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Data: Only 19 percent of medical evacuations in Mideast battle-related

TOKYO — Only one out of five medical evacuations of troops from Iraq and Afghanistan in the past eight years were diagnosed as battle-related injuries, according to a new analysis by the Armed Forces Health Surveillance Center.

During the same time, evacuations for mental disorders rose drastically, from 61 instances in 2002 to 1,014 in 2008, the last full year analyzed.

The majority of the medical evacuations from Iraq and Afghanistan occurred because of injuries classified as happening outside the battlefield, including back and knee problems, mental disorders, and other physical problems such as digestive, respiratory or urinary symptoms, according to the report.

The analysis was the first of its kind to look comprehensively at all 52,283 medical evacuations from October 2001 to September 2009, according to Army Col. Robert DeFraites, a preventive medicine doctor who directs the center.

The findings — including the low ratio of battle-related injuries and the sharp increase in mental disorder-related evacuations — were not surprising, DeFraites said during a phone interview Monday.

Disease, heat and work injuries have historically injured more wartime troops than bullets or bombs, he and other military medical officials said. The increase in treatment of mental disorders also was expected, though it’s unclear whether that’s because of increased attention by military leaders to mental health problems or the effect of repeated deployments and stresses as the wars continue, they said.

"It’s validation of what we’ve seen," said Air Force Col. Michael Butel, who works for Global Health Surveillance, an analysis unit within the Military Health System.

Military health officials review similar information monthly. Now, Butel and DeFraites say, they have a better tool to watch for trends across the categories that could identify preventable injuries and illnesses.

The analysis could help reshape pre-deployment screenings as well, Butel and DeFraites said. Many troops were evacuated for symptoms that had prompted treatment in the 90 days before deployment.

For example, of 8,543 patients evacuated for muscle or bone problems, 29 percent had gone to a medical appointment for the same problem within three months of deploying.

All told, the 52,283 evacuations occurred among about 2 million deployments during the eight years. Battle-related injuries were the overall leading reason for evacuations — 10,103 cases or 19 percent — though not in every year. Battle-related injuries peaked in 2007, with 2,178 evacuations.

The next year, evacuations for musculoskeletal (1,253) and mental disorders (1,014) surpassed battle-related injuries (983), according to the report.

Overall, about one in 50 servicemembers who deploy seek medical care while downrange, according to Dr. Michael Kilpatrick, a retired Navy officer and infectious disease doctor who is now working in the Military Health System.

The report shows only primary medical reasons for evacuation and does not show what caused the injury or illness. That information is contained within each medical file and is not necessarily accessible for computer-based analysis, Kilpatrick and DeFraites said.

Still, the data could prompt commanders to look at how to reduce preventable diagnoses.

"We can drill down and look at the cause of injury," Kilpatrick said on the same telephone call on Monday. "There are things to prevent injuries. It does set the table for looking at that in the future."

About 15 percent of the evacuations for female patients were prompted by genitourinary disorders, problems with urinary and genital organs. Women can be more susceptible to urinary problems, which are often brought on by dehydration, Kilpatrick said.

That, to some degree, can be a result of routine work at war in the desert.

"It’s a hot, dry place and people don’t drink enough," Kilpatrick said, and women sometimes will drink less to avoid urination in certain situations. "They are not going to drink and stop a convoy."

Pregnancy and childbirth issues accounted for 248 evacuations. Those removals do not account for all pregnancies at war, the doctors said, but only the patients who needed immediate medical attention. The military removes pregnant troops from conflict as quickly as possible, though not necessarily as a medical evacuation, they said.

Pregnancy became an issue late last year when Maj. Gen. Anthony Cucolo, commander of forces in northern Iraq, included pregnancy among offenses that could lead to a court-martial and jail time. He argued units suffered when pregnant soldiers left units. The military dropped the ban Jan. 1, when a realignment of commands in Iraq voided Cucolo’s policy.

The evacuation report is based on numbers collected by U.S. Transportation Command, a joint logistics unit headquartered at Scott Air Force Base, Ill. The report can be found at www.afhsc.mil/msmr.

The analysis looks solely at the number of patients recommended for care outside of military facilities in Iraq and Afghanistan. The data do not show severity of injury or weigh the number of evacuations against the number of troops in either country at a certain time.


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