Cronrath Corey M, Venezia Joseph, Rund Titus J, Cho Timothy H, Solana Nicole M, Benincasa Jennifer A
Department of Occupational Medicine, United States Army School of Aviation Medicine, 540 Hulse Road, NAS Pensacola, FL 32504.
Department of Soldier Research Development and Engineering Center, Natick Soldier System Center, 15 Kansas Street, Natick, MA 01760.
Mil Med. 2017 Mar;182(3):e1704-e1708. doi: 10.7205/MILMED-D-16-00182.
Historically, disease and nonbattle injuries (DNBI) have caused more casualties during military operations than enemy combatants. Recent deployments to U.S. Central Commands (USCENTCOM) area of operation (AOR) have demonstrated similar outcomes. Intuitively, appropriate medical standards for our deploying Soldiers should result in no greater redeployments rates for those Soldiers who are waived for various medical conditions. However, no formal study has been published on redeployment rates of Soldiers with medical deployment waivers. The objective of this report was to evaluate the redeployment rates of Soldiers with and without medical waivers.
A matched retrospective cohort study design was used in this study. Data were obtained from USCENTCOM, Army Central Command, Transportation Command, and the Armed Forces Health Surveillance Center. All U.S. Soldiers deploying to USCENTCOM's AOR with a medical deployment waiver during the calendar years of 2008-2013 were eligible for inclusion into the exposure group of this study. Soldiers with a medical deployment waiver were matched 1:5 to Soldiers without a medical deployment waiver. The Soldiers with a medical deployment waiver and their matched counterparts were then subdivided into 5 strata on the basis of their diagnosis. A McNemar's χ test was performed to calculate risk ratios (RRs) per strata and for the group as a whole.
The overall risk of being medically evacuated because of DNBI for all medical deployment waivers was an RR of 2.03 (CI: 1.74, 2.36). The greatest risk of being medically evacuated because of DNBI was from the group of Soldiers on a waiver for neurological conditions with an RR of 3.81 (CI: 1.99, 7.30). The RR of medical evacuation because of DNBI was increased and statistically significant for all strata (p < 0.05).
There is a statistically significant increased RR of Soldiers with a Modification of the Operational Order waiver being medically redeployed for a DNBI reason from USCENTCOM's AOR from 2008 to 2013 compared with their matched peers without a waiver. The results of this study provide Commanders with additional information when making decisions regarding Soldier deployment.
从历史上看，在军事行动中，疾病和非战斗损伤（DNBI）造成的伤亡比敌方战斗人员更多。最近在美军中央司令部（USCENTCOM）行动区域（AOR）的部署也显示出类似的结果。直观地说，为我们部署的士兵制定适当的医疗标准，对于因各种医疗状况而被豁免的士兵，重新部署率不应更高。然而，尚未有关于有医疗部署豁免的士兵重新部署率的正式研究发表。本报告的目的是评估有和没有医疗豁免的士兵的重新部署率。
本研究采用匹配的回顾性队列研究设计。数据来自USCENTCOM、陆军中央司令部、运输司令部和武装部队健康监测中心。2008 - 2013年历年中，所有因医疗部署豁免而部署到USCENTCOM行动区域的美国士兵均有资格纳入本研究的暴露组。有医疗部署豁免的士兵与没有医疗部署豁免的士兵按一比五进行匹配。然后，有医疗部署豁免的士兵及其匹配对象根据诊断结果分为5个层次。进行McNemar卡方检验以计算每个层次以及整个组的风险比（RR）。
所有医疗部署豁免因DNBI而被医疗后送的总体风险为RR 2.03（CI：1.74，2.36）。因DNBI而被医疗后送的最大风险来自因神经疾病而豁免的士兵组，RR为3.81（CI：1.99，7.30）。所有层次因DNBI而医疗后送的RR均增加且具有统计学意义（p < 0.05）。
与没有豁免的匹配同龄人相比，2008年至2013年期间，因作战命令修改豁免而从USCENTCOM行动区域因DNBI原因被医疗重新部署的士兵的RR有统计学意义的增加。本研究结果为指挥官在做出关于士兵部署的决策时提供了更多信息。
