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arose with regard to mass casualty planning and sick call scheduling. The 
SME's believed strongly that the 935B -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 make 
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 ATC 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 crossfeed 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 positions.
	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. Additionally, 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. 
	Reporting 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 injury or dermatological 
problem.  Some categories were not clinically useful e.g. whether or not a 
gastroenteritis was treated with IV fluids. Some physicians were more inclined 
to treat borderline cases with oral rehydration than IV's. Daily MEDRED-C 
reports in their current format provided little useful information. ATC 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 ATC 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 OPERATIONS 
 
	D-Day was 16 Jan 91. Cease fire was declared 28 Feb 91. In that time span, 
the U.S. Air Force flew 67,151 sorties. 
	Fatigue was the most significant and pervasive aircrew problem in 
Operation Desert Storm. CAP missions of 6-8 hours were routine and often 
followed by an alert scramble of an additional 6-8 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 missile 
alerts. Dedicated "day" 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. 
 

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