title: Army Ranger casualty, attrition, and surgery rates for airborne operations in Afghanistan and Iraq.
abstract: BACKGROUND
  Although numerous articles have been published documenting parachute injuries, a search of the medical literature revealed none that detail casualty, attrition, and surgery rates for airborne operations conducted into actual combat. This study examines observed airborne casualty, attrition, and surgery rates in U.S. Army Rangers during combat operations in order to identify risk factors attributed to static-line parachute injuries and provide a comparison to estimated attrition rates.
  
  
  METHODS
  Data were recorded on standardized manual casualty cards and tracking forms while treatment was provided during two missions into Afghanistan during Operation Enduring Freedom and two missions into Iraq during Operation Iraqi Freedom, and then consolidated onto an electronic database for further analysis.
  
  
  RESULTS
  There were 4 airborne missions totaling 634 jumpers that resulted in 83 injuries sustained by 76 Rangers (12%). Of those, 27 Rangers (4%) were unable to continue the mission and were subsequently evacuated. There were 11 Rangers (2%) who required surgery following evacuation. The overall observed attrition rate differed from the estimated rate (p = 0.04). Although observed attrition rates did not differ from estimations in Afghanistan (p = 0.75), attrition rates in Iraq were greater than estimated rates (p = 0.02) and observed rates in Afghanistan (p = 0.05).
  
  
  CONCLUSIONS
  Many factors impact casualty, attrition, and injury patterns. Terrain and equipment load were notable associations analyzed in this study.
  
  
  CONCLUSIONS
  Medical, logistical, and operational personnel can optimize support for airborne forces through improved estimation of casualty, attrition, and surgical rates. Risk factors associated with military parachuting can potentially provide further accuracy in estimating attrition and are recommended for integration into current models.
authors.affiliation: Army-Navy Aerospace Medicine Residency, Naval Operational Medicine Institute, Pensacola, FL 32508, USA. russ.kotwal@us.army.mil
authors.forename: Russ S
authors.initials: RS
authors.lastname: Kotwal
authors.forename: David E
authors.initials: DE
authors.lastname: Meyer
authors.forename: Kevin C
authors.initials: KC
authors.lastname: O'Connor
authors.forename: Bruce A
authors.initials: BA
authors.lastname: Shahbaz
authors.forename: Troy R
authors.initials: TR
authors.lastname: Johnson
authors.forename: Raymond A
authors.initials: RA
authors.lastname: Sterling
authors.forename: Robert B
authors.initials: RB
authors.lastname: Wenzel
mesh_terms: D000293:Adolescent; D000328:Adult; D000346:Afghanistan; D001359:Aviation; D005544:Forecasting; D006801:Humans; D007493:Iraq / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D008889:Military Personnel; D020380:Needs Assessment; D012307:Risk Factors; D013514:Surgical Procedures, Operative / Q000706:statistics & numerical data*; D014187:Transportation of Patients; D014947:Wounds and Injuries / Q000453:epidemiology* / Q000601:surgery*