Page 107 - JSOM Winter 2017

Health Surveillance Branch (AFHSB) of the Defense Health Step 2: identify causes and risk factors for injuries.
Agency. This is available at https://health.mil.afhsb to medi- Research determined that, although a few injuries occurred at
cal care providers, safety officers, military researchers, and altitude (associated with aircraft exits problems and entangle-
civilian collaborators working with military research and ments 10,12 ), the greatest risk of injury occurred on landing; one
operations personnel. The DMED contains current and his- study reported 88% of injuries were associated with ground im-
torical data on injuries and other medical events of active duty pact. With regard to risk factors, well-researched extrinsic fac-
10
personnel. Data can be compiled and analyzed by a number tors that increased injury risk included night jumps, jumps with
of demographic characteristics (e.g., sex, age, military oc- extra equipment, higher wind speeds, higher environmental
cupation, rank). The AFHSB also provides monthly reports temperatures, jumps from fixed-wing aircraft (compared with
of injury rates by service branch and installation at https:// rotary-wing aircraft), jumps onto certain types of terrain, not
health.mil/Military-Health-Topics/Health-Readiness/Armed using the parachute ankle brace (PAB), smaller parachute cano-
-Forces-Health-Surveillance-Branch/Reports-and-Publications pies, and simultaneous exits from both sides of an aircraft. 13
/Installation-Injury-Reports.
Step 3: intervene to reduce injuries.
The second step in the Injury Prevention Process is identifying Borrowing from the British, the US Army Airborne School be-
the causes of and risk factors for injuries. Causes of injuries gan to use the parachute landing fall (PLF) in the later parts
have been identified through systematic research in a number of World War II because it appeared to reduce ground-impact
of military situations. Risk factors for injuries have been de- injuries. 14,15 A more modern example was the development of
4–7
termined by examining associations between injuries and vari- the PAB. It was known from the medical literature that pro-
ous intrinsic and extrinsic factors. Intrinsic factors are those phylactic ankle bracing could reduce ankle sprains in sports 16–18
related to the individual (e.g., age, sex, fitness level, lifestyle), and that many airborne-related injuries involved ankle sprains
whereas extrinsic factors are those external to the individual and ankle fractures. 19–23 The Airborne School began using the
(e.g., weather, shoes, terrain, types of training). Demonstrated PAB in 1998. Another example is larger parachute canopies.
risk factors that can be modified (e.g., fitness, terrain, type of Research suggested that using parachutes with larger canopies
training) should receive more attention than those that cannot could reduce injuries, likely because of slower descent rates. In
24
(e.g., sex, race, body height). 2010, the US Army developed and began phasing into airborne
operation the new T-11 parachute that had a larger canopy. 25
The third step in the Injury Prevention Process is identifying
interventions that prevent injuries. This can be done by look- Steps 4 and 5: implement and monitor.
ing in the literature for techniques or procedures that have The fourth step in the process is to implement programs and
already been successful or by doing studies to test new ideas the fifth is to monitor them. After implementation of the PLF in
that might reduce injuries. Ideas can be generated from prior 1943, injuries were systematically tracked and surveillance at the
research on risk factors, from the literature, practical experi- Airborne School indicated that injuries continued to decline. 14,15
ence, or other sources. This suggested that the PLF was effective in reducing injuries.
The PLF is now well embedded in US Army Airborne doctrine.
The fourth step is for commanders to implement programs
based on research showing these programs to be effective. Another example of program implementation and evaluation is
Commanders make these decisions because they have the the PAB, which has an interesting history at the Airborne School
larger picture and best know how injury prevention measures and illustrates the effectiveness of program monitoring. After
might, or might not, fit into their training and operations. results of an initial investigation suggested that the PAB reduced
ankle injuries, it was used for all training jumps at the Air-
26
Finally, implemented programs should be evaluated for effec- borne School from October 1998 to September 2000. In Sep-
tiveness in the operational environment in which they have been tember 2000, the Airborne School discontinued use of the PAB
introduced. In a larger sense, this is going to back to the first because of anecdotal concerns that the PAB increased risk of
step (surveillance), because the first step establishes the injury entanglements and lower body injuries. Later, systematic stud-
baseline rate and the question is now whether the program has ies showed that entanglements were very rare and incidence of
10
shifted that baseline downward, toward injury reduction. Once lower body injuries did not increase when the PAB was used.
22
the new data have been evaluated, a decision to keep, change, The PAB was reintroduced into the Airborne School in July
or eliminate the program can be made by the commander. 2005. A study compared injuries at the Airborne School while
the PAB was initially used, not used, and was reintroduced.
Example Risk of ankle injuries when PABs were not used were 1.67 times
Airborne-related injuries can be used to illustrate the Injury higher (95% confidence interval, 1.33–2.13) compared with
Prevention Process. the initial use period, and 1.61 times higher (95% confidence
interval, 1.28–2.04) compared with the reintroduction period.
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Step 1: determine the size of the problem. Now, results of six independent studies involving Airborne stu-
When airborne operations began in the era of the Second dents and Soldiers in operational units have confirmed that the
World War, there was a very high incidence of injuries—21 risk of ankle sprains and ankle fractures can be substantially
to 27 injuries per 1,000 jumps. As various methods, equip- reduced by using the PAB. 13,28 The PAB is currently an optional
8,9
ment, and programs were introduced, injury rates declined to item of equipment but available to Soldiers who want them. 29
about six to nine injuries per 1,000 jumps. 10,11 Further refine-
ments have reduced injuries to about five injuries per 1,000 With regard to larger parachute canopies, the US Army began
jumps. Despite these reductions in the overall incidence of in- the transition from the older T-10 parachute with a surface
10
juries over time, airborne injuries were the sixth leading cause area of 121m to the new T-11 parachute with a surface area
2
of hospitalizations in the active duty military in 2004. 6 of 155m in 2010. During the transition, injuries were found
2
Assessing and Reducing Injury Risk | 105