Military Admin Office, Army Personnel Centre, Glasgow, UK
Defence Postgraduate Medical Deanery, Defence Medical Services Whittington, Lichfield, UK.
BMJ Mil Health. 2020 Oct;166(5):312-317. doi: 10.1136/jramc-2018-001109. Epub 2019 Feb 2.
In April 2017, 22% of Army Full-time Trade Trained Strength was downgraded, reducing fully deployable strength to 60 546, against a target of 82 000. In June 2017, Commander 20 Armoured Infantry Brigade (20 AI Bde) initiated a study to look at the principal conditions causing medical downgrading, as a stepping stone to finding ways of reducing injury, enhancing rehabilitation and improving deployability.
The Defence Medical Information Capability Programme medical records for every downgraded soldier in 20 AI Bde and supporting units were scrutinised to identify their Medical Deployment Standard and the primary condition causing downgrading.
A total of 842 downgraded soldiers were identified from a held strength of 3827 personnel. Sixty-five per cent of these downgrades were due to musculoskeletal injury (MSKI). Of this 65%, the majority were due to knee (31%), spine (28%) and foot/ankle (23%). Of the remaining 35%, the majority were due to noise-induced hearing loss (NIHL) (22%), adjustment disorders (19%) and non-freezing cold injury (NFCI) (13%).Several factors that slowed an individual's recovery pathway were identified. They mainly relate to soldiers being lost to follow-up through lack of active case management.
MSKI is responsible for most downgraded personnel at Brigade level. The distribution of principal conditions is similar to previous studies looking at recruits and individual units.The creation of a rehabilitation troop, delivering active case management, can reduce the number of soldiers leaking out of the rehabilitation pipeline.
2017 年 4 月，陆军全职贸易训练人员的 22%被降级，使完全可部署的兵力减少到 60546 人，而目标是 82000 人。2017 年 6 月，第 20 装甲步兵旅（20AI 旅）指挥官启动了一项研究，旨在研究导致医疗降级的主要条件，以此作为寻找减少伤害、加强康复和提高部署能力的途径。
对 20AI 旅和支援部队中每一位降级士兵的国防医疗信息能力计划医疗记录进行了详细审查，以确定他们的医疗部署标准和导致降级的主要条件。
从 3827 名现役人员中确定了 842 名降级士兵。这些降级人员中有 65%是由于肌肉骨骼损伤（MSKI）。在这 65%中，大多数是由于膝盖（31%）、脊柱（28%）和脚/脚踝（23%）。在剩下的 35%中，大多数是由于噪声性听力损失（NIHL）（22%）、适应障碍（19%）和非冻结性冷伤（NFCI）（13%）。确定了一些导致个人康复途径放缓的因素。它们主要与由于缺乏积极的病例管理而导致士兵失去跟踪有关。
在旅级，肌肉骨骼损伤是导致大多数降级人员的原因。主要条件的分布与之前研究新兵和个别部队的情况相似。创建一个康复部队，提供积极的病例管理，可以减少从康复管道中流失的士兵数量。
