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The Burden of Deployment-Related Non-battle Injuries (NBIs) and Their Impact on the Musculoskeletal System

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Book cover Musculoskeletal Injuries in the Military

Abstract

Despite the large volume of news reports focused on battle-related injuries resulting from the recent conflicts in Iraq (Operation Iraqi Freedom, OIF) and Afghanistan (Operation Enduring Freedom, OEF), these injuries are only the tip of the iceberg. Soldiers have traditionally been two to five times as likely to be hospitalized or medically evacuated from combat zones due to disease and non-battle injuries (DNBIs) than for injuries directly related to combat, and trends in the distribution of DNBIs have significantly shifted over the last century. Recent data suggest that 83 % of medical evacuations from OIF and OEF were due to DNBIs and that 34.8 % of these were due to non-battle injuries (NBIs) compared with 48.2 % that were due to disease. When only examining medical evacuations due to DNBIs, 58 % were due to disease while the remaining 42 % were due to NBIs, with the majority of these injuries impacting the musculoskeletal system. The data also suggest that participation in sports and physical training are a leading cause for these NBIs. Those serving in the Army and Marine Corps, as well as younger soldiers and those in the junior and senior enlisted ranks, appear to be at the greatest risk for NBIs during deployment. Though many of these injuries are likely preventable, there is limited data available on the efficacy or effectiveness of injury prevention interventions among soldiers deployed in support of OIF or OEF. The purpose of this chapter is to provide an overview of the burden that NBIs pose during military operations and deployments. We will discuss historical trends in the distribution of NBIs and also review the most recent data on NBIs from the Gulf War and the conflicts in Iraq and Afghanistan. Finally, we will discuss the prevention of NBIs during military deployments.

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Abbreviations

BCT:

Brigade Combat Team

DNBI:

Disease and Non-battle Injury

FORECAS:

Medical Casualty Forecasting System Software

NBI:

Non-battle Injury

OIF:

Operation Iraqi Freedom

OEF:

Operation Enduring Freedom

ODS:

Operation Desert Storm/Shield

TRAC2ES:

US Transportation Command’s Regulating and Command and Control Evacuation System

TRANSCOM:

US Transportation Command

WWI:

World War I

WWII:

World War II

References

  1. Belmont PJ, Jr, Goodman GP, Waterman B, DeZee K, Burks R, Owens BD. Disease and nonbattle injuries sustained by a US Army Brigade Combat Team during operation Iraqi freedom. Mil Med. 2010;175(7):469–76.

    Google Scholar 

  2. Hauret KG, Taylor BJ, Clemmons NS, Block SR, Jones BH. Frequency and causes of nonbattle injuries air evacuated from operations Iraqi freedom and enduring freedom, U.S. Army, 2001–2006. Am J Prev Med. 2010;38(Suppl 1):S94–107.

    Google Scholar 

  3. Hoeffler DF, Melton LJ, 3rd. Changes in the distribution of Navy and Marine Corps casualties from World War I through the Vietnam conflict. Mil Med. Nov 1981;146(11):776–779.

    Google Scholar 

  4. Holland BD, Long AP. Cost of non-battle injuries and diseases as compared to battle casualties. Mil Med. Jul 1955;117(1):46–50.

    Google Scholar 

  5. Johnson BA, Carmack D, Neary M, Tenuta J, Chen J. Operation Iraqi freedom: the Landstuhl regional medical center experience. J Foot Ankle Surg. 2005;44(3):177–183.

    Google Scholar 

  6. Jones BH, Perrotta DM, Canham-Chervak ML, Nee MA, Brundage JF. Injuries in the military: a review and commentary focused on prevention. Am J Prev Med. 2000;18(Suppl 3):71–84.

    Google Scholar 

  7. Palinkas LA, Coben P. Disease and non-battle injuries among U.S. Marines in Vietnam. Mil Med. 1988;153(3):150–155.

    Google Scholar 

  8. Waterman BR, Schoenfeld AJ, Holland CA, Goodman GP, Belmont PJ, Jr. Burden of musculoskeletal disease and nonbattle nontraumatic injury in both war and disaster zones. J Surg Orthop Adv. Spring 2011;20(1):23–29.

    Google Scholar 

  9. Zouris JM, Wade AL, Magno CP. Injury and illness casualty distributions among U.S. Army and Marine Corps personnel during Operation Iraqi freedom. Mil Med. 2008;173(3):247–252.

    Google Scholar 

  10. Cohen SP, Brown C, Kurihara C, Plunkett A, Nguyen C, Strassels SA. Diagnoses and factors associated with medical evacuation and return to duty for service members participating in Operation Iraqi Freedom or Operation Enduring Freedom: a prospective cohort study. Lancet. 2010;375(9711):301–09.

    Google Scholar 

  11. Eaton M, Marshall SW, Fujimoto S, Gould PL, Poole C, Richardson DB. Review of non-battle injuries in air force personnel deployed in support of Operation Enduring Freedom and Operation Enduring Freedom. Mil Med. 2011;176(9):1007–14.

    Google Scholar 

  12. Goodman GP, Schoenfeld AJ, Owens BD, Dutton JR, Burks R, Belmont PJ. Non-emergent orthopedic injuries sustained by soldiers in operation Iraqi freedom. J Bone Joint Surg Am. 2012;94(8):728–35.

    Google Scholar 

  13. Withers BG, Craig SC. The historical impact of preventive medicine in war. In: Kelley PW, editor. Textbook of military medicine: military preventive medicine, mobilization, and deployment. Vol 1. Washington, D.C.: Office of the Surgeon General at TMM Publications; 2003:21–57.

    Google Scholar 

  14. Writer JV, DeFraites RF, Keep LW. Non-battle injury casualties during the Persian Gulf War and other deployments. Am J Prev Med. Apr 2000;18(Suppl 3):64–70.

    Google Scholar 

  15. Armed Forces Health Surveillance Center. Medical evacuations from operation Iraqi freedom/operation new dawn, active and reserve components, U.S. Armed Forces, 2003–2011.(MSMR). 2012;17(2):18–22.

    Google Scholar 

  16. Writer JV, DeFraites RF, Brundage JF. Comparative mortality among US military personnel in the Persian Gulf region and worldwide during operations desert shield and desert storm. JAMA. 1996;275(2):118–121.

    Google Scholar 

  17. Harman DR, Hooper TI, Gackstetter GD. Aeromedical evacuations from operation Iraqi freedom: a descriptive study. Mil Med. 2005;170(6):521–27.

    Google Scholar 

  18. Hauret KG, Jones BH, Canham-Chervak M, Bullock SH, Canada S, Knapik JJ. Frequencies and characteristics of medical evacuations of soldiers by air (with emphasis on non-battle injuries), operations enduring freedom/Iraqi freedom (OEF/OIF). Medical Surveillance Monthly Report (MSMR). 2004;10(3):8–12.

    Google Scholar 

  19. Hauret KG, Taylor BJ, Patel A, Kersellius G, Comer J, Jones BH. Sports injuries among US Army soldiers deployed to operations Iraqi freedom, New Dawn, and enduring freedom, 2001–2012. Paper presented at: Third International Congress on Soldiers’ Physical Performance; 18–21 August, 2014; Boston, MA.

    Google Scholar 

  20. Sanders JW, Putnam SD, Frankart C, et al. Impact of illness and non-combat injury during operations Iraqi freedom and enduring freedom (Afghanistan). Am J Trop Med Hyg. 2005;73(4):713–719.

    Google Scholar 

  21. Skeehan CD, Tribble DR, Sanders JW, Putnam SD, Armstrong AW, Riddle MS. Nonbattle injury among deployed troops: an epidemiologic study. Mil Med. 2009;174(12):1256–1262.

    Google Scholar 

  22. Blood CG, O’Donnell ER. A system to project injury and illness incidence during military operations. J Med Syst. 1995;19(6):457–64.

    Google Scholar 

  23. Lynch LC, Elliott CW, McMurry P. Disease and nonbattle injury forecasting. US Army Med Dep J. 1999;Jul-Sep(3):2–8.

    Google Scholar 

  24. Wojcik BE, Hassell LH, Humphrey RJ, Davis JM, Oakley CJ, Stein CR. A disease and non-battle injury model based on Persian Gulf War admission rates. Am J Ind Med. 2004;45(6):549–557.

    Google Scholar 

  25. Zouris JM, Blood CG. Medical resource planning for combat operations: utilizing percentile estimates as an alternative to the mean. J Med Syst. 2000;24(6):379–387.

    Google Scholar 

  26. Wojcik BE, Humphrey RJ, Czejdo B, Hassell LH. U.S. Army disease and nonbattle injury model, refined in Afghanistan and Iraq. Mil Med. 2008;173(9):825–835.

    Google Scholar 

  27. Withers BG, Erickson RL, Petruccelli BP, Hanson RK, Kadlec RP. Preventing disease and non-battle injury in deployed units. Mil Med. 1994;159(1):39–43.

    Google Scholar 

  28. Ruscio BA, Jones BH, Bullock SH, et al. A process to identify military injury prevention priorities based on injury type and limited duty days. Am J Prev Med. 2010;38(Suppl 1):S19–33.

    Google Scholar 

  29. Padua DA, Frank B, Donaldson A, et al. Seven steps for developing and implementing a preventive training program: lessons learned from JUMP-ACL and beyond. Clin Sports Med. 2014;33(4):615–632.

    Google Scholar 

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Correspondence to Kenneth L. Cameron PhD, MPH, ATC .

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Cameron, K. (2016). The Burden of Deployment-Related Non-battle Injuries (NBIs) and Their Impact on the Musculoskeletal System. In: Cameron, K., Owens, B. (eds) Musculoskeletal Injuries in the Military. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-2984-9_3

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  • DOI: https://doi.org/10.1007/978-1-4939-2984-9_3

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