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Nonmilitary personnel in Iraq and Afghanistan more likely to be medically evacuated

Nonmilitary personnel serving in military operations in Iraq and Afghanistan were more likely to be evacuated with nonwar-related injuries and more likely to return to duty after such injuries compared with military personnel, according to a study published in CMAJ (Canadian Medical Association Journal) (pre-embargo link only)

About 50% of personnel serving in Iraq and around two-thirds in Afghanistan are nonmilitary.

"Nonmilitary personnel play an increasingly critical role in modern wars," writes Dr. Steven P. Cohen, Johns Hopkins School of Medicine, Baltimore, with coauthors. "Stark differences exist between the demographic characteristics, training and missions of military and nonmilitary members. We examined the differences in types of injury and rates of returning to duty among nonmilitary and military personnel participating in military operations in Iraq and Afghanistan."

The study was conducted by researchers from Johns Hopkins School of Medicine, Baltimore, Maryland; the Walter Reed Army Medical Center, Washington, DC; the University of Texas at Austin; the 31st Combat Support Hospital, Camp Dwyer, Afghanistan; and the Landstuhl Regional Medical Center, Landstuhl, Germany.

The researchers analyzed data from 2155 nonmilitary members who were evacuated from US Operations Iraqi Freedom and Enduring Freedom in Afghanistan between 2004 and 2007. Nonmilitary members include Department of Defense civilians, private contractors and diplomats.

In the analysis, the researchers divided injuries into two main groups, "war-related injuries," including combat-related, psychiatric and traumatic brain injuries, and "nonwar-related injuries or disease" such as noncardiac chest pain and circulatory disorders.

Military personnel were more likely to be evacuated for war-related injuries. Seventy-five per cent of medically evacuated nonmilitary personnel did not return to duty and were less likely to return to duty after war-related injuries than military persons. However, they were more likely than military personnel to return to duty after nonwar-related injuries.

"The observation that military personnel were more likely to be evacuated with war-related injuries, and nonmilitary members with nonwar-related injuries, was not unexpected," write the authors. "What was surprising was that the principal contributor to this disparity was the higher evacuation rates among military personnel than among nonmilitary personnel because of psychiatric diagnoses (9.1% v. 2.1%). This effect was amplified by the fact that military personnel were less likely than nonmilitary members to return to duty after evacuation because of a psychiatric condition."

The authors conclude that "because nonmilitary members are expected to play an increasingly prominent role in future military operations, recognizing the types of medical conditions they experience may be useful in implementing preventive measures and treatment strategies."


Contact: Kim Barnhardt
613-520-7116 x2224
Canadian Medical Association Journal

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