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arose with regard to mass casualty planning and sick call scheduling.        The
SME's believed strongly that the 9356 slot on the ATH should always be filled by
an experienced flight surgeon.      Ideally, this position would also be the
commander, but in cases where an individual's rank and experience do not niake
him/her the best candidate for ATH commander, he/she should function as an
executive advisor to the ATH/SG for aeromedical and professional affairs
       The ATO ConOps made no clear provision for integration of multiple SME's
at a single location resulting in poor coordination at some bases.  In the Riyadh
area, 5 separate 1041 logs existed and there was no croesfeed among the clinic
sites. Lack of credible senior flight surgeon experience at all locations and at the
Headquarters impaired coordination of operations and problem solving.    Chart 4
contains a list of deployed Aerospace Medicine Specialists and their postions.
       Some problems arose when ARC flight surgeons who were senior in rank
but junior in experience tried to assume a supervisory role over active flight
surgeons.   Additionally1 poor coordination between active and ARC elements
resulted in alternating manning overages and shortages at some locations.
Morale was adversely impacted when ARC personnel arrived for specified times
then departed, leaving their active counterparts behind.
       Rep6rting requirements were conflicting and overlapping.    Three separate
formats for disease reporting were in place.   Disease categories were not always
defined e.g. whether sun burn should be reported as heat i~jury or dermatological
problem.    Some categories were not clinically useful e.g. whether or not a
gastroenteritis was treated with W fluids.    Some physicians were more inclined
to treat borderline cases with oral rehydration than W's.     Daily MEDRED-C
reports in their current format provided little useful information.   ATO after-
action report format published in AFR 128-4 and TACR 400-10 had inadequate
aeromedical emphasis.   Not all SME's were aware of the revised format sent by
message early in the deployment. Report of patients submitted by ATH's did not
always break out the ATO patient counts separately making it difficult to validate
planning assumptions.    Had it been necessary to report casualty status in
addition to all other patient categories, the process would have become even more
confusing.

                          COMBAT OPERA~ONS

       D-Day was 16 Jan 91. Cease fire was declared 28 Feb 91. In that time span,
the U.S. Air Force flew ~71151 sorties.
       Fatigue was the most significant and pervasive aircrew problem in
Operation Desert Storrn-   CAP missions of 6-8 hours were routine and often
followed by an alert scramble of an additional 6-3 hours.  Tanker scheduling at
some locations was 12 hours flying, 12 hours off, 12 hours alert. Thirty-hour crew
duty days existed.  Crew rest periods of less than 6 hours were not uncommon.
Sleep periods in many locations were interrupted by jet noise and SCUD rnissile
alerts.  Dedicated `4day" and "night" squadrons worked well.  Heavy air tasking
orders, especially at the start of the war forced significant deviations from normal
crew rest/scheduling practices. Fatigue was a consideration in at least two non-
combat fatal mishaps during Desert Storm. Real time acquisition of intelligence
made targeting and retargeting information available more rapidly than in past
wars.   Some flight surgeons felt line commanders had a poor understanding of
the effects of stress and chronic fatigue.  Many felt the aircrews were pushed to
the limits, and that had the war lasted any longer, substantial adverse impact on
performance and flying safety would have occurred.
                                          .12.

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