Public Health and Risk Management

Injuries represent the leading problem of U.S. military personnel across the spectrum of health, from deaths and disabilities to hospitalization and those requiring only outpatient treatment.1 and 2 More serious injuries result from accidents than any other cause, including combat.3, 4 and 5 As a consequence of knowledge about the magnitude of the injury problem for the U.S. military and the belief that “world-class organizations do not tolerate preventable accidents,” in May of 2003 the U.S. Secretary of Defense challenged the Department of Defense with aggressive accident-reduction goals.6 The secretary also created the Defense Safety Oversight Council (DSOC) to provide governance over the department\u27s accident-reduction initiatives. To support execution of this responsibility, the DSOC chartered nine task forces, each covering a specific mission or mission support functional area. The Military Training Task Force (MTTF) was created to study and recommend policies, programs, and investments to achieve accident reductions in military ground training. The MTTF is composed of military training, safety, and occupational health subject matter experts from the Air Force, Navy, Marine Corps, and Army. In order to provide the leadership and training experience necessary to achieve the goals of the MTTF, the U.S. Army\u27s Deputy Director of Training chairs the task force. In some aspects, the MTTF\u27s task is more challenging than that of the other task forces. First, in order to accomplish the operational mission and save lives in combat, military training must closely replicate the dangerous conditions soldiers, sailors, airmen, and marines will face in combat. Additionally, unlike motor vehicle and aviation accident prevention, for which interventions (such as seat belts) have been tested and proven to reduce injuries, there are no well-established military or civilian prevention strategies for military training-related injuries. From its inception, the MTTF utilized the Army\u27s mishap risk management process to identify and analyze risks in military training and develop meaningful, effective risk-control measures that would reduce injuries while maintaining training readiness. Mishap risk management is the process of identifying and assessing hazards associated with a mission or with the design and operations of a system, facility, or equipment; determining their risk (the combined expression of loss severity and probability); developing, evaluating, and selecting controls; making risk acceptance decisions; and implementing and managing those decisions to improve operational effectiveness and conserve Army resources. While the mishap risk management process proved to be a valuable tool in identifying and managing risks, the MTTF felt the need for a systematic approach to military training mishap reduction that would prioritize mishap-reduction initiatives and also provide for an evaluation of initiatives\u27 effectiveness. This would assist leaders in determining where to focus their efforts and where to most effectively apply other resources, to include money, personnel, and time. Leveraging past affiliations between the U.S. Army Center for Health Promotion and Preventive Medicine and the CDC, the MTTF turned to the public health approach, an epidemiologic tool (Table 1). The MTTF was of the opinion that combining the Army mishap risk management process and the public health approach7 and 8 would provide a framework for a systematic process to prevent injuries. Because of the close similarities of the two, it was felt that line officers and safety and preventive medicine personnel would all understand this systematic process. The systematic process would (1) identify and (2) describe the causes of military injuries; (3) conduct trials and evaluations to determine what initiatives are effective in preventing military injuries; (4) implement injury prevention policies and programs; and (5) monitor and evaluate these policies and programs to determine success or failure