RESUMO
The prime mission of the Air Force Medical Service (AFMS), like those of the medical departments of its sister services, is to provide medical care during wartime. AFMS currently runs three successful in-theater hospitals that treat severely injured or wounded U.S. personnel from all four services. But this wartime mission depends on capabilities built at home, as critical-care specialists maintain their technical proficiency, as much as peacetime opportunities allow, by meeting health-care needs of Department of Defense beneficiaries at home. These patients have ranged from young, healthy active-duty personnel to aging retirees, historically presenting a broad range of injuries and illnesses for treatment. However, between the demands of deployments creating gaps in staff at home and changes in care plans, some beneficiaries now seek care in the civilian sector. In addition, several AFMS hospitals stateside have been closed, converted to clinics, or combined with those of other services for various reasons. All is problematic for two reasons: First, inpatient workloads in particular represent the best opportunities for critical care providers to prepare for their wartime missions. AFMS will need to increase these opportunities, perhaps working with other services, the Department of Veterans Affairs, or civilian hospitals. Second, AFMS's funding depends, in part, on the workload performed, but current measurement methods do not necessarily do a good job of accounting for the work AFMS practitioners accomplish outside their home stations. Some imminent changes may help resolve this situation, but AFMS should pursue opportunities to create additional workload for its medical personnel and to increase its budgets.
RESUMO
U.S. policymakers have stepped up systematic disaster preparedness efforts sharply since the terrorist attacks of September 11, 2001, including the creation of the U.S. Department of Homeland Security and a plethora of federal initiatives. Against a backdrop of natural disasters that occur each year in the United States and heightened concern about pandemic influenza, there is an emerging national consensus that the best path is an all-hazards approach to disaster preparedness planning and that effective local planning is critical. Military installations and their civilian counterparts-local government and local health-care providers, especially the U.S. Department of Veterans Affairs-can strengthen local-level disaster preparedness planning. This is an interim report for the first phase of a larger study aiming to develop a planning support tool for local military and civilian planners. It describes current policies and programs-especially those with nationwide application-for domestic emergency preparedness, risk analysis, and capabilities-based planning. It also describes results from interviews with local military and civilian planners at five selected sites to help understand how local preparedness planning currently operates and identify the needs of local planners. Collectively, these form the basis for a proposed tool, for which the framework is described in this article. The next phase of the study will include development and field testing of a proof-of-concept prototype of the tool.
RESUMO
The United States Air Force's Medical Corps has declined in size in recent years. Although the medical corps' attrition rate has been near historic lows, the trend in medical corps accessions dating back to the early 1990s has been negative. Multiyear special pay (MSP) provides supplemental annual payments to qualifying physicians who make 2-, 3-, or 4-year commitments to additional service. Our analysis shows the majority of eligible physicians have refused MSP, but there have been increases in MSP acceptance rates as MSP levels have increased. Physicians who receive residency training at military medical centers are much more likely to accept MSP than those who receive residency training at civilian medical centers. While further MSP increases might yet further reduce medical corps attrition, the corps will grow increasingly senior unless accessions are increased.
