Analysis of Non-Battle Deaths Among U.S. Service Members in the Deployed Environment.

OBJECTIVE: Describe etiologies and trends in non-battle deaths (NBD) among deployed U.S. service members to identify areas for prevention.

BACKGROUND: Injuries in combat are categorized as battle (result of hostile action) or non-battle related. Previous work found that one-third of injured US military personnel in Iraq and Afghanistan had non-battle injuries (NBI) and emphasized prevention. NBD have not yet been characterized.

METHODS: U.S. military casualty data for Iraq and Afghanistan from 2001-2014 were obtained from the Defense Casualty Analysis System (DCAS) and the Department of Defense Trauma Registry (DoDTR). Two databases were used because DoDTR does not capture pre-hospital deaths, while DCAS does not contain clinical details. NBI and NBD were identified, etiologies classified, and NBD trends were assessed using a weighted moving average and time-series analysis with autoregressive integrated moving average. Future NBD rates were forecast.

RESULTS: DCAS recorded 59,799 casualties; 21.0% (n=1,431) of all deaths (n=6,745) were NBD. DoDTR recorded 29,958 casualties; 11.5% (n=206) of all deaths (n=1788) were NBD. After early fluctuations, NBD rates for both Iraq and Afghanistan stabilized at approximately 21%. Leading causes of NBD were gunshot wounds and vehicle accidents, accounting for 66%. Approximately 25% was self-inflicted. A 24% NBD rate was forecasted from 2015 through 2025.

CONCLUSIONS: Approximately 1 in 5 deaths were NBD. The majority were potentially preventable, including a significant proportion of self-inflicted injuries. A single comprehensive data repository would facilitate future mortality monitoring and performance improvement. These data may assist military leaders with implementing targeted safety strategies.