FAREWELL TO ARMYS FIRST 06 PHYSICIAN ASSISTANT By COL Pauline Gross Colonel Tozier was the first Regular Army PA (physician assistant) to be promoted to Colonel and served for eight years in the AMEDDC&S and MEDCOM as well as the 3rd MEDCOM during OIF. He will be retired with just short of forty years of service to the Army, eleven in the ARNG and twenty-eight on active duty. After serving as a battalion PA in artillery, armor and aviation units, he achieved a Masters in Public Health to push occupational health to Soldiers. He was the first and only PA to serve as the Chief, Pre-ventive Medicine at a CONUS installation and later served as the Occupational Medicine Consultant to Korea. Subsequently he was selected and completed a doctorate in High-er Education that prepared him for his follow on assignments at the AMEDDC&S and MEDCOM. He has served in both Operation Desert Storm and Operation Iraqi Free-dom. In 2002, after initial reports by returning PAs of inadequate training for POI (point of in-jury) resuscitation skills in combat, he convened a workgroup and resourced the devel-opment of the TCMC (Tactical Combat Medical Care) course. This was the first course in the Army to train physicians and physician assistants in the latest skills for combat re-suscitation at POI. Time from concept to first class was less than two years. This course is now mandatory for all PAs and physicians deploying and has resulted in saving countless lives on the battlefield. While assigned to the MEDCOM he used funding from a new project to scan all the historical physician assistant documents to digital files. The Army Medical Specialist Corps and AMEDD Museum now have copies of all PA historical documents going back to 19 71. Colonel Tozier designed and staffed the CSRB (Critical Skills Retention Bonus) as PA Consultant, 2002-6 to counter PA losses from the service while awaiting increased stu-dent output and re-start of civilian accessions. Implemented in 2006 when losses reached a high of 64 each year. The CSRB reduced losses to 54, 35, and 36 over the next three years allowing continuous fill of the critical positions in combat BAS‟s (battalion aid stations). While serving as Senior PA, 3rd MEDCOM in OIF 2007, he took the most recent guide-lines for screening mTBI (mild Traumatic Brain Injury) from the DVBIC (Defense and Veterans Brain Injury Center) and created an educational program that was disseminated to all primary level providers in OIF within two months. This resulted in patient screen-ing using the MACE (Military Acute Concussion Evaluation) and allowed these incidents to be recorded in MC4 (Medical Communications for Combat Casualty Care) for later documentation of disability. Further, he developed an educational video for Soldiers ex-posed to mTBI using 1st CAV assets that was later used by the DA in its Suicide Preven-tion Program in 2008.

COL Tozier Retires after nearly 40 Years

T H I S I S S U E

Tozier Retires 1

Presidential

Proclamation

3

Lunkenheimer

Remembered

4

Briggs SAPA Presi-

dent Elect

5

LTC Balser Swear-

ing In Ceremony

7

Afghans Start PA

Program

8

Cole Earns Valor

Award

11

PA Week

Celebration

12

PAs Win AKO

Homepage Award

14

Prehospital

Analgesia

15

PA Documentation 19

aTCMC Course 24

BMOP Course 25

PAs in the News 26

SAPA Members 27

SAPA Meeting

Minutes

28

SAPA Leadership 34

SAPA JOURNAL The Society of Army Physician Assistants

A Civilian Organization Representing Army PAs

S E P T / O C T 2 0 1 0 Vol. 22, NO. 4 A P O I N TS O F

I N TE R E S T:

Farewell to COL

Tozier

LTC Balser Sworn

In

Afghan PA Program

President Elect

Speaks

PO Box 07490

Fort Myers, FL 33919

Phone & Fax

239-482-2162

P A G E 2

“Colonel Tozier

has been

responsible for

the most

significant

improvements

in PA education

at the IPAP.”

Tozier continued

COL Tozier has been responsible for the most significant improvements to PA education

at the IPAP. As Academic Coordinator in 2002, developed the plan and gained approval for

expansion to the masters degree. Returning as Program Director in 2007, Skillfully navi-

gated the quad-service politics to expand IPAP to meet service combat needs by getting

increased class size within 12 months, to include quad-service concurrence, expansion of

additional lab and classroom space as well as accreditation approval. This allowed the PAs

to meet end strength as requested by the PA Consultant in 2007.

Finally, he was the architect of the program extension from 24 months to 29 months align-

ing the program with appropriate graduate education principles designed to reduce student

stress and decrease losses. He completed accreditation of the world‟s largest PA program

in 2009, with the fewest findings, none significant, of any of the three previous site visits.

He has also advised both the Canadian and Australian military on the development of PAs

for their nation and military forces.

S A P A J O U R N A L

Presidential Proclamation

P A G E 3 V O L . 2 2 , N O . 4 A

THE WHITE HOUSE

Office of the Press Secretary

For Immediate Release October 6, 2010

NATIONAL PHYSICIAN ASSISTANTS WEEK, 2010

- - - - - - -

BY THE PRESIDENT OF THE UNITED STATES OF AMERICA

A PROCLAMATION

In communities across our Nation, physician assistants serve tirelessly everyday to care for Americans and fulfill a critical func-

tion in our health care system. They provide important medical attention and treatment to patients and their loved ones, and

can be the principal care provider in rural or inner-city clinics, and other settings with provider shortages. During National Phy-

sician Assistants Week, we honor these dedicated medical professionals and their essential role in providing diagnostic, thera-

peutic, and preventive health care services to millions of American men, women, and children.

With compassion matched by professionalism, physician assistants work as part of a team to provide vital support to both pa-

tients in need and the doctors who balance the care of many individuals. Recognizing their essential function in our medical sys-

tem, we allocated more than $30 million from the Prevention and Public Health Fund under the Affordable Care Act to expand

the Physician Assistant Training Program, and to increase the number of physician assistants in primary care over the next 5

years. Primary care is the foundation of preventive health care, and we must support the training of hundreds of new physician

assistants who can join the medical field and increase access to providers and services in underserved areas. Our Nation needs a

strong primary care workforce and the continued dedication of physician assistants in our hospitals, clinics, and medical offices

to address the crucial health issues of our time.

Countless American families have relied on the skill, concern, and commitment of physician assistants, in both joyous times and

heart-wrenching circumstances. As we recognize their countless contributions this week, we also pay tribute to the kind and

meticulous care provided by all of America's medical professionals. Our Nation is stronger because of these invaluable workers,

and their efforts safeguard a healthy future for all Americans.

NOW, THEREFORE, I, BARACK OBAMA, President of the United States of America, by virtue of the authority vested in me by

the Constitution and the laws of the United States, do hereby proclaim October 6 through October 12, 2010, as more

National Physician Assistants Week. I call upon all Americans to observe this week with appropriate ceremonies,

activities, and programs that honor and foster appreciation for our physician assistants and all medical professionals.

IN WITNESS WHEREOF, I have hereunto set my hand this

sixth day of October, in the year of our Lord two thousand ten, and of the Independence of the United States of

America the two hundred and thirty-fifth.

BARACK OBAMA

P A G E 4

Captain Patrick Lunkenheimer Laid to Rest

The information below comes from an internet article referencing the death of

Captain Paul Lunkenheimer.

Captain Patrick Lunkenheimer died May 30, 2010 at the age of 40 in San Antonio, TX after

a courageous three year battle with cancer. He was born March 18, 1970 in Munich, Ger-

many and grew up in Severn, MD. Pat was a 1988 graduate of Archbishop Spalding High

School where he played lacrosse and soccer. He attended college at St Mary‟s College of

Maryland and received his degree in physician assistant studies from the University of Ne-

braska. Pat was an Eagle Scout, life guard and Walt Disney World cast member before en-

listing in the Army in 1995. He served first as a combat medic and paratrooper and then as

a physician assistant. Military units he served with include the 82nd Airborne, 10th Moun-

tain Division and 11th Armored Cavalry.

Pat deployed on a humanitarian mission to Kosovo as well as two combat tours in Iraq.

He earned many military awards in his fifteen years of service including the Bronze Star.

More important than any awards were the friends, neighbors, patients and fellow

soldiers he knew throughout his military career. Pat was an avid runner and completed

many road races and marathons. He enjoyed camping, biking and geocaching. He was

also known as a bit of a prankster who brought laughter and joy to everyone who knew

him. He was a wonderful husband and a great dad who will be forever missed.

Patrick is survived by his wife of almost 20 years, Tammy (Briggs) Lunkenheimer a 1988

graduate of Northeast High School and their five children: Kelsey, Derek, Kevin,

Meredith and William, all of Schertz, TX. He is also survived by his mother, Luise and

step father Fredrik Langfeld formerly of Severn, now of Norway, his brother Jack and

sister-in-law Leslie Lunkenheimer of Severn and half-brother Al and sister-in-law Shari

Lunkenheimer of Keyport, NJ. Also surviving are in-laws Don and Mary Briggs formerly

of Pasadena, now of Apopka, FL, sister-in-law Tanya (Briggs) and Kevin Steele of Las

Vegas, NV as well as eight nephews and nieces.

Patrick is preceded in death by his father MSgt (R) John G. Lunkenheimer of Severn, also

taken by cancer in 1983. Burial with full military honors took place on Wednesday Septem-

ber 15th at 1:00 PM at Arlington National Cemetery.

S A P A J O U R N A L

P A G E 5

“I spoke up and

stated that

much of the

current state of

attendance was

a combination

of operational

tempo,

questionable

apathy/

commitment to

family and

overall

economy.”

Briggs Named New SAPA President

Greetings,

Another six months have flown bye. It just seems like yesterday that we were attending

another successful SAPA Annual Physician Assistant refresher course. I‟m still not sure

how I ended up as the “President Elect”. Well, actually I do…but I‟ll address that in a mo-

ment. I would like to first introduce myself and thank everyone who voted for me to rep-

resent you and all the other constituents of the SAPA membership.

I am an Active Duty Major with 30 years of Active Duty Service and currently I am assigned

at MacDill Air Force Base in Tampa Florida. Like many of my predecessors, mentors and

many of you, I had a full and rewarding career as an Enlisted Service Member, prior to be-

coming a PA. I served in Special Operations as a Medic, Intelligence and then as an Opera-

tion Sergeant. In April 1996, I attended the 1st IPAP course. My first assignment, as a PA,

was to Camp Hovey, Korea. There I was assigned to a Field Artillery Battalion (2-17 FA). I

PCS‟d to Ft. Lewis and was assigned to another Field Artillery Battalion (2-8 FA) and then

to 3/1st Special Forces Group. In 2003 I was assigned to the United States Special Opera-

tions Command (USSOCOM) until 2007. In January 2008 I went back to Korea, where I

was the OIC of a clinic at Camp Humphreys and then assigned to the DMZ. I am currently

stationed back in Tampa, Fl.

Now, back to how we got here. At the General Membership Meeting there was a conver-

sation about dwindling attendance by Active Duty Service Members and vendors. In the

discussion it came up that about a third to half of the Active Duty personnel were currently

deployed. So, why where there only a handful of Active Duty members present at the

meeting? I spoke up and echoed what I‟ve heard from my peers and other Soldiers, that

even though the SAPA may be the “Biggest Bang for the Buck”, many feel that the content

of the lectures and venue itself are at times lacking. I spoke up and stated that much of the

current state of attendance was a combination of operation tempo, questionable apathy/

commitment to family (on the part of the newer generation) and overall economy. Hence,

I was asked by Sherry Womack, if I would accept the nomination of President, for which I

did…and here we are.

S A P A J O U R N A L

When John Detro asked me to outline my goals and agenda in one to two pages for the newsletter I had to take pause

(LOL), because as a Special Operator and “quiet professional” I have never been one for many words and believe that

actions speak much louder than any words. So, as for an agenda I personally have no agenda other than to follow the

footsteps of those elected before me and to continue to make SAPA a venue of excellence for Continuing Medical Edu-

cation (CME), to attract new membership, to bring in new sponsorship and vendors and most important is to be an

advocate for the SAPA constituency and issues that are important to the SAPA membership and its future.

So what needs to be done? Well, new membership and an infusion of fresh blood in to the organization are desperate-

ly needed. Many of the “old-guard” has done more than their share to get us were we are today and their hard work,

time, experience and mentorship is greatly appreciated and needed as we infuse it into the next generation (s) of SAPA

membership.

Years ago COL Robertson was talking to a handful of Active Duty PAs at the SAPA conference and asked what it

would take to keep us in the Army. I remember looking around the table and those of us he was speaking to had near,

or over 20 years of active service. I told him that most of us (at the table) stayed in the military because we actually

enjoyed doing what we do. The problem was to figure out what motivates the newer generation of PAs. Many of the

Active Duty PAs were/are younger, with younger families. Three things arose in the discussion, as important factors to

keeping them in the Service; 1) Patriotic duty, 2) family stability (deployment cycles and PCSing) and 3) financial gain.

Likewise, I think as we move forward with the SAPA venues we need to take all three of these things into considera-

tion. Many are deployed and when they are back want to spend quality time with their families. Many have expressed

that they would like to see a SAPA setting more family oriented and with a CME venue that is diverse, yet relevant to

“Army” PAs. They would like a choice of what CME to attend each hour and continue to keep the conference eco-

nomically feasible to attend.

It is not my wish to offend anyone for past performances as they have all done a remarkable job. Again I echo the sen-

timents of others and do not advocate (one way or the other) for a change of SAPA venue. I think that it is prudent to

explore the possibilities of having it at other locations, such as San Antonio, Tampa, or elsewhere. There are pros and

cons to maintaining the location at Fayetteville, as opposed to another location. The biggest hurdle is that of financial

support/sponsorship. This is a monumental impediment, especially in today‟s economy. Things to look at are cost of

travel into different locations, cost of per diem, big business support/sponsorship and current business ties/

relationships forged over the years.

If anyone has any comment, suggestion, concerns or would be interested in exploring future locations or CME content

for upcoming SAPA venues or have any issues relevant to the SAPA constituency please contact myself at

xsf18z@gmail.com.

Respectfully,

Steve Briggs

Courtesy Army Medical Specialist Corps Connection Courtesy Army Medical Specialist Corps Connection

Courtesy Army Medical Specialist Corps Connection

P A G E 9

Update Afghan PA Program

U.S. Army PA‟s Pilot Afghanistan‟s First Physician Assistant Program

The goal: In one year‟s time, graduate 40 Afghan Physician Assistants. A challenging goal be-

cause in the United States the program runs for 2 years and requires students to have com-

pleted prerequisite courses.

On June 21, 2010, the Surgeon General of the Afghan National Army, General Yaftali, was

presented with the idea of implementing the first ever Physician Assistant program in Af-

ghanistan. The start date, October 2, 2010. Documents were signed and the candidate se-

lection process began the very same day. The Office of the Surgeon General proctored a

placement exam given to approximately 200 prospective civilian candidates. The accommo-

dations were simple and many of the candidates sat on the floor for the opportunity to take

the entrance exam. The remaining students would be selected from throughout the prov-

inces, the best to graduate from the regions combat medic schools.

On the first day of class, 82 eager students crowded into a tiny classroom in the basement

of the Military Medical Education Center adjacent to the Kabul National Military Hospital.

Midway through week two, the number of students had grown to 107. Although space is

cramped, many of the students will sit 5-6 per row on 4 chairs without complaining. The

atmosphere is charged and the students are bustling with nervous excitement. For most of

the students, this is a chance to get an education that will provide them with civic respect,

honor, and a career that will provide financial support for several generations of family

members. Additionally, the top students will have a chance for State funded higher educa-

tion. In an interview by SSG Rachel Martinez, General Yaftali was quoted saying, “They will

have the opportunity to participate in other schooling and university based on their

scores.”

The program begins with a repeat of the combat medic course. Many of the new students

did not have the opportunity to attend the medic course prior to the start of the PA pro-

gram and this will be their first introduction to medicine and trauma based skills. Following

the 7 weeks of combat medic training, the program intensifies with classes covering physical

exams, pathology, pulmonology, cardiology, and 15 other focused disciplines.

S A P A J O U R N A L

P A G E 1 0

Update Afghan PA Program

Week after week the U.S. mentors CPT Peacock and CPT Paulson, both Army physician

Assistants, with the help of Afghan physicians from NMH hospital, progressively build on

the learning concepts and skills that were taught the previous week. Educating these future

PA‟s on how to perform a proper physical exam, recognizing what “normal” looks and feels

like, how to use the physical exam equipment, and how to perform clinic and trauma medi-

cine is not only an extraordinary challenge, but critical in the survivability and sustainability

of the Afghan PA program and their Army. The didactic portion culminates in a field train-

ing exercise patterned after the Army sponsored TCMC course in San Antonio, Texas.

Much depends on the success of this program. The Afghan Army is growing at a rapid pace

and is in desperate need of providers on the front lines. The greatest need for a medical

provider is in the trenches embedded with the troops, a place where you will rarely find a

doctor or a nurse. The PA will be responsible for providing troop medical care, continued

training for the combat medics, and above all, will be the first on scene to provide life-

saving trauma management.

Physician Assistants are proving themselves worldwide. They are not only skilled clinicians

and leaders in trauma management, but also resilient in adapting to the ever changing de-

mands of war. History is being made „NOW‟ and the Army PA‟s are at the forefront.

Written by CPT Brian Paulson PA-C

USFOR A/NKC

CSTCA

S A P A J O U R N A L

P A G E 1 1

Chris Cole Awarded BSM with “V” Device

Courtesy Major Kathleen Schultz, XO Army Medical Specialist Corps

Major Christopher Cole, a physician assistant for Special Forces Operational Detachment

Alpha– 3212 was awarded the BSW with “V” Device for his actions on 2 November 2007.

Major Cole heroically distinguished himself by exceptionally valorous conduct in the face of

the enemy of the United States as a physician assistant, Forward Operating Base 32, Kanda-

har Airfield, Afghanistan, in support of Operation Enduring Freedom on 2 November, 2007,

in the hostile Sarsina Valley during a combat reconnaissance patrol, Operation First Look.

Major Cole distinguished himself when his patrol was ambushed by approximately six hun-

dred enemy fighters. During the ambush, MAJ Coles vehicle maneuvered into the enemy

kill zone to assist the Ground Force Commander in recovering casualties. During this ma-

neuver, MAJ Cole‟s vehicle was severely damaged. While under heavy machinegun, mortar,

and rocket-propelled grenade fire, and despite his injuries, MAJ Cole dismounted his vehi-

cle, assisted other passengers, and then provided suppressive fire that enabled injured Civil

Affairs Soldiers to maneuver to a covered position. MAJ Cole exposed himself to over-

whelming enemy fire and engaged and destroyed advancing enemy fighters prior to moving

to a position to provide medical aid to U.S and Afghan casualties. Upon learning that the

casualties had been killed in action, he willingly risked his life and assisted in the retrieval of

their remains. Three hundred meters of open terrain separated his position from friendly

forces, but he continued to risk his life while engaging the enemy to prevent his force from

being overrun. When SOF Detachment Alpha 3214 maneuvered to a forward position,

MAJ Cole ensured that the deceased were placed into his vehicle. After his vehicle became

disabled, MAJ Cole exposed himself to danger and moved the casualties and dead into an-

other vehicle. MAJ Cole then ran alongside the convoy while engaging the enemy. MAJ

Cole‟s incredible bravery under direct enemy fire, tactical and technical proficiency, and

dedication to mission accomplishment against insurmountable odds, directly resulted in the

recovery of American and Afghan Soldiers. His actions are in keeping with the finest tradi-

tions of heroism and reflect directly upon himself , the Joint Special Operations Task Force

-Afghanistan, Special Operations Command Central, and the United States Army.

S A P A J O U R N A L

P A G E 1 2

IPAP Celebrates National PA Week

On 7 October, the Interservice Physician Assistant Program (IPAP) held the nations largest

PA Week Celebration. The event was held at Salado Creek, Fort Sam Houston. There

were over 250 folks in attendance. Susan Roberts, IPAP Educational Technician, did an out-

standing job organizing the event which included a 3 kilometer run, inspirational speech by

LTC Timothy Karcher (a true American hero), and catered barbeque. The event started

with the 3 kilometer run. Winners of the run were 1LT Christopher Smith (possesses his

father COL Lou Smith‟s DNA), and 1LT Chelsea Kendrick. Following the run, COL John

Chitwood (US Air Force), Director of IPAP, introduced the guest speaker. LTC Karcher,

former Commander of 2nd Battalion, 5th Cavalry Regiment, 1st Cavalry Division gave an

inspirational talk about the role of the PA and their interaction with the command group.

He spoke of his respect for PAs stating that during his career he never met a bad PA. He

reflected on less than stellar performers he supervised in every branch but said that the

PAs never needed his direction. He spoke of the role of PAs in training their PROFIS pro-

viders and medics stating the PA is the expert on tactical combat casualty care. Last, he

spoke of PA CPT Wayne Wilson. Wilson was his battalion PA who he credits with saving

his life. In early June 2009, LTC Karcher turned over control of Sadr City to the Iraqi Ar-

my. A few days later, his HUMMV was struck by an EFP causing bilateral traumatic leg am-

putations. He was moved to his aid station by the convoy medic. Upon arrival, CPT Wil-

son provided life saving care. LTC Karcher‟s inner strength and sense of humor is extraor-

dinary. He states of Wilson , “He is definitely one of my personal heroes, not just because

he saved my life, but that doesn't hurt. He's a great PA.” Following his remarks, COL Chit-

wood read a San Antonio proclamation marking Oct 7 as San Antonio PA day. Next, John

Purnell (race director) presented awards for the top 3 male and female runners. Last, eve-

ryone enjoyed a great barbeque and the company of fellow PAs and physicians.

You can find a sensational interview of LTC Timothy Karcher at the website below.

http://www.southcountytimes.com/Articles-i-2009-06-26-165805.113118_Lt_Col_T

By John Detro

S A P A J O U R N A L

“The 65D AKO

Homepage won the

category of “Best

Web Viewer Channel 2010.”

P A G E 1 4

65D AKO Home Page Best of 2010 AKO Award

Courtesy MAJ Kathleen M. Schultz, SP Corps XO

While CPT Ryan McGill attended the Captains Career Course (May 2010), he asked,

“What else can I do to help out the Corps?” The response I gave him was “We really need

help with communication and if you are up to the challenge, I could really use a webmaster

for the 65D AKO Homepage.” I provided him a period of time to play on AKO and the

contacts at the AMEDD AKO Administrators at Fort Detrick, MA. About a week later, he

developed his homepage for practice and said, “I am ready to go.” CPT McGill became the

administrator for the 65D AKO Homepage in June and his work has paid off. CPT McGill,

with the assistance of the Fort Detrick team, created a homepage that was submitted for

the Best of AKO 2010. The 65D AKO Homepage won the category for “Best Web View-

er Channel 2010.” I personally would like to say congratulations and thanks for all the as-

sistance. If you are a Physician Assistant, you really need to check out the webpage and if

you have comments for improvement forward them to CPT McGill.

65D AKO Webmaster: CPT Ryan McGill: ryan.mcgill@mail.us.army.mil

S A P A J O U R N A L

P A G E 1 5

“Many unit

medical officers

do not use

injectable

narcotic

analgesics in

their daily

practice as

well.

Consequently,

there is some

trepidation in

administration

of these

medication to

the critically ill

patient. How

do we

overcome this

training gap?”

Use of Analgesics in the Prehospital Arena

By Don Parsons

Battlefield trauma frequently results in injuries that require pain medication as part of the

treatment plan. First responders on patrol and away from the treatment facility must be

versed and equipped to provide this pain relief. Combat medics (68Ws) are familiarized in

the use of different analgesic medications to provide this pain relief, but get little in practical

application in their use. Many of the unit medical officers do not use injectable narcotic an-

algesics in their daily practice as well. Consequently, there is some trepidation in admin-

istration of these medications to a critically injured patient. How do we overcome this

training gap?

There is a plethora of pain medication that is recommended for pain relief in combat trau-

ma. These begin at the simple over the counter use of Acetaminophen, to the use of inject-

able narcotics.

The Committee on Tactical Combat Casualty Care has made recommendations of different

levels of pain medication administration. Some can be administered by the casualty them-

selves to medication provided by combat medics, PAs, and MDs.

The Combat Pill Pack first originated in the SOF community in the Ranger Regiment. This

pack consists of two extra strength Acetaminophen tablets (650mg) in conjunction with an

anti-inflammatory medication Meloxicam (Mobic 15 mg). In addition, there is a broad spec-

trum antibiotic as well (Moxifloxacin 400 mg). While this item is currently available with a

NSN 6505-01-548-5129 it is rarely used by units outside the SOF community. Why? The

distribution plan for this item is one per Soldier carried in the individuals IFAK. Directions

are: if injured with an open battlefield wound and you are still able to fight, continue the

mission, perform any lifesaving interventions and then take the entire contents of the pill

pack. The non-sedating nature of these medications will provide a moderate level of analge-

sia, without interfering with the Soldiers ability to function. In addition, this medication has

little effect on the blood clotting mechanism. This regimen is probably the best non narcotic

oral form of pain medication currently available to the individual Soldier. Other anti-

inflammatory medications like Ibuprofen, Naprosyn, and especially Aspirin, can have a detri-

mental effect on the blood clotting process and should be avoided.

S A P A J O U R N A L

Analgesics Continued

P A G E 1 6 V O L . 2 2 , N O . 4 A

Injectable medications include:

Toradol (ketorolac): this anti inflammatory provides moderate pain relief when given IV, but has the drawback of

affecting blood clotting. Most medics will have little experience with using this medication by the intravenous route.

Morphine: Morphine is the gold standard for severe pain relief and has been used by medics and providers for eons.

I can remember the old morphine stylet that was like a tube of toothpaste that you stuck in your patient and

squeezed the contents out while it was in the patients arm. Currently morphine comes in two primary forms. The

auto injector, and the tubex (carpuject). Each of these carries 10 mg of the medication. The problem is the auto in-

jector can only be used IM. There are many instances in battlefield care that IM medication is not well absorbed and

does not work very well. Considerable numbers of Medics and Corpsmen have been interviewed on how they use

Morphine and most use the auto injector. The results of their attempts to relieve the casualty‟s pain has been less

than satisfactory. Most describe the casualty as still being in pain after the injection. The alternative and the recom-

mended route of administration is to give the medication IV push in small, more frequent increments. However, this

method requires the casualty to have a vascular line or saline lock in place. Currently the recommended dosage is

5mg given slow IV push every 10 minutes and titrated to your casualty‟s response. This is where part of the problem

occurs. Most practitioners are not familiar with using Narcotics as an IV push medication. If you have never given

Morphine or some other narcotic IV push in the controlled environment of your clinic or ER, then giving it in the

austere environment of a chaotic aid station or at the point of wounding is a little scary. Medics never get a chance

to practice giving any medication IV push as it is not in their scope of practice in the local MTF. However, we expect

them to be able to perform this task in the field. Why aren‟t we practicing this technique in training? Most medics

and many medical officers do not give IV narcotics in their daily practice and are a little afraid to give the patient too

much. I have always wondered about this because we can reverse the effects of the drug relatively easily with Nar-

can. The other problem that arises with IV use of morphine is that the medics must carry the tubex version, and

keep them in something that will prevent them from getting broken while in their aid bag. A number of different

companies make small medication cases that are hardened enough to prevent any glass ampoules or tubex‟s from

getting broken.

Analgesics Continued

P A G E 1 7 V O L . 2 2 , N O . 4 A

The next problem for the line medic is each tubex contains 10 mg of morphine in a 1 ml amount. So to give

the recommended dose you must only give 0.5 ml of the one ml in the tubex. It is easier to get a 3-5 cc syringe and

draw up 3-4 cc‟s of some IV fluid and then squirt 0.5 cc‟s of the morphine into this larger amount, then slowly inject

it into the saline lock or the port on the IV tubing. This makes it easier for the medic to give the medication as a

slow IV push rather than trying to just inject 0.5 cc‟s of Morphine out of the tubex. Use of sterile IV fluids as a sub-

stitute for the narcotic can be practiced during training and gives the medic a chance to go through the motions of

actually performing this skill multiple times before he ever has to use it for real. It is imperative that medics who are

carrying Morphine as the narcotic of choice for pain relief also carry Narcan, and probably some Phenergan for nau-

sea and vomiting, as this is a common side effect. There may be medical officers who don‟t feel that medics should

carry narcotics. I assure them that the medics get a block of instruction on battlefield pain medication. However, I

would encourage them to develop their own training program to refresh and sustain the training the medics re-

ceived in school. This training should include the indications, contraindications, side effects, and proper dosing in-

structions for the medication. I would even give them a little quiz to insure they have mastered the fundamental

knowledge with this medication. This way they can be confident that those carrying this medication know what they

are doing. I have some examples of training if you are interested. Now I will also say I have had some medics that I

would not let carry narcotics, because either they couldn‟t master the fundamental knowledge necessary, or I didn‟t

trust them. This would be even more important with the following Fentanyl lozenge.

Fentanyl: The easier solution to narcotic pain relief at the point of wounding is the use of the Fentanyl Lozenge.

(Oral Transmucosal Fentanyl Citrate) is available for use as a substitute for injectable narcotics in casualties who may

not require a vascular line. This item comes in several different dosing choices, (400mcg, 800mcg, and 1600mcg).

These devices have been used extensively by the Special Operations community with very good success and very

minimal side effects(1) . The primary drawback on this medication is the fact that the FDA has placed a Black Box

warning on it. The Army Pharmacy Consultant to the Surgeon General has recommended against its use on the bat-

tlefield. I doubt that this individual has ever had an aid bag on his back, or been at the point of wounding with a se-

verely injured soldier. Consequently, the only units who are using this medication are the SOF. However, the

Committee on Tactical Combat Casualty Care continues to recommend this medication and is working to counter

some of the obstacles on its availability. This would be my first choice for a narcotic pain reliever if I was on patrol.

Dosage is one 800mcg lozenge in between the cheek and gum, reassess in 15 minutes, you may add a second

800mcg lozenge as needed to control severe pain. Monitor your casualty for respiratory depression. If worried

about overdose, tape the lozenge to the casualty‟s finger so they will auto regulate if they fall asleep, the lozenge will

come out when their arm falls down.

Analgesics Continued

P A G E 1 8 V O L . 2 2 , N O . 4 A

Ketamine: While injectable Ketamine is being used frequently in hospital emergency rooms for analgesia and

sedation, this will probably not be the recommended delivery route of choice for the front line medic. There are a

couple of different studies on Intranasal Ketamine ongoing and some results should be available shortly. This drug at

lower doses than is used for anesthesia is a potent pain killer with much less of the extra pyramidal and hallucino-

genic side effects seen at anesthesia doses. It has shown results that are comparable to 10 mg of morphine without

any respiratory depression woes. Look for more information on this drug and route of administration being made

available as these studies conclude.

Recommendations for the appropriate use of analgesics by 68Ws is to develop a unit based training program. Teach

your medics some basic pharmacology and familiarize them with the medications you feel they should have available

to treat casualties with while on patrol, or when they are assigned to a remote outpost (COP or FOB), that is sepa-

rated from the unit medical officer. Do not hesitate to allow your competent medics to carry narcotic pain meds as

long as they are properly trained in their use. Remember if they are carrying narcotics they must also carry Narcan

and probably some Phenergan. There are a number of other pain medications available too numerous to mention in

this article. Pick out those that you feel would benefit the casualty and allow the medics to grasp the knowledge nec-

essary for them to be able to dispense these drugs easily in the chaotic battlefield environment. Proper use of anal-

gesia is part of a well rounded treatment regimen for the severely injured casualty. Give your medics the tools nec-

essary to facilitate their use and be able to offer this pain relief to those injured Soldiers who need it.

References:

A novel pain management strategy for combat casualty care.

Kotwal RS. O'Connor KC. Johnson TR. Mosely DS. Meyer DE. Holcomb JB.

Annals of Emergency Medicine. 44(2):121-7, 2004 Aug.

Pain management in the Wilderness and Operational Setting

Wedmore IS, Johnson T, Czarnik J, Hendrix S.

Emergency Medicine Clinics of North America 23,(2005) 585-601

The Practice Dilemma of a Military Independent, Dependent Provider

the Military Physician Assistant

P A G E 1 9 V O L . 2 2 , N O . 4 A

By COL William Tozier

I have several observations as a culmination of my recent and past experiences reviewing medical malpractice claims

against Army PAs. Over the past several years I have been asked to sit on several MEDCOM Special Review Panels

as a senior PA. I believe these cases reveal some very critical situations that PAs face as part of their role as inde-

pendent, dependent providers. To understand these observations and my recommendations, it is important to re-

view the makeup and process of the Special Review Panels as well as some general ,yet basic fundamentals about pa-

tient care and documentation.

The MEDCOM Special Review Panels consider cases in which the Army paid out money to patients claiming clinical

negligence or malpractice on the part of one or more civilian or military providers at Army treatment facilities

(MTF). Each case has a clinician representing the specialty of the provider involved. A senior PA represents any PAs

involved, be they active, reserve, civil service or contract. I present the case and then the panel discusses the details

as reflected in the records. If more than one provider is involved, there will be presentations by each of the clinical

representatives. The record viewed by the panel, includes copies of all original clinical care, provider notes, laborato-

ry and diagnostic studies. The record also has the local reviews conducted by credential committee of each MTF,

which also includes clinicians representing the specialty of each provider involved. Occasionally, there are some out-

side specialists opinions. Finally, the record contains the response afforded each provider to explain their actions.

The panel then votes whether the PA met the standard of care (SOC). I do not vote on whether the SOC was met

by a physician, but physicians vote on whether a PA met the SOC. The vote can say met, not met or indeterminate.

The panel can also comment whether a system process was involved. Identifying system problems is important as

the military treatment environment presents some unique clinical settings (the combat or deployed settings are not

considered), such as the troop medical clinics staffed only with PAs. The results of the Special Review Panel then go

the Surgeon General (TSG). If the vote determined SOC not met, TSG can forward the providers name to the Na-

tional Provider Data Bank. If the panel identified a system problem, TSG can direct some solution to avoid future

problems.

What follows are my summative observations as they relate to provider documentation of patient care. I will not

give the details of any particular case, but will describe what I have seen as repetitive problems. Not to trivialize the

cases, some of which resulted in death, but I believe there are several problems PA face in dealing with that can be

best characterized as „Bouncing Time Bombs‟.

PA Malpractice Continued

P A G E 2 0 V O L . 2 2 , N O . 4 A

First, most of the cases involve patients with unusual presentations or a difficult diagnosis.

Second, the PA happens to be one of many providers involved as the patient‟s condition continues over an

extended period of time.

Third, the PA may be situated at an outlying clinic, distant from the hospital. However, in the vast majority

of cases, the PA is working in a hospital or outlying clinic well staffed by physicians.

Fourth, there is no pattern that I can see as to age, gender or type of diagnosis. Cases have been presented

involving children, adults, geriatrics, male and female patients. Some patients are post surgical, some involve

Infectious disease, and some involve trauma or cardio pulmonary conditions. Again, there is a wide variety

of medical problems among the various cases. The important point is that it could be any patient you see on

any given day – a service member, dependent or retiree.

Very rarely have I seen the PA grossly error in the patient‟s evaluation and treatment. They may have missed the

true diagnosis, but they made a reasonable attempt and developed an adequate plan based upon their assessment.

However, I have seen poor documentation with incomplete reporting of the history, physical exam findings and

treatment plan or abbreviated notations that leave the reviewer guessing what was done and what the PA was think-

ing. You will live and die by your documentation. This brings me to my primary list recommendations regarding the

basics of clinical documentation:

First the history. Do a thorough, focused history, and do NOT let the AHLTA template feature fill symptoms or

review of systems (ROS) findings that you did NOT ask. We have all seen provider notes that have enough ques-

tions on the ROS section to easily occupy the entire allotted patient encounter time. Obviously, the provider did

not ask the questions, but used the auto fill feature of AHLTA to create the justification for increased relative value

units (RVU). If your emergency department (ED) uses a T-sheet, please do more than just check off boxes and

scratch out words. Take the time to write descriptive text of the critical findings so there is no doubt you asked the

question and or made the observation.

Next the physical exam. Be sure you clearly define the location and character of the finding. As I mentioned, many

of these cases developed over a period of time and your observations will be compared to someone else‟s. Does

your documentation support that the problem was getting better or worse. Also, be sure to do a complete focused

exam. For example, if you see a female with abdominal pain, that patient should not leave the clinic until after you

have completed a pelvic exam as part of your workup. Do not just note the gaits or location of palpable tenderness

when assessing back pain, you need to evaluate for neurological deficit. Finally, write down CLEARLY what you

found or didn‟t find, NOT what you EXPECTED to find. If you look in that child‟s ear and you are convinced that

the fever comes from an otitis media, but the ear findings are normal, don‟t stretch the appearance of tympanic

membrane made pink by a screaming child into the findings of the infected drum you want to see.

PA Malpractice Continued

P A G E 2 1 V O L . 2 2 , N O . 4 A

The differential diagnosis. You don‟t have to select just one word or one phrase. There is a text box in AHLTA that

allows you to add comments, such as “rule out”, or “considering the following other diagnoses B, C, D, etc.”. You

can also add how you will change your plan based upon the results of your diagnostic workup or their response to

your planned treatment.

Then, the treatment plan. This needs to include more than just the name of the drug and the dose. You need to

include further diagnostics and your direction and intent if you didn‟t list this in the box under the differential as sug-

gested in the above paragraph. Most importantly, you need to be specific about when and to whom they are to fol-

low up for care. Remember there is no such person as a PCM. A PCM doesn‟t exist. A PCM is a vague dysfunc-

tional organizational process in the Army. Provide the patient specific directions on who they are to see when they

return. Contact the person you intend the patient to see and brief them on what you have done and your concerns.

This becomes very important for critical patients. I am not talking about routine problems, but those cases where

you have some degree of unease about the cause and treatment of their illness or injury. There is a reason I titled

these cases Bouncing Time Bombs, because the military system has almost no continuity of provider care. You need

to take extraordinary measures to ensure handoff to the providers who will see this patient next.

Finally, a discussion of consulting with physicians. The main reason for writing this paper was to address when and

how we consult with physicians. Remember the dilemma I mentioned at the beginning. We are the only licensed

independent, dependent providers in the military system. That‟s a potentially impossible conundrum. Our profes-

sional scope of practice is based upon working with physicians under their supervision. Military PAs are given an

incredible amount of autonomy. On more than one occasion in the Special Review Panels, I have heard physicians

recognize that the isolated settings where PAs frequently provide care, puts them at increased risk for not having the

support available when it is needed. I am not talking about the combat or deployed settings. I am talking about CO-

NUS MTFs. We all recognize that many MTFs are located as far away from troops on a post as they could be with-

out being off post. Military physicians do not expect that we require direct supervision, but they realize their obliga-

tion to be available when we have questions about patient care. Therein lies your obligation as a military PA. You

must refer patients to our supporting physicians when you have uncertainty about what to do with a patient‟s care.

In a recent Special Review Panel, two of the PAs being reviewed, at two very different locations, quoted a policy they

claimed did not require them to consult a physician until the third episode, for the same condition, that was not im-

proved. We queried these MTFs and that policy does not exist. What does exist is the following paragraph from

AR 40-68:

PA Malpractice Continued

P A G E 2 2 V O L . 2 2 , N O . 4 A

Patients returning with the same complaint. PAs must consult with a physician when a patient presents with the same

unresolved complaint twice in a single episode of care. Physician consultation will be documented on either a standard

form (SF) 600 (Health Record-Chronological Record of Medical Care) or an SF 513 (Medical Record-Consultation

Sheet). (See AR 40–66 for instructions on the use of these forms.) This does not apply to patients who are returning

for routine follow up as directed or for treatment of chronic illnesses previously documented in their medical record.

(paragraph 7-16)

There are inconsistencies with this policy across the DoD. The Navy uses the same policy, however the Air Force

has eliminated any such policy several years ago. Some Army MTFs have different, more restrictive policies, for re-

turning patients seen in the emergency department (ED). PAs must recognize that inconsistent policies exists, but

more importantly, they must understand the basic principle that underlies these policies. This principle can be sum-

marized as the obligation of a PA, a dependent provider, to refer any patient who is worsening or not improving, to a

provider with more advanced treatment knowledge and skills. In one sense, this requirement is no different than the

professional obligation of any family practice or generalist physician who reaches the limits of their knowledge and

skills and refers a patient to a specialist.

This brings us to a discussion of the Bouncing Time Bombs. Please remember the following:

Just because a patient has seen one provider, maybe even a physician, doesn‟t mean that the correct diagnosis or

treatment plan was implemented. You must make your own, independent and thorough assessment and plan.

Patients with unusual presentations exist. If someone returns after being treated for a high fever and pain for the

fourth time in as many days or weeks, you need to get help, no matter how many providers may have seen this patient

before. It is probably more than a coincidence that the prior treatment plan/s are not working.

You also need to contact those prior providers and specialists and make them aware their patient‟s problem has not

resolved, especially patients with post surgical complications.

When you do consult with a physician, write down the details of what transpired and what that physician recommend-

ed, not just “consulted with Dr. X”. Be sure you provide the consulting physician all the details in the patient‟s case. I

have consulting physicians claim they were not completed advised about the patient.

If you want the physician to see the patient, say so and be clear about your request. You may get berated, especially if

it is an afterhours call, but repeat your request until you get the support you need.

That doesn‟t mean you can use your lack of knowledge to avoid patient care. If you need additional education or

training, then get it. You are responsible for knowing as much as you can.

Nor can you hide behind a physician consult. You must consult the correct physician. If you have a supervising physi-

cian that you know is weak in an area, don‟t just check the box by consulting with that person. Get the right consult

for the right patient.

PA Malpractice Continued

P A G E 2 3 V O L . 2 2 , N O . 4 A

Finally, you must learn to recognize the truly sick patient. All patients come in with an illness or injury that is bother-

ing them. Many of these problems will resolve even without our intervention. However, some of these conditions

are worse than even the patient realizes. Also, many patients come to us not because they couldn‟t take of the prob-

lem themselves, but because the system requires them to get a profile to be excused from work or training. Sit back

and think about your patient as you draw up a treatment plan. Ask the big question, “Is this patient seriously sick”,

does this patient need significant intervention to prevent serious morbidity or even death.

Egos and overconfidence have no place in medicine. The practice of medicine means doing what is right for the pa-

tient. As a licensed independent, dependent provider, your obligation is to provide the best quality of care for that

patient by educating yourself on an continuing basis and referring to a physician when you have reached the limits of

your knowledge and skills.

COL William Tozier, PA-C, MPH, PhD

“By becoming

readiness programs,

these courses will

become mandatory

every 3-4 years.

With this change in

status, it may be

time to consider a

second level of

TCMC training.”

P A G E 2 4

Advanced Tactical Combat Medicine Course (aTCMC)

By Major John F. Detro, Deputy Director, Center for Predeployment Medicine

The Tactical Combat Medicine Course (TCMC) was designed to provide pre-combat

training for medical officers, specifically those assuming level I positions. The Center

For Predeployment Medicine is the proponent for TCMC along with the MiTT Medi-

cal NCO Course, Brigade Combat Tactical Trauma Training (BCT3) Course, and

Joint Forces Tactical Trauma Training (JFTCMC) Courses. The CPDM is currently

reviewing its programs with the eventual goal of moving the TCMC and BCT3 cours-

es from pre-combat to readiness programs. By becoming readiness programs, these

courses will become mandatory every 3-4 years. With this change in status, it may be

time to consider a second level of TCMC training. This course would be held quar-

terly and like TCMC encompass five days of training. Below is a rough idea of the

new program entitled “Advanced Tactical Combat Medicine Course (aTCMC).

Course development is in its infancy and ideas from the field are welcome.

Purpose: Provide increased training in medical procedures, advanced technologies,

and medical planning. This increased knowledge is designed to improve the treatment

ability of far forward medical providers in order to improve survivable combat deaths.

Faculty– Physician Assistants assigned to the traditional TCMC Course.

Audience: Medical practitioners who are graduates of the Tactical Combat Medicine

Course (TCMC) and are physicians, physician assistants, or senior combat medics (E-7

and above).

Curriculum: The course is 5 work days in length. The curriculum is designed to im-

prove combat casualty care and includes advanced airway procedures, advanced pain

management techniques, advanced fracture management, burn care, medical planning

exercises, medic training techniques, and culminating in a 24 hour survivability lab.

S A P A J O U R N A L

“One brigade com-

mander from the

101st stated, they

have never been

medics or worked

with PAs…. How

do they know what

right looks like?”

P A G E 2 5

Battalion/Brigade Medical Officer Preparation (BMOP) Course

By Major John F. Detro, Deputy Director, Center for Predeployment Medicine

During recent conversations with multiple battalion, brigade, and division command-

ers, I have been struck by a common theme. These individuals state the change in

selection for the Interservice Physician Assistant Program (IPAP) away from medics

toward individuals of any specialty, many without any medical experience has led to a

much “greener” PA. One Brigade Commander from the 101st Airborne Division

personally told me, “they have never been medics or worked with a PA.” He went

on to say, “How do they know what right looks like.” He confided that he felt less

than comfortable deploying with a brigade having only one PA with prior medical ex-

perience. After speaking to several senior leaders like him, I decided that it is our

responsibility as fellow PAs to bring these new providers up to a level needed to be

ready to assume responsibilities in a battalion or brigade aid station. As the deputy

for the Center for Predeployment Medicine (CPDM), I have been working with my

fellow unit PAs to develop a course to assist in this task. After serving as the 65D

OBLC Track advisor, I determined that all the courses taught during the first week of

track training could be transferred from the classroom to the aid station. Currently,

the second week of OBLC track training is TCMC. Therefore, along with the TCMC

PAs, we have begun to evaluate the possibility of creating (changing) the TCMC

course to become two weeks in length versus one. The first week would be the new

BMOP Course and the second would remain the traditional TCMC. Below is a ge-

neric description of the BMOP Course:

Purpose: Provide newly assigned battalion medical officers with the skills and tools

necessary to perform successfully as special staff officers.

Rationale: Field commanders have recently expressed a concern regarding the new

Army PA. One Colonel stated, “Many of these men and women have either not

been medics or have not been involved in military medicine in any form.” He went on

to say, “They don‟t know what right looks like.”

Faculty: TCMC staff and potentially other SP officers.

Audience: All Medical Corps, Dental Corps, and Army Medical Specialist Corps offic-

ers who are newly assigned to a battalion or brigade level medical units.

Curriculum: The course is one week in length and replaces OBLC branch track train-

ing. The curriculum will be divided into courses pertinent to each specialty with in-

structors of the same profession. All students will be instructed on medical planning,

medical briefing, use of communications equipment, use of medical equipment (SKOs),

employment of information technology (MODS, ALHTA, CHCS), medical logistics, aid

station operations, and training of medics and first responders. Upon completion of

BMOP, students will attend the TCMC.

S A P A J O U R N A L

Schumacher Selected for WTB Command

P A G E 2 6 V O L . 2 2 , N O . 4 A

Major (P) James (Tom) Schumacher has been selected by the XVIII Corps Commander to become the next com-

mander of the Warrior Transition Battalion, Fort Bragg, NC. MAJ Schumacher was born and raised in Fayetteville,

NC. In 1984, he attended the Virginia Military Institute for 1 ½ years prior to enlisting in the US Army as a com-

munications specialist. He graduated from the Special Force Medical Qualification Course in 1990 and served on

several A-teams until he departed as a Sergeant First Class to attend the Army‟s Physician Assistant (PA) Program

at Fort Sam Houston, Texas. After graduating he was commissioned a second lieutenant in the Army Medical Spe-

cialist Corps in 1996 and later completed his Masters Degree with the University of Nebraska. He is a graduate of

the Command and General Staff College, Military Free fall and Combat Diver courses and the US Army Ranger

School. His operational medical experience includes four assignments as a Battalion Physician Assistant with the

following units: 3d Ranger Battalion, 75th Ranger Regiment (Airborne), Fort Benning, GA; 245th Area Support

Battalion, Fort Clayton, Panama; 1st Battalion (Airborne), 321st Field Artillery Regiment, Fort Bragg, NC and 1st

Brigade Special Troops Battalion, 1st Brigade Combat Team, 1st Cavalry Division, Baghdad Iraq. Additionally, he

has served as a special staff officer with the 82nd Airborne Division as the Senior Physician Assistant and Deputy

Surgeon for Clinical Operations. Subsequently, he served on the XVIII Airborne Corps staff as the Senior Physi-

cian Assistant and culminated his assignment as the Task Force Bragg Surgeon. He also commanded both the Bra-

vo and Headquarters Companies of the 261st Area Support Medical Battalion (Airborne) and the Head-

quarters & Headquarters Company of the 44th Medical Command (Airborne), all at Fort Bragg, NC. His

most recent assignment was serving at the Phase II Program Manager for the Interservice Physician Assis-

tant Program at Womack Army Medical Center.

Major Craig V. Paige has become the second PA to command a Forward Surgical Team. Major Paige is

the commander of the 745th FST at Fort Bliss, Texas. In addition, he remains concurrently the Director

of the Baylor University Doctorate of Science in Clinical Orthopedics Residency Program. Recently, Ma-

jor Paige relinquished duties as the William Beaumont Army Medical Center (WBAMC) Phase II Clinical

Coordinator, Interservice Physician Assistant Program (IPAP).

Paige Assumes Afghan Combat Command

SAPA Membership News

P A G E 2 7 V O L . 2 2 , N O . 4 A

Retirements/ETS

The SAPA Leadership would like to thank the following PAs for their service to the US Army and our Nation.

They will leave the military in the next several months. Please wish them luck with their new endeavors.

CPT Donald A. Adams MAJ Marlin D. Payne

CPT Veronica Alston CPT Lisa L. Postell

CPT Gregory B. Archer MAJ Keith Powell

MAJ Nathan T. Boykin CPT Vince Reed

MAJ Shon D. Compton MAJ Louis A. Santiago

CPT David Cox CPT John Shaughnessy

MAJ John Dana MAJ Bret M. Smith

CPT David L. Donelson MAJ Raymond Sterling

CPT Kristen C. Donesec COL William Tozier

MAJ Anna M. Ferguson CPT Donald Turner

CPT Alan P. Garcia MAJ Joseph W. Walbert

MAJ Michael K. Garcia CPT Lillie M. Walker

CPT Robert W. Hamblin CPT Rudolph R. Wencl

CPT Nicholas Harrison

MAJ Darren L. Hightower

CPT Carl Hill

MAJ Freddie C. Hobson

MAJ Colleen Hurst

MAJ Roderick Kelly

MAJ Esther Lazo

CPT Robyn L. Mason

MAJ Alex Morales

MAJ Donna F. Moultry

31st SAPA Conference Meeting Minutes

P A G E 2 8 V O L . 2 2 , N O . 4 A

General Membership Meeting ( Thursday, April 29, 2010)

Meeting was called to order at 13:35 pm.

DIRECTORS PRESENT: President: Steve Ward

President Elect: Sherry Womack

Immediate Past President: Pat Malone

Treasurer: Jim Miller

Secretary: Karen McMillan

Executive Director: Hal Slusher

Director of Reserves: Frank Piper

Director of National Guard: Nolan Wright

Membership Director: Paul Lowe

Absent: Director of Active Duty: Theresa Martin

CONFERNCE STAFF: Conference Registrar and Coordinator: Bob Potter

Assistant Conference Coordinator: Dave Paulson

COMMITTEE CHAIRS: Sales Booth/Technology: Steve Ward

Sean Grimes Scholarship Committee: Don Black

GENERAL MEMBERSHIP: Forty-one members present of which thirty-seven (36) voting members were in attend-

ance.

Steve Ward welcomed the members and thanks them for their attendance.

31st SAPA Conference Meeting Minutes

P A G E 2 9 V O L . 2 2 , N O . 4 A

General Membership Meeting ( Thursday, April 29, 2010)

REPORTS:

Past President: Pat Malone had no report.

President: Steve Ward expresses his gratitude to the membership for without their support SAPA would cease to

exist. He also encourages members to step forward and serve on the BOD to keep the organization going after the

older BOD retires. Steve thanks Bob Potter for a job well done on this year‟s conference and congratulated him on

being the conference coordinator for the past fifteen years. Over the past year we awarded three $1000.00 SAPA

scholarships and one $1000.00 scholarship to the Veterans Caucus. Steve informed the members that next year

SAPA will award two $1000.00 scholarships and one $1000.00 scholarship to the Veterans Caucus due to the declin-

ing economy. Steve urges the membership to help by serving on committees while bringing ideas to the table to re-

vive SAPA. During the last AAPA, SAPA spent over $6000 to host a reception and only 100 attendees showed up to

participate, the BOD decided not to sponsor a reception for the Atlanta conference due to cost and the economy.

Steve encouraged each member to go to the NCCPA website and take the survey concerning the 10 year recertifi-

cation which will add two more requirements: a self assessment course for a fee every two years and also comple-

tion of a mini clinical research QI project with your supervising physician. Steve would like you to voice your Pros

and Cons about changes. It was approved that we would add a Director of Retired Army PAs and it will be added to

the ballots and candidates will be appointed later today. In keeping up with the protocol of AAPA we have to add a

Vice President so the BOD decided to change the name of President -Elect to Vice President/President -Elect. It will

not change the way we do business, the Vice president will have the same duties and responsibilities as President-

Elect. Steve states we are looking for committee chairs and members. The goal is to get the newer PA‟s involved in

SAPA and to market our profession. Three committees are the top priority:

PR Committee ; Especially here in Fayetteville where there are boots on the ground to get things organized, need

a chairperson and 2 other members. Hopefully invite the Mayor out to the opening ceremony to get out organiza-

tion recognized and to give back to the community.

Strategic Planning Committee– Chair and 2 members

Benevolence Committee – Chair Pat Malone/ Stan Shank

Steve would like to see these committees up and running and asked if anyone would like to volunteer to serve and

to notify him no later than 1 July 2010. We have a change in the Newsletter editor which is now published on the

website SAPAeditor@g.mail. John Detro will be the editor for the Newsletter, he is currently at IPAP, please do

not overwhelm him with stuff that do not need to be published in the Newsletter.

31st SAPA Conference Meeting Minutes

P A G E 3 0 V O L . 2 2 , N O . 4 A

President –Elect: Sherry Womack‟s main focus is Public Relations, PA‟s should be out promoting our profession. Se

met with “Artist For America” and he will need a collection of pictures of PA‟s in the workforce that can be send to

form a collage collection to represent the PA profession. Facebook is up and running for SAPA.

4. Treasurer: Jim Miller provided each member with a copy of the financial status. (Enclosure 1). Mike Adcock

donated $1000.00 last year and again this year to the SAPA scholarship fund, Jim encourages members to donate by

using credit card, check and cash. Jim stated an internal review audit was conducted by 3 members once yearly dur-

ing the conference. Irv Fish made a motion to accept the treasurer report and Steve seconded the motion and the

motion carried.

5. Secretary: Karen McMillan requested the membership review the minutes of the General Membership

Meeting on 23 April 2009. Karen thanked the BOD for all the support that was given throughout the year and Irvin

Fish had a correction to the spelling of Dan Paulson to Dave Paulson, correction was noted and Jim Miller made a

motion to the membership to accept the amended minutes as written. Tom Matherly seconded the motion and the

motion carried.

6. Executive Director: Hal Slusher informed the membership that the reports are finalized and submitted. The

Post office box has been renewed for another year. General Liability Insurance renewed as well as all Officers and

Directors policy is updated. Steve Ward added his appreciation for all Hal‟s direction and mentoring throughout the

years.

7. Conference Committee/Registration Coordinator: Bob Potter thanked everyone for attending the conference

and stated that without them the conference would not exist. He stated 501 were registered for last year and we

were down this year to 479. He felt this was due to the economy and the AAPA conference being held in Atlanta

this year. Last year we had 35 guests and this year we were up to 41 guests. The one area that went down this year

is exhibitors; last year we had 34 this year we only had 19 and 90% of the exhibitor‟s registrar at the lowest level

which in $1000.00. The funds were tremendously cut this year and without the exhibitors we cannot keep the cost

to SAPA down. Bob states it‟s extremely important to get exhibitors for next year; he wants all members to pick up

cards when they attend other conferences and mail the cards to him and he will contact them. Bob stresses we need

more local reps, so urge members who attend conferences in the surrounding are to get cards and he will do the

rest. Next, Bob would like people to sign up for lectures for next year and he strongly needs help to procure local

drug reps but can be insurance companies and medical equipment companies as well. Finally the goal of SAPA is to

provide low cost CME.

31st SAPA Conference Meeting Minutes

P A G E 3 1 V O L . 2 2 , N O . 4 A

We are looking at options to cut costs:

Banquet- charge separately around $15-$20 plus registrar fees; cut guest fees by $10 and charge for banquet.

Stop banquet- would save money and eliminate waste, SAPA has to pay for each meal regardless if at attendee

comes or not.

Cut the conference to a 4 day conference.

Speaker‟s cost will remain the same- Bob opened the floor for discussion for New Business to get some ideas and

comments.

Bob commented on the absence of the HRC during this conference. Sherry Womack commented that MAJ Ran-

dolph Moss is here and scheduled and will be here next year as scheduled.

8. Director of Active Duty: Theresa Martin absent.

9. Director of Reserve: LTC® Frank Piper states he is retired from this position and has enjoyed working with

SAPA. His replacement is LTC Tanya Moore and she will serve as the reserve consultant, she could not attend the

conference due to other obligations.

10. Director of National Guard: CPT Nolan Wright states the 180 day policy is effective this year which is a

huge incentive for retention of soldiers. His Job for an IPAP slots for an instructor is pending so put the word out if

anyone interested (later hired by IPAP). Nolan also encourages members to get more involved in SAPA.

11. Membership Director: Paul Lowe states down by 30 members from last year with a total of 714. Cost of do-

ing business was $715.34. We had 26 people that still wanted a hard copy of Newsletter by mail, but using online

methods saves SAPA on cost. Hal reminded the membership to choose Army as their constituent chapter so we get

representation and AAPA delegates to be our voice. A question from the floor about relocating conference to an-

other venue was entertained. Bob Potter states its more cost productive to have it in Fayetteville because you have

boots on the ground to get things started on this end and arrange set-up, If conference was moved would need peo-

ple in place at that location to get things started, Steve suggested to the membership that we discuss this in new

business.

12. Sales Booth: Steve reports this year the sales booth was open for 18 hours and gave out a certificate to

attendees for being inside of the lecture hall. The certificate could be use towards a purchase at the sales booth. Ste-

ve thanks all the volunteers who worked the booth, specifically Tom Matherly, Laurie Wysong, Bob Egbert, and Rita

Ward. Steve stressed all profits go to the Scholarship Fund and the profits this year were $1076 down from last

year. The Sales Booth will be closed for the remainder of the conference for inventory.

31st SAPA Conference Meeting Minutes

P A G E 3 2 V O L . 2 2 , N O . 4 A

Old Business:

The proposal to add an additional board position was voting on last year and approved by the membership and will

be nominating a nominee for Director of US Army Retired Component.

New Business:

Steve stated that we have over 500 active duty PA‟s and SAPA only has 142 fellow members, he urged everyone to

market the profession and encourage PAs to join SAPA to revitalize the organization. C.J. stated a good way to help

membership is by keeping in touch on AKO accounts. She states she had a proposal to increase membership but did

not have it available at the meeting. Sherry stated that we have 22 phase two sites and a PA preceptors who should

be promoting SAPA. Steve Briggs stated that the younger PA‟s has lost interest in SAPA and we need to do some-

thing to get the active duty more involved. Nolan Wright stated that it may be a conflict of interest using AKO ac-

counts to blanket e-mails. After much discussion the membership agreed we all have to do something to help keep

the profession alive. C.J. volunteered to give her service and that she will email her proposal with a solution to the

BOD. Steve Ward urges the membership to step-up and become committee members, serves as a BOD, and get

more involved in SAPA.

Marvin Cole informed the membership that PA‟s are being listed as Other since Nursing has taken control of cre-

dentialing for the Army. PA‟s are losing their identity. PA‟s were classified as Allied Health Services. Steve will pre-

sent the case to AAPA and have them issue a statement to give to duty stations stating that PA‟s are Health Care

Provider not Allied Health Services. Marvin Cole stresses that the membership must defend the profession to pre-

vent a loss of identity.

Jim Miller remind the membership that renewal memberships will take 1-3 months to process; so you

will not see it on your bank statement in 1-3 days due to this process. Jim reminds the membership that they can

donate directly or through their insurance policy and or Wills to the Scholarship Fund.

It was mentioned to rotate the site of the SAPA conference to allow PA‟s to share with their families at the

same time and enjoy a vacation. Steve Ward informed the membership that BOD are investigating that idea and will

need a cost analysis before we can commit to rotating sites of conference.

31st SAPA Conference Meeting Minutes

P A G E 3 3 V O L . 2 2 , N O . 4 A

Nominations- Sherry Womack opened the floor for nominations for positions on the BOD of SAPA and

delegates to the AAPA House of Delegates. Sherry reminded members that nominees must be a fellow member of

SAPA and a member of AAPA and designate SAPA as their constituent chapter. Sherry opens nominations for Presi-

dent Elect/Vice President. Maggie Joplin nominated Steve Briggs. Steve Briggs accepted nomination. Karen McMillan

nominated Frank Piper for President Elect/Vice President. Frank Piper accepted the nomination. Hearing no other

nominations, the nomination for President- Elect/Vice President was closed. Sherry closed the nominations for Presi-

dent-Elect/Vice President. Sherry opened the nomination for office of Secretary. Frank Piper nominated Karen

McMillan for the office of Secretary. Karen accepted the nomination.

Hearing no other nominations, Sherry closed the nominations for Secretary. Sherry opened the nominations for

Treasurer. Tom Matherly nominated Jim Miller for the office of Treasurer. Jim accepted the nomination. Hearing no

other nominations, the nominations for Treasurer were closed. Sherry opened the floor for nominations for the po-

sition of Director of Active Duty. Tom Matherly nominated Col Pauline Gross for the office Director of Active Du-

ty. Col Pauline Gross accepted the nomination. Sherry Womack nominated CPT Marie Duggan for Director of Ac-

tive Duty. Marie Duggan accepted the nomination. Hearing no other nominations; Sherry closed the nominations for

Director of Active Duty. Sherry opened the floor for nominations for the position of Director of National Guard.

Frank Piper nominated CPT Nolan Wright for the position of Director of National Guard. Wright accepted the

nomination. Hearing no other nominations, Sherry closed the nominations. Sherry opened the floor for nominations

for the office of Director of Reserves. LTC Tanya Moore self declared for the office of Director of Reserves. Hear-

ing no other nominations, Sherry closed the nominations for the position of Director of Reserves. Sherry opened

the floor for nominations Director of Retired Army. Paul Lowe nominated Casey Bond for the Director of Retired

Army. Casey Bond accepted the nomination. Reggie Smith nominated Frank Piper for the position of Director of

retired Army. Frank Piper accepted the nominations. Tom Matherly nominated Margaret Joplin for the Director of

Retired Army. Maggie Joplin accepted the nomination. Hearing no other nominations, Sherry closed the nominations.

Sherry opened the nominations for alternates to the AAPA House of Delegates 2011. Hal Slusher, Orie Potter,

Frank Piper, and Steven Ward were nominated to be alternates to the AAPA House of Delegates and all accepted

the nominations. There were no other nominations from the floor and nominations were closed. The official ballot

will be mailed immediately following the conclusion of this conference and it will include a space for write-in votes in

each category. Steve Ward will serve as the primary chief delegate to the AAPA House of Delegates.

ADJOURNMENT:

Hearing no further business, Steve entertained a motion to adjourn. Tom Matherly so moved, Pat seconded the mo-

tion and the motion carried. The meeting adjourned at 1545 hrs.

Respectfully submitted: Karen McMillan, Secretary Approved by: Steve Ward, President

SAPA OFFICERS SOCIETY OF ARMY PHYSICIAN ASSISTANTS

P O Box 07490, FT. MYERS, FL 33919-6402

Phone and Fax - 239-482-2162

EXECUTIVE DIRECTOR: Harold E. Slusher, PA-C

Address and phone as above, e-mail - hal.slusher@juno.com SAPA Web Page: http://www.sapa.org

(Webmaster: Orie Potter)

PRESIDENT Sherry L. Womack, Major, SP, PA-C

E-mail: womachj@wave-net.net

PRESIDENT ELECT Steven L. Briggs, Major, SP, PA-C

E-mail: steven.briggs@us.army.mil

IMMEDIATE PAST PRESIDENT Steven W. Ward, PA-C

E-mail: swardpac@ctvea.net

SECRETARY Karen McMillan, PA-C

E-mail: kl4u@comcast.net

TREASURER James L.C. Miller, PA-C

E-mail - jmillx2@earthlink.net

DIRECTOR, ACTIVE DUTY ARMY PAs Pauline Gross, COL, SP, U.S. Army

E-mail: pauline.gross@us.army.mil

DIRECTOR, US ARMY NATIONAL GUARD PAS Nolan Wright, CPT, PA-C Texas Army National Guard

E-mail: nolan.wright@us.army.mil

DIRECTOR, US ARMY RESERVE PAS Tonya Moore, LTC, PA-C

E-Mail: tfmoore60@gmail.com

MEMBERSHIP DIRECTOR Paul W. Lowe, PA-C

E-mail: lowepw@earthlink.net

RETIRED COMPONENT DIRECTOR Jan (Casey) Bond, PA-C

E-Mail: bond@earthlink.net

SAPA CONFERENCE STAFF CONFERENCE COORDINATOR: Bob Potter, PA-C

PO Box 623

2Monmouth, IL 61462

SAPA Voice Line: 309-734-5446

Fax: 309-734-4489

E-mail: orpotter@aol.com

CONFERENCE REGISTRAR: Bob Potter, PA-C Info for Bob Potter same as immediately above

ASST. CONFERNECE COORDINATOR:

Pat Malone, PA-C E-mail: sapamed@aol.com

Dave Paulson

E-mail: DNORSK3@aol.com CO-REGISTRAR: Judy Potter

DECORUM AND MORALE: Nicole Potter

E-mail: pottercats@aol.com

SALES AND MARKETING: Stephen Ward, PA-C,

Bob Egbert, PAC, Tom Matherly, PA-C

MODERATORS/AUDIO/VISUAL: LCDR Irwin Fish, PA-C

SAPA JOURNAL STAFF Editor: Major John F. Detro, MPAS, PA-C

E-mail: john.f.detro@us.army.mil

COMMITTEES SCHOLARSHIPS/AWARDS

LTC-R Donald Parsons, PA-C (Chair)

COL -R Sherry Morrey, PA-C CW4-R Marvin W. Cole, PA-C COL-R Donald Black, SP, PA-C

POC for Captain Sean P. Grimes Physician Assistant Educational Scholarship Award)

E-mail: donald.black@se.amedd.army.mil

SAPA HISTORIAN William Long, PA-C

MINORITY AFFAIRS Karen McMillan, PA-C

PUBLIC EDUCATION Harold E. Slusher, PA-C

PROFESSIONAL WELLNESS Michael Champion, PA-C

LEGISLATIVE AFFAIRS Harold E. Slusher, PA-C

DELEGATES TO AAPA HOUSE OF DELEGATES Sherry L. Womack, PA-C (Chief Delegate)

Steven L. Briggs, PA-C

ACADEMY LIASON COL Pauline Gross, SP, PA-C E-mail: pauline.gross@us.army.mil

COMMUNICATIONS/ELECTRONICS Stephen Ward, PA-C

Irvin Fish, PA-C Bob Potter, PA-C

The SAPA Journal staff and SAPA Board of Directors encourages membership participation in this publication. Feel free to use this

forum to present your views on any topic you desire. The publication of clinical articles on any subject is also solicited, however, to reduce

our workload, we do request articles be presented typed, double-spaced format, and on CD, Microsoft Word format. The editor

reserves the right of final acceptance of articles as well as the right to serialize articles which are too lengthy to be included in a single issue.

Articles will be accepted via email.

The SAPA Journal is the official publication of the Society of Army Physician Assistants. The views and opinions expressed herein are not

necessarily those of the editors, SAPA, the SAPA Board of Directors or the Department of the Army unless explicitly expressed as such.

This is not an official Army Publication.