Kuckelman John, Mitchell Christopher, Garcia Fernando, Breazeale Travis, Wallace Roxanne, Radowsky Jason
Department of Thoracic Surgery, Dwight D. Eisenhower Army Medical Center, Augusta, GA 30905, USA.
Department of Emergency Medicine, Darnell Army Medical Center, Fort Cavazos, TX 76544, USA.
Mil Med. 2025 Jun 30;190(7-8):e1480-e1484. doi: 10.1093/milmed/usae529.
Protective ballistic body armor (BA) may be needed during certain threat postures while deployed. This requirement often adds between 35 and 45lbs of extra weight carried by the service member (SM) for multiple hours during the day. The physical toll of that extra weight and the effect it may have on deployed medical resources has not been clearly characterized in the literature. We sought to evaluate the association of a protective BA wear requirement with musculoskeletal (MSK) complaints and to better characterize how these effects are manifested within the deployed military health care system.
All encounters at a Role III Field Hospital were evaluated and queried for MSK injury. Data collected included the SM type, age, gender, MSK anatomy of concern, type of evaluating provider, disposition, and medications rendered. Injuries and outcomes were then compared between two groups; SMs who were seen for MSK complaints while BA was required (October 2023 to March 2024) and those during a period when BA was not required (No-BA = October 2022 to March 2023).
A total of 2,805 encounters were evaluated. Non-SM visits were excluded (455) leaving 2,350 left for evaluation. In all, 969 (41.2%) were identified as encounters for MSK injury. No-BA had significantly fewer visits of MSK injury at 429 (38%) compared to the BA group at 540 (44%, P = .001). Active duty (AD) and National Guard (NG) SMs made up a larger portion of MSK visits in the BA group at 54% and 41%, respectively, compared to 35% Reserve (AR) and 36% NG in the No-BA group (P < .001). Service member were 12 times more likely to require a physical therapy treatment in the BA group (60%) vs. the No-BA (5%, P < .001). Prescriptions of non-steroidal anti-inflammatory medication were more common in the BA group at 11% of all visits compared to 4% in the No-BA group (P < .001). This was also true for muscle relaxers at 1% vs. 3% (P = .008). Shoulder and back injuries represented the largest proportion of MSK areas of concern at 22% and 24%, respectively, with only neck injuries being higher in the BA group at 8.5% vs. 5% (P = .03).
Required wear of BA was associated with an increase in MSK visits across all types of US SMs. Shoulder and back injuries were the most common with a significant increase in visits to physical therapy in the BA group. Anti-inflammatory and muscle-relaxing medications were prescribed more frequently in the BA group. A dedicated prospective study would help better elucidate the causality of these associations. Risk-benefit analysis of threat posture, with the knowledge of these health care associations, deserves serious consideration.
在部署期间的某些威胁态势下，可能需要防护性防弹衣（BA）。这一要求通常会使服役人员（SM）在白天多个小时内额外背负35至45磅的重量。额外负重对身体造成的影响以及它可能对部署期间医疗资源产生的影响，在文献中尚未得到明确描述。我们试图评估防护性防弹衣穿着要求与肌肉骨骼（MSK）疾病之间的关联，并更好地描述这些影响在部署的军事医疗系统中是如何表现出来的。
对一家三级野战医院的所有就诊情况进行评估，并询问肌肉骨骼损伤情况。收集的数据包括服役人员类型、年龄、性别、所关注的肌肉骨骼解剖部位、评估医生类型、处置情况和所开药物。然后比较两组之间的损伤情况和结果；一组是在需要穿着防弹衣时因肌肉骨骼疾病就诊的服役人员（2023年10月至2024年3月），另一组是在不需要穿着防弹衣的时期（无防弹衣组=2022年10月至2023年3月）。
共评估了2805次就诊情况。排除非服役人员就诊（455次）后，剩余2350次可供评估。其中，969次（41.2%）被确定为肌肉骨骼损伤就诊。无防弹衣组的肌肉骨骼损伤就诊次数明显较少，为429次（38%），而防弹衣组为540次（44%，P = 0.001）。现役（AD）和国民警卫队（NG）服役人员在防弹衣组的肌肉骨骼就诊中占比更大，分别为54%和41%，而在无防弹衣组中，预备役（AR）占35%，国民警卫队占36%（P < 0.001）。防弹衣组的服役人员需要接受物理治疗的可能性是无防弹衣组的12倍（60%对5%，P < 0.001）。非甾体类抗炎药的处方在防弹衣组更为常见，占所有就诊的11%，而在无防弹衣组为4%（P < 0.001）。肌肉松弛剂的情况也是如此，分别为1%对3%（P = 0.008）。肩部和背部损伤在肌肉骨骼关注部位中占比最大，分别为22%和24%，只有颈部损伤在防弹衣组中更高，为8.5%对5%（P = 0.03）。
要求穿着防弹衣与各类美国服役人员的肌肉骨骼就诊次数增加有关。肩部和背部损伤最为常见，防弹衣组的物理治疗就诊次数显著增加。防弹衣组更频繁地开具抗炎和肌肉松弛药物。一项专门的前瞻性研究将有助于更好地阐明这些关联的因果关系。结合这些医疗关联知识，对威胁态势进行风险效益分析值得认真考虑。
