PACAF Airmen use ACE medicine to successfully treat civilian medical in-flight emergencies

  • Published
  • By Tech. Sgt. Nick Wilson
  • Pacific Air Forces Public Affairs

(Editor’s note: This article is part one of a three-part series about in-flight medical support among Pacific Air Forces Surgeon General Team members.)


Multiple flights across the Pacific recently featured unforeseen medical emergencies occurring midflight.

Fortunately, two U.S. Airmen sprang into action, averting rising crises.

Lt. Col. Ross Graham, Deputy Chief, Medical Readiness Division, PACAF Surgeon General, and Maj. Michael Yim, PACAF SG international health specialist, provided in-flight emergency care on separate occasions, helping to save lives until their aircraft landed.

The distinctive in-flight responses of Graham and Yim exemplify how PACAF Airmen across the Indo-Pacific can push the envelope to be more diverse, ready, innovative, and lethal from the medical front.


In real-world in-flight medical emergencies, there is value in knowing the capabilities of available personnel; whether they are emergency-trained flight attendants or off-duty medical providers. Additionally, it’s important to assess any available physical resources that can be utilized by responders or volunteers in the scenario, according to Graham.

“Recognizing the value of diversity of experiences and perspectives creates better outcomes,” Graham said, who recently leveraged an off-duty paramedic passenger and a team of flight attendants to resolve an in-flight emergency. “You can have a very diverse skillset and knowledge base that you’re trying to work with, and you have to figure out everyone’s backgrounds very quickly. I used the flight attendants to help with emotional support, and I used the flight steward to communicate with the outside world and the airline medical control through the cockpit.”

In contrast to Graham’s event, Yim’s scenario dealt with international diversity in terms of providing aid to an Australian civilian on an international flight. Yim explained that each positive interaction between the United States military and Allied or partner nations helps to positively expand on that relationship between both countries.

“There’s a saying in Korea: ‘If there is a rice grain and there are many of them, it can become a mountain,’” Yim recited. “Credibility doesn’t just happen in one event. It’s a constant of small events that accumulates overtime.”


Yim and Graham’s in-flight responses to medical emergencies relates to readiness by illustrating the value of maintaining credentials, awareness of recent information, and mental preparation to be able to provide support anywhere, anytime.

“You need to be ready to really know when a situation might occur or if a situation that’s occurring might spin out of control,” Graham said. “You need to be ready to deal with whatever may happen, which ties back to good education and training. If you’re well educated, and well trained, then you’ve already mentally been through a lot of those situations, so you already have your playbook.”


Airmen have education, training and ideal practices in situations that allow them to hone that training. However, sometimes there are scenarios that trained procedures aren’t practical for based on situational factors and available resources. Graham explained that real-world experiences that aren’t ideal can often result in innovation.

“It goes back to the genesis of the Air Force; we’re a very innovative force,” Graham explained. “We’re creating and improvising all the time to make the mission happen.”

Both Graham and Yim had to think outside the box with their in-flight medical scenarios to solve medical problems with limited available resources.


Graham and Yim demonstrated lethality in both scenarios with their decisive initiative and respective abilities to “crush it” from a medical standpoint by supporting the team. In these instances, the team encompassed the affected civilian community, the present flight attendants, and the patients’ families.

“Obviously we don’t want to be lethal in the medical world, but we do want to be lethal in the sense that if you have a medical problem, we’re going to knock it out of the park,” Graham said. “People will say, ‘Hey, you are an expert at what you do.’”

Agile Combat Employment

Graham explained what medicine looks like to support ACE, and how he and Yim utilized ACE principles within their in-flight scenarios to save lives.

“The medicine on the plane is not exactly like the medicine I’m doing in the Emergency Department or in the clinic,” Graham said. “It’s a very different environment, just like ACE environments are very different from what we’re used to. In support of Agile Combat Employment operations we talk about Austere, Contested, Expeditionary medicine.  These two medical emergencies in the air fit with this ACE medicine concept.  They were Austere in the sense that we didn’t have the equipment and expertise usually available at our fingertips like we would on the ground.”

In terms of being Contested, Graham explained that while off-duty staff are not being attacked in flight, it’s contested in the medical sense because of limitations in communication. “Nobody is jamming us or anything like that, but it is contested in that you don’t have the normal communication chains that you would in a clinic or hospital,” Graham said. “And it does have that Expeditionary feel because you’re on an airplane going from one place to another with a limited equipment kit just like you might if you’re deploying. I think both of these events are great examples of ACE medicine. That’s what we do every day as we shift to support ACE operations in peer conflict.”