Injuries in the military: A review and commentary focused on prevention
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
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Dr. Jones is currently affiliated with the National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia.