ACN 118/20 - OCT 2020 UTILIZATION OF AEROMEDICAL PHYSICIAN ASSISTANTS (APA) IN THE COAST GUARD, UPDATE

ALCOAST COMMANDANT NOTICE CANCEL DATE 05 OCT 2021

R 061253 OCT 20
FM COMDT COGARD WASHINGTON DC//CG-7/CG-11//
TO ALCOAST
UNCLAS //N06410//
ACN 118/20
SUBJ: UTILIZATION OF AEROMEDICAL PHYSICIAN ASSISTANTS (APA) IN THE COAST GUARD, UPDATE
A. COMDT COGARD WASHINGTON DC 180954 JUN 19/ACN 062/19
B. Coast Guard Medical Manual, COMDTINST M6000.1 (series)
C. Health, Safety and Work-Life Service Center (HSWL-SC) Technical
Directive (TD) 2016-005 Provider Peer Review
D. HSWL-SC TD 2019-011 Advanced Practice Provider (APP) Practice
1. This ACN extends the provisions promulgated in REFs (A) while
REFs (B) and (C) are being revised. REF (D) provides procedural guidance
for these policies.
2. This ACN establishes updated policy regarding utilization and scope of
practice of Aeromedical Physician Assistants (APAs) and Designated Aeromedical
Physician Assistants (APA-Ds).
3. 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.
4. 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.
5. 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.
6. REFs (B) through (D) 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).
7. POC: CAPT Shane C. Steiner, Assistant Chief Medical Officer, Office of Health
Services, 202-475-5256, Shane.C.Steiner@uscg.mil.
8. Released by RADM Dana Thomas, Director, Health, Safety and Work-Life (CG-11).
9. Internet release is authorized.