WRIGHT-PATTERSON AIR FORCE BASE, Ohio -- If you are on active duty, a dependent, retiree or even an eligible Veterans Affairs patient in the Dayton area who needs specialized medical care, odds are you’re going to pay a visit to the doctors, nurses and other medical staff at Wright-Patterson Medical Center, one of the largest military treatment facilities in the Air Force.
WPMC is home to the 88th Surgical Operations Squadron, which performs an average of 2,500 surgeries in 10 operating rooms each year, in addition to over 60,000 outpatient visits, personifying the 88th Air Base Wing’s mission to “dominate the dirty work.”
The 88th Surgical Operations Squadron consists of six flights with areas of responsibility spanning a wide range of medical practice. Their mission is to prevent disease, promote health and optimize performance for all eligible patients.
“We have 17 surgical services that we support for over 67,000 beneficiaries in the area,” said Lt. Col. Lanette Walker, commander of the squadron’s Operating Room Flight. “If the patient can get here, then we can support them.”
With the exception of plastic surgery, the journey from doctor’s office to surgical suite starts with a referral from the patient’s primary care provider. Once that referral comes in, the patient will see a physician who specializes in whatever area of the body needs their attention.
General Surgery Flight
Despite its name, the General Surgery Flight practices two areas of medicine: general surgery and plastic surgery. General surgery primarily focuses on the abdominal region, which includes the stomach, intestines, liver and pancreas, in addition to skin diseases.
“To name just a handful, general surgery performs procedures such as hernia repairs, colonoscopies, gallbladder and appendix removal,” said Maj. Omar Carrasco, the General Surgery Flight commander. “Our surgeons provide 24/7 coverage and respond to patients in the emergency room that may need urgent surgery.”
As for plastic surgery, which involves altering or reconstructing the body, Carrasco said patients can get seen either by self-referral or one from a primary care provider. If a patient wants to self-refer, he or she needs to fill out a form in the Plastic Surgery Clinic and will be contacted by a provider once it has been reviewed.
“Plastic surgery provides services from scar revisions and skin or breast cancer surgery to breast reduction or augmentation,” he said. “Cosmetic surgeries and injectable services such as Botox are also available after consultation with one of our surgeons.”
Carrasco said such cosmetic procedures provide crucial practice for surgeons who may one day be called upon to perform reconstructive surgery on personnel wounded in combat.
“Both general and plastic surgery play a crucial role in wartime environments,” he said. “We will provide optimal care to our warfighters if and when these surgeries are needed.”
Orthopedic and Neurosurgery Flight
Underneath the skin, the Orthopedic and Neurosurgery Flight specializes in orthopedics, treatment of the musculoskeletal system, and neurology, which addresses the nervous system, including the brain and spinal cord. The flight also specializes in podiatry, which treats feet and lower-leg issues.
“Here, we see injuries related to the joints, bones, spine, brain, feet and more,” said Tech. Sgt. Russell Wians, the Orthopedic and Neurosurgery Flight chief. “As you get older, you develop arthritis, joint pain and things like that. At a certain point in everyone’s life, they will most likely need us.”
Although not doctors or nurses, the enlisted Airmen in Wians’ flight are orthopedic-surgical technicians, specially trained by the Air Force to assist.
“We are the doctor’s extra set of hands in the operating room,” Wians said. “We help with positioning the patients, retraction, suturing and whatever else they need from us. A big part of what we do is anticipating their needs.”
The flight’s Airmen also have all undergone an additional six weeks of training in the making of casts and splints. Wians said this allows them the unique opportunity to serve in a clinical setting, as well as a surgical one, which has its own benefits.
“I enjoy working with my hands,” he said. “In the operating room, once you reach a certain rank, you get taken out to do administrative work. With orthopedic technicians, you can stay in patient care for longer. That is the most rewarding part of our job.”
OB-GYN Flight
The doctors, nurse practitioners, midwives and medical technicians of the OB-GYN Flight deal in matters relating to the health of women and girls. This scope of practice includes obstetrics, the care of pregnant women from conception to childbirth, and gynecology, which deals with the female reproductive system.
“We provide care to women in all stages of life, from reproductive and prenatal to menopausal,” said Lt. Col. (Dr.) Halei Wong, the OB-GYN Flight commander. “We keep our active duty mission-ready by listening to their concerns and making sure they are taken care of.”
Unlike most other women’s health clinics, Wong said her flight has a staff of subspecialists that offer women full-scope gynecologic care. It has a reproductive endocrinologist, who specializes in treating infertility; gynecologic oncologist, who specializes in female-reproductive system cancers; and urogynocologist, who specializes in the treatment of pelvic-floor conditions.
All these doctors completed an additional three-year fellowship on top of medical school and residency.
“This is unique because we are all in-house,” Wong said. “If we refer you, we are referring you to a specialist here instead of sending you in-network and hoping you find somebody.”
Additionally, Wong’s staff members are trained on the latest in technology: Three surgeons operate a robotic-laparoscopic platform and two can perform vaginal natural orifice transluminal endoscopic surgery, otherwise known as vNOTES. Both methods are less invasive than traditional open surgery.
In 2022 alone, Wong said the OB/GYN Flight performed 248 surgeries and delivered 217 babies. She added that her flight also hosts a walk-in contraception clinic, which is available to all eligible beneficiaries every Friday.
“This clinic is a hidden gem of women’s health care in Dayton,” Wong said. “Nowhere else are you going to find everybody under one roof, offering patients all the cutting-edge treatment options that we do. This is a wonderful place to practice.”
Surgical Specialties Flight
As the metaphorical “odd one out,” the Surgical Specialties Flight serves as a catchall for practices that do not fit with the other flights in the squadron: urology, ophthalmology, and ear, nose and throat.
“ENT deals with most disorders above the collarbone,” said Maj. (Dr.) Matthew Ward, Surgical Specialties Flight commander. “We deal with a lot of nasal and sinus disease, neck and thyroid disease and ear disorders. Urology focuses on disorders of the genitourinary tract including bladder, kidney and prostate disorders. Ophthalmology handles surgical disease of the eye including laser-eye surgery, which is a big focus for the active-duty population.”
The flight’s Laser Eye Clinic performs these surgeries in their own suite instead of the hospital’s operating rooms. In the past year, they have performed over 800 of these procedures.
Ward said the Air Force places a particular emphasis on providing laser-eye surgery to improve Airmen’s vision and remove the dependence on corrective lenses. This can immensely improve warfighter readiness in locations where access to care is limited.
“There are many career fields in the Air Force that require good visual perception and are not conducive to having corrective lenses,” he said. “If you lose or break your glasses while in a deployed environment, you may not be able to perform your job. Laser eye fixes that.”
Much like the Orthopedic and Neurosurgery Flight, each Surgical Specialties Flight practice has at least one enlisted surgical technician who specializes in that field and has undergone additional training. Ward stressed their importance to mission success.
“It is immensely helpful,” he said. “Without them, the efficiency of our clinic drops dramatically. Having somebody who knows exactly what instruments we use, our techniques, the decisions we make and why, it improves the efficiency and the quality of care that we can provide.”
Anesthesia Flight
Once the provider recommends surgery, patients will likely have their first introduction to the Anesthesia Flight. Lt. Col. Corey Norton, the unit’s commander, said his team is heavily involved in the surgical process from start to finish.
“We perform pre-admission testing so the patient is cleared to come back for surgery,” he said. “On the day of surgery, the patient comes to our Ambulatory Procedures Unit and we escort them to a bed, run through some paperwork, make sure their consents are signed, get an IV started and get them ready to go to the operating room.”
Keeping a patient unconscious and pain-free during surgery is a delicate balancing act performed by a specially trained doctor known as an anesthesiologist (or certified registered nurse anesthetist). For this reason, no matter what procedure is being performed, there will always be an Anesthesia Flight provider present.
After the surgery is over, Norton’s flight will escort patients to the Post-Anesthesia Care Unit and his nurses and medical technicians keep them under close observation while they wake up.
“This is the phase everyone traditionally understands as the recovery room,” he said. “If they are going home the same day, we get them something to eat and drink to make sure they can do that, make sure they can urinate if that is required, and get them the medications and discharge instructions they are going home with. If they are staying a couple of days, when they are ready, we will move them up a floor and get them admitted for that.”
The Anesthesia Flight also runs WPMC’s Outpatient Pain Management Clinic. Although trained in administering anesthesia for surgery, anesthesiologists are ultimately experts in the therapies and medications necessary to alleviate pain.
Norton said the clinic is run by four physicians, a nurse, X-ray technician, physical therapist, physical therapy technician and licensed clinical social worker who provides emotional support to patients in chronic pain.
“Pain itself is not just, ‘Oh, this hurts,’” Norton said. “Pain alters everything, physiologically and behaviorally. Depression and anxiety set in, which makes the pain worse, and it can become a cycle. Our social worker helps them through that.”
Operating Room Flight
The sixth and last flight in the 88th Surgical Operations Squadron is the team behind the scenes when the magic happens: the Operating Room Flight. Responsible for providing nurses, equipment, supplies and surgical technicians, it is in constant coordination with the other flights to help manage each unique surgery.
Walker said that although patients do not get to see the impact her flight has on their care, unit personnel are essential to the success of each procedure and often required to stay well past traditional working hours.
“We are like the ‘Wizard of Oz’ because we are behind the curtains,” she said. “I call it ‘controlled chaos’ because you never know what you are going to get when you go into a surgery. You have to be ready at all times. It’s not a 9-to-5 job; it’s a 6-to-whenever job.”
Technicians keep everything professional to make sure the patient is taken care of, said Master Sgt. Tamara Bruinink, the Operating Room Flight chief.
“There are hundreds of surgeries with hundreds of surgical instruments,” she added. “A technician could be supporting general surgery one minute and a neurology or ENT case the next. You are on your feet eight to 12 hours a day running around, sometimes more, and Airmen do not get bonuses or overtime.”
Walker emphasized that her flight not only helps with surgeries, but also serves as patient advocates while keeping an eye on everyone’s safety in the room.
“Before we go to surgery, the operating room nurse and patient have an in-depth conversation about what their plan is, what procedure they are having done, complications that could arise and making sure all of their questions are answered,” she said.
“It is a lot of communication. During surgery, we need to have situational awareness of the room. How is the patient doing with anesthesia? How is the surgery going? Are we documenting everything properly? It is pretty in-depth and very, very important that we know what we are doing because of what can go wrong.”
The flight also runs the Sterile Processing Department, which performs the critical task of sterilizing all instruments used in the hospital. Bruinink said this is unique because her Airmen are dually trained to work in SPD while also serving as surgical technicians.
“On the civilian side, those would be two completely different jobs,” she added. “It is a lot of work, expertise and responsibility.”
People first, mission always
The 88th Surgical Operations Squadron’s mission is taking care of people, and without people, the overall mission fails.
“In the Air Force, we take care of our own,” Ward said. “We are here to support active duty and what they do, and taking care of families, veterans and retirees is a part of that."
Squadron leaders also said that being able to watch patient outcomes improve is what helps them through the long hours and keeps them motivated to do their job every day.
“People are going to get sick and need medical care,” Carrasco said. “We see patients when they are at their worst, and the most rewarding part of our job is saying goodbye to them when they have fully recovered from surgery.”
Added Wians: “The best part of our job is the end of a patient’s time with us. When they follow up six months later and you see how their life was completely changed, knowing you were part of that, it just makes your whole day.”