Aeromedical Evacuations from Operation Iraqi Freedom: A Descriptive Study

Military Medicine, Jun 2005 by Harman, Dale R, Hooper, Tomoko I, Gackstetter, Gary D

Objective: To describe health patterns in evacuated military members during Operation Iraqi Freedom (OIF) and utilize demographic, diagnostic, and pre- and postdeployment health information to understand the utility of data collected for aeromedical evacuations. Methods: We conducted a descriptive analysis of U.S. evacuees from 2003 using data from the U.S. Transportation Command's Regulating and Command & Control Evacuation System and the Defense Medical Surveillance System. Results: The typical patient was an Army male under the age of 29 requiring orthopedic or surgical care. Disease/ nonbattle injuries were six times as common as battle injuries and 94% were classified as routine evacuees. Eighty-six percent had health data available in the Defense Medical Surveillance System. Two thirds had pre- and/or postdeployment questionnaire data. Conclusions: Combining data sources increases our understanding of disease patterns in deployed troops. Targeted preventive interventions can then be implemented. Changes in the U.S. Transportation Command's Regulating and Command & Control Evacuation System database can improve its utility as an epidemiological tool.

Introduction

The enormous utility of health-related data that is thoroughly and systematically acquired is well documented.1-5 When automated health information relating to exposures, demographic attributes, illnesses, injuries, and other health outcomes is combined into an analyzable form, it offers the opportunity to identify and characterize potential health hazards and their consequences and to detect trends over time. More importantly, these data can lead to the design, implementation, and evaluation of preventive interventions and provide the basis for efficient resource allocation and appropriate policies to reduce future adverse health events.6

Advances in electronic databases and information management systems have made large amounts of health-related information more accessible. However, the ability to locate specific data sources can be challenging, since health information is frequently stored in a variety of disparate locations under the authority of different organizations. Moreover, data are collected and stored in nonstandardized formats and, thus, are difficult to collate, analyze, and compare. Overcoming the hurdles of variability in coding patterns and the different structure and architecture of automated databases still makes the formation and use of large-scale, integrated information systems difficult, but the rewards are worth the effort.7,8

Assembling epidemiological health information under combat conditions provides additional unique challenges. The pace of military medical operations in this type of setting is almost always frantic, and the need to treat, stabilize, and evacuate patients to higher echelons of care is fundamental to saving lives and minimizing disability. These situational factors combine to make complete and accurate documentation of injury and illness data extremely challenging. Add the stressors of a combat environment, including the constant threat of hostile fire, and it is easy to understand why only information deemed absolutely critical to the patient's immediate care and well-being is recorded. Unfortunately, vital communications are frequently verbal, temporary (handwritten directly on the injured patient), or on paper triage tags. Thus, a clear and comprehensive characterization of injury and illness patterns, at the population level, is inherently difficult to obtain under these conditions.

For most U.S. military combat operations, summary reports of disease and nonbattle injury (DNBI) have been the mainstay of medical surveillance.9-13 At best, these data provide only a general overview of injury and illness patterns not directly due to combat, within a framework of location and time. DNBI reports present aggregate numbers of illnesses and injuries in broad categories. As a result, it is not possible to document the circumstances of the illness or injury event or relevant exposures. Nor is it possible to link these data to other databases containing medical outcomes or other patient demographic data at the individual level. Denominator data used to calculate DNBI rates is also reported in broad categories, precluding the ability to conduct other important subgroup analyses. At best, DNBI data can only be used to explore possible associations using ecological study designs.

To make progress toward a comprehensive medical surveillance system for combat operations and the subsequent development and implementation of preventive interventions, existing health-related data sources should be systematically assessed. Operation Iraqi Freedom (OIF) provides us with the opportunity to evaluate our current ability to identiry illness and injury patterns and trends as well as to enhance how we currently collect and use health data in combat settings. As a first step, this report focuses on the U.S. Transportation Command's (TRANSCOM) Regulating and Command and Control Evacuation System (TRAC^sup 2^ES) data, which is collected for the purposes of tracking aeromedical evacuations.