Operational Tempo Research Articles

Opioid Prescription Reduction after Dentoalveolar Surgery-A Success Story in the Recruit Training Environment.

Given the public health toll exacted by the Opioid Crisis, it is important for providers in all disciplines to examine their opioid prescribing patterns to see where opioid reduction strategies can be effectively employed. Limiting the impact of the Opioid Crisis on active duty service members is a critical component of maintaining a ready fighting force. One avenue for reducing the potential for opioid diversion and abuse is developing and implementing non-opioid postsurgical pain management strategies that both provide adequate pain relief and also ensure an expedient return to full duty. Dentoalveolar surgeries performed by oral and maxillofacial surgeons to maintain operational dental readiness are a good example of common procedures necessitating post-procedural pain medications and convalescent days impacting availability for full duty. The providers at US Navy Recruit Training Command's oral surgery clinic undertook a process improvement initiative to reduce opioid prescriptions after dentoalveolar surgery. This change was accompanied by a concerted education effort aimed at both providers and patients on the benefits of avoiding opioids as well as the importance of strict adherence to a standardized medication dosing regimen for efficacious non-opioid pain control consisting of maximum doses of ibuprofen and acetaminophen taken every six hours. No increase in convalescent time off and no increase in postoperative visits related to pain control were noted. In our experience, eliminating routine post-procedure opioids for dentoalveolar surgery was a viable strategy for reducing the potential for opioid diversion and abuse among our patients with no negative impact on the operational and training tempo of the associated command.

NBACC's Scientific Research and Operational Posture During the 2020-2021 COVID-19 Pandemic.

The National Biodefense Analysis and Countermeasures Center (NBACC) is a national resource established to understand the scientific basis of the risk posed by biological threats, and to analyze evidentiary material from bioterror or biocrime events. Like many other U.S. research institutions, the emergence of the SARS-CoV-2 virus, and rapid development of the COVID-19 pandemic allowed only a few short weeks of preparations before infectious disease controls could be implemented. Due to the nature of its mission, the NBACC must be available on a 24/7 readiness posture to support bioforensic casework from the Federal Bureau of Investigation (FBI). It also serves to provide the Department of Homeland Security (DHS) with key scientific data to assess the hazard from biological agents, especially in this instance to inform the national response to COVID-19. These factors caused the operational tempo to significantly increase. To accomplish our mission during a national emergency, laboratory staffing levels needed to be maintained at prepandemic levels. As a result, the Battelle National Biodefense Institute (BNBI) leadership took significant actions to prevent COVID-19 exposure and transmission within the workforce. These multiple actions included engineering changes to the facility, stockpiling of personal protective equipment and consumable products, educating the staff on the signs and symptoms of COVID-19, reducing the population of the nonlaboratory staff, and the completion of a comprehensive risk assessment to quantify the risk of COVID-19 infection for all NBACC staff. These early actions, used in tandem, were successful in maintaining a healthy and stable workforce so that BNBI's research objectives could be met.

Sex, military occupation and rank are associated with risk of anterior cruciate ligament injury in tactical-athletes

IntroductionAnterior cruciate ligament (ACL) injury is common within the US military and represents a significant loss to readiness. Since recent changes to operational tempo, there has not been an analysis...

Войны будущего в свете опыта прошлого

The rise of international tensions revitalizes discussions on potential scenarios of military struggle. The related literature focuses primarily on the evolution in the armed forces and suggests contradictory conclusions on possible developments. One approach focuses on the rising costs for generating a modern force, which encourages states to be cautious regarding its deployment. The other concentrates on the growing lethality and precision of long-range weapons, increasing the tempo of operations. The article seeks to place these competing claims in the context of political aims of the adversaries. It also highlights the role of negotiations with local elites in consolidating gains on the battlefield, underappreciated in recent debates. Using the qualitative comparative analysis, the article reviews the record of military campaigns conducted by Russia and the U.S. since the Cold War. It seeks to acquire lessons from these past engagements for potential armed standoffs in the future. The analysis demonstrates that common expectations of rapid military is applicable only to the instance of confrontation pursuing limited political aims. In many cases, states engage in warfare with decisive political aims. Outcomes on such conflicts critically depend on the ability of the winning side to legitimize its rule through deals with powerbrokers on the ground. Meanwhile, the technical dominance plays limited role in defining military and political success. It is often compensated through asymmetric means available even to backward actors. The record of recent decades also emphasizes the growing role of city guerilla, used by a weaker side to shift fortunes in confrontation.

Operational Curriculum and Research Initiatives: Shaping the Future of Military Medicine.

The current operational tempo and transitions in the structure of the military health system demands a renewed commitment to operational medicine readiness. There is an official mandate as well as the practical necessity to increase operational readiness within the medical corps. There is also a need to continue the scholarly evaluation of military medicine through research to ensure the progression of evidence-based medical care for the war fighter. Military graduate medical education (GME) has been threatened by budget cuts and lack of understanding of its value. This article reviews the literature on operational medicine curriculums and makes recommendations to restructure current military medicine training to produce operationally prepared clinicians who are informed in operationally focused research principles. During early medical training operational curriculum cements military identity, fosters military leadership skills, provides practice of scenarios unique to military medicine, and connects learners to experienced mentors. There have been several versions of curriculum development in various GME programs observed from a literature search; however, the curriculum overall is fragmented and there is no universal implementation. Studies have shown that deliberately mapped longitudinal curriculums can be well integrated into a existing medical curriculum. Multiple studies also suggest that military GME is a large component of the production of operational-themed medical research and is vital for continued advancements. Value-based analysis performed by multiple sources have found that the initial increased cost of a military medical school education and GME becomes cost-effective based on increased retention, deployments, and filling of leadership billets. Access to existing operational training structures that have well-established programs should be increased, and individual GME program curriculums should be modeled on those that have shown proven success with a focus on operational training, leadership, and research.

Beyond Limb Salvage: Limb Restoration Efforts Following Remote Combat-Related Extremity Injuries Optimize Outcomes and Support Sustained Surgical Readiness.

As the combat operational tempo of the military conflicts in Iraq and Afghanistan has declined over the last decade, there has been a decrease in the number of patients requiring acute limb salvage. In their place, a growing population of patients with persistent functional deficits, pain, and inadequate soft tissue coverage stemming from prior limb salvage strategies have returned to our institution seeking revision surgery. Herein, we examine our institution's evolving surgical approach to extremity reconstruction from 2011 through 2019, culminating in the development of our limb restoration concept. We also discuss the impact of this orthoplastic approach on the acute management of complex extremity trauma and its role in providing sustained surgical readiness during interwar years. We retrospectively reviewed all limb reconstructive procedures performed at our tertiary care military treatment facility between September 1, 2011 to December 31, 2019 to characterize the trends in extremity reconstruction procedures performed at our institution. Cases were identified as limb restoration procedures if they involved secondary/revision reconstructive procedures designed to optimize function, treat pain, or improve the durability of the injured extremity following initial reconstruction efforts. Nearly 500 limb restoration procedures were performed during the study period. These procedures steadily increased since 2011, reaching a maximum of 120 in 2018. Orthoplastic procedures such as osseointegration, targeted muscle reinnervation, regenerative peripheral nerve interface, agonist-antagonist myoneural interface, and soft tissue resurfacing flap reconstruction accounted for the rise in secondary/revision reconstruction performed during this time period. Limb restoration is a collaborative orthoplastic approach that utilizes state-of-the-art surgical techniques for treating complex extremity trauma. Although limb restoration originally developed in response to managing the long-term sequelae of combat extremity trauma, the concept can be adapted to the acute management setting. Moreover, limb restoration provides military surgeons with a means for maintaining critical war-time surgical skills during the current low casualty rate era. Level of Evidence: V, therapeutic.

U.S. Federal Aviation Administration Neighborhood Environmental Survey: Noise Methodology

As part of the agency's broader noise research program, the Federal Aviation Administration (FAA) has undertaken a multi-year research effort to quantify the impacts of aircraft noise exposure on communities around commercial service airports in the United States (U.S.). The overall goal of the study was to produce an updated and nationally representative civil aircraft dose-response curve; providing the relationship between annoyance and aircraft noise exposure around U.S. airport communities. To meet this goal, the FAA sponsored a research team to help design and conduct a national survey, known as the Neighborhood Environmental Survey (NES). A multi-stage and statistically rigorous process was used to select a representative sample of US airports, including a balanced sampling frame that included six factors: geographic distribution, temperature, day-night split, operational tempo, fleet mis, and population density. The research team computed Day-Night Average Sound Levels (DNL) for the 20 airports in two waves: first for survey respondent selection, and then for pairing with respondent locations to create the dose response curve. Analysis of the responses and the associated DNL was used to generate dose-response curves for each individual airport and a national dose-response curve showing the percent "Highly Annoyed" for a given noise level. The National dose-response curve created from the mail questionnaire shows considerably more people are highly annoyed by aircraft noise at a given noise exposure level compared to historical FICON data. This paper presents the airport selection and noise modeling process used to support the creation of the National dose-response curve. Additional information describing the motivation to conduct the NES and how its findings will help inform ongoing work to address aircraft noise concerns; and the survey methodology are provided in companion papers.

Characterization of Falcon 9 launch vehicle noise from far-field measurements.

This study investigates source-related noise characteristics of the Falcon 9, a modern launch vehicle with a high operational tempo. Empirical prediction of the noise characteristics of launched rockets has long been a topic of study; however, there are relatively few comparisons with high-fidelity, far-field data, and historical inconsistencies persist. Various quantities are considered: overall directivity, overall sound power, maximum overall sound pressure level (OASPL), and peak frequency. The noise directivity of the Falcon 9 vehicle is shown to be between two disparate ranges given in the historical literature, but the observed peak directivity angle is well represented using convective Mach number concepts. A comparison between mechanical and acoustic power yields a radiation efficiency is consistent with the literature. Two independent methods of predicting maximum OASPL produce results accurate within 2 dB, even at distances of several kilometers. Various scaling parameters are calculated for observed spectral peak frequency and connect these measurements with prior observations. Finally, the impact of terrain shielding on levels and spectra is assessed. These determined source characteristics of the Falcon 9 vehicle provide a connection to prior launch vehicle acoustics studies, which helps identify useful models and methods for understanding rocket noise.

Predictors and protective factors for suicide ideation across remotely piloted aircraft career fields

ABSTRACT The US Air Force remote warrior community comprises several career fields including remotely piloted aircraft pilots and intelligence, cyber, and sensor operators. The crews are responsible for working seamlessly together to provide 24/7 real-time intelligence, surveillance, and reconnaissance and precision-strike weapons capabilities for a wide range of global combat operations. Due to the rapid increase in global demands and operational tempo, there is growing concern from military leadership about the impact of operational stress on the health and psychological well-being of remote warriors. Previous assessments from 2011 and 2015 have demonstrated a significant increase in the reported rates of operators experiencing suicide ideation. The current study examined two protective factors expected to reduce the risk of suicide ideation – team member social support and leader social support. A total of 905 active duty remote warriors participated in occupational health assessments conducted in 2018. Risk factors for suicide ideation included being unmarried, worsening relationship problems, occupational burnout, and increased operational stress. Results indicated that team member and leader social support were significant protective factors for shift workers and those who reported being less likely to seek mental healthcare. Implications of the findings, intervention recommendations, and directions for future research are discussed.

Menstrual Practices in Operational Military Women.

Women's sex-specific health care and hygiene needs are part of military readiness for female service members and important for their leaders to ensure unit readiness. Promoting readiness that includes women's health needs contributes to the overall strength of the military. Because women comprise over 15% of today's military force and growing in proportion, readiness for military women has obtained increased attention in research and health practice. Menstruation is a sex-specific experience that must be part of the consideration for individual military readiness. Little research has explored the in-garrison readiness of women, particularly for women in high operations tempo settings, when considering menstruation management. The specific aim of this study was to explore how active duty U.S. Air Force women manage their menstruation while living day-to-day in a military culture. A qualitatively driven mixed-method design using ethnography was conducted. Data collection included multiple sources: observations, questionnaire data, interviews, and focus groups among a group of Air Force Security Forces women. Data from questionnaires (n = 16) and interviews or focus groups (n = 10) were analyzed. Themes included knowledge, cop culture, and support. Comprehensive findings demonstrated that women were knowledgeable about menstruation and menstrual suppression, but did not practice it. No women in the study were suppressing menstruation. Military culture had minimal impact on menstrual practices, whereas knowledge, attitudes, and beliefs gained from family and friends was more influential on how women in this study managed menstruation. This study was the first to use a qualitatively driven mixed-method design to explore military women's menstrual practices in an operational setting. This study can be used in collaboration with other evidence to promote health of military women through clinical education and support in command environments. Future research should consider other operational settings where women are expected to maintain a high level of readiness.

The Importance of Validating Sleep Behavior Models for Fatigue Management Software in Military Aviation.

The propensity for air mobility missions to exhaust aircrews is strongly dependent on operational tempo. Most flying is performed during periods of low to moderate operational tempo, but a major flight safety risk can emerge when operational tempo becomes very high. This risk can be managed by software tools that contain fatigue and sleep behavior modeling, but optimization/validation of the model using the specific target population is required to ensure that the modeled predictions are accurate. The goal of the study was to validate the sleep behavior model settings for a fatigue modeling tool that is used within the RCAF, the Fatigue Avoidance Scheduling Tool, taking into account the organizational requirements for pre- and postflight routines, especially within the Air Mobility force. Four Royal Canadian Air Force Air Mobility Squadrons from Canadian Forces Base Trenton took part in this trial over a 3-month period (May 3 to August 21, 2016). All 22 missions of the trial included long-range transmeridian flights. All members of the participating aircrew wore wrist actigraphs to measure their sleep. We compared cognitive effectiveness modeling scenarios (preharmonization) based on the SAFTE-FAST sleep behavior model with its default settings against cognitive effectiveness modeling scenarios based on actigraphically-measured sleep. The measured sleep was then harmonized against the predicted sleep to optimize accuracy of the sleep behavior algorithm. During the harmonization process, the "Autosleep" prediction settings were optimized to match the actigraphically-measured sleep timings. Prior to the harmonization effort, the sleep behavior algorithm overpredicted the sleep obtained by CAF Aircrews. The most significant adjustment to the sleep behavior model was the increase in commute time to account for briefing, flight planning, debriefing, and postflight activities. Following harmonization, the sleep behavior model provided nearly perfect estimates of overall fatigue risk against missions modeled with actigraphically-measured sleep. For both measured and predicted sleep, most of the time in flight was in a low-fatigue, high-cognitive effectiveness state (90%-95% cognitive effectiveness). Current Fatigue Risk Management Systems require accurate fatigue and sleep behavior modeling, which can only be achieved by studying specific target populations to determine their culture of work/rest routines, and optimizing sleep behavior model settings accordingly.

Evolution of the United States Military Extracorporeal Membrane Oxygenation Transport Team.

The use of extracorporeal membrane oxygenation (ECMO) for the care of critically ill adult patients has increased over the past decade. It has been utilized in more austere locations, to include combat wounded. The U.S. military established the Acute Lung Rescue Team in 2005 to transport and care for patients unable to be managed by standard medical evacuation resources. In 2012, the U.S. military expanded upon this capacity, establishing an ECMO program at Brooke Army Medical Center. To maintain currency, the program treats both military and civilian patients. We conducted a single-center retrospective review of all patients transported by the sole U.S. military ECMO program from September 2012 to December 2019. We analyzed basic demographic data, ECMO indication, transport distance range, survival to decannulation and discharge, and programmatic growth. The U.S. military ECMO team conducted 110 ECMO transports. Of these, 88 patients (80%) were transported to our facility and 81 (73.6%) were cannulated for ECMO by our team prior to transport. The primary indication for ECMO was respiratory failure (76%). The range of transport distance was 6.5 to 8,451miles (median air transport distance=1,328miles, median ground transport distance=16miles). In patients who were cannulated remotely, survival to decannulation was 76% and survival to discharge was 73.3%. Utilization of the U.S. military ECMO team has increased exponentially since January 2017. With an increased tempo of transport operations and distance of critical care transport, survival to decannulation and discharge rates exceed national benchmarks as described in ELSO published data. The ability to cannulate patients in remote locations and provide critical care transport to a military medical treatment facility has allowed the U.S. military to maintain readiness of a critical medical asset.

Air Power and Allenby’s Army: Combined Arms in Palestine 1917–1918

Historians have overlooked the important role played by airpower in combined arms during the Palestine Campaign, 1917–1918. This article argues the Egyptian Expeditionary Force adopted Western Front command structures, successfully integrating airpower within their command and control systems. Tactical and strategic airpower provided intelligence which allowed Corps and Army Headquarters to control the tempo of operations, while ground attack operations disrupted Ottoman command and control arrangements. This integration made a clear contribution to the success of the Egyptian Expeditionary Force at the crucial battles of Third Gaza and Megiddo.

Sources of Stress and Psychological Health Outcomes for Remotely Piloted Aircraft Operators: A Comparison Across Career Fields and Major Commands.

U.S. Air Force remotely piloted aircraft (RPA) operators perform a variety of around-the-clock global intelligence, surveillance, and reconnaissance (ISR) missions that are considered critical to operational effectiveness. The growing need for ISR operations has led to significant increases in operational tempo and workload, resulting in elevated operational stress, burnout, and psychological distress. These negative outcomes are linked to conditions such as long hours, low manning, lack of sleep, and communication issues. Through regular assessments and the implementation of additional resources (i.e., embedded health care providers), Air Force leadership is working to alleviate the stressors and maintain psychological well-being. Thus, the purpose of this study is to compare the levels of stress, and prevalence of burnout and psychological distress across RPA career fields within two major commands. Assessments were completed by 571 RPA operators from 2 major commands: Air Force Special Operations Command (n = 158) and Air Combat Command (n = 413). RPA career fields included pilots (n = 331), sensor operators (n = 137), and intelligence operators (n = 103). Results revealed that high stress levels from an array of sources continue to result in increased risk of burnout and psychological distress for RPA operators. Several significant differences in sources of high stress across career fields and major commands are identified and discussed. Overall, the results of this study highlight specific problem areas unique to certain subsets of the RPA community in need of targeted intervention and clarify several avenues for future research.

Adapting the U.S. Air Force's combat rescue management practices could improve organizational responses to challenges posed by the COVID-19 pandemic

In this article, we argue that U.S. Air Force Special Operations Command (AFSOC) pararescue teams offer a model of best practices that could be adapted by leaders of other organizations during the COVID-19 crisis. AFSOC teams recover and provide medical treatment to personnel in unpredictable and dangerous environments. Our research suggests that the ability of AFSOC teams to operate effectively in situations of uncertainty, complexity, and urgency depends on several critical factors: an operational tempo that includes time for reflection; effective assessment, selection, and training of team members; risk assessment and ongoing revision of the planning process; and fluid leadership with a chief executive who maintains ultimate accountability. These same management practices could be adapted by organizational leaders to help them respond more effectively to the challenges posed by the constantly changing COVID-19 pandemic.

A Decade of mTBI Experience: What Have We Learned? A Summary of Proceedings From a NATO Lecture Series on Military mTBI.

Mild traumatic brain injury (mTBI, also known as a concussion) as a consequence of battlefield blast exposure or blunt force trauma has been of increasing concern to militaries during recent conflicts. This concern is due to the frequency of exposure to improvised explosive devices for forces engaged in operations both in Iraq and Afghanistan coupled with the recognition that mTBI may go unreported or undetected. Blasts can lead to mTBI through a variety of mechanisms. Debate continues as to whether exposure to a primary blast wave alone is sufficient to create brain injury in humans, and if so, exactly how this occurs with an intact skull. Resources dedicated to research in this area have also varied substantially among contributing NATO countries. Most of the research has been conducted in the US, focused on addressing uncertainties in management practices. Development of objective diagnostic tests should be a top priority to facilitate both diagnosis and prognosis, thereby improving management. It is expected that blast exposure and blunt force trauma to the head will continue to be a potential source of injury during future conflicts. An improved understanding of the effects of blast exposure will better enable military medical providers to manage mTBI cases and develop optimal protective measures. Without the immediate pressures that come with a high operational tempo, the time is right to look back at lessons learned, make full use of available data, and modify mitigation strategies with both available evidence and new evidence as it comes to light. Toward that end, leveraging our cooperation with the civilian medical community is critical because the military experience over the past 10 years has led to a renewed interest in many similar issues pertaining to mTBI in the civilian world. Such cross-fertilization of knowledge will undoubtedly benefit all. This paper highlights similarities and differences in approach to mTBI patient care in NATO and partner countries and provides a summary of and lessons learned from a NATO lecture series on the topic of mTBI, demonstrating utility of having patients present their experiences to a medical audience, linking practical clinical care to policy approaches.

The state of military families in Canada: A scoping review

Introduction: For some families, the military way of life fosters close social support networks and adaptability. For others, the stresses and strains resulting from military operational requirements are challenging. Canadian Forces Morale and Welfare Services reviewed the most recent Canadian research to detail the issues currently facing Canadian military families. Methods: The scoping review yielded 72 articles and reports. Additionally, exclusive demographic data on family members were analyzed using data compiled by Chief Force Development. Results: Of the 72 Canadian articles, 53 were published within the past five years. These were organized thematically into categories, including demographics, common military lifestyle challenges, common family transitional challenges, and family resiliency. Discussion: Canadian military families commonly face three military journey challenges and three family journey challenges: geographical relocations due to postings; absences from family due to operational tempo; operational illness, injury, or death; personal well-being and mental health; financial stress; and intimate partner relationships. The majority of families are resilient and manage these challenges successfully; only a small percentage struggle. For those who struggle, access to systems of care and supports could enhance their resilience to manage these transitional challenges. Overall participation rates in programs and services are currently low, but the majority of those who used them perceived that they were helpful. For families to experience a stabilized family life in the face of military challenges, they need to be aware of, and able to advocate for services that are available and aligned with when, where and how they need them.

Final Word: The Health Technology Community Steps Up to Combat COVID-19.

There are times in life when the words “thank you” are not enough. I am grateful to our AAMI community members' caring and noble actions making such a profound difference during the COVID-19 pandemic. Every part of the health technology ecosystem has answered the call. While the examples are numerous and significant, I've listed just a handful below.Medical device manufacturers have leaned into higher rates of production and distribution, and some have even shared their engineering drawings for ventilators publicly in an altruistic action to bootstrap additional production. Subject-matter experts in ventilators and respirators from clinical organizations, manufacturers, and the Food and Drug Administration have developed reports and guidance documents in a matter of days—not years or months—which AAMI has published to further diffuse this critical information.Healthcare technology management and sterilization professionals across the entire health spectrum have shared knowledge and resources for ensuring critical equipment is functional, safe, and available, many participating on AAMI Connect, virtual town hall events, and social media. Companies new to the AAMI community have partnered with manufacturers and venture capitalists to produce much-needed personal protective equipment and identify locations of greatest need for their distribution at no cost to the end-user.I would be remiss to not publicly thank AAMI's extraordinary volunteers and staff members and include them among the heroes of this community. They have been pushed well beyond their comfort zones and normal operational tempo to assist those in need. There is no doubt this community is very special. When presented with critical, life-threatening needs, the AAMI community has responded across individual and organizational boundaries to improve, over everything else, patient safety and treatment.It is admittedly inadequate—but thank you so much for all you do.

Military civilian partnerships: International proposals for bridging the Walker Dip.

The Walker Dip refers to the cycle of the improvement of care for the battle injured soldier over the course of a conflict, followed by the decline in the skills needed to provide this care during peacetime, and the requisite need to relearn those skills during the next conflict. As the operational tempo of the conflicts in Afghanistan and Iraq has declined, concerns have arisen regarding whether US military surgeons are prepared to meet the demands of future conflicts. This problem is not unique to the US military, and allied nations have taken creative steps to address the Walker Dip in their own surgical communities. A panel entitled "Military and Civilian Trauma System Integration: Where Have We Come; Where Are We Going and What Can We Learn from Our International Partners" at the 2018 American Association for the Surgery of Trauma meeting brought together a cadre of civilian and military surgeons with experience in this area. The efforts described involved the creation of a new trauma training program in Doha, Qatar, the military civilian partnership in the Netherlands, and the steps taken to address the deficit of penetrating trauma in Sweden. This article focuses on the lessons that can be learned from our allied partners to assure readiness for deployment among military surgeons. LEVEL OF EVIDENCE: Economic and Value Based Evaluations, level V.

Exploring Nonbattle Injury in the Deployed Military Environment Using the Department of Defense Trauma Registry.

The impact of disease and nonbattle injury (DNBI) on casualty burden of military operations has historically been greater than that of battle-related injuries. The ratio of battle to DNBI casualties has changed as advances in equipment, hygiene, and infectious diseases have been made; however, during military operations in Iraq and Afghanistan, 30% of serious injuries treated or evacuated from the area of operations were secondary to NBI. Most DoD research and intervention efforts focus on battle injuries; NBI has received much less practical attention. We aimed to explore the potential utility of the largest Department of Defense casualty database in identifying potential intervention targets for preventing NBI events. Phase I was a comprehensive NBI literature review from historical and current military operations. Phase II was an IRB exempt initial examination of relevant data contained in the Department of Defense Trauma Registry (DoDTR). Phase I: A MEDLINE search using the terms "military", "injury", and "nonbattle/non battle" was performed, and articles containing useful data points to characterize the unique risks of the modern deployed military environment and identify potentially preventable NBI hazards in the modern deployed military environment were retrieved and reviewed in full-text. Phase II: This information was used to explore data within the DoDTR's and its ability to provide data to inform NBI prevention efforts in the following areas: most prevalent NBI causes, NBI location and timing related to operational tempo, characteristics of the population at risk for NBI. Phase I: Falls and motor vehicle crashes (MVCs) accounted for most of the serious NBI in Iraq and Afghanistan. No specific epidemiologic data was readily available to guide NBI prevention efforts. Phase II was limited to NBI and falls from Iraq and Afghanistan in the DoDTR. Only aggregate data were available with a total of 1829 falls and 1899 MVCs. Case fatality for falls was 1.1% and for MVCs 6.5%. The greatest frequency of NBI was in Iraq among U.S. Army personnel, but comparison of rates is not possible without reliable denominators for individual variables. Annual NBI incidence seems proportional to overall level of personnel deployed to each theater, but without knowledge of the true denominator of total deployed personnel, it is impossible to conclude definitively. The annual number of falls was stable throughout the period of highest operational tempo in Iraq (2003-2011), although MVCs were more common earlier in the operation (2003-2005), likely corresponding to greater operational maneuver. The deployed military environment is dangerous and NBI presents a primary prevention target for expeditionary operations. The DoDTR is a database of detailed injury and medical care information and lacks much of the data required to perform a comprehensive epidemiologic NBI analysis. Specific prevention recommendations cannot be made based solely on DoDTR data and integration with other DoD databases that assess operational and tactical data should be considered.