Operation Aegis 2002

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  • 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

  • Chart4

    0.20.050.64

    0.420.250.32

    Injury Rates among Recruits

    Sheet1

    MalesFemales

    20%42%

    5%25%

    64%32%

    23%42%

    Sheet1

    000

    000

    Injury Rates among Recruits

    Sheet2

    Sheet3

  • 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

    Public Health

    SurveillanceInterventionEvaluationDissemination

  • 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!

  • Staffs Perceptions

    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?

    Leverage

  • Surveillance

    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

    106.bin

  • 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

  • Results

    10.8% reduction360 fewer clinic visits$26,280 annual savings

    Chart2

    67

    49

    36

    38

    49

    54

    42

    46

    71

    53

    28

    58

    41

    46

    34

    43

    5/7C

    5/21D

    6/4E

    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