title: Diagnoses and factors associated with medical evacuation and return to duty among nonmilitary personnel participating in military operations in Iraq and Afghanistan.
abstract: BACKGROUND
  Nonmilitary personnel play an increasingly critical role in modern wars. Stark differences exist between the demographic characteristics, training and missions of military and nonmilitary members. We examined the differences in types of injury and rates of returning to duty among nonmilitary and military personnel participating in military operations in Iraq and Afghanistan.
  
  
  METHODS
  We collected data for nonmilitary personnel medically evacuated from military operations in Iraq and Afghanistan between 2004 and 2007. We compared injury categories and return-to-duty rates in this group with previously published data for military personnel and identified factors associated with return to duty.
  
  
  RESULTS
  Of the 2155 medically evacuated nonmilitary personnel, 74.7% did not return to duty. War-related injuries in this group accounted for 25.6% of the evacuations, the most common causes being combat-related injuries (55.4%) and musculoskeletal/spinal injuries (22.9%). Among individuals with non-war-related injuries, musculoskeletal injuries accounted for 17.8% of evacuations. Diagnoses associated with the highest return-to-duty rates in the group of nonmilitary personnel were psychiatric diagnoses (15.6%) among those with war-related injuries and noncardiac chest or abdominal pain (44.0%) among those with non-war-related injuries. Compared with military personnel, nonmilitary personnel with war-related injuries were less likely to return to duty (4.4% v. 5.9%, p = 0.001) but more likely to return to duty after non-war-related injuries (32.5% v. 30.7%, p = 0.001).
  
  
  CONCLUSIONS
  Compared with military personnel, nonmilitary personnel were more likely to be evacuated with non-war-related injuries but more likely to return to duty after such injuries. For evacuations because of war-related injuries, this trend was reversed.
authors.affiliation: Department of Anesthesiology, Johns Hopkins School of Medicine, Baltimore, MD, USA. scohen40@jhmi.edu
authors.forename: Steven P
authors.initials: SP
authors.lastname: Cohen
authors.forename: Charlie
authors.initials: C
authors.lastname: Brown
authors.forename: Connie
authors.initials: C
authors.lastname: Kurihara
authors.forename: Anthony
authors.initials: A
authors.lastname: Plunkett
authors.forename: Conner
authors.initials: C
authors.lastname: Nguyen
authors.forename: Scott A
authors.initials: SA
authors.lastname: Strassels
mesh_terms: D055826:Afghan Campaign 2001-; D015331:Cohort Studies; D005260:Female; D006801:Humans; D054542:Iraq War, 2003-2011; D016015:Logistic Models; D008297:Male; D008889:Military Personnel / Q000706:statistics & numerical data*; D015999:Multivariate Analysis; D012189:Retrospective Studies; D014187:Transportation of Patients; D014857:Warfare; D014947:Wounds and Injuries / Q000175:diagnosis* / Q000628:therapy*