Military dermatologists complete their residency training at 1 of 3 large military medical centers across the country: Walter Reed National Military Medical Center (Bethesda, Maryland), San Antonio Military Health System (San Antonio, Texas), or Naval Medical Center San Diego (San Diego, California). While in training, army dermatology residents in particular fall under the US Army Medical Command, or MEDCOM, which provides command and control of the army’s medical, dental, and veterinary treatment facilities. Upon graduating from residency, army dermatologists often are stationed with MEDCOM units but become eligible for deployment with US Army Forces Command (FORSCOM) units to both combat and noncombat zones depending on each individual FORSCOM unit’s mission.
The process by which dermatologists and other army physicians are tasked to a deploying FORSCOM unit is referred to as the Professional Filler System, or PROFIS, which was designed to help alleviate the financial cost and specialty skill degradation of having a physician assigned to a FORSCOM unit while not deployed.1 In general, the greater the amount of time that an army medical officer has not been deployed, the more likely they are to be selected for deployment with a FORSCOM unit. For the army dermatologist, deployment often comes shortly after completing residency or fellowship.
In this article, we review the various functions of the deployed dermatologist and also highlight the importance of maintaining basic emergency medical skills that could be generalized to the civilian population in case of local or national emergencies.
THE FIELD SURGEON
With rare exceptions, the US Army does not deploy dermatologists for their expertise in diagnosing and managing cutaneous diseases. Typically, a dermatologist will be assigned to a FORSCOM unit in the role of field surgeon. Other medical specialties including emergency medicine, family practice, internal medicine, pediatrics, and obstetrics and gynecology also are eligible for deployment as field surgeons.2 Field surgeons typically are assigned to a battalion-sized element of 300 to 1000 soldiers and are responsible for all medical care rendered under their supervision. Duties include combat resuscitation, primary care services, preventive medicine, medical training of battalion medical personnel, and serving as the medical adviser to the battalion commander.1 In some instances, a field surgeon will be stationed at a higher level of care co-located with a trauma surgeon; in those cases, the field surgeon also may be expected to assist in trauma surgery cases.
ARMY DEPLOYMENT MEDICAL SYSTEM
To better understand the responsibilities of a field surgeon, it is important to discuss the structure of the army’s deployment medical system. The US Military, including the army, has adopted a system of “roles” that have specific requirements regarding their associated medical capabilities.3 There are 4 roles designated within the army. Role 1 facilities are known as battalion aid stations (BASs). Capabilities include initial treatment, triage, and evacuation, with a goal of returning soldiers to combat or stabilizing and evacuating them to a higher-role facility. Role 2 facilities are capable of providing a higher level of emergency care, including basic radiology, laboratory services, transfusion of blood products, and surgical interventions when co-located with a forward surgical team (Figure 1). Role 3 facilities, also known as combat support hospitals, have inpatient hospitalization capabilities including subspecialty surgery and intensive care. Role 4 facilities are fully capable medical centers located in the United States and other noncombat locations.3
Figure 1. A Role 2 battalion aid station in Afghanistan.