Non-Military Medically Evacuated Personnel from Iraq, Afghanistan More Likely to Return to Duty, University of Texas at Austin College of Pharmacy Researcher Says

Compared to military members, non-military personnel serving in Iraq and Afghanistan were more likely to be evacuated with non-war injuries, but more likely to return to duty, according to a new study co-authored by a University of Texas at Austin researcher.

Results of the study on the diagnoses and factors associated with medical evacuation and return-to duty-rates among nonmilitary personnel were published recently in the Canadian Medical Association Journal.

Dr. Scott Strassels, assistant professor in the College of Pharmacy and an expert on pain management, says nonmilitary personnel have an increasingly critical function in modern wars.

"Because nonmilitary members are expected to continue playing a prominent role in future military operations," Strassels said, "recognizing the types of medical conditions they experience may be useful in implementing preventive measures and treatment strategies."

Non-military personnel were not included in a recent large four-year study on the causes for medical evacuations from U.S. operations. Yet nonmilitary personnel serving in Iraq and Afghanistan have assumed many of the responsibilities once reserved for military personnel, such as transport missions.

"Unlike previous conflicts, nonmilitary personnel, therefore, could experience similar injury patterns," said members of the research group, which also included lead investigator Dr. Steven Cohen of Johns Hopkins School of Medicine.

Department of Defense civilians, private contractors and diplomats make up nonmilitary personnel.

Injuries were divided into two groups -- war-related injuries, including combat-related, psychiatric and traumatic brain injuries -- and non-war related injuries or diseases such as noncardiac chest pain and circulatory disorders.

Diagnoses associated with the highest return-to-duty rates in the nonmilitary group were psychiatric diagnoses (15.6 percent) among those with war-related injuries and noncardiac chest or abdominal pain (44 percent) among those with non-war related injuries.

The finding that military personnel were more likely to be evacuated with war-related injuries and nonmilitary members with non-war related injuries was not unexpected, said the researchers.

"What was surprising was that the principal contributor to this disparity was the higher evacuation rates among military personnel than nonmilitary personnel due to psychiatric diagnoses (9.1 percent versus 2.1 percent)," the researchers said. "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."

Compared with nonmilitary members, military personnel may have had a higher rate of psychiatric diagnoses and a lower return-to-duty rate for various reasons, including that service members are ordered to war, whereas most nonmilitary personnel volunteer for hazardous duty. Age is also a factor with nonmilitary members being older and perhaps having better coping skills and support networks.

The other major finding was the higher toll that circulatory conditions and noncardiac chest or abdominal pain exacted on nonmilitary members. In contrast, military personnel evacuated with non-war related injuries were more likely to have a diagnosis related to musculoskeletal/spine disorders.

In looking at return-to-war rates, researchers noted that the financial incentive to remain in the "theater" is stronger for some nonmilitary members than for military personnel.