Operation Aegis: Injury Control during Advanced Individual Training LTC Annette BergeronMAJ Vicki ConnollyCPT Allyson PritchardDr. Mary Z. MaysSSG Mark Kenyon SSG Shelia MickelsonIleana King Darrel GerikClaude Lee COL Valerie J. Berg Rice
BrigadeCOL Larry E. Campbell COL Kenneth R. CrookLTC Rosaline Cardinelli LTC Brian AllgoodCPT Marc Bustamante CPT Clyde L. HillCPT Greer M. Evans-Christopher
MedicalCOL Gemryl SammuelsLTC Suzanne E. CudaLTC Stanley H. UnserCPT Deanna S. Pekarek
All company commanders, all drill sergeants, cadre, All TMC providers, OT/PT, Community Health Nursing
OPERATION AEGISConceived 1999Implemented 2000 LTG James P. Peake Scientifically-based Musculoskeletal Injury Prevention Program Goals: Decrease Musculoskeletal Injuries among AIT soldiers on Ft. Sam Houston Develop a Guideline Methodology that can be used at other posts
2 JUL 99 Presidential Memo Directs Secretary of Labor to lead an initiative focusing on Federal workplace injury reduction over a period of 5 years with 3 measurable goals.
1. Reducing the overall occurrence of injuries by 3 percent per year, while improving the timeliness of reporting of injuries and illnesses by agencies to the Department of Labor by 5 percent per year
2 JUL 99 Presidential Memo2. For those work sites with the highest rates of serious injuries, reducing the occurrence of such injuries by 10 percent per year; and
3. Reducing the rate of lost production days (i.e. the number of days employees spend away from work) by 2 percent per year
Injury Rates among Recruits
Injury Rates among Recruits
Studies at Ft. Sam HoustonBCTHendersonRicemen 26% 28%women 52% 48%AITmen 24% 24%women 30% 24%
Important: Henderson = record reviewRice = self report
Macroergonomic and Public Health ApproachesErgonomics
AssessDesign (intervention)Test & evaluation
Macroergonomics Each system and each level within a systemBroad to Focused Organizational structure, resources, agencies, personnel, policies, procedures, surveillance systems, dataCommunication/AdvisorsWho will be of assistance?For or against?Participatory: They should own it
PremisesTop Level Support is EssentialParticipatory Ergonomics/Organizational EffectivenessDictated changes, unless they are Army-wide, do not last - attitude/belief changes do lastLocally dictated changes are often sabotagedTop down, bottom up, sidewaysEveryone is involved & has responsibilities
Top level support opens the door and trouble shoots WHEN NECESSARY
PremisesInjury Management is a Commanders Responsibility
Health Care Professionals are SMEs/Advisors/Consultants
Setting the Stage(& Assessing)Understanding the Literature
Understanding the People
Understanding the Rules and the Roles
Broad to FocusedInformal Advisors nationwideCDC, Universities, Ergo/Injury Prevention Programs, Professional Societies DoD IOIPC (Ill & Occ Injury Prev Comm) Ergonomics Committee, MWRNavy/Marines/AF/Corps of Engineers, CGArmy CHPPM, MRMC esp. USARIEM, Safety Center, Corps Activities/Committees, other posts
Informal Advisors nationwide - CDC, Universities, Ergo programsDoD - IOIPC (Ill & Occ Injury Prev Comm), Ergo, Navy/Marines/AF/Corps of Engineers, CGArmy - CHPPM, MRMC esp. USARIEM, Safety Ctr, Ind Hygien, Post - MWR, Comm Health Nursing, Occupational Health, PTRP, Sports-intermural, Wellness CenterUS Army Medical Center and School - PT/OT, Behavioral Health, Nutrition, Rules/regulationsCenter Brigade - People, rules/regulations, sleep/wake, etc. etc.BattalionsCompanies
Again: Organizational structure, resources, agencies, personnel, policies, procedures, surveillance systems, data
Broad to FocusedPostMWR, Comm Health Nursing, Occupational Health, PTRP, Sports-intramural, Wellness Center, OH&S, Ergo CommitteeUS Army Medical Center and SchoolCenter BrigadeBattalionsCompaniesOrganizational structure, resources, agencies, personnel, policies, procedures, surveillance systems, data
Messages to CommandWe think we can reduce injuries.We are here to try it.We will use a scientific approach to discover why injuries occur and how to decrease them.Well do all we can to interfere as little as possible.We are here as allies, not adversaries.
What are you, the PT Police???
Establish Communication PatternsRegular meetings at all levelsMatching rank w/ rank, mixing too!Matching civilians w/ rank and/or groupsBriefings a lot or a little?iterativetopics
Consultants not dictators!
Only by knowing what they think/believe, do you know how to approach and work with them... Drill SergeantsCadreCommanders
Are there too many overuse injuries occurring in your unit?
Most dont think its a problem
What do you think is an acceptable rate of soldiers being on profile for injury at any given time?
~ 20% at the extreme
~ 60% at 1-10%
What are the main factors contributing to injuries in your unit?
Can injuries be decreased by changing the way you train?
Theres nothing I can do.Its not my fault.Its BCT.
All this and we havent even started our program yet?
Rememberfor this program there was no solution yettell them the solution for their problem right away and they have to feel defensiveits perceived as extra work for themthey dont see the value, esp. for themthey arent convinced!they dont know how to use you
You have been learning, and as you learn, you implement.
It all happens simultaneously..
At each level:What Exists? Who is doing what, when, and how? How does what they do relate? What should be happening?What are their attitudes/opinions?How can we make what should happen, happen effectively?
Inprocessing 8094 soldiers, 9015 surveysOutprocessing 6111 soldiers, 6819 surveysTMC Visits 3278 soldiers, 4466 surveysProfiles2172 soldiers, 3194 surveys
Initial InterventionsCommand ClimateInjury preventionPerformanceInjury Control Advisory CommitteeBN Standard Operating ProceduresEducation on Latest InformationReporting & Accountability System
Army ValuesICAC monthly, problem solving/advisory, educationalUSA Physical Fitness School type evaluations of each companys PT program, including observations (multiple), written review of PT OP Plan, interviews followed by rewrite of SOPUSA Physical Fitness School info to BNs, 1 wk training programEducation: injury control (long & short), shoe fit, running, stretching, ergonomics. Drill SGT Recertification, Initial arrival on post, company, ICAC, whomever! Nutrition, supplements...Reporting & accountability: data base system from Ft. Jackson, simple data system for PT.Problem!
Injury Control Advisory CommitteePurpose: To advise the Commander on musculoskeletal injury prevention
Mission: To advise the Commander on methods to reduce and/or maintain an acceptable level of musculoskeletal injuries and lost duty time within the battalion by identifying injury trends and causative factors, and recommending/implementing targeted injury prevention programs
ICACCompositionTasks/ResponsibilitiesTrack injury trendsStandardize data to be collected/reportedEstablish baselinesInterpret findings
Take Time & TeachIdentify and Solve ProblemsNo concern left unaddressed!
ICAC Problem SolvingPoorly written profilesEach company turn in copiesReviewed by SMEsTaken to TMC ChiefCoordinated solutionTraining course for health care practitioners
ICAC Identified ProblemsBN Commander ConsultingInjuries during/after DAPFTArrival screening (HCP, DS, Traditional)Positive Prediction HCP 92%, DS 80% Negative Prediction HCP 91%, DS 95%Initial profiles increasedNo difference in # of profiles, profile length during the course, pass rate on RAPFT, holdovers30% on profile w/ profile of 3 wks40% of those on profile went on in the first week - 48% passed RAPFT, 58% on profile later - 80% passed RAPFTIdentify Porcelain Soldiers
Porcelain SoldiersProfile*SymptomsMore than one*Lower Extremity*Injured in BCT or last 90 days*Upper Extremity Symptoms(That interferes w/ duty*)
Moderate/High Stress*Female*Poor/Fair Physical Fitness*Over 24 yrs of age
* predictive of injury during AIT
ICACBN Commander Consulting
One ability group injured more?
Did they REALLY pass the PT test during basic?
Injuries during field problems
Early intervention clinic
ICACBN Commander ConsultingDrill Sergeant RecertificationIn-processing ClassesOther Classes, as requested InjuriesPhysical TrainingNutritionSpecial Population PT
ICACConsultingClassesRunning (form, breathing, etc.)Shoe Fit
Soldiers on sick call immediately after exodusFear factor when changing running routes
10.8% reduction360 fewer clinic visits$26,280 annual savings
Number of Clinic Visits for Musculoskeletal Injury per 100 Soldiers in the Ten-week Course
232nd Battalion Change in "Per Course Musculoskeletal Injury Rates" During Operat