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prescription and baseline laboratory data. Occasionally a call to home base was
required to clarify some question, but t~iis presented no problems.
      Many individuals were deployed on prescription medications for which
refills were ~vailable on either the ATO or ATH TA.   Women's heal~ issues
were poorly addressed in planning deployment supply packages.     ~irth control
pills should be added to the ATC Table of Allowances (TA).
      There was no system to return patients to their bases after referral care.
The Navy ships Mercy and Comfort provided excellent specialty services, but the
ships' ~~ernents were not predictable and once the vessel was out of port, it was
irnpeseibls to return a patient to his unit. Army helicopters were unable to pick
~p patients from the hospital ships.  Although Wing interest persisted, it was
impos.ible to keep track of a patient once he left a base for care. There was a low
level of confidence in the aeromedical evacuation system, and some patients were
sent home by regular airlift in lieu of aerevac when deemed safe to do so. Joint
Service cooperation was variable.  Cases were related ~ which Air Force ATH's
refused care to Army patients.   Doctor to doctor cooperation was more effective
than system to system.
      There was almost universal need for better access to dental caae. Deployed
SME's disagreed on whether the majority of the demand was a result of poor pre-
deployment enThrcement of dental standards or due to acute problems.      The
dentists reported their workload consisted of large numbers of acute problems but
also that the demand for care of preexisting problems was high among ARC
personnel. Dental ServiceS were also provided to Allies.
      SME's felt they had no background to deal with dental problems.
      Squadrons deployed to Desert Shield with much higher numbers of
individuals than predicted by exercise experience and planned for in the ATO
Concept of Operations.  Deployed bases continued to grow throughout Desert
Shield far beyond original estimates. ATO's designed to support 300 people for 30
days wore supporting up to 1200 alone. Routine sick call medications were rapidly
depleted. Only 4 of 17 flying wings had ATH's in place by the end of August. For
supporting bases such as Moron, Cairo West, and Diego Garcia, the ever-
expanding ?0le was not matched by reevaluation of medical needs.    Most SME's
felt the four-man ATC manpower U,rC would be adequate to support 800 deployed
personnel at the visit rate seen during Desert Shield.  Supplies should be
increased to match that number.
      There was one case of pain-only decompression sickness reported. An A-1O
had rapid deoompresslon at 25,000 feet.   Symptoms resolved at ground and
hyperbaric theray was not required.
      One AWAS mission was terminated early for an in-flight attack of renal
colic with subsequent lithotripsy of a stone.

              COMMAND AND CONTROL
      Response of line commanders to SME input was variable and probably
depended   heavily on the degree of rapport and credibility established before
deployment.
      Command and control of SME's was frequently misunderstood by the
medical command structure. Of the 18 ~ndividuaIs who commanded a TAO ATH,
only 7 were experienced flight surgeons. Several SME's were required to perform
MOD duties at the ATH. In other cases, this requost was reflised by squadron or
wing commanders.  Other initiatives attempted to locate ATO operations within
the ATH impairing aircrew accessibility to their flight surgeon.  Conflicts also
                                       11-

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