Physical training injuries and interventions for military recruits

Low physical fitness levels are associated with increased musculoskeletal injury risk and attrition among military recruits. The authors review physical fitness trends, injury risk factors, and Department of the Army initiatives to address recruit fitness, injuries, and attrition. Initiatives include the Fitness Assessment Program, which reduced injury risk and attrition among low-fit trainees, and the Assessment of Recruit Motivation and Strength, which enabled the Army to enlist individuals exceeding body composition accession standards without increasing attrition. Physical Readiness Training (PRT) is the Army's primary initiative to address training-related injuries and attrition. PRT's inherent injury control and exercise progression components are designed to address low fitness levels across entry-level training. PRT has been shown to decrease injury rates, but low-fit recruits remain at increased risk regardless of program design. The authors recommend resuming pre-enlistment fitness screening and fitness programming before low-fit recruits begin entry-level training. The decision whether to screen for fitness before beginning entry-level training could be based upon the existing recruiting environment in terms of applicant supply and the demand for recruits. However, the Army should anticipate increased injury and attrition rates when discontinuing screening and/or fitness programming for low-fit recruits.     

Revised curriculum on cardiothoracic radiology for diagnostic radiology residency with goals and objectives related to general competencies

This document is a revision of a previously published cardiothoracic curriculum for diagnostic radiology residency, and reflects interval changes in the clinical practice of cardiothoracic radiology and changes in the Accreditation Council for Graduate Medical Education (ACGME) requirements for diagnostic radiology training programs. The revised ACGME Program Requirements for Residency Education in Diagnostic Radiology went into effect December 2003.     

The characteristics of the staffing of the 40th Army with medical service officers]

The officer procurement for the Medical Service of the 40th Army had some specific features which were predetermined by the character of an active service in Afghanistan. The article describes the screening process and training system of army physicians who were assigned to the 40-th Army. The authors stress the fact that even in peaceful time it is necessary to constitute a reserve of medical specialists for operational activation of units and establishments.     

Making prevention of abuse and neglect through dental awareness green

Family violence encompasses child, spouse, and elder abuse and neglect and is viewed as a serious public health threat in our society. Unfortunately, abuse and neglect are commonplace in our society and are not limited to the civilian sector. The military community mirrors the civilian sector in the prevalence of abuse and neglect. Traditionally, identification and intervention of suspected cases of abuse and neglect was thought to be the role of the medical provider. Reports that up to 94% of family violence injuries have head and neck components, which is the very site that dental providers focus their attention, justifies the need for dental involvement. The U.S. Army Dental Command's Health Promotion and Disease Prevention Program's newest initiative is a family violence awareness program called Prevention of Abuse and Neglect through Dental Awareness (PA.N.D.A.). The program augments the Army Family Advocacy Program and gives dental-specific knowledge to our providers. The goals of this article are to describe the new program of the U.S. Army Dental Command that focuses on providing education and awareness to the dental community regarding family violence and to report the results of a survey that has been administered during the family violence training. More than 71% of individuals attending the P.A.N.D.A. training claimed to have previous training in family violence, whereas only 44% were knowledgeable about military regulations governing abuse and neglect.     

Health assessment of U.S. Army Rangers

PURPOSE: Assess the health behaviors of U.S. Army Rangers, including their diet and physical activity patterns, and their use of alcohol, tobacco, and nutritional supplements. METHODS: Army Rangers (N=38) completed selected self-report and food frequency questionnaires, and anthropometric measures (height, weight, circumferences) were taken. RESULTS: Dietary patterns were collected from questionnaires that asked respondents to report the frequency of usual consumption from a list of foods over a period of 1 year. The data collected indicated a diet high in fat (38.0% of energy) and low in carbohydrates (41.9%). Protein intake (17.9% of energy) was consistent with recommendations for endurance and strength training athletes. Hours engaged in physical activity averaged 12 per week. Overall, 76% of the volunteers reported using alcohol on a regular basis, and 52.6% used some form of tobacco: 50% reported using either snuff or chewing tobacco. The use of supplements was high with 13% taking creatine and ephedrine products on a regular basis. CONCLUSION: Although physical activity patterns indicated a high level of activity, dietary and other health behaviors, such as smoking, alcohol use, and patterns of supplement use, suggest that health education programs may be important in this select Army population.     

The epidemiology of varicella hospitalizations in the U.S. Army

Varicella infections affect the U.S. Army, but the extent has not been quantified recently. We obtained 1990 to 1997 hospitalization data from the U.S. Army Medical Command and calculated rates using data from the Army Medical Surveillance Activity and the U.S. Army Training Command. There was a decline in the number and incidence of varicella hospitalizations for U.S. Army active duty soldiers from 1990 to 1997. Varicella incidence rates for active duty soldiers are significantly higher for females, blacks, those younger than 20 years, and those whose home of record were tropical island regions. Army initial entry training hospitalizations constitute 11.8% of active duty Army hospitalizations and have also declined. Varicella continues to affect the training and health of the U.S. Army; however, the impact has diminished over the years. A feasible approach to limit varicella in the U.S. Army is to target trainees for screening or vaccination. Refinement of this strategy should be determined from a follow-up cost-effectiveness analysis.     

Joint task force "forward care" multicomponent health service support for an Army Reserve separate infantry brigade (mechanized)--Part III.

At the conclusion of 4 years' careful study of the health services support of a separate infantry brigade (mechanized) during the unit's annual training periods, the authors report on the effectiveness of a support team consisting of Army Reserve medical elements, an Active Army field unit, and a Public Health Service Clearing/Staging unit joining forces in a field environment to provide real world medical care to the same unit in a follow-on annual training period. The emphasis of the team created was on validating the forward care concept of field medical support. The result of this effort was "state of the art" medical service to the troops in the most forward areas, and a savings of 0.66 training days per soldier out of 10 days possible field training time. The cross-training of joint elements was enhanced by providing hands-on treatment of soldiers in a tactical environment, training that cannot be adequately replaced by simulated training.     

Annual training medical support for a Reserve Separate Infantry Brigade (Mechanized).

The authors have combined their experience of recent changes in the Health Service Support of a separate mechanized infantry brigade during 10-day field training exercises conducted by the same population, in the same geographical area, and in the same season in 4 consecutive years. The development of Health Service Support and the reasons necessitating its evolution are discussed. The impact of MedForce activities on training effectiveness is highlighted. The intensive use of health care providers in the most forward field medical treatment facilities, to include the nursing pool from the training support reserve hospital and Army Medical Department augmentation pool doctors, can alleviate unit medical staff shortfalls and provide exceptional training for unit medics "in house." The deployment of medical assets far forward and the maximization of "in situ" treatment of casualties prevents significant loss of training time and can prevent loss of life in combat. The authors recommend changing the medical care doctrine of Vietnam, from the life-threatening "scoop and run" doctrine to the life-preserving "doc in the box" doctrine presented in this article.     

Enhancing military primary care research.

Military primary care resident research training varies widely among internal medicine, pediatrics, and family practice programs. The level of resident physician participation in clinical investigations appears to be less than 30% in the federal physician training system. This paper reviews the current research activity in the Army, Navy, and Air Force primary care programs. It also reports on the results of a research training workshop and offers strategies to enhance resident involvement in clinical investigations.     

Preparation of the flight crew to bailout

The authors demonstrate that the training of flight personnel to the ejection from an aircraft in distress is a learning system that includes interconnected types of land-based activities: studying the material part of the means of salvation, documentation, regulatory need for ejection and the ejection rule; exercises in the cockpit; training on special simulators; parachute training; demonstration bailout; making available to the flight crew documents the forced ejection of the Air Force to analyze their outcomes.     

Status of trauma care in U.S. Army hospitals

OBJECTIVE: This study documents the recent trends and current state of inpatient trauma care in U.S. Army hospitals. METHODS: Inpatient trauma cases from Army hospitals worldwide from October 1988 through April 2001 were analyzed. Facilities included 3 Certified Trauma Centers (CTCs), 7 non-CTC Army Medical Centers, and 42 Army Community Hospitals. Logistic regression identified mortality risk factors. RESULTS: Overall, the Army treated 166,124 trauma cases, with a mortality rate of 0.8% (trend of 0.66% to 1.18% in fiscal years 1989-2000, p < 0.0001). The number of Army hospitals decreased by 44% and the number of trauma cases decreased by nearly 75%. Injury severity, patient age, hospital trauma volume, beneficiary category, hospital type, and a resource intensity measure were all significantly associated with the probability of death. CONCLUSIONS: The overall trauma mortality rate at Army hospitals during the study period was lower than that reported for civilian trauma centers. However, changes in patient profiles, increased average severity, and decreased trauma volume might have contributed to a 13% increase in mortality rates at CTCs.     

The corps disease: brucellosis and its historical association with the Royal Army Medical Corps.

Brucellosis (also known as Malta, Mediterranean or Undulant Fever) has aptly been nicknamed the Corps Disease because of the major role played by the Royal Army Medical Corps in elucidating its nature and discovering its mode of spread, thus leading to its prevention and eradication. This history of brucellosis, incorporating a complete bibliography of all references to the disease in the Journal of the Royal Army Medical Corps from 1903 to 1992, documents the fascinating story of this association.     

Urology/urogynecology medical readiness training exercise: experience for the military surgeon.

A medical readiness training exercise was conducted in conjunction with Task Force Bravo in Honduras during July and August 2000. Surgical teams from Madigan Army Medical Center performed 46 major pelvic reconstructive surgical procedures and treated more than 300 patients. The mission was an exceptional training opportunity for Army Medical Department personnel, who performed complex surgical procedures with limited logistical support under austere surgical conditions. Team members gained invaluable experience in mobilization preparedness and tested their predeployment training and resourcefulness while providing needed services to the people of the host nation.     

Risk factors for training injuries among British Army recruits

This study aimed to identify risk factors for training injuries resulting in referral to a remedial instructor (RI) or medical discharge (MD) among British Army recruits undertaking initial training. Physical performance and anthropometric data for 11,937 male and 1,480 female recruits were examined as potential risk factors for RI referral and MD, using Cox regression. There was a trend showing that female recruits' MD rates were higher than male recruits' rates (p = 0.096), and RI referral rates were significantly greater for women than for men (p = 0.041). The independent risk factors for MD were 2.4-km run time, ethnicity, and Army training regiment attended (p < 0.001), and those for RI referral were 2.4-km run time, ethnicity, Army training regiment attended, and body mass index (p < 0.001). Gender was not an independent risk factor for injury, suggesting that lower levels of aerobic fitness are the primary cause of the greater incidence of injury among female recruits during British Army initial training.     

Discrepancies in clinical definitions of stress fractures: implications for the United States Army

ABSTRACT In the United States Army initial entry training (IET) environment, stress fractures are common musculoskeletal injuries. Due to the repetitive physical demands placed on soldiers, stress fractures are particularly common in individuals matriculating through basic combat training (BCT) and advanced individual training (AIT). Within the Army medical department, the clinical definitions of stress fractures vary widely among providers who are directly responsible for diagnosing these injuries. The use of diversified definitions of stress fractures in patient evaluations, treatment, communication measures, and injury data collection negatively affect patient dispositions and soldier training outcomes. This report identifies discrepancies in clinical definitions of stress fractures and the implications for the Army regarding the lack of a standardized definition for stress fractures.     

Importance of the radiology program coordinator

The ACGME requires adequate lengths of appointment for both the program director and faculty as being essential to maintaining an appropriate continuity of leadership (1). Although this requirement does not apply to the program coordinator, the ACGME does require that a program have a dedicated coordinator. Any list of coordinator duties is long, but underestimates the true volume of the coordinator’s responsibilities. Although the program director is accountable for all aspects of the program, much of the director’s work is delegated to the coordinator. The training period for a new coordinator is from months to years, and coordinator turnover can be very disruptive to the program. The coordinator must possess skills in communication, problem solving, decision making, administration, organization, and supervision. He or she must have a broad knowledge of academic medicine and radiology training. The coordinator is generally the first and last person to interact with resident candidates, visiting speakers, and ACGME site reviewers. His or her professional and administrative skills are a reflection of the quality of the program and effectiveness of the program director. The work of a coordinator involves managing many complex tasks at once, while maintaining the flexibility to accommodate changes in work priorities in the face of unexpected events. He or she should be seen as an advocate of both faculty and residents. The coordinator needs to work independently within prescribed guidelines, engage in continuous professional development and suggest initiatives to improve the quality of the program. When done well, the coordinator’s work is accomplished effortlessly in the eyes of the program director, faculty, and residents. A highly skilled and experienced coordinator is a valuable asset to the program. Providing the coordinator with adequate support (i.e., clerical assistance, materials, training, and workspace) is a smart investment, the return on which can be substantial.     

Factors associated with stress fracture in young army women: indications for further research.

Several factors which affect bone density and predict risk of osteoporosis (e.g., ethnic origin, amenorrhea) are reportedly associated with a higher incidence of stress fracture in active premenopausal women. The authors surveyed 2,312 active duty Army women for the prevalence of ever having been diagnosed ("told by a doctor") with a stress fracture (16.1% of respondents) and examined the relationship between surveyable risk factors for low bone density and this self-reported stress fracture history (self-reported SF). Current smoking, previous history of amenorrhea (menses absent greater than 6 months), and known family history of osteoporosis were significantly associated with self-reported SF, while black ethnic origin was a protective factor. These data suggest hypotheses of stress fracture pathogenesis in Army women which bear further testing.     

Humanitarian assistance medicine: perceptions of preparedness: a survey-based needs assessment of recent U.S. Army internal medicine residency graduates

The U.S. military provides humanitarian assistance in many areas around the globe. With recent changes in the force structure of the U.S. Army, internal medicine physicians are now at the forefront of providing this care, but the extent of their involvement is not known. This study measured the frequency with which recently trained Army internists provided humanitarian assistance, and it assessed their perceived preparedness for such missions. All graduates from Army internal medicine programs for 4 consecutive years were invited by e-mail to participate in an Internet-based survey. Eighty-nine personnel (49% of those contacted) completed the survey. Of those in a deployable position for >6 months, 72% provided medical humanitarian assistance. Most thought that additional training was needed, especially in tropical disease management, sanitation, and the practices of civilian humanitarian workers. This study demonstrates that military-trained internists are frequently involved in humanitarian assistance medicine, and it suggests that they might benefit from additional training.     

The Central Simulation Committee (CSC): a model for centralization and standardization of simulation-based medical education in the U.S. Army healthcare system

In this report, we describe the organizational framework, operations and current status of the Central Simulation Committee (CSC). The CSC was established in 2007 with the goals of standardizing simulation-based training in Army graduate medical education programs, assisting in redeployment training of physicians returning from war, and improving patient safety within the Army Medical Department. Presently, the CSC oversees 10 Simulation Centers, controls over 21,000 sq ft of simulation center space, and provides specialty-specific training in 14 medical specialties. In the past 2 years, CSC Simulation Centers have trained over 50,000 Army medical students, residents, physician assistants, nurses, Soldiers and DoD civilian medical personnel. We hope this report provides simulation educators within the military, and our civilian simulation colleagues, with insight into the workings of our organization and provides an example of centralized support and oversight of simulation-based medical education.