Page 121 - Journal of Special Operations Medicine - Fall 2017

Figure 1 Traditional epidemiologic triad applied to a potential Table 2 The Haddon Matrix, With Potential Ways to Reduce Risks
injury situation in which a Soldier descends a set of stairs. During Military Airborne Operations
Factors
Phases Human Equipment Environment
Rest Aircraft Weather
Pre-event Fitness Parachute Time of day
packing
Spacing between
jumpers Ankle braces Obstacle-free LZ
Event
Lateral drift Parachute type Soft, smooth LZ
control
First aid Ambulance Evacuation routes
Post-event knowledge First aid kit MEDEVAC ready
Prior injury
LZ, landing zone; MEDEVAC, medical evacuation.

Finally, consider the postevent phase when an injury has already
occurred. In terms of the human, prior injuries will increase in-
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jury risk ; if Soldiers have first aid knowledge, they may be able
Table 1 The 3 × 3 Haddon Matrix to provide some self-treatment or assist others who are injured.
In terms of equipment, an ambulance available with medics
Factors
Phases Human Equipment Environment and first aid equipment can assist in the treatment of injuries.
Pre-event In terms of environment, the fastest routes to the hospital
should be known and medical evacuation ( MEDEVAC) assets
Event (for serious injuries) might be put on call during the operation.
Post-event
The matrix provides ways to think about how injury risk might
The second dimension of the matrix involves time and con- be reduced. It may not be possible or desirable to fully imple-
siders what can be done before (pre-event), during (event), ment all the potential injury control measures that come to
and after (postevent) the injury-producing episode. In the pre- mind. For example, Soldiers generally have little control over
event phase, the aim is to think about strategies that might the size of their parachute canopies, so it may not be possible
eliminate or reduce the likelihood of the injury occurring. In to implement this injury control measure. Also, Soldiers should
the event phase, the aim is to limit, reduce, or alter the severity train for specific military operations and some operations will
of an injury once the injury-producing event is in progress. In involve night jumps that will increase injury risk. Nonetheless,
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the postevent phase, the injury has already happened and the some administrative jumps might be conducted during the day
aim is to reduce pain and/or disability. to reduce the injury risk because daytime jumps still involve
most of the operational procedures of night jumps.
Table 2 shows an application of the Haddon Matrix aimed at
reducing injuries during military airborne operations. Many
of these interventions are already in place as a result of prior The 10 Countermeasure Strategies
thinking about injury prevention and control. To apply the Another useful tool is the 10 Countermeasure Strategies. 11–13
Haddon Matrix, first consider the pre-event phase of an air- The basic premise of this tool is that injuries are largely due to
borne operation, before the jumps have begun. In terms of energy exchanges between a person and the external environ-
the human factor, rest and fitness may reduce the likelihood ment in such a way that body cannot properly avoid or absorb
of a jump injury, because studies have shown that fatigue can the energy, and damage to anatomic structures results. The
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lead to errors and that higher levels of physical fitness are energy exchange can be acute, such as occurs when a runner
5
associated with lower injury risk during airborne operations. is hit by a car, or it can develop over time, such as an overuse
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In terms of equipment, aircraft should be well maintained and injury when a runner damages the knee meniscus as a result of
hold appropriate altitude and speed ; parachutes should be small microtraumas that accumulate over months or years. The
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adequately maintained and packed properly because of the countermeasures strategies address various aspects of the en-
obvious consequences of not doing so. In terms of the envi- ergy transfer to assist in thinking about ways to (1) prevent the
ronmental factor, the weather and time of day can be consid- injury, (2) reduce the effects of energy exchanges, or (3) assist
ered because studies have demonstrated that higher winds and with healing and rehabilitation once the injury has occurred.
night jumps increase injury risk. 8
Table 3 presents the 10 countermeasures and provides ex-
Next, consider the event phase, when Soldiers have begun ex- amples from airborne operations. There are many potential
iting the aircraft. In terms of the human factor, we could con- hazards in airborne operations and the ones listed are just to
sider more space between jumpers and ways to reduce lateral provide examples to show how the countermeasure strategies
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drift through better canopy control (lateral drift increases can be used. The airborne hazards shown in Table 3 are those
landing velocity and risk of injury due to less controlled land- that are well recognized and largely documented. 8
ing). In terms of equipment, it has been well demonstrated
that ankle braces and larger parachute canopies can re- The first countermeasure involves eliminating the hazard alto-
10
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duce injuries. In terms of environment, injuries appear less gether. In the example in Table 2, the hazard is an airborne op-
likely if the landing zone is free of obstacles and is softer and eration in high winds, which can result in less controlled and
smoother. 8 higher impact landings. Currently, personnel jumps in winds
Assessing and Reducing Injury Risk | 117