According to U.S. Defense Health Agency-Public Health experts, noncombat-related injuries are the primary reason active duty service members seek medical treatment.

Department of Defense active duty service members require medical treatment for injuries almost 5 million times each year. In addition to causing pain, injuries often lead to physical restrictions and medical profiles. As a result, injuries degrade force readiness through millions of lost duty and training days and billions of dollars annually.

How Do We Know the Extent of the DOD Injury Problem?

To identify reasons for medical visits, military health experts routinely monitor the medical data of all service members, an essential public health service also referred to as health surveillance. Surveillance allows the military to monitor health care use and trends over time and in useful groups, such as at the installation level. For example, across all services, there are more than twice as many medical visits for injury as for behavioral and mental health, the second-most common reason for visits.

The DOD’s routine surveillance provides insights to the nature of the injury visits as well as evidence to support strategic injury reduction priorities. Surveillance, however, is not always adequate to identify the unique types of injuries, injury patterns, hazards, exposures, or characteristics of individual units.

Commanders and public health personnel may need additional targeted injury investigations to identify risk factors for specific groups.

What Are Injury Investigations?

“Injury investigations require our experts to go beyond the medical records used for routine surveillance,” said Michelle Chervak, chief of the military injury prevention division of DHA-PH in Aberdeen, Maryland. “Additional information pertaining to a specific type of injury in a ‘sub-population,’ or unit of interest, is collected using a variety of techniques, including questionnaires, focus groups or interviews, and in-depth reviews of recent scientific publications.”

A variety of units benefit from the extensive specialized assessment. In addition to the investigations mentioned below, other examples of military unit sub-populations that have been investigated include military police, infantry units, U.S. Army wheeled vehicle mechanics, hospital medical staff, a chemical brigade, and even military working dogs.

“During investigations, we gather information about a unit’s specific mission and training schedule,” said Chervak. “Some characteristics, such as higher body fat and lower aerobic fitness, tend to be associated with musculoskeletal injury risk for all military members. Risks that may be specific to this population include occupational demands, training requirements, and health behaviors such as tobacco use, sleep, and nutrition. These details are not always available in medical records or other centralized data sources.”

Injury investigations involve comprehensive data collection and statistical analyses that can take time to complete, but interim findings can often be provided at multiple stages.

The following are examples of recent and ongoing investigations.

MSK Injuries Among U.S. Military Paratroopers, 2019 and 2023

Changes in tactical paratrooper procedures, most notably the implementation of a new parachute known as the T-11 after 2015, resulted in a two-phase investigation of paratrooper injuries.

The first phase focused on a comprehensive review of the available literature. The second phase compared medical injury data of active paratroopers with groups of peers who did not parachute.

“We realized that many past studies had been performed on service members who were in training, or ’jump school,’” says Chervak. “So we identified different patterns of injuries and risk variation between the trainees and those who went on to become active paratroopers in a military unit.”

The comparison with nonparatroopers also provided a new understanding of injury risks among U.S. military paratroopers.

“Most injuries experienced by paratroopers were overuse injuries, which is similar to nonparatroopers,” said Chervak. “While findings showed paratroopers do experience a slightly higher risk of acute traumatic injuries, there appear to be fewer ankle fractures and sprains than in past studies. We also found that paratroopers appear to experience slightly more shoulder-related injuries than their nonparatrooper peers.”

The DHA has summarized the current evidence in a factsheet.

Musculoskeletal Injuries Among U.S. Army Band Members, 2023

“We conducted an investigation of members of the Army Band at the request of their command, who felt band members may have different musculoskeletal, or MSK, injuries than other Army populations given the units’ older average age and unique occupational activities,” said Anna Renner, a safety engineer and senior injury prevention investigator at DHA-PH in Aberdeen, Maryland. “Extended sitting, standing, and marching for rehearsals and performances; awkward postures while playing instruments; and carrying heavy instruments or equipment are all unique risk factors for MSK injuries among musicians.”

Data on these risk factors were collected using an electronic self-reported questionnaire. Common factors such as body mass index and fitness levels were assessed against self-reported injuries

“Based on our findings, we recommended increased physical training, additional rest breaks during rehearsals, and ergonomic assessments to ensure proper postures are maintained,” said Renner.

Hearing Injuries Among Special Operations Forces, Ongoing

While all service members are at risk for experiencing auditory damage, the risks of hearing-related injury are considered especially high for those in special operations forces, or SOF, due to noise exposure from firing weapons. A military public health investigation is underway to assess SOF hearing risk.

“The SOF personnel likely have greater risk of hearing damage than those of a typical soldier because they are trained on a wider variety of heavy weapon systems, use weapons more regularly in training, and remain in a front-line combat role longer than other service members,” said Alyssa Davidson, a research audiologist with Walter Reed National Military Medical Center supporting the DHA’s investigation.

Davidson explains the investigation allows audiologists to evaluate hearing and auditory function of SOF service members before, during and after training exercises to identify any acute changes in hearing function.

“We will compare any hearing changes to the exposure data collected with minimally-invasive blast dosimeters and boothless audiometers,” said Davidson.

When complete, the study findings will assist SOF leaders with recommendations to reduce risks of hearing impairment among their units. The same type of evaluation can be extended to other units.

“Now that we have an established protocol, we are interested in working with other units concerned about noise and blast exposure in their trainings,” said Davidson.

Like the other injury investigations, this study is evaluating exposures that cause hearing- related injuries and hearing loss. The noise and blast exposure data being collected for this study may also have even broader implications and help inform the Warfighter Brain Health initiative to counter blast overpressure risk

Learn More

As evidenced by these examples, injury prevention investigations can assist local leaders in developing injury prevention strategies in their unique populations.

Local leaders and public health personnel with concerns about their unit’s injuries and risks can reach out to the military’s public health injury specialists and by filling in basic contact and topic information as a Defense Centers for Public Health-Aberdeen mission request.

The Defense Health Agency supports our Nation by improving health and building readiness—making extraordinary experiences ordinary and exceptional outcomes routine.

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