Non-battle injury casualties during the Persian Gulf War and other deployments

Abstract

Objective: To review injury occurrence and to evaluate various injury surveillance systems used on recent deployments of U.S. military personnel.

Background: Injuries that occur in a deployed military force are more likely to have an immediate and detrimental effect on the military mission than those in garrison or training. These injuries have a direct impact on deployed personnel and unit readiness and consume limited field medical resources.

Methods: Data collected during four recent deployments were evaluated. Administrative databases established for the routine collection of death and hospital admissions were used to characterize mortality and morbidity in the Persian Gulf War. Surveillance teams deployed to Haiti, Somalia, and Egypt provided inpatient and outpatient data for those missions.

Results: Data collected by these surveillance systems are presented. Unintentional trauma accounted for 81% of deaths during the Persian Gulf War and 25% of hospital admissions. During operations in Somalia and Haiti, 2.5% to 3.5% of about 20,000 troops in each deployment sought medical treatment for an injury or orthopedic problem each week. In Egypt, injuries accounted for about 25% of all outpatient visits to medical treatment facilities.

Conclusions: Injuries were the leading cause of death and a leading cause of morbidity during recent deployments of U.S. troops. Comprehensive injury surveillance systems are needed during deployments to provide complete and accurate information to commanders responsible for the safety of the force. Recommendations for establishing such systems are made in this article.

Introduction

Injuries that occur in a deployed military force are more likely to have an immediate and detrimental effect on the mission than those in garrison or training. These injuries have a direct impact on personal and unit readiness and consume limited field medical resources.

The deployment environment contains myriad opportunities for injuries to occur. Although similar opportunities may be present in garrison or on exercises, the deployed service member is more likely to be fatigued, exposed to dangerous materials, physically and mentally stressed, working in unfamiliar surroundings, and placing less emphasis on safety rules and procedures.

The mechanization of the Army, especially the use of motor vehicles, combined with improved treatment and control of many infectious diseases, have increased the relative importance of non-battle injuries (NBIs) during deployments.1 During the First World War, NBIs were the fourth leading cause of admission after respiratory system, infectious, and digestive system diseases.2 They ranked third in the Second World War2, 3 and Korea.2, 4 In the Vietnam War, NBIs were the leading type of casualty.5 A review of U.S. Navy and Marine Corps injury casualty data show that, in deployments this century, injury casualty rates—both battle and non-battle—have remained constant while disease casualties have declined dramatically.5

Despite the increasing importance of injuries, there are relatively few published articles on the epidemiology of injuries in deployed military forces.5, 6, 7, 8, 9, 10 This historical information can be used to predict losses due to NBIs and help identify the number and composition of medical units to be deployed.4 Although published articles may be useful in planning future operations, commanders need the routine surveillance and reporting of injuries and other conditions during a deployment. Complete, accurate, and timely surveillance data provide the essential medical intelligence to effectively prevent and treat injuries.

An investigation of recent deployments is especially important because the composition of the forces was significantly different from those of World War II, Korea, and Vietnam. These differences included a greater female presence in the theater of operations,11 a greater reliance on reserve and National Guard units,11 and reduced alcohol use by troops.12

In this paper, the epidemiology of NBIs on U.S. Army soldiers deployed to four separate operations—encompassing combat, humanitarian assistance, and a training exercise—is described.