ORIGINAL ARTICLES - Defense Technical Information Center

1 ORIGINALARTICLESA uthorsaloneareresponsibleforopinionsexpr essedinthecontributionandforitsclearance throughtheirfederalhealthagency, ,175,7:469,2010 DiseaseandNonbattleInjuriesSustain !dbya ,MCUSA*; ,MCUSA*;CPTB rianWaterman,MCUSA*;LTCKentDeZee,MeUSA*; COLRobBurks,QMUSAf; ,MCUSAtABSTRACTB ackground:Alongitudinalcohortanalysisofd iseasenonbattleinjuries(DNBI)sustainedby a :Adescriptiveanalysiswasundertakentoeval uateforDNBI casualtycarestatisticsincurredbya (BCT)duringa :Ofthe4,122soldiersdeployed,therewere1,3 24 DNBI with5 ( )deaths,208( )medicalevacuations(MEDEVAC),and1,111( ) , ,comparedwithmales,hada significantlyincreasedinci-denceraterati oforbecominga (95% , ).Of47femalesoldiersreceivingMEDEVAC35(7 4%) ( )andpsychiatricdisorders( ) , ,000combat- , :Musculoskeletalinjuriesandpsychiatricdi sordersaccountedfor74%ofthetotalDNBI casualties,and430 suicideratenearlyfourtimesgreaterthanpre viouslyreported, :(1)enemyaction,whichbydefinitioninclude snotonlybattleinjuriesbutalsobeingcaptur ed;(2)disease;(3)nonbattleinjury;(4)dese rtion;and(5) ,diseaseandnonbattleinjury(DNBI)hasresul tedinsignifi-cantlymorehospitalizationsa ndtimelostthanbattleinju-riesasa *WilliamBeaumontArmyMedicalCenter,EIPaso , ,NavalPostgraduateSchool,Monterey,CA,939 43.

2 :j:KellerArmyCommunityHospital,UnitedSta tesMilitaryAcademy,WestPoint, , ,July2010hasaccountedfor75%ofallhospital izationsduringtheini-tialphasesofOperati onIraqiFreedom(OIF).8 Overthepast6 yearsduringoIF, ,andover37, ,theintensityofcombat,8,11-14typeofunit, 12-14branchofmilitaryservice,pres-enceof endemicdiseases, , ,12, (BCT)is Documentation PageForm ApprovedOMB No. 0704-0188 Public reporting burden for the collection of Information is estimated to average 1 hour per response, including the time for reviewing instructions, searching existing data sources, gathering andmaintaining the data needed, and completing and reviewing the collection of Information . Send comments regarding this burden estimate or any other aspect of this collection of Information ,including suggestions for reducing this burden, to Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, ArlingtonVA 22202-4302.

3 Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to a penalty for failing to comply with a collection of Information if itdoes not display a currently valid OMB control number. 1. REPORT DATE JUL 2010 2. REPORT TYPE 3. DATES COVERED 00-00-2010 to 00-00-2010 4. TITLE AND SUBTITLE Disease and Nonbattle Injuries Sustained by a Army BrigadeCombat Team During Operation Iraqi Freedom 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) 5d. PROJECT NUMBER 5e. TASK NUMBER 5f. WORK UNIT NUMBER 7. PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES) William Beaumont Army Medical Center ,El Paso,TX,79920 8. PERFORMING ORGANIZATIONREPORT NUMBER 9. SPONSORING/MONITORING AGENCY NAME(S) AND ADDRESS(ES) 10.

4 SPONSOR/MONITOR S ACRONYM(S) 11. SPONSOR/MONITOR S REPORT NUMBER(S) 12. DISTRIBUTION/AVAILABILITY STATEMENT Approved for public release; distribution unlimited 13. SUPPLEMENTARY NOTES 14. ABSTRACT Background: A longitudinal cohort analysis of disease nonbattle injuries (DNBI) sustained by a largecombat-deployed maneuver unit has not been performed. Methods: A descriptive analysis was undertakento evaluate for DNBI casualty care statistics incurred by a Army Brigade Combat Team (BCT) duringa counterinsurgency campaign of Operation Iraqi Freedom. Results: Of the 4,122 soldiers deployed, therewere 1,324 DNBI with 5 ( ) deaths, 208 ( ) medical evacuations (MEDEVAC), and 1,111( ) returned to duty. The DNBI casualty rate for the BCT was ,000 soldier , compared with males, had a significantly increased incidence rate ratio for becoming a DNBI casualty (95% CI , ).

5 Of 47 female soldiers receiving MEDEVAC 35 (74%) were forpregnancy-related issues. Musculoskeletal injuries ( ) and psychiatric disorders ( ) were themost common body systems involved with DNBI casualties. Among the BCT cohort the psychiatric DNBI casualty rate and suicide rate were and per 1,000 soldier combat-years. The BCT cohortincidence rates for common musculoskeletal injuries per 1,000 combat-years were as follows: ankle , anterior cruciate ligament rupture and shoulder dislocation Conclusions: Musculoskeletalinjuries and psychiatric disorders accounted for 74% of the total DNBI casualties, and 430/0 of the DNBI casualties requiring subsequent MEDEVAC. The BCT cohort had a suicide rate nearly four times greaterthan previously reported, and selected musculoskeletal injury incidence rates were fivefold greater thanthe general population.

6 15. SUBJECT TERMS 16. SECURITY CLASSIFICATION OF: 17. LIMITATION OF ABSTRACT Same asReport (SAR) 18. NUMBEROF PAGES 8 19a. NAME OFRESPONSIBLE PERSON a. REPORT unclassified b. ABSTRACT unclassified c. THIS PAGE unclassified Standard Form 298 (Rev. 8-98) Prescribed by ANSI Std Z39-18 DiseaseNonbattleInjuriesSustainedbyanArm yBeTcohortinthisstudyis thereforeidealforanalysisbecauseit isnotonlytheprincipalcombatunitfortheArm ybutit alsoparticipatedina classiccounterinsurgencyoperation"TheSur ge,"makingit ' unitlevelhasyettobedefined,andthefewexis tingreportsthathavebeenpublishedonONBI fromOIFandfromOperationEnduringFreedom(O EF) ,14 StudiesofDNBI casualtystatisticsfromWorldWarI ,thepurposeofthisresearchis toconductalongitudinalcohortstudyofa largecombatunitinwhichthenumberofsoldier sis ,a longitudinalcohortstudyofa ( )

7 Comprehensivedatabasewascreatedbyque-ryi ngeachsoldier'selectronicmedicalrecordan dtheunit' ,startingat thepoint-of-entry,progress-ingthroughall ascendingechelonsofcare,andterminatingat ' eliminatethemultiplecountingofONBIat differentlevelsofcareforthesamemedi-calp roblems,aswellasto is importanttonotethatasoldiercanbecounteda sa "casualty" (combat)injuryis asfollows19 Anycasualtyincurredasthedirectresultofho stileactionsustainedincombatorsustainedg oingtoorfroma a hostileforceorwhatwasthoughttobea ,thefollowinginjuriesarenotbattlecasualt ies:(1)self-inflictedwounds(exceptinunus ualcases);and(2)woundsordeathinflictedby a ,droppedfromtherolls,oris a (died),thosetreatedandmedicallyevacuated (MEOEVAC)andthosetreatedandreturnedtodut ywithin72hours(RTD)( ).

8 20 TheONBI werefurtherana-lyzedandcategorizedbybody systemtoincludehead/eyes/ears/nose/throa t(HEENT),pulmonary,cardiovascular,gas-tr ointestinal,genitourinary,femalereproduc tive,musculo-skeletal,psychiatric,neurol ogic,dermatologic, :upperextremity, ,depression/mood,bipolar,post-traumatics tress,acutestressreaction,anxiety,adjust ment,sleepdisturbance,occupational,perso nality,psychotic, 'sONBI epidemiologyduringthecombatdeploymentinc ludedtheoverallONBI casualtyrateandselectedmusculoskeletalin cidenceratestoincludeanklesprain,plantar fasciitis,anteriorcruciateligament(ACL)r up-turesandfirst-timeshoulderdislocation (per1,000at-riskcombat-years). , (El-E4),seniorenlisted(E5-E9),warrantoff icers(WOI-W05)throughjunioroffi-cers(01- 03),andseniorofficers(04-06).

9 StatisticalanalysiswasperformedusingSAS( Cary,NC).Significancewassetatp< ,genderandONBI casualtycarestatistics,andbodyregioninju redandONBIMILITARYMEDICINE, , (DNBI)CasualtyCareStatistics(Ratesper1,0 00 Combat-Years[N]) (3) (109) *(594) *(706) (1) (84) *(449) *(534)01-03 (1) (11) (55) (67) (0) (4) (13) (17) (5) (208) (1111) (1324)*Withinthesamecolumnrepresentssign ificantdifference(p< ) ,diseasenonbattleinjury;died,diedofDNBI; MEDEVAC,medicalevacuation;RTD, ,000combatyears=(DNBI casualtyx 1,000n/(Nx ). 'sexacttestwasusedwhentherewasnota (IRR)aswellasconfidenceintervals(CIs)for thedemographiccategories,usingthedemogra phicsubsetwiththelowestincidentrate,warr antofficers(W01-W05)throughjuniorofficer s(01-03).RESULTSA totalof4,122(3,797male,325female) (range,18to52).)

10 ThemedianmilitaryrankwasenlistedgradeE4( SPC).In4,122deployedsoldiers(5,152soldie rcombat-yearsatrisk),therewere390combatc asualtiesand1, ,themajorityofcasualtiessustainedbytheBC Twerea resultofDNBI( ). ,324 DNBI casu-alties,5 diedoftheirDNBI,208wereMEDEVAC,and1,111( ) categorizestheDNBI casualtycarestatisticsandinci-dencerates per1, totalof1, , ,000combat-yearswereasfollows:diedofDNBI = ,MEDEVAC= ( ,000combat-years;p< )andtheE5-E9( ,000combat-years,p< )rankcat-egorywereata significantlyincreasedriskforbeinga DNBI casualtywhencomparedtothe01-03/W01-W05ca te-gory( ,000combat-years).BoththeE1-E4(p< )andtheE5-E9(p< )categoryhadsignificantlyhigherratesforb einga DNBI casualtyRTD, , ,000combat-years,respectively,MILITARYME DICINE, , (Ratesper1,000 Combat-Years[N]) (0) *(47) *(119) *(166) (5) (161) (992) (1158) (5) (208) (1111) (1324)*Withinthesamecolumnrepresentssign ificantdifference(p< ) ,whichhada , , , , ,com-paredwithmales,hada significantlyincreasedincidencerateratio (IRR)forbecominga DNBI casualty, (95% , ).