VERONIQUE HAUSCHILD
Clinical Public Health and Epidemiology Directorate
U.S. Army Public Health Center
Aberdeen Proving Ground, Maryland

Does it seem like there are a particularly high number of knee, ankle and foot problems in your unit right now? Did it seem the ice and snow caused more slips and falls than usual this past winter? Have you been hearing about a lot of Soldiers in motor vehicle accidents lately? Do you have co-workers who had to take time off for a strained muscle from lifting heavy objects? How many Soldiers do you know who have hurt themselves playing sports, or developed a stress fracture from weeks of running and foot marching? How common is it for office workers in your organization to be diagnosed with carpal tunnel syndrome?

These scenarios represent the hundreds of thousands of unintentional injuries experienced by Army personnel each year. These injuries cost the Army millions of lost or restricted work hours and dollars. It’s a common belief that injuries are just unfortunate accidents — the inevitable result of physically demanding jobs that require repetitive body motions or awkward positioning. But even though they are unplanned, many injuries can be avoided.

Because there are numerous conditions and individual variables that lead to an injury incident, it is difficult to provide one-size-fits-all prevention solutions.

“An in-depth review of the types and causes of injuries that occur at the local level is necessary to be able to successfully reduce injuries,” said Dr. Michelle Chervak, a senior epidemiologist in the Army Public Health Center’s Injury Prevention Division. “Prevention strategies, such as changes to the physical environment (engineering controls), leadership roles and procedural policy, and/or training and awareness, can then be prioritized and tailored to fit the local situation.”

For example, slips and falls are a leading mechanism of injuries among active-duty Soldiers and often the result of icy conditions. If a review of relevant installation-level safety and medical data identify slips and falls as a leading mechanism of injury, the installation may want to improve its policies, equipment and/or procedures to better address ice and snow hazards. But a training installation in the southern U.S., with few ice-related falls, might instead find, after a review of their data, that a focus on training-related musculoskeletal overuse and heat-related injuries that commonly occur in Soldier trainee populations is the best use of limited prevention resources.

So what is the injury situation at your installation? How does it compare with other installations? With the overall Army? As a baseline for each installation to investigate its local injury situation, the APHC-IPD creates annual installation injury summaries. Two annual summaries are prepared for each installation and are detailed below.

Active-duty installation injury summaries
These summaries are based on data from Soldiers’ medical records that are ultimately maintained in the Defense Medical Surveillance System. Any injury for which medical treatment is sought at a military medical facility or through TRICARE purchased care is captured. Injury rates encompass both traumatic injuries (such as traumatic brain injuries, fractures and sprains) and injury-related musculoskeletal conditions (such as low back pain, tendinitis and bursitis).

The installation injury summaries compare injuries to all other medical conditions for which treatment was sought and provide quarterly injury rates and trends for injuries that required hospitalization as well as for those treated on an outpatient basis, including the top five causes of injuries. In addition to comparisons to total Armywide injuries, rates are shown relative to “red/amber/green” levels to help identify when trends near or surpass the level of concern. These active-duty summaries are available online in Public Health 360 (PH360) and the Army Strategic Management System. More-specific surveillance analyses can be requested from APHC.

Civilian installation injury summaries
These summaries are based on workers’ compensation claims. The civilian summaries often represent a much smaller population. However, at installations with uniquely skilled civilian occupational populations, these summaries can guide commander, safety and preventive medicine efforts to address leading causes of the more severe injuries among their civilians. As noted by Maj. Luke Mease, chief of Preventive Medicine, Medical Department Activity Bavaria: “The civilian installation summary provides a greater level of detail about civilian injuries than we have been able to find or generate from any other data source.” These civilian summaries are currently available from APHC by request.

During the development of these products, Chervak enlisted the assistance of safety engineer Dr. Anna Schuh to formulate the red/amber/green tool used to monitor active-duty injury rates — referred to as a statistical process control chart. This tool puts the data into a usable context for Army leaders. This good business practice fits well with the Army risk management process. Installation injury summary reports have only been provided by the APHC for two years, but a number of installations are already making use of this valuable resource.

"We’ve used the active-duty injury summary on multiple occasions when briefing leadership,” said Capt. Erin Johnson, chief of Orthopedics and Physical Therapy, Kenner Army Health Clinic, Fort Lee, Virginia. “It helps show the importance of our injury problem before we get into the weeds. And the charts have provided motivation for our current injury prevention initiatives."

For more information on Army public health injury monitoring tools, visit the APHC website at http://phc.amedd.army.mil/TOPICS/DISCOND/PTSAIP/Pages/ArmyInstallationInjurySurveillanceReports.aspx. For requests or questions, contact the APHC Injury Prevention Division at usarmy.apg.medcom-phc.mbx.injuryprevention@mail.mil or call 410-436-4655/DSN 584-4655.