Musculoskeletal Injuries in the Australian Defence Force- “No Worries Mate!” ?

Background: Does Australia have a problem with Musculoskeletal Injury (MSKI) in the Defence Force? What has changed over the last 20 years? Method: A narrative review of US, UK and ADF MSKI injury reports over the last 20 years was undertaken and the findings synthesised. Results: Musculoskeletal Injury (MSKI) is reportedly the most significant cost to military health services around the world. In 2018, 53% of the U.S. Army had sustained a new musculoskeletal injury (MSKI), resulting in over two million injury-related medical presentations, accounting for 59% of 4.1 million work-days-lost. Of these, 71% were overuse injuries, likely preventable. In the U.K. in 2018/2019 injury rates increased over the previous 5 years to be between 44 and 91 injuries/1000 personnel. These injuries accounted for 63% (n=13,896 ) of all Health and Safety incidents reported. Illnesses accounted for approximately 2% of all reports. These datasets were obtained from integrated sources including medical records, personnel records, and Health and Safety Reports. These countries are now leading the way in injury surveillance and prevention for military organisations. In 2000 the Australian Defence Force (ADF) commissioned the Health Status Report, in which the lack of data and surveillance was identified as a key deficiency. As a direct consequence the Defence Injury Prevention Program was developed. This system captured 80-95% of all care-seeking injuries, and revealed an alarming injury rate in some units of up to 2100 injuries /1000 personnel. The priorities and countermeasures informed by this data contributed to injury reductions of up to 30% per year, and ran for 7 years. Since closure of the DIPP, no current similar system exists in the ADF. The ADF has since spent $133 million on the Defence electronic Health System (DeHS). However the data required to produce the 2015 Physical Health Status report had to rely on a survey of defence members, to which only 17% of the serving ADF responded. Perhaps MSKI in the ADF is not really a big problem. Yet the 2019 Productivity Commission Inquiry into Veterans Compensation and Rehabilitation found DVA are spending $5.3bn per year on medical expenses. Current focus and investment into cognitive performance optimisation, next generation technologies, better equipment, revised physical employment standards, and physical conditioning optimisation have all included an aim of reduced injury burden. However, where similar initiatives have been deployed in the US, the MSKI burden is not decreasing, it is merely diversifying injury types. Without surveillance evidence, force preservation efforts in the ADF can only be evaluated by anecdote. Conclusion: Data from other countries indicates that 10-50% of ADF personnel will be injured each year. The ADF cannot currently quantify the MSKI impact nor evaluate the efficacy of Human Performance initiatives with sufficient fidelity. The current lack of direct injury surveillance within the ADF creates an inability to develop appropriate prevention, and reduces the ability to keep personnel “Fighting Fit”. References: 1. U.S.Army Public Health Centre (2020)- “2019 Health of the Force Report” https://phc.amedd.army.mil/PHC%20Resource%20Library/EXSUM_2019_HOF.pdf Accessed 2020 2. U.K. Ministry of Defence 2020 “MOD Health and Safety Statistics: Annual Summary & Trends Over Time 2014/15 – 2018/19” 3.https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/919998/Enclosure_1_MOD_Health_and_Safety_Statistics_Annual_Report_2018-19_Revision.pdf Accessed 2020 4. Productivity Commission Report – A Better Way to Support Veterans 2019 https://www.pc.gov.au/inquiries/completed/veterans#report