ACN 062/19 - JUN 2019 UTILIZATION OF AEROMEDICAL PHYSICIAN ASSISTANTS (APA) IN THE COAST GUARD

ALCOAST COMMANDANT NOTICE                                    CANCEL DATE  17 JUN 2020

R 180954 JUN 19
FM COMDT COGARD WASHINGTON DC//CG-7/CG-11//
TO ALCOAST
UNCLAS //N06410//
ACN 062/19
SUBJ:  UTILIZATION OF AEROMEDICAL PHYSICIAN ASSISTANTS (APA) IN THE COAST GUARD
A. Coast Guard Medical Manual, COMDTINST M6000.1 (series)
B. Coast Guard Aviation Medicine Manual, COMDTINST M6410.3 (series)
C. Coast Guard Air Operations Manual, COMDTINST M3710.1 (series)
D. Coast Guard Safety and Environmental Health Manual, COMDTINST M5100.47 (series)
E. Coast Guard Aeromedical Policy Letters (2012 revision)
F. Coast Guard Aeromedical Technical Bulletins
G. Health Services Quality Improvement Implementation Guide Eight
H. HSWL-SC Technical Directive, Tactics, Techniques and Procedures for Advanced Practice
Provider (APP) Practice
1. This ACN establishes updated policy regarding utilization and scope of practice of
Aeromedical Physician Assistants (APAs) and Designated Aeromedical Physician
Assistants (APA-Ds).
2. This ACN applies to active duty and reserve Coast Guard (CG) providers, other Uniformed
Services providers detailed to the Coast Guard, CG civilian providers, and contract providers
to the maximum extent practicable so long as it does not conflict with their contract.
Aviation Medicine Provider (AMP) is the collective term for all types of these providers.
3. First preference will be given to flight surgeons for aviation medicine operational
requirements for designated flight surgeon billets, but Flight Surgeon Trainees (FSTs),
Aviation Medical Officers (AMOs), and APA-Ds may be utilized to meet requirements for aviation
medicine duties. Only a fully qualified FS may serve as the senior medical officer on a mishap
analysis board, an Aeromedical Consultation Advisory Board, serve as the Aviation Medicine
Standardization Officer, or serve as the Commander, PSC, reviewer. Specific supervisory practices
will be determined at the local level for non-designated aviation medicine providers, and current
policies for co-signature remain for these non-designated providers. FSTs, AMOs and APA-Ds are
authorized to complete the Medical Recommendation for Flying Duty, Form DD-2992, without an FS
co-signature. These providers will also complete and sign aviation physical examinations and
submit directly to Commander PSC for review and approval. Designated aviation medicine providers
will be fully responsible only for the care they provide. Adverse privileging action will not be
taken against collaborating physicians for APA-Ds unless involved in the patient care episode not
meeting the medical standard of care, or in cases where the collaborating physician did not
reasonably make him or herself available for consultation. For APA-Ds not collocated with the
collaborating flight surgeon, the flight surgeon will at a minimum make quarterly site visits,
although monthly is preferred. In addition, a physician who has a collaborative practice
agreement with an APA-D will have no more than two supervisory and/or collaborative practice
agreements with advanced practice providers. Requests for exceptions to policy will be routed
to the Health, Safety and Work-Life Service Center Operational Medicine Division.
    a. REFs (A) through (F) will be updated to reflect these changes, which will be released
within the next year. In general, all references to the term FS will be replaced with Aviation
Medicine Provider (AMP).
    b. The minimum aviation medicine staffing requirements matrix will be inserted into
REF (C) Appendix (B). The following language will follow the matrix: “The AMP’s evaluation,
Commissioned Officers’ Effectiveness Report (COER) for Public Health Service officers, and
the Officer Evaluation Report (OER) for CG officers, will be the usual mechanism for
recommending placement or removal of an AMP by either the Health, Safety and Work-Life
Directorate, or the CG unit’s command. When the staffing standard is not able to be met by
available qualified personnel, alternates will be recommended and approved through a process
of collaboration between COMDTs (CG-112), (CG-711), and the relevant District
or Area Commander. COMDT (CG-11) retains final authority."
    c. REF (G) is hereby cancelled. This will be replaced by REF (H).
4. POCs: CAPT Frederick C. Riedlin, Chief, Office of Aviation Forces, COMDT (CG-711),
202-372-2201, Frederick.C.Riedlin@uscg.mil; and CDR Charlene Criss, Advanced Practice
Provider Force Manager, COMDT (CG-1121), 202-475-5183, Charlene.R.Criss@uscg.mil.
5. Released by RDML M. Ryan, Assistant Commandant for Capability and RADM D. Thomas,
Director of Health, Safety and Work-Life.
6. Internet release is authorized.