Guardsman Provides Health Care on the Ground and in the Air

By Army 2nd Lt. Crystal Farris, Idaho Army National Guard

BOISE, Idaho, Oct. 12, 2017 — As an undergraduate, Army Capt. Derek Derkacs was studying to be a registered dietitian. In his junior year, he began feeling as if he wanted to do something more with his career. His father suggested looking into becoming a physician assistant. Never having heard of the profession before, Derkacs said, he didn't put much thought into it until a year later when he cut his head.

"I got a sizable cut on my head, and a physician assistant took care of me at the ER," he said. "I remember asking him, 'You're a PA, and you're going to staple me up?' That's when I knew I wanted to be one."

Derkacs graduated from physician assistant school in 2006 from the University of Utah and later moved to Idaho. Today, he is a physician assistant at the Boise Veterans Affairs Medical Center, where he works in the surgical department and provides care for veterans from all branches of the military. He also serves part time in the Idaho Army National Guard as an aeromedical physician assistant for the 183d Aviation Battalion.

"When it comes to caring for a soldier and completing the mission, I will find any gap that needs to be filled," Derkacs said. "I'll sit out on a firing range, give vaccinations, splint an injured limb, suture a laceration, place a chest tube, read an [electrocardiogram] or write a prescription."

Derkacs is one of 11 Idaho Army National Guard physician assistants serving in seven units throughout the state. As commissioned officers, they handle a wide array of health care responsibilities in addition to their common soldier tasks, such as weapons qualification and land navigation.

"In the combat units, the physician assistant's focus is on conserving the strength of the force in wartime through individual medical readiness, sick call and trauma care, to include life saving measures," said Army Lt. Col. Heidi Munro, physician assistant for the office of the state surgeon. "Everything we do in training should be focused on preparation for that."

Special Relationship

The physician assistant profession originated in the 1960s to ease a shortage of primary health care providers that followed the Vietnam conflict. The first physician assistants were three former Navy hospital corpsmen. Today, many physician assistants continue to have prior medical training as former medics in the armed forces.

"Physician assistants are very multifaceted, because they are midlevel practitioners," Munro said. "Many of them have been medics, so the enlisted troops really relate to them as far as working and training with them. It is always a special relationship between medics and physician assistants."

While Derkacs had no prior military service before becoming a physician assistant, he worked with two Idaho Army National Guard medics and one Navy corpsman, which led his decision to join the Guard at age 31.

"I had students that I was a clinical preceptor for, and three of them had prior service," Derkacs said. "Just hearing about what they did as medics, taking care of soldiers as kind of a first-line intervention really stuck with me and impressed me. I felt it was something I needed to do before I got too old."

Derkacs entered the Idaho Army National Guard in 2011 as a physician assistant assigned to the 145th Brigade Support Battalion. There, he first learned what it meant to be a military physician assistant and how to work with other medical providers within the Guard.

He was reassigned to the 183d Aviation Battalion in 2012 and sent to flight surgeon school at Fort Rucker, Alabama, and he received training in aviation survival, flight physiology, aviation medicine programs and aviation operations and mishaps.

After graduating, Derkacs returned home to begin flying with his crew as a certified aeromedical physician assistant, one of four in the Idaho Army National Guard. In this position, he is responsible for managing the health care of the unit's pilots and flight crews.

"The best part about being a flight surgeon is that you make a big impact with medical readiness, and that's pretty cool," Derkacs said.

Medical readiness is the biggest aspect of Derkacs' job, and is necessary in keeping both pilot and crew fit to fly. This includes managing sick call and conducting flight physicals, involving screening for cardiovascular disease, vision and hearing loss, and back and neck problems.

In addition to these medical tasks, Derkacs must fly at least 12 hours every six months, like all flight crew members, and at least once a year on each of the Idaho Army National Guard's three airframes.

Integrated into Flight Crews

The Army dictates that aeromedical physician assistants be integrated into flight crews to give them a better understanding of what soldiers are exposed to in flight. It also helps in gaining the trust of crew members, which makes the soldiers more comfortable when approaching him with medical concerns, Derkacs said.

"Having a physician assistant as an active crew member in the aircraft benefits our organization because it gives him a real perspective of the environment crew members operate in," said Army Capt. Thomas Westall, commander of Headquarters and Headquarters Company, 183d Aviation Battalion. "This ultimately leads to improved aviation medical care."

Besides traditional drill weekends, physician assistants deploy with their units and participate in annual training events. They also have the unique opportunity to attend voluntary training events, both in and outside the country, that are only available to service members.

In September, Derkacs traveled with other soldiers and subject matter experts from the Idaho Army National Guard to Cambodia for nine days as part of the National Guard's State Partnership Program and worked with Cambodian soldiers to teach lifesaving skills.

"I've been thinking lately about stuff I've done with the Guard," Derkacs said. "I've had some really cool experiences and neat opportunities presented to me lately that I've taken advantage of, and really appreciate the ability to do, because I'm a physician assistant in the Guard."