Injuries in the military: A review and commentary focused on prevention

https://doi.org/10.1016/S0749-3797(99)00169-5Get rights and content

Abstract

Background: In November 1996, the Armed Forces Epidemiological Board (AFEB) Injury Prevention and Control Work Group issued a report that cited injuries as the leading cause of morbidity and mortality among military service members. This article reviews the types and categories of military morbidity and mortality data examined by the AFEB work group and the companion Department of Defense (DoD) Injury Surveillance and Prevention Work Group. This article further uses the injury data reviewed to illustrate the role of surveillance and research in injury prevention. The review provides the context for discussion of the implications of the AFEB work group’s findings for the prevention of injuries in the military.

Methods: The AFEB work group consisted of 11 civilian injury epidemiologists, health professionals and scientists from academia, and other non-DoD government agencies, plus six military liaison officers. Injury data from medical databases were provided to the civilian experts on the AFEB work group by the all-military DoD Injury Surveillance and Prevention Work Group. The AFEB work group assessed the value of each database to the process of prevention and made recommendations for improvement and use of each data source.

Results: Both work groups found that injuries were the single leading cause of deaths, disabilities, hospitalizations, outpatient visits, and manpower losses among military service members. They also identified numerous data sources useful for determining the causes and risk factors for injuries. Those data sources indicate that training injuries, sports, falls, and motor vehicle crashes are among the most important causes of morbidity for military personnel.

Conclusions: While the work group recommends ways to prevent injuries, they felt the top priority for injury prevention must be the formation of a comprehensive medical surveillance system. Data from this surveillance system must be used routinely to prioritize and monitor injury and disease prevention and research programs. The success of injury prevention will depend not just on use of surveillance but also partnerships among the medical, surveillance, and safety agencies of the military services as well as the military commanders, other decision makers, and service members whose direct actions can prevent injuries and disease.

Introduction

In November 1996, the Armed Forces Epidemiological Board (AFEB) Injury Prevention and Control Work Group issued a report that cited injuries as the leading cause of morbidity and mortality among military service members.1 This finding was not surprising since i njuries are also the leading cause of deaths and less severe health outcomes for comparable groups of young civilian Americans.2, 3, 4 The work group also reviewed military injury research that has identified causes and risk factors for injuries and tested prevention strategies.

The AFEB work group concluded that the top priority for injury prevention must be the formation of a comprehensive medical surveillance system. They recommended that surveillance data be routinely used to prioritize and monitor injury and disease prevention and research programs. In addition, the work group defined the types of partnerships necessary to implement successful prevention programs. A complete chronology of the work group’s investigation can be found at the beginning of this supplement.5 The work group’s recommendations are consistent with those discussed in the injury and public health surveillance literature.6, 7, 8, 9

In this paper, we review the types and categories of morbidity and mortality data examined by the AFEB and DoD work groups and by authors in the current medical literature and suggestions on how such data contribute to each step of the public health process of injury prevention and control. We discuss the key recommendations and conclusions of the AFEB work group and, most importantly, the creation of a comprehensive military medical surveillance system. This paper also explores future actions that might result from the work group’s findings, including a description of the partnerships necessary to implement successful prevention programs.

Section snippets

The public health process

The AFEB work group recognized that a systematic process is necessary to successfully reduce injuries and other public health problems in a population.7, 10 Likewise, a systematic process for evaluating DoD databases was deemed necessary. The work group chose a five-step public health approach as the framework for evaluating the value of military medical information systems for injury prevention and control. The five steps of the process, which were adapted from other sources,6, 10, 11, 12 are

Discussion

After examining data on the health of military service members similar to that reviewed in this article, the AFEB work group concluded that injuries are the most important health problem confronting U.S. military forces. The findings of the work group revealed not only the size of the injury problem but also the richness of medical data maintained by all the military services and its availability for injury prevention purposes. The results of the work group’s examination1, 14, 17, 18, 20, 22

Summary

The primary conclusion of the AFEB work group was that injuries in the military currently pose the most significant threat to the health and readiness of the U.S. Armed Forces. This article and preceding articles5, 14, 17, 18, 20, 22 in this supplement show how the AFEB work group arrived at this conclusion. The AFEB report and the articles in this supplement also illustrate how existing military data sources offer great value to the entire process of injury prevention and control. However, to

Acknowledgements

The extraordinary efforts of Ms. M. Barbara Weyandt and Ms. Judith B. Schmitt of LB&B Associates, Inc., made publication of this article and others in this series possible. They coordinated the writing and revisions of all papers in this supplement on injuries in the military. In addition, they produced many of the graphs and tables in this paper, as well as others. Their personal investment in and dedication to seeing the process of publishing this article and the others completed was the

References (49)

  • Injury in Americaa continuing health problem

    (1985)
  • L.A Fingerhut et al.

    Injury chart book

    (1997)
  • Healthy People 2000

    (1991)
  • S.M Teutsch

    Considerations in planning a surveillance system

  • S.B Thacker et al.

    Future directions for comprehensive public health surveillance and health information systems in the United States

    Am J Epidemiol

    (1994)
  • J.L Weeks et al.

    Preventing occupational injury and disease

    (1991)
  • L.S Robertson

    Injury epidemiology

    (1992)
  • Mercy JA, Rosenberg ML, Powell KE, Broome CV, Roper WL. Public health policy for preventing violence. Health Affairs...
  • B.H Jones et al.

    Physical training and exercise-related injuriessurveillance, research and prevention in military populations

    Sports Med

    (1999)
  • Atlas of injuries in the U

    S. Armed Forces. Mil Med

    (1999)
  • Helmkamp JC, Kennedy RD. National mortality profile of active duty personnel in U.S. Armed Forces. Washington, DC: U.S....
  • J.M Rothberg et al.

    Life and death in the U.S. Army

    JAMA

    (1990)
  • S Neel

    Medical support of the U.S. Army in Vietnam 1965–1970

    (1973)
  • U.S. Army Center for Health Promotion and Preventive Medicine. Medical Surveillance Monthly Report, November...
  • Cited by (99)

    • Military personnel with self-reported ankle injuries do not demonstrate deficits in dynamic postural stability or landing kinematics

      2017, Clinical Biomechanics
      Citation Excerpt :

      Musculoskeletal injury is a significant health concern for the United States military resulting in lost duty time, disability, hospitalization, high healthcare costs, and ultimately impacts military readiness (Jones et al., 2000; Lauder et al., 2000).

    • Non-battle injuries among U.S. Army soldiers deployed to Afghanistan and Iraq, 2001–2013

      2017, Journal of Safety Research
      Citation Excerpt :

      In 1992, falls represented the second highest rate (5.6 per 1000 person-years) of all hospitalized injuries in the Army (Smith, Dannenberg, & Amoroso, 2000). Military vehicle accidents are also among the leading causes of morbidity for U.S. military personnel (Jones, Perrotta, Canham-Chervak, Nee, & Brundage, 2000). From 2004 to 2007, motor-vehicle accidents made up 8.3% of non-battle injury in Iraq (MacGregor, Mayo, Dougherty, Girard, & Galarneau, 2012).

    View all citing articles on Scopus
    1

    Dr. Jones is currently affiliated with the National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia.

    View full text