Page 74 - Journal of Special Operations Medicine - Summer 2015

Injuries, Medical Conditions, and Changes in Blood Levels
in German Special Operations Forces Selection

Raimund Lechner, MD; Bernhard Tausch, MD;
Uwe Unkelbach, MD; Markus Tannheimer, MD; Christian Neitzel, MD

ABSTRACT

Background: Medical conditions often develop during may result in death, occur frequently in both the civil-
military training. The aim of this study was to compile ian and the military sector. While prolonged exertion
1–7
medical conditions and injuries sustained during a 5-day is undertaken voluntarily in the civilian sector and the
military exercise, compare them with incidences at simi- responsibility for doing so lies solely with the athletes,
lar civilian events, and subsequently identify differences members of the military sector, especially those within
between those who finished the exercise (Finishers) and the Special Operations Forces (SOF), are obligated
those who did not (Nonfinishers) to identify preventable by nature of their profession. Physical exertion in the
causes for not finishing and to reduce unnecessary health Armed Forces is an accepted and essential requirement
risks. Methods: Fifty-one soldiers had their blood pa- in training and mission accomplishment. The overall
rameters (creatine kinase [CK], aspartate transaminase responsibility for its military members, which includes
[AST], alanine transaminase [ALT], gamma-glutamyl the medical risk due to physical exertion, is shouldered
transferase [GGT], C-reactive protein [CRP], leukocytes, by their superiors. To assist commanders and superi-
sodium), weight loss, and body temperature determined ors in minimizing unnecessary casualties and to ensure
after the exercise. Additionally, the injuries and con- optimum training and mission execution, the risks of
ditions that led the Nonfinishers to drop out were re- physical exertion to the soldier must be better identified
corded. Results: The main reasons why Nonfinishers did and, subsequently, mitigation strategies developed and
not complete the exercise were physical exhaustion and implemented.
minor injuries. After exercise, the Finishers showed only
slightly increased incidence of hyponatremia, higher lev- The aim of this study was to identify the frequency and
els of CK, and significantly higher levels of AST, ALT, intensity of injuries and exertion-related medical con-
and CRP, and body weight loss. The Nonfinishers’ re- ditions during a military combat survival exercise per-
sults were significant for an elevated leukocyte count and formed by the German Army SOF and to compare the
lower mean temperatures. Conclusion: The specifics of results with the frequency and intensity of injuries and
military training did not influence the kind or the num- exertion-related medical conditions in similar civilian
ber of exertion-related medical conditions compared to events. This study also examined how the frequency and
similar civilian events. Both Finishers and Nonfinishers severity of exertion-related conditions differed among
are at risk of developing exertion-related medical condi- those who finished the exercise (Finishers) and those
tions such as rhabdomyolysis and hyponatremia. How- who did not (Nonfinishers) to identify contributory
ever, plain water did not increase the risk of exertional medical causes. The data was evaluated to aid the opti-
hyponatremia. Leukocytosis found in the Nonfinisher mization of medical care for the patterns of injuries and
group could have been due to acute excessive exertion medical conditions that might be sustained or developed
and, therefore, may be an indicator of general systemic during the course of extreme physical exertion, as expe-
fatigue. This could be used to differ between physical rienced in military training and missions.
and psychological reasons for not finishing.

Methods
Keywords: blood test; endurance; military; rhabdomyolysis,
exertional; hyponatremia, exertional; strain, physical; inju- The Ethics Committee of the Medical Association of
ries; body temperature; selection Baden-Württemberg approved the publication of ano-
nymized data.

In March 2012, 51 male soldiers aged between 22 and
Introduction
33 years (mean age: 26.3 years) participated in a 5-day
A review of the medical literature shows that medical military combat survival exercise as part of the aptitude
conditions caused by prolonged exertion, some of which assessment procedure for SOF. To participate in the

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