Incidence and causes of air-evacuated non-battle injuries among U.S. Army soldiers deployed to Iraq and Afghanistan, 2001 – 2009

Background: Non-battle injuries (NBIs) are a leading health problem for the U.S. Army. Even when soldiers are deployed, NBIs are an important problem. In fact, preliminary data for Iraq and Afghanistan (2001 – 2006) showed that 35% of Soldiers requiring air evacuation to Germany had an NBI. Purpose: Determine the casualty type, incidence, leading causes, types, and anatomical locations of air-evacuated NBIs among soldiers deployed for the ongoing operations in Iraq and Afghanistan from 2001 – 2009. Methods: Air evacuation records were examined for all soldiers who required medical air evacuation from Iraq or Afghanistan from October 2001 to December 2009. Medical history and coded diagnosis were used to identify casualty type (Battle Injury [BI], NBI, or illness) and to identify the cause, injury type, and anatomical location for NBIs. Results: Of the 51,519 soldiers evacuated, 34.1% had a NBI (rate: 14.7/1,000 person-years) compared to 17.3% (rate: 7.5/1,000 person-years) for BI. The three leading causes of NBI were: sports/physical training (22.2%), falls/jumps (16.8%) and land transport mishaps (14.0%). Fractures (19.4%), pain/inflammation (15.5%) and sprains/strains/ruptures (12.0%) accounted for the majority of injury types, with the most commonly affected anatomical locations consisting of the back (17.3%), knee (15.5%), and wrist/hand (13.3%). Conclusion: The findings of this report are consistent with earlier data from Iraq and Afghanistan. More soldiers were air evacuated for NBIs (34.1 %) than for BIs (17.3%) or any category of disease. Identifying the leading causes of NBI is the first step toward developing future policy and injury prevention strategies.