Army Burden of InjuriesDefining the Problem and Prevention

BG Timothy AdamsAUSA, Washington Convention Center

6 OCT 2009

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Relative Burden of Injuries and Diseases, U.S. Army Active Duty, 2008

Source: Defense Medical Surveillance System, Armed Forces Health Surveillance Center, 2009 2

Army Deployment Injuries and DiseasesOIF Medical Evacuations, 2003 - 20081

1 Total evacuations: n= 38,619

Source: USACHPPM Deployment Injury Surveillance System

ICD

-9-C

M C

od

e G

rou

ps

3

Five Key Public Health Questions

1. Is there a problem and how big is it?

2. What causes the problem?

3. What works to prevent the problem?

4. Who needs to know and do what?

5. How effective is what we have done?

Five Steps of the Public Health Approach

1. Surveillance

2. Research & field investigations

3. Intervention trials & systematic reviews

4. Program and policy implementation

5. Public health evaluations & monitoring

4

Pe

rcent

(%

) o

f All

Ca

uses

Leading Causes of Injury Hospitalizations

U.S. Army Active Duty, 2008

5Source: Defense Medical Surveillance System, Armed Forces Health Surveillance Center, 2009

Leading Causes of Deployment Non-Battle Injuries

Army OIF Medical Evacuations, 2003-2008

Source: USACHPPM Deployment Injury Surveillance System 6

USACHPPM Top Ten Injury Prevention Priorities*

* Results of a prioritization process conducted by Army members of the DoD Health Affairs Military Injury Prevention Priorities Working Group, 2006

Rank Injury ProblemPrioritization

Score

1 Physical Training 34.0

2 Parachuting 31.8

3 Falls 30.6

4 Athletic Sports 28.4

5 Privately-owned vehicle accidents 27.2

6 Military vehicle accidents 26.2

7 Guns/explosives handling 26.2

8 Slip/twist/turn (near fall) 24.6

9 Tools/machinery 21.0

10 Non-traffic vehicle accidents 19.4

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Recommendations for Prevention

Cause Prevention Strategy Reduction in Rate

Physical Training Prevent overtraining PT injuries 30%-50%

Sports - Softball

- Basketball

Breakaway bases

Inside shoe ankle brace

Ankle sprain 95%

Ankle injuries 65-80%

MV Military Seat belts in HMMWV Deaths 80%

Falls/Jumps Research/Evaluations Needed

----------

Parachuting Parachute ankle brace Ankle injuries 50-80%

Guns & Explosives Research/Evaluations Needed

----------

Tools/Mach/Equip Research/Evaluations Needed

----------

Military Training Outside of boot brace Ankle injuries 70%

8

Injury visit rates among Army trainees, 2000-2008

9

0500

10001500200025003000350040004500

2000 2001 2002 2003 2004 2005 2006 2007 2008

Rat

e pe

r 1,0

00 P

erso

n Ye

ars

All Injuries Overuse Injuries

New PT Program

Source: Defense Medical Surveillance System, Armed Forces Health Surveillance Center, 2009

USACHPPM Injury Prevention Services & Products

Detection Surveillance & surveillance analysis

Response Field investigations Systematic scientific reviews of science Recommendations for policies and programs Evaluations of policies and programs

Dissemination Consultations & Information Requests (phone, e-mail, site visits) Lay information products (web, magazines, news articles, talks, etc.) Scientific information (tech reports, peer-reviewed publications, presentations, etc.)

Customers Examples: Training & Doctrine Command, Forces Command, Medical Command, Deputy

Assistant Sec’y of Army/Safety & Occupational Health, Army Combat Readiness/Safety Center, Assistant Sec’y of Defense/Health Affairs, Under Sec’y of Defense/Personnel & Readiness, Unit Commanders, other Fed Agencies

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Army Injury Prevention Partners and Activities

USACHPPM Lead for injury surveillance and prevention

Key Partners and Activities Army

Office of the Surgeon General Proponency Office for Rehabilitation & Reintegration

Musculoskeletal Action Plan (MAP) TBI Surveillance and Prevention

Army Medical Research and Development Command Army Combat Readiness /Safety Center

DOD Defense Safety Oversight Council

Military Training Task Force Deployment & Operations Task Force Joint Military Vehicle Safety Working Group

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The Public Health Approach

1. Surveillance

2. Research and field investigations

3. Intervention trials and systematic reviews

4. Program and policy implementation

5. Public health evaluations and monitoring

A problem this large & complex requires a systematic approach to prevention.

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Conclusions & Future Directions Keys to Injury Program Success

Routine use of surveillance data to identify & monitor problems Strategic planning and established priorities Credibility and durability of science derived from peer-reviewed publications Partnerships Quick response capabilities

Requirements for Future Success Disseminate injury data to MACOMs and units

for visibility for accountability

Wide adoption of evidence-based public health approach by Army and DOD Enhanced dissemination and training for Injury Prevention within Army and

DOD Establish DOD, Army, Installation and large unit committees to set priorities,

share information, and monitor success Enforcement of Safety and Injury Prevention standards

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Contact information and resources

Contact Information:

USACHPPM Injury Prevention Homepagehttp://chppm-www.apgea.army.mil/DEDS-Injury/

(410) 436-3534DSN 584-3534

Resources:

Physical Training Injury Prevention Toolboxhttp://chppm-www.apgea.army.mil/ptipt/default.aspx

Injury Prevention Through Leadership CourseAvailable through the PT Injury Prevention Toolbox homepage (above)

US Army Combat Readiness/Safety Center Knowledge Publicationhttps://safety.army.mil/Knowledge_Online/Default.aspx?alias=safety.army.mil/Knowledge_Online/October2009

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