1. Army Burden of Injuries Defining the Problem and Prevention BG Timothy Adams AUSA, Washington Convention Center 6 OCT 2009 1

2. Relative Burden of Injuries and Diseases, U.S. Army Active Duty, 2008 Source: Defense Medical Surveillance System, Armed Forces Health Surveillance Center, 2009 2

3. Army Deployment Injuries and Diseases OIF Medical Evacuations, 2003 - 2008 1 1 Total evacuations: n= 38,619 Source: USACHPPM Deployment Injury Surveillance System ICD -9-CM Code Groups 3

4. Five Key Public Health Questions 1.Is there a problem and how big is it? 2.What causes the problem? 3.What works to prevent the problem? 4.Who needs to know and do what? 5.How effective is what we have done? Five Steps of the Public Health Approach 1.Surveillance 2.Research & field investigations 3.Intervention trials & systematic reviews 4.Program and policy implementation 5.Public health evaluations & monitoring 4

5. Leading Causes of Injury Hospitalizations U.S. Army Active Duty, 2008 5 Source: Defense Medical Surveillance System, Armed Forces Health Surveillance Center, 2009

6. Leading Causes of Deployment Non-Battle Injuries Army OIF Medical Evacuations, 2003-2008 Source: USACHPPM Deployment Injury Surveillance System 6

7. USACHPPM Top Ten Injury Prevention Priorities* * Results of a prioritization process conducted by Army members of the DoD Health Affairs Military Injury Prevention Priorities Working Group, 2006 RankInjury Problem Prioritization Score 1Physical Training34.0 2Parachuting31.8 3Falls30.6 4Athletic Sports28.4 5Privately-owned vehicle accidents27.2 6Military vehicle accidents26.2 7Guns/explosives handling26.2 8Slip/twist/turn (near fall)24.6 9Tools/machinery21.0 10Non-traffic vehicle accidents19.4 7

8. Recommendations for Prevention CausePrevention StrategyReduction in Rate Physical TrainingPrevent overtrainingPT injuries 30%-50% Sports - Softball - Basketball Breakaway bases Inside shoe ankle brace Ankle sprain 95% Ankle injuries 65-80% MV MilitarySeat belts in HMMWVDeaths 80% Falls/Jumps Research/Evaluations Needed ---------- ParachutingParachute ankle braceAnkle injuries 50-80% Guns & Explosives Research/Evaluations Needed ---------- Tools/Mach/Equip Research/Evaluations Needed ---------- Military TrainingOutside of boot braceAnkle injuries 70% 8

9. Injury visit rates among Army trainees, 2000-2008 9 New PT Program Source: Defense Medical Surveillance System, Armed Forces Health Surveillance Center, 2009

10. USACHPPM Injury Prevention Services & Products Detection Surveillance & surveillance analysis Response Field investigations Systematic scientific reviews of science Recommendations for policies and programs Evaluations of policies and programs Dissemination Consultations & Information Requests (phone, e-mail, site visits) Lay information products (web, magazines, news articles, talks, etc.) Scientific information (tech reports, peer-reviewed publications, presentations, etc.) Customers Examples: Training & Doctrine Command, Forces Command, Medical Command, Deputy Assistant Secy of Army/Safety & Occupational Health, Army Combat Readiness/Safety Center, Assistant Secy of Defense/Health Affairs, Under Secy of Defense/Personnel & Readiness, Unit Commanders, other Fed Agencies 10

11. Army Injury Prevention Partners and Activities USACHPPM Lead for injury surveillance and prevention Key Partners and Activities Army Office of the Surgeon General Proponency Office for Rehabilitation & Reintegration Musculoskeletal Action Plan (MAP) TBI Surveillance and Prevention Army Medical Research and Development Command Army Combat Readiness /Safety Center DOD Defense Safety Oversight Council Military Training Task Force Deployment & Operations Task Force Joint Military Vehicle Safety Working Group 11

12. The Public Health Approach 1.Surveillance 2.Research and field investigations 3.Intervention trials and systematic reviews 4.Program and policy implementation 5.Public health evaluations and monitoring A problem this large & complex requires a systematic approach to prevention. 12

13. Conclusions & Future Directions Keys to Injury Program Success Routine use of surveillance data to identify & monitor problems Strategic planning and established priorities Credibility and durability of science derived from peer-reviewed publications Partnerships Quick response capabilities Requirements for Future Success Disseminate injury data to MACOMs and units for visibility for accountability Wide adoption of evidence-based public health approach by Army and DOD Enhanced dissemination and training for Injury Prevention within Army and DOD Establish DOD, Army, Installation and large unit committees to set priorities, share information, and monitor success Enforcement of Safety and Injury Prevention standards 13

14. Contact information and resources Contact Information: USACHPPM Injury Prevention Homepage http://chppm-www.apgea.army.mil/DEDS-Injury/ (410) 436-3534 DSN 584-3534 Resources: Physical Training Injury Prevention Toolbox http://chppm-www.apgea.army.mil/ptipt/default.aspx Injury Prevention Through Leadership Course Available through the PT Injury Prevention Toolbox homepage (above) US Army Combat Readiness/Safety Center Knowledge Publication https://safety.army.mil/Knowledge_Online/Default.aspx?alias=safety.ar my.mil/Knowledge_Online/October2009 14