Page 78 - JSOM Fall 2021

deployed environments may contribute to injury reporting dif- have been reported casually. SMs may have easier access to
ferences, however there are no studies which have evaluated non-licensed personnel and/or feel more comfortable discuss-
these relationships. ing medical conditions outside of a typical medical environ-
ment. Since these “reports” rarely make it into the electronic
The austere environments that special warfare personnel op- medical record, we excluded non-licensed personnel from
erate in puts them at a higher risk for MSKIs and subsequent our medical provider definition. The number of injuries “re-
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lost duty time. During operations/maneuvers, without direct ported” to a non-licensed provider remains unknown.
access to medical providers to care for injuries, SMs may be
more apt to conceal injuries to remain in the fight. In an Army The AFSPECWAR units analyzed for this survey are located
population, soldiers with easier access to medical specialty on various Army installations throughout the United States.
providers were less likely to exaggerate an injury and less Because the survey was aimed at a unique population, the
likely to select “inconvenience of seeking care” as an influence findings from this study should not be considered indicative
on their decision to not report their injury. Because TACPs of typical Air Force medical and injury reporting procedures.
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are often geographically separated from a servicing Air Force Data was obtained through electronic methods; emails and a
military treatment facility (MTF), personnel indicated that in- survey link were used to recruit participants. Although 32% of
juries are not always directly communicated from the Army the targeted population completed the survey, data was more
provider to an Air Force medical provider. An additional fac- difficult to acquire from airmen who were deployed and those
tor which may contribute to the underreporting of MSKIs in without regular access to a computer with a CAC reader. This
the current population is the different requirements between anonymous survey study and the previous study provide con-
the Army and Air Force that drive the Duties Not to Include sistent results for different military populations, but generaliz-
Controlling (DNIC) status. As an example, anecdotally, USAF ing these should be cautioned. 19
personnel have indicated it is a common occurrence to have an
Army Flight Surgeon return a TACP to full duty status for a
condition or treatment that might typically warrant continued Conclusion
DNIC by an Air Force Flight Surgeon. The findings of this study reveal that nearly half (48%) of
probable MSKIs in a specialized population of USAF person-
Negative stereotypes associated with limited-duty profiles con- nel are not reported to medical personnel. Consistent with
tinue to be a barrier for reporting injuries. Previous findings previous research within military populations, injury under-
have expressed the cultural concern of injury minimization and reporting and concealment were more common than injury
concealment. 2,18–21 Sauers et al. reported on the “suck it up” exaggeration in this cohort. Greater understanding of factors
mentality that one unit revealed when dealing with an injury. that make seeking medical care for MSKIs undesirable may
Over half of SMs agreed that it is better to work through any empower leaders to modify current practices, manning levels,
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aches and pains they experience. This mindset is common and placement of medical assets. Future research should inves-
among the special warfare population because of the enhanced tigate ways to reduce barriers and stigmas for injury reporting
negative perceptions surrounding injuries and not wanting to and early intervention for MSKI. This includes initiatives such
appear weak. In one Special Forces (SF) unit, the average num- as the influence of embedded medical providers within units
ber of lost duty days was over threefold higher when com- in order to optimize human performance and operational
23
pared to the other non-SF units. Perhaps the stigmatization readiness.
of injuries deterred some of these soldiers from reporting. Due
to the absence of embedded medical assets and daily oversight, Author Contributions
TACPs may often be “faking well.” Not reporting minor inju- RW, BH, and JT conceived the study concept. RW obtained
ries may allow them to worsen until manifested as debilitating funding. BH, RW, BC, KW, and JT developed the protocol
injuries, which could directly affect combat effectiveness. and modified the survey. JT coordinated survey deployment
and subject recruitment. BH and JE analyzed data, and BH and
Results from surveys of self-reported injury data should be RW wrote initial draft and all other authors read, revised, and
interpreted cautiously due to inherent reliability and validity approved the final manuscript.
limitations. However, this study design allows for an inves-
tigation into the cognitive process of a problem, such as the Funding
emotional and behavioral reasoning aspects associated with All work was funded by the US Army Research Institute of
29
injury reporting. Previous anonymous survey studies of Environmental Medicine, US Army Medical Research and
military personnel on these topics have reported very similar Development Command. This research was supported in part
results. 18,19 by appointments to the Postgraduate Research Participation
Program at the US Army Research Institute of Environmental
The sample included in this study is representative of a special- Medicine administered by the Oak Ridge Institute for Science
ized and predominantly male unit, and therefore should not be and Education.
considered representative of the general Air Force population.
Current demographic reports state that females constitute ap- Disclaimer
proximately 21.1% of the total Air Force. 30 The opinions or assertions contained herein are the private
views of the author(s) and are not to be construed as official
Our study design addressed only care received by medical per- or as reflecting the views of the United States Air Force, the
sonnel and excluded non-licensed personnel (exercise physiol- United States Army, or the Department of Defense. For the
ogists and strength and conditioning personnel) in an effort to protection of human subjects, the investigators adhered to pol-
focus on identifying injuries that should have been formally icies of applicable Federal Law CFR 46. Human subjects par-
captured in the SMs medical record and not those which could ticipated in these studies after giving their free and informed

76 | JSOM Volume 21, Edition 3 / Fall 2021