Surveillance of causes of fatal non-battle injuries among army soldiers deployed for operations enduring freedom (Afghanistan) and iraqi freedom/new dawn (Iraq), 2001-2011

Introduction: Non-battle injuries (NBIs) have been an important cause of death in the on-going Army deployments in Operations Enduring Freedom, Afghanistan (OEF) and Iraqi Freedom/New Dawn (OIF/OND). During 2001 to 2009, fatal NBIs accounted for 21 percent of all deaths. The overall fatal NBI rate was 74.1/100,000 person-years. Purpose: The objective of this investigation was to utilize routine casualty and safety surveillance data to provide an update for the incidence and causes of fatal NBIs of Army service members deployed in support of OEF and OIF/OND, from October 2001 to December 2011. Methods: Two electronic data sources were used to identify soldiers who died from NBIs: the Defense Casualty Information Processing System and Army Safety Management Information System. Descriptive statistics (frequencies and percentages) were used to report the casualty type and cause of injury for soldiers with fatal NBIs. Results: Overall, there were 4,668 fatalities among soldiers in OEF and OIF/OND (2001-2011). Among these fatalities, 20% (n=940) were NBIs, 78% (n=3,641) were battle injuries, and 2% (n=87) were due to illness/disease. Leading causes of fatal NBIs included: motor vehicle accidents (OIF/OND: 37%; OEF: 18%; p<.001); air transport (OIF/OND: 11%; OEF: 29%; p<.001); intentional, self-inflicted (OIF/OND: 26%; OEF: 21%; p=.15); and unintentional, handling weapons (OIF/OND: 10%; OEF: 11%; p=.66). Conclusion: Surveillance data show that non-battle injuries are an important cause of mortality in combat operations. These findings illustrate how valuable surveillance data can be for focusing prevention efforts on the leading causes of fatal NBIs in a particular theater of operations.