as specialisation in Aerospace Medicine.

Reviewing the Doctor-Pilot Role

In the present efforts for imparting flying training to the Med Offrs, the overall objective should be to employ him more as an operationally expert Av Med specialist than as any other Op pilot or Av Med Specialist to fulfil the respective tasks. By and large, every sortie by such ‘Flight Physicians’ should be to achieve some specific Aeromedical objectives for Aeromed Research, inputs for Pilot Training, inflight evaluation of pilots for aeromedical ailments, inflight Medicare to Cas-Evac of patients and rendering design inputs & Evaluation of the Life-Support & Safety Equipment when sought. It must be appreciated by the three services that these specially trained Flight Physicians have been crafted for a very special role other than purely a pilot or a doctor. Such specially trained man-power must boost the special tasks of combining the human part of the pilot to his Op skills and be utilised for larger Aeromedical objectives. Med Dte/IAM may have a say in the selection of these doctors to recommend only those with much pleasing personalities & Tact (of assimilating with aircrew) and possessing somewhat higher Aeromedical Research acumen. Obviously, they all will have to clear the PABT and medical fitness tests.

There could be two approaches in the selection of candidates for Flying Training:-

• Train Doctor-Pilots into Aerosp medicine. Select a newly commissioned services Medical Officer around 24-25 yrs of age for Flight Training Course during which he may be subjected to a short Primary Aviation Medicine course. After graduation in flying, his flying experience (in Aviation Stresses) and Primary Av Med training may enable him to earn MD (Aerosp med whenever detailed) in only 2 yr with the concurrence of NMC providing a waiver. One should keep currency with flying during MD course. Any other speciality (other than Av-Med) may cause problems of employability and job-insatisfaction at the Station levels during subsequent postings.
• Train Aerosp Med Spls into Flying. Select an Av Med Specialist for Pilot training who will be around 27-28 yr old. Since he is already a trained soldier, the routine ground training may be removed from his syllabi and tenure of the various stages of training may be reduced with total flying hours retained. He could be surely at odds in acquiring flying skills as compared to the other cadets but since his role is going to be different, the yardsticks for his flight graduation need not be clubbed strictly with others. Air HQs may even lay down a different training schedule for the Doctor-Pilot (or ‘Flight Physician’) whose employability is going to be different from other pilots performing the combat roles of the squadron.

Logical Approach to Training

Training in Pilots’ course is very demanding and unforgiving for any errors. A mistake in handling an aircraft or emergency may have serious consequences. Flying duties (both training & Op) has to be fully dedicated, can’t be a part-time affair. Even one Op sortie requires substantial planning of 1-2 hr, in coordination with the flight supervisors and technical teams. On the other hand, selecting a trained specialist in Aerospace Medicine to Pilot training appears theoretically more appropriate but is fraught with slow learning ability of the relatively aged specialists. It may be advantageous to the services utilising them as better specialists in their free times during flying training. The Flight Trg Dte may decide if jet flying training of 1st / 2nd phase is going to be beneficial at all for those opting for Helicopters; as the controls and handling are totally different in the two. Army Av Med Specialists may only be trained in helicopters.

Career Profiles of Doctor-Pilots (or Flight Physicians)

Since these are the doctors specially screened for possessing pleasing personality, they would be a true “friend, philosopher and guide” for the pilot community at the station levels. They must be granted permission to fly in all squadrons of the Station having similar type aircraft. They may also be entrusted with sick report, medical exam and disposal of the pilots only. Normal sick reports must be looked-after by other MOs. Their DMO duties may be tailored appropriately so as not to disturb in the nights to adversely affect their flying fitness the next day. Of course, more nitty-gritty may have to be worked out by the concerned service HQs during the course of their training and employment. The career profile of this category of soldiers performing highly specialised roles of both Av Med Speciality and Op Flying, must be regarded commensurate with any super-specialists for the matters of promotions and career prospects.

At IAM/AFCME, these Flight Physicians will be better Av Med specialists to opine on the flight fitness for those in Lower Med Categories, a better President of Med Boards; a better Research head in Aeromed Research and a better OPTRAM Coordinator. At Command HQs, they may be better PMOs of Op Commands. At Air HQs, a separate ACAS/JDMS (Av med) post may be created for them in addition to the existing ACAS (Med)/JDMS(S) that must have a say in all Med Boards of all Pilots and may also have close coordination with Op Trg and Flt Safety Dtes.

Views of some Top Brasses of the IAF

Previous Director Generals of the Medical Services (Air). Air Mshl L K Verma, Air Mshl J K Gupta, Air Mshl Pawan Kapoor and Air Mshl MS Butola were kind enough to respond with comments/suggestions. In principle, all of them felt that this initiative will strengthen the knowledge of Aeromedical principles of combat flying to all pilots and also enable the physician doctors to appreciate the effects of combat flying on aviator’s physiology. This in turn, will facilitate in applying the newly gained knowledge to strengthen the training to enhance performance in combat maneuvres. Air Mshl J K Gupta who has been a stalwart in Av Med having long experience at the squadrons, does feel that the utility of Flight Physicians at the station levels may be limited if going by past experience. Air Mshl Pawan Kapoor who had followed up the case vigorously as DGMS (Air), also felt that the intent of restarting doctor’s entry into combat flying was not to make them only pilots but make them better understand the physical/physiology/cognitive challenges of combat flying and translate them to overcome the technological limitations, challenges and engineering concepts for better performance, ergonomics as well as effective counter-measures in technique and protective clothings. It is expected to enrich the Aeromedical principles and practices of Combat flying in Indian perspectives as elaborated in the text above.

They were also of the view that using the physician pilots purely for ‘Op flying’ will be a retrograde step, going back to the old practice of the 1960s. Hence, the better role for them will be to enhance the understanding of the Av Med Specialists in R&D as well as in Human Factors associated with combat flying elaborated above. Some of them did mention of minor administrative issues of rationale of a doctor learning combat flying, career prospects and overall benefit to the nation but all those can be taken care of while working out the nitty-gritty at the services Directorates.

Two Previous Chiefs of Air Staff, Air Chief Mshl P V Nayak and Air Chief Mshl BS Dhanoa were kind enough to respond to the overall objectives of this new initiative. Ex-Air Chief Mshl Nayak touched upon the many aspects of its usefulness to the two streams, the possibility of becoming a jack of all trades but a master of none, the burden of dual roles and overall utility. He felt it was a new idea different from those of 1960s and must be given a try to enhance the skills and knowledge. We should not repeat those mistakes of the past and should strive to further the cause of operational aerospace Medicine in the overall benefit of the speciality in the context of the Indian combat pilots, in Indian perspective. It was essentially at the instance of the Institute of Aerospace Medicine (IAM), IAF Bangalore that the specialists in Aerospace Medicine especially needed this expertise to research and explore the unexplored. Ex-Air Chief Marshal Dhanoa mentioned that he was the one who recommended the proposal mooted by IAM as Air Chief. He too mentioned briefly that it was for the furtherance of the cause of Aerospace Medicine to enrich their Aeromedical expertise and for transferring the knowledge to the pilots to improve their overall combat performance. He was abroad hence, could not render detailed views.

Concluding Thoughts

The present effort in inducting doctors to flying is a good step for the IAF and must not repeat the mistakes of the past. ‘Flight Physician’ will be a boon for the growth of Aerospace medicine speciality in gaining first-hand experience of combat operations, some very complex too; and apply these advanced skills to train the pilots for better performance. The advanced Aeromedical knowledge and skills gained by these Flight Physicians would surely enhance the performance of the combat pilots through training in the better interest of the Flying communities, making them a better ‘friend, philosopher and guide’. Their employment objectives must be different as specified above; different from being only an Op pilot or a doctor. It will be for the betterment of both Flyers and Aerospace Medicine if this highly specialised branch of Flight Physician takes shape as suggested above. It will go a long way in the furtherance of the cause of Aerospace Medicine as well as the Flying communities. As more inputs come during the actual experience, utilities and difficulties at different levels, a course correction is always possible. The entire IAF fraternity will be looking keenly towards the outcome.