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Mission

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to ensure maximum wartime readiness by developing and operating a comprehensive community-based healthcare system maintaining the health and morale of Air Force members by providing or arranging timely, quality medical service for all active duty members, their families and beneficiaries. During contingencies, this healthcare system must rapidly expand, mobilize, and deploy to provide medical support to Air Force operations worldwide.

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AFMS is headed by

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Air Force Surgeon General, who is the medical staff advisor to the Secretary of the Air Force and Air Force Chief of Staff

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Surgeon General is advised by

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corps chiefs of the Medical, Dental, Nursing, Medical Service, and BSC.

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The BSC is made up of many different specialties; some of these are

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physician assistants, medical laboratory, pharmacy, diet therapy, physical therapy, and of course, optometry

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Ophthalmology falls under the

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Medical Service Corps (MSC).

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Each medical specialty within the BSC or MSC is headed by

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an associate chief who advises the chief, BSC, or MSC on current data for their particular specialty

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Within the medical facility, the commander, also known as

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the Director

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the commander, also known as the Director, Base Medical Services (DBMS), has the overall responsibility for all

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activities and medical resources of the unit

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the commander, also

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delegates authority to carry out specific functions within the medical facility. The size and authorized/assigned personnel of the facility dictate if other services or functions are included.

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Each medical group (MDG) usually has four subordinate squadrons

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1. Medical Support Squadron. 2. Medical Operations Squadron. 3. Aerospace Medicine Squadron. 4. Dental Squadron.

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Medical groups over 600 authorizations may have a

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Surgical Operations Squadron if required due to mission requirements

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Medical groups over 1000 authorizations may also have a

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Diagnostics and Therapeutics Squadron, if required

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MDGs, but only have two subordinate squadrons. This would occur if the MTF has less than

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100,000 visits per year, but is still designated as a group to maintain consistency with the other organizations on the base

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Matrixing means

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assigning individuals across functional areas to improve service and support of medical care. The need to matrix manpower occurs when personnel are permanently assigned to one squadron, but perform their regular duty wholly or substantially in direct support of another squadron.

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This concept allows commanders flexibility in aligning personnel with special skills to those parts of the organization requiring their dedicated support. This promotes an integrated team approach by aligning manpower closer to supported functions.

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Matrixing

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At the present time, there's only one

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medical wing (MDW)—Wilford Hall Medical Center

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objective medical group (OMG) organizational structure is designed to

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provide greater integration of operation and support functions with a clearer chain of command

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The benefits of the OMG are

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focuses medical services on patient needs, improves your ability to compete in a business case/managed care environment, and provides a better management framework for our MTFs without adversely impacting our readiness mission

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Three organizational structures are approved for Air Force-wide implementation of the OMG

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1. Medical groups with four subordinate squadrons (fig. 1-1). 2. Medical groups with two subordinate squadrons (fig. 1-2). 3. Medical squadrons with four functional flights (fig. 1-3).

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Medical squadrons are assigned to

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groups with functionally similar operations

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flight is either

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numbered or functional.

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numbered flight is the

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lowest organized structure (level) in the Air Force. Its administrative characteristics are like those of a squadron.

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functional flight is

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part of a squadron and composed of elements performing specific missions. The establishment of functional flights is aligned by product or service-lines;

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Elements are

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the smallest, cohesive collection of personnel in the performance of a specific role or mission Alignment of elements under a particular squadron is a local option with the approval made by the MDG commander.

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breakdown of the four squadron systems established within the OMG structuring

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Medical Operations. • Medical Support. • Aerospace Medicine. • Dental Squadron

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If the MTF isn't large enough to be formed as a group, it will be formed as

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squadron and the squadrons just listed will become flights (i.e., medical operations flight, medical support flight, etc.).

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The medical operations squadron provides or arranges

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full scope of preventive and clinical health care services for the defined population. The squadron also assesses the health care needs and expectations of the population it serves

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the medical operations squadron

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plans, organizes, operates, evaluates, and improves its comprehensive system of health care services

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In addition, the medical operations squadron develops

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processes to provide seamless, customer-focused access, assessment, diagnostic services, preventive and treatment services, education, and continuity in all care settings for health maintenance--as well as acute and chronic management of disease and injury. Personnel of the medical operations squadron support information requirements of beneficiaries, staff, and management. They also develop programs to continuously analyze and improve system performance. This includes measures of customer satisfaction, clinical outcomes, costs, and effectiveness of all key processes

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describes a typical medical operations organization

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Medical Services Surgical Services Maternal/Child Care

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Medical Services /medical operations organization.

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Family practice. • Primary care. • Internal medicine. • Mental health. • Medical nursing units. • Emergency room. • Acute care service. • Physical therapy service

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Surgical Services/medical operations organization

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Anesthesia. • Surgery suite. • General surgery. • Surgical subspecialties, such as ophthalmology. • Surgical nursing units.

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Maternal/Child Care/medical operations organization.

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Obstetrics/gynecology. • Pediatrics. • Inpatient obstetrics. • Newborn nursery, to include the preparation of birth certificates. • Pediatric nursing units.

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Separate mental health functional flights will be established under

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medical operations squadron at select MTFs

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Mental health service-lines include

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Clinical services (psychiatry, psychology, and social work). • Separately identified inpatient facilities. • Specialized treatment functions (alcohol and drug rehabilitation). • Family advocacy.

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medical support squadron provides

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diagnostic and therapeutic services, resource management (financial and manpower), TRICARE (managed care), medical logistics, medical information systems management, and personnel and administration support for the MDG.

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Resource Management

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Plan, program, and allocate manpower and funds. In addition, they perform billing and collecting, data analysis, workload accounting, and other related functions.

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TRICARE

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Responsible for planning, developing, and implementing the MTF managed care program to include beneficiary and provider services, analysis and utilization management, and interaction with the regional managed care program

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Medical Logistics

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Provide materiel, facilities, equipment, maintenance, and services. In addition, they manage war reserve materiel and transportation for the medical mission

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Medical Information Services

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• Composite Health Care System (CHCS). • Military Health Care Medical Information System (MHCMIS). • Retrospective Case Mix Analysis System (RCMAS). • Local area network (LAN) and wide area network (WAN). • Automated forms and publications. • Automated medical records.

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Diagnostic and Therapeutic

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Responsible for diagnostic, preventive, therapeutic, education and food services for patients, providers, and other customers.

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Personnel and Administration

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Tasked to provide and arrange for all personnel, administrative, educational, and training needs for the MDG.

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Nutritional medicine flight

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provides dietetic services for patients and staff, including food production and service activities, clinical nutrition management services, nutritional education, subsistence management, and cost accounting

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Aerospace medicine squadron

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tasked to support the operational Air Force by enhancing the health of its people, protecting the environment, and anticipating medical contingencies. In essence, aerospace medicine squadron personnel provide a comprehensive preventive medicine program.

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Flight/Missile Medicine

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Provide care to flying and operational duty personnel. Optometry generally falls under this flight.

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Health Promotions

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Responsible for wellness and illness prevention. These members manage the health and wellness centers that provide assessments, evaluations, and programs designed to improve quality of life and reduce illness of active duty and civil servant populations

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Public Health

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Provide programs designed to communicate workplace and environmental risks and hazards. Military public health is the center for education, prevention, and intervention of communicable, environmental, and occupational illnesses

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Bioenvironmental Engineering

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Charged to ensure regulatory compliance in our industrial and community environments. Through effective sampling, analysis, and monitoring, bioenvironmental engineering flight personnel constantly survey for chemical, physical, radiological, and biological threats to air, water, and ground

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Dental squadron

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personnel implement and maintain comprehensive programs for the prevention and treatment of dental disease, thus ensuring maximum personnel readiness and optimal oral health. In essence, the MDDS members ensure a dental health program integrating quality, cost, and access for qualified beneficiaries.

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Clinical Dentistry

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Provide diagnostic and preventive services, deliver comprehensive dental treatment, and ensure professional oversight in support of the dental squadron. In essence, they're responsible for ensuring an Air Force full of healthy teeth and gums.

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Dental Laboratory

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Fabricate dental prostheses and other appliances to support local treatment needs

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Dental Support

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Provide support in matters relating to personnel management, logistics, records, reports, publications, correspondence, training, and patient data.

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In September 1917, the military services standardized

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lenses and frames for use by military personnel; however, glasses were still purchased through the PX

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At the beginning of World War II,

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military services provided glasses to the troops only when required by visual defects caused in the line of duty

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In January 1943

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US military base optical shop was established in England; however, jobs beyond the base optical shop's capability were still contracted to local London firms

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By the early 1940

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need for military opticians was so great that an optical course was established at the US Army Medical Field Service School, Fort Sam Houston, Texas

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optometry and ophthalmology clinics support

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defense of the country by maintaining the visual health and efficiency of all military members (active and retired) and other eligible personnel.

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ophthalmic clinic's capabilities are

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dependent on the resources available in the medical facility, but generally the clinics are responsible for the prevention, detection, treatment, or referral (in the case of an optometry clinic) of eye problems

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Preventive measures are accomplished through

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visual analysis by the health care provider and through the vision conservation program

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Detection of visual anomalies, while still in their early stages, is usually accomplished by

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vision screenings conducted in local schools or offered in the clinic as part of the eye examination.

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Treatment of vision problems are performed with

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appropriate ophthalmic devices, orthoptics (visual training), or by referral to another clinic for medical, surgical, or psychiatric treatment

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USAF installation should provide the following optometry services:

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Routine exams/refractions. • Treatment or referral of ocular disorders. • Glaucoma detection/visual field (VF) testing. • Spectacle fitting, ordering, dispensing, adjustment, and repair. • Prescription verification/duplication. • Occupational vision program (ordering prescription safety glasses). • Contact lens services. • Driver's license exams. • Vision screenings (for schools and health fairs). • Vision training procedures.

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a large USAF installation should provide the following ophthalmology services

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Routine exams/refractions. • Treatment of ocular disorders. • Glaucoma detection/visual field (VF) testing. • A and B scans. • Major and minor surgical services. • Medically indicated contact lens services. • Vision training procedures.

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In 1992, the Chief of Staff of the USAF directed all AFSs to develop

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career field education and training plan (CFETP). The CFETP for the ophthalmic AFS is designed to provide management with the framework and guidance necessary for planning, developing, managing, and conducting career training programs.

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The CFETP plan

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plan provides a training guide for the career field to identify mandatory and optional skill-level training individuals must receive during their career progression

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The CFETP

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identifies the specific training and education individuals will receive during each phase of their career. In this way, the plan enables ophthalmic personnel to keep pace with future technological advances within the career field.

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4V0X1 1st

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Functional grouping—Medical

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4V0X1 2nd

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Career field family—Ophthalmic (think "V" for vision).

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Third 4V0X1

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Career field subdivision. Officers are identified with a letter while enlisted AFSCs carry a number in this column; 4V0 signifies enlisted personnel in the ophthalmic career field

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Fourth 4V0X1

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Skill level of the AFS. This skill level may be shown as 1, 3, 5, 7, or 9.

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1

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Airman at the helper level (in technical school).

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3

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Semiskilled or an apprentice (graduated technical school).

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5

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Journeymen (experience and career development course (CDC)).

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7

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Advanced or craftsman level (experience and CDC).

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9

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Superintendent level, 4V090 (lots of experience!).

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Fifth 4V0X1

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The fifth digit identifies enlisted specialties and specific expertise.

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An individual with a chief enlisted manager (CEM) code has an AFSC

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4V000. CEMs are only awarded to Chief Master Sergeants (CMSgt) or CMSgt selectees

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Often, the highest ranking CEM will be selected for the position

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Air Force career field manager (AFCFM) in each specialty

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The AFCFM consults with and advises the

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ssociate chief on enlisted issues, concerns, and the career field.

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fully qualified journeyman, you'll administer ophthalmic patient care, using various procedures and equipment, including:

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performing visual tests including visual acuity, cover test, pupillary testing, color vision, depth perception, visual field charting, and tonometry, or other procedures like eye patching, keratometry, fundus photography, and so forth. 2. Ordering, dispensing, fitting, and repairing military spectacles. 3. Instructing patients on contact lens procedures. 4. Assisting aircrew members with their military-approved contact lenses and, in some circumstances, the night vision goggle program. 5. Assisting personnel in the occupational vision (safety glasses) program. 6. Recording patient case history. 7. Instilling approved ophthalmic drugs as directed by a doctor.

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Administration supports patient care and your administrative responsibilities include journeyman

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Initiating and maintaining records of eye clinic patients, patient accounting, and activity reports. 2. Ordering supplies or equipment, developing operating instructions (OI) or checklists, or assisting with the quality assurance (QA)/risk management (RM) program. 3. Maintaining a safe, sanitary clinic environment and ensuring the safe operation and maintenance of all ophthalmic equipment.

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To attain your 7 level, you must meet the following requirements

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Be a staff sergeant (E-5). 2. Complete 12 months of upgrade training (6 months for retrainees) and the 7-level CDC

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administrative duties craftsman's responsibilities

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1. Coordinates, monitors, and evaluates ophthalmic services and activities against established standards of patient care, policies and regulations. 2. Evaluates technical and administrative activities to determine methods of improving efficiency. Analyzes requirements for personnel, equipment, supplies, and other resources. 3. Makes resource recommendations. 4. Ensures compliance with inspection and safety procedures. 5. Requisitions and supervises the issue, storage, and security of ophthalmic materiel.

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ophthalmology personnel have the following responsibilities:

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1. Prepare patients for treatment. 2. Schedule surgery. 3. Complete consent forms. 4. Set up for patient pre-op testing. 5. Perform as surgical assistants during ophthalmic surgery. 6. Prepare injectable ophthalmic anesthetics and antibiotics. 7. Perform suture removal. 8. Obtain eye cultures. 9. Perform fluorescein angiography (fundus photography). 10. Assist the doctor as needed.

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At the 9-skill level, a superintendent isn't

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classified as optometry or ophthalmology because they're at a management level where the two career fields merge

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ophthalmic superintendent is tasked with

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1. Managing personnel, materiel, finances (budgets), equipment, administration, and other related activities. 2. Developing and improving the working environment to make it more cost effective, efficient, and productive in rendering quality patient care. 3. Coordinating optometry/ophthalmology technical and administrative activities to achieve quality health care programs. 4. Supervising training development for continuing health education. 5. Evaluating the adequacy of formal and clinical training programs, and recommending changes.

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The optometry AFSC—4V0X1—was authorized as a career field subdivision on

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1 January 1971

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Early in 1986, the ophthalmology career field (AFSC 4V0X1A) became

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the shredout (shred A) of the optometry career field

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All career fields have

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mandatory basic 3-skill level course

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The ophthalmic CFETP provides ophthalmic personnel

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a clear career path to success and instills vigor in unit level training

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CFETP consists

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two parts

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CFETP Part I

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provides information necessary for the overall management of training in the career field. It contains administrative details, a description of the specialty, the purpose and use of the CFETP, suggested career field progression, training decisions, skill level requirements, and resource constraints.

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CFETP Part II

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provides the specialty training standard (STS) and training course index. MAJCOMs may attach Air Force job qualification standards (AF JQS) to this plan. Supervisors and trainers at the unit level will use Part II to identify, plan, and conduct unit-level training commensurate with the overall goals of the plan.

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Formal training

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training consists of in-residence training, such as your 3-level tech school, and CDCs

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Formal training

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focuses primarily on task and subject knowledge. Task knowledge is the knowledge needed to perform a particular task safely, accurately, and effectively. It includes theories or principles common to a particular task, and even the detailed step-by-step parts of a task, if needed.

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Qualification training (job proficiency training

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increases hands-on skills while you're performing the duties and tasks on the job. It's the application of the knowledge you learned from formal training (technical school/CDC).

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STS is really Par

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II of the CFETP

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Your trainer must be appointed by

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the commander, already be certified on the tasks to be trained, and be trained on how to train others by attending the Air Force Training Course

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Trainer responsibilities.

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The trainer and supervisor may be the same individual. If necessary, the supervisor may assign someone else to provide the training. Trainers are selected based on their experience and ability to provide instruction to trainees. • Attend the Air Force Training Course. • Maintain required task qualifications. • Record task qualification according to prescribed instructions when a trainee performs a task to required standards. • Plan, conduct, and document training. • Develop evaluation tools. Evaluation responsibilities may be assigned to an equally qualified third party. Prepare and use teaching outlines or task breakdowns, as necessary. • Brief the trainee and supervisor on the training evaluation results.

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Certifiers will provide

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third-party certification and evaluation on tasks identified by the AFCFM

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The responsibility of the certifier is

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conduct additional evaluations and certify qualification on those designated tasks.

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Certifiers must

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Be at least a SSgt (E-5) with a 5-skill level or civilian equivalent. • Attend the Air Force Training Course. • Be capable of evaluating the task being certified. • Evaluate training and certify qualifications. • Use established training evaluation tools and methods to determine the trainee's ability and training program effectiveness. • Develop evaluation tools. • Brief the trainee, supervisor, and trainer on the training evaluation results. Identify the trainee's strengths and areas needing improvement. • When necessary, request assistance from the supervisor and unit training manager (UTM). • The certifier must be someone other than the trainer.

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your supervisor, who may also be your trainer or certifier, but

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NOT both

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There are two basic types of field evaluations

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field visit and correspondence methods

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Field visit method

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team of evaluators visits your work area between the fourth and sixth month following your graduation. During the visit, the evaluator talks with you, your supervisor, and anyone else having knowledge of your performance. They also observe your ability to perform the trained task(s). Again, they use the STS as the reference for evaluation.

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Correspondence method

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The second and most frequently used type of field evaluation is the correspondence method, which is used for nearly all types of training. This method uses basically two types of correspondence—field evaluation questionnaires (FEQ) and the graduate assessment surveys (GAS).

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Base education services office

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center for educational opportunities. The people there are the most qualified to guide you in your educational goals and planning

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Enrollment in CCAF occurs

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automatically upon completion of basic military training (BMT).

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Occupational instructor certificate

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available on completion of basic instructors course (BIC), successful completion of a teaching practicum (practice teaching), and possession of an associates degree or higher

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Trade skill certification

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1. Apprentice. 2. Journeyman. 3. Craftsman/Supervisor. 4. Master Craftsman/Manager. All of these are transcribed on a CCAF transcript.

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American Optometric Association (AOA)

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keeps a list of approved optometry-related courses. It has investigated and approved the J3ABR4V031 course at Sheppard AFB, Texas. All course materials in both the J3ABR4V031 course and CDC 4V051 meet the high standards of the AOA.

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For ophthalmology certifications contact

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Joint Commission on Allied Health Personnel on Ophthalmology (JCAHPO)

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CPO—contact

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AOA.

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CPOA—contact

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AOA.

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CPOT—contact

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AOA.

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American Board of Opticianry Certified (ABOC)—contact

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ABO.

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Certified Ophthalmic Assistant (COA)—contact

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JCAHPO.

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Certified Ophthalmic Technician (COT

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contact the JCAHPO.

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Certified Ophthalmic Medical Technologist (COMT

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contact the JCAHPO.

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Certified Ophthalmic Surgical Assistant (COSA

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contact the JCAHPO.

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two primary concepts involved in preventing accidents

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• Understand the general principles of safety. • Identify unsafe situations or conditions

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Discipline Imposed

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Is much like BMT where someone else told you how, what, when, where, and how often. Not much thinking is required, and the discipline to do the right thing is imposed on you.

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Discipline Task

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This is where you do a job using procedures in the way they were taught to you.

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Discipline Self-discipline

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Requires you to think, act, and govern your behavior. Selfdiscipline is necessary for safely administering optometric care. There won't always be someone watching over you and there won't always be specific, step-by-step instructions available

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unsafe practices

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• set the non-contact tonometer (NCT) safety lock or improper procedures.

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unsafe practices

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• cool glasses down after heating them in the frame warmer.

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unsafe practices

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• use the optician's table when inserting or removing screws from glasses.

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unsafe practices

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• clean floors after spilling frame warmer beads on it.

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unsafe practices

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• call in machinery that's loose or "not working quite right."

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unsafe practices

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• assist patients (especially the elderly or injured) in sitting down.

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unsafe practices

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• use a stationary-type chair or stool.

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unsafe practices

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• never recap needles.

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Mental fitness

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essential to performing your ophthalmic duties safely maintained by proper diet, exercise, and rest and is another element of personal excellence

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Hazard avoidance

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Anticipate the results of a "what if" situation. Know what potential hazards exist and then take the necessary steps to eliminate them.

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You can eliminate the potential for fire by

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keeping the three elements of combustion (fuel, oxygen, and heat) separated

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Environmental safety

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Keep exam and dispensing rooms uncluttered, having only the amount of equipment or supplies necessary. Don't make them into pseudo-storage areas. Wall hooks for clothing should be high enough to prevent eye injuries, yet accessible and convenient to the patient.

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Environmental safety

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Arrange storage areas so there's no congestion. Have equipment and supplies readily accessible. Store and label flammable or caustic materials in accordance with local directives.

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Environmental safety

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Administrative areas also have safety concerns. Close file cabinet and desk drawers after you use them. One scraped shin or tripping incident will usually reinforce this principle.

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Environmental safety

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Drink and eat only in approved areas. Never place a drink on a piece of electrical equipment, whether it's on or off. The results could be shocking. Eating in public (patient) areas is very unprofessional and presents a potential health hazard. Please do not place food in the same refrigerator as the medications.

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Preoperational planning

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Think ahead and try to anticipate problems before they occur.

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Horseplay

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unprofessional and can lead to serious injury or damage to government property

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Haste

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Working too fast can also be unsafe. Don't use shortcuts. Pace yourself so you can complete the task in an efficient and safe manner.

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Proper tools

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Always use the right tool for the job.

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Back injuries caused by improper lifting are

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one of the biggest causes of job absenteeism in the Air Force and civilian industry

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