Non-battle Injury Research Articles

Health Data from Operation Resolute (Bosnia). Part 1: Primary Care Data

This paper describes routine sickness events occurring during Weeks 1-19 of Operation Resolute (Bosnia). The period covered is 20 December 1995 to 28 April 1996. Primary care data were collected...

U.S. Army Vector Control (Preventive Medicine) Operations during Operation Restore Hope, Somalia

During the early stages of Operation Restore Hope, three U.S. Army preventive-medicine detachments were deployed to Somalia to counter the disease and non-battle injury threat to deployed forces. The activities of these units are discussed, with an emphasis on the entomology detachment. The preventive medicine (PVNTMED) threat facing deployed forces was considerable, and probably greater than that encountered in any recent operation. This threat is discussed, as are the methods used by the PVNTMED detachments to counter the threat. Vector control and pest management operations of the entomology detachment are highlighted, and how they related to the health and comfort of deployed personnel. These operations ranged from routine mosquito surveillance to large-area vector-control missions using a helicopter-slung pesticide dispersal unit. A variety of "lessons learned" are also discussed, focusing on individual and company-level PVNTMED measures.

A Proposal for Improving the Acquisition of Medical Data in Forward Field Hospitals

Current medical recording policy in forward field hospitals adequately delineates battle and non-battle injuries and incapacitation from sickness or disease. Although useful for planning, such data do not often provide insights that could improve medical care. The author has gathered combat medical data in Vietnam and Desert Storm and concludes that by providing and storing carbon copies of admission and operating room logs plus operative notes, discharge summaries, and the clinical record cover sheet, the Army Medical Corps would have a permanent, analyzable account of field hospital medical activities. Digital copying and disk storage of these specific documents would greatly increase their usefulness, especially if coupled with standard data formats for admission and operating logs and a simple diagnosis coding scheme to aid data retrieval either by hand or computer. Medical data should be made available to concerned forward medical personnel because in past wars some of the most insightful medical observations of immediate help to the sick and wounded have been made by individual physicians analyzing medical data at the front.

A system to project injury and illness incidence during military operations

Modeling of medical resource requirements during military operations requires projections of disease and non-battle injury (DNBI) and wounded-in-action (WIA) rates. Historical data were extracted from unit diaries of infantry and support troops deployed during four previous combat engagements. A planning tool (FORECAS) was developed that uses the statistical distributions of DNBI and WIA incidence from previous operations to simulate injury and illness arrival rates under future scenarios. Output of the simulated data reflects the nuances of the empirical data.

The Impact of Infectious Diseases on the Health of U.S. Troops Deployed to the Persian Gulf During Operations Desert Shield and Desert Storm

An assessment was conducted of the impact of infectious diseases on the 697,000 U.S. troops deployed to the Persian Gulf during 1990-1991 in Operations Desert Shield and Desert Storm. The incidence of nonbattle injuries, including infectious diseases, during this conflict was lower than during previous wars involving U.S. military personnel. The major reported causes of morbidity were generally mild cases of acute diarrheal and upper respiratory disease. The most unexpected outcome was the lack of arboviral infections, particularly sandfly fever, and the occurrence among U.S. troops of 12 cases of visceral leishmaniasis due to Leishmania tropica. The fact that infectious diseases were not a major cause of lost manpower, in sharp contrast to the experience among military personnel in World War II, can be attributed to a combination of factors: the presence of a comprehensive infrastructure of medical care, extensive preventive medicine efforts, and several fortuitous circumstances. Beneficial conditions that may not be present in future conflicts in this region include isolation of most combat troops to barren desert locations during the cooler, winter months, which provided the least favorable conditions for transmission of arthropod-borne diseases.

Comparisons of Disease and Nonbattle Injury Incidence across Various Military Operations

Daily rates of disease and nonbattle injury (DNBI) incidence were analyzed and compared for four ground operations: Okinawa, Korea, Vietnam, and the Falklands. Average daily DNBI admission rates among operations ranged from 0.99 per 1,000 strength to 4.03 for combat troops. Average daily admission rates for support troops ranged from 0.71 to 1.15. Among combat troops, between 26 and 38% of DNBI presentations were of a nature that precluded returns to their unit due to a medical transfer; among support troops, less than 17% were not returned to their units due to transfers.

Preventing Disease and Non-Battle Injury in Deployed Units

Most military physicians know that disease and non-battle injuries (DNBIs) have historically caused more death during war than battle injury. Most DNBIs are preventable, but many unit surgeons and physician assistants, especially at battalion/squadron and brigade/wing level, may not have had the benefit of preventive medicine training or experience. The authors present a logical and thorough framework that all unit surgeons can use to organize their preventive efforts.

Environmental medicine research to sustain health and performance during military deployment: Desert, arctic high altitude stressors

1. 1. Rapid deployment of military forces to extreme naturally harsh environments presents combatants with physiological, biological and psychological stresses that: (1) affect mood, motivation, activation; (2) result in decreased job performance; (3) make accidents more likely; (4) lead to illnesses and non-battle injuries; and (5) jeopardize mission success 2. 2. Laboratory and field research help develop countermeasures to assist military forces in adjusting to hot dry desert, hot wet jungle, cold arctic regions, and high terrestrial altitudes 3. 3. Proven preventive medicine techniques and advanced concepts for deployment preparation include: pre-acclimatization, anti-jet lag measures, hydration, selection of rations based on nutrition requirements, pharmacological intervention, field sanitation, work-rest-sleep scheduling, and controlling operational stresses.

The Relationship between Battle Intensity and Disease Rates among Marine Corps Infantry Units

Disease and non-battle injury (DNBI) rates were examined in conjunction with casualty rates across two Marine Corps operational scenarios, the assault on Okinawa and the Korean War. DNBI rates increased significantly with battle intensity among Marine infantry battalions involved in both operations. Highly significant positive correlations (p < 0.001) were evidenced between DNBI rate and wounded-in-action (WIA) rate, DNBI rate and killed-in-action rate, and DNBI rate and the preceding week's WIA rate among infantry units in both Okinawa and Korea. The severity of wounds and DNBI rate were also significantly correlated.

Comparisons of Wartime and Peacetime Disease and Non-Battle Injury Rates Aboard Ships of the British Royal Navy

Disease and non-battle injury rates were computed for ships of the British Royal Navy which were deployed during wartime and peacetime operations. The wartime sick list admission rates were lower aboard carriers, battleships, and cruisers when compared with their counterparts deployed in peacetime; rate differences for battleships and cruisers were statistically significant (p < 0.05). Several categories of disease also yielded significant differences in the wartime/peacetime contrasts. Infections and parasitic disorders aboard carriers, skin diseases aboard battleships, and skin diseases, injuries, and generative system disorders occurring on cruisers were all lower during wartime than on peacetime deployments. Illness rates also varied by ship type, with the lowest rates evidenced aboard carriers.

NBCI—Another threat to Operational Effectiveness?

Battle casualties are well recognised as a threat to Operational Effectiveness (OE) at times of conflict. Less well appreciated is that naturally occurring illnesses and injuries--Non-Battle Casualties and Injuries (NBCI)--continue to present at such times and will add to the problems of fighting the ship. This prospective study showed that NBCI resulted in a total of 1369 man days of lost personnel effectiveness among some 1738 RN servicemen during a 180 day deployment. That is just 0.42% of the possible man working days. This represents a loss of 4.3 man days per 1000 at risk per day in terms of fitness for Full Duties or 2.74/1000/day excluding those able to perform Light Duties. It is unlikely that such rates would affect the OE of the fighting units but they do represent a significant challenge to the Royal Naval Medical Service to continue to maintain the rates at such low levels, so that when aggregated to the numbers of battle casualties, OE is maintained as far as possible.

The Offensive-Defensive Distinction in Military Biological Research

Should medical researchers not participate in military biological research? The argument for falsely assumes there is no practical and moral distinction between offensive and defensive military biological research. In April 1989, the U.S. Army Medical Research and Development Command published the Final Programmatic Environmental Impact Statement (FEIS) that allowed the Biological Defense Research Program (BDRP) to continue. This document states that the purpose of the BDRP is to maintain and promote national defense with respect to potential biological wayfare threats. The major objectives of the BDRP are to develop measures for detection, treatment, protection from, and decontamination of potential biological warfare agents; and development of medical defenses, prophylactic vaccines and drugs, therapeutic measures, and management of protocols. The impact statement holds that, in addition to promoting the national defense through improvements in diagnostic methods and drug therapies, such a program would benefit the scientific community in general. Though supposedly dealing only with environmental concerns of the BDRP, the FEIS has created the opportunity for organizations and individuals to voice their opposition to the entire biological defense program. The document opens the way for arguments such as those raised by Jonathan King, Charles Pillar, or Barbara Hatch Rosenberg that the BDRP could foster the development of offensive weapons or encourage other nations to do so, thus spawning a biological weapons race. (1) This opposition stems from serious concerns about rDNA technology and genetically engineered microorganisms that have driven many biomedical scientists to refuse to participate in Pentagon-sponsored medical research. (2) Some researchers are even signing pledges not to engage knowingly in research they believe will further the development of biological agents. (3) (see p. 21) I want to consider here what I will call the participation argument, of which the Committee for Responsible Genetics (and Jonathan King as their spokesman) are perhaps the principle proponents. (4) Behind this argument is an assumption that no real distinction exists between offensive and defensive biological research. If this claim is true, then we must ask whether people who conduct this research for the military establishment face a healing-killing moral conflict. Further, if such a conflict exists, are researchers morally obligated to stop conducting military medical research to conform to the traditional moral standard of the healing professions? I think the assumption of the participation argument is false, though ensuring we do only defensive biological research is a moral imperative. Research Gains, Moral Questions The participation argument presents several problems. Superficially, it posits nonparticipation as the way to dissociate oneself from evil. This eliminates working within the system to generate reform, whistle-blowing on violations of agreements prohibiting offensive weapons developments, or developing experimental pathways that ensure biomedical scientists do not cross the line between offensive and defensive research. Moreover, complete dissociation from military biological research programs risks losing benevolent gains in vaccine development and drug therapies. American soldiers, who may be deployed worldwide, face a real threat from naturally occurring endemic diseases. In Europe, in the fall of 1944 during the Lorraine campaign American forces suffered the loss of 46,000 troops-the equivalent of three infantry divisions-to disease and nonbattle injury. (5) In Vietnam, from 1966 to 1969, disease accounted for every four of six hospitalizations (battle and nonbattle injury accounting for the other two). In fact, disease was the single greatest cause of morbidity during our involvement in the Vietnam War. (6) The medical situation in Vietnam could have been much worse if not for the efforts of military biological research and development. …

Disease and Non-Battle Injuries Among U.S. Marines in Vietnam

Abstract : This paper examines disease and non-battle injuries among U.S. Marines stationed in Vietnam between 1965 and 1972. Computerized records were searched for all hospital admissions among male U.S. Marines throughout the world during the study period, and rates of first hospitalization for Marines stationed in Vietnam were compared with rates of Marines stationed elsewhere. In all but two diagnostic categories, the risk of first hospitalizations among U.S. Marines stationed in Vietnam was significantly higher than it was for Marines stationed elsewhere. This was particularly true for infective and parasitic diseases, and symptoms and ill-defined conditions. Keywords: Reprints.

Cost of Non-Battle Injuries and Diseases as Compared to Battle Casualties

Cost of Non-Battle Injuries and Diseases as Compared to Battle Casualties