DEFENCE PHYSICAL EMPLOYMENT STANDARDS PROJECT Infantry and Airfield Defence Guards
REPORT 7
RETROSPECTIVE SURVEYS OF INJURIES (2004 & 2005): INFANTRY AND ADG
J T Harvey W R Payne E L Otago D A Pascoe
September 2006
DPESP REPORT 7 Retrospective Surveys of Injuries (2004 & 2005): Infantry and ADG
Contract C538679
Conduct of a Physical Employment Standards Study for the Australian Defence Force
CONTACT Professor Warren Payne Project Manager Defence Physical Employment Standards Project School of Human Movement and Sport Sciences University of Ballarat PO Box 663 Ballarat Victoria 3353 Phone: 03 5327 9693 Fax: 03 5327 9060 Email: [email protected]
This report was accepted by the Department of Defence on 22/9/2006 i DPESP REPORT 7 Retrospective Surveys of Injuries (2004 & 2005): Infantry and ADG
DEFENCE PHYSICAL EMPLOYMENT STANDARDS PROJECT Infantry and Airfield Defence Guards
COMPLETED AND PLANNED REPORTS No. Short Title1 Date1 Type
Completed Reports
1 Selection of Key Trade Tasks for Detailed Observation Mar 04 Minor
2 Selection of Potential Endurance Tests & Anthropometric Measures Sep 04 Minor
3 Review of Injury Data: Infantry and ADG Feb 05 Minor
4 Trade Tasks Movement Analysis: Infantry and ADG Apr 05 Minor
5 Trade Tasks Risk Analysis: Infantry and ADG Jul 06 Minor
6 The Effect of Physically Demanding Infantry and ADG Trade Tasks on Apr 05 Minor Cognitive Performance: a Pilot Observational Study
7 Retrospective Surveys of Injuries (2004 & 2005): Infantry and ADG Sep 06 Minor
8 Selection of Criterion Trade Tasks: Infantry and ADG Mar 05 Minor
9 Trade Task Analysis: Infantry and ADG Sep 06 Major
10 Reliability of Simulation Tests: Infantry and ADG May 06 Minor
11 Normative Physical Performance Data: Infantry and ADG Sep 06 Major
13 Capacity of Women to Improve Physical Performance: a Review Sep 06 Minor
Planned Reports
12 Physical Performance Standards: Infantry and ADG Oct 06 Major 1 In the case of planned reports, both the titles and the dates of publication are provisional.
ACKNOWLEDGEMENTS
The authors wish to acknowledge the assistance and support of Mr John Mathieson of the Defence Physical Employment Standards Project Office; Major Brett de Masson, Army Personnel; Dr Rodney Pope, Project Director, Defence Injury Prevention Program; Mr Gary Hansen, Mr Mike Power and Ms Nicole Barton, Directorate of Strategic Personnel Planning and Research. Thanks also to the volunteers who took part in pilot testing at 2 RAR and AFDW, to those involved in the distribution of the 2004 survey, and to the volunteers who completed survey forms in the 2004 and 2005 surveys.
The authors also acknowledge the contributions of the members of the University of Ballarat and Victoria University field testing teams who administered the 2005 survey: Mr Richard Citroen, Ms Paige Colgrave Mr Matthew Fittolani, Mr Daniel Ham, Ms Michelle King, Mr Craig Lee, Ms Lauren Philipson and Mr Wade Sinclair; of the following members of the DPESP Peer Review Panel, who critically reviewed a draft of this report: Dr John Culvenor, Dr Wade Knez, Dr Barbara Palmer, Dr Mark Rayson, Dr Bob Stacy, Ms Judy Swan and Dr Chris Turville; and of Mrs Jill Boatman in the production of this report.
This report was accepted by the Department of Defence on 22/9/2006 ii DPESP REPORT 7 Retrospective Surveys of Injuries (2004 & 2005): Infantry and ADG
CONTENTS LIST OF TABLES ...... v THE AUTHORS ...... x EXECUTIVE SUMMARY...... xi REFERENCE DOCUMENTS ...... xviii ABBREVIATIONS AND ACRONYMS ...... xix 1 INTRODUCTION ...... 1 1.1 Background...... 1 1.2 Aims ...... 1 1.3 Scope...... 1 2 METHODOLOGY ...... 2 2.1 Background...... 2 2.2 Design of the Questionnaire ...... 2 2.3 Ethics Approval...... 3 2.4 Pilot Testing ...... 3 2.5 Selection of the Sample...... 3 2.6 Implementation of the Survey ...... 4 2.7 Data Management, Validation and Analysis...... 5 2.8 Presentation, Terminology and Interpretation ...... 5 2.9 Limitations...... 6 2.10 Supplementary Survey ...... 8 3 SURVEY OF INFANTRY 2004: RESULTS AND DISCUSSION ...... 10 3.1 Introduction ...... 10 3.2 Characteristics of Respondents and Their Physical Activities...... 10 3.3 Injury Experience and Injury Status...... 14 3.4 Relationship between Injury Occurrence and Respondent Characteristics ...... 17 3.5 Characteristics of Acute Injuries ...... 21 3.6 Relationship between Characteristics of Trade-related Acute Injuries and Respondent Characteristics...... 30 3.7 Characteristics of Chronic Injuries...... 37 3.8 Relationship between Characteristics of Trade-related Chronic Injuries and Respondent Characteristics...... 42 3.9 Opinions of Respondents ...... 47 4 SURVEY OF INFANTRY 2005: RESULTS AND DISCUSSION ...... 51 4.1 Introduction ...... 51 4.2 Characteristics of Respondents...... 51 4.3 Injury Experience and Injury Status...... 53 4.4 Characteristics of Acute Injuries ...... 56 4.5 Characteristics of Chronic Injuries...... 58 4.6 Opinions of Respondents ...... 61 5 SURVEY OF AIRFIELD DEFENCE GUARDS 2004: RESULTS AND DISCUSSION...... 66 5.1 Introduction ...... 66 5.2 Characteristics of Respondents and Their Physical Activities...... 66 5.3 Injury Experience and Injury Status...... 70 5.4 Relationship between Injury History and Respondent Characteristics...... 73 5.5 Characteristics of Acute Injuries ...... 75 5.6 Relationship between Characteristics of Trade-related Acute Injuries and Respondent Characteristics...... 83 5.7 Characteristics of Chronic Injuries...... 90
This report was accepted by the Department of Defence on 22/9/2006 iii DPESP REPORT 7 Retrospective Surveys of Injuries (2004 & 2005): Infantry and ADG
5.8 Relationship between Characteristics of Trade-related Chronic Injuries and Respondent Characteristics...... 95 5.9 Opinions of Respondents...... 100 6 SURVEY OF AIRFIELD DEFENCE GUARDS 2005: RESULTS AND DISCUSSION...... 104 6.1 Introduction ...... 104 6.2 Characteristics of Respondents ...... 104 6.3 Injury Experience and Injury Status ...... 106 6.4 Characteristics of Acute Injuries ...... 108 6.5 Characteristics of Chronic Injuries ...... 110 6.6 Opinions of Respondents...... 112 7 SUMMARY OF FINDINGS...... 116 7.1 Introduction ...... 116 7.2 Infantry Survey 2004...... 116 7.3 Infantry Survey 2005...... 119 7.4 ADG Survey 2004 ...... 120 7.5 ADG Survey 2005 ...... 123 8 RECOMMENDATIONS...... 125 REFERENCES ...... 126 ANNEXES ...... 127
Annex 1 2004 Survey: ADG survey form Annex 2 2004 Survey: ARMY survey form Annex 3 2004 Survey: Information sheet Annex 4 2004 Survey: ADHREC guidelines for volunteers Annex 5 2004 Survey: Consent form Annex 6 2004 Survey: Cover sheet Annex 7 2004 Survey: Unit instructions Annex 8 2005 Survey: Infantry survey form Annex 9 2005 Survey: ADG survey form Annex 10 2005 Survey: Infantry personal information form Annex 11 2005 Survey: Infantry IET personal information form Annex 12 2005 Survey: ADG personal information form Annex 13 2005 Survey: ADG IET personal information form Annex 14 2005 Survey: Infantry information sheet & consent form Annex 15 2005 Survey: ADG information sheet & consent from Annex 16 Accuracy of Sample Estimates of Population Proportions
This report was accepted by the Department of Defence on 22/9/2006 iv DPESP REPORT 7 Retrospective Surveys of Injuries (2004 & 2005): Infantry and ADG
LIST OF TABLES
Table 1. Survey Liaison Meeting Participants...... 2 Table 2. Infantry and ADG Units/Personnel Included in the DPESP Survey Sample ...... 4 Table 3. Infantry: Age Distribution ...... 10 Table 4. Infantry: Length of Service...... 11 Table 5. Infantry: Rank...... 11 Table 6. Infantry: Primary Employment Category...... 11 Table 7. Infantry: Basic Physical Characteristics...... 12 Table 8. Infantry: BMI Category...... 12 Table 9. Infantry: Work Cycle...... 12 Table 10. Infantry: Number of Activities (Excluding Leave)...... 13 Table 11. Infantry: Number of Major and Minor Exercises ...... 13 Table 12. Infantry: Involvement in Sport ...... 14 Table 13. Infantry: Physical Training Activity ...... 14 Table 14. Infantry: Acute Injury...... 15 Table 15. Infantry: Trade-related1 and Non-trade-related Acute Injury ...... 15 Table 16. Infantry: Chronic Injury...... 15 Table 17. Infantry: Trade-related and Non-trade-related Chronic Injury ...... 16 Table 18. Infantry: Number of Acute Injuries ...... 16 Table 19. Infantry: Number of Chronic Injuries...... 16 Table 20. Infantry Chronic Injuries: Medical Employment Category1 ...... 17 Table 21. Infantry: Relationships between Injury Occurrence and Indicators of Potential Susceptibility to Injury or Exposure to Risk ...... 19 Table 22. Infantry: Correlations between Age, Length of Service, Weight and BMI ...... 20 Table 23. Infantry: Statistically Significant1 Relationships between Injury Occurrence and Work Cycle Indicators ...... 20 Table 24. Infantry Acute Injuries: Unit...... 21 Table 25. Infantry Acute Injuries: Activity...... 22 Table 26. Infantry Trade-related Acute Injuries: Month ...... 23 Table 27. Infantry Trade-related Acute Injuries: Time of Day...... 24 Table 28. Infantry Trade-related Acute Injuries: Job Phase ...... 24 Table 29. Infantry Trade-related Acute Injuries: New or Recurring ...... 24 Table 30. Infantry Trade-related Acute Injuries: Nature of Main Injury...... 25 Table 31. Infantry Trade-related Acute Injuries: Nature of Other Injuries...... 25 Table 32. Infantry Trade-related Acute Injuries: Bodily Location...... 25 Table 33. Infantry Trade-related Acute Injuries: Trade-related Activity ...... 26 Table 34. Infantry Trade-related Acute Injuries: Actions Taken ...... 27 Table 35. Infantry Trade-related Acute Injuries: Outcome...... 27 Table 36. Infantry: Return to Work before Full Recovery from Trade-related Acute Injury ...... 27 Table 37. Infantry: Safeguards or Preventative Strategies in Place...... 28 Table 38. Infantry: Failure of Safeguards or Preventative Strategies...... 28 Table 39. Infantry: Risk Taking as a Contributing Factor to Trade-related Acute Injury...... 28 Table 40. Infantry Acute Injuries: Time of Day of Trade-related and Non-trade-related Injuries...... 29 Table 41. Infantry Acute Injuries: Nature of Trade-related and Non-trade-related Injuries ...... 29 Table 42. Infantry Trade-related Acute Injuries: Nature of Main Injury by Activity1 ...... 31 Table 43. Infantry Trade-related Acute Injuries: Bodily Location of Injury by Activity1 ...... 32 Table 44. Infantry Trade-related Acute Injuries: Nature of Main Injury by Outcome ...... 33 Table 45. Infantry Trade-related Acute Injuries: Bodily Location of Main Injury by Outcome ...... 34
This report was accepted by the Department of Defence on 22/9/2006 v DPESP REPORT 7 Retrospective Surveys of Injuries (2004 & 2005): Infantry and ADG
Table 46. Infantry Trade-related Acute Injuries: Activity by Outcome...... 34 Table 47. Infantry Trade-related Acute Injuries: Activity by Age...... 35 Table 48. Infantry Trade-related Acute Injuries: Activity by Length of Service ...... 35 Table 49. Infantry Trade-related Acute Injuries: Activity by Rank...... 36 Table 50. Infantry Trade-related Acute Injuries: Activity by Basic Physical Characteristics ...... 36 Table 51. Infantry Chronic Injuries: Contributing Activities (1)...... 37 Table 52. Infantry Chronic Injuries: Contributing Activities (2)...... 37 Table 53. Infantry Trade-related Chronic Injuries: Duration...... 38 Table 54. Infantry Trade-related Chronic Injuries: Nature of Injury...... 38 Table 55. Infantry Trade-related Chronic Injuries: Bodily Location...... 39 Table 56. Infantry Trade-related Chronic Injuries: Trade-related Activity ...... 39 Table 57. Infantry Trade-related Chronic Injuries: Actions Taken ...... 40 Table 58. Infantry Trade-related Chronic Injuries: Effects on Performance of Duties ...... 40 Table 59. Infantry Trade-related Chronic Injuries: Period per Year on Restricted Work Program ... 40 Table 60. Infantry Chronic Injuries: Duration of Trade-related and Non-trade-related Injuries...... 41 Table 61. Infantry Chronic Injuries: Bodily Location of Trade-related and Non-trade-related Injuries...... 41 Table 62. Infantry Chronic Injuries: Actions Taken for Trade-related and Non-trade-related Injuries...... 42 Table 63. Infantry Chronic Injuries: Effects on Performance of Duties of Trade-related and Non-trade-related Injuries ...... 42 Table 64. Infantry Trade-related Chronic Injuries: Nature of Injury by Activity ...... 43 Table 65. Infantry Trade-related Chronic Injuries: Bodily Location of Injury by Activity...... 43 Table 66. Infantry Trade-related Chronic Injuries: Nature of Injury by Medical Employment Category...... 44 Table 67. Infantry Trade-related Chronic Injuries: Bodily Location of Injury by Medical Employment Category...... 44 Table 68. Infantry Trade-related Chronic Injuries: Activity by Medical Employment Category...... 45 Table 69. Infantry Trade-related Chronic Injuries: Activity by Age...... 45 Table 70. Infantry Trade-related Chronic Injuries: Activity by Length of Service...... 46 Table 71. Infantry Trade-related Chronic Injuries: Activity by Rank...... 46 Table 72. Infantry Trade-related Chronic Injuries: Activity by Basic Physical Characteristics...... 47 Table 73. Infantry: Deficiencies in Manning Levels as a Contributing Factor to Acute or Chronic Injury ...... 48 Table 74. Infantry: Time Pressure as a Contributing Factor to Acute or Chronic Injury ...... 48 Table 75. Infantry: Equipment Limitations as a Contributing Factor to Acute or Chronic Injury ...... 48 Table 76. Infantry Time Pressure as a Contributing Factor to Injury: by Acute vs Chronic Injury .... 48 Table 77. Infantry Perceived Attitudes to Injury within the ADF...... 50 Table 78. Infantry 2005: Age Distribution...... 51 Table 79. Infantry 2005: Length of Service ...... 52 Table 80. Infantry 2005: Rank...... 52 Table 81. Infantry 2005: Primary Employment Category...... 52 Table 82. Infantry 2005: Basic Physical Characteristics...... 52 Table 83. Infantry 2005: BMI Category ...... 53 Table 84. Infantry 2005: Acute Injury ...... 53 Table 85. Infantry 2005: Trade-related and Non-trade-related Acute Injury...... 53 Table 86. Infantry 2005: Chronic Injury...... 54 Table 87. Infantry 2005: Trade-related and Non-trade-related Chronic Injury...... 54 Table 88. Infantry 2005: Number of Acute Injuries ...... 55 Table 89. Infantry 2005: Number of Chronic Injuries ...... 55
This report was accepted by the Department of Defence on 22/9/2006 vi DPESP REPORT 7 Retrospective Surveys of Injuries (2004 & 2005): Infantry and ADG
Table 90. Infantry 2005 Acute Injuries: Activity...... 56 Table 91. Infantry 2005 Acute Injuries: by Associated CATTs ...... 57 Table 92. Infantry 2005 Acute Injuries: by Associated Physical Actions ...... 58 Table 93. Infantry 2005 Chronic Injuries: Contributing Activities (1)...... 58 Table 94. Infantry 2005 Chronic Injuries: Contributing Activities (2)...... 59 Table 95. Infantry 2005 Chronic Injuries: by Associated CATTs...... 60 Table 96. Infantry 2005 Chronic Injuries: by Associated Physical Actions...... 61 Table 97. Infantry 2005: Deficiencies in Manning Levels as a Contributing Factor to Acute or Chronic Injury...... 61 Table 98. Infantry 2005: Time Pressure as a Contributing Factor to Acute or Chronic Injury...... 62 Table 99. Infantry 2005: Equipment Limitations as a Contributing Factor to Acute or Chronic Injury ...... 62 Table 100. Infantry 2005 Perceived Attitudes to Injury within the ADF ...... 65 Table 101. ADG: Age Distribution...... 66 Table 102. ADG: Length of Service ...... 67 Table 103. ADG: Rank...... 67 Table 104. ADG: Basic Physical Characteristics...... 67 Table 105. ADG: BMI Categories ...... 67 Table 106. ADG: Work Cycle...... 68 Table 107. ADG: Number of Activities (Excluding Leave) ...... 68 Table 108. ADG: Number of Major and Minor Exercises ...... 69 Table 109. ADG: Involvement in Sport ...... 69 Table 110. ADG: Physical Training Activity ...... 70 Table 111. ADG: Acute Injury ...... 70 Table 112. ADG: Trade-related and Non-trade-related Acute Injury...... 70 Table 113. ADG: Chronic Injury...... 71 Table 114. ADG: Trade-related and Non-trade-related Chronic Injury...... 71 Table 115. ADG: Number of Acute Injuries ...... 71 Table 116. ADG: Number of Chronic Injuries ...... 72 Table 117. ADG Chronic Injuries: Medical Employment Category1 ...... 72 Table 118. ADG: Relationships between Injury Occurrence and Indicators of Potential Susceptibility to Injury or Exposure to Risk ...... 74 Table 119. ADG: Correlations between Age, Length of Service and BMI...... 75 Table 120. ADG: Statistically Significant1 Relationships between Injury Occurrence and Work Cycle Indicators ...... 75 Table 121. ADG Acute Injuries: Activity...... 76 Table 122. ADG Trade-related Acute Injuries: Month ...... 77 Table 123. ADG Trade-related Acute Injuries: Time of Day ...... 78 Table 124. ADG Trade-related Acute Injuries: Job Phase ...... 78 Table 125. ADG Trade-related Acute Injuries: New or Recurring ...... 78 Table 126. ADG Trade-related Acute Injuries: Nature of Main Injury...... 79 Table 127. ADG Trade-related Acute Injuries: Nature of Other Injuries...... 79 Table 128. ADG Trade-related Acute Injuries: Bodily Location...... 79 Table 129. ADG Trade-related Acute Injuries: Trade-related Activity ...... 80 Table 130. ADG Trade-related Acute Injuries: Actions Taken...... 80 Table 131. Infantry Trade-related Acute Injuries: Outcome...... 81 Table 132. Return to Work before Full Recovery from Trade-related Acute Injury ...... 81 Table 133. ADG: Safeguards or Preventative Strategies in Place ...... 81 Table 134. ADG: Failure of Safeguards or Preventative Strategies...... 82 Table 135. ADG: Risk Taking as a Contributing Factor to Trade-related Acute Injury...... 82
This report was accepted by the Department of Defence on 22/9/2006 vii DPESP REPORT 7 Retrospective Surveys of Injuries (2004 & 2005): Infantry and ADG
Table 136. ADG Acute Injuries: Job Phase of Trade-related and Non-trade-related Injuries...... 82 Table 137. ADG Acute Injuries: Time of Day of Trade-related and Non-trade-related Injuries ...... 83 Table 138. ADG Trade-related Acute Injuries: Nature of Main Injury by Activity...... 84 Table 139. ADG Trade-related Acute Injuries: Bodily Location of Injury by Activity ...... 85 Table 140. ADG Trade-related Acute Injuries: Nature of Main Injury by Outcome...... 86 Table 141. ADG Trade-related Acute Injuries: Bodily Location of Main Injury by Outcome...... 87 Table 142. ADG Trade-related Acute Injuries: Activity by Outcome...... 87 Table 143. ADG Trade-related Acute Injuries: Activity by Age ...... 88 Table 144. ADG Trade-related Acute Injuries: Activity by Length of Service ...... 88 Table 145. ADG Trade-related Acute Injuries: Activity by Rank ...... 89 Table 146. ADG Trade-related Acute Injuries: Activity by Basic Physical Characteristics ...... 89 Table 147. ADG Chronic Injuries: Contributing Activities (1) ...... 90 Table 148. ADG Chronic Injuries: Contributing Activities (2) ...... 90 Table 149. ADG Trade-related Chronic Injuries: Duration...... 91 Table 150. ADG Trade-related Chronic Injuries: Nature of Injury...... 91 Table 151. ADG Trade-related Chronic Injuries: Bodily Location ...... 91 Table 152. ADG Trade-related Chronic Injuries: Trade-related Activity ...... 92 Table 153. ADG Trade-related Chronic Injuries: Actions Taken...... 92 Table 154. ADG Trade-related Chronic Injuries: Effects on Performance of Duties ...... 92 Table 155. ADG Trade-related Chronic Injuries: Period per Year on Restricted Work Program...... 93 Table 156. ADG Chronic Injuries: Bodily Location of Trade-related and Non-trade-related Injuries...... 93 Table 157. ADG Chronic Injuries: Nature of Trade-related and Non-trade-related Injuries...... 94 Table 158. ADG Chronic Injuries: Actions Taken for Trade-related and Non-trade-related Injuries...... 94 Table 159. ADG Chronic Injuries: Effects on Performance of Duties of Trade-related and Non-trade-related Injuries ...... 95 Table 160. ADG Trade-related Chronic Injuries: Nature of Injury by Activity...... 96 Table 161. ADG Trade-related Chronic Injuries: Bodily Location of Injury by Activity...... 96 Table 162. ADG Trade-related Chronic Injuries: Nature of Injury by Medical Employment Category...... 97 Table 163. ADG Trade-related Chronic Injuries: Bodily Location of Injury by Medical Employment Category...... 97 Table 164. ADG Trade-related Chronic Injuries: Activity by Medical Employment Category...... 98 Table 165. ADG Trade-related Chronic Injuries: Activity by Age...... 98 Table 166. ADG Trade-related Chronic Injuries: Activity by Length of Service ...... 99 Table 167. ADG Trade-related Chronic Injuries: Activity by Rank...... 99 Table 168. ADG Trade-related Chronic Injuries: Activity by Basic Physical Characteristics ...... 100 Table 169. ADG: Deficiencies in Manning Levels as a Contributing Factor to Acute or Chronic Injury...... 100 Table 170. ADG: Time Pressure as a Contributing Factor to Acute or Chronic Injury ...... 101 Table 171. ADG: Equipment Limitations as a Contributing Factor to Acute or Chronic Injury ...... 101 Table 172. ADG: Perceived Attitudes to Injury within the ADF...... 103 Table 173. ADG 2005: Age Distribution...... 104 Table 174. ADG 2005: Length of Service ...... 105 Table 175. ADG 2005: Rank ...... 105 Table 176. ADG 2005: Basic Physical Characteristics ...... 105 Table 177. ADG 2005: BMI Category ...... 105 Table 178. ADG 2005: Acute Injury ...... 106 Table 179. ADG 2005: Trade-related and Non-trade-related Acute Injury ...... 106
This report was accepted by the Department of Defence on 22/9/2006 viii DPESP REPORT 7 Retrospective Surveys of Injuries (2004 & 2005): Infantry and ADG
Table 180. ADG 2005: Chronic Injury...... 107 Table 181. ADG 2005: Trade-related and Non-trade-related Chronic Injury...... 107 Table 182. ADG 2005: Number of Acute Injuries ...... 107 Table 183. ADG 2005: Number of Chronic Injuries ...... 108 Table 184. ADG 2005 Acute Injuries: Activity...... 108 Table 185. ADG 2005 Acute Injuries: by Associated CATTs ...... 109 Table 186. ADG 2005 Acute Injuries: by Associated Physical Actions ...... 110 Table 187. ADG 2005 Chronic Injuries: Contributing Activities (1)...... 110 Table 188. ADG 2005 Chronic Injuries: Contributing Activities (2)...... 111 Table 189. ADG 2005 Chronic Injuries: by Associated CATTs ...... 111 Table 190. ADG 2005 Chronic Injuries: by Associated Physical Actions ...... 112 Table 191. ADG 2005: Deficiencies in Manning Levels as a Contributing Factor to Acute or Chronic Injury...... 113 Table 192. ADG 2005: Time Pressure as a Contributing Factor to Acute or Chronic Injury ...... 113 Table 193. ADG 2005: Equipment Limitations as a Contributing Factor to Acute or Chronic Injury ...... 113 Table 194. ADG 2005: Perceived Attitudes to Injury within the ADF...... 115
This report was accepted by the Department of Defence on 22/9/2006 ix DPESP REPORT 7 Retrospective Surveys of Injuries (2004 & 2005): Infantry and ADG
THE AUTHORS
Dr Jack Harvey is a Senior Research Fellow in the School of Information Technology and Mathematical Sciences at the University of Ballarat. He is a mathematical statistician with over 20 years experience in applied research in many contexts including human movement science, health sciences, occupational health & safety, and social and behavioural sciences. In the Defence Physical Employment Standards Project (DPESP), Dr Harvey has professional roles in research design, data management and statistical analysis, and is also Technical Manager of the project.
Professor Warren Payne is the Professor of Human Movement Science in the School of Human Movement and Sport Sciences at the University of Ballarat. He is an exercise physiologist with over 20 years of research and consulting experience. This experience has included working with a variety of groups and individuals from a range of backgrounds including elite athletes (rowing, cycling, badminton and swimming) and workers involved in heavy manual trades (sheep shearers, fire fighters, aircraft baggage handlers and plasterers). Professor Payne is the Project Manager and Research Leader of the DPESP.
Associate Professor Leonie Otago is Head, School of Human Movement and Sport Sciences at the University of Ballarat. Her major research area is injury prevention and risk management both in sport and industry settings. She has been an active researcher in these areas for over 18 years. In the DPESP, Assoc Prof Otago has professional roles in injury epidemiology and movement risk analysis, and is a member of the University of Ballarat Project Review Board.
Deborah Pascoe is a lecturer in the School of Human Movement and Sport Sciences at the University of Ballarat. She is an active teacher and has extensive experience as a clinician in musculoskeletal injury and rehabilitation. Deborah has taught at the tertiary level for over 20 years and currently is the Course Coordinator for the Masters in Exercise Rehabilitation program and Clinical Director of the Unisports Exercise Rehabilitation Centre. In the DPESP, Ms Pascoe’s role is in the analysis of injury risk.
This report was accepted by the Department of Defence on 22/9/2006 x DPESP REPORT 7 Retrospective Surveys of Injuries (2004 & 2005): Infantry and ADG
EXECUTIVE SUMMARY
Military operational tasks are physically demanding and incur the risk of injury. In order to address the issues and costs associated with the high injury rates and focus on ways to reduce the risk of injury to Australian Defence Force (ADF) personnel, the ADF Chiefs of Service Committee (COSC) has endorsed a number of injury prevention strategies aimed at examining, analysing and evaluating injury-related risks and hazards within the ADF. In line with those strategies, COSC has affirmed that ADF employment policy is to be competency based and agreed that physical employment standards should be developed for combat arms trades. The purpose of the Defence Physical Employment Standards Project (DPESP) is to develop these performance-based competency standards.
The ADF has employed the services of the University of Ballarat (UB) to undertake the DPESP. This involves reviewing combat arms trade tasks (CATTs), establishing a set of criterion CATTs, developing a battery of simulation and predictive tests based on the criterion CATTs to be used to assess the physical competency of ADF combat personnel, and making recommendations for associated physical employment standards.
In the initial phase, the study is focused on one Army corps - Infantry, and one Air Force mustering - Airfield Defence Guards (ADG).
Data already available in ADF databases regarding incidents and injuries were found to be incomplete and unable to be linked to particular trade task activities. The aim of this work package was to supplement these data by means of large-scale retrospective surveys of injuries to Infantry and ADG personnel. Two retrospective surveys were conducted, in 2004 and 2005. Compared to existing data sources, these surveys included a stronger focus on the activity being undertaken at the time each injury occurred, with particular reference to CATT-related activity categories. In interpreting and evaluating the key findings reiterated here, the sampling limitations of the two surveys should be borne in mind. In particular, whilst the 2004 survey was widely distributed throughout Infantry and ADG units, the response rates varied greatly from unit to unit, and there was evidence that the age, length of service and rank profiles of survey respondents were not representative of population profiles. The 2005 survey was conducted in conjunction with field testing of PETs which skewed the survey sample towards younger and more junior personnel, including cohorts of initial employment trainees (IETs). Notwithstanding the large scale of both surveys, some findings are necessarily based on the responses of quite small numbers of survey respondents (such as “ADGs who reported work-related acute injuries”). Whilst all sample sizes have been cited throughout the report, for brevity they have been omitted here. KEY FINDINGS Infantry Survey 2004 Incidence of acute injury; prevalence of chronic injury • Forty six percent of Infantry respondents had suffered an acute injury in the 12 month period prior to the survey. Of these personnel, between 16% and 29%1 reported trade-related acute injuries. • Forty six percent of Infantry respondents were carrying chronic injuries at the time of the survey. Of these personnel, around 35%1 reported having trade-related chronic injuries. • The reported incidence of acute injury was 817 acute injuries per thousand persons per year and the reported prevalence of chronic injury was 804 chronic injuries per thousand persons. These are of the same order of magnitude as estimates based on data from the Defence Injury Prevention Program (DIPP) and EpiTrack databases, and an order of magnitude higher than estimates based on data from Defcare. The reported incidence of trade-related acute injury was 359 acute injuries per thousand persons per year, and the reported prevalence of trade-related chronic injury was 382 per thousand persons for chronic injuries attributed wholly to trade-related activities and 583 per thousand persons for chronic injuries attributed wholly or in part to trade- related activities.
1 The uncertainty in these percentages is due to incomplete information being supplied by some respondents.
This report was accepted by the Department of Defence on 22/9/2006 xi DPESP REPORT 7 Retrospective Surveys of Injuries (2004 & 2005): Infantry and ADG
Characteristics of injured personnel • No significant distinguishing demographic characteristics of respondents with acute injury were identified. Statistically significant indicators of chronic injury were age, length of service, weight and BMI. • In general, the best indicator of both acute and chronic injury – both for injured vs non injured, and in the case of acute injuries, for trade-related vs not trade-related injury – was the number of hours per week of structured activity supervised by someone other than a PTI in the previous four weeks. The association between reported acute and chronic injury and the level of this type of activity may indicate poor quality of supervision leading to the occurrence of acute injuries and the recurrence of chronic injuries. Trade-related Acute Injuries • Forty four percent of acute injuries were trade-related (21% sport; and 27% PT). This profile differs from the profile presented in the ADF Health Status Report (2000). • Trade-related acute injuries reported were mostly strains (in 71% of reported incidents) and sprains (in 59% of reported incidents), with fractures, dislocations, bruising and crushing also common. Predominant bodily locations were hips and lower limbs (44%), shoulders and upper limbs (20%) and lower back (21%). • The most frequently reported activities in which the trade-related acute injury occurred included patrolling (35%), route marching (32%), carrying (22%), assaulting (16%) and lifting (15%). • Actions taken after injury included reporting to a RAP (76% of incidents) or a military health centre or military hospital (21%), and seeking civilian assistance (5%). • In 47% of cases, respondents indicated that they returned to work (in some cases to light duties) before they had fully recovered. • In almost two thirds of cases (62%), the respondent thought that no safeguards or preventative strategies were in place. When safeguards or preventative strategies were in place, they were generally perceived not to have failed (86%). Risk taking was thought to have been a contributing factor in almost one third (30%) of cases. • Lower back injuries were associated with both strength activities (lifting, passing, carrying, pushing/pulling) and strength-endurance activities (route-marching, patrolling), and with both combat and administrative activities. Injuries to the lower limbs were more likely to be associated with combat activities. • The group most generally susceptible to injury across a wide range of activities was 25-29 year- olds with less than 5 years of service, i.e. older recruits, whilst younger recruits tended to be injured mainly in the more physically demanding combat tasks. It was apparent that a complex interaction of exposure, susceptibility and experience influenced injury occurrence. • Soldiers with a BMI of 25 or above (classified as “overweight”) were not represented disproportionately in the injury profile, but they were more likely to have been injured performing administrative tasks than combat tasks. This reflects the positive correlation between BMI, age and length of service. Trade-related Chronic Injuries • In 73% of chronic injuries, trade-related activities were cited as a contributing factor (23% sport, 28% PT); 48% of chronic injuries were entirely trade-related. • Eighty percent of trade-related chronic injuries had persisted for over two years. • Seventy percent of trade-related chronic injuries were sustained to the joints and 24% to soft tissue. Most common bodily locations were lower limbs including hips (55%), lower back (16%) and upper limbs including shoulders (14%). • The most frequently reported activities contributing to trade-related chronic injury included route marching (57%) patrolling (45%), carrying (40%), assaulting (26%) and lifting (20%). • Actions taken included reporting to a RAP (58%), self treatment (40%), military health centre or military hospital (24%) and seeking civilian assistance (17%). Note that different actions might be taken on different occasions of recurrence of the same injury.
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• Performance of duties was affected in 89% of cases; medical downgrading occurred in 20% of cases, and occasional temporary restrictions in a further 20% of cases. Of those who reported the duration of restrictions, 10% were for the whole year, 33% were for short periods of up to 10 days, and 57% fell somewhere between these extremes. • High impact force activities such as striking, route marching, assaulting and urban operations were most likely to be associated with chronic overuse disorders of the joints. The activities of passing, pushing and pulling had the highest proportion of associated soft tissue injuries. • Whilst the prevalence of chronic injury generally increased with age and length of service (and hence cumulative exposure), even in the 20-24 year age group a substantial proportion reported chronic injuries associated with several activities. • With regard to length of service, the relative prevalence of chronic injury peaked at 10-14 years and then declined, which may reflect a tendency for personnel with chronic injuries to leave the service sooner than those without chronic injury • Those with BMI ≥30 (classified as “obese”) were over-represented by a factor of three in the chronically injured group. Those with a BMI of 25-29.99 (classified as “overweight”) were not represented disproportionately in the overall injury profile, but they were over-represented in the profiles for most activities, indicating that they were more likely to associate their injuries with multiple activities than the other groups. These results are consistent with the greater likelihood of chronic injuries among older, longer serving personnel. Opinions and Attitudes Regarding Trade-related Injury • When asked about the contribution of three systemic factors to trade-related injuries, 22% of respondents who had incurred acute injuries or who were carrying chronic injuries during the 12- month survey period reported manning levels, 35% reported time pressure, and 29% reported equipment limitations. A total of 60% of respondents with trade-related injury believed that at least one of these systemic factors contributed to their injury. This finding is very important. It is likely that the systemic factors identified in this survey as contributing to injury can be seen as indicators of a more general and pervasive influence of systemic failure upon soldier injury. • Key themes which emerged regarding attitudes to injury within the ADF culture were awareness of injury prevention measures; variation in levels of risk taking and avoidance of risk; concern about the effect of injury on capacity to do the job, including deployment, but no concern regarding income or family relationships; and willingness to report injury in spite of some concern about repercussions. Those with trade-related injuries tended to perceive higher levels of risk taking, less capacity to avoid risks and greater likelihood of being injured, and were less likely to report injury and more likely to fear repercussions of doing so. Infantry Survey 2005 Differences between 2004 and 2005 Results • The results of the 2005 survey, conducted in conjunction with normative field testing of physical performance, generally supported and confirmed the 2004 results. Most of the differences were explicable in terms of the differences in respondent profiles which have been discussed above. • For example, the incidence of acute injury was somewhat lower in the 2005 sample than in the weighted 2004 sample. This difference is attributable to the inclusion of IETs, who had a shorter exposure time, in the 2005 sample, and the exclusion of personnel with recent injuries from the 2005 sample. The proportions of trained soldiers reporting acute injuries were very similar in the two surveys. The prevalence of chronic injury was considerably lower in the 2005 survey. This is attributable partly to the inclusion of IETs in 2005, and partly to self selection bias and consequent over-representation of chronically injured personnel in the 2004 survey. The reported incidence of acute injury was 657 acute injuries per thousand persons per year (817 in 2004) and the reported prevalence of chronic injury was 439 chronic injuries per thousand persons (804 in 2004). For trained soldiers, the 2005 rates were 733 and 508 per thousand persons respectively. • Regarding attitudes to injury, whilst the 2004 and 2005 response profiles were very similar, there was a higher level of agreement in 2005 that there are adequate resources available to prevent injuries during sport, other physical activity and physical work tasks. This may be a consequence of the rollout of DIPP in many of the units surveyed.
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Supplementary Information from the 2005 Survey • Of the 25 high-risk and/or physically demanding CATTs listed on the 2005 survey form, eight were not associated with any acute injury. Of the 17 which were, the most frequently cited were Forced March, Patrol in Marching Order and Section Attack. The predominant associated actions were marching, walking and running; going to ground and crawling; and carrying loads, either in hands/arms but especially on the back. • Of the 25 high-risk and/or physically demanding CATTs listed on the 2005 survey form, all but five were reported as contributing to chronic injuries. The most frequently cited, as with acute injury, were Forced March, Patrol in Marching Order and Section Attack. Carriage of stores and stretchers featured more prominently in terms of chronic injury than acute injury. By far the most common actions associated with chronic injury were marching and carrying loads on the back, which were each cited in almost half the reported cases of injury. Most chronic injuries were associated with multiple CATTs and multiple actions; on average, each injury was associated with around two CATTs and three physical actions. ADG Survey 2004 Incidence of acute injury; prevalence of chronic injury • Forty five percent of ADG respondents had suffered an acute injury in the 12 month period prior to the survey. Of these personnel, between 22% and 32%1 reported trade-related acute injuries. • Forty two percent of ADG respondents were carrying chronic injuries at the time of the survey. Of these personnel, around 30%1 reported having trade-related chronic injuries. • The reported incidence of acute injury was 758 acute injuries per thousand persons per year and the reported prevalence of chronic injury was 639 chronic injuries per thousand persons. These are of the same order of magnitude as estimates based on data from the Defence Injury Prevention Program (DIPP) and EpiTrack databases, and an order of magnitude higher than estimates based on data from Defcare. The reported incidence of trade-related acute injury was 349 acute injuries per thousand persons per year, and the reported prevalence of trade-related chronic injury was 183 per thousand persons for chronic injuries attributed wholly to trade-related activities and 396 per thousand persons for chronic injuries attributed wholly or in part to trade- related activities. Characteristics of injured personnel • The only significant distinguishing characteristic of those reporting acute injury was length of service. On average, those reporting acute injury had shorter length of service than those without injury. • Length of service was also the strongest indicator of chronic injury; in this case those with chronic injury had on average greater length of service than those who were uninjured. Other statistically significant indicators of chronic injury were age and BMI (positively associated) and hours per week of structured activity supervised by someone other than a PTI (negatively associated). Hours per week of structured activity supervised by a PTI was the only significant discriminator of trade-related chronic injuries (negatively associated). The negative associations may be indicative of the presence of chronic injury reducing the capacity to undertake physical activity. Trade-related Acute Injuries • Forty six percent of acute injuries were trade-related (21% sport; and 27% PT). This profile differs from the profile presented in the ADF Health Status Report (2000). • Trade-related acute injuries reported were mostly strains (the main injury in 41% of reported incidents, and a secondary injury in 40% of reported incidents) and sprains (the main injury in 18% of reported incidents, and a secondary injury in 40% of reported incidents). Predominant bodily locations were hips and lower limbs (41%) and lower back (18%). • The most frequently reported activities in which the trade-related acute injury occurred were patrolling (36%) and carrying (32%). • Actions taken after injury included reporting to a military health centre or military hospital (59%) or a RAP (36% of incidents). There were no reported cases of seeking civilian assistance.
1 The uncertainty in these percentages is due to incomplete information being supplied by some respondents.
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• In 60% of cases, respondents indicated that they returned to work (in some cases to light duties) before they had fully recovered. • In almost two thirds of cases (59%), the respondent thought that no safeguards or preventative strategies were in place. When safeguards or preventative strategies were in place, they were generally perceived not to have failed (88%). Risk taking was thought to have been a contributing factor in only a small proportion (14%) of cases. • Lower back injuries were associated with both both combat and administrative activities, including strength activities (lifting, carrying) and strength-endurance activities (patrolling). Injuries to the lower limbs were associated with a wide range of combat activities, but not with lifting. • With regard to age and length of service, the youngest and oldest personnel, and those with the shortest and longest service, were slightly more likely to be injured than those of intermediate age and length of service, who tended to be correspondingly under-represented among the injured. • Airmen with a BMI of 25 or above (classified as “overweight”) were slightly under-represented in the injury profile compared to those with a BMI below 25 (classified as “normal”) particularly in association with lifting, carrying and patrolling. • Whilst some differences were apparent in the characteristics of trade-related and non-trade- related acute injuries, the sample size was too small for any firm conclusions to be drawn. Trade-related Chronic Injuries • In 62% of chronic injuries, trade-related activities were cited as a contributing factor (31% sport, 57% PT); 29% of chronic injuries were entirely trade-related. • Sixty four percent of trade-related chronic injuries had persisted for over two years. • Forty six percent of trade-related chronic injuries were sustained to soft tissue and 35% to the joints. By far the most common bodily location was lower limbs including hips (69%), with less than 10% of injuries being associated with each other bodily location. • The most frequently reported activities contributing to trade-related chronic injury included assaulting (54%), route marching (50%), patrolling (31%), carrying (27%), lifting (27%) and urban operations (27%). • Actions taken included reporting to military health centre or military hospital (50%), no action (31%), reporting to a RAP (27%) and self treatment (27%). Note that different actions might be taken on different occasions of recurrence of the same injury. • Performance of duties was affected in 94% of cases; medical downgrading occurred in 15% of cases, and occasional temporary restrictions in a further 46% of cases. Of those who reported the duration of restrictions, 8% were for the whole year, 46% were for short periods of up to 10 days, and 46% fell somewhere between these extremes. • High impact force activities such as route marching, patrolling, assaulting and urban operations were most likely to be associated with chronic overuse disorders of the joints. Muscle tendon and other soft tissue injuries were associated with a wide range of activities. • Whilst the prevalence of chronic injury is much higher in the older age groups (as would be expected, reflecting the effect of cumulative exposure) even in the 20-24 year age group a substantial proportion reported chronic injuries associated with all types of activity listed. • With regard to length of service, whilst the group with less than 5 years service was under- represented as would be expected, even in this group a substantial proportion reported chronic injuries associated with all activities. The relative prevalence then declined through the 5-14 year period (possibly reflecting a tendency for personnel with early chronic injuries to leave the service sooner than those without chronic injury), and then increased to its highest levels among the longest serving airmen, as would be expected. • Airmen with chronic injury tended to have higher than average weight and BMI. The BMI profiles told a similar story of over-representation of airmen with high BMIs among the chronically injured, which is consistent with the greater likelihood of chronic injuries among older, longer serving personnel. The relationship between BMI and chronic injury was in contrast to the pattern for acute injuries, reflecting the interaction of age, bodily strength and exposure in determining injury.
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Opinions and Attitudes Regarding Trade-related Injury • When asked about the contribution of three systemic factors to trade-related injuries, 13% of respondents who had incurred acute injuries or who were carrying chronic injuries during the 12- month survey period reported manning levels, 41% reported time pressure, and 19% reported equipment limitations. A total of 49% of respondents with trade-related injury believed that at least one of these systemic factors contributed to their injury. This finding is very important. It is likely that the systemic factors identified in this survey as contributing to injury can be seen as indicators of a more general and pervasive influence of systemic failure upon airman injury. • Key themes which emerged regarding attitudes to injury within the ADF culture were awareness of injury prevention measures; variation in levels of risk taking and avoidance of risk; concern about the effect of injury on capacity to do the job, including deployment; and willingness to report injury in spite of some concern about repercussions. Those with trade-related injuries tended to perceive a greater likelihood of being injured, and were more likely to fear repercussions of reporting an injury. ADG Survey 2005 Differences between 2004 and 2005 Results • The results of the 2005 survey, conducted in conjunction with normative field testing of physical performance, generally supported and confirmed the 2004 results. A few key differences are summarised in the following paragraphs. • The profiles of age and length of service were very similar, although the 2004 sample included a small proportion of older, longer serving personnel. This is consistent with the fact that the 2005 survey was administered in conjunction with normative field testing, whilst the 2004 survey encompassed the full range of personnel in the AFDW. The inclusion of IETs in 2005 might have been expected to increase the proportions in the lowest categories of age and length of service, but this was not the case. In both survey samples the younger, less experienced airmen were over-represented by comparison with the 2 AFDS population profile. • The incidence of acute injury was somewhat lower in the 2005 sample than in the 2004 sample. This difference is largely attributable to the inclusion of IETs, who had a shorter exposure time, in the 2005 sample, and the exclusion of personnel with recent injuries from the 2005 sample. The prevalence of chronic injury was almost identical in the 2005 and 2004 surveys. The reported incidence of acute injury was 672 acute injuries per thousand persons per year (758 in 2004) and the reported prevalence of chronic injury was 643 chronic injuries per thousand persons (639 in 2004). • In the 2004 survey, 46% of acute injuries were trade-related; in 2005 the figure was 41%. The proportions of trade-related chronic injuries were more similar (62% and 65% respectively). • Regarding attitudes to injury, the 2004 and 2005 response profiles were very similar, though there were some indications in 2005 of higher levels of agreement that there are adequate resources available to prevent injuries during physical work tasks, and higher levels of personal steps being taken to prevent injuries. Supplementary Information from the 2005 Survey • Of the 25 high-risk and/or physically demanding CATTs listed on the 2005 survey form, only six were associated with instances of acute injury. The most frequently cited were Patrol in Marching Order, Patrol in Patrol Order and Section Attack. The predominant associated actions were patrolling and walking; going to ground; and carrying loads, either in hands/arms or on the back. On average, each injury was associated with two or three physical actions, typically combinations such as patrolling and load carriage. • All of the 25 high-risk and/or physically demanding CATTs listed on the 2005 survey form were reported as contributing to chronic injuries. The most frequently cited, as with acute injury, were Patrol in Marching Order, Patrol in Marching Order and Section Attack. Debussing and Stretcher Carry were the next most commonly cited CATTs. The most common actions associated with chronic injury were running, going to ground and carrying loads on the back. Most injuries were associated with multiple CATTs and multiple actions; on average, each injury was associated with around five CATTs and around five physical actions.
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RECOMMENDATIONS • Specific recommendations regarding strategies for mitigating injury risk were provided in Report 5 in this series. This report provides further evidence regarding the association between the occurrence of injury and the physical demands of particular CATTs, together with the perceived effects of organisational, systemic, cultural and behavioural factors on risk of injury. These factors should be considered by Defence agencies when planning risk mitigation interventions. • Findings from the 2004 survey were considered when decisions were made regarding potential physical employment tests (PETs) at the DPESP Criterion Tasks Workshop, which are discussed in Report 8 in this series. • The aim of this work package was to supplement the data already available in ADF databases regarding incidents and injuries, which had been found to be incomplete and unable to be linked to particular trade task activities. Whilst the immediate aim of providing supporting information for the DPESP research project was achieved, the difficulties of survey implementation and the extremely low response rate in the 2004 survey conducted by DSPPR reinforces the need, already identified in the recommendations from Report 3 in this series, for a comprehensive and reliable injury surveillance system to provide a more solid evidence base for OH&S management in general and for the identification and evaluation of injury prevention interventions in particular.
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REFERENCE DOCUMENTS
A. Commonwealth of Australia. (2002). Request for Tender for Conduct of a Physical Employment Standards Study for the Australian Defence Force, Part One: Draft Statement of Work. Canberra.
B. Commonwealth of Australia. (2002). Contract C538679 Conduct of a Physical Employment Standards Study for the Australian Defence Force. Canberra.
C. Stacy, R.J., Payne, W.R. and Harvey, J.T. (2004). Defence Physical Employment Standards Project, Infantry and Airfield Defence Guards; Report 1: Selection of Key Trade Tasks for Detailed Observation. Canberra: Department of Defence, Defence Personnel Executive.
D. Harvey, J.T., Payne, W.R. and Otago, E.L. (2004). Defence Physical Employment Standards Project, Infantry and Airfield Defence Guards; Report 3: Review of Infantry and ADG Injury Data. Canberra: Department of Defence, Defence Personnel Executive.
E. Payne, W.R., Knez, W.L., Harvey, J.T., Sinclair, W.H., Elias, G.P. and Ham, D.J. (2005). Defence Physical Employment Standards Project, Infantry and Airfield Defence Guards; Report 4: Trade Tasks Analysis: Infantry and ADG. Canberra: Department of Defence, Defence Personnel Executive.
F. Culvenor, J.F., Pascoe, D.A., Payne, W.R., Harvey, J.T., Knez, W.L. and Cunningham, J.E. (2006), Defence Physical Employment Standards Project, Infantry and Airfield Defence Guards, Report 5: Trade Tasks Risk Analysis and Mitigation: Infantry and ADG. Canberra: Department of Defence, Defence Personnel Executive.
G. Payne, W.R., Harvey, J.T., Knez, W.L, and Ham D.J. (2005). Defence Physical Employment Standards Project, Infantry and Airfield Defence Guards, Report 8: Selection of Criterion Trade Tasks: Infantry and ADG. Canberra: Department of Defence, Defence Personnel Executive.
H. Payne, W.R., Harvey, J.T., Knez, W.L., Selig, S.E, Sinclair, W.H., Ham, D.J. and Lee C.A. (2006). Defence Physical Employment Standards Project, Infantry and Airfield Defence Guards, Report 11: Normative Physical Performance Data: Infantry And ADG. Canberra: Department of Defence, Defence Personnel Executive.
I. Defence Health Service Branch. (2000). Australian Defence Force Health Status Report. Canberra: Defence Publishing Service.
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ABBREVIATIONS AND ACRONYMS
ADF Australian Defence Force ADG Airfield Defence Guard AFDW Airfield Defence Wing CATT Combat Arms Trade Task DHSB Defence Health Services Branch DIPP Defence Injury Prevention Program DPESP Defence Physical Employment Standards Project DSMA Defence Safety Management Authority DSPPR Directorate of Strategic Personnel Planning and Research IET Initial Employment Training ITS Infantry Training School (see also SOI) OHS Occupational Health and Safety PES Physical Employment Standards PMKeyS Personnel Management Key Solution RAAFSFS Royal Australian Air Force Security and Fire School RAP Regimental Aid Post SOI School of Infantry (see also ITS) SOP Standard Operating Procedures 1 RAR 1st Battalion, Royal Australian Regiment 2 RAR 2nd Battalion, Royal Australian Regiment 25/49 RQR 25th/49th Battalion, Royal Queensland Regiment 3 RAR 3rd Battalion, Royal Australian Regiment 5/7 RAR 5th/7th Battalion, Royal Australian Regiment 6 RAR 6th Battalion, Royal Australian Regiment 9 RQR 9th Battalion, Royal Queensland Regiment 1 AFDS 1st Airfield Defence Squadron 2 AFDS 2nd Airfield Defence Squadron 3 AFDS 3rd Airfield Defence Squadron
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DPESP REPORT 7 Retrospective Surveys of Injuries (2004 & 2005): Infantry and ADG
1 INTRODUCTION
1.1 Background
1.1.1 Military operational tasks are physically demanding and incur the risk of injury. In order to address the issues and costs associated with the high injury rates and focus on ways to reduce the risk of injury to Australian Defence Force (ADF) personnel, the ADF Chiefs of Service Committee (COSC) has endorsed a number of injury prevention strategies aimed at examining, analysing and evaluating injury-related risks and hazards within the ADF. In line with those strategies, COSC has affirmed that ADF employment policy is to be competency based and agreed that physical employment standards should be developed for combat arms trades. The purpose of the Defence Physical Employment Standards Project (DPESP) is to develop these performance-based competency standards.
1.1.2 The ADF has employed the services of the University of Ballarat (UB) to undertake the DPESP. This involves reviewing combat arms trade tasks (CATTs), establishing a set of criterion CATTs, developing a battery of simulation and predictive tests based on the criterion CATTs to be used to assess the physical competency of ADF combat personnel, and making recommendations for associated physical employment standards (See Reference Documents A and B).
1.1.3 In the initial phase, the study is focused on one Army corps - Infantry, and one Air Force mustering - Airfield Defence Guards (ADG).
1.1.4 The steps in the DPESP study are:
a. identification and observation of CATTs;
b. analysis of physical and cognitive demands of CATTs;
c. identification and analysis of injury risks of CATTs;
d. identification of criterion CATTs on which to base tests of physical performance;
e. development of a set of potential physical employment tests (PETs), and establishment of their reliability and validity;
f. collection of normative data on the PETs;
g. selection of the final battery of PETs and determination of minimum performance standards on each.
1.2 Aims
1.2.1 This work package (WBS 1.2.2) relates to 1.1.4.c. Data already available in ADF databases regarding incidents and injuries were found to be incomplete and unable to be linked to particular trade task activities (Reference Document D). The aim of this work package was to supplement these data by means of large-scale retrospective surveys of injuries to Infantry and ADG personnel, designed to identify the characteristics of injured personnel, the characteristics of their acute and chronic injuries, and the trade-related activities contributing to these injuries.
1.3 Scope
1.3.1 Two retrospective surveys of Infantry and ADG personnel were conducted, the first in 2004 and the second in conjunction with field testing of PETs in 2005.
1.3.2 Compared to existing data sources, these surveys included a stronger focus on the activity being undertaken at the time each injury occurred, with particular reference to CATT-related activity categories (Reference Documents C and F).
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2 METHODOLOGY
2.1 Background
2.1.1 The Defence Safety Management Agency (DSMA) and Defence Health Service Branch (DHSB) provided initial briefings for members of the DPESP research team on 16 October 2003 (Reference Document D). At these meetings, it was established that three related surveys of Defence personnel were being planned for the first half of 2004, and it was agreed that there should be coordination in order to avoid duplication of effort by researchers and survey fatigue for ADF members.
2.1.2 A liaison meeting was held in Canberra on 22 January 2004 between members of the DPESP research team and representatives of the Behavioural Baseline Study (BBS) being planned by DSMA, and the Defence Injury Prevention Program (DIPP) injury surveillance survey, a project of the Defence Health Service Branch (DHSB), which was to be conducted in collaboration with the Directorate of Strategic Personnel Planning and Research (DSPPR). Table 1 lists those present at the meeting, together with their affiliations and roles.
Table 1. Survey Liaison Meeting Participants Name Affiliation Role Mr Scott Clarke DSMA BBS Dr Jack Harvey University of Ballarat DPESP Statistics Mr John Mathieson Defence PES Project Manager Chair Assoc Prof Leonie Otago University of Ballarat DPESP Injury Epidemiology Prof Warren Payne University of Ballarat DPESP Project Manager Dr Rod Pope DHSB DIPP Survey Mr Mike Power DSPPR DIPP Survey
2.1.3 After exchange of information about aims, objectives and proposed methodologies, it was agreed that the BBS survey should proceed independently, but that there was sufficient commonality between the DIPP and DPESP surveys to consider combining these surveys.
2.1.4 At a second meeting on the same day, attended by all but Mr Clarke and Mr Mathieson, a framework for a combined DIPP/DPESP survey was mapped out, and it was agreed to seek approval to proceed with this strategy. Approval was subsequently granted by the sponsors of both surveys - the Director General Defence Health Services and the Director General Career Management Policy.
2.1.5 Considering the potentially sensitive nature of information about injuries, particularly injuries which may have not been disclosed to the ADF, and opinions about factors contributing to injuries, it was considered that privacy was a crucial consideration. For this reason, together with consideration of feasibility given the resources available, it was decided to use an anonymous self-completion survey methodology. To optimise participation rates, distribution in each unit was to be accompanied by briefings about the DPES project and the purpose of the survey.
2.2 Design of the Questionnaire
2.2.1 Design of the questionnaire began at the 22 January 2004 meeting. Dr Harvey coordinated the development of the questionnaire and associated documentary materials through several revision cycles conducted by email and telephone conferences throughout February and March 2004. In determining the content of the questionnaire, reference was made to the work of Finch et al. (1999) and to the OH&S classification systems cited in Chapter 4 of Report 3 in this series (Reference Document D). Mr Power produced the first production draft using DSPPR’s optical character recognition (OCR) survey processing system in time for pilot testing at the end of March 2004.
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2.2.2 The questionnaire consisted of four sections, concerning:
a. personal details and information about physical activities (work-related and sport-related) undertaken during the previous 12 months;
b. details of up to four acute injury incidents during the previous 12 months;
c. details of up to four current chronic injury conditions;
d. general opinions regarding contributing causes, and systemic and cultural issues.
2.2.3 An acute injury incident was defined as a specific incident leading to a physical injury (including heat stress) which made it difficult for the respondent to effectively perform his or her duties for at least one day after the incident, including both new injuries and repeat episodes of previous injuries. A chronic injury was defined as an ongoing physical injury which is difficult to relate to particular times and places – for example persistent knee joint pain over the past six to twelve months. There was some unavoidable uncertainty as to where individual respondents would draw the line between recurrences and chronic injuries.
2.2.4 The necessity to provide for multiple injuries of each sort resulted in a more extensive form (over 30 pages) than would usually be the case for a self-completion questionnaire. It was recognised that the briefing information provided must clearly explain the structure and stress the fact that most participants would not have to fill in every page.
2.3 Ethics Approval
2.3.1 Protocols for recruiting subjects for both developmental pilot testing and for the survey proper, together with the survey forms, were approved by the Australian Defence Human Research Ethics Committee (ADHREC) and the University of Ballarat Human Research Ethics Committee (UBHREC).
2.4 Pilot Testing
2.4.1 Pilot testing was carried out with personnel from 2 RAR (Townsville) on 30 March 2004 and at AFDW (Amberley) on 2 April 2004. Two sessions were held at 2 RAR, with a total of 19 participants, ranging in rank from PTE to LT. One session was held at AFDW, involving 9 participants ranging in rank from LCPL to WOFF.
2.4.2 The pilot session involved introductory briefing and recruitment by a member of the research team (supported at 2 RAR by a DIPP staff member), followed by distribution of the survey package (survey form and information sheet) and a feedback sheet. Participants were then given 40 minutes to complete the survey form and fill in the feedback sheet. Participants then took a break while the researcher scanned the completed forms and read the feedback sheets, after which the researcher led the group in a discussion of the survey form and the points raised in the feedback sheets.
2.4.3 As a result of pilot testing, a number of changes were made to the wording of a number of items. In addition, data gathered from the completed questionnaires confirmed that it was appropriate to make provision for collecting information on up to four acute injuries and four chronic injuries. The final questionnaires (Infantry and ADG versions) and associated survey documents can be found at Annexes 1-7.
2.5 Selection of the Sample
2.5.1 The scope of the DIPP survey was all Army corps. The scope of the DPESP survey was Infantry and ADG. The combined sample was thus to be drawn from all Army corps and ADG.
2.5.2 The target DPESP sample size was 500. Advice from Defence health personnel, supported by an analysis of DIPP and EpiTrack data (See Reference Document D), was that an
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average of one acute injury episode per year and one chronic injury per soldier could be expected. The anticipated sample of around 500 of each type of injury (acute and chronic) was considered adequate for the purposes of establishing an injury profile, triangulating the injury profile obtained from ADF databases, and indicating associations between injury risk and classes of physical activity.
2.5.3 The planned sampling strategy was to use PMKeyS1 to identify personnel posted to either Darwin or Townsville (estimated by DSPPR to be approximately 3000 and 4500 respectively), and to randomly select approximately 1200 from each location, stratified by rank proportions based on the total Regular Army population in PMKeyS. Additionally, infantry personnel were to be oversampled relative to personnel from other Army corps to ensure a sufficient sample size for the DPESP study; around 1200 were to be selected (600 in each location), which assuming a 30% response rate would provide around 400 infantry responses overall. Given the small number of ADGs (around 350) all of them were to be surveyed to ensure a sample size of around 100, which together with the Infantry sample of 400, would make up the target sample of 500.
2.5.4 On further investigation, it was found that the number of available infantry personnel was lower than anticipated, and that a sample of 1200 would constitute around 50% of all available infantry personnel, and an even higher proportion of those based in Darwin and Townsville. It was ultimately decided to simplify the logistics and distribute forms to all available infantry personnel in units based in Darwin, Townsville, Brisbane and Sydney. The units surveyed are listed in Table 2.
2.6 Implementation of the Survey
2.6.1 The Assistant Director, Military Personnel Projects, working in liaison with Army and RAAF personnel, arranged for a person in each surveyed unit to be designated as a survey point of contact/co-ordinator. Their role included distribution of background information prior to the survey, distribution of the survey forms, the associated briefings, issuing of reminder notices a week after distribution of the survey forms, and collection and dispatch of completed survey forms2. Background information about the survey was also distributed prior to the survey through ADF publications.
Table 2. Infantry and ADG Units/Personnel Included in the DPESP Survey Sample Unit Type Available Number of Response Case Effective Infantry/ADG responses rate weight* (weighted) personnel % sample size 1 RAR Light 579 43 7.4 1.71 74 2 RAR Light 570 34 6.0 2.13 72 25/49 RQR Reserve 68 30 44.1 0.29 9 3 RAR Airborne 461 17 3.7 3.45 59 5/7 RAR Mechanised 366 81 22.1 0.57 46 6 RAR Motorised 280 89 31.8 0.40 36 9 RQR Reserve 27 5 18.5 0.69 3 Total Infantry 2351 299 12.7 299 1 AFDS 28 2 AFDS 55 3 AFDS 11 4 AFDW 1 Total ADG 320 95 29.7 Total 2761 394 14.3 * See paragraph 2.7.6
1 Personnel Management Key Solution - the Defence human resources information system. 2 Respondents were given the choice of placing their completed form in a collection box in their unit or returning the form directly to DSPPR in the return envelope provided. It is believed that most chose the former option, but it is not possible to quantify the proportions because DSPPR could not distinguish between forms bundled within units and individually returned forms bundled in mail rooms.
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2.6.2 Survey forms were distributed to the designated unit contacts during May 2004, at times negotiated to fit in with scheduled unit activities. Within the scope of the DPESP, a total of 394 survey forms were returned to DSPPR and processed during the period June- September 2004. The Infantry and ADG units included in the sample are listed in Table 2, together with estimated numbers of available personnel1, numbers of survey forms returned, and response rates.
2.7 Data Management, Validation and Analysis
2.7.1 Automated optical scanning data entry was carried out at DSPPR, Campbell Park, ACT, under the supervision of the Defence principal researchers. In accordance with established DSPPR procedure, approved by ADHREC, electronic images of all survey forms will be stored indefinitely under a Staff-in-Confidence caveat (access restricted to the staff member him/herself and authorised DSPPR personnel) on a restricted computer network at DSPPR. The paper originals will be shredded, under a DSPPR protocol for destruction of classified materials, at the completion of the study.
2.7.2 An electronic file of data relevant to the DPESP was provided to the DPESP research team, under protocols approved by UBHREC.
2.7.3 Statistical analyses were performed using Excel and SPSS statistical software. All relevant files have been provided to the Defence PES Project Office in electronic form.
2.7.4 Because each respondent could report on up to four acute injuries and up to four chronic injuries, three sets of analyses were carried out, based on:
a. characteristics and general opinions of respondents; in these analyses, a “case” is a respondent to the survey;
b. characteristics of acute injury incidents; in these analyses, a “case” is an acute injury incident; each respondent could contribute up to four cases; and
c. characteristics of chronic injury conditions; in these analyses, a “case” is a chronic injury condition; each respondent could contribute up to four cases.
2.7.5 Although Infantry soldiers and ADG airmen share a common core of CATTs, there are also many CATTs specific to each group, as well as distinct differences in work/training regimens and in the relative importance of particular CATTs for the two groups. For these reasons, Infantry and ADG are considered separately in this report.
2.7.6 Whilst all Infantry units share a common set of CATTs, there are also differences from unit to unit in role, emphasis and work/training regimens. Whilst it was beyond the scope of this study to compile separate reports for each unit, it was recognised that if the survey data were treated as a simple random sample, the unbalanced representation of the various Infantry units in the sample (see Table 2) could result in biased estimates for the Infantry population as a whole. Consequently, the sample was treated as a stratified sample (the strata being the units) and the responses from each unit were differentially weighted to ensure proportional representation of all units in the overall estimates for Infantry. Case weights and effective sample sizes for each unit are shown in Table 2. As a consequence, all counts, percentages and mean values cited in the Infantry analysis (Section 3) are weighted values. It should also be noted that small discrepancies occur in reported counts and percentages due to the rounding off of weighted frequencies to whole numbers.
2.8 Presentation, Terminology and Interpretation
2.8.1 Results and discussion are presented separately for Infantry (Chapters 3 and 4) and ADG (Chapters 5 and 6). Some comparisons with other data sources and some general points of interpretation are repeated in order to ensure that the results and discussion for Infantry and ADG are each complete in themselves.
1 These estimates were provided to DSPPR by unit contact personnel in April 2004.
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2.8.2 Not all questions were answered by all respondents. In the individual frequency tables, the percent column shows the frequency of each response expressed as a percentage of the total number of respondents. Generally more informative is the valid percent column, which shows the frequency as a percentage of those cases for which the particular question was answered. All cases for which a question was not answered (either through omission or because particular respondents were not required to answer the question) have been tagged automatically by the statistical software, and are labelled as “missing - system”.
2.8.3 Some composite frequency tables are presented in a simpler format, without explicit enumeration of missing cases. The percentages in these tables correspond to the ‘valid percent’ in the individual frequency tables.
2.8.4 The percentages in cross-tabulations are percentages of all respondents to the questions being tabulated. Again, there is no reference to missing cases.
2.8.5 With multiple response items (those for which the respondent could select more than one response) two types of percentage can be reported – the percentage of all responses (which add to 100% but are usually of relatively little interest) and the percentage of cases i.e. respondents (which generally add to more than 100% and are generally of more interest). All such percentages in this report are of the latter type. Again, there is no explicit reference in multiple response tables to missing cases i.e. those who made no responses at all.
2.8.6 For reasons explained in paragraph 2.7.6, all percentages, means etc. in Section 3, whether tabulated or cited in the text, are based on a weighted analysis. This is also true of all tabulated counts or frequencies, which it is stressed do not represent the actual counts/frequencies in the survey data. It should also be noted that small discrepancies may occur in reported counts and percentages due rounding off of weighted frequencies to whole numbers.
2.8.7 Most of the tables in this report include percentages which indicate the proportions of particular injury/incident characteristics or outcomes within the survey sample or particular sub-samples of the survey sample (rank categories, age groups, BMI categories, etc.). These sample proportions provide estimates of the corresponding proportions within the ADF population. Sample estimates of proportions are subject to two sources of uncertainty or “error”, sampling errors and non-sampling errors, which must be borne in mind when interpreting the percentages cited in this report. Margins of uncertainty are discussed in Annex 16.
2.8.8 Unless otherwise stated, ‘significant’ should be taken to mean ‘statistically significant at the 0.05 level’.
2.9 Limitations
2.9.1 It must be strongly stressed that the statistical inferences made in this report (and in particular the cited statistical significance levels) are predicated on the assumption that the survey respondents in each unit surveyed are a representative sample of the whole population of the unit. Because of the voluntary nature of the survey and the low response rates, especially in light Infantry units, there is a strong possibility that the validity of the interpretations and conclusions might be undermined to some degree by self-selection bias. There may be important differences between the personal characteristics, injury histories, attitudes and opinions of those with whom contact was made and who chose to respond, and those who were either not contacted and briefed, or who declined to participate. Hence the sample data might not be representative of the Infantry and ADG populations as a whole. This is an inherent risk in self-completion surveys of this kind.
2.9.2 The indications from pilot testing were that, notwithstanding the length of the survey form, it was “user friendly” and able to be completed in a reasonable time. However in the survey proper, in the absence of any pressure to comply, many respondents were not sufficiently motivated to complete the form fully and accurately. In many cases the number of injury incidents for which details were supplied was less than the reported number of injuries
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experienced in the survey period. Furthermore, even when details were given about an injury incident, they were frequently incomplete.
2.9.3 For close to a quarter (45 or 22%) of the acute injury incidents about which details were provided, the date of the incident was either not entered (15 incidents or 7%), or it was outside the specified 12-month retrospective time frame1 (25 incidents or 12% too early; 5 incidents or 2% too late). These incidents were excluded from the acute injury analysis, and in each case the number of injury incidents reported by the respondent was reduced accordingly for the respondent analysis.
2.9.4 The anonymous self-completion survey methodology was used for reasons of privacy and feasibility given the resources available. However, this methodology proved to have limited effectiveness in this population and with a lengthy and searching survey form. Response rates were low, particularly in Light Infantry units, and many forms submitted were only partially filled out. The fact that the dates of some reported incidents were out of scope (in some cases by several years) indicates that not all respondents were fully cognizant of specifications of the survey. By implication, this might also cast some doubt on the accuracy of some of the data supplied.
2.9.5 Another limitation concerns the categorisation of activities. An important motivation for conducting the retrospective survey of injuries was the paucity of information in existing Defence databases about the contribution of particular trade task activities to acute and chronic injuries (see Reference Document D). A series of Trade Task Workshops was held in November 2003, and from initial lists of 80 Rifleman2 tasks and 91 Airfield Defence Guard tasks identified by Defence, a set of 34 CATTs was selected for observation and detailed analysis (see Reference Document C). At the time the survey questionnaire was developed, this list of 34 CATTs was being reviewed, in the context of consultation with units and detailed planning for the task observation. In considering how much detail to seek in the retrospective survey, the complete list of CATTs was clearly prohibitively long, and it was considered that even the list of 34 CATTs was probably still too long (and in any case was under review). In the light of this, it was decided not to make any reference in the survey to specific CATTs, but rather to use a set of 12 CATT-based activity categories that had been developed in the Trade Task Workshops3. Whilst this categorisation was more generic than a list of particular CATTs, it provided a finer and more precise categorisation of CATT-related activity than was available from any existing Defence injury database, and was regarded as a feasible compromise.
2.9.6 Finally, it should be noted that this report is based on an analysis of the characteristics of all injuries reported, regardless of severity (though severity indicators are included in the analysis). Even so, some findings are necessarily based on the responses of quite small numbers of survey respondents (such as “ADGs who reported work-related acute injuries”). Though this was a large survey, severe injuries were sufficiently infrequent to preclude a statistical analysis based on only these injuries.4
1 The survey was planned to take place during May 2004, and so the 12-month time frame specified in the survey documents was the period May 2003 – April 2004. Forms were despatched from DSPPR to all units on 6 May 2004. Distribution within the units occurred throughout May, with the great majority of completed forms being received by DSPPR during June and July 2004. It was decided not to exclude reports of incidents which occurred in June or July 2004. Incidents for which the reported date of occurrence was either earlier than May 2003 (together with a few for which the reported date was later than the time stamp assigned by DSPPR at the time of processing) were regarded as out of scope and were excluded. 2 Rifleman is the combat trade of an Infantry soldier 3 The 12 activity categories developed in the Trade Task Workshops were common to Infantry and ADG. Later, during the Criterion Tasks Workshop, it was decided that Infantry do not use the term “Pursuit” and ADG do not use the term “Route March”. Notwithstanding this, the 2004 survey data did include some “Pursuit” responses from Infantry soldiers and some “Route March” responses from ADGs. 4 In any case, the relative impact in the ADF context of a single severe injury versus the cumulative effects of a sequence of less severe injuries is debatable. Be that as it may, data on the less frequent severe injuries would be better collected via a comprehensive injury surveillance system rather than a sample survey.
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2.10 Supplementary Survey
2.10.1 During 2005, following the development of the DPESP battery of physical employment tests (PETs), a program of normative field testing was implemented in a number of Infantry and ADG units. A supplementary retrospective survey of injuries was undertaken in conjunction with this field testing, with two main objectives.
2.10.2 The first objective was to obtain further information about the relationship between the occurrence of injury and particular CATTs and the critical physical actions involved in those CATTs. In the 2004 survey, trade-related activity was characterised using fairly broad categories as outlined in paragraph 2.9.5 above. The 2004 survey took place prior to the completion of detailed observation of trade tasks and the subsequent physical movement analysis, which was followed by identification of critical high-risk and/or physically demanding CATTs in the Criterion Tasks Workshop (see Reference Document G). The 2005 survey incorporated two questions based on this later work, one about CATTs and the other about physical actions, both of which were much more finely differentiated than the categories used in the 2004 survey.
2.10.3 To offset the extra workload for respondents involved in these more detailed questions about trade tasks, a number of other questions from the 2004 survey form were either reduced in detail or omitted altogether1. The 2005 survey forms (Infantry and ADG versions) and associated survey documents can be found at Annexes 8-15.
2.10.4 The second objective was to obtain richer qualitative narrative material about injury causation to complement the quantitative analysis. Whilst there was provision for this in the 2004 survey, the combined effect of a lengthy survey form and the mode of administration (self completion and mailback) was that the responses to the open-ended questions were relatively few and relatively brief. It was considered that personal distribution and retrieval of survey forms by DPESP field staff, together with the opportunity to provide direct motivation and encouragement and the allocation of time specifically for the purpose of completing the survey form, should result in more thorough responses and better data quality.
2.10.5 A third benefit of the supplementary survey was the potential for confirmation and cross- validation of the 2004 survey results. In particular, in the 2004 survey the distribution of survey forms was locally administered in each unit, and the sample was individually self selected. In 2005, the more uniform mode of distribution and the structured section-based mode of administration acted to reduce non-response and self-selection bias. Hence, by comparing the 2004 and 2005 profiles of responses to key questions, it was possible to assess whether the low response rates and the variation in the response rates in different units in the 2004 survey had resulted in a sample that was biased either demographically or with regard to injury experience2.
Administration of the Survey
2.10.6 Protocols for recruiting subjects for normative testing, protocols for the actual testing, and protocols for the associated administration of the survey of injuries were approved by the Australian Defence Human Research Ethics Committee (ADHREC), and the University of Ballarat Human Research Ethics Committee (UBHREC).
2.10.7 The research design specified a sample of around 390 personnel – 210 Infantry soldiers (70 from each of three Infantry battalions), 60 Infantry IET (SOI), 70 ADG including IET, and 50
1 These were questions relating to general levels of physical activity throughout the period, and to non-CATT- related injuries, which were included in the 2004 survey because of their relevance to the DPESP’s survey partner DIPP rather than to the DPESP per se. 2 It is recognised that the 2005 sample was biased towards under-representation of injury, since personnel injured recently enough or seriously enough to be on sick leave at the time of the survey were not available to take part, and because the IETs included in the 2005 sample did not have a full year of exposure. Nevertheless, because the primary aim of the 2005 survey was to elicit more detailed information about the relationship between trade tasks and injury, with cross-validation of the 2004 survey results being a secondary consideration, the IET data were retained and included in the 2005 analysis.
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females. The females, whose employment was not in the combat arms trades, were not included in the survey of injuries and will not be discussed further in this report.
2.10.8 Normative testing took place with volunteer personnel from the following units: soldiers from 1 RAR during the period 11 Apr – 22 Apr 2005; airmen from AFDW and Initial Employment Trainees (IETs) from RAAFSFS during the period 16 May – 27 May 2005; soldiers from 3 RAR from 23 May – 27 May 2005; Infantry IETs at SOI during the period 6 Jun – 24 Jun 2005; soldiers from 6 RAR during the period 27 Jun - 8 July 2005; and soldiers from 2 RAR during the period 25 Jul – 5 Aug 2005. The sample was drawn mainly from rifle sections within rifle companies, with the inclusion of some support and administrative personnel.
2.10.9 Excluding females, a total of 322 volunteers were recruited for physical testing. The numbers in each unit are tabulated in Chapters 4 and 6. Participants volunteered after receiving a request to take part in the project from a member of the ADF who was not in the individual soldier’s or airman’s direct chain of command. Each volunteer was given an information sheet and a set of test procedures and signed a consent form (see Reference Document H for details). Each soldier or airman also completed a confidential health status form. Soldiers or airmen who reported a pre-existing injury or illness that was likely to place them at an unacceptable degree of injury risk as a result of participation in the project were excluded from physical testing by the Chief Investigator.
2.10.10 Survey forms were distributed, completed and collected during the initial session of the normative testing program. Eight volunteers who were excluded from physical testing were nevertheless included in the survey sample and completed a survey form. Conversely, ten volunteers who were absent from the first session did not complete a survey form. Hence the final survey sample size was 320, comprising 249 Infantry personnel and 71 ADG personnel.
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3 SURVEY OF INFANTRY 2004: RESULTS AND DISCUSSION
3.1 Introduction
3.1.1 In Section 3.2 the characteristics of the 299 Infantry respondents and their work programs and physical activities during the survey period are examined.
3.1.2 In Sections 3.3 and 3.4 the reported injury histories of the respondents are examined, and relationships between injury history and key characteristics of the respondents and their physical activities during the survey period are explored.
3.1.3 The survey form provided for details of up to four acute injuries. Information was provided by 88 respondents regarding 113 acute injury incidents which occurred during the survey period. In Sections 3.5 and 3.6 the characteristics of the individual incidents and injuries are examined, together with relationships between acute injury characteristics and respondent characteristics.
3.1.4 The survey form also provided for details of up to four chronic injuries. Information was provided by 105 respondents regarding 163 chronic injuries being carried at the time of the survey. In Section 3.7 and 3.8 the characteristics of the individual chronic injuries are examined, together with relationships between chronic injury characteristics and respondent characteristics.
3.1.5 Respondents were asked their opinions about factors contributing to injury, and about attitudes to injury within the ADF culture. They were also invited to comment about any aspect of the survey or related issues. In Section 3.9 the opinions of respondents are examined.
3.2 Characteristics of Respondents and Their Physical Activities
3.2.1 Weighted1 summaries of characteristics of the 299 respondents are presented in Tables 3 to 18. Also included in Tables 3 to 5 for purposes of comparison are profiles of age, length of service and rank for Infantry as at April 2006, provided by Army.
Table 3. Infantry: Age Distribution 2004 Survey Sample Infantry Population 2006 Valid Cum. Cum. Age group Frequency % % % Frequency % % Valid 17-19 10 3.5 3.5 3.5 277 2.6 2.6 20-24 138 46.1 46.7 50.2 2,217 20.7 23.3 25-29 76 25.3 25.7 75.9 2,204 20.6 43.9 30-34 36 12.2 12.3 88.2 1,908 17.8 61.7 35-39 22 7.3 7.4 95.6 1,507 14.1 75.8 40-44 7 2.4 2.4 98.0 1,093 10.2 86.1 45-49 3 1.1 1.2 99.1 759 7.1 93.1 50-54 3 .8 .9 100.0 733 6.9 100.0 Total 295 98.7 100.0 10,698 100.0 Missing System 4 1.3 Total 299 100.0
3.2.2 Table 3 shows that if the 2006 Infantry population is indicative of the 2004 Infantry population, then the 17-29 year age groups were over-represented and the 30-54 year age groups were correspondingly under-represented in the 2004 survey sample. Similarly, whilst the available Infantry population length-of-service profile did not exactly align with the survey profile, it is clear that those with less than 15 years service were over-represented, and those with more than 15 years service were under-represented (Table 4).
1 For information about the weighting procedure, see paragraph 2.7.6.
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Table 4. Infantry: Length of Service 2004 Survey Sample Infantry Population 2006 Length of Valid Cum. LOS Cum. service (yrs) Frequency % % % (years) Frequency % % Valid <5 153 51.0 51.0 51.0 ≤5 4,969 46.4 46.4 5-9 77 25.7 25.7 76.7 6-10 2,454 22.9 69.4 10-14 36 12.1 12.1 88.7 11-15 1,215 11.4 80.7 15-19 20 6.8 6.8 95.5 16-20 1,012 9.5 90.2 ≥20 13 4.5 4.5 100.0 >20 1,048 9.8 100.0 Total 299 100.0 100.0 Total 10,698 100.0
Table 5. Infantry: Rank 2004 Survey Sample Infantry Population 2006 Valid Cum. Cum. Rank category Frequency % % % Frequency % % Valid Other rank 173 57.8 57.9 57.9 4,522 42.3 42.3 NCO 124 41.4 41.5 99.4 3,782 35.4 77.6 Officer 2 .6 .6 100.0 2394 22.4 100.0 Total 298 99.8 100.0 10,698 100.0 Missing System 1 .2 Total 299 100.0
Table 6. Infantry: Primary Employment Category
Cumulative Primary Employment Category Frequency Percent Valid Percent Percent Valid Combat Clerk (Rainf) 1 .3 .3 .3 Crew Commander Mech 0 .1 .1 .4 Mortarman 2 .8 .8 1.2 Quartermaster/Storeman 11 3.6 3.6 4.8 Storeman (Engineers) 2 .6 .6 5.4 Rifleman 267 89.2 89.2 94.6 Supervisor Platoon Infantry Ops 13 4.3 4.3 98.9 Supervisor Company Ops 1 .4 .4 99.3 Sniper Supervisor 2 .7 .7 100.0 Total 299 100.0 100.0
3.2.3 Table 5 shows that other ranks, and to a lesser degree NCOs, were over-represented in the survey sample and that Officers were almost entirely absent from the survey sample. Table 6 shows that the survey sample was predominantly comprised of Riflemen.
3.2.4 The pattern of representation evidenced by Tables 3 to 6 may indicate self-selection bias, with higher response rates from personnel whose age, length of service, rank and employment category renders them more likely to be injured. Another possible contributing factor is the fact that the processes for distribution and collection of survey forms were determined and managed within the individual units.
3.2.5 The summaries of height, weight and body mass index (BMI) (Table 7) were compared to those for the soldiers who participated in the task observation phase of the DPESP (see Reference Document E). There were no statistically significant differences between the mean heights, mean weights or mean BMIs, and the profiles of all three measures were broadly comparable.
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Table 7. Infantry: Basic Physical Characteristics
Characteristic N Minimum Maximum Mean Std. Deviation Height (cm) 296 154 199 179.22 7.01 Weight (kg) 299 58 119 81.60 9.92 1 -2 Body mass index (BMI) (kg m ) 295 18.99 35.42 25.38 2.48 1 BMI = (weight (kg))/(height (m))2 Table 8. Infantry: BMI Category
Cumulative BMI category1 Frequency Percent Valid Percent Percent Valid <20 1 .3 .3 .3 20-24.99 149 49.8 50.4 50.7 25-29.99 133 44.4 44.9 95.7 ≥30 13 4.3 4.3 100.0 Total 295 98.8 100.0 Missing System 4 1.2 Total 299 100.0 1 BMI<20: underweight; 20≤BMI<25: normal; 25≤BMI<30: overweight; BMI>30: obese (WHO, 2000)
3.2.6 The categories used in Table 8 are those defined by the World Health Organisation (WHO, 2000). According to these criteria, almost half of the respondents were overweight. However, it is recognised that BMI has limitations as an indicator of adiposity, since high lean muscle mass can also result in a BMI of 25 or more (Expert Panel on the Identification, Evaluation and Treatment of Overweight and Obesity in Adults, 1998).
3.2.7 Weighted summaries of work programs and physical activities during the survey period are presented in Tables 9 to 13.
Table 9. Infantry: Work Cycle Number of occurrences Activity 0 1 2 3 % % % % Major exercise1 34.9 37.2 15.6 12.3 Minor exercise1 35.9 38.9 12.6 12.6 Pre-deployment 87.0 13.0 - - Deployment 70.4 29.4 - - Course 54.9 39.0 4.8 1.3 Leave 25.3 51.1 16.3 7.3 N=223. On advice from Defence informants, it was assumed that any respondent who did not indicate ANY of the listed activities had not answered the question. These non-responses were excluded from the analysis – they did not contribute to the counts in the ‘zero’ column. 1 A major exercise is one involving multiple Services and Agencies. The nominal duration is two to eight weeks; this may be broken down into phases to achieve particular outcomes. Major exercises are usually aimed to exercise higher end requirements (Service outcomes), with large scale involvement and co-ordination issues. A minor exercise involves a Unit or group of Units. The nominal duration is one to four weeks. A minor exercise is usually aimed at a specific role / task / function that the Unit is required to perform. A particular soldier or airman may be involved in either type of exercise for two to four weeks. The nature of the task (intensity / duration / location / conditions etc) can vary greatly for both types of exercise; a particular soldier or airman may work harder on a minor exercise than on a major exercise.
3.2.8 Table 9 summarises the level of involvement of respondents in six types of activity. It is not surprising that the proportion who were deployed (29.4%) closely matches the proportion who did not take part in major and minor exercises (34.9% and 35.9% respectively).
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Table 10. Infantry: Number of Activities (Excluding Leave)
Cumulative Number Frequency Percent Valid Percent Percent Valid 0 14 6.5 6.5 6.5 1 35 15.8 15.8 22.3 2 50 22.6 22.6 44.9 3 50 22.4 22.4 67.2 4 27 11.9 11.9 79.2 5 23 10.5 10.5 89.7 6 8 3.7 3.7 93.4 7 6 2.5 2.5 96.0 8 6 2.5 2.5 98.5 9 3 1.5 1.5 100.0 Total 223 100.0 100.0
3.2.9 Table 10 shows the profile of the total number of all the types of activity listed in Table 9 with the exception of leave. Because pre-deployment, deployment and courses are very diverse in their physical demands, and advice from ADF was that an individual soldier’s involvement in either major or minor exercises would be similar in duration (in the order of two weeks) and intensity, the total number of major and minor exercises was taken as an approximate measure of exposure to high intensity physical activity during the 12-month period. Table 11 shows that all but 16% of respondents were involved in at least one such activity during the survey period.
Table 11. Infantry: Number of Major and Minor Exercises
Cumulative Number Frequency Percent Valid Percent Percent Valid 0 36 16.2 16.2 16.2 1 54 24.1 24.1 40.3 2 60 26.9 26.9 67.2 3 33 14.6 14.6 81.8 4 22 9.9 9.9 91.7 5 9 4.1 4.1 95.8 6 9 4.2 4.2 100.0 Total 223 100.0 100.0
3.2.10 Basic Fitness Assessment (BFA) and Combat Fitness Assessment (CFA). Most respondents (270) had undergone the BFA and all but two had passed it on the first occasion. Of the 110 who had been tested a second time, all but one had passed. Similarly, 195 had undergone the CFA and all but one had passed; 40 had been tested a second time, and again all but one had passed. Since neither of these were strongly discriminating tests, they are not discussed further in this report.
3.2.11 Table 12 shows time spent in regular sport and training for sport. Almost half of the respondents played games and trained during the season in at least one sport. Around two thirds of participants also trained pre-season. The distributions of average hours per week were very positively skewed, with a small proportion of respondents estimating average hours well above the mean value for all participants. These may be sub-elite players who spend much more time training than the majority. It should be noted that the mean and standard deviation of the reported average hours per week for all sports includes the non- participants with zero hours per week of sporting activity.
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Table 12. Infantry: Involvement in Sport
Extent of involvement in the Average hours/wk 12 months prior to survey of sport-related activity % of respondents who… Trained Trained Played Mean Standard Sport pre- during games Deviation season season % % % Touch Football 6.3 7.4 11.4 3.9 2.0 Rugby Union 8.4 9.0 10.2 5.1 2.3 Rugby League 2.5 2.5 2.5 4.7 1.9 Australian Rules Football 8.9 12.6 12.7 5.0 1.7 Netball 0.7 0.7 0.8 3.2 2.0 Volleyball 1.8 2.9 3.8 3.7 2.0 Hockey 0.3 0.3 0.3 4.2 5.9 Cricket 1.4 1.9 2.1 5.3 3.8 Soccer 2.1 4.8 4.7 4.3 3.9 Other sport 6.2 13.3 11.5 6.0 4.9 All sports 28.1 44.5 45.5 3.1 5.2 N=299
3.2.12 Table 13 summarises the respondents’ estimated hours per week in physical training activity over the four weeks prior to the survey. These are measures of exposure to physical activity which complement the measures based on participation in sport and exercises during the 12-month period. The four-week measures are more finely graduated but more limited in temporal scope. Again, the distributions of average hours per week were very positively skewed, with a small proportion of respondents estimating average hours well above the mean value for all respondents. These respondents may have interpreted the question to include trade-related physical activity as well as physical training activity.
Table 13. Infantry: Physical Training Activity
N Minimum Maximum Mean Std. Deviation Hours of structured activity supervised by PTI 185 0 28 4.0 5.1 Hours of structured activity supervised by other than PTI 217 0 44 6.1 5.5 Unstructured/unsupervised activity 214 0 50 5.3 4.9
3.3 Injury Experience and Injury Status
3.3.1 Tables 14 and 15 show details of acute injury experience during the survey period. Tables 16 and 17 give corresponding information regarding chronic injury status at the time of the survey. These tables are based on respondents, not individual incidents/injuries (see Section 3.4 for that analysis). The purpose here is to divide the respondents into those who have had injuries of the nominated type, and those who have not. The category ‘trade- related’ encompassed five ‘work or trade-related’ categories from Question 8 of the acute injury section (and Question 4 of the chronic injury section) of the questionnaire (see Annex 1), but excluded travel to and from work. Because the primary focus of the DPESP study is Combat Arms Trade Tasks (CATTs), physical training (PT) was also excluded from this category. The “possibles” in Tables 15 and 17 are due to some respondents failing to answer these questions.
3.3.2 Summaries of weighted numbers of reported acute injury incidents experienced during the survey period and chronic injuries being carried are presented in Tables 18 and 19.
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Table 14. Infantry: Acute Injury
Cumulative Acute injury Frequency Percent Valid Percent Percent Valid Yes 138 46.3 46.3 46.3 No 161 53.7 53.7 100.0 Total 299 100.0 100.0
Table 15. Infantry: Trade-related1 and Non-trade-related Acute Injury
Cumulative Injury category1 Frequency Percent Valid Percent Percent Valid Some or all trade-related 49 16.2 16.2 16.2 2 Possible trade-related 38 12.7 12.7 28.9 Non-trade-related only 52 17.4 17.4 46.3 No acute injuries 161 53.7 53.7 100.0 Total 299 100.0 100.0 1 The category ‘trade-related’ encompassed five ‘work or trade-related’ categories from Question 8 of the acute injury section of the questionnaire (see Annex 1), but excluded travel to and from work. Because the primary focus of the DPESP study is Combat Arms Trade Tasks (CATTs), physical training (PT) was also excluded from this category. 2 The “possibles” are due to some respondents failing to answer this question.
3.3.3 Tables 14 and 15 indicate that during the 12-month survey period, close to half (46%) of Infantry soldiers suffered at least one acute injury which made it difficult for them to perform their duties for at least one day, and between 16% and 29%1 attributed at least one acute injury to trade-related activity.
3.3.4 Tables 16 and 17 indicate that at the time of the survey, a similar proportion (46%) of Infantry soldiers were carrying at least one chronic injury, and 35% ascribed trade-related activity as either the sole factor or as a contributing factor to the initial occurrence of their chronic injury.
Table 16. Infantry: Chronic Injury
Cumulative Chronic injury Frequency Percent Valid Percent Percent Valid Yes 106 35.5 45.9 45.9 No 125 41.9 54.1 100.0 Total 231 77.4 100.0 Missing System 68 22.6 Total 299 100.0
1 Evidence from the supplementary survey in 2005 suggests that the actual proportion is near the middle of this range (see paragraph 4.3.3). This is also supported by an analysis of the details for individual injuries (see paragraph 3.5.2).
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Table 17. Infantry: Trade-related and Non-trade-related Chronic Injury
Cumulative Injury category1 Frequency Percent Valid Percent Percent Valid Some or all trade-related 81 27.1 35.1 35.1 Possible trade-related 1 .5 .6 35.7 Non-trade-related only 24 7.9 10.2 45.9 No chronic injuries 125 41.9 54.1 100.0 Total 231 77.4 100.0 Missing System 68 22.6 Total 299 100.0 1 The category ‘trade-related’ encompassed five ‘work or trade-related’ categories from Question 4 of the chronic injury section of the questionnaire (see Annex 1), but excluded travel to and from work. Because the primary focus of the DPESP study is Combat Arms Trade Tasks (CATTs), physical training (PT) was also excluded from this category. 2 The “possible” is due to one respondent failing to answer this question.
Table 18. Infantry: Number of Acute Injuries
Cumulative Number Frequency Percent Valid Percent Percent Valid 0 161 53.7 53.7 53.7 1 73 24.6 24.6 78.3 2 43 14.3 14.3 92.6 3 13 4.3 4.3 96.9 4 7 2.2 2.2 99.0 6 1 .2 .2 99.2 7 2 .6 .6 99.8 9 1 .2 .2 100.0 Total 299 100.0 100.0
Table 19. Infantry: Number of Chronic Injuries
Cumulative Number Frequency Percent Valid Percent Percent Valid 0 125 41.9 54.1 54.1 1 60 20.0 25.9 80.0 2 24 8.1 10.5 90.5 3 14 4.8 6.2 96.7 4 5 1.8 2.4 99.1 6 2 .7 .9 100.0 Total 231 77.4 100.0 Missing System 68 22.6 Total 299 100.0
3.3.5 The average rates underlying Tables 18 and 19 are (mean ± standard error) 0.817 ± 0.068 acute injuries per person (817 ± 68) per thousand persons per year) and 0.804 ± 0.075 chronic injuries per person (804 ± 75 per thousand persons). These estimates are of the same order of magnitude as estimates based on data from the Defence Injury Prevention Program (DIPP) and EpiTrack databases, and of the estimated injury rate in a US Army battalion (Knapik et al., 1993), and an order of magnitude higher than estimates based on data from Defcare (see Table 55 in Reference Document D). A subsequent analysis of details reported for individual acute injuries indicated that 44.0% were trade-related (see Table 25). On this basis, the rate of trade-related acute injuries is estimated to be 359 ± 30 per thousand persons per year. Similarly, analysis of details reported for individual chronic
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injuries indicated that 47.5% were entirely trade-related and a further 25.0% were to some degree trade-related (see Table 52). On this basis, the prevalence is estimated to be 382 ± 36 per thousand persons for chronic injuries attributed wholly to trade-related activities and 583 ± 54 per thousand persons for chronic injuries attributed wholly or in part to trade-related activities.
3.3.6 Table 20 shows the proportions of respondents who had chronic injuries who were graded at each Medical Employment Category (MEC) level. Over half (58%) were at MEC level 1: ‘Medically fit, without restriction for deployment’, whilst 42% had some degree of medical employment restriction.
Table 20. Infantry Chronic Injuries: Medical Employment Category1
Cumulative Medical Employment Category Frequency Percent Valid Percent Percent Valid MEC1 61 20.4 58.1 58.1 MEC2 11 3.7 10.5 68.6 MEC3 21 7.1 20.3 88.9 MEC4 11 3.6 10.3 99.2 Temporarily Medically Unfit (TMU) 1 .3 .8 100.0 Total 105 35.1 100.0 Missing System 194 64.9 Total 299 100.0 1 MEC1: Medically fit, without restriction for deployment. MEC2: Medically fit for deployment, but with some limitations on the duties able to be performed, geographic restrictions and requirements for access to various levels of health support. MEC3: Medically unfit for deployment in the medium term (up to 12 months). MEC4: Medically unfit for deployment in the long term (more than 12 months).
3.4 Relationship between Injury Occurrence and Respondent Characteristics
3.4.1 Relationships between injury occurrence and key characteristics of the respondents and their work program and physical activities during the survey period are summarised in Tables 21 to 24.
3.4.2 Table 21 summarises the differences in the means of eight key measures, between respondents who reported having injuries and those who did not. Results are presented for four categories of injury: acute, trade-related acute, chronic and trade-related chronic. Each of the four sections of Table 21 presents a comparison between two groups: injured vs. not injured, and those with a trade-related injury vs. those with no trade-related injury, for both acute and chronic injuries. All significant differences were positive in the sense that the mean of the first named group (i.e. injured or trade-related) was higher than the mean of the comparison group.
3.4.3 All three physical activity indicators were significantly related to the occurrence of physical injury. “Hours per week of structured activity supervised by someone other than a PTI in the last 4 weeks” was the strongest discriminator between those with and without acute injury, and between those with trade-related and non-trade-related acute injuries. Those who had suffered acute injuries had a higher mean number of hours per week of activity than those who had not suffered acute injuries; and those with trade-related acute injuries had a higher mean number of hours per week of activity than those with non-trade-related acute injuries. The association between the level of physical training activity and the occurrence of acute injury generally can be explained in terms of exposure to risk. The reason for an association between the level of physical training activity and the occurrence of trade-related acute injury is less obvious. Two possible mechanisms are the effects of fatigue and behavioural effects - the possibility that the more physically active soldiers may tend to undertake trade activities in a manner which increases the risk of injury.
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3.4.4 “Hours per week of structured activity supervised by someone other than a PTI in the last 4 weeks” was also significantly positively associated with chronic injury overall, but not with trade-related vs. non-trade-related chronic injury. This was also the case for age, length of service, weight and BMI. Mean age and mean length of service were also significantly higher for those with trade-related chronic injuries. The links between chronic injury and age, length of service, weight and BMI are explicable in terms of cumulative exposure over time.
3.4.5 Physical training supervisors other than a PTI may include both Combat Fitness Leaders and coaches and fitness leaders in non-occupational contexts. The association between reported acute and chronic injury and the level of this type of activity in the four weeks before the survey may indicate poor quality of supervision leading to the occurrence of acute injuries and the recurrence of chronic injuries.
3.4.6 Because age, length of service, weight and BMI are all positively correlated (see Table 22), a multivariate analysis (stepwise logistic regression) was used to determine the capacity of each of these four variables to predict the presence/absence of chronic injury (either chronic injury in general or trade-related chronic injury), whilst allowing for the effects of the other three variables. It was found that age was the best predictor of both categories of chronic injury (p<0.0005 in both cases). After controlling for the effects of age, length of service did not add significantly to the predictive capacity of age in either case. However, BMI was found to have a significant relationship to both chronic injury in general (p<0.0005) and to trade-related chronic injury (p=0.002); and weight was found to have a significant relationship to chronic injury in general (p=0.008) but not to trade-related chronic injury. After controlling for the effects of both age and BMI, weight was not found to have a significant relationship to either chronic injury categorisation.
3.4.7 These results indicate that whilst age and length of service are closely related, age is the stronger predictor of chronic injury. Once the effect of age on the likelihood of chronic injury is taken into account, length of service becomes redundant as a predictor of chronic injury. On the other hand, whilst weight and BMI also increase with age, adjusting for the effects of age does not render them redundant as predictors of chronic injury. Even in soldiers of the same age, high weight and high BMI are still associated with increased risk of chronic injury.
3.4.8 A similar logistic regression analysis was carried out on Riflemen only (who with 260 weighted cases made up the great majority of the survey sample). The results were generally similar, the only exception being that for this group, after controlling for the effects of age, length of service did add significantly to the prediction of chronic injury (p=0.042). However, when BMI was included, it displaced length of service as a significant predictor.
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Table 21. Infantry: Relationships between Injury Occurrence and Indicators of Potential Susceptibility to Injury or Exposure to Risk Class of injury Acute Chronic Injured (a) vs. Trade-related (a) vs. Injured (a) vs. Trade-related (a) vs. Susceptibility or exposure indicator not injured (b) non-trade-related (b) not injured (b) non-trade-related (b) Mean1 SD N Mean1 SD N Mean1 SD N Mean1 SD N Age a 26.4 6.7 135 28.1 8.9 46 29.3 7.0 104 30.5 7.2 79 b 26.6 6.0 161 24.6 4.1 50 24.9 4.9 125 25.5 4.0 24 *** *** Length of service in ADF a 6.9 6.2 138 8.4 8.3 49 8.7 6.8 106 10.0 7.1 81 b 6.6 5.7 161 5.2 3.5 52 5.5 5.0 125 4.8 3.2 24 *** *** Height a 178.7 7.0 138 178.5 7.6 49 178.8 6.5 106 178.1 6.5 81 b 179.7 7.1 158 180.2 6.4 51 179.7 7.5 123 180.4 5.9 24
Weight a 82.0 10.2 138 81.5 10.7 49 84.3 10.1 106 83.6 10.4 81 b 81.3 9.7 160 83.8 10.3 52 80.5 9.6 125 86.3 9.1 24 ** BMI a 25.7 2.6 138 25.6 2.9 49 26.3 2.6 106 26.3 2.6 81 b 25.1 2.3 158 25.8 2.6 51 24.9 2.2 122 26.5 2.5 24 *** Hours per week of structured activity a 4.9 6.4 86 4.5 4.2 22 4.1 4.6 65 3.7 4.7 47 supervised by a PTI in the last 4 weeks b 3.2 3.5 99 6.2 8.3 36 4.4 5.8 85 5.3 4.4 16 * Hours per week of structured activity a 7.7 6.6 107 8.2 6.0 40 7.5 6.4 76 7.9 5.7 59 supervised by someone other than a b 4.5 3.7 111 5.0 4.2 36 4.2 3.5 96 5.7 8.7 16 PTI in the last 4 weeks *** ** *** Hours per week of unstructured/ a 5.1 4.5 107 6.5 5.4 32 5.2 4.7 72 4.9 4.7 53 unsupervised activity in the last 4 weeks b 5.5 5.2 107 3.8 3.2 43 5.0 5.0 100 6.3 4.6 17 * 1 In each case, differences in the mean values of each indicator for the two categories were tested using independent sample t-tests. In cases where the statistical assumption underlying the t test (normal distributions within each group) were not met, results were confirmed using logarithmic transformations and/or non-parametric Mann-Whitney tests. * p<0.05, ** p<0.01, *** p<0.001.
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Table 22. Infantry: Correlations between Age, Length of Service, Weight and BMI
Years of Age service in ADF Weight BMI Age Pearson Correlation 1 .859(**) .082 .198(**) Sig. (2-tailed) . .000 .159 .001 N 295 295 295 292 Years of Pearson Correlation .859(**) 1 .072 .190(**) service in Sig. (2-tailed) .000 . .215 .001 ADF N 295 299 299 295 Weight Pearson Correlation .082 .072 1 .763(**) Sig. (2-tailed) .159 .215 . .000 N 295 299 299 295 BMI Pearson Correlation .198(**) .190(**) .763(**) 1 Sig. (2-tailed) .001 .001 .000 . N 292 295 295 295 ** Correlation is significant at the 0.01 level (2-tailed).
3.4.9 Numbers of injuries suffered or carried. Differences between groups of respondents who had suffered no injuries, one injury, two injuries etc., were investigated by one-factor analyses of variance on the same set of measures listed in Table 21. The results for numbers of both acute and chronic injuries were consistent with the two-group results (injury vs. no injury) reported above (paragraphs 3.4.2 to 3.4.4), with evidence of dose-response relationships up to around three injuries1, i.e. as the number of injuries increased, the mean of the predictive measure (age, LOS, BMI, hours of physical activity) showed a consistent trend. The trend was generally upward, consistent with the results for injury vs. no injury.
3.4.10 Table 23 shows the statistically significant relationships between injury occurrence and eight categorical indicators of work cycle events during the 12-month survey period. The features associated with increased injury occurrence were major and minor exercises, and pre- deployments. For acute injuries the strongest differentiation was between those with trade- related injuries and non-trade-related injuries; in the case of chronic injuries the distinction was between those with injuries and those without injuries. There was also a significant relationship between acute injury and leave, for which various causes could be conjectured.
Table 23. Infantry: Statistically Significant1 Relationships between Injury Occurrence and Work Cycle Indicators Class of injury Acute Chronic Injured Trade- Injured Trade- vs. related vs. related Work cycle indicator2 not vs. non- not vs. non- injured trade- injured trade- related related Number of major exercises * Number of minor exercises * *** Number of pre-deployments ** Number of deployments Number of courses Leave * Total number of activities * Number of activities excluding leave Typical N 223 75 175 123 1 Chi-square tests of association. * p<0.05, ** p<0.01, *** p<0.001 2 Because the number reporting more than two occurrences of each indicator were small, for statistical validity all these measures were recoded into three categories: 0, 1, 2 or more.
1 Beyond two injuries, the sample sizes were very small, and the results were inconclusive.
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3.4.11 Differences between units. There were statistically significant differences between the units1 with regard to the incidence of acute injuries in general (χ2(5)=12.1, p=0.034) (see Table 24), but not with regard to the incidence of trade-related acute injuries or the prevalence of chronic injuries or trade-related chronic injuries. It might be conjectured that paratroopers from 3 RAR might have a propensity towards risk-taking both at work and outside working hours. However it should again be emphasised that the figures shown in Table 24 are weighted; in particular, the figures for 3 RAR are based on a very small sample.
Table 24. Infantry Acute Injuries: Unit Acute injury during the past year? Total
Yes No Unit 1 RAR Count 34 39 73 % within Unit 46.6% 53.4% 100.0% 2 RAR Count 30 43 73 % within Unit 41.1% 58.9% 100.0% 1 25/49 RQR Count 2 7 9 % within Unit 22.2% 77.8% 100.0% 3 RAR Count 38 21 59 % within Unit 64.4% 35.6% 100.0% 5/7 RAR Count 20 26 46 % within Unit 43.5% 56.5% 100.0% 6 RAR Count 13 22 35 % within Unit 37.1% 62.9% 100.0% 1 9 RQR Count 1 2 3 % within Unit 33.3% 66.7% 100.0% Total Count 138 160 298 % within Unit 46.3% 53.7% 100.0% 1 Reserve units. For details of unit types, refer to Table 2.
3.5 Characteristics of Acute Injuries
3.5.1 A total of 206 acute injury incidents were reported by 121 respondents as having occurred during the survey period. However, details were only provided by 88 respondents regarding 114 (129 weighted) of these injury incidents. A weighted summary of the contexts of the individual incidents and injuries is presented in Table 25.
3.5.2 Table 25 shows that almost half (44%) of reported acute incidents/injuries were identified as being trade-related2, 21% related to sport and 27% related to PT.
3.5.3 For comparison, Table 25 also includes a profile taken from Figure 1-7 of the ADF Health Status Report (Reference Document I). It should be noted that the survey results in Table 25 pertain only to Infantry, and only to acute physical injury incidents as defined in paragraph 2.2.3, whereas the scope of Figure 1-7 of the ADF Health Status Report was all ADF casualties reported to DEFCARE for FY 97/98, for which the activity was reported.
3.5.4 The effects of the difference in organisational scope, of severity, and of any differences in reporting bias3 are difficult to estimate. However, the effect of the difference in the scope of injury type can be estimated as follows. It is reasonable to assume that the great majority of sport, PT and travel to work casualties would be physical in nature, and that casualties of a non-physical nature (exposure to substances, sensory injury, disease, mental illness, etc.)
1 To ensure statistical validity, the small numbers for the two Reserve units (25/49 RQR and 9 RQR) were aggregated. 2 See paragraph 3.3.1 and note 2 to Table 25. 3 The issue of incomplete reporting in the present survey is discussed in various places throughout this report. The issue of incomplete reporting in DEFCARE is discussed in DPESP Report 3 (Reference Document D).
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would be classified as work-related. That being so, to enable a more valid comparison, a proportion of the work-related injuries should be excluded from the DEFCARE profile in Table 25, and the percentages then recalculated with respect to the reduced total. To illustrate, suppose we assume that of the 41% of trade-related casualties, 4% (i.e. around 10% of trade-related injuries) are not due to physical injury. Then physical injuries make up 37% of the 41% of trade-related casualties (i.e. around 90% of trade-related casualties) and 96% of all casualties. Compared to the profile of all casualties, the proportion of trade-related physical injuries is slightly lower (37/96=38.5%), whilst the proportions of sport- and PT- related physical injuries are slightly higher (33.3% and 18.8% respectively). Whilst this effect would be stronger If the proportion of trade-related casualties which are not physical injuries were higher than 10%, it would appear that this difference in scope is unlikely to substantially invalidate a comparison between the two profiles in Table 25.
Table 25. Infantry Acute Injuries: Activity 2004 Survey Sample1 DEFCARE 97/981 Valid Cum. Cum. Activity Frequency % % % % % Valid Sport 24 18.4 20.6 20.6 32 32 PT 31 23.8 26.8 47.4 18 50 2 Trade-related 50 39.2 44.0 91.4 41 91 Travel to work 6 4.8 5.4 96.7 5 96 & other ADF Other 4 2.9 3.3 100.0 4 100 Total 115 89.1 100.0 100 Missing System 14 10.9 Total 129 100.0 1 For differences in scope, see paragraph 3.5.3 2 The category ‘trade-related’ encompassed five ‘work or trade-related’ categories from Question 8 of the acute injury section of the questionnaire (see Annex 1), but excluded travel to and from work and ‘other ADF’. Because the primary focus of the DPESP study is Combat Arms Trade Tasks (CATTs), physical training (PT) was also excluded.
3.5.5 If the DEFCARE profile for the whole of the ADF is assumed to apply to the Infantry subpopulation, and if differences in scope with regard to severity and in the patterns of reporting to DEFCARE and to the DPESP/DIPP survey are assumed to be inconsequential, then it would appear from Table 25 that in the six-year period from 1997/1998 to 2003/2004 there was a substantial reduction in the proportion of acute physical injuries attributable to sport, a substantial increase in the proportion attributable to PT, and a slight increase in the proportion attributable to trade-related activity. The changes in the proportions attributable to sport and PT are statistically significant (p<.05); the change in the proportion attributable to trade-related activity is not statistically significant.
3.5.6 Some support for this conclusion can be found in Report 3 of this series (Reference Document D). Table 4 in Report 3 shows DEFCARE reports by Infantry and ADG personnel for calendar years 1998-2003, broken down into trade-related, other work-related and non work-related. The latter two categories are approximately aligned with PT and sport, respectively. Compared to 1998, the figures for 1999-2002 show a slight increase in the proportion of trade-related injuries, a more marked increase in the proportion of other work- related injuries (possibly PT related) and a very substantial reduction in the proportion of non-trade-related injuries (possibly sport related).
3.5.7 However there are two anomalies in Table 4 of Report 3. Calendar year 2003 shows a very different pattern, which is probably attributable to lag effects (the data were extracted in December 2003). More importantly, calendar year 1998 shows very high figures in all three categories, with sharp declines in 1999-2000 followed by moderate increases in 2001-2002. These reversed J-shaped trends must be taken in to account when interpreting changes in proportions with reference to 1998 as a baseline. It would appear that overall there was a sharp decline in injury rates in 1999-2000. Non work-related (predominantly sport) injuries dropped most markedly (from 301 reports in 1998 to 80 in 2000), followed in order of magnitude by trade-related injuries and other work-related (including PT) injuries. During
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2001-2002, the trend was reversed, with trade-related injuries almost returning to 1998 levels and other work-related (including PT) injuries exceeding 1999 levels. However, even after this reversal, the number of non work-related (predominantly sport) injuries remained less than half the level of 1998.
3.5.8 Anecdotal evidence from Defence informants suggests that the reduction in sports injuries is due to a reduction in sports participation, which may be attributable to the perceived potential for sports injuries to affect employment and career progression under the provisions of the Army Individual Readiness Notice (AIRN), first introduced in 1997 and revised in 2001.
Characteristics of Trade-related Acute Injuries
3.5.9 Table 25 shows that 501 of the acute incidents/injuries were identified as being trade- related2, representing almost half of the injuries whose cause was reported. Tables 26 to 41 summarise the characteristics of these trade-related acute incidents/injuries, which are the primary focus of this report.
3.5.10 Tables 26 and 27 show summaries of the month and time of day of occurrence of the injuries. The low figures for October to December are regarded as genuine, reflecting reduced exposure in that part of the work cycle. However the peak in April-June is thought to be, at least in part, an artefact of the retrospective methodology. The survey was completed during the months of May and June. Details were provided for only 129 of the 299 injuries reported to have occurred (Tables 18 and 25), of which only 50 were clearly identified as trade-related (Table 25). It is considered that details are more likely to have been provided for more recent injuries. It is considered that this bias is more likely to be related to “form completion fatigue” than to an inability to recall the occurrence of earlier injuries, so that the apparent under-reporting of earlier injuries in Table 26 is not indicative of a commensurate under-reporting of the overall number of injuries in Table 18. This conclusion is supported by the fact that the rates estimated from the counts in Table 18 are commensurate with estimates from other sources (see paragraph 3.3.5)
Table 26. Infantry Trade-related Acute Injuries: Month
Cumulative Month Frequency Percent Valid Percent Percent Valid 1 3 5.0 5.0 5.0 2 2 4.2 4.2 9.2 3 4 8.8 8.8 18.0 4 14 28.2 28.2 46.2 5 6 11.2 11.2 57.4 6 9 17.6 17.6 75.0 7 4 8.4 8.4 83.5 8 4 8.7 8.7 92.2 9 2 4.5 4.5 96.7 10 1 1.4 1.4 98.1 11 1 1.9 1.9 100.0 12 0 0.0 0.0 100.0 Total 50 100.0 100.0
3.5.11 The profile of Table 27 reflects the diurnal patterns of exposure, with peaks at times of high activity (early morning; mid-afternoon; and especially evening, presumably when on exercises) and troughs at meal times.
1 Weighted count. 2 See paragraph 3.3.1 and note 2 to Table 25.
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Table 27. Infantry Trade-related Acute Injuries: Time of Day
Cumulative Hour of day Frequency Percent Valid Percent Percent Valid 6 2 3.4 4.7 4.7 7 3 5.0 7.0 11.7 8 1 2.3 3.2 14.8 9 6 11.3 15.7 30.5 10 2 4.8 6.7 37.2 11 3 5.8 8.1 45.2 12 1 1.1 1.6 46.8 13 1 1.9 2.7 49.5 14 3 6.4 8.8 58.3 15 0 .8 1.1 59.4 16 6 12.2 16.9 76.3 19 3 6.8 9.5 85.8 23 5 10.2 14.2 100.0 Total 36 72.1 100.0 Missing System 14 27.9 Total 50 100.0
3.5.12 Table 28 summarises the job phase in which each of the trade-related injuries occurred. Regular trade activity and training was interpreted as including minor exercises and courses as well as routine day-to-day activities within units. The rate of injuries during pre- deployment was clearly lower than for the other phases. However, whilst the majority of injuries occurred during regular trade activity and training, in the absence of information about overall exposure of personnel to these phases, it is not possible to judge whether the rates of injury for major exercises, deployments, and regular trade activity and training are commensurate with exposure to each activity.
Table 28. Infantry Trade-related Acute Injuries: Job Phase
Cumulative Job phase Frequency Percent Valid Percent Percent Valid Major exercise 6 11.3 11.5 11.5 Pre-deployment 01 .8 .8 12.3 Deployment 12 23.5 23.7 36.0 Regular trade activity / training 32 63.3 64.0 100.0 Total 50 98.9 100.0 Missing System 1 1.1 Total 50 100.0 1 This is an artefact of the weighting procedure (see paragraph 2.7.6). A weighted frequency of approximately 0.4 has been rounded down to zero.
3.5.13 Table 29 shows that three-quarters of reported acute injuries were new, and one quarter represented distinct acute recurrences of previous injuries (as opposed to chronic injuries, which are considered in Section 3.8).
Table 29. Infantry Trade-related Acute Injuries: New or Recurring
Cumulative Frequency Percent Valid Percent Percent Valid New 39 76.4 76.4 76.4 Recurring 12 23.6 23.6 100.0 Total 50 100.0 100.0
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3.5.14 Tables 30 to 35 summarise the characteristics of the reported trade-related acute injuries, the actions taken and the outcomes.
3.5.15 Taken together, Tables 30 and 31 indicate that most incidents resulted in sprains and strains, either as the main injury or as a secondary injury1. Other common types of injury were fractures, dislocations and bruising or crushing.
Table 30. Infantry Trade-related Acute Injuries: Nature of Main Injury Pct of Pct of Nature of main injury Count Responses Cases Fracture/stress non spinal 6 10.9 12.2 Joint dislocation 10 18.2 20.4 Sprain of joint(s) and/or ligaments 16 28.7 32.2 Strain of muscles and/or tendons 8 14.2 15.9 Open wound not involving traumatic amputation 1 1 1.2 Bruise or crushing injury, not involving fracture 6 10.7 12 Foreign body in eye, ear etc. 1 1 1.2 Burn(s) 01 0.7 0.8 Injury to nerves or spinal cord 2 3.8 4.3 Effects of weather, exposure, air pressure (incl. heat stress) 2 3.8 4.3 Other or unspecified injuries 4 6.8 7.7 Total responses 56 100 111.9 1 missing case; 50 valid cases 1 This is an artefact of the weighting procedure (see paragraph 2.7.6). A weighted frequency of approximately 0.4 has been rounded down to zero. Table 31. Infantry Trade-related Acute Injuries: Nature of Other Injuries Pct of Pct of Nature of other injuries Count Responses Cases Joint dislocation 1 1.9 2.7 Sprain of joint(s) and/or ligaments 9 30.2 44.2 Strain of muscles and/or tendons 17 56.8 83.1 Head injury/concussion 2 5.6 8.1 Superficial cuts and abrasions 1 1.9 2.7 Bruise or crushing injury, not involving fracture 1 1.9 2.7 Other or unspecified injuries - other 1 1.9 2.7 Total responses 31 100 146.4 29 missing cases; 21 valid cases Table 32. Infantry Trade-related Acute Injuries: Bodily Location
Valid Cumulative Location of injury Frequency Percent Percent Percent Valid Head 1 1.1 1.1 1.1 Neck 1 1.1 1.1 2.3 Upper Limbs (including shoulders) 10 20.4 20.4 22.7 Lower Limbs (including hips) 22 44.0 44.0 66.7 Chest/ribs/upper back 3 5.0 5.0 71.7 Lower back 10 20.6 20.6 92.4 Whole body (e.g. heat stress) 4 7.6 7.6 100.0 Total 50 100.0 100.0
1 These are both multiple response items (See paragraph 2.8.5). The ‘nature of injury’ question was framed as a single response item (nature of main injury) plus a multiple response item (nature of other injuries). However, some respondents did not distinguish between the two, and instead selected multiple options for the main injury.
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3.5.16 Table 32 shows that almost half the acute injuries (44%) were to the lower limbs, with a further 41% being equally divided between upper limbs and lower back. Lower back injuries are of particular concern because of their potential to become chronic and their impact on quality of life and work capacity. These injuries also tend to incur high rehabilitation costs (National Occupational Health and Safety Commission, 2003).
3.5.17 Table 33 shows the association of reported injuries with a list of trade-related activities which was developed in the Trade Task Analysis Workshops (see Reference Document C). Around one third of injuries were associated with each of Route Marching and Patrolling, and around a quarter with Carrying. The 47 injuries reported were associated with a total of 91 activities, i.e. on average just under two activities per injury. Most commonly, route marching and patrolling were reported in association with lifting, carrying and assaulting. The relationship between acute injury and particular trade activities was investigated further in the supplementary survey in 2005, the results of which are discussed in Section 4.4.
Table 33. Infantry Trade-related Acute Injuries: Trade-related Activity Pct of Pct of Activity Count Responses Cases Lifting 7 7.8 15.1 Passing 4 4.7 9.1 Carrying 10 11.5 22.2 Climbing 2 2.4 4.6 Pushing/pulling 6 6.5 12.7 Striking 2 2.4 4.6 Digging 2 2.4 4.6 Route marching 15 16.5 31.8 Patrolling 16 18 34.8 Assaulting 7 8.1 15.7 Urban operations 6 6.2 11.9 Pursuit 2 1.9 3.7 Other 11 11.8 22.8 Total responses 91 100 193.5 4 missing cases; 47 valid cases
3.5.18 Ninety four comments were made in response to the request for the soldiers to explain how the acute injury occurred. Forty-one (43.6%) pertained to trade-related tasks. The comments were spread evenly (1-4 comments per trade-related task) across a range of trade-related tasks including patrolling, obstacle course, digging, assaulting, route marching, parachuting, urban operations and wiring. Non-specific trade-related activities accounted for 18.1% of the comments made. The comments indicated that the contributing factors to these acute trade- related injuries included falling while carrying heavy pack weight, going to ground during an assault while carrying section equipment and poorly fitted packs. Comments related to each of these contributing factors include: "patrolling border East Timor, a mixture of heavy pack weight & webbing weight on arduous terrain I rolled ankle resulting in spiral fracture to fibula"; ”assault course with gun & first line ammo, went to ground & a rock punctured the area around my left knee”; “equipment we were issued trial marching order & it was s---, didn't sit properly on my shoulder & f----- it up”. The remaining 56.4% of the comments related to activities such as sport, PT, personal activities, running, unclassified training and other activities.
3.5.19 Tables 34 to 36 summarise the actions taken after the injury and the resulting outcomes. Table 34 shows that the injury was reported to a Regimental Aid Post (RAP) in over three quarters of cases, and that in only 4% of cases was assistance or advice sought from outside the military system.
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Table 34. Infantry Trade-related Acute Injuries: Actions Taken Pct of Pct of Action taken Count Responses Cases No Action 3 4.1 5.6 Self treated 8 12 16.7 Received first aid 7 10.6 14.7 Reported to Regimental Aid Post (RAP) 38 54.8 76.0 Reported to military health centre or military hospital 11 15.2 21.1 Sought civilian medical assistance or advice: from an emergency department 2 2.5 3.4 from another civilian facility 1 0.8 1.1 Total responses 69 100 138.6 1 missing case; 50 valid cases Table 35. Infantry Trade-related Acute Injuries: Outcome Pct of Pct of Outcome Count Responses Cases Spent time in hospital 9 11.2 22.3 Took sick leave 10 13.1 26.2 Took days off work 7 8.7 17.4 Spent time on light duties 36 44.8 89.4 Affected work program 18 22.1 44.1 Total responses 80 100 199.3 11 missing case; 40 valid cases
3.5.20 Table 35 shows a summary of the outcomes of acute injuries. Almost all of the injuries resulted in time spent on light duties. The work program was affected in almost half of the reported cases. Almost a quarter of injuries resulted in time spent in hospital, and a similar proportion resulted in sick leave being taken.
3.5.21 Table 36 shows that in almost half of the cases where an injury resulted in absence from work, return to work occurred before full recovery.
Table 36. Infantry: Return to Work before Full Recovery from Trade-related Acute Injury
Cumulative Frequency Percent Valid Percent Percent Valid Yes 7 13.9 46.9 46.9 No 8 15.7 53.1 100.0 Total 15 29.5 100.0 Missing Not applicable - I was not off 25 49.9 work System 10 20.6 Total 36 70.5 Total 50 100.0
3.5.22 Tables 37 to 39 summarise opinions about risks and safeguards. In almost two thirds of cases, the respondent thought that no safeguards or preventative strategies were in place. When safeguards or preventative strategies were in place, they were generally perceived not to have failed. However, the fact that injuries occurred in such cases may indicate that the safeguards were inadequate. Risk taking was thought to have been a contributing factor in almost one third of cases. The question did not explicitly ask on whose part the risk taking behaviour had occurred; however descriptive details were provided by 16 soldiers, approximately one third of the respondents. These individuals were of the view that injuries were due to a lack of safeguards and those that were put in place often were inadequate or failed. For example individual safeguards or prevention strategies, in the form of ankle
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taping, knee bracing and elbow pads were used, but these were seen to be ineffective. However, system based treatment strategies such as provision of ambulance, medics and first aid personnel was considered appropriate. The apparent success of the treatment strategies and the failure of the preventative strategies appear to be important issues to consider when devising future injury prevention approaches. It was disturbing that many soldiers reluctantly accepted the risk inherent in performing infantry tasks. Telling comments included “…it’s just accepted that infantry has done this sort of training for years and always will because no-one knows any better or cares” and “…route marching across country always has a degree of risk. It is acceptable”.
Table 37. Infantry: Safeguards or Preventative Strategies in Place
Cumulative Frequency Percent Valid Percent Percent Valid Yes 12 23.7 26.0 26.0 No 29 56.9 62.4 88.3 Unsure 5 10.6 11.7 100.0 Total 46 91.2 100.0 Missing System 4 8.8 Total 50 100.0
Table 38. Infantry: Failure of Safeguards or Preventative Strategies
Cumulative Frequency Percent Valid Percent Percent Valid Yes 2 4.2 14.3 14.3 No 13 25.3 85.7 100.0 Total 15 29.5 100.0 Missing System 36 70.5 Total 50 100.0
Table 39. Infantry: Risk Taking as a Contributing Factor to Trade-related Acute Injury
Cumulative Frequency Percent Valid Percent Percent Valid Yes 14 27.1 29.7 29.7 No 32 64.1 70.3 100.0 Total 46 91.2 100.0 Missing System 4 8.8 Total 50 100.0
Comparison between Trade-related and Non-trade-related Acute Injuries
3.5.23 For those characteristics which apply to both trade-related and non-trade-related injuries1, the profiles of the two types of injury were compared2. There were no significant differences in the profiles with respect to month, job phase, whether the injury was new or recurring, bodily location, outcomes, or timeliness of return to work. The only statistically significant
1 The category ‘trade-related’ encompassed five ‘work or trade-related’ categories from Question 8 of the acute injury section of the questionnaire (see Annex 1), but excluded travel to and from work and ‘other ADF’. Because the primary focus of the DPESP study is Combat Arms Trade Tasks (CATTs), physical training (PT) was also excluded. Most non-trade-related injuries were associated with PT or sport. 2 Caution should be exercised in interpreting these comparisons because there were some inconsistencies in the responses to questions 8 and 9 in Section B (see Annex 1) which indicated that some respondents classified some trade-related activities as physical training rather than trade-related training.
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difference was with regard to time of day (χ2(5)=19.9, p=0.001) (see Table 40). The higher proportions of non-trade-related injury may be attributable to PT in the early mornings, regimental sport in the afternoons, and after-work sport in the late afternoons. The trade- related injuries in the evenings may be attributable to exercises.
3.5.24 Because some respondents gave multiple responses to the question ‘nature of main injury’, no formal statistical test of the difference between the profiles of trade-related injuries and non-trade-related injuries was possible. However the profile for non-trade-related injuries was markedly different from that for trade-related injuries (Table 41). Proportions which differed markedly were fractures and muscle strains (higher at 16.8% and 34.5% respectively) and joint dislocations, sprains and bruises (lower at 3.6%, 25.4% and 6.1% respectively). These differences indicate that trade-related injuries are more likely to involve impacts, whilst non-trade-related injuries are more likely to be caused by over-exertion.
Table 40. Infantry Acute Injuries: Time of Day of Trade-related and Non-trade-related Injuries
Activity Trade-related Other Total Time of day 0000-0559 Count 0 4 4 % within Activity .0% 7.3% 4.3% 0600-0859 Count 5 12 17 % within Activity 13.5% 21.8% 18.5% 0900-1159 Count 11 11 22 % within Activity 29.7% 20.0% 23.9% 1200-1459 Count 5 15 20 % within Activity 13.5% 27.3% 21.7% 1500-1759 Count 7 13 20 % within Activity 18.9% 23.6% 21.7% 1800-2359 Count 9 0 9 % within Activity 24.3% .0% 9.8% Total Count 37 55 92 % within Activity 100.0% 100.0% 100.0%
Table 41. Infantry Acute Injuries: Nature of Trade-related and Non-trade-related Injuries
Activity Nature of main injury Trade- Non-trade- All injuries related related % % % Fracture/stress fracture 12.2 16.8 14.8 Joint Dislocation 20.4 3.6 11.0 Sprain of joint(s) 32.2 25.4 28.4 Strain of muscles 15.9 34.5 26.3 Head injury/concussion 0.0 3.6 2.0 Open wound 1.2 3.4 2.4 Bruise or crushing 12.0 6.1 8.7 Foreign body in ear, eye etc. 1.2 0.0 0.5 Burn(s) - major 0.8 0.0 0.4 Injury to nerves or spinal cord 4.3 2.7 3.4 Effects of weather 4.3 5.8 5.1 Other or unspecified 7.7 19.0 14.0 N 50 63 113
3.5.25 In the case of actions taken (the other multiple response item), there were no marked differences in the profiles of non-trade-related injuries and trade-related injuries.
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3.6 Relationship between Characteristics of Trade-related Acute Injuries and Respondent Characteristics
3.6.1 Relationships among some key characteristics of trade-related acute injuries and between characteristics of the incidents/injuries and characteristics of the respondents who reported them1 are summarised in Tables 42 to 50. The row and column totals in these tables are numbers of incidents/injuries.
3.6.2 Note that because of the large number of categories and the relatively small sample size, Tables 42 and 43 are very sparse. The sampling errors are so large in relative terms as to render the mostly very small cell counts and percentages quantitatively unreliable and potentially misleading. For this reason, the data for each cell have been displayed only as a dichotomy of zero and non-zero values i.e. either the combination occurred (*) or it did not (blank). The row and column totals indicate the relative importance of the individual categories of each variable, and the asterisks indicate which combinations were reported. Shaded rows and columns indicate categories which did not occur at all in the survey.
3.6.3 Table 42 shows the nature of the injuries associated with each activity. Because both of these items allowed multiple responses, the row and column totals add up to more than the total number of injury incidents. The injuries which occurred with the highest frequency (joint dislocations, sprains and strains, fractures and stress fractures) were each associated with a wide range of activities.
3.6.4 Table 43 shows the bodily locations of the injuries associated with each activity. It is noticeable that lower back injuries were associated with both strength activities (lifting, passing, carrying, pushing/pulling) and strength-endurance activities (route-marching, patrolling), and with both combat and administrative activities. Injuries to the lower limbs were more likely to be associated with combat activities.
1 The unit of data for the analyses in this section is the injury/incident. In relating characteristics of injuries/incidents to characteristics of the persons involved, data pertaining to respondents who gave details about more than one injury incident are necessarily repeated.
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Table 42. Infantry Trade-related Acute Injuries: Nature of Main Injury by Activity1
Activity N 2
Nature of Main Injury Lifting Passing Carrying Climbing Pushing/ Pulling Striking Digging Route marching Patrolling Assaulting Urban Operations Pursuit Other N injuries Fracture/ stress fracture (non-spinal) * * * * * * 6 Fracture/ stress fracture of the spine Joint dislocation * * * * * 10 Sprain of joint(s) and/or ligaments * * * * * * 14 Strain of muscles and/or tendons * * * * * * * * * 7 Head injury/ concussion Internal injury of chest, abdomen and/or pelvis Traumatic amputation Open wound, not involving traumatic amputation * 1 Superficial cuts and abrasions Bruise or crushing injury, not involving fracture * * * 6 Foreign body on external eye, in ear or nose or in respiratory,
digestive or reproductive system Burn(s) * 1 Injury to nerves or spinal cord without evidence of spinal bone injury * * 2 Effects of weather, exposure, air pressure or other external causes 2 * * * * * * * (including heat stress) Other or unspecified injuries * * * * 4 N injuries2 7 4 10 2 6 2 2 14 16 7 6 2 11 46 1 An asterisk (*) indicates a combination of nature of injury and activity which occurred in the survey data. 2 Both of the variables in this table included multiple responses and so both row and column totals sum to more than the total number of injuries.
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Table 43. Infantry Trade-related Acute Injuries: Bodily Location of Injury by Activity1
Activity
Location of Injury Lifting Passing Carrying Climbing Pushing/ Pulling Striking Digging Route marching Patrolling Assaulting Urban Operations Pursuit Other N injuries Head Neck * * 1 Chest/ribs/upper back * * 3 Abdomen Lower back * * * * * * * 10 Pelvis Upper limbs (including shoulders) * * * * * * * 7 Lower limbs (including hips) * * * * * * * 22 Multiple locations Whole body (e.g. heat stress) * * * * * * * * 4 N injuries2 7 4 10 2 6 2 2 15 16 7 6 2 11 47 1 An asterisk (*) indicates a combination of nature of injury and activity which occurred in the survey data. 2 Reported activities included multiple responses and so column totals sum to more than the total number of injuries.
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3.6.5 In Tables 44 to 50, percentages have been rounded to whole numbers, and zero percentages have been omitted. It should be noted that for very small counts the sampling errors are relatively large, so such counts and the corresponding percentages are quantitatively unreliable. This is further exacerbated by anomalies introduced by the weighting procedure, which can have a substantial impact on small counts. Shaded rows indicate categories which did not occur at all in the survey.
3.6.6 Table 44 shows for each type of injury, the percentage of instances in which the five listed outcomes occurred. Because the outcomes are not mutually exclusive, the percentages for each type of injury can sum to more than 100%. Table 44 shows that of the most frequently occurring injuries, strains and bruises usually had the least serious outcomes; sprains resulted in sick leave in a quarter of cases; and fractures and dislocations resulted in hospitalisation and sick leave in about one third of cases.
Table 44. Infantry Trade-related Acute Injuries: Nature of Main Injury by Outcome
Outcome1
Nature of Main Injury Hospital Sick leave Days off work Light duties Affected work program N injuries % % % % % Fracture/ stress fracture (non-spinal) 35 35 28 72 84 6 Fracture/ stress fracture of the spine Joint dislocation 28 38 17 89 51 10 Sprain of joint(s) and/or ligaments 8 24 9 70 19 16 Strain of muscles and/or tendons 5 5 5 46 38 8 Head injury/ concussion Internal injury of chest, abdomen and/or pelvis Traumatic amputation Open wound, not involving traumatic amputation 100 100 100 1 Superficial cuts and abrasions Bruise or crushing injury, not involving fracture 42 7 6 Foreign body on external eye, in ear or nose or in 12 respiratory, digestive or reproductive system Burn(s) Injury to nerves or spinal cord without evidence of 100 100 100 100 100 2 spinal bone injury Effects of weather, exposure, air pressure or other 100 2 external causes (including heat stress) Other or unspecified injuries 45 45 55 4 All trade-related acute injuries 18 21 14 71 35 50 1 Percentages do not sum to 100% across rows because the outcomes are not mutually exclusive. 2 One injury due to a foreign body was reported, however none of the listed outcomes was reported.
3.6.7 Table 45 shows for each bodily location of injury, the percentage of instances in which the five listed outcomes occurred. Again, the percentages for each location can sum to more than 100%. An aspect of Table 45 which may be noteworthy, albeit based on a small sample, is the high proportion of injuries to upper limbs which resulted in hospitalisation.
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Table 45. Infantry Trade-related Acute Injuries: Bodily Location of Main Injury by Outcome
Outcome1
Location of Injury Hospital Sick leave Days off work Light duties Affected work program N injuries % % % % % Head 12 Neck 100 100 100 100 1 Chest/ribs/upper back 100 100 3 Abdomen Lower back 20 20 20 46 20 10 Pelvis Upper limbs (including shoulders) 40 27 20 80 30 11 Lower limbs (including hips) 14 23 9 70 41 22 Multiple locations Whole body (e.g. heat stress) 7 70 35 4 All trade-related acute injuries 18 21 14 71 35 50 1 Percentages do not sum to 100% across rows because the outcomes are not mutually exclusive. 2 One injury due to the head was reported, however none of the listed outcomes was reported.
3.6.8 Table 46 shows for each activity associated with injury, the percentage of instances in which the five listed outcomes occurred. Again, the percentages for each activity can sum to more than 100%. Table 46 shows that the most of the activities fell into two groups: those for which there was a single common outcome (light duties) and those for which the full range of outcomes was reported. Of the latter group, assaulting was most likely to lead to injuries with more serious consequences. The exception was injuries during urban operations, which resulted in hospitalisation in all reported cases.
Table 46. Infantry Trade-related Acute Injuries: Activity by Outcome
Outcome1
Activity Hospital Sick leave Days off work Light duties Affected work program N injuries % % % % % Lifting 30 30 30 100 40 7 Passing 100 4 Carrying 21 21 21 84 37 8 Climbing 100 2 Pushing/Pulling 7 7 7 100 12 6 Striking 100 2 Digging 100 2 Route marching 12 12 12 62 23 15 Patrolling 13 13 11 47 45 16 Assaulting 23 60 31 95 37 7 Urban Operations 100 6 Pursuit 100 2 Other 56 50 41 76 77 50 All trade-related 18 21 14 71 35 50 acute injuries 1 Percentages do not sum to 100% across rows because the outcomes are not mutually exclusive.
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3.6.9 Table 47 shows the age profiles for each activity associated with injury. The pattern of filled and empty cells in Table 47 shows that the youngest soldiers (20-24 yrs) were predominantly injured performing combat activities; the oldest (35-49 yrs) were predominantly injured performing administrative activities; and the intermediate group (25-29 years) were injured across the full range of activities. This pattern appears to represent an interaction between changes in the occupational exposure profile throughout a military career and the effects of ageing on body strength and susceptibility to injury. The profiles of length of service (Table 48) illuminate the interactive relationships further, showing that the group who suffered injuries across all tasks was those with less than 5 years service. This suggests that the group most generally susceptible to injury across a wide range of activities are 25-29 year- olds with less than 5 years of service, i.e. older recruits, whilst younger recruits tend to be injured mainly in the more physically demanding combat tasks.
Table 47. Infantry Trade-related Acute Injuries: Activity by Age
Age group (yrs) N Activity <20 20-24 25-29 30-34 35-39 40-44 45-49 50-54 injuries1 % % % % % % % % Lifting 43 43 14 5 Passing 50 50 4 Carrying 42 33 26 8 Climbing 100 2 Pushing/Pulling 17 36 36 12 6 Striking 100 2 Digging 100 2 Route marching 46 27 27 15 Patrolling 45 55 16 Assaulting 81 19 7 Urban Operations 38 62 6 Pursuit 100 2 Other 62 32 5 11 Age profiles All trade-related 43 37 1 5 8 2 46 acute injuries All respondents 4 47 26 12 7 2 1 1 295 1 Reported activities included multiple responses and so row totals sum to more than the total number of injuries.
Table 48. Infantry Trade-related Acute Injuries: Activity by Length of Service
Length of service (yrs) N Activity <5 5-9 10-14 15-19 20+ injuries1 % % % % % Lifting 60 40 7 Passing 50 50 4 Carrying 80 20 10 Climbing 100 2 Pushing/Pulling 52 48 6 Striking 100 2 Digging 100 2 Route marching 50 4 23 23 15 Patrolling 45 13 42 16 Assaulting 52 40 8 7 Urban Operations 38 62 6 Pursuit 100 2 Other 60 3 38 11 LOS profiles All trade-related 51 13 23 7 6 47 acute injuries All respondents 51 26 12 7 5 299 1 Reported activities included multiple responses and so row totals sum to more than the total number of injuries.
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3.6.10 Comparison of the age profiles of those injured with the profiles of all survey respondents (the two bottom rows of Table 47) shows that the second cohort (25-29 yrs) were over- represented and the third cohort (30-34 yrs) were under-represented in the injury profiles. For length of service (Table 48), the pattern was reversed, with the second cohort (5-9 yrs) being under-represented and the third cohort (10-14 yrs) being over-represented. This is further evidence of the complex interaction of exposure, susceptibility and experience which influences injury occurrence.
3.6.11 Table 49 shows a rank profile for each injury-related activity. The last two rows of the table show that NCOs had a slightly higher representation overall than other ranks. Disregarding the four activities for which the sample sizes were only 2, the biggest discrepancies were carrying, for which other ranks were over-represented, and urban operations, for which NCOs were over-represented.
Table 49. Infantry Trade-related Acute Injuries: Activity by Rank
Rank Other N Activity NCO rank injuries1 % % Lifting 60 40 7 Passing 50 50 4 Carrying 80 20 10 Climbing 100 2 Pushing/Pulling 52 48 6 Striking 100 2 Digging 100 2 Route marching 50 50 15 Patrolling 45 55 16 Assaulting 60 40 7 Urban Operations 38 62 6 Pursuit 100 2 Other 65 35 11 Rank profiles All trade-related 52 48 47 acute injuries All respondents 58 42 299 1 Reported activities included multiple responses and so row totals sum to more than the total number of injuries. Table 50. Infantry Trade-related Acute Injuries: Activity by Basic Physical Characteristics
Height Weight BMI BMI Category
1 1 1 N Activity Mean SD Mean SD Mean SD <25 ≥25 2 injuries cm cm kg kg kg.m-2 kg.m-2 % % Lifting 178.0 6.1 80.8 12.4 25.5 3.4 40 60 7 Passing 176.0 6.9 86.5 13.1 27.8 2.1 100 4 Carrying 178.9 5.8 85.2 10.3 26.6 2.7 21 79 10 Climbing 170.0 0.0 75.0 0.0 26.0 0.0 100 2 Pushing/Pulling 175.7 6.7 82.6 13.2 26.6 2.8 18 82 6 Striking 170.0 0.0 75.0 0.0 26.0 0.0 100 2 Digging 170.0 0.0 75.0 0.0 26.0 0.0 100 2 Route marching 177.5 7.9 80.0 8.4 25.4 1.6 70 30 15 Patrolling 177.3 4.1 79.9 6.8 25.4 1.3 53 47 16 Assaulting 184.2 8.2 74.9 8.5 22.0 1.8 100 7 Urban Operations 182.6 10.7 78.4 4.8 23.6 1.3 100 6 Pursuit 176.0 0.0 86.0 0.0 27.8 0.0 100 2 Other 178.2 6.3 83.1 14.0 26.1 3.7 70 30 11 All trade-related 179.1 8.0 80.3 10.0 25.0 2.7 52 48 47 acute injuries All respondents 179.2 7.1 81.6 9.9 25.4 2.5 51 49 295 1 SDs of zero based on two cases indicates two injury incidents reported by one person. 2 Reported activities included multiple responses and so row totals sum to more than the total number of injuries.
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3.6.12 Table 50 shows summaries of height, weight and BMI associated with each injury-related activity. The most notable pattern in Table 50 is the relationship between BMI category and type of activity. Soldiers with a BMI of 25 or above (classified as “overweight”) were not represented disproportionately in the injury profile, but they were more likely to have been injured performing administrative tasks than combat tasks. This reflects the positive correlation between BMI, age and length of service, and is consistent with Tables 47 and 48.
3.7 Characteristics of Chronic Injuries
3.7.1 A total of 166 chronic injuries were reported by 105 respondents as being carried at the time of the survey. Details were provided by all 105 respondents regarding 163 of the injuries. This very comprehensive reporting can be contrasted with the case for acute injuries, where details were provided regarding fewer than half of the reported injuries, and by only three quarters of those who reported having had an injury (see paragraph 3.5.1). This is consistent with the scenario (proposed in paragraph 3.2.4) of those with chronic injury being more likely to respond to the survey and to take the opportunity give a detailed account of their injury.
3.7.2 Weighted summaries of the contributing factors to these 163 (178 weighted) injuries are presented in Tables 51 and 52. Unlike an acute injury, which is unequivocally related to a particular trade activity or non-trade activity, a chronic injury may have more than one contributing factor - trade-related, non-trade-related, or both. Table 51 shows that in almost three quarters of all chronic injuries, trade activities were cited as a contributing factor. Table 52 shows that almost half of the reported chronic injuries were entirely trade-related. This is a similar proportion to that reported for acute injuries (see paragraph 3.5.2). The proportions of sport- and PT-related injuries are also similar to the corresponding proportions for acute injuries (see Table 25).
Table 51. Infantry Chronic Injuries: Contributing Activities (1) Pct of Pct of Type of Activity Count Responses Cases Sport 39 17.2 23.3 PT 47 20.5 27.7 Trade-related1 123 53.6 72.5 Travel to work & other ADF 9 3.8 5.1 Other 11 4.9 6.7 Total responses 229 100 135.4 9 missing cases; 169 valid cases 1 The category ‘trade-related’ encompassed five ‘work or trade-related’ categories from Question 4 of the chronic injury section of the questionnaire (see Annex 1), but excluded travel to and from work and ‘other ADF’. Because the primary focus of the DPESP study is Combat Arms Trade Tasks (CATTs), physical training (PT) was also excluded. Table 52. Infantry Chronic Injuries: Contributing Activities (2)
Valid Cumulative Type of Activity Frequency Percent Percent Percent 1 Valid Trade-related only 80 45.2 47.5 47.5 Non-trade-related only 46 26.1 27.5 75.0 Both trade and non-trade-related 42 23.8 25.0 100.0 Total 169 95.1 100.0 Missing System 9 4.9 Total 178 100.0 1 See note to Table 51
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Characteristics of Trade-related Chronic Injuries
3.7.3 Tables 53 to 59 summarise the characteristics of the 1231 trade-related chronic injuries, which are the primary focus of this report. This includes both those which were reported as exclusively trade-related and those to which both trade and non-trade activities have contributed. Table 53 shows that the duration of trade-related chronic injuries was distributed across a range of times; this is to be expected because of the range of lengths of service in the survey sample.
Table 53. Infantry Trade-related Chronic Injuries: Duration
Cumulative Duration Frequency Percent Valid Percent Percent Valid Less than 2 years 21 17.5 20.0 20.0 2 - 4 years 47 38.3 43.8 63.7 5 years or longer 39 31.7 36.3 100.0 Total 107 87.6 100.0 Missing System 15 12.4 Total 123 100.0
3.7.4 Tables 54 to 59 summarise the characteristics of the reported trade-related chronic injuries, the actions taken and the outcomes.
3.7.5 Table 54 indicates that over half of trade-related chronic injuries involved disorders of the joints, and a further quarter involve disorders of muscles, tendons and or/other soft tissues. Table 55 shows that injuries to lower limbs predominated, followed by injuries to the lower back and upper limbs. The qualitative data were in agreement, with 15 of the 32 comments received relating to chronic lower limb injuries.
Table 54. Infantry Trade-related Chronic Injuries: Nature of Injury
Cumulative Nature of Injury Frequency Percent Valid Percent Percent Valid Disorder of the joints 64 52.0 52.9 52.9 Disorder of the spinal vertebrae and/or 21 16.8 17.1 70.0 interverterbral disc Disorder of muscles, tendons and or/other soft 28 23.2 23.7 93.7 tissues Other 8 6.2 6.3 100.0 Total 120 98.3 100.0 Missing System 2 1.7 Total 123 100.0
1 Weighted count.
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Table 55. Infantry Trade-related Chronic Injuries: Bodily Location
Valid Cumulative Location of injury Frequency Percent Percent Percent Valid Head 4 3.4 3.4 3.4 Neck 6 4.5 4.5 7.9 Upper Limbs (including shoulders) 17 13.7 13.7 21.6 Lower Limbs (including hips) 67 54.8 54.8 76.4 Multiple Locations 3 2.6 2.6 79.0 Chest/ribs/upper back 2 1.7 1.7 80.8 Abdomen 1 .8 .8 81.6 Lower back 20 16.2 16.2 97.8 Pelvis 0 .3 .3 98.1 Whole body (e.g. heat stress) 2 1.9 1.9 100.0 Total 123 100.0 100.0
3.7.6 Table 56 shows the association of reported injuries with a list of trade-related activities which was developed in the Trade Task Analysis Workshops (see Reference Document C). The 115 injuries reported were associated with a total of 298 activities, i.e. on average between two and three activities per injury. Over half of the injuries were associated with Route Marching, and close to half with each of Patrolling and Carrying. Most commonly, route marching and patrolling were reported in association with lifting, carrying and assaulting. The apparent association between chronic injuries and high demand, long duration tasks may indicate that the task was inappropriate or that the training and preparation for the task was insufficient; ‘too much, too soon’ coupled with inappropriate equipment. The relationship between chronic injury and particular trade activities was investigated further in the supplementary survey in 2005, the results of which are discussed in Section 4.5.
Table 56. Infantry Trade-related Chronic Injuries: Trade-related Activity Pct of Pct of Activity Count Responses Cases Lifting 23 7.7 20.0 Passing 4 1.4 3.6 Carrying 46 15.3 39.5 Climbing 7 2.2 5.7 Pushing/pulling 8 2.7 7.0 Striking 3 1.2 3.0 Digging 15 5.0 12.8 Route marching 66 22.1 57.2 Patrolling 52 17.4 45.0 Assaulting 30 10.1 26.2 Urban operations 14 4.6 12.0 Pursuit 4 1.2 3.2 Other 27 9.0 23.4 Total responses 298 100.0 258.6 7 missing cases; 115 valid cases
3.7.7 Tables 57 to 59 summarise the actions taken regarding trade-related chronic injuries and the consequences of these injuries.
3.7.8 Tables 57 and 58 are multiple response tables, reflecting the fact that chronic injuries recur episodically, and it is possible for the same injury to be treated differently on different occasions. Table 57 shows that either no action or self treatment was a response in over half the chronic injuries reported. Reporting to a a Regimental Aid Post (RAP) occurred in over half of reported cases and to military health centre or military hospital in a quarter of cases.
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It is worth noting that in 17% of cases assistance or advice was sought from outside the military system.
Table 57. Infantry Trade-related Chronic Injuries: Actions Taken Pct of Pct of Action taken Count Responses Cases No Action 19 9.7 15.8 Self treated 49 24.5 40.0 Received first aid 11 5.5 9.0 Reported to Regimental Aid Post (RAP) 70 35.3 57.7 Reported to military health centre or military hospital 30 14.9 24.3 Sought civilian medical assistance or advice: from an emergency department 10.3 0.5 from another civilian facility 20 9.8 16.0 Total responses 199 100 163.3 1 missing case; 122 valid cases
3.7.9 Tables 58 and 59 summarise the effects of trade-related chronic injuries. Whilst performance of duties is affected in all but a small proportion of cases, medical downgrading occurred in only 20% of cases, and occasional temporary restrictions in a further 20% of cases. Of those who reported the duration of restrictions, around one tenth were permanent, one third were for short periods of up to 10 days, and half fell somewhere between these extremes.
Table 58. Infantry Trade-related Chronic Injuries: Effects on Performance of Duties Pct of Pct of Effect Count Responses Cases No effect 14 10.1 11.7 Affected, but without restrictions 76 54 62.5 Occasional temporary restrictions 24 17 19.7 Medically downgraded 27 18.9 21.9 Total 141 100 115.7 1 missing case; 122 valid cases Table 59. Infantry Trade-related Chronic Injuries: Period per Year on Restricted Work Program
Cumulative Frequency Percent Valid Percent Percent Valid Up to 10 days 12 10.0 37.0 37.0 11-364 days 18 14.5 53.7 90.6 All year 3 2.5 9.4 100.0 Total 33 26.9 100.0 Missing System 90 73.1 Total 123 100.0
Comparison between Trade-related and Non-trade-related Chronic Injuries
3.7.10 For those characteristics which apply to both trade-related and non-trade-related injuries1, (i.e. all characteristics except the nature of the activity at the time of the injury) the profiles of the two types of injury were compared. The only statistically significant difference in the profiles was with regard to duration of injury, with trade-related injuries tending to have been
1 The category ‘trade-related’ encompassed five ‘work or trade-related’ categories from Question 4 of the chronic injury section of the questionnaire (see Annex 1), but excluded travel to and from work and ‘other ADF’. Because the primary focus of the DPESP study is Combat Arms Trade Tasks (CATTs), physical training (PT) was also excluded. Most non-trade-related injuries were associated with PT or sport.
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longer in duration (χ2(2)=16.8, p<0.0005) (see Table 60). There were also indications of a higher proportion of lower back injuries associated with trade activities (see Table 61), but the difference was not statistically significant. There were no significant differences with respect to nature of injury or restrictions to work program.
Table 60. Infantry Chronic Injuries: Duration of Trade-related and Non-trade-related Injuries Did trade-related activities contribute? Total
Yes No Duration Less than 2 years Count 21 23 44 % within Did trade-related activities contribute? 19.6% 52.3% 29.1% 2 - 4 years Count 47 9 56 % within Did trade-related activities contribute? 43.9% 20.5% 37.1% 5 years or longer Count 39 12 51 % within Did trade-related activities contribute? 36.4% 27.3% 33.8% Total Count 107 44 151 % within Did trade-related activities contribute? 100.0% 100.0% 100.0%
Table 61. Infantry Chronic Injuries: Bodily Location of Trade-related and Non-trade-related Injuries Did trade-related activities contribute? Total
Yes No Body Upper limbs Count 17 8 25 location % within Did trade-related activities contribute? 14.3% 17.4% 15.2% Lower limbs Count 67 27 94 % within Did trade-related activities contribute? 56.3% 58.7% 57.0% Lower back Count 20 2 22 % within Did trade-related activities contribute? 16.8% 4.3% 13.3% Other Count 15 9 24 % within Did trade-related activities contribute? 12.6% 19.6% 14.5% Total Count 119 46 165 % within Did trade-related activities contribute? 100.0% 100.0% 100.0%
3.7.11 Because ‘actions taken’ and ‘effects on performance of duties’ were multiple response items, no formal statistical tests of the difference between the profiles of trade-related injuries and non-trade-related injuries were possible. However, the profiles were noticeably different in each case (see Tables 62 and 63). In the case of actions taken, higher proportions had reported to a military health centre, military hospital or civilian emergency department for non-trade-related injuries than for trade-related injuries. All other types of action were more likely to have taken place with trade-related injuries than with non-trade-related injuries. In the case of effects on performance of duties, a higher proportion of non-trade-related injuries led to medical downgrading, whereas trade-related injuries were more likely to have less serious effects or no effect.
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Table 62. Infantry Chronic Injuries: Actions Taken for Trade-related and Non-trade-related Injuries
Trade-related
Action taken Yes No % % No Action 16 6 Self treated 40 30 Received first aid 9 7 Reported to RAP 58 49 Reported to military health centre or military hospital 24 46 Sought civilian medical assistance or advice: from an emergency department 1 5 from another civilian facility 16 10 N 122 45
Table 63. Infantry Chronic Injuries: Effects on Performance of Duties of Trade-related and Non-trade-related Injuries
Trade-related
Effect on performance of duties Yes No % % No effect 12 6 Affected, but without restrictions 63 47 Occasional temporary restrictions 20 6 Medically downgraded 22 41 N 122 43
3.8 Relationship between Characteristics of Trade-related Chronic Injuries and Respondent Characteristics
3.8.1 Relationships among some key characteristics of trade-related chronic injuries and between characteristics of the injuries and characteristics of the respondents who reported them1 are summarised in Tables 64 to 72. Note that because of the large number of categories and the relatively small sample size, some of these tables are very sparse. For clarity, percentages have been rounded to whole numbers, and zero percentages have been omitted. It should be noted that for very small counts the sampling errors are relatively large, so such counts and the corresponding percentages are quantitatively unreliable. This is further exacerbated by anomalies introduced by the weighting procedure, which can have a substantial impact on small counts.
3.8.2 Table 64 shows for each injury-related activity, the percentage of each type of injury reported. Because multiple activities could be reported for a particular injury, the column totals add up to more than the total number of injuries reported. Table 64 shows that high impact force activities such as striking, route marching, assaulting and urban operations were most likely to be associated with chronic overuse disorders of the joints. The activities of passing, pushing and pulling had the highest proportion of associated soft tissue injuries. Spinal disorders were most commonly associated with lifting, climbing and digging.
3.8.3 Table 65 shows for each injury-related activity, the percentage of each location of injury reported. Again, because multiple activities could be reported for a particular injury, the column totals add up to more than the total number of injuries reported. Among the strongest associations apparent in Table 65 are those of lower limb injuries with route marching, patrolling, assaulting and urban operations, and upper limb injuries with climbing and striking.
1 The unit of data for the analyses in this section is the injury. In relating characteristics of injuries to characteristics of the persons involved, data pertaining to respondents who gave details about more than one injury are necessarily repeated.
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Table 64. Infantry Trade-related Chronic Injuries: Nature of Injury by Activity
Activity
Nature of Injury Lifting Passing Carrying Climbing Pushing/ Pulling Striking Digging Route marching Patrolling Assaulting Urban Operations Pursuit Other All injuries % % % % % % % % % % % % % % Disorder of the joints 37 23 45 35 35 67 33 56 54 52 75 31 57 53 Disorder of the spinal vertebrae and/or intervertebral discs 36 16 22 41 14 37 14 9 14 16 16 3 16 Disorder of muscles, tendons and/or other soft tissues 23 60 30 24 46 33 37 27 33 33 6 53 25 25 Other 4 2 5 4 3 3 2 4 15 15 N1 23 4 46 7 8 3 15 64 52 30 14 4 27 113 1 Reported activities included multiple responses and so column totals sum to more than the total number of injuries.
Table 65. Infantry Trade-related Chronic Injuries: Bodily Location of Injury by Activity
Activity
Location of Injury Lifting Passing Carrying Climbing Pushing/ Pulling Striking Digging Route marching Patrolling Assaulting Urban Operations Pursuit Other All Injuries % % % % % % % % % % % % % % Head 17 8 3 4 Neck 2 5 1 2 2 4 Chest/ribs/upper back 9 51 5 27 14 3 4 2 Abdomen 4 1 9 12 4 1 1 1 Lower back 21 26 29 7 27 18 13 14 3 15 Pelvis 1 1 1 <1 Upper limbs (including shoulders) 11 15 50 18 83 15 11 12 9 18 58 14 12 Lower limbs (including hips) 32 14 38 35 21 17 27 60 60 66 79 42 63 57 Multiple locations 4 10 2 6 10 5 5 6 8 3 10 3 Whole body (e.g. heat stress) 3 1 4 1 2 6 2 N1 23 4 46 7 8 3 15 66 52 30 14 4 27 115 1 Reported activities included multiple responses and so column totals sum to more than the total number of injuries.
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3.8.4 Table 66 shows for each type of injury, the Medical Employment Category (MEC) profile of the respondents. Table 66 shows that the MEC levels of those with spinal disorders were relatively evenly spread across all categories, whereas more than two thirds of soft tissue injuries and almost three quarters of joint injuries had not resulted in downgrading from MEC1. Nevertheless, the 11% of 64 joint injuries and 25% of 28 soft tissue injuries associated with MEC4 constitute larger numbers of injuries than the 20% of 20 lower back injuries associated with this MEC level.
Table 66. Infantry Trade-related Chronic Injuries: Nature of Injury by Medical Employment Category
Medical Employment
Classification (MEC)1
s
urie U) j TM N in Nature of Injury MEC 1 MEC 2 MEC 3 MEC 4 Temporarily Medically Unfit ( % % % % % Disorder of the joints 72 11 6 11 64 Disorder of the spinal vertebrae and/or intervertebral discs 30 35 15 20 20 Disorder of muscles, tendons and/or other soft tissues 68 7 25 28 Other 29 71 7 All trade-related chronic injuries 61 13 10 15 119 1 MEC1: Medically fit, without restriction for deployment. MEC2: Medically fit for deployment, but with some limitations on the duties able to be performed, geographic restrictions and requirements for access to various levels of health support. MEC3: Medically unfit for deployment in the medium term (up to 12 months). MEC4: Medically unfit for deployment in the long term (more than 12 months).
3.8.5 Table 67 shows for each bodily location of injury, the MEC profile of the respondents. Consistently with Table 66, Table 67 shows that the MEC levels of those with lower back disorders were relatively evenly spread across all categories, whereas more than two thirds of lower limb injuries and four fifths of upper limb injuries had not resulted in downgrading from MEC 1. Nevertheless, the 20% of 67 lower limb injuries associated with MEC levels 3 and 4 constitute a larger number of injuries than the 30% of 20 lower back injuries associated with these MEC levels.
Table 67. Infantry Trade-related Chronic Injuries: Bodily Location of Injury by Medical Employment Category
Medical Employment Classification (MEC)1
Location of Injury MEC 1 MEC 2 MEC 3 MEC 4 Temporarily Medically Unfit (TMU) N injuries % % % % % Head 100 3 Neck 20 20 60 5 Chest/ribs/upper back 100 2 Abdomen 100 1 Lower back 35 35 10 20 20 Pelvis Upper limbs (including shoulders) 82 18 17 Lower limbs (including hips) 69 10 10 10 67 Multiple locations 75 25 4 Whole body (e.g. heat stress) 100 2 All trade-related chronic injuries 60 16 10 14 121 1 See footnote to Table 67.
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3.8.6 Table 68 shows for each injury-associated activity, the MEC profile of the respondents. Consistently with the patterns shown in Tables 64-67, Table 68 shows that injuries associated with lifting and carrying (i.e. injuries to lower backs, hips and knees) were most likely to result in the most serious consequences.
Table 68. Infantry Trade-related Chronic Injuries: Activity by Medical Employment Category
Medical Employment Classification (MEC)1
2
Activity MEC 1 MEC 2 MEC 3 MEC 4 Temporarily Medically Unfit (TMU) N injuries % % % % % Lifting 52 25 6 17 23 Passing 74 26 4 Carrying 55 24 5 16 46 Climbing 67 33 7 Pushing/Pulling 71 24 5 8 Striking 100 3 Digging 70 26 4 15 Route marching 64 24 7 5 <1 66 Patrolling 81 5 8 7 52 Assaulting 76 14 9 2 30 Urban Operations 80 18 3 14 Pursuit 73 27 4 Other 58 4 14 25 27 All trade-related 60 16 9 15 <1 115 chronic injuries 1 See footnote to Table 67. 2 Reported activities included multiple responses and so row totals sum to more than the total number of injuries. Table 69. Infantry Trade-related Chronic Injuries: Activity by Age
Age group (yrs) N Activity <20 20-24 25-29 30-34 35-39 40-44 45-49 50-54 injuries1 % % % % % % % % Lifting 10 61 17 5 3 4 23 Passing 60 14 16 10 4 Carrying 5 54 22 12 3 3 2 46 Climbing 56 35 9 7 Pushing/Pulling 5 64 7 14 10 8 Striking 33 50 17 3 Digging 6 56 24 4 5 5 15 Route marching 1 6 47 13 21 8 3 1 64 Patrolling 8 58 14 15 2 1 2 52 Assaulting 15 29 18 30 2 7 30 Urban Operations 3 84 7 4 2 14 Pursuit 22 47 16 16 4 Other 35 11 14 26 2 2 27 Age profiles All trade-related 1 16 42 16 19 4 2 1 113 chronic injuries (a) All respondents (b) 4 47 26 12 7 2 1 1 295 Ratio a:b 0.25 0.34 1.62 1.33 2.71 2.00 2.00 1.00 1 Reported activities included multiple responses and so row totals sum to more than the total number of injuries.
3.8.7 Table 69 shows the age profiles for each activity associated with injury. The last three rows compare the age profile of respondents with trade-related chronic injuries with that of all respondents. It is noteworthy that whilst the prevalence of trade-related chronic injury (as
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indicated by ratio in the last row of the table) generally increases with age (and hence cumulative exposure) and whilst the two youngest age groups were under-represented as would be expected, even in the 20-24 year age group a substantial proportion reported chronic injuries associated with several activities.
Table 70. Infantry Trade-related Chronic Injuries: Activity by Length of Service
Length of service (yrs) N Activity <5 5-9 10-14 15-19 20+ injuries1 % % % % % Lifting 15 70 3 11 23 Passing 60 40 4 Carrying 12 50 21 10 7 46 Climbing 26 39 26 9 7 Pushing/Pulling 26 41 9 24 8 Striking 17 17 50 17 3 Digging 12 46 28 14 15 Route marching 18 25 30 20 8 66 Patrolling 18 32 36 9 2 52 Assaulting 20 24 36 11 8 30 Urban Operations 21 73 6 14 Pursuit 58 11 31 4 Other 41 6 49 4 27 LOS profiles All trade-related 23 29 30 13 4 115 chronic injuries (a) All respondents (b) 51 26 12 7 5 299 Ratio a:b 0.45 1.12 2.50 1.86 0.80 1 Reported activities included multiple responses and so row totals sum to more than the total number of injuries. Table 71. Infantry Trade-related Chronic Injuries: Activity by Rank
Rank NCO Other N Activity or rank injuries1 Officer % % Lifting 46 54 23 Passing 100 4 Carrying 35 65 46 Climbing 18 82 7 Pushing/Pulling 34 66 8 Striking 17 83 3 Digging 32 68 15 Route marching 29 71 66 Patrolling 26 74 50 Assaulting 26 74 30 Urban Operations 3 97 14 Pursuit 69 31 4 Other 45 55 27 Rank profiles All trade-related 43 73 115 chronic injuries All respondents 58 42 299 1 Reported activities included multiple responses and so row totals sum to more than the total number of injuries.
3.8.8 Table 70 shows the profiles of length of service (LOS) for each activity associated with injury. The last three rows compare the LOS profile of respondents with trade-related chronic injuries with that of all respondents. Again it is noteworthy that whilst the group with less than 5 years service was under-represented as would be expected, even in this group a substantial proportion reported chronic injuries associated with most activities. The prevalence ratio in the last row of the table peaks at 10-14 years and then declines, which
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may reflect a tendency for personnel with chronic injuries to leave the service sooner than those without chronic injury.
3.8.9 Table 71 shows a rank profile for each injury-related activity. The last two rows of the table show that NCOs had a higher representation overall than other ranks, which is consistent with the age profiles in table 70. The over-representation of NCOs applied to most activities.
3.8.10 Table 72 shows summaries of height, weight and BMI associated with each injury-related activity. The last two rows of the table show that respondents with chronic injury tended to have higher than average weight and BMI. Those with BMI ≥30 (classified as “obese”) were over-represented by a factor of three in the chronically injured group. Those with a BMI of 25-29.99 (classified as “overweight”) were not represented disproportionately in the overall injury profile, but they were over-represented in the profiles for most activities, indicating that they were more likely to associate their injuries with multiple activities than the other groups. Considering the positive correlation between BMI, weight, age and length of service (see Table 22) these results are consistent with the increase in the rate of chronic injuries with age (up to 39 years) and length of service (up to 14 years) (see Tables 69 and 70).
Table 72. Infantry Trade-related Chronic Injuries: Activity by Basic Physical Characteristics
Height Weight BMI BMI Category
20 - 25 - N Activity Mean SD Mean SD Mean SD <20 ≥30 1 24.99 29.99 injuries % % % % Lifting 178.3 2.8 84.5 10.4 26.6 2.9 4 25 61 11 23 Passing 177.1 3.0 80.0 13.5 25.4 3.6 10 26 65 4 Carrying 179.4 4.6 84.7 9.3 26.3 2.2 2 25 70 4 46 Climbing 180.4 4.9 87.3 8.5 26.8 2.0 9 91 7 Pushing/Pulling 178.0 3.0 85.8 14.7 27.0 4.3 10 18 53 19 8 Striking 179.3 2.3 88.5 4.6 27.5 1.2 100 3 Digging 177.4 2.9 84.1 11.3 26.7 3.3 5 12 78 4 15 Route marching 179.1 5.9 84.2 9.4 26.2 2.5 1 35 59 4 66 Patrolling 178.4 4.5 84.4 8.1 26.5 2.4 2 28 66 4 52 Assaulting 178.3 5.0 82.3 10.9 25.8 2.7 44 49 7 30 Urban Oper’ns 178.4 4.1 90.6 4.5 28.5 2.0 3 95 2 14 Pursuit 179.3 6.4 89.1 11.2 27.8 4.1 27 58 16 4 Other 177.0 6.6 98.8 33.8 31.8 12.2 36 26 38 27 All trade-related 178.5 5.7 87.6 18.5 27.6 6.4 1 39 48 12 123 chronic injuries All respondents 179.2 7.1 81.6 9.9 25.4 2.5 <1 51 45 4 295 1 Reported activities included multiple responses and so row totals sum to more than the total number of injuries.
3.9 Opinions of Respondents
3.9.1 Respondents who had incurred acute injuries or who were carrying chronic injuries during the 12-month survey period were asked three questions about possible systemic factors that might contribute to trade-related injuries. Summaries of weighted responses from the 105 respondents with trade-related injuries1 are presented in Tables 73 to 75. Manning levels was nominated by 22% of respondents, time pressure by 35% and equipment limitations by 29%.
1 Many respondents who had either reported no trade-related injuries, or for whom there was uncertainty as to the trade-related status of their injuries (or in some cases who had reported no injuries at all), also answered these questions, generally in the negative; however a few of these responded in the affirmative. All of these responses were regarded as invalid and were excluded from the analysis.
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Table 73. Infantry: Deficiencies in Manning Levels as a Contributing Factor to Acute or Chronic Injury
Cumulative Frequency Percent Valid Percent Percent Valid Yes 20 19.5 21.7 21.7 No 74 70.6 78.3 100.0 Total 94 90.1 100.0 Missing System 10 9.9 Total 105 100.0
Table 74. Infantry: Time Pressure as a Contributing Factor to Acute or Chronic Injury
Cumulative Frequency Percent Valid Percent Percent Valid Yes 33 31.5 35.2 35.2 No 61 58.1 64.8 100.0 Total 94 89.6 100.0 Missing System 11 10.4 Total 105 100.0
Table 75. Infantry: Equipment Limitations as a Contributing Factor to Acute or Chronic Injury
Cumulative Frequency Percent Valid Percent Percent Valid Yes 28 26.3 29.2 29.2 No 67 63.8 70.8 100.0 Total 94 90.1 100.0 Missing System 10 9.9 Total 105 100.0
3.9.2 Cross-tabulation of these three questions by injury type revealed significant differences with respect to time pressure (χ2(3)=11.7, p=0.009). Table 76 shows that respondents with both chronic and acute injuries were most likely to regard time pressure as a contributing factor, followed by those with chronic injury only, whilst those with only acute injuries were least likely to hold this view.
Table 76. Infantry Time Pressure as a Contributing Factor to Injury: by Acute vs Chronic Injury
Trade-related injury? Chronic Both and acute & Acute Chronic possible chronic only only acute Total In your view did Yes Count 12 2 11 8 33 time pressure % within contribute to any Trade-related 50.0% 11.1% 28.2% 61.5% 35.1% of the injuries you injury? have reported in No Count 12 16 28 5 61 sections B & C? % within Trade-related 50.0% 88.9% 71.8% 38.5% 64.9% injury? Total Count 24 18 39 13 94 % within Trade-related 100.0% 100.0% 100.0% 100.0% 100.0% injury?
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3.9.3 Considering the three sets of responses together, a three-factor cross-tabulation (not shown here) revealed that of the 105 respondents with trade-related injuries, eight did not answer any of the three questions. Of the 97 respondents who answered at least one of the three questions, five (5.2%) answered yes to all three questions, a further 14 (14.4%) answered yes to two of the three questions, and a further 39 (40.2%) answered yes to one of the three questions. Hence a total of 59.8% of respondents with trade-related injury believed that at least one of these systemic factors contributed to their injury. This finding is very important. It is likely that the systemic factors identified in this survey as contributing to injury can be seen as indicators of a more general and pervasive influence of systemic failure upon soldiers’ injuries. Further, it also needs to be acknowledged that system failure is often closely aligned and significantly influenced by a range of cultural factors that may affect overall work behaviour and injury risk (Sasoua and Reason, 1999; Reason, 1998).
3.9.4 Twenty comments were made in relation to the contribution of manning levels to injury. The focus appears to be on the impact of reduced section numbers causing an increase in workload and thereby increasing injury risk. For example it was commented that “low numbers in section however members still required to carry all gear for the section”, and “short of numbers in section forced us to carry a lot more weight 28kg to 45kg increase”. Another interesting comment related to the impact on combat clerks: “shortfalls in manning at clerical (level) within the battalion meant longer hours behind the desk and fewer maintaining physical levels”. This view was supported by other soldiers required to undertake administrative duties who commented "PT needs to be squeezed between administrative requirements. The older the soldier the more admin the soldier is required to output” and "difficult to participate in longer forms of PT such as route marching, due to work commitments in clerical system".
3.9.5 Time pressure was commented upon 38 times, with criticisms being made of competition between sections, racing against other fitter people, and maintaining timeframes set for a section on the assumption that there was a full complement of soldiers in each section.
3.9.6 The contribution of equipment to injury was commented on 32 times, with the majority of comments being of a general nature; however boots were commented upon seven times and packs six times. General comments tended to highlight the heavy loads and poor fit of equipment carried during route marches and the lack of lifting equipment such as forklifts to reduce the likelihood of injury during administrative loading tasks.
3.9.7 Finally, all respondents were asked a number of questions about attitudes to injury within the ADF culture. A summary of weighted responses is presented in Table 77. Key themes which emerge from Table 77 are: awareness of injury prevention measures; variation in levels of risk taking and avoidance of risk; concern about the effect of injury on capacity to do the job, including deployment, but not on income or family relationships; and willingness to report injury in spite of some concern about repercussions.
3.9.8 Differences of opinion between those known to have had trade-related injuries and those known not to have had trade-related injuries in the survey period were also explored. Respondents for whom it was uncertain whether or not they had had trade-related injuries (due to incomplete responses) were excluded from this analysis. Significant differences in response patterns are also indicated in Table 77. Those with trade-related injuries tended to perceive higher levels of risk taking, less capacity to avoid risks and greater likelihood of being injured, and were less likely to report injury and more likely to fear repercussions of doing so.
3.9.9 Respondents were also invited to comment about any aspect of the survey or related issues. However, the comments were not transcribed into digital form, and so were not available to the DPESP research team for analysis. Comments from the 2005 DPESP survey were transcribed and analysed, and are discussed in Section 4.6.
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Table 77. Infantry Perceived Attitudes to Injury within the ADF Difference b/w Strongly Strongly Trade-related and Disagree Disagree Uncertain Agree Agree Non-trade-related % % % % % Sig. level1,2 Difference3 It is quite likely that I will suffer an injury in the next month 12.8 21.0 44.9 17.7 3.5 *** Agree↑ If I had a typical/common injury for my trade I would be unable to do my current job 6.3 15.3 21.0 41.6 15.8 ns If I had a typical/common injury for my trade it would significantly affect my take 11.5 39.4 27.1 12.5 9.5 ns home income If I had a typical/common injury for my trade it would significantly affect my ability 0.9 5.2 7.0 44.5 42.4 ** Uncertain↓ to deploy If I had a typical/common injury for my trade it would significantly affect my ability 3.2 3.5 9.8 49.5 34.0 ns to attend promotion courses If I had a typical/common injury for my trade it would significantly affect my 18.1 35.8 19.7 16.1 10.3 ns relationship with my close family members If I had a typical/common injury for my trade and reported it to a Defence doctor it 1.3 4.1 23.5 43.8 27.4 ns is likely that I would be medically downgraded I would report any injury that I suffered to a Defence Health facility 7.0 25.0 18.6 42.3 7.1 * Agree↓ It is accepted practice in my work area to prevent injuries during sport or other 2.3 12.2 10.9 56.2 18.4 ns physical activities (including job related activities) wherever possible It is accepted practice in my work area to report all injuries to Defence medical staff 6.5 19.0 7.7 56.2 10.6 ns I frequently risk injury during sport and other physical activity, or to achieve work 5.2 23.6 14.6 33.0 23.6 *** Agree↑ goals It is accepted practice in my work area to risk injuries during sport or other physical 5.6 22.8 16.0 34.1 21.5 *** Agree↑ activities (including job related activities) I take steps to prevent injuries during sport or other physical activity 2.4 3.9 6.6 69.8 17.3 ns I take steps to prevent injuries during the performance of physical work tasks 0.8 6.6 7.0 73.9 11.7 ns There are adequate resources available to prevent injuries during sport and other 6.3 24.3 22.5 39.7 7.1 ns physical activity There are adequate resources available to prevent injuries during the performance 8.9 22.4 22.7 39.8 6.2 ns of physical work tasks I am able to avoid risking injury during sport and other physical activities 11.9 16.1 26.2 39.8 5.9 ** Agree↓ I am able to avoid risking injury during physical work activities 12.3 26.2 21.2 35.9 4.4 ** Agree↓ I can report any injury that I have to a Defence medical facility without any fear of 17.1 22.3 23.3 32.2 5.2 * Agree↓ repercussions N=248-251 1 Because the numbers in many of the cells of the cross-tabulations were small, for statistical validity all χ2 tests were based on responses collapsed into three categories: Disagree, Uncertain, Agree. 2 * p<0.05, ** p<0.01, *** p<0.001, ns Not significant 3 Main difference in the responses of those with trade-related injuries compared with the responses of those without trade-related injuries. For example, Agree↑ means that those with trade-related injuries were more likely to agree than those without trade-related injuries.; Uncertain↓ means that those with trade-related injuries were less likely to be uncertain (i.e they were more polarised in their views) than those without trade-related injuries.
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4 SURVEY OF INFANTRY 2005: RESULTS AND DISCUSSION
4.1 Introduction
4.1.1 In Section 4.2 the characteristics of the 249 Infantry respondents are examined and compared with those of respondents to the 2004 survey.
4.1.2 In Section 4.3 the reported injury experience and injury status of the respondents are examined, and compared with those of respondents to the 2004 survey.
4.1.3 Information was provided regarding 127 acute injury incidents which occurred during the survey period. In Section 4.4 selected characteristics of the individual incidents and injuries are examined.
4.1.4 Information was provided regarding 83 chronic injuries being carried at the time of the survey. In Section 4.5 selected characteristics of the individual injuries are examined.
4.1.5 Respondents were asked their opinions about factors contributing to injury, and about attitudes to injury within the ADF culture. They were also invited to comment about any aspect of the survey or related issues. In Section 4.6 the opinions of respondents are examined.
4.2 Characteristics of Respondents
4.2.1 Summaries of characteristics of the 299 respondents are presented in Tables 78 to 83. Also included in Tables 3 to 5 for purposes of comparison are profiles of age, length of service and rank for Infantry as at April 2006, provided by Army.
Table 78. Infantry 2005: Age Distribution 2005 Survey Sample Infantry Population 2006 Valid Cum. Cum. Age group Frequency % % % Frequency % % Valid 17-19 29 11.6 12.7 12.7 277 2.6 2.6 20-24 121 48.6 52.8 65.5 2,217 20.7 23.3 25-29 50 20.1 21.8 87.3 2,204 20.6 43.9 30-34 22 8.8 9.6 96.9 1,908 17.8 61.7 35-39 4 1.6 1.7 98.7 1,507 14.1 75.8 40-44 3 1.2 1.3 100.0 1,093 10.2 86.1 45-49 759 7.1 93.1 50-54 733 6.9 100.0 Total 229 92.0 100.0 10,698 100.0 Missing System 20 8.0 Total 249 100.0
4.2.2 Comparing Tables 78 and 79 with Tables 3 and 4, the 2005 sample had higher proportions in the lower categories of age (65.5%) and length of service (72.8%) than the weighted 2004 sample (50.2% and 51.0% respectively). This is consistent with the inclusion of IETs in the 2005 survey and the administration of the survey within the battalions in conjunction with physical testing, mainly involving rifle sections within rifle companies. The 2004 survey did not include IETs, but encompassed the full range of personnel in the battalions.
4.2.3 Table 80 and Table 5 differ in two ways. First, IETs were included in the 2005 sample (15.0%) but not in 2004. Second, there was a much lower proportion of NCOs in 2005 (21.2%) than in 2004 (41.5%). This is in part due to the conjunction with normative field testing in 2005; the pool of volunteers was probably weighted towards other ranks. It is also consistent with the higher proportions of older and longer serving personnel in 2004. The reasons for this will be considered in Section 4.3.
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Table 79. Infantry 2005: Length of Service 2005 Survey Sample Infantry Population 2006 Valid Cum. LOS Cum. Length of service Freq. % % % (years) Freq. % % Valid < 6 mths 35 14.1 15.4 15.4 6 mths – 1 yr 12 4.8 5.3 20.6 1-4 yrs 119 47.8 52.2 72.8 ≤5 4,969 46.4 46.4 5-9 yrs 46 18.5 20.2 93.0 6-10 2,454 22.9 69.4 10-14 yrs 8 3.2 3.5 96.5 11-15 1,215 11.4 80.7 15-19 yrs 5 2.0 2.2 98.7 16-20 1,012 9.5 90.2 ≥20 yrs 3 1.2 1.3 100.0 >20 1,048 9.8 100.0 Total 228 91.6 100.0 Total 10,698 100.0 Missing System 21 8.4 Total 249 100.0
Table 80. Infantry 2005: Rank 2005 Survey Sample Infantry Population 2006 Valid Cum. Cum. Rank category Frequency % % % Frequency % % Valid Other rank 136 54.6 60.2 60.2 4,522 42.3 42.3 NCO 48 19.3 21.2 81.4 3,782 35.4 77.6 Officer 8 3.2 3.5 85.0 2394 22.4 100.0 IET 34 13.7 15.0 100.0 Total 226 90.8 100.0 10,698 100.0 Missing System 23 9.2 Total 249 100.0
4.2.4 Tables 81 and 6 show that both samples were predominantly comprised of riflemen. Tables 82, 83, 7 and 8 show similar distributions of height, weight and BMI in the two samples.
Table 81. Infantry 2005: Primary Employment Category
Cumulative Employment category Frequency Percent Valid Percent Percent Valid Rifleman 155 62.2 75.6 75.6 IET 34 13.7 16.6 92.2 Other 16 6.4 7.8 100.0 Total 205 82.3 100.0 Missing System 44 17.7 Total 249 100.0
Table 82. Infantry 2005: Basic Physical Characteristics
Characteristic N Minimum Maximum Mean Std. Deviation Height (cm) 237 160 202 177.86 6.234 Weight (kg) 237 55 121 79.79 10.239 -2 Body mass index (BMI) (kg m ) 237 19.75 34.37 25.19 2.678
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Table 83. Infantry 2005: BMI Category
Cumulative BMI Category Frequency Percent Valid Percent Percent Valid <20 2 .8 .8 .8 20-24.99 118 47.4 49.8 50.6 25-29.99 104 41.8 43.9 94.5 ≥30 13 5.2 5.5 100.0 Total 237 95.2 100.0 Missing System 12 4.8 Total 249 100.0
4.3 Injury Experience and Injury Status
4.3.1 Tables 84 and 85 show details of acute injury experience during the survey period. Tables 86 and 87 give corresponding information regarding chronic injury status at the time of the survey. These tables are based on respondents, not individual incidents/injuries (see Section 4.4 for that analysis). The purpose here is to divide the respondents into those who have had injuries of the nominated type, and those who have not. The category ‘trade- related’ encompassed five ‘work or trade-related’ categories from Question 8 of the acute injury section (and Question 4 of the chronic injury section) of the questionnaire (see Annex 8), but excluded travel to and from work. Because the primary focus of the DPESP study is Combat Arms Trade Tasks (CATTs), physical training (PT) was also excluded from this category. The “possibles” in Tables 85 and 87 are due to some respondents failing to answer these questions.
Table 84. Infantry 2005: Acute Injury
Cumulative Acute injury Frequency Percent Valid Percent Percent Valid Yes 104 41.8 43.3 43.3 No 136 54.6 56.7 100.0 Total 240 96.4 100.0 Missing System 9 3.6 Total 249 100.0
Table 85. Infantry 2005: Trade-related and Non-trade-related Acute Injury
Cumulative Injury category1 Frequency Percent Valid Percent Percent Valid Some or all trade-related 56 22.5 23.3 23.3 2 Possible trade-related 7 2.8 2.9 26.2 Non trade-related only 41 16.5 17.1 43.3 No acute injuries 136 54.6 56.7 100.0 Total 240 96.4 100.0 Missing System 9 3.6 Total 249 100.0 1 The category ‘trade-related’ encompassed five ‘work or trade-related’ categories from Question 8 of the acute injury section of the questionnaire (see Annex 8), but excluded travel to and from work. Because the primary focus of the DPESP study is Combat Arms Trade Tasks (CATTs), physical training (PT) was also excluded from this category. 2 The “possibles” are due to some respondents failing to answer this question.
4.3.2 Again, it is useful to compare Tables 84 and 85 with Tables 14 and 15. The proportion of respondents reporting acute injury was slightly lower in the 2005 sample (43.3%) than in the weighted 2004 sample (46.3%) (Tables 84 and 14). This is consistent with the fact (discussed in Section 2.10) that the 2005 sample was biased towards under-representation of injury, since personnel injured recently enough or seriously enough to be on sick leave at
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the time of the survey were not available to take part, and because the IETs included in the sample had not had a full year of exposure1. A supplementary analysis (not tabulated here) showed that the proportion of trained soldiers reporting acute injuries was 46.8%, virtually identical to the 2004 figure of 46.3%.
4.3.3 At first glance, the proportion of respondents with trade-related acute injury appears higher in 2005 than 2004 (Tables 85 and 15). However, whilst this is true of the definite cases (22.5% vs 16.2%), the reverse is true of the possible cases; the combined figure was slightly lower in 2005 (25.3%) than in 2004 (28.9%). The reason for the difference is that, as was anticipated (see paragraph 2.10.4) survey forms were filled in more thoroughly and completely in the 2005 survey, and there was less ambiguity about the trade-related status of injuries.
Table 86. Infantry 2005: Chronic Injury
Cumulative Chronic injury Frequency Percent Valid Percent Percent Valid Yes 58 23.3 27.2 27.2 No 155 62.2 72.8 100.0 Total 213 85.5 100.0 Missing System 36 14.5 Total 249 100.0
Table 87. Infantry 2005: Trade-related and Non-trade-related Chronic Injury
Cumulative Injury category1 Frequency Percent Valid Percent Percent Valid Some or all trade-related 43 17.3 20.2 20.2 2 Possible trade-related 3 1.2 1.4 21.6 Non trade-related only 12 4.8 5.6 27.2 No chronic injuries 155 62.2 72.8 100.0 Total 213 85.5 100.0 Missing System 36 14.5 Total 249 100.0 1 The category ‘trade-related’ encompassed five ‘work or trade-related’ categories from Question 4 of the chronic injury section of the questionnaire (see Annex 8), but excluded travel to and from work. Because the primary focus of the DPESP study is Combat Arms Trade Tasks (CATTs), physical training (PT) was also excluded from this category. 2 The “possibles” are due to some respondents failing to answer this question.
4.3.4 Tables 86 and 87 can be compared with Tables 16 and 17. The proportion of respondents reporting chronic injury was substantially lower in the 2005 sample (27.2%) than in the weighted 2004 sample (45.9%) (Tables 86 and 16), which is consistent with the different composition of the 2005 sample, in particular the inclusion of IETs, who were less likely to have developed chronic conditions. The fact that the proportions of both trade-related and non-trade-related injuries differ consistently (Tables 87 and 17) supports the notion that the different age profiles in the two surveys is the key factor. A supplementary analysis (not tabulated here) showed that the proportion of trained soldiers reporting chronic injuries was 31.1%, which is closer to the 2004 figure of 35.1%. The remaining difference between these two figures, together with the differences in the distributions of age, length of service and rank noted above (paragraphs 4.2.2 to 4.2.4) suggest that older, more experienced soldiers with more chronic injuries were more likely to respond to the 2004 survey, and were thus over-represented.
4.3.5 Summaries of numbers of reported acute injury incidents experienced during the survey period and chronic injuries being carried are presented in Tables 88 and 89. Compared to
1 Nevertheless, because the primary aim of the 2005 survey was to elicit more detailed information about the relationship between trade tasks and injury, with cross-validation of the 2004 survey results being a secondary consideration, the IET data was retained and included in the 2005 analysis.
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the corresponding Tables 18 and 19, these tables display corresponding similarities and differences to those discussed in paragraphs 4.3.2 to 4.3.4.
Table 88. Infantry 2005: Number of Acute Injuries
Cumulative Number Frequency Percent Valid Percent Percent Valid 0 136 54.6 57.6 57.6 1 64 25.7 27.1 84.7 2 26 10.4 11.0 95.8 3 8 3.2 3.4 99.2 5 1 .4 .4 99.6 10 1 .4 .4 100.0 Total 236 94.8 100.0 Missing System 13 5.2 Total 249 100.0
Table 89. Infantry 2005: Number of Chronic Injuries
Cumulative Number Frequency Percent Valid Percent Percent Valid 0 155 62.2 73.1 73.1 1 33 13.3 15.6 88.7 2 17 6.8 8.0 96.7 3 3 1.2 1.4 98.1 4 3 1.2 1.4 99.5 5 1 .4 .5 100.0 Total 212 85.1 100.0 Missing System 37 14.9 Total 249 100.0
4.3.6 The average rates underlying Tables 88 and 89 are (mean ± standard error) 0.657 ± 0.069 acute injuries per person (657 ± 69 per thousand persons per year) and 0.439 ± 0.060 chronic injuries per person (439 ± 60 per thousand persons). A subsequent analysis of details reported for individual acute injuries indicated that 51% were trade-related (see Table 90). On this basis, the rate of trade-related acute injuries is estimated to be 335 ± 35 per thousand persons per year. The corresponding estimates from the 2004 survey (see paragraph 3.3.5) are 817 ± 68 acute injuries per thousand persons per year, 359 ± 30 trade- related acute injuries per thousand persons per year, and 804 ± 75 chronic injuries per person per thousand persons. A supplementary analysis of the 2005 data for trained soldiers (not tabulated here) produced estimated rates of 733 ± 78 acute injuries per thousand persons per year, 391± 41 trade-related acute injuries per thousand persons per year and 508 ± 69 chronic injuries per thousand persons. It is concluded that the lower acute injury rate in 2005 is consistent with the inclusion of IETs, who had a shorter exposure time, in the 2005 sample, and the exclusion of personnel with recent injuries from the 2005 sample. It is further concluded that the significantly lower chronic injury rate in 2005 is attributable the same two factors plus a third factor: self selection bias and consequent over- representation of chronically injured personnel in the 2004 survey.
4.3.7 In summary, it is concluded that the 2005 sample and the weighted 2004 sample are broadly similar in profile; where discrepancies exist feasible explanations have been proposed. Because of the methodological limitations in both cases, neither sample is completely representative of the Infantry population. In particular IETs, with less exposure, would be expected to have lower rates of both acute and chronic injuries. It is considered that the acute injury profiles for the two samples are each representative of the population from which they were sampled, and that all four calculated rates can be regarded as unbiased estimates of the population rates. With regard to chronic injuries, the 2005 survey results
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suggest that the rate calculated from the 2004 survey data (see paragraph 3.3.5) is probably an overestimate, and that the true rate for the population of trained soldiers lies somewhere between the two estimates.
4.4 Characteristics of Acute Injuries
4.4.1 A total of 155 acute injury incidents were reported by 100 respondents as having occurred during the survey period. However, details were only provided (by all 100 respondents) for 127 of these injury incidents. A summary of the contexts of the individual incidents and injuries is presented in Table 90. Just over half of the reported injuries were trade-related, representing a somewhat higher proportion than the figure of 44.0% from the 2004 survey (see Table 25).
Table 90. Infantry 2005 Acute Injuries: Activity
Cumulative Activity Frequency Percent Valid Percent Percent Valid Sport 24 18.9 19.0 19.0 PT 24 18.9 19.0 38.1 Sport & PT 1 .8 .8 38.9 Trade-related 64 50.4 50.8 89.7 Travelling to/from ADF work 1 .8 .8 90.5 Other 12 9.4 9.5 100.0 Total 126 99.2 100.0 Missing System 1 .8 Total 127 100.0
4.4.2 Whilst most of the questions from the 2004 survey about specific acute injury incidents were asked again in 2005, their purpose was essentially as a prelude to the two new questions on the 2005 survey, relating to CATTs and physical actions. The discussion of detailed characteristics of acute injuries from the 2004 survey (see Sections 3.5 and 3.6) is not replicated here for the 2005 survey. Discussion is limited to the two new questions.
4.4.3 The first objective of the 2005 survey (which was discussed in paragraph 2.10.2) was to obtain further information about the relationship between the occurrence of injury and particular CATTs and the critical physical actions involved in those CATTs. In the 2004 survey, trade-related activity was characterised using fairly broad categories developed at a series of Trade Tasks Analysis Workshops held in November 2003, at the beginning of the DPESP (see Reference Document C). The 2004 survey took place prior to the completion of detailed observation of trade tasks and the subsequent physical movement analysis and identification of critical CATTs in the Criterion Tasks Workshop (see Reference Document G). The 2005 survey incorporated two questions based on this later work, one about CATTs and the other about physical actions, both of which were much more finely differentiated (see Annexes 2 and 8).
4.4.4 Table 91 shows the CATTs to which the trade-related acute injuries were attributed, and Table 92 shows the physical actions which were involved. These tables show that of the 25 high-risk and/or physically demanding CATTs listed on the survey form, eight were not associated with any acute injury. Of the 17 which were, the predominant causes of acute injury were Forced March, Patrol in Marching Order and Section Attack. The predominant associated actions were marching, walking and running; going to ground and crawling; and carrying loads, either in hands/arms but especially on the back1. Most injuries were associated with a single CATT (as per the instructions on the form), but a few respondents were unable to pinpoint the occurrence of the injury sufficiently to differentiate between such
1 It is conjectured that the lack of any reports of the activity “passing” in Table 92 may be due to the fact that in the 2004 survey “passing” was listed after “lifting”, whereas in the extended alphabetical list in the 2005 survey it occurred between “marching” and “patrolling”, and may have been misinterpreted.
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combinations as Forced March and Section Attack. On average, each injury was associated with around three physical actions, such as marching, load carriage and crawling.
4.4.5 Of 121 narrative comments made by soldiers to explain how the acute injury occurred, 58 (47.9%) pertained to trade-related tasks. Route marching (15.7%), followed by assaulting (7.4%) and patrolling (5.8%) were the most commonly mentioned trade-related tasks. Non- specific trade-related activities accounted for 11.6% of the comments made. The comments indicated that the contributing factors to these acute trade-related injuries included fatigue, night operations, load carriage, landing on rough, uneven ground, route marching, boots and heat. Comments related to each of these contributing factors include: “I was in a creek line evading 2 Leopard tanks during a section defence exercise. Whilst dodging the T2 tanks I was running/sprinting and due to fatigue, I had lost stability and crushed my right ankle underneath my back side and between the ground forcing my whole body weight onto it. Due to shock, my right ankle was paralysed for a few hours”; “was not issued Night Vision - most others had Night Vision. Fell down a ditch and sprained ankle. Continued on - however found it difficult to keep up with normal duties for next 2 weeks - i.e. running. Discomfort in affected area for up to 6 months”; “patrolling in very hilly arduous terrain, contributing factors were the amount of equipment carried eg. excessive water up to 18 litres, and not being allowed to obtain water locally when it was possible to do. Also at time 3RAR SOP was for patrol commander carried radio”; “fire and moving, threw myself on the ground with machine gun in hand, landed on a rock with hand wedged under machine gun, felt the bone snap in half”; “The 40km pack march is too f------long and destroys soldiers, other military skills are conducted along the way also. This decreases the ability to deploy and just cripples your body”; “I was marching and over time started getting pain in my foot from bad boots”; “forced march in middle of day on black bitumen. Had just returned from field. Only had 6 litres in pack, middle of day, heat coming off road, stretcher carry”.
Table 91. Infantry 2005 Acute Injuries: by Associated CATTs Pct of Pct of CATT Count Responses Cases Bayonet assault 2 2.3 3.2 Casualty evacuation drag Company level replenishment Dig to Stage 1, 2 or 3 Forced entry and stair climb Forced march 17 19.3 27.4 Jerry can carry 3 3.4 4.8 Ladder lift Load and unload UNIMOG 1 1.1 1.6 Mortar forced march (8 km) 2 2.3 3.2 Patrol in marching order 15 17.0 24.2 Patrol in patrol order 2 2.3 3.2 Population protection & control 1 1.1 1.6 Rope climb 1 1.1 1.6 Sand bagging Second storey drop 1 1.1 1.6 Section attack 14 15.9 22.6 Stores carry 4 4.5 6.5 Stretcher carry 6 6.8 9.7 Tunnel crawl 1 1.1 1.6 Urban rushing Wall climb: 1.82 m 1 1.1 1.6 Wall climb: 2.43 m 1 1.1 1.6 Wall climb: 3.66 m 1 1.1 1.6 Wiring Other 15 17.0 24.2 Total 88 100.0 141.9 2 missing cases; 62 valid cases
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Table 92. Infantry 2005 Acute Injuries: by Associated Physical Actions Pct of Pct of Action Count Responses Cases Carrying load in hands/arms 17 8.8 27.9 Carrying load on back 25 12.9 41.0 Climbing a ladder 3 1.5 4.9 Climbing a rope 3 1.5 4.9 Climbing a wall 4 2.1 6.6 Crawling 10 5.2 16.4 Crouching 6 3.1 9.8 Digging 1 0.5 1.6 Dropping & landing 6 3.1 9.8 Going to ground 13 6.7 21.3 Jumping 4 2.1 6.6 Lying 2 1.0 3.3 Lifting 6 3.1 9.8 Marching 21 10.8 34.4 Passing Patrolling 10 5.2 16.4 Pushing/Pulling 3 1.5 4.9 Rising to your feet 8 4.1 13.1 Running 18 9.3 29.5 Sitting Sprinting 8 4.1 13.1 Standing 3 1.5 4.9 Striking 2 1.0 3.3 Walking 13 6.7 21.3 Other 8 4.1 13.1 Total 194 100.0 318.0 3 missing cases; 61 valid cases
4.5 Characteristics of Chronic Injuries
4.5.1 A total of 93 chronic injury conditions were reported by 57 respondents as having occurred during the survey period. However, details were only provided by 56 respondents regarding 83 of these injuries.
4.5.2 A summary of the contexts of the individual injuries is presented in Tables 93 and 94. Unlike an acute injury, which is generally related to a particular trade activity or non-trade activity, a chronic injury may have more than one contributing factor - trade-related, non-trade-related, or both. Table 93 shows that in over two thirds of all chronic injuries, trade activities were cited as a contributing factor. Table 94 shows that almost half of the reported chronic injuries were entirely trade-related. This is a slightly lower proportion to the figure of 50.8% reported for acute injuries (see Table 90), and is also slightly lower than the corresponding figure of 53.6% from the 2004 survey (Table 51).
Table 93. Infantry 2005 Chronic Injuries: Contributing Activities (1)
Pct of Pct of Type of activity Count Responses Cases Sport 23 20.5 28.4 PT 31 27.7 38.3 Trade-related 56 50.0 69.1 Other 2 1.8 2.5 Total 112 100.0 138.3 2 missing cases; 81 valid cases
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Table 94. Infantry 2005 Chronic Injuries: Contributing Activities (2)
Valid Cumulative Type of Activity Frequency Percent Percent Percent Valid Trade-related only 35 42.2 43.2 43.2 Non-trade-related only 25 30.1 30.9 74.1 Both trade and non-trade-related 21 25.3 25.9 100.0 Total 81 97.6 100.0 Missing System 2 2.4 Total 83 100.0
4.5.3 As in the case of acute injuries (see paragraph 4.4.2), the discussion of detailed characteristics of chronic injuries from the 2004 survey (see Sections 3.7 and 3.8) is not replicated here for the 2005 survey. Discussion is limited to the two new questions on the 2005 survey, relating to CATTs and physical actions.
4.5.4 Table 95 shows the CATTs to which the trade-related chronic injuries were attributed, and Table 96 shows the physical actions which were involved. These tables show that of the 25 high-risk and/or physically demanding CATTs listed on the survey form, all but five were reported as contributing to chronic injuries. The predominant causes of chronic injury, as with acute injury, were Forced March, Patrol in Marching Order and Section Attack. Carriage of stores and stretchers featured more prominently in terms of chronic injury than acute injury.
4.5.5 Table 96 shows that by far the most common actions associated with chronic injury were marching and carrying loads on the back, which were each cited in almost half the reported cases of injury1. Most injuries were associated with multiple CATTs and multiple actions; on average, each injury was associated with around two CATTs and three physical actions.
1 It is conjectured that the lack of any reports of the activity “passing” in Table 92 may be due to the fact that in the 2004 survey “passing” was listed after “lifting”, whereas in the extended alphabetical list in the 2005 survey it occurred between “marching” and “patrolling”, and may have been misinterpreted.
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Table 95. Infantry 2005 Chronic Injuries: by Associated CATTs Pct of Pct of CATT Count Responses Cases Bayonet assault 2 2.1 4.1 Casualty evacuation drag 2 2.1 4.1 Company level replenishment Dig to Stage 1, 2 or 3 2 2.1 4.1 Forced entry and stair climb 1 1.0 2.0 Forced march 20 20.8 40.8 Jerry can carry 1 1.0 2.0 Ladder lift Load and unload UNIMOG 1 1.0 2.0 Mortar forced march (8 km) Patrol in marching order 9 9.4 18.4 Patrol in patrol order 6 6.3 12.2 Population protection & control 2 2.1 4.1 Rope climb 3 3.1 6.1 Sand bagging 2 2.1 4.1 Second storey drop 1 1.0 2.0 Section attack 9 9.4 18.4 Stores carry 8 8.3 16.3 Stretcher carry 8 8.3 16.3 Tunnel crawl 2 2.1 4.1 Urban rushing 2 2.1 4.1 Wall climb: 1.82 m 1 1.0 2.0 Wall climb: 2.43 m 1 1.0 2.0 Wall climb: 2.43 m Wiring Other 13 13.5 26.5 Total 96 100.0 195.9 7 missing cases; 49 valid cases
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Table 96. Infantry 2005 Chronic Injuries: by Associated Physical Actions Pct of Pct of Action Count Responses Cases Carrying load in hands/arms 11 7.1 21.6 Carrying load on back 23 14.9 45.1 Climbing a ladder Climbing a rope 2 1.3 3.9 Climbing a wall Crawling 3 1.9 5.9 Crouching 5 3.2 9.8 Digging 3 1.9 5.9 Dropping & landing 5 3.2 9.8 Going to ground 8 5.2 15.7 Jumping 7 4.5 13.7 Lying 1 0.6 2.0 Lifting 4 2.6 7.8 Marching 23 14.9 45.1 Passing Patrolling 12 7.8 23.5 Pushing/Pulling 1 0.6 2.0 Rising to your feet 8 5.2 15.7 Running 13 8.4 25.5 Sitting 2 1.3 3.9 Sprinting 6 3.9 11.8 Standing 2 1.3 3.9 Sitting Walking 7 4.5 13.7 Other 8 5.2 15.7 Total 154 100.0 302.0 5 missing cases; 51 valid cases
4.6 Opinions of Respondents
4.6.1 Respondents who had incurred acute injuries or who were carrying chronic injuries during the 12-month survey period were asked three questions about possible systemic factors that might contribute to trade-related injuries. Summaries of weighted responses from the 105 respondents with trade-related injuries1 are presented in Tables 97 to 99. Manning levels was nominated by 25% of respondents, time pressure by 27% and equipment limitations by 22%. These proportions were not substantially nor significantly different from the 2004 survey results (22%, 35%, 29% respectively).
Table 97. Infantry 2005: Deficiencies in Manning Levels as a Contributing Factor to Acute or Chronic Injury
Cumulative Frequency Percent Valid Percent Percent Valid Yes 21 22.8 25.3 25.3 No 62 67.4 74.7 100.0 Total 83 90.2 100.0 Missing System 9 9.8 Total 105 92 100.0
1 Many respondents who had either reported no trade-related injuries, or for whom there was uncertainty as to the trade-related status of their injuries (or in some cases who had reported no injuries at all), also answered these questions, generally in the negative; however a few of these responded in the affirmative. All of these responses were regarded as invalid and were excluded from the analysis.
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Table 98. Infantry 2005: Time Pressure as a Contributing Factor to Acute or Chronic Injury
Cumulative Frequency Percent Valid Percent Percent Valid Yes 22 23.9 27.2 27.2 No 59 64.1 72.8 100.0 Total 81 88.0 100.0 Missing System 11 12.0 Total 105 92 100.0
Table 99. Infantry 2005: Equipment Limitations as a Contributing Factor to Acute or Chronic Injury
Cumulative Frequency Percent Valid Percent Percent Valid Yes 18 19.6 22.2 22.2 No 63 68.5 77.8 100.0 Total 81 88.0 100.0 Missing System 11 12.0 Total 105 92 100.0
4.6.2 Considering the three sets of responses together, a three-factor cross-tabulation (not shown here) revealed that of the 105 respondents with trade-related injuries, nine did not answer any of the three questions. Of the 96 respondents who answered at least one of the three questions, four (4.2%) answered yes to all three questions, a further 12 (12.5%) answered yes to two of the three questions, and a further 38 (39.6%) answered yes to one of the three questions. Hence a total of 56.3% of respondents with trade-related injury believed that at least one of these systemic factors contributed to their injury. This profile of responses is almost identical to the profile from the 2004 survey (see paragraph 3.9.3).
4.6.3 Eighteen comments were made in relation to the manning levels. As in 2004 the focus was on reduced section numbers and the need to continue to undertake work tasks (including equipment carriage) without acknowledging the reduction in section numbers: “as Infantry Battalions get less and less people each year, the sections still have to carry a section's worth of equipment, even though the section or platoon is deficient in numbers”; “the less men you have the more the individual load increases. You still have to take the whole section's worth of equipment.”
4.6.4 Time pressure was commented on 25 times, with the majority being related to the pressure of time to perform a task, but it was also noted that soldiers were under pressure to resume work following injuries: “we are constantly given time restrictions, some unrealistic; the men work extra hard to meet the deadlines, therefore creating an environment for injury through fatigue.” There was a greater emphasis on the time pressure associated with lead-up training and return to work following injury in the 2005 survey compared to the 2004 survey: “lack of time for lead-up training caused injuries due to lack of battle fitness”; “not adequate time to get fit after leave. They just assume everybody does PT during leave and the work rate when we get back reflects this”; “problem … was compounded by training program not graduated (too much, too soon) and little or no time to recover from injury”; “pressured to get back to work”; “not given time to recover “; “…at times when injured to feel an obligation to return to work or deploy field when carrying an injury”; “at Kapooka ARTC you have no time for even slight injuries to heal.”
4.6.5 Comments in the 2005 survey regarding equipment support those made in 2004 where a concern was expressed concerning the adequacy of boots and the fit of packs. The soldiers appear to be frustrated as they believe the quality of boots issued was inferior to those provided to the British and US personnel and promises had continually been made that packs would be improved but this has not been forthcoming.
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4.6.6 Finally, all respondents were asked a number of questions about attitudes to injury within the ADF culture. A summary of weighted responses is presented in Table 100. Key themes which emerge from Table 100 are, as for the 2004 survey: awareness of injury prevention measures; variation in levels of risk taking and avoidance of risk; concern about the effect of injury on capacity to do the job, including deployment, but not on income or family relationships; and willingness to report injury in spite of some concern about repercussions. The 2005 and 2004 response patterns were very similar, the most apparent difference being a higher level of agreement in 2005 that there are adequate resources available to prevent injuries during sport, other physical activity and physical work tasks. This may be a consequence of the rollout of DIPP in many of the units surveyed.
4.6.7 Differences of opinion between those known to have had trade-related injuries and those known not to have suffered trade-related injuries in the survey period were also explored. Respondents for whom it was uncertain whether or not they had had trade-related injuries (due to incomplete responses) were excluded from this analysis. Significant differences in response patterns are also indicated in Table 100. Those with trade-related injuries tended to perceive higher levels of risk taking, less capacity to avoid risks and greater likelihood of being injured, and were less likely to report injury and more likely to fear repercussions of doing so.
4.6.8 Respondents were also given the opportunity to comment about any aspect of the survey or related issues. Sixty-one comments were made. These comments generally reaffirmed those noted previously in other parts of the report, and included statements related to acceptance of injuries as part of the job, low manning levels contributing to injury and increasing the workload, pressure to return to work before fully recovered, equipment design including boots and packs, and the perceived inappropriateness of long duration (40 km) route marches.
4.6.9 However, comments were also made regarding other issues including: commanders requiring soldiers to ignore medical restrictions; difficulty accessing timely and appropriate medical care; under-reporting of injuries especially in reference to potential medical down- grading; excessive load carriage due to a perceived lack of logistical support; and the need for improved access to PTIs. Concerns were also expressed regarding AIRN for infantry and its effect on job standards and a perceived decrease in required fitness standards. Finally, the previously mentioned general acceptance of injury was sometimes expressed as a preparedness to risk injury during training in order to reduce the likelihood of injury in combat.
4.6.10 The following is a representative sample of these comments: “if you sustain an injury you are pushed to ignore medical restrictions by your bosses”; “I believe that over the years our equipment we carry has increased and so has the tempo of training. I feel this contributes to the amount of injuries as we don't have the time to recover from soft tissue strains”; “it is a known fact that the Australian Infantry soldier carries a huge marching order load. I've worked with many other armies and they carry significantly less. Why? The Americans for example have an excellent logistics that enables the frequent resupply and thus their load is lighter. The Australian Army is asking way too much of a young infantry digger. We are NOT pack mules. To stop injuries in pack marching is simple, lighten our load!!”; “when I ignored my back the treatment that I received was a major cause of my chronic injury. If my treatment was better I believe I would have had a better chance of avoiding my back injury”; “we rarely use Defence Medical because it takes too long to be seen. I prefer to spend my pay on a civic professional because I know he/she will do a good job and it (my injury) will be addressed quickly and properly. I am not alone on this subject and course of action”; “the opinion that most senior members within the Army is that it is weaker everyday that we allow standards to drop. 2-4 km in a BFA - bring back 5 km, heaves and ropes for Infantry. Today’s soldiers have problems with a 2-4km run, increase the standard now in order to start raising the standard within the Infantry Corps”; “Get rid of AIRN for Infantry. It is creating COMPETENCY BASED TRAINING. No longer do we train as sections or platoons in Army time, we have to do it after work or on holidays. "Sorry can't do this or that today. PTE Bloggs and co need a BFA or HUET, or a med board" etc. This is being managed, but still, it cripples learning. Bring back Pay level testing and the PTT or old BFT for Infantry Soldiers had to learn everything about their job before earning a pay-rise, therefore they were fully
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competent”; “PTI should run all fitness programme so training is done progressively and properly so all ranks are made to meet one standard, not unqualified people smashing peoples body when they have no understanding of how the body works”; “if more training exercises are removed or avoided due to a risk of injury then soldiers won't be reasonably prepared for their job. I would rather risk any injury during training to lower the risk of being killed on deployment”.
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Table 100. Infantry 2005 Perceived Attitudes to Injury within the ADF Difference b/w Strongly Strongly Trade-related and Disagree Disagree Uncertain Agree Agree Non-trade-related % % % % % Sig. level1,2 Difference3 It is quite likely that I will suffer an injury in the next month 6.6 23.2 52.7 13.3 4.1 *** Agree↑ If I had a typical/common injury for my trade I would be unable to do my current job 2.9 21.6 34.9 33.6 7.1 ns If I had a typical/common injury for my trade it would significantly affect my take 19.1 49.0 24.1 6.2 1.7 * Agree↑ home income If I had a typical/common injury for my trade it would significantly affect my ability 1.7 5.8 10.8 50.6 31.1 * Agree↑ to deploy If I had a typical/common injury for my trade it would significantly affect my ability 2.9 11.2 19.5 46.9 19.5 ns to attend promotion courses If I had a typical/common injury for my trade it would significantly affect my 27.0 46.9 16.2 7.1 2.9 * Agree↑ relationship with my close family members If I had a typical/common injury for my trade and reported it to a Defence doctor it 2.1 10.8 38.6 37.3 11.2 ns is likely that I would be medically downgraded I would report any injury that I suffered to a Defence Health facility 7.5 26.6 16.6 37.3 12.0 ** Agree↓ It is accepted practice in my work area to prevent injuries during sport or other 2.1 9.2 10.4 59.2 19.2 * Agree↓ physical activities (including job related activities) wherever possible It is accepted practice in my work area to report all injuries to Defence medical staff 4.6 18.0 11.3 56.9 9.2 *** Agree↓ I frequently risk injury during sport and other physical activity, or to achieve work 4.2 20.4 15.8 43.8 15.8 ns goals It is accepted practice in my work area to risk injuries during sport or other physical 2.1 26.3 15.4 42.1 14.2 ns activities (including job related activities) I take steps to prevent injuries during sport or other physical activity 0.8 3.8 4.2 74.2 17.1 ns I take steps to prevent injuries during the performance of physical work tasks 1.2 5.0 7.5 71.0 15.4 ns There are adequate resources available to prevent injuries during sport and other 2.5 18.7 24.5 49.8 4.6 ns physical activity There are adequate resources available to prevent injuries during the performance 2.1 9.2 24.7 60.3 3.8 ns of physical work tasks I am able to avoid risking injury during sport and other physical activities 2.9 24.5 24.1 43.6 5.0 ns I am able to avoid risking injury during physical work activities 4.1 31.5 26.6 34.4 3.3 ns I can report any injury that I have to a Defence medical facility without any fear of 9.5 23.7 22.8 33.6 10.4 ** Agree↓ repercussions N=239-241 1 Because the numbers in many of the cells of the cross-tabulations were small, for statistical validity all χ2 tests were based on responses collapsed into three categories: Disagree, Uncertain, Agree. 2 * p<0.05, ** p<0.01, *** p<0.001, ns Not significant 3 Main difference in the responses of those with trade-related injuries compared with the responses of those without trade-related injuries. For example, Agree↑ means that those with trade-related injuries were more likely to agree than those without trade-related injuries.
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5 SURVEY OF AIRFIELD DEFENCE GUARDS 2004: RESULTS AND DISCUSSION
5.1 Introduction
5.1.1 In Section 5.2 the characteristics of the 95 Airfield Defence Guard (ADG) respondents and their work programs and physical activities during the survey period are examined.
5.1.2 In Sections 5.3 and 5.4 the reported injury histories of the respondents are examined, and relationships between injury history and key characteristics of the respondents and their physical activities during the survey period are explored.
5.1.3 The survey form provided for details of up to four acute injuries. Information was provided by 38 respondents regarding 55 acute injury incidents which occurred during the survey period. In Sections 5.5 and 5.6 the characteristics of the individual incidents and injuries are examined, together with relationships between acute injury characteristics and respondent characteristics.
5.1.4 The survey form also provided for details of up to four chronic injuries. Information was provided by 29 respondents regarding 43 chronic injuries being carried at the time of the survey. In Section 5.7 and 5.8 the characteristics of the individual chronic injuries are examined, together with relationships between chronic injury characteristics and respondent characteristics.
5.1.5 Respondents were asked their opinions about factors contributing to injury, and about attitudes to injury within the ADF culture. They were also invited to comment about any aspect of the survey or related issues. In Section 5.9 the opinions of respondents are examined.
5.2 Characteristics of Respondents and Their Physical Activities
5.2.1 Summaries of characteristics of the 95 respondents and their work programs and physical activities during the survey period are presented in Tables 101 to 110. Also included in Tables 101 to 103 for purposes of comparison are profiles of age, length of service and rank for 2 AFDS as at December 2005, provided by ADG.
Table 101. ADG: Age Distribution 2004 Survey Sample 2 AFDS Population 2005 Valid Cum. Cum. Age group Frequency % % % Frequency % % Valid 17-19 5 5.3 5.3 5.3 1 0.7 0.7 20-24 51 53.7 53.7 58.9 56 38.9 39.6 25-29 18 18.9 18.9 77.9 51 35.4 75.0 30-34 12 12.6 12.6 90.5 18 12.5 87.5 35-39 6 6.3 6.3 96.8 13 9.0 96.5 40-44 1 1.1 1.1 97.9 3 2.1 98.6 45-49 1 1.1 1.1 98.9 2 1.4 100.0 50-54 1 1.1 1.1 100.0 Total 95 100.0 100.0 144 100.0
5.2.2 Table 101 shows that if the 2005 2 AFDS population is indicative of the 2004 ADG population, then the 17-24 year age group was over-represented and the 25-29 year age group was correspondingly under-represented in the 2004 survey sample. Similarly, those with less than five years service were over-represented, and those with 5-9 years service were under-represented (Table 102).
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Table 102. ADG: Length of Service 2004 Survey Sample 2 AFDS Population 2005 Valid Cum. Cum. Length of service Frequency % % % Frequency % % Valid Less than 5 years 64 67.4 67.4 67.4 50 34.7 34.7 5-9 years 15 15.8 15.8 83.2 76 52.8 87.5 10-14 years 8 8.4 8.4 91.6 5 3.5 91.0 15-19 years 4 4.2 4.2 95.8 9 6.3 97.2 20 years or more 4 4.2 4.2 100.0 4 2.8 100.0 Total 95 100.0 100.0 144 100.0 1 20 years or more
5.2.3 Table 103 shows that NCOs were considerably over-represented in the survey sample. It would appear that almost all NCOs from both 2 AFDS and 3 AFDS were included in the survey sample.
Table 103. ADG: Rank 2004 Survey Sample 2 AFDS Population 2005 Valid Cum. Cum. Rank category Frequency % % % Frequency % % Valid Other rank 70 73.7 73.7 73.7 125 86.8 86.8 NCO 20 21.1 21.1 94.7 10 6.9 93.8 Officer 5 5.3 5.3 100.0 9 6.3 100.0 Total 95 100.0 100.0 144 100.0
Table 104. ADG: Basic Physical Characteristics
Characteristic N Minimum Maximum Mean Std. Deviation Height (cm) 94 164 195 180.04 6.76 Weight (kg) 95 64 106 82.94 10.37 1 -2 Body mass index (BMI) (kg m ) 94 18.41 33.26 25.59 3.07 1 BMI = (weight (kg))/(height (m))2
5.2.4 The summaries of height, weight and body mass index (BMI) (Table 104) were compared to those for the ADGs who participated in the task observation phase of the DPESP (see Reference Document E). There were significant differences between the mean weights (survey sample 82.94 kg; task observation sample 76.65; t = 2.72, p<0.01) and mean BMIs (survey sample 25.59 kg; task observation sample 24.20; t = 2.04, p<0.05), but no significant differences between the mean heights.
Table 105. ADG: BMI Categories
Cumulative BMI category1 Frequency Percent Valid Percent Percent Valid <20 2 2.1 2.1 2.1 20-24.99 41 43.2 43.6 45.7 25-29.99 44 46.3 46.8 92.6 ≥30 7 7.4 7.4 100.0 Total 94 98.9 100.0 Missing System 1 1.1 Total 95 100.0 1 BMI<20: underweight; 20≤BMI<25: normal; 25≤BMI<30: overweight; BMI>30: obese (WHO, 2000)
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5.2.5 The categories used in Table 105 are those defined by the World Health Organisation (WHO, 2000). According to these criteria, more than half of the respondents were overweight. However, it is recognised that BMI has limitations as an indicator of adiposity, since high lean muscle mass can also result in a BMI of 25 or more (Expert Panel on the Identification, Evaluation and Treatment of Overweight and Obesity in Adults, 1998).
5.2.6 Summaries of work programs and physical activities during the survey period are presented in Tables 106 to109.
Table 106. ADG: Work Cycle Number of occurrences Activity 0 1 2 3 % % % % Major exercise1 61.1 13.0 16.7 9.3 Minor exercise1 27.8 24.1 16.7 31.5 Pre-deployment 75.9 22.2 1.9 - Deployment 70.4 29.6 - - Course 55.6 31.5 9.3 3.7 Leave 33.3 42.6 11.1 13.0 N=54. On advice from Defence informants, it was assumed that any respondent who did not indicate ANY of the listed activities had not answered the question. These non-responses were excluded from the analysis – they did not contribute to the counts in the ‘zero’ column. 1 A major exercise is one involving multiple Services and Agencies. The nominal duration is two to eight weeks; this may be broken down into phases to achieve particular outcomes. Major exercises are usually aimed to exercise higher end requirements (Service outcomes), with large scale involvement and co-ordination issues. A minor exercise involves a Unit or group of Units. The nominal duration is one to four weeks. A minor exercise is usually aimed at a specific role / task / function that the Unit is required to perform. A particular soldier or airman may be involved in either type of exercise for two to four weeks. The nature of the task (intensity / duration / location / conditions etc) can vary greatly for both types of exercise; a particular soldier or airman may work harder on a minor exercise than on a major exercise.
5.2.7 Table 106 summarises the level of involvement of respondents in six types of activity. It is not surprising that the proportion who were deployed (29.6%) closely matches the proportion who did not take part in minor exercises (27.8%). Whilst the level of involvement in major exercises was low (with 61.1% not taking part), involvement in minor exercises was high, with almost one third of respondents taking part in three minor exercises.
Table 107. ADG: Number of Activities (Excluding Leave)
Cumulative Frequency Percent Valid Percent Percent Valid 0 1 1.9 1.9 1.9 1 6 11.1 11.1 13.0 2 13 24.1 24.1 37.0 3 12 22.2 22.2 59.3 4 7 13.0 13.0 72.2 5 7 13.0 13.0 85.2 6 4 7.4 7.4 92.6 7 2 3.7 3.7 96.3 8 2 3.7 3.7 100.0 Total 54 100.0 100.0
5.2.8 Table 107 shows the profile of the total number of all the types of activity listed in Table 106 with the exception of leave. Because pre-deployment, deployment and courses are very diverse in their physical demands, and advice from ADF was that an individual airman’s involvement in either major or minor exercises would be similar in duration (in the order of two weeks) and intensity, the total number of major and minor exercises was taken as an approximate measure of exposure to high intensity physical activity during the 12-month
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period. Table 108 shows that all but 17% of respondents were involved in at least one such activity during the survey period.
Table 108. ADG: Number of Major and Minor Exercises
Cumulative Frequency Percent Valid Percent Percent Valid 0 9 16.7 16.7 16.7 1 11 20.4 20.4 37.0 2 9 16.7 16.7 53.7 3 16 29.6 29.6 83.3 4 2 3.7 3.7 87.0 5 5 9.3 9.3 96.3 6 2 3.7 3.7 100.0 Total 54 100.0 100.0
5.2.9 Physical Fitness Test (PFT) and Battle Efficiency Test (BET). Most respondents (84) had undergone the PFT and most (87%) had passed it on the first occasion. Of the 38 who had been tested a second time, all but four had passed. Similarly, 58 had undergone the BET with a pass rate of 88% on the first attempt; 20 had been tested a second time, and all but one had passed. Since neither of these were strongly discriminating tests, they are not discussed further in this report.
5.2.10 Table 109 shows time spent in regular sport and training for sport. Around a quarter of the respondents played games; of these around two thirds trained during the season and one third trained pre-season in at least one sport. The distributions of average hours per week were very positively skewed, with a small proportion of respondents estimating average hours well above the mean value for all participants. These may be sub-elite players who spend much more time training than the majority. It should be noted that the mean and standard deviation of the reported average hours per week for all sports includes the non- participants with zero hours per week of sporting activity.
Table 109. ADG: Involvement in Sport
Extent of involvement in the Average hours/wk 12 months prior to survey of sport-related activity % of respondents who… Trained Trained Played Mean Standard Sport pre- during games Deviation season season % % % Touch Football - 4.2 6.3 2.4 1.6 Rugby Union 1.1 1.1 1.1 2.0 2.8 Rugby League 1.1 3.2 3.2 3.0 2.6 Australian Rules Football 5.3 8.4 8.4 5.3 2.6 Netball - - 1.1 0.5 0.7 Volleyball - 1.1 3.2 1.4 1.1 Hockey - - - - Cricket - - - - Soccer - 1.1 1.1 0.7 0.6 Other sport 5.3 5.3 10.5 7.1 4.8 All sports 12.6 18.9 26.3 2.0 4.0 N=95
5.2.11 Table 110 summarises the respondents’ estimated hours per week in physical training activity over the 4 weeks prior to the survey. These are measures of exposure to physical activity which complement the measures based on participation in exercises during the 12- month period. The 4-week measures are more finely graduated but more limited in temporal
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scope. Again, the distributions of average hours per week were very positively skewed, with a small proportion of respondents estimating average hours well above the mean value for all respondents. These respondents may have in interpreted the question to include trade- related physical activity as well as physical training activity.
Table 110. ADG: Physical Training Activity
N Minimum Maximum Mean Std. Deviation Hours of Structured activity supervised by PTI 70 0 32 4.9 5.4 Hours of structured activity supervised by other than 70 0 32 5.4 5.9 PTI Unstructured/unsupervised activity 80 0 30 6.4 5.2
5.3 Injury Experience and Injury Status
5.3.1 Tables 111 and 112 show details of acute injury experience during the survey period. Tables 113 and 114 give corresponding information regarding chronic injury status at the time of the survey. These tables are based on respondents, not individual incidents/injuries (see Section 5.4 for that analysis). The purpose here is to divide the respondents into those who have had injuries of the nominated type, and those who have not. The category ‘trade- related’ encompassed five ‘work or trade-related’ categories from Question 8 of the acute injury section (and Question 4 of the chronic injury section) of the questionnaire (see Annex 2), but excluded travel to and from work. Because the primary focus of the DPESP study is Combat Arms Trade Tasks (CATTs), physical training (PT) was also excluded from this category. The “possibles” in Tables 112 and 114 are due to some respondents failing to answer these questions.
Table 111. ADG: Acute Injury
Cumulative Acute injury Frequency Percent Valid Percent Percent Valid Yes 43 45.3 45.3 45.3 No 52 54.7 54.7 100.0 Total 95 100.0 100.0
Table 112. ADG: Trade-related and Non-trade-related Acute Injury
Cumulative Injury category1 Frequency Percent Valid Percent Percent Valid Some or all trade-related 21 22.1 22.1 22.1 2 Possible trade-related 9 9.5 9.5 31.6 Non-trade-related only 13 13.7 13.7 45.3 No acute injuries 52 54.7 54.7 100.0 Total 95 100.0 100.0 1 The category ‘trade-related’ encompassed five ‘work or trade-related’ categories from Question 8 of the acute injury section of the questionnaire (see Annex 2), but excluded travel to and from work. Because the primary focus of the DPESP study is Combat Arms Trade Tasks (CATTs), physical training (PT) was also excluded from this category. 2 The “possibles” are due to some respondents failing to answer this question.
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5.3.2 Tables 111 and 112 indicate that during the 12-month survey period, close to half (45%) of ADG airmen suffered at least one acute injury which made it difficult for them to perform their duties for at least one day, and between 22% and 32% attributed at least one acute injury to trade-related activity.
5.3.3 Tables 113 and 114 indicate that at the time of the survey, a similar proportion (42%) of ADG airmen were carrying at least one chronic injury, and around 30% ascribed trade-related activity as either the sole factor or as a contributing factor to the initial occurrence of their chronic injury.
Table 113. ADG: Chronic Injury
Cumulative Chronic injury Frequency Percent Valid Percent Percent Valid Yes 30 31.6 41.7 41.7 No 42 44.2 58.3 100.0 Total 72 75.8 100.0 Missing System 23 24.2 Total 95 100.0
Table 114. ADG: Trade-related and Non-trade-related Chronic Injury
Cumulative Injury category1 Frequency Percent Valid Percent Percent Valid Some or all trade-related 21 22.1 29.2 29.2 2 Possible trade-related 1 1.1 1.4 30.6 Non-trade-related only 8 8.4 11.1 41.7 No chronic injuries 42 44.2 58.3 100.0 Total 72 75.8 100.0 Missing System 23 24.2 Total 95 100.0 1 The category ‘trade-related’ encompassed five ‘work or trade-related’ categories from Question 4 of the chronic injury section of the questionnaire (see Annex 2), but excluded travel to and from work. Because the primary focus of the DPESP study is Combat Arms Trade Tasks (CATTs), physical training (PT) was also excluded from this category. 2 The “possible” is due to one respondent failing to answer this question.
Table 115. ADG: Number of Acute Injuries
Cumulative Number Frequency Percent Valid Percent Percent Valid 0 52 54.7 54.7 54.7 1 26 27.4 27.4 82.1 2 10 10.5 10.5 92.6 3 5 5.3 5.3 97.9 5 1 1.1 1.1 98.9 6 1 1.1 1.1 100.0 Total 95 100.0 100.0
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Table 116. ADG: Number of Chronic Injuries
Cumulative Number Frequency Percent Valid Percent Percent Valid 0 42 44.2 58.3 58.3 1 17 17.9 23.6 81.9 2 10 10.5 13.9 95.8 3 3 3.2 4.2 100.0 Total 72 75.8 100.0 Missing System 23 24.2 Total 95 100.0
5.3.4 Summaries of reported numbers of acute injury incidents experienced during the survey period and chronic injuries being carried are presented in Tables 115 and 116. The average rates underlying these tables are (mean ± standard error) 0.758 ± 0.098 acute injuries per person (758 ± 98 per thousand persons per year) and 0.639 ± 0.088 chronic injuries per person (639 ± 88 per thousand persons). These estimates are of the same order of magnitude as estimates based on data from the Defence Injury Prevention Program (DIPP) and EpiTrack databases, and of the estimated injury rate in a US Army battalion (Knapik et al., 1993), and an order of magnitude higher than estimates based on data from Defcare (see Table 55 in Reference Document D). A subsequent analysis of details reported for individual acute injuries indicated that 45.8% were trade-related (see Table 121). On this basis, the rate of trade-related acute injuries is estimated to be 349 ± 45 per thousand persons per year. Similarly, analysis of details reported for individual chronic injuries indicated that 28.6% were entirely trade-related and a further 33.3% were to some degree trade-related (see Table 148). On this basis, the prevalence is estimated to be 183 ± 25 per thousand persons for chronic injuries attributed wholly to trade-related activities and 396 ± 54 per thousand persons for chronic injuries attributed wholly or in part to trade-related activities.
5.3.5 Medical Employment Category (MEC). Table 117 shows the proportions of respondents who had chronic injuries who were graded at each MEC level. Almost two thirds were at MEC level 1: ‘Medically fit, without restriction for deployment’, whilst one third had some degree of medical employment restriction.
Table 117. ADG Chronic Injuries: Medical Employment Category1
Cumulative Frequency Percent Valid Percent Percent Valid MEC1 19 20.0 65.5 65.5 MEC2 3 3.2 10.3 75.9 MEC3 5 5.3 17.2 93.1 MEC4 1 1.1 3.4 96.6 Temporarily Medically Unfit (TMU) 1 1.1 3.4 100.0 Total 29 30.5 100.0 Missing System 66 69.5 Total 95 100.0 1 MEC1: Medically fit, without restriction for deployment. MEC2: Medically fit for deployment, but with some limitations on the duties able to be performed, geographic restrictions and requirements for access to various levels of health support. MEC3 Medically unfit for deployment in the medium term (up to 12 months). MEC4 Medically unfit for deployment in the long term (more than 12 months).
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5.4 Relationship between Injury History and Respondent Characteristics
5.4.1 Relationships between injury occurrence and key characteristics of the respondents and their work program and physical activities during the survey period are summarised in Tables 118 to 120.
5.4.2 Table 118 summarises the differences in the means of eight key measures, between respondents who reported having injuries and those who did not. Results are presented for four categories of injury: acute, trade-related acute, chronic and trade-related chronic. Each of the four sections of Table 118 presents a comparison between two groups: injured vs. not injured, and those with a trade-related injury vs. those with no trade-related injury, for both acute and chronic injuries.
5.4.3 None of the eight key measures discriminated significantly between those with and without acute injury, and only one (length of service in the ADF) discriminated between those with trade-related and non-trade-related acute injuries. The association was negative; those with trade-related acute injuries had a shorter mean time of service (5.9 years) than those with non-trade-related acute injuries (7.9 years).
5.4.4 Length of service was also the strongest discriminator of chronic injury, but in this case the association was positive; those with chronic injury had a longer mean time of service (9.3 years) than those with no chronic injury (4.3 years). Other indicators of chronic injury were age and BMI (positively associated) and hours per week of structured activity supervised by someone other than a PTI (negatively associated). Hours per week of structured activity supervised by a PTI was the only significant discriminator of trade-related chronic injuries (negatively associated). The negative associations may be indicative of the presence of chronic injury reducing the capacity to undertake physical activity.
5.4.5 Because age, length of service and BMI are all positively correlated (see Table 119), a multivariate analysis (stepwise logistic regression) was used to determine the capacity of each of these three variables to predict the presence/absence of chronic injury whilst allowing for the effects of the other two variables. It was found that length of service was the best predictor of chronic injury (p=0.007). After controlling for the effects of length of service, neither age nor BMI added significantly to the predictive capacity of length of service.
5.4.6 These results indicate that whilst age and length of service are closely related, length of service is the stronger predictor of chronic injury. Once the effect of length of service on the likelihood of chronic injury is taken into account, age becomes redundant as a predictor of chronic injury. Similarly, BMI also increases with age and length of service, and adjusting for the effects of length of service also renders BMI redundant as a predictor of chronic injury. That is, in airmen with the same length of service, differences in age and BMI are not associated with changes in the risk of chronic injury.
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Table 118. ADG: Relationships between Injury Occurrence and Indicators of Potential Susceptibility to Injury or Exposure to Risk Class of injury Acute Chronic Injured (a) vs. Trade-related (a) vs. Injured (a) vs. Trade-related (a) vs. Susceptibility or exposure indicator not injured (b) non-trade-related (b) not injured (b) non-trade-related (b) Mean1 SD N Mean1 SD N Mean1 SD N Mean1 SD N Age a 25.7 7.0 43 25.2 7.7 21 28.2 8.0 30 28.2 8.3 21 b 25.6 5.4 52 26.8 6.9 13 24.6 4.6 42 28.8 8.1 8 * Length of service in ADF a 6.1 7.0 43 5.9 8.0 21 9.3 8.7 30 9.5 9.1 21 b 5.6 5.2 52 7.9 7.0 13 4.3 3.5 42 9.5 8.5 8 * ** Height a 180.4 6.4 42 179.9 6.4 20 178.9 6.1 30 178.4 5.3 21 b 179.7 7.1 52 178.8 4.6 13 180.4 7.4 41 180.0 8.4 8
Weight a 83.5 11.2 43 83.6 12.5 21 85.2 9.5 30 85.6 9.2 21 b 82.4 9.7 52 81.1 11.0 13 80.9 10.9 42 84.9 11.3 8
BMI a 25.6 3.3 42 25.7 3.3 20 26.6 2.6 30 26.9 2.7 21 b 25.6 2.9 52 25.4 3.4 13 24.9 3.4 41 26.2 2.6 8 * Hours per week of structured activity a 4.2 2.9 33 4.7 2.6 15 4.5 6.3 24 4.2 7.4 17 supervised by a PTI in the last 4 weeks b 5.5 7.0 37 4.5 3.3 11 5.3 5.7 32 5.2 2.2 6 * Hours per week of structured activity a 4.0 2.7 31 4.1 3.1 12 3.1 2.3 22 2.7 2.5 15 supervised by someone other than a b 6.5 7.3 39 5.0 2.3 12 6.4 7.3 31 3.7 1.6 6 PTI in the last 4 weeks * Hours per week of unstructured/ a 5.5 2.8 36 5.7 2.7 15 6.0 5.5 26 6.6 6.5 17 unsupervised activity in the last 4 weeks b 7.1 6.5 44 6.2 2.8 13 6.6 5.4 35 4.6 3.3 8
1 In each case, differences in the mean values of each indicator for the two categories were tested using independent sample t-tests. In cases where the statistical assumptionsunderlying the t test (normal distributions within each group) were not met, results were confirmed using logarithmic transformations and/or non-parametric Mann-Whitney tests. * p<0.05, ** p<0.01, *** p<0.001.
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Table 119. ADG: Correlations between Age, Length of Service and BMI
Years of Age service in ADF BMI Age Pearson Correlation 1 .870(**) .229(*) Sig. (2-tailed) .000 .026 N 95 95 94 Years of Pearson Correlation .870(**) 1 .191 service in ADF Sig. (2-tailed) .000 .065 N 95 95 94 BMI Pearson Correlation .229(*) .191 1 Sig. (2-tailed) .026 .065 N 94 94 94 ** Correlation is significant at the 0.01 level (2-tailed). * Correlation is significant at the 0.05 level (2-tailed).
5.4.7 Numbers of injuries suffered or carried. Differences between groups of respondents who had suffered no injuries, one injury, two injuries etc., were investigated by one-factor analyses of variance on the same set of measures listed in Table 118. The results for numbers of both acute and chronic injuries were consistent with the two-group results (injury vs. no injury) reported above (paragraphs 5.4.3 and 5.4.4), with evidence of dose-response relationships up to two injuries1, i.e. as the number of injuries increased, the mean of the “exposure” measure (age, LOS, BMI, hours of physical activity) showed a consistent trend.
5.4.8 Table 120 summarises the statistically significant relationships between injury occurrence and six categorical indicators of work cycle events during the 12-month survey period. The only features significantly associated with patterns of injury occurrence were taking part in courses (fewer trade-related acute injuries and more non-trade-related acute injuries) and taking part in minor exercises (more trade-related chronic injuries and fewer non-trade- related chronic injuries).
Table 120. ADG: Statistically Significant1 Relationships between Injury Occurrence and Work Cycle Indicators Class of injury Acute Chronic Injured Trade- Injured Trade- vs. related vs. related Work cycle indicator2 not vs. non- not vs. non- injured trade- injured trade- related related Took part in major exercises Took part in minor exercises ** Took part in pre-deployments Took part in deployments Took part in courses * Had leave N 54 24 54 22 1 Chi-square tests of association. * p<0.05, ** p<0.01, *** p<0.001 2 Because the small numbers reporting each indicator, for statistical validity all counts of activities were recoded into two categories: took part in the activity vs. did not take part in the activity.
5.5 Characteristics of Acute Injuries
5.5.1 A total of 72 acute injury incidents were reported by 43 respondents as having occurred during the survey period. Details were provided regarding 55 of these injury incidents by 38 respondents. A summary of the contexts of the individual injury incidents is presented in Table 121.
1 Beyond two injuries, the sample sizes were very small, and the results were inconclusive.
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5.5.2 Table 121 shows that almost half (46%) of reported acute incidents/injuries were identified as being trade-related1, 21% related to sport and 27% related to PT.
5.5.3 For comparison, Table 121 also includes a profile taken from Figure 1-7 of the ADF Health Status Report (Reference Document I). It should be noted that the survey results in Table 121 pertain only to ADG, and only to acute physical injury incidents as defined in paragraph 2.2.3, whereas the scope of Figure 1-7 of the ADF Health Status Report was all ADF casualties reported to DEFCARE for FY 97/98, for which the activity was reported.
5.5.4 The effects of the difference in organisational scope, of severity, and of any differences in reporting bias2 are difficult to estimate. However, the effect of the difference in the scope of injury type can be estimated as follows. It is reasonable to assume that the great majority of sport, PT and travel to work casualties would be physical in nature, and that casualties of a non-physical nature (exposure to substances, sensory injury, disease, mental illness, etc.) would be classified as work-related. That being so, to enable a more valid comparison, a proportion of the work-related injuries should be excluded from the DEFCARE profile in Table 121, and the percentages then recalculated with respect to the reduced total. To illustrate, suppose we assume that of the 41% of trade-related casualties, 4% (i.e. around 10% of trade-related injuries) are not due to physical injury. Then physical injuries make up 37% of the 41% of trade-related casualties (i.e. around 90% of trade-related casualties) and 96% of all casualties. Compared to the profile of all casualties, the proportion of trade-related physical injuries is slightly lower (37/96=38.5%), whilst the proportions of sport- and PT- related physical injuries are slightly higher (33.3% and 18.8% respectively). Whilst this effect would be stronger If the proportion of trade-related casualties which are not physical injuries were higher than 10%, it would appear that this difference in scope is unlikely to substantially invalidate a comparison between the two profiles in Table 121.
Table 121. ADG Acute Injuries: Activity 2004 Survey Sample1 DEFCARE 97/981 Valid Cum. Cum. Activity Frequency % % % % % Valid Sport 10 18.2 20.8 20.8 32 32 PT 13 23.6 27.1 47.9 18 50 2 Trade-related 22 40.0 45.8 93.8 41 91 Travel to work 2 3.6 4.2 97.9 5 96 & other ADF Other 1 1.8 2.1 100.0 4 100 Total 48 87.3 100.0 100 Missing System 7 12.7 Total 55 100.0 1 For differences in scope, see paragraph 5.5.3 2 The category ‘trade-related’ encompassed five ‘work or trade-related’ categories from Question 8 of the acute injury section of the questionnaire (see Annex 2), but excluded travel to and from work and ‘other ADF’. Because the primary focus of the DPESP study is Combat Arms Trade Tasks (CATTs), physical training (PT) was also excluded.
5.5.5 If the DEFCARE profile for the whole of the ADF is assumed to apply to the ADG subpopulation, and if differences in scope with regard to severity and in the patterns of reporting to DEFCARE and to the DPESP/DIPP survey are assumed to be inconsequential, then it would appear from Table 121 that in the six-year period from 1997/1998 to 2003/2004 there was a substantial reduction in the proportion of acute physical injuries attributable to sport, a substantial increase in the proportion attributable to PT, and a slight increase in the proportion attributable to trade-related activity. The changes in the proportions attributable to sport and PT are statistically significant (p<.05); the change in the proportion attributable to trade-related activity is not statistically significant.
1 See paragraph 5.5.3 and note 2 to Table 121. 2 The issue of incomplete reporting in the present survey is discussed in various places throughout this report. The issue of incomplete reporting in DEFCARE is discussed in DPESP Report 3 (Reference Document D).
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5.5.6 Some support for this conclusion can be found in Report 3 of this series (Reference Document D). Table 4 in Report 3 shows DEFCARE reports by Infantry and ADG personnel for calendar years 1998-2003, broken down into trade-related, other work-related and non work-related. The latter two categories are approximately aligned with PT and sport, respectively. Compared to 1998, the figures for 1999-2002 show a slight increase in the proportion of trade-related injuries, a more marked increase in the proportion of other work- related injuries (possibly PT-related), and a very substantial reduction in the proportion of non-trade-related injuries (possibly sport-related).
5.5.7 However there are two anomalies in Table 4 of Report 3. Calendar year 2003 shows a very different pattern, which is probably attributable to lag effects (the data were extracted in December 2003). More importantly, calendar year 1998 shows very high figures in all three categories, with sharp declines in 1999-2000 followed by moderate increases in 2001-2002. These reversed J-shaped trends must be taken in to account when interpreting changes in proportions with reference to 1998 as a baseline. It would appear that overall there was a sharp decline in injury rates in 1999-2000. Non work-related (predominantly sport) injuries dropped most markedly (from 301 reports in 1998 to 80 in 2000), followed in order of magnitude by trade-related injuries and other work-related (including PT) injuries. During 2001-2002, the trend was reversed, with trade-related injuries almost returning to 1998 levels and other work-related (including PT) injuries exceeding 1999 levels. However, even after this reversal, the number of non work-related (predominantly sport) injuries remained less than half the level of 1998.
Characteristics of Trade-related Acute Injuries
5.5.8 Table 121 shows that 22 of the acute incidents/injuries were identified as being trade- related1, representing almost half of the injuries whose cause was reported. Tables 122 to 135 summarise the characteristics of these trade-related acute incidents/injuries, which are the primary focus of this report.
Table 122. ADG Trade-related Acute Injuries: Month
Cumulative Month Frequency Percent Valid Percent Percent Valid 1 - - - - 2 - - - - 3 5 22.7 22.7 22.7 4 3 13.6 13.6 36.4 5 1 4.5 4.5 40.9 6 3 13.6 13.6 54.5 7 1 4.5 4.5 59.1 8 2 9.1 9.1 68.2 9 2 9.1 9.1 77.3 10 3 13.6 13.6 90.9 11 1 4.5 4.5 95.5 12 1 4.5 4.5 100.0 Total 22 100.0 100.0
5.5.9 Tables 122 and 123 show summaries of the month and time of day of occurrence of the injuries. Subject to a substantial proportional level of variation associated with the small sample size, Table 122 shows a reasonably uniform spread of incidents/injuries throughout the period from March to October. The low figures for November to February probably reflect reduced exposure in that part of the work cycle.
1 See paragraph 5.5.3 and note 2 to Table 121.
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5.5.10 Table 123 shows peaks in the early and late morning which may coincide with periods of high activity, but the sample size is inadequate to establish a clear and reliable diurnal pattern of occurrence.
Table 123. ADG Trade-related Acute Injuries: Time of Day
Cumulative Hour of day Frequency Percent Valid Percent Percent Valid 3 1 4.5 6.3 6.3 5 1 4.5 6.3 12.5 6 1 4.5 6.3 18.8 7 1 4.5 6.3 25.0 8 4 18.2 25.0 50.0 9 1 4.5 6.3 56.3 10 1 4.5 6.3 62.5 11 3 13.6 18.8 81.3 14 1 4.5 6.3 87.5 20 1 4.5 6.3 93.8 21 1 4.5 6.3 100.0 Total 16 72.7 100.0 Missing System 6 27.3 Total 22 100.0
5.5.11 Table 124 summarises the job phase in which each of the trade-related injuries occurred. By default, ‘regular trade activity and training’ was interpreted as including minor exercises and courses as well as routine day-to-day activities within units. No injuries were reported to have occurred during pre-deployment. However, whilst the majority of injuries occurred during regular trade activity and training, in the absence of information about overall exposure of personnel to these phases, it is not possible to judge whether the rates of injury for major exercises, deployments, and regular trade activity and training are commensurate with exposure to each activity.
Table 124. ADG Trade-related Acute Injuries: Job Phase
Cumulative Job phase Frequency Percent Valid Percent Percent Valid Major exercise 5 22.7 22.7 22.7 Deployment 5 22.7 22.7 45.5 Regular trade activity / training 12 54.5 54.5 100.0 Total 22 100.0 100.0
5.5.12 Table 125 shows that three-quarters of reported acute injuries were new, and one quarter represented distinct acute recurrences of previous injuries (as opposed to chronic injuries, which are considered in Section 3.8).
Table 125. ADG Trade-related Acute Injuries: New or Recurring
Cumulative Frequency Percent Valid Percent Percent Valid New 15 68.2 68.2 68.2 Recurring 7 31.8 31.8 100.0 Total 22 100.0 100.0
5.5.13 Tables 126 and 127 summarise the nature of trade-related injuries. Taken together, they indicate that most incidents resulted in sprains and strains, either as the main injury or as a
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secondary injury1. The other types of injury which were reported more than once were effects of weather and injury to nerves or spinal cord.
Table 126. ADG Trade-related Acute Injuries: Nature of Main Injury
Pct of Pct of Nature of main injury Count Responses Cases Fracture/stress non spinal 1 4.5 4.8 Sprain of joint(s) and/or ligaments 4 18.2 19.0 Strain of muscles and/or tendons 9 40.9 42.9 Head injury/concussion 1 4.5 4.8 Internal injury of chest, abdomen and/or pelvis 1 4.5 4.8 Bruise or crushing injury, not involving fracture 1 4.5 4.8 Burn(s) 1 4.5 4.8 Effects of weather, exposure, air pressure (incl. heat stress) 3 13.6 14.3 Other or unspecified injuries 1 4.5 4.8 Total responses 22 100.0 104.8 1 missing case; 21 valid cases
Table 127. ADG Trade-related Acute Injuries: Nature of Other Injuries
Pct of Pct of Nature of other injuries Count Responses Cases Strain of muscles and/or tendons 2 40.0 40.0 Injury to nerves or spinal cord, no evidence of spinal injury 2 40.0 40.0 Other or unspecified injuries 1 20.0 20.0 Total responses 5 100.0 100.0 17 missing cases; 5 valid cases
5.5.14 Table 128 shows that almost half the acute injuries (41%) were to the lower limbs, with a further 18% to the lower back and 14% being whole body injuries. Lower back injuries are of particular concern because of their potential to become chronic and their impact on quality of life and work capacity. These injuries also tend to incur high rehabilitation costs (National Occupational Health and Safety Commission, 2003).
Table 128. ADG Trade-related Acute Injuries: Bodily Location
Valid Cumulative Location of injury Frequency Percent Percent Percent Valid Head 1 4.5 4.5 4.5 Neck 1 4.5 4.5 9.1 Upper Limbs (including shoulders) 2 9.1 9.1 18.2 Lower Limbs (including hips) 9 40.9 40.9 59.1 Abdomen 1 4.5 4.5 63.6 Lower back 4 18.2 18.2 81.8 Pelvis 1 4.5 4.5 86.4 Whole body (e.g. heat stress) 3 13.6 13.6 100.0 Total 22 100.0 100.0
5.5.15 Table 129 shows the association of reported injuries with a list of trade-related activities which was developed in the Trade Task Analysis Workshops (see Reference Document C). Around one third of injuries were associated with each of Patrolling and Carrying. The 22 injuries reported were associated with a total of 37 activities, i.e. on average between one
1 These are both multiple response items (See paragraph 2.8.5). The ‘nature of injury’ question was framed as a single response item (nature of main injury) plus a multiple response item (nature of other injuries); however, some respondents did not distinguish between the two, and instead selected multiple options for the main injury. Consequentially, both questions were analysed as multiple response items. As it transpired, only one of the ADG respondents gave multiple responses to either question.
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and two activities per injury. Most commonly, patrolling and route marching were reported in association with lifting, carrying and assaulting. The relationship between acute injury and particular trade activities was investigated further in the supplementary survey in 2005, the results of which are discussed in Section 6.4.
5.5.16 Narratives explaining how the trade-related acute injuries occurred were provided by 32 respondents. The trade-related activities most frequently mentioned in relation to acute injury were patrolling, assaulting and transport and lifting/carrying tasks. Airmen commented that patrolling on uneven ground caused slips and falls, while the heavy loads carried contributed to musculoskeletal injuries to the legs and back. For example, comments included “patrolling through creek line, slipped on rocks with pack, radio etc”, and “patrolling with large pack up steep incline, ruptured right quadriceps just above knee”. During the assault task a range of factors were reported to have contributed to the injuries sustained, including fatigue induced by heavy load during a combined pursuit-patrol-assault activity, and impact with rocky surfaces when going to ground. Comments included “during a 2km webbing & weapon & Kevlar vest/helmet run into patrol then assault up hill” and “I went to ground for the contact drill & smashed my leg on a rock/root. Nothing could have been done to change it”. Transport and/or lifting/carrying tasks were identified as contributing to a number of acute injuries. In particular, the injuries related to transport highlighted concerns regarding prolonged sitting in a confined environment followed by lifting and carrying tasks. This is illustrated by the comment, “(the injury) occurred over a number of days of lifting/carrying & transport/seating in confined environments”.
Table 129. ADG Trade-related Acute Injuries: Trade-related Activity Pct of Pct of Activity Count Responses Cases Lifting 3 8.1 13.6 Carrying 7 18.9 31.8 Climbing 3 8.1 13.6 Pushing/pulling 1 2.7 4.5 Route marching 4 10.8 18.2 Patrolling 8 21.6 36.4 Assaulting 4 10.8 18.2 Urban operations 3 8.1 13.6 Other 4 10.8 18.2 Total responses 37 100 168.2 0 missing cases; 22 valid cases
5.5.17 Tables 130 to 132 summarise the actions taken after the injury and the resulting outcomes. Table 130 shows that the injury was most frequently reported to a military health centre or military hospital, and less frequently to a Regimental Aid Post (RAP). In no case was it reported that assistance or advice was sought from outside the military system. The relationship between acute injury and particular trade activities was investigated further in the supplementary survey in 2005, the results of which are discussed in Section 6.3.
Table 130. ADG Trade-related Acute Injuries: Actions Taken Pct of Pct of Actions taken Count Responses Cases Self treated 5 16.1 22.7 Received first aid 5 16.1 22.7 Reported to RAP 8 25.8 36.4 Reported to military health centre or military hospital 13 41.9 59.1 Total responses 31 100 140.9 0 missing cases; 22 valid cases
5.5.18 Table 131 shows a summary of the outcomes of acute injuries. Almost three quarters of the reported injuries resulted in time spent on light duties. The work program was affected in
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almost half of the reported cases, and a similar proportion resulted in sick leave being taken. One sixth of injuries resulted in time spent in hospital.
Table 131. Infantry Trade-related Acute Injuries: Outcome Pct of Pct of Outcome Count Responses Cases Spent time in hospital 3 8.6 16.7 Took sick leave 8 22.9 44.4 Took days off work 3 8.6 16.7 Spent time on light duties 13 37.1 72.2 Affected work program 8 22.9 44.4 Total responses 35 100 194.4 4 missing cases; 18 valid cases
5.5.19 Table 132 shows that in over half of the cases where an injury resulted in absence from work, return to work occurred before full recovery.
Table 132. Return to Work before Full Recovery from Trade-related Acute Injury
Cumulative Frequency Percent Valid Percent Percent Valid Yes 3 13.6 60.0 60.0 No 2 9.1 40.0 100.0 Total 5 22.7 100.0 Missing Not applicable - I was not off work 11 50.0 System 6 27.3 Total 17 77.3 Total 22 100.0
5.5.20 Tables 133 to 135 summarise opinions about risks and safeguards. In almost two thirds of cases, the respondent thought that no safeguards or preventative strategies were in place. When safeguards or preventative strategies were in place, they were generally perceived not to have failed. However, the fact that injuries occurred in such cases may indicate that the safeguards were inadequate. Risk taking was perceived to have been a contributing factor in only a small proportion of cases. The question did not explicitly ask on whose part the risk taking behaviour had occurred. Some respondents provided descriptive details, which supported the quantitative data in relation to individual and systemic risk. Three relevant comments included “when hurt you don’t stop you just keep going till the job’s done then you can relax”; “troops encouraged to complete exercise despite injury”; and “hadn’t carried a pack in months, no build up in training”.
Table 133. ADG: Safeguards or Preventative Strategies in Place
Cumulative Frequency Percent Valid Percent Percent Valid Yes 5 22.7 22.7 22.7 No 13 59.1 59.1 81.8 Unsure 4 18.2 18.2 100.0 Total 22 100.0 100.0
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Table 134. ADG: Failure of Safeguards or Preventative Strategies
Cumulative Frequency Percent Valid Percent Percent Valid Yes 1 4.5 12.5 12.5 No 7 31.8 87.5 100.0 Total 8 36.4 100.0 Missing System 14 63.6 Total 22 100.0
Table 135. ADG: Risk Taking as a Contributing Factor to Trade-related Acute Injury
Cumulative Frequency Percent Valid Percent Percent Valid Yes 3 13.6 13.6 13.6 No 19 86.4 86.4 100.0 Total 22 100.0 100.0
Comparison between Trade-related and Non-trade-related Acute Injuries
5.5.21 For those characteristics which apply to both trade-related and non-trade-related injuries1, the profiles of the two types of injury were compared2. There were no significant differences with respect to month, whether the injury was new or recurring, bodily location, outcomes, or timeliness of return to work. The only statistically significant difference in the profiles was with regard to job phase (χ2(5)=12.0, p=0.007), with non-trade related injuries more likely to occur during regular trade activity and training or during leave, and trade related injuries being more predominant during exercises and deployments (see Table 136).
Table 136. ADG Acute Injuries: Job Phase of Trade-related and Non-trade-related Injuries
Activity Trade-related Other Total Job phase Major Count 5 2 7 exercise % within 22.7% 7.7% 14.6% Activity Deployment Count 5 0 5 % within 22.7% .0% 10.4% Activity Leave Count 0 4 4 % within .0% 15.4% 8.3% Activity Regular trade Count 12 20 32 activity / % within 54.5% 76.9% 66.7% training Activity Total Count 22 26 48 % within 100.0% 100.0% 100.0% Activity
1 The category ‘trade-related’ encompassed five ‘work or trade-related’ categories from Question 8 of the acute injury section of the questionnaire (see Annex 2), but excluded travel to and from work and ‘other ADF’. Because the primary focus of the DPESP study is Combat Arms Trade Tasks (CATTs), physical training (PT) was also excluded. Most non-trade-related injuries were associated with PT or sport. 2 Caution should be exercised in interpreting these comparisons because there were some inconsistencies in the responses to questions 8 and 9 in Section B (see Annex 2) which indicated that some respondents classified some trade-related activities as physical training rather than trade-related training.
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5.5.22 The difference in the profiles with regard to time of day approached statistical significance (χ2(5)=9.7, p=0.086) (see Table 137). The higher proportions of non-trade-related injury may be attributable to PT in the early mornings, regimental sport in the afternoons, and after- work sport in the late afternoons.
Table 137. ADG Acute Injuries: Time of Day of Trade-related and Non-trade-related Injuries
Activity Trade-related Other Total Time of day 0000-0559 Count 2 1 3 % within 12.5% 4.2% 7.5% Activity 0600-0859 Count 6 10 16 % within 37.5% 41.7% 40.0% Activity 0900-1159 Count 5 1 6 % within 31.3% 4.2% 15.0% Activity 1200-1459 Count 1 5 6 % within 6.3% 20.8% 15.0% Activity 1500-1759 Count 0 4 4 % within .0% 16.7% 10.0% Activity 1800-2359 Count 2 3 5 % within 12.5% 12.5% 12.5% Activity Total Count 16 24 40 % within 100.0% 100.0% 100.0% Activity
5.5.23 Because some respondents gave multiple responses to the question ‘nature of main injury’, no formal statistical test of the difference between the profiles of trade-related injuries and non-trade-related injuries was possible. The same was true of the other multiple response item, actions taken. Whilst some differences were apparent in the profiles of trade-related and non-trade-related injuries, the sample size was too small for any firm inferences to be drawn.
5.6 Relationship between Characteristics of Trade-related Acute Injuries and Respondent Characteristics
5.6.1 Relationships among some key characteristics of trade-related acute injuries and between characteristics of the incidents/injuries and characteristics of the respondents who reported them1 are summarised in Tables 138 to 146. The row and column totals in these tables are numbers of incidents/injuries.
5.6.2 Note that because of the large number of categories and the relatively small sample size, Tables 138 and 139 are very sparse. The sampling errors are so large in relative terms as to render the mostly very small cell counts and percentages quantitatively unreliable and potentially misleading. For this reason, the data for each cell has been displayed only as a dichotomy of zero and non-zero values i.e. either the combination occurred (*) or it did not (blank). The row and column totals indicate the relative importance of the individual categories of each variable, and the asterisks indicate which combinations were reported. Shaded rows and columns indicate categories which did not occur at all in the survey.
1 The unit of data for the analyses in this section is the injury/incident. In relating characteristics of injuries/incidents to characteristics of the persons involved, data pertaining to respondents who gave details about more than one injury incident are necessarily repeated.
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Table 138. ADG Trade-related Acute Injuries: Nature of Main Injury by Activity
Activity N 1
Nature of Main Injury Lifting Passing Carrying Climbing Pushing/ Pulling Striking Digging Route marching Patrolling Assaulting Urban Operations Pursuit Other N injuries Fracture/ stress fracture (non-spinal) * 1 Fracture/ stress fracture of the spine * Joint dislocation Sprain of joint(s) and/or ligaments * * * * 4 Strain of muscles and/or tendons * * * * * * 9 Head injury/ concussion 1 Internal injury of chest, abdomen and/or pelvis * 1 Traumatic amputation Open wound, not involving traumatic amputation Superficial cuts and abrasions * 1 Bruise or crushing injury, not involving fracture Foreign body on external eye, in ear or nose or in respiratory,
digestive or reproductive system Burn(s) * 1 Injury to nerves or spinal cord without evidence of spinal bone injury Effects of weather, exposure, air pressure or other external causes 3 * * * * * (including heat stress) Other or unspecified injuries * * * 1 N injuries1 2 5 3 1 4 8 4 2 4 21 1 Both of the variables in this table included multiple responses and so both row and column totals sum to more than the total number of injuries.
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Table 139. ADG Trade-related Acute Injuries: Bodily Location of Injury by Activity
Activity
Location of Injury Lifting Passing Carrying Climbing Pushing/ Pulling Striking Digging Route marching Patrolling Assaulting Urban Operations Pursuit Other N injuries Head * 1 Neck * * * 1 Chest/ribs/upper back Abdomen * 1 Lower back * * * 4 Pelvis * 1 Upper limbs (including shoulders) * * * * * * 2 Lower limbs (including hips) * * * * * * * 9 Multiple locations Whole body (e.g. heat stress) * * * * 3 N injuries1 3 7 3 1 4 8 4 3 4 22 1 Reported activities included multiple responses and so column totals sum to more than the total number of injuries.
This report was accepted by the Department of Defence on 22/9/2006 85 DPESP REPORT 7 Retrospective Surveys of Injuries (2004 & 2005): Infantry and ADG
5.6.3 Table 138 shows the nature of the injuries associated with each activity. Because both of these items allowed multiple responses, the row and column totals add up to more than the total number of injury incidents. The types of injury which occurred with the highest frequency (sprains and strains) were associated with a wide range of activities.
5.6.4 Table 139 shows the bodily locations of the injuries associated with each activity. It is noticeable that lower back injuries were associated with both predominantly administrative strength activities (lifting and carrying) and specific combat-related strength-endurance activities (patrolling). Injuries to the lower limbs were more likely to be associated with a wider range of combat activities.
5.6.5 In Tables 140 to 146, percentages have been rounded to whole numbers, and zero percentages have been omitted. It should be noted that for very small counts the sampling errors are relatively large, so such counts and the corresponding percentages are quantitatively unreliable. Shaded rows indicate categories which did not occur at all in the survey.
5.6.6 Table 140 shows, for each type of injury, the percentage of instances in which the five listed outcomes occurred. Because the outcomes are not mutually exclusive, the percentages for each type of injury can sum to more than 100%. Table 140 shows that the most frequently occurring injuries, strains of muscles and/or tendons, resulted in hospitalisation in a quarter of cases, sick leave in a third of cases, and affected the work program in half of cases.
Table 140. ADG Trade-related Acute Injuries: Nature of Main Injury by Outcome
Outcome1
Nature of Main Injury Hospital Sick leave Days off work Light duties Affected work program N injuries % % % % % Fracture/ stress fracture (non-spinal) 100 100 100 1 Fracture/ stress fracture of the spine Joint dislocation Sprain of joint(s) and/or ligaments 25 75 25 4 Strain of muscles and/or tendons 22 33 22 78 44 9 Head injury/ concussion 1 Internal injury of chest, abdomen and/or pelvis 1 Traumatic amputation Open wound, not involving traumatic amputation Superficial cuts and abrasions Bruise or crushing injury, not involving fracture 100 1 Foreign body on external eye, in ear or nose or in respiratory, digestive or reproductive system Burn(s) 100 100 100 1 Injury to nerves or spinal cord without evidence of spinal bone injury Effects of weather, exposure, air pressure or other 56 33 3 external causes (including heat stress) Other or unspecified injuries 100 100 1 All trade-related acute injuries 14 38 14 52 22 1 Percentages do not sum to 100% across rows because the outcomes are not mutually exclusive.
5.6.7 Table 141 shows for each bodily location of injury, the percentage of instances in which the five listed outcomes occurred. Again, the percentages for each location can sum to more than 100%. The pattern in Table 141, taken in conjunction with Table 140, shows that the strains of muscles and/or tendons tended to occur to the lower limbs.
This report was accepted by the Department of Defence on 22/9/2006 86 DPESP REPORT 7 Retrospective Surveys of Injuries (2004 & 2005): Infantry and ADG
Table 141. ADG Trade-related Acute Injuries: Bodily Location of Main Injury by Outcome
Outcome1
Location of Injury Hospital Sick leave Days off work Light duties Affected work program N injuries % % % % % Head 12 Neck 100 1 Chest/ribs/upper back Abdomen 1 Lower back 25 75 25 4 Pelvis 100 1 Upper limbs (including shoulders) 50 100 100 100 50 2 Lower limbs (including hips) 22 33 11 67 56 9 Multiple locations Whole body (e.g. heat stress) 67 33 3 All trade-related acute injuries 14 36 14 59 36 22 1 Percentages do not sum to 100% across rows because the outcomes are not mutually exclusive. 2 One injury to the head was reported, however none of the listed outcomes was reported.
5.6.8 Table 142 shows for each activity associated with injury, the percentage of instances in which the five listed outcomes occurred. Again, the percentages for each activity can sum to more than 100%. Table 142 shows that most of the reported activities, including those most frequently reported (carrying and patrolling) resulted in injuries with a wide range of severities.
Table 142. ADG Trade-related Acute Injuries: Activity by Outcome
Outcome1
Activity Hospital Sick leave Days off work Light duties Affected work program N injuries % % % % % Lifting 33 56 33 56 56 3 Passing Carrying 29 57 29 57 57 7 Climbing 33 33 56 33 3 Pushing/Pulling 100 100 100 100 100 1 Striking Digging Route marching 50 75 4 Patrolling 25 38 25 75 38 8 Assaulting 50 25 25 50 50 4 Urban Operations 56 3 Pursuit Other 50 25 4 All trade-related 14 35 14 59 35 22 acute injuries 1 Percentages do not sum to 100% across rows because the outcomes are not mutually exclusive.
This report was accepted by the Department of Defence on 22/9/2006 87 DPESP REPORT 7 Retrospective Surveys of Injuries (2004 & 2005): Infantry and ADG
5.6.9 Table 143 shows the age profiles for each activity associated with injury. The pattern of filled and empty cells in Table 143 shows that airmen aged 20-24 yrs were injured performing a wide range of administrative and combat activities, whereas the 25-29 year-olds were injured predominantly during combat activities. In the older age groups, injuries were most likely to be associated with carrying. It is noticeable that the substantial cohort of 30-34 year-olds in the survey sample reported no trade-related injuries. This pattern appears to represent an interaction between changes in the occupational exposure profile throughout a military career and the effects of ageing on body strength and susceptibility to injury. The profiles of length of service (Table 144) reinforce this interpretation. Comparison of the profiles of those injured with the profiles of all survey respondents (the two bottom rows of Table 144), shows some over-representation among the injured of the least experienced and most experienced groups, with two of the three intervening groups being under-represented.
Table 143. ADG Trade-related Acute Injuries: Activity by Age
Age group (yrs) N Activity <20 20-24 25-29 30-34 35-39 40-44 45-49 50-54 injuries1 % % % % % % % % Lifting 67 33 3 Passing Carrying 71 14 14 7 Climbing 100 3 Pushing/Pulling 100 1 Striking Digging Route marching 75 25 4 Patrolling 88 13 8 Assaulting 50 50 4 Urban Operations 33 33 33 3 Pursuit Other 50 50 4 Age profiles All trade-related 9 59 23 5 5 22 acute injuries All respondents 5 54 19 13 6 1 1 1 95 1 Reported activities included multiple responses and so row totals sum to more than the total number of injuries. Table 144. ADG Trade-related Acute Injuries: Activity by Length of Service
Length of service (yrs) N Activity <5 5-9 10-14 15-19 20+ injuries1 % % % % % Lifting 67 33 3 Passing Carrying 100 7 Climbing 100 3 Pushing/Pulling 100 1 Striking Digging Route marching 100 4 Patrolling 87 13 8 Assaulting 100 4 Urban Operations 33 33 33 3 Pursuit Other 50 50 4 LOS profiles All trade-related 73 9 9 9 22 acute injuries All respondents 67 16 8 4 4 95 1 Reported activities included multiple responses and so row totals sum to more than the total number of injuries.
This report was accepted by the Department of Defence on 22/9/2006 88 DPESP REPORT 7 Retrospective Surveys of Injuries (2004 & 2005): Infantry and ADG
5.6.10 Table 145 shows a rank profile for each injury-related activity. The last two rows of the table show that officers were slightly over-represented. However, other ranks were injured across a much broader range of activities than NCOs or officers.
Table 145. ADG Trade-related Acute Injuries: Activity by Rank
Rank Other N Activity NCO Officer rank injuries1 % % % Lifting 67 33 3 Passing Carrying 71 14 14 7 Climbing 100 3 Pushing/Pulling 100 1 Striking Digging Route marching 100 4 Patrolling 88 8 Assaulting 100 4 Urban Operations 33 33 33 3 Pursuit Other 50 25 25 4 Rank profiles All trade-related 73 18 9 22 acute injuries All respondents 74 21 5 95 1 Reported activities included multiple responses and so row totals sum to more than the total number of injuries.
5.6.11 Table 146 shows summaries of height, weight and BMI associated with each injury-related activity. Perhaps the most notable pattern in Table 146 is a relationship (albeit a weak one) between BMI category and type of activity. Airmen with a BMI of 25 or above (classified as “overweight”) were slightly under-represented in the injury profile compared to those with a BMI below 25 (classified as “normal”), particularly in association with lifting, carrying and patrolling.
Table 146. ADG Trade-related Acute Injuries: Activity by Basic Physical Characteristics
Height Weight BMI BMI Category
N Activity Mean SD Mean SD Mean SD <25 ≥25 1 injuries cm cm kg kg kg.m-2 kg.m-2 % % Lifting 181.3 6.4 76.7 3.1 23.4 1.6 67 33 3 Passing Carrying 179.0 6.0 78.9 7.6 24.7 2.7 57 43 7 Climbing 179.5 0.7 96.0 9.2 31.0 2.4 100 2 Pushing/Pulling 186.0 - 80.0 - 23.1 - 100 1 Striking Digging Route marching 182.5 3.7 88.0 14.8 26.6 5.3 50 50 4 Patrolling 180.4 4.5 80.5 11.8 24.7 3.4 63 38 8 Assaulting 185.3 5.9 87.5 12.1 25.5 3.3 50 50 4 Urban Operations 177.3 6.7 83.3 16.3 26.3 3.1 33 67 3 Pursuit Other 177.3 2.4 87.0 12.7 27.6 3.4 25 75 4 All trade-related 180.1 5.7 84.0 13.2 25.8 3.8 52 48 21 acute injuries All respondents 180.0 6.8 82.9 10.4 25.6 3.1 46 54 95 1 Reported activities included multiple responses and so row totals sum to more than the total number of injuries.
This report was accepted by the Department of Defence on 22/9/2006 89 DPESP REPORT 7 Retrospective Surveys of Injuries (2004 & 2005): Infantry and ADG
5.7 Characteristics of Chronic Injuries
5.7.1 A total of 46 chronic injuries were reported by 30 respondents as being carried at the time of the survey. Details were provided regarding 43 of these by 29 respondents. This reporting rate with regard to the details was rather higher than was the case for acute injuries (see paragraph 5.5.1).
5.7.2 Summaries of characteristics of the individual chronic injuries are presented in Tables 147 and 148. Unlike an acute injury, which is unequivocally related to a particular trade activity or non-trade activity, a chronic injury may have more than one contributing factor - trade- related, non-trade-related, or both. Table 147 shows that in 62% of chronic injuries, trade activities were cited as a contributing factor. Table 148 shows that around half of these (29%) were regarded as being entirely trade-related. By comparison, 46% of acute injuries were reported as being trade-related (see Table 121).
Table 147. ADG Chronic Injuries: Contributing Activities (1) Pct of Pct of Type of Activity Count Responses Cases Sport 13 19.1 31.0 PT 24 35.3 57.1 Trade-related1 26 38.2 61.9 Travel to work & other ADF 2 2.9 4.8 Other 3 4.4 7.1 Total responses 68 100.0 161.9 1 missing case; 42 valid cases 1 The category ‘trade-related’ encompassed five ‘work or trade-related’ categories from Question 4 of the chronic injury section of the questionnaire (see Annex 2), but excluded travel to and from work and ‘other ADF’. Because the primary focus of the DPESP study is Combat Arms Trade Tasks (CATTs), physical training (PT) was also excluded. Table 148. ADG Chronic Injuries: Contributing Activities (2)
Cumulative Type of Activity Frequency Percent Valid Percent Percent 1 Valid Trade-related only 12 27.9 28.6 28.6 Non-trade-related only 16 37.2 38.1 66.7 Both trade and non- trade-related 14 32.6 33.3 100.0 Total 42 97.7 100.0 Missing System 1 2.3 Total 43 100.0 1 See footnote to Table 147.
Characteristics of Trade-related Chronic Injuries
5.7.3 Tables 149 to 155 summarise the characteristics of the 26 trade-related chronic injuries, which are the primary focus of this report. This includes both those which were reported as exclusively trade-related and those to which both trade and non-trade activities have contributed.
5.7.4 Table 149 shows that the duration of trade-related chronic injuries was distributed across a range of times; this is to be expected because of the range of lengths of service in the survey sample.
This report was accepted by the Department of Defence on 22/9/2006 90 DPESP REPORT 7 Retrospective Surveys of Injuries (2004 & 2005): Infantry and ADG
Table 149. ADG Trade-related Chronic Injuries: Duration
Cumulative Duration Frequency Percent Valid Percent Percent Valid Less than 2 years 9 34.6 36.0 36.0 2 - 4 years 9 34.6 36.0 72.0 5 years or longer 7 26.9 28.0 100.0 Total 25 96.2 100.0 Missing System 1 3.8 Total 26 100.0
5.7.5 Table 150 indicates that almost half of trade-related chronic injuries involve disorders of the muscles, tendons and or/other soft tissues, and a further third involve disorders of joints. Table 151 shows that injuries to lower limbs predominate, followed by injuries to the lower back and upper limbs.
Table 150. ADG Trade-related Chronic Injuries: Nature of Injury
Cumulative Frequency Percent Valid Percent Percent Valid Disorder of the joints 9 34.6 34.6 34.6 Disorder of the spinal vertebrae and/or 2 7.7 7.7 42.3 interverterbral disc Disorder of muscles, tendons and or/other soft 12 46.2 46.2 88.5 tissues Other (please specify) 3 11.5 11.5 100.0 Total 26 100.0 100.0
Table 151. ADG Trade-related Chronic Injuries: Bodily Location
Valid Cumulative Location of injury Frequency Percent Percent Percent Valid Head 1 3.8 3.8 3.8 Neck 1 3.8 3.8 7.7 Upper Limbs (including shoulders) 2 7.7 7.7 15.4 Lower Limbs (including hips) 18 69.2 69.2 84.6 Chest/ribs/upper back 1 3.8 3.8 88.5 Lower back 2 7.7 7.7 96.2 Pelvis 1 3.8 3.8 100.0 Total 26 100.0 100.0
5.7.6 Table 152 shows the association of reported injuries with a list of trade-related activities which was developed in the Trade Task Analysis Workshops (see Reference Document C). Half of the injuries were associated with Route Marching and Assaulting, and more than a quarter were associated with each of a number of other activities: Lifting, Carrying, Climbing, Pushing/pulling, Patrolling, Urban Operations and Pursuit. The 26 injuries reported were associated with a total of 89 activities, i.e. on average between three and four activities per injury. This may reflect the integrated mode of training employed by ADGs; however not enough descriptive detail was reported to enable this to be explored further. The relationship between chronic injury and particular trade activities was investigated further in the supplementary survey in 2005, the results of which are discussed in Section 6.5.
This report was accepted by the Department of Defence on 22/9/2006 91 DPESP REPORT 7 Retrospective Surveys of Injuries (2004 & 2005): Infantry and ADG
Table 152. ADG Trade-related Chronic Injuries: Trade-related Activity Pct of Pct of Activity Count Responses Cases Lifting 7 7.9 26.9 Passing 3 3.4 11.5 Carrying 7 7.9 26.9 Climbing 6 6.7 23.1 Pushing/pulling 6 6.7 23.1 Striking 3 3.4 11.5 Digging 4 4.5 15.4 Route marching 13 14.6 50.0 Patrolling 8 9.0 30.8 Assaulting 14 15.7 53.8 Urban operations 7 7.9 26.9 Pursuit 6 6.7 23.1 Other 5 5.6 19.2 Total responses 89 100.0 342.3 0 missing cases; 26 valid cases
5.7.7 Tables 153 to 155 summarise the actions taken regarding trade-related chronic injuries and their consequences. Tables 153 and 154 are multiple response tables, reflecting the fact that chronic injuries recur episodically, and it is possible for the same injury to be treated differently on different occasions. Table 153 shows that either no action or self treatment was a response in over half the chronic injuries reported. Reporting to a military health centre or military hospital occurred in half of reported cases and to a Regimental Aid Post (RAP) in a quarter of cases. In 10% of cases assistance or advice was sought from civilian sources.
Table 153. ADG Trade-related Chronic Injuries: Actions Taken Pct of Pct of Action taken Count Responses Cases No Action 8 20.0 30.8 Self treated 7 17.5 26.9 Received first aid 25.0 7.7 Reported to Regimental Aid Post (RAP) 7 17.5 26.9 Reported to military health centre or military hospital 13 32.5 50.0 Sought civilian medical assistance or advice: from an emergency department -- - from another civilian facility 3 7.5 11.5 Total responses 40 100.0 153.8 0 missing cases; 26 valid cases
5.7.8 Table 154 shows that whilst performance of duties was affected in all but a small proportion of cases, medical downgrading occurred in only 13% of cases, and occasional temporary restrictions in a further 40% of cases. Table 155 shows that of those who reported the duration of restrictions, about half were for periods of up to 10 days and half for longer periods, with only a small proportion (one case in the survey sample) being permanent.
Table 154. ADG Trade-related Chronic Injuries: Effects on Performance of Duties Pct of Pct of Effect Count Responses Cases No effect 2 6.7 7.7 Affected, but without restrictions 12 40.0 46.2 Occasional temporary restrictions 12 40.0 46.2 Medically downgraded 4 13.3 15.4 Total responses 30 100.0 115.4 0 missing cases; 26 valid cases
This report was accepted by the Department of Defence on 22/9/2006 92 DPESP REPORT 7 Retrospective Surveys of Injuries (2004 & 2005): Infantry and ADG
Table 155. ADG Trade-related Chronic Injuries: Period per Year on Restricted Work Program
Cumulative Frequency Percent Valid Percent Percent Valid Up to 10 days 6 23.1 46.2 46.2 11-364 days 6 23.1 46.2 92.3 All year 1 3.8 7.7 100.0 Total 13 50.0 100.0 Missing System 13 50.0 Total 26 100.0
Comparison between Trade-related and Non-trade-related Chronic Injuries
5.7.9 For those characteristics which apply to both trade-related and non-trade-related injuries1, (i.e. all characteristics except the nature of the activity at the time of the injury) the profiles of the two types of injury were compared. The only statistically significant difference in the profiles was with regard to bodily location (χ2(3)=7.81, p=0.050) (see Table 156), with trade- related injuries more likely to involve lower limbs and less likely to involve upper limbs. Nature of injury was statistically significant at the 10% level (χ2(3)=7.12, p=0.066) (see Table 157), with trade-related activities tending to be more frequently associated with soft tissue injuries, and less with injuries to joints. There were no significant differences with respect to duration of injury.
Table 156. ADG Chronic Injuries: Bodily Location of Trade-related and Non-trade-related Injuries
Did trade-related activities contribute? Total Yes No Body location Upper limbs Count 2 7 9 % within Did trade-related activities contribute? 7.7% 43.8% 21.4% Lower limbs Count 18 7 25 % within Did trade-related activities contribute? 69.2% 43.8% 59.5% Lower back Count 2 1 3 % within Did trade-related activities contribute? 7.7% 6.3% 7.1% Other Count 4 1 5 % within Did trade-related activities contribute? 15.4% 6.3% 11.9% Total Count 26 16 42 % within Did trade-related activities contribute? 100.0% 100.0% 100.0%
1 The category ‘trade-related’ encompassed five ‘work or trade-related’ categories from Question 4 of the chronic injury section of the questionnaire (see Annex 2), but excluded travel to and from work and ‘other ADF’. Because the primary focus of the DPESP study is Combat Arms Trade Tasks (CATTs), physical training (PT) was also excluded. Most non-trade-related injuries were associated with PT or sport.
This report was accepted by the Department of Defence on 22/9/2006 93 DPESP REPORT 7 Retrospective Surveys of Injuries (2004 & 2005): Infantry and ADG
Table 157. ADG Chronic Injuries: Nature of Trade-related and Non-trade-related Injuries Did trade-related activities contribute? Total Yes No c1 Nature Disorder of the joints Count 9 12 21 of the injury % within Did trade-related activities contribute? 34.6% 75.0% 50.0%
Disorder of the spinal Count 2 1 3 vertebrae and/or % within Did trade-related interverterbral disc activities contribute? 7.7% 6.3% 7.1%
Disorder of muscles, Count 12 3 15 tendons and or/other % within Did trade-related soft tissues activities contribute? 46.2% 18.8% 35.7%
Other (please specify) Count 3 0 3 % within Did trade-related activities contribute? 11.5% .0% 7.1% Total Count 26 16 42 % within Did trade-related activities contribute? 100.0% 100.0% 100.0%
5.7.10 Because ‘actions taken with regard to the injury’ and ‘effects on performance of duties’ were multiple response items, no formal statistical tests of the difference between the profiles of trade-related injuries and non-trade-related injuries were possible. However, there were some apparent differences between the profiles in each case (see Tables 158 and 159). In the case of actions taken, a higher proportion had reported to a military health centre, military hospital or a civilian facility for trade-related injuries than for non-trade-related injuries, whereas first aid was more likely to have taken place with non-trade-related injuries than with trade-related injuries. In the case of effects on performance of duties, trade-related injuries tended to be more severe, with a higher proportion of trade-related injuries leading to occasional temporary restrictions, whereas non-trade-related injuries were less likely to lead to any restrictions. These differences must be interpreted with caution because of the small sample sizes involved.
Table 158. ADG Chronic Injuries: Actions Taken for Trade-related and Non-trade-related Injuries
Trade-related
Action taken Yes No % % No Action 31 31 Self treated 27 23 Received first aid 8 31 Reported to RAP 27 23 Reported to military health centre or military hospital 50 31 Sought civilian medical assistance or advice: from an emergency department - - from another civilian facility 12 8 N 26 13
This report was accepted by the Department of Defence on 22/9/2006 94 DPESP REPORT 7 Retrospective Surveys of Injuries (2004 & 2005): Infantry and ADG
Table 159. ADG Chronic Injuries: Effects on Performance of Duties of Trade-related and Non-trade-related Injuries
Trade-related
Effect on performance of duties Yes No % % No effect 8 13 Affected, but without restrictions 46 67 Occasional temporary restrictions 46 7 Medically downgraded 15 20 N 26 15
5.8 Relationship between Characteristics of Trade-related Chronic Injuries and Respondent Characteristics
5.8.1 Relationships among some key characteristics of trade-related chronic injuries and between characteristics of the injuries and characteristics of the respondents who reported them1 are summarised in Tables 160 to 168. Note that because of the large number of categories and the relatively small sample size, some of these tables are very sparse. For clarity, percentages have been rounded to whole numbers, and zero percentages have been omitted. It should be noted that for very small counts the sampling errors are relatively large, so such counts and the corresponding percentages are quantitatively unreliable. This is further exacerbated by anomalies introduced by the weighting procedure, which can have a substantial impact on small counts.
5.8.2 Table 160 shows for each injury-related activity, the percentage of each type of injury reported. Because multiple activities could be reported for a particular injury, the column totals add up to more than the total number of injuries reported. Table 160 shows that high impact force activities such as route marching, patrolling, assaulting and urban operations were most likely to be associated with chronic overuse disorders of the joints. Muscle tendon and other soft tissue injuries were associated with a wide range of activities.
5.8.3 Table 161 shows for each injury-related activity, the percentage of each location of injury reported. Again, because multiple activities could be reported for a particular injury, the column totals add up to more than the total number of injuries reported. The preponderance of lower limb injuries associated with a wide range of activities suggests that many of the soft tissue injuries reported in Table 160 were probably ligament injuries such as twisted ankles.
1 The unit of data for the analyses in this section is the injury. In relating characteristics of injuries to characteristics of the persons involved, data pertaining to respondents who gave details about more than one injury are necessarily repeated.
This report was accepted by the Department of Defence on 22/9/2006 95 DPESP REPORT 7 Retrospective Surveys of Injuries (2004 & 2005): Infantry and ADG
Table 160. ADG Trade-related Chronic Injuries: Nature of Injury by Activity
Activity
Nature of Injury Lifting Passing Carrying Climbing Pushing/ Pulling Striking Digging Route marching Patrolling Assaulting Urban Operations Pursuit Other All Injuries % % % % % % % % % % % % % % Disorder of the joints 14 14 17 17 31 25 43 29 17 35 Disorder of the spinal vertebrae and/or intervertebral discs 29 33 14 17 33 20 8 Disorder of muscles, tendons and/or other soft tissues 23 67 57 67 50 67 75 62 63 50 57 67 20 46 Other 14 14 17 17 25 8 13 7 14 17 60 12 N1 7 3 7 6 6 3 4 13 8 14 7 6 5 26 1 Reported activities included multiple responses and so column totals sum to more than the total number of injuries.
Table 161. ADG Trade-related Chronic Injuries: Bodily Location of Injury by Activity
Activity
Location of Injury Lifting Passing Carrying Climbing Pushing/ Pulling Striking Digging Route marching Patrolling Assaulting Urban Operations Pursuit Other All Injuries % % % % % % % % % % % % % % Head 20 4 Neck 14 33 14 17 33 20 4 Chest/ribs/upper back 14 14 17 17 25 8 13 7 17 20 4 Abdomen Lower back 14 7 8 Pelvis 8 7 4 Upper limbs (including shoulders) 14 33 14 17 17 33 50 8 13 14 14 17 8 Lower limbs (including hips) 43 33 57 67 50 33 25 77 75 64 86 67 40 69 Multiple locations Whole body (e.g. heat stress) N1 7 3 7 6 6 3 4 13 8 14 7 6 5 26 1 Reported activities included multiple responses and so column totals sum to more than the total number of injuries.
This report was accepted by the Department of Defence on 22/9/2006 96 DPESP REPORT 7 Retrospective Surveys of Injuries (2004 & 2005): Infantry and ADG
5.8.4 Table 162 shows for each type of injury, the Medical Employment Category (MEC) profile of the respondents. Table 162 shows that disorders of the joints did not result in downgrading below MEC2, whereas with soft tissue injuries this occurred in over a third of cases.
Table 162. ADG Trade-related Chronic Injuries: Nature of Injury by Medical Employment Category
Medical Employment
Classification (MEC)
U) TM N injuries Nature of Injury MEC1 MEC 2 MEC 3 MEC 4 Temporarily Medically Unfit ( % % % % % Disorder of the joints 78 22 9 Disorder of the spinal vertebrae and/or intervertebral discs 100 1 Disorder of muscles, tendons and/or other soft tissues 55 9 27 9 11 Other 100 3 All trade-related chronic injuries 71 13 13 4 24 1 MEC1: Medically fit, without restriction for deployment. MEC2: Medically fit for deployment, but with some limitations on the duties able to be performed, geographic restrictions and requirements for access to various levels of health support. MEC3: Medically unfit for deployment in the medium term (up to 12 months). MEC4: Medically unfit for deployment in the long term (more than 12 months).
5.8.5 Table 163 shows for each bodily location of injury, the MEC profile of the respondents. Table 163 shows that the more serious soft tissue injuries were to the lower back, pelvis and lower limbs.
Table 163. ADG Trade-related Chronic Injuries: Bodily Location of Injury by Medical Employment Category
Medical Employment Classification (MEC)
Location of Injury MEC1 MEC 2 MEC 3 MEC 4 Temporarily Medically Unfit (TMU) N injuries % % % % % Head 100 1 Neck 100 1 Chest/ribs/upper back 100 1 Abdomen Lower back 100 1 Pelvis 100 1 Upper limbs (including shoulders) 100 2 Lower limbs (including hips) 71 18 12 17 Multiple locations Whole body (e.g. heat stress) All trade-related chronic injuries 71 13 13 4 24
5.8.6 Table 164 shows for each injury-associated activity, the MEC profile of the respondents. Consistently with the patterns shown in Tables 160-163, Table 164 shows that injuries associated with route marching, patrolling and assaulting (i.e. injuries to lower backs, hips and knees) were most likely to result in the most serious consequences.
This report was accepted by the Department of Defence on 22/9/2006 97 DPESP REPORT 7 Retrospective Surveys of Injuries (2004 & 2005): Infantry and ADG
Table 164. ADG Trade-related Chronic Injuries: Activity by Medical Employment Category
Medical Employment Classification (MEC)
1
Activity MEC1 MEC 2 MEC 3 MEC 4 Temporarily Medically Unfit (TMU) N injuries % % % % % Lifting 83 17 6 Passing 100 3 Carrying 86 14 7 Climbing 100 5 Pushing/Pulling 83 17 6 Striking 100 3 Digging 100 4 Route marching 54 23 15 8 13 Patrolling 75 13 13 8 Assaulting 79 7 7 7 14 Urban Operations 86 14 7 Pursuit 83 17 6 Other 100 5 All trade-related 71 13 13 4 24 chronic injuries 1 Reported activities included multiple responses and so row totals sum to more than the total number of injuries.
5.8.7 Table 165 shows the age profiles for each activity associated with injury. The last three rows compare the age profile of respondents with trade-related chronic injuries with that of all respondents. It is noteworthy that whilst the prevalence of chronic injury (as indicated by the ratio in the last row of the table) is much higher in the older age groups (as would be expected, reflecting the effect of cumulative exposure) even the 20-24 year age group were proportionally represented, reporting chronic injuries associated with all types of activity listed.
Table 165. ADG Trade-related Chronic Injuries: Activity by Age
Age group (yrs) N Activity <20 20-24 25-29 30-34 35-39 40-44 45-49 50-54 injuries1 % % % % % % % % Lifting 57 14 14 14 7 Passing 67 33 3 Carrying 57 14 14 14 7 Climbing 67 17 17 6 Pushing/Pulling 67 17 17 6 Striking 67 33 3 Digging 100 4 Route marching 54 15 15 8 8 13 Patrolling 63 13 13 13 8 Assaulting 64 14 7 7 7 14 Urban Operations 57 14 14 14 7 Pursuit 67 17 17 6 Other 60 20 20 5 Age profiles All trade-related 50 15 8 12 8 8 26 chronic injuries (a) All respondents (b) 5 54 19 13 6 1 1 1 95 Ratio a:b 0 0.93 0.79 0.62 2.00 8.00 0 8.00 1 Reported activities included multiple responses and so row totals sum to more than the total number of injuries.
This report was accepted by the Department of Defence on 22/9/2006 98 DPESP REPORT 7 Retrospective Surveys of Injuries (2004 & 2005): Infantry and ADG
5.8.8 Table 166 shows the profiles of length of service (LOS) for each activity associated with injury. The last three rows compare the LOS profile of respondents with trade-related chronic injuries with that of all respondents. Again it is noteworthy that whilst the group with less than 5 years service was under-represented as would be expected, even in this group a substantial proportion reported chronic injuries associated with all activities. The decline in the prevalence ratio (in the last row of the table) through the 5-14 year period may reflect a tendency for personnel with early chronic injuries to leave the service sooner than those without chronic injury.
Table 166. ADG Trade-related Chronic Injuries: Activity by Length of Service
Length of service (yrs) N Activity <5 5-9 10-14 15-19 20+ injuries1 % % % % % Lifting 57 14 29 7 Passing 67 33 3 Carrying 57 14 29 7 Climbing 67 33 6 Pushing/Pulling 67 17 17 6 Striking 67 33 3 Digging 100 4 Route marching 62 8 8 15 8 13 Patrolling 63 13 13 13 8 Assaulting 64 14 14 7 14 Urban Operations 57 14 14 7 Pursuit 67 17 17 6 Other 60 20 20 5 LOS profiles All trade-related 54 12 4 12 19 26 chronic injuries (a) All respondents (b) 67 16 8 4 4 95 Ratio a:b 0.81 0.75 0.50 3.00 4.75 1 Reported activities included multiple responses and so row totals sum to more than the total number of injuries.
5.8.9 Table 167 shows a rank profile for each injury-related activity. The last two rows of the table show that NCOs and officers had a higher representation overall than other ranks. The over- representation of NCOs and officers applied across a wide range of activities.
Table 167. ADG Trade-related Chronic Injuries: Activity by Rank
Rank Other N Activity NCO Officer rank injuries1 % % % Lifting 57 29 14 7 Passing 67 33 3 Carrying 57 29 14 7 Climbing 67 33 6 Pushing/Pulling 67 16 14 6 Striking 67 33 3 Digging 100 4 Route marching 69 23 8 13 Patrolling 63 38 8 Assaulting 64 29 7 14 Urban Operations 57 43 7 Pursuit 67 33 6 Other 60 20 20 5 Rank profiles All trade-related 58 35 8 26 chronic injuries All respondents 74 21 5 95 1 Reported activities included multiple responses and so row totals sum to more than the total number of injuries.
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5.8.10 Table 168 shows summaries of height, weight and BMI associated with each injury-related activity. The last two rows of the table show that respondents with chronic injury tended to have higher than average weight and BMI. The BMI profiles told a similar story of over- representation of airmen with high BMIs among the chronically injured, which is consistent with the greater likelihood of chronic injuries among older, longer serving personnel. The relationship between BMI and chronic injury was in contrast to the pattern for acute injuries (Table 146), reflecting the interaction of age, bodily strength and exposure in determining injury.
Table 168. ADG Trade-related Chronic Injuries: Activity by Basic Physical Characteristics
Height Weight BMI BMI Category
20 - 25 - N Activity Mean SD Mean SD Mean SD <20 ≥30 1 24.99 29.99 injuries % % % % Lifting 177.6 4.8 82.1 8.7 26.1 2.6 43 57 7 Passing 180.0 5.2 77.3 1.2 23.9 1.0 67 33 3 Carrying 178.7 3.5 85.1 8.3 26.7 2.8 29 71 7 Climbing 178.7 4.8 84.8 9.9 26.6 3.1 50 50 6 Pushing/Pulling 178.8 3.8 83.8 8.2 26.2 2.8 33 67 6 Striking 180.0 5.2 77.3 1.2 23.9 1.0 67 33 3 Digging 181.0 2.3 86.0 9.2 26.3 3.5 50 50 4 Route marching 178.5 5.4 86.7 8.2 27.3 2.9 31 62 8 13 Patrolling 177.4 5.7 85.4 7.3 27.2 2.6 25 75 8 Assaulting 179.4 2.7 87.2 9.2 27.1 3.0 36 50 14 14 Urban Oper’ns 179.7 3.3 84.6 6.6 26.2 2.7 43 57 7 Pursuit 179.5 3.1 86.7 7.9 27.0 3.0 33 67 6 Other 180.6 4.9 90.8 9.0 27.8 2.0 100 5 All trade-related 178.5 5.2 85.2 9.1 26.8 2.7 39 54 8 26 chronic injuries All respondents 180.0 6.8 82.9 10.4 25.6 3.1 2 44 47 7 95 1 Reported activities included multiple responses and so row totals sum to more than the total number of injuries.
5.9 Opinions of Respondents
5.9.1 Respondents who had incurred acute injuries or who were carrying chronic injuries during the 12-month survey period were asked three questions about possible systemic factors that might contribute to trade-related injuries. Summaries of responses from the 34 respondents with trade-related injuries1 are presented in Tables 169 to 171. Manning levels was nominated by 13% of respondents, time pressure by 41% and equipment limitations by 19%.
Table 169. ADG: Deficiencies in Manning Levels as a Contributing Factor to Acute or Chronic Injury
Cumulative Frequency Percent Valid Percent Percent Valid Yes 4 11.8 12.9 12.9 No 27 79.4 87.1 100.0 Total 31 91.2 100.0 Missing System 3 8.8 Total 34 100.0
1 Many respondents who had either reported no trade-related injuries, or for whom there was uncertainty as to the trade-related status of their injuries (or in some cases who had reported no injuries at all), also answered these questions, generally in the negative; however a few of these responded in the affirmative. All of these responses were regarded as invalid and were excluded from the analysis.
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Table 170. ADG: Time Pressure as a Contributing Factor to Acute or Chronic Injury
Cumulative Frequency Percent Valid Percent Percent Valid Yes 13 38.2 40.6 40.6 No 19 55.9 59.4 100.0 Total 32 94.1 100.0 Missing System 2 5.9 Total 34 100.0
Table 171. ADG: Equipment Limitations as a Contributing Factor to Acute or Chronic Injury
Cumulative Frequency Percent Valid Percent Percent Valid Yes 6 17.6 19.4 19.4 No 25 73.5 80.6 100.0 Total 31 91.2 100.0 Missing System 3 8.8 Total 34 100.0
5.9.2 Considering the three sets of responses together, a three-factor cross-tabulation (not shown here) revealed that of the 34 respondents with trade-related injuries, one did not answer any of the three questions. Of the 33 respondents who answered at least one of the three questions, none answered yes to all three questions, seven (21.2%) answered yes to two of the three questions, and a further nine (27.3%) answered yes to one of the three questions. Hence a total of 48.5% of respondents with trade-related injury believed that at least one of these systemic factors contributed to their injury. This finding is very important. It is likely that the systemic factors identified in this survey as contributing to injury can be seen as indicators of a more general and pervasive influence of systemic failure upon airmen’s injuries. Further, it also needs to be acknowledged that system failure is often closely aligned and significantly influenced by a range of cultural factors that may affect overall work behaviour and injury risk (Sasoua and Reason, 1999; Reason, 1998).
5.9.3 Explanatory comments from airmen focused upon insufficient section numbers and the need to return to work before full recovery from injury in order to maintain minimal section numbers and operational capacity. Comments included: “for injury to my knee my 5 man patrol was carrying the equipment of a 10 man section”; “carrying of section items at under strength level, 6 people carrying the amount of 10 people”; and “even on chit made to work outside boundaries on chit as not enough people to do all work”. The comments regarding time pressures were related to return to work following injury rather than a focus upon insufficient time to undertake work tasks per-se; for example “sprained ankle did not have time to heal properly due to training requirements”. The small number of comments made regarding the contribution of equipment to injury tended to focus on inadequately fitting boots and packs. It was also stated that some airmen purchased their own equipment as they believed the issued equipment to be inadequate.
5.9.4 Finally, all respondents were asked a number of questions about attitudes to injury within the ADF culture. A summary of responses is presented in Table 172. Key themes which emerge from Table 172 are: awareness of injury prevention measures; variation in levels of risk taking and avoidance of risk; concern about the effect of injury on capacity to do the job, including deployment, but not on income or family relationships; and willingness to report injury in spite of some concern about repercussions.
5.9.5 Differences of opinion between those known to have had trade-related injuries and those known not to have had trade-related injuries in the survey period were also explored. Respondents for whom it was uncertain whether or not they had had trade-related injuries (due to incomplete responses) were excluded from this analysis. There were significant differences in response patterns on only two items, which are also indicated in Table 172.
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Those with trade-related injuries tended to perceive a greater likelihood of being injured, and were more likely to fear repercussions of reporting an injury.
5.9.6 Respondents were also invited to comment about any aspect of the survey or related issues. However, the comments were not transcribed into digital form, and so were not available to the DPESP research team for analysis. Comments from the 2005 DPESP survey were transcribed and analysed, and are discussed in Section 6.6.
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Table 172. ADG: Perceived Attitudes to Injury within the ADF Difference b/w Strongly Strongly Trade-related and Disagree Disagree Uncertain Agree Agree Non-trade-related % % % % % Sig. level1,2 Difference3 It is quite likely that I will suffer an injury in the next month 10.7 20.2 41.7 22.6 4.8 * Agree ↑ If I had a typical/common injury for my trade I would be unable to do my current job 3.6 16.7 26.2 41.7 11.9 ns If I had a typical/common injury for my trade it would significantly affect my take 19.8 34.9 22.1 20.9 2.3 ns home income If I had a typical/common injury for my trade it would significantly affect my ability 1.2 1.2 9.3 44.2 44.2 ns to deploy If I had a typical/common injury for my trade it would significantly affect my ability 3.5 8.2 16.5 42.4 29.4 ns to attend promotion courses If I had a typical/common injury for my trade it would significantly affect my 25.6 30.2 27.9 11.6 4.7 ns relationship with my close family members If I had a typical/common injury for my trade and reported it to a Defence doctor it 1.2 4.7 40.7 37.2 16.3 ns is likely that I would be medically downgraded I would report any injury that I suffered to a Defence Health facility 4.7 15.1 23.3 40.7 16.3 ns It is accepted practice in my work area to prevent injuries during sport or other 3.5 9.3 18.6 55.8 12.8 ns physical activities (including job related activities) wherever possible It is accepted practice in my work area to report all injuries to Defence medical staff 1.2 17.4 15.1 57.0 9.3 ns I frequently risk injury during sport and other physical activity, or to achieve work 6.0 17.9 17.9 42.9 15.5 ns goals It is accepted practice in my work area to risk injuries during sport or other physical 4.7 16.3 20.9 43.0 15.1 ns activities (including job related activities) I take steps to prevent injuries during sport or other physical activity 2.3 4.7 11.6 68.6 12.8 ns I take steps to prevent injuries during the performance of physical work tasks 1.2 5.8 12.8 66.3 14.0 ns There are adequate resources available to prevent injuries during sport and other 5.8 7.0 33.7 48.8 4.7 ns physical activity There are adequate resources available to prevent injuries during the performance 3.5 11.6 38.4 44.2 2.3 ns of physical work tasks I am able to avoid risking injury during sport and other physical activities 5.8 23.3 34.9 30.2 5.8 ns I am able to avoid risking injury during physical work activities 4.7 37.2 31.4 24.4 2.3 ns I can report any injury that I have to a Defence medical facility without any fear of 5.8 11.6 32.6 46.5 3.5 * Agree ↑ repercussions N=84-86 1 Because the numbers in many of the cells of the cross-tabulations were small, for statistical validity all χ2 tests were based on responses collapsed into three categories: Disagree, Uncertain, Agree. 2 * p<0.05, ** p<0.01, *** p<0.001, ns Not significant 3 Difference in the responses of those with trade-related injuries compared with the responses of those without trade-related injuries. For example, Agree↑ means that those with trade-related injuries were more likely to agree than those without trade-related injuries.
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6 SURVEY OF AIRFIELD DEFENCE GUARDS 2005: RESULTS AND DISCUSSION
6.1 Introduction
6.1.1 In Section 6.2 the characteristics of the 71 ADG respondents are examined and compared with those of respondents to the 2004 survey.
6.1.2 In Section 6.3 the reported injury experience and injury status of the respondents are examined, and compared with those of respondents to the 2004 survey.
6.1.3 Information was provided regarding 42 acute injury incidents which occurred during the survey period. In Section 6.4 selected characteristics of the individual incidents and injuries are examined.
6.1.4 Information was provided regarding 35 chronic injuries being carried at the time of the survey. In Section 6.5 selected characteristics of the individual injuries are examined.
6.1.5 Respondents were asked their opinions about factors contributing to injury, and about attitudes to injury within the ADF culture. They were also invited to comment about any aspect of the survey or related issues. In Section 6.6 the opinions of respondents are examined.
6.2 Characteristics of Respondents
6.2.1 Summaries of characteristics of the 95 respondents are presented in Tables 173 to 177. Also included in Tables 173 to 175 for purposes of comparison are profiles of age, length of service and rank for 2 AFDS as at December 2005, provided by ADG.
6.2.2 Comparing Tables 173 and 174 with the 2004 survey results (Tables 101 and 102), the profiles of age and length of service were very similar, although the 2004 sample included a small proportion of older, longer serving personnel. This is consistent with the fact that the 2005 survey was administered in conjunction with normative field testing, whilst the 2004 survey encompassed the full range of personnel in the AFDW. The inclusion of IETs in 2005 might have been expected to increase the proportions in the lowest categories of age and length of service, but this was not the case. In both survey samples the younger, less experienced airmen were over-represented by comparison with the 2 AFDS population profile.
Table 173. ADG 2005: Age Distribution 2005 Survey Sample 2 AFDS Population 2005 Valid Cum. Cum. Age group Frequency % % % Frequency % % Valid 17-19 5 7.0 7.0 7.0 1 0.7 0.7 20-24 36 50.7 50.7 57.7 56 38.9 39.6 25-29 18 25.4 25.4 83.1 51 35.4 75.0 30-34 9 12.7 12.7 95.8 18 12.5 87.5 35-39 3 4.2 4.2 100.0 13 9.0 96.5 40-44 3 2.1 98.6 45-49 2 1.4 100.0 Total 71 100.0 100.0 144 100.0
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Table 174. ADG 2005: Length of Service 2005 Survey Sample 2 AFDS Population 2005 Valid Cum. Cum. Length of service Frequency % % % Frequency % % Valid Less than 6 months 22 31.0 31.0 31.0 6 months - 1 year 1 1.4 1.4 32.4 1-4 years 23 32.4 32.4 64.8 501 34.7 34.7 5-9 years 20 28.2 28.2 93.0 76 52.8 87.5 10-14 years 3 4.2 4.2 97.2 5 3.5 91.0 15-19 years 2 2.8 2.8 100.0 9 6.3 97.2 20-24 years 2 1.4 98.6 25-29 years 1 0.7 99.3 30-34 years 1 0.7 100.0 144 100.0 1 < 5 years
6.2.3 Comparison of Tables 175 and 103 shows that there was a lower proportion of NCOs in the 2005 sample (12.9%) than the 2004 sample (21.1%). There was also a much lower proportion of other ranks (48.6%), with IETs (32.9%) displacing much of the “other ranks” category from the 2004 sample (73.7%). With reference to the 2005 2 AFDS population, NCOs were over-represented in both survey samples.
Table 175. ADG 2005: Rank 2005 Survey Sample 2 AFDS Population 2005 Valid Cum. Cum. Rank category Frequency % % % Frequency % % Valid Other rank 34 47.9 48.6 48.6 125 86.8 86.8 NCO 9 12.7 12.9 61.4 10 6.9 93.8 Officer 4 5.6 5.7 67.1 9 6.3 100.0 IET 23 32.4 32.9 100.0 Total 70 98.6 100.0 144 100.0 Missing System 1 1.4 Total 71 100.0
Table 176. ADG 2005: Basic Physical Characteristics
Characteristic N Minimum Maximum Mean Std. Deviation Height (cm) 69 164 192 177.56 6.212 Weight (kg) 69 62 106 79.01 8.101 -2 Body mass index (BMI) (kg m ) 69 20.25 30.08 25.08 2.392
Table 177. ADG 2005: BMI Category
Cumulative BMI Category Frequency Percent Valid Percent Percent Valid 20-24.99 32 45.1 46.4 46.4 25-29.99 35 49.3 50.7 97.1 ≥30 2 2.8 2.9 100.0 Total 69 97.2 100.0 Missing System 2 2.8 Total 71 100.0
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6.2.4 Comparison of Tables 176 and 104 shows that the profiles of height, weight and body mass for the two survey samples were similar; there were no significant differences between the mean values.
6.2.5 Comparison of Tables 177 and 105 shows that the categorised BMI profiles were similar, though there were fewer extreme values in the 2005 sample.
6.3 Injury Experience and Injury Status
6.3.1 Tables 178 and 179 show details of acute injury experience during the survey period. Tables 180 and 181 give corresponding information regarding chronic injury status at the time of the survey. These tables are based on respondents, not individual incidents/injuries (see Section 4.4 for that analysis). The purpose here is to divide the respondents into those who have had injuries of the nominated type, and those who have not. The category ‘trade- related’ encompassed five ‘work or trade-related’ categories from Question 8 of the acute injury section (and Question 4 of the chronic injury section) of the questionnaire (see Annex 9), but excluded travel to and from work. Because the primary focus of the DPESP study is Combat Arms Trade Tasks (CATTs), physical training (PT) was also excluded from this category. The “possibles” in Tables 179 and 181 are due to some respondents failing to answer these questions.
Table 178. ADG 2005: Acute Injury
Cumulative Acute injury Frequency Percent Valid Percent Percent Valid Yes 31 43.7 46.3 46.3 No 36 50.7 53.7 100.0 Total 67 94.4 100.0 Missing System 4 5.6 Total 71 100.0
Table 179. ADG 2005: Trade-related and Non-trade-related Acute Injury
Cumulative Injury category1 Frequency Percent Valid Percent Percent Valid Some or all trade-related 16 22.5 23.9 23.9 2 Possible trade-related 1 1.4 1.5 25.4 Non-trade-related only 14 19.7 20.9 46.3 No acute injuries 36 50.7 53.7 100.0 Total 67 94.4 100.0 Missing System 4 5.6 Total 71 100.0 1 The category ‘trade-related’ encompassed five ‘work or trade-related’ categories from Question 8 of the acute injury section of the questionnaire (see Annex 9, but excluded travel to and from work. Because the primary focus of the DPESP study is Combat Arms Trade Tasks (CATTs), physical training (PT) was also excluded from this category. 2 The “possible” is due to one respondent failing to answer this question.
6.3.2 It is useful to compare Tables 178 and 179 with Tables 111 and 112. The proportion of respondents reporting acute injury was very similar in the 2005 sample (46.3%) and the 2004 sample (45.3%) (Tables 178 and 111). Again, the proportion of injuries known to be trade-related was similar in 2005 (23.9%) and 2004 (22.1%) (Tables 179 and 112). However, the 2004 sample had a higher proportion of possible trade-related injuries (9.5%) than the 2005 sample (1.5%). As was anticipated (see paragraph 2.10.4) survey forms were filled in more thoroughly and completely in the 2005 survey, and there was less ambiguity about the trade-related status of injuries.
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6.3.3 Tables 180 and 181 can be compared with Tables 113 and 114. The rates of reported chronic injury and trade-related chronic injury were very similar in both samples (2005: 42.9% and 30.4%; 2005: 41.7% and 29.2%)
Table 180. ADG 2005: Chronic Injury
Cumulative Chronic injury Frequency Percent Valid Percent Percent Valid Yes 24 33.8 42.9 42.9 No 32 45.1 57.1 100.0 Total 56 78.9 100.0 Missing System 15 21.1 Total 71 100.0
Table 181. ADG 2005: Trade-related and Non-trade-related Chronic Injury
Cumulative Injury category1 Frequency Percent Valid Percent Percent Valid Some or all trade-related 17 23.9 30.4 30.4 2 Possible trade-related 1 1.4 1.8 32.2 Non-trade-related only 6 8.5 10.7 42.9 No chronic injuries 32 45.1 57.1 100.0 Total 56 78.9 100.0 Missing System 15 21.1 Total 71 100.0 1 The category ‘trade-related’ encompassed five ‘work or trade-related’ categories from Question 4 of the chronic injury section of the questionnaire (see Annex 9), but excluded travel to and from work. Because the primary focus of the DPESP study is Combat Arms Trade Tasks (CATTs), physical training (PT) was also excluded from this category. 2 The “possible” is due to one respondent failing to answer this question.
6.3.4 Summaries of numbers of reported acute injury incidents experienced during the survey period and chronic injuries being carried are presented in Tables 182 and 183. The profiles are similar to the corresponding 2004 profiles (Tables 115 and 116). Indeed the average rates underlying Tables 180 and 181 are (mean ± standard error) 0.672 ± 0.090 acute injuries per person (672 ± 90 per thousand persons per year) and 0.643 ± 0.102 chronic injuries per person (643 ± 102 per thousand persons). The chronic injury rate is almost identical to that calculated from the 2004 data (639 ± 88) (see paragraph 5.3.4). The acute injury rate is lower than the 2004 estimate (758 ± 98). Whilst this difference is not statistically significant, it is consistent with the inclusion of IETs, who had a shorter exposure time, in the 2005 sample, and the exclusion of personnel with recent injuries from the 2005 sample.
Table 182. ADG 2005: Number of Acute Injuries
Cumulative Number Frequency Percent Valid Percent Percent Valid 0 36 50.7 53.7 53.7 1 18 25.4 26.9 80.6 2 12 16.9 17.9 98.5 3 1 1.4 1.5 100.0 Total 67 94.4 100.0 Missing System 4 5.6 Total 71 100.0
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Table 183. ADG 2005: Number of Chronic Injuries
Cumulative Number Frequency Percent Valid Percent Percent Valid 0 32 45.1 57.1 57.1 1 14 19.7 25.0 82.1 2 8 11.3 14.3 96.4 3 2 2.8 3.6 100.0 Total 56 78.9 100.0 Missing System 15 21.1 Total 71 100.0
6.4 Characteristics of Acute Injuries
6.4.1 A total of 45 acute injury incidents were reported by 31 respondents as having occurred during the survey period. However, details were only provided (by all 31 respondents) regarding 42 of these injury incidents. A summary of the contexts of the individual incidents and injuries is presented in Table 184. Forty one percent of the reported injuries were trade- related, a slightly lower proportion than the 46% in 2004 (see Table 121). Forty two comments were made regarding how the acute injury occurred. These included 21 (50.1%) trade-related comments, 18 (42.8%) comments related to sport, PT and non-trade related training, and three (7.2%) other, personal and unknown comments.
Table 184. ADG 2005 Acute Injuries: Activity
Cumulative Type of activity Frequency Percent Valid Percent Percent Valid sport 6 14.3 14.3 14.3 PT 17 40.5 40.5 54.8 Sport & PT 1 2.4 2.4 57.1 Trade-related 17 40.5 40.5 97.6 Other 1 2.4 2.4 100.0 Total 42 100.0 100.0
6.4.2 Whilst most of the questions from the 2004 survey about specific acute injury incidents were asked again in 2005, their purpose was essentially as a prelude to the two new questions on the 2005 survey, relating to CATTs and physical actions. The discussion of detailed characteristics of acute injuries from the 2004 survey (see Sections 5.5 and 5.6) is not replicated here for the 2005 survey. Discussion is limited to the two new questions about CATTs and physical actions.
6.4.3 The first objective of the 2005 survey (discussed in paragraph 2.10.2) was to obtain further information about the relationship between the occurrence of injury and particular CATTs, and the critical physical actions involved in those CATTs. In the 2004 survey, trade-related activity was characterised using fairly broad categories developed at a series of Trade Tasks Analysis Workshops held in November 2003, at the beginning of the DPESP (see Reference Document C). The 2004 survey took place prior to the completion of detailed observation of trade tasks and the subsequent physical movement analysis and identification of critical CATTs in the Criterion Tasks Workshop (see Reference Document G). The 2005 survey incorporated two questions based on this later work, one about CATTs and the other about physical actions, both of which were much more finely differentiated (see Annexes 1 and 9).
6.4.4 Table 185 shows the CATTs to which the trade-related acute injuries were attributed, and Table 186 shows the physical actions which were involved. These tables show that of the 25 high-risk and/or physically demanding CATTs listed on the survey form, only six were associated with instances of acute injury. These were Patrol in Marching Order, Patrol in Patrol Order and Section Attack. The predominant associated actions were patrolling and
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walking; going to ground; and carrying loads, either in hands/arms or on the back. Most injuries were associated with a single CATT (as per the instructions on the form), but a few respondents were unable to pinpoint the occurrence of the injury sufficiently to differentiate between such combinations as Patrol and Section Attack. On average, each injury was associated with between two and three physical actions, typically combinations such as patrolling and load carriage.
6.4.5 The narrative data support the quantitative data, in that the most commonly reported causes of acute injury were related to assaulting (16.7% of comments) and sustained patrolling or patrolling in marching order (16.7% of comments). Relevant comments included, “going to ground, crawling in fire and movement, should have padding built into combat clothing should have uniforms for barracks duties separate uniform with padding for fire & movement, contact drills” and “battle hiking with webbing up Morialta (mountain) rocks all over path. Tired, twisted my ankle on a rock and landed on my right knee on another rock”. The remaining comments referred to patrolling (2.4%), transport and carrying/lifting (4.8%) and non-specific ADG-related tasks (7.1%).
6.4.6 As in 2004, a small amount of data were obtained in 2005 that related to whether safeguards and preventative strategies were in place when the incident occurred, whether these strategies and safeguards failed or whether excessive risk-taking behaviour or acceptance of risk contributed to the incident. These data highlighted an acceptance of individual risk and systemic failure. For example, “I was responsible. I took excessive risks in the activity. I accept responsibility for the accident” and “we were just tired from being worked so hard so naturally injuries were going to occur.”
Table 185. ADG 2005 Acute Injuries: by Associated CATTs Pct of Pct of CATT Count Responses Cases Bayonet assault Casualty evacuation drag Debussing 1 5.6 6.7 Dig to Stage 1, 2 or 3 Jerry can carry Load and unload UNIMOG 1 5.6 6.7 Patrol in marching order 6 33.3 40.0 Patrol in patrol order 3 16.7 20.0 Pursuit 2 11.1 13.3 Sand bagging Section attack 3 16.7 20.0 Stores carry Sqn. level replenishment Stretcher carry Wiring Urban Operations Forced entry & stair climb Ladder lift Population protection Rope climb Second storey drop Tunnel crawl Urban rushing Wall climb: 1.82 m Wall climb: 2.43 m Wall climb: 3.66 m Other 2 11.1 13.3 Total 18 100.0 120.0 2 missing cases; 15 valid cases
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Table 186. ADG 2005 Acute Injuries: by Associated Physical Actions Pct of Pct of Action Count Responses Cases Carrying load in hands/arms 4 10.8 25.0 Carrying load on back 5 13.5 31.3 Climbing a ladder Climbing a rope Climbing a wall Crawling 1 2.7 6.3 Crouching Digging Dropping & landing 2 5.4 12.5 Going to ground 4 10.8 25.0 Jumping Lying Lifting 2 5.4 12.5 Marching 2 5.4 12.5 Passing Patrolling 4 10.8 25.0 Pushing/Pulling 1 2.7 6.3 Rising to your feet 2 5.4 12.5 Running 2 5.4 12.5 Sitting Sprinting 1 2.7 6.3 Standing Striking Walking 5 13.5 31.3 Other 2 5.4 12.5 Total 37 100.0 231.3 1 missing case; 16 valid cases
6.5 Characteristics of Chronic Injuries
6.5.1 A total of 36 chronic injury conditions were reported by 24 respondents as having occurred during the survey period. Details were provided by all 24 respondents regarding 35 of these injuries.
6.5.2 A summary of the contexts of the individual injuries is presented in Tables 187 and 188. Unlike an acute injury, which is generally related to a particular trade activity or non-trade activity, a chronic injury may have more than one contributing factor - trade-related, non- trade-related, or both. Table 187 shows that in almost two thirds of all chronic injuries, trade activities were cited as a contributing factor. However, Table 188 shows that only a minority of these (21% of all reported chronic injuries) were entirely trade-related. This is a much lower proportion than the 41% reported for acute injuries (see Table 184), and is also slightly lower than the corresponding figure from the 2004 survey (Table 148).
Table 187. ADG 2005 Chronic Injuries: Contributing Activities (1)
Pct of Pct of Type of activity Count Responses Cases Sport 7 14.0 20.6 PT 20 40.0 58.8 Trade-related 22 44.0 64.7 Other 1 2.0 2.9 Total 50 100.0 147.1 1 missing case; 34 valid cases
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Table 188. ADG 2005 Chronic Injuries: Contributing Activities (2)
Valid Cumulative Type of Activity Frequency Percent Percent Percent Valid Trade-related only 7 20.0 20.6 20.6 Non-trade-related only 12 34.3 35.3 55.9 Both trade and non-trade-related 15 42.9 44.1 100.0 Total 34 97.1 100.0 Missing System 1 2.9 Total 35 100.0
6.5.3 As in the case of acute injuries (see paragraph 6.4.2), the discussion of detailed characteristics of chronic injuries from the 2004 survey (see Sections 5.7 and 5.8) is not replicated here for the 2005 survey. Discussion is limited to the two new questions on the 2005 survey, relating to CATTs and physical actions.
Table 189. ADG 2005 Chronic Injuries: by Associated CATTs Pct of Pct of CATT Count Responses Cases Bayonet assault 1 1.1 5.6 Casualty evacuation drag 4 4.5 22.2 Debussing 6 6.8 33.3 Dig to Stage 1, 2 or 3 3 3.4 16.7 Jerry can carry 2 2.3 11.1 Load and unload UNIMOG 2 2.3 11.1 Patrol in marching order 10 11.4 55.6 Patrol in patrol order 7 8.0 38.9 Pursuit 3 3.4 16.7 Sand bagging 3 3.4 16.7 Section attack 13 14.8 72.2 Stores carry 3 3.4 16.7 Sqn. level replenishment 1 1.1 5.6 Stretcher carry 5 5.7 27.8 Wiring 2 2.3 11.1 Urban Operations Forced entry & stair climb 1 1.1 5.6 Ladder lift 1 1.1 5.6 Population protection 1 1.1 5.6 Rope climb 3 3.4 16.7 Second storey drop 2 2.3 11.1 Tunnel crawl 3 3.4 16.7 Urban rushing 2 2.3 11.1 Wall climb: 1.82 m 4 4.5 22.2 Wall climb: 2.43 m 3 3.4 16.7 Wall climb: 3.66 m 1 1.1 5.6 Other 2 2.3 11.1 Total 88 100.0 488.9 4 missing cases; 18 valid cases
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Table 190. ADG 2005 Chronic Injuries: by Associated Physical Actions Pct of Pct of Action Count Responses Cases Carrying load in hands/arms 3 2.9 15.0 Carrying load on back 11 10.5 55.0 Climbing a ladder 1 1.0 5.0 Climbing a rope 1 1.0 5.0 Climbing a wall 3 2.9 15.0 Crawling 4 3.8 20.0 Crouching 5 4.8 25.0 Digging 4 3.8 20.0 Dropping & landing 6 5.7 30.0 Going to ground 10 9.5 50.0 Jumping 4 3.8 20.0 Lying 3 2.9 15.0 Lifting 3 2.9 15.0 Marching 5 4.8 25.0 Passing 2 1.9 10.0 Patrolling 6 5.7 30.0 Pushing/Pulling 5 4.8 25.0 Rising to your feet 6 5.7 30.0 Running 9 8.6 45.0 Sitting 1 1.0 5.0 Sprinting 5 4.8 25.0 Standing 1 1.0 5.0 Striking 2 1.9 10.0 Walking 2 1.9 10.0 Other 3 2.9 15.0 Total 105 100.0 525.0 2 missing cases; 20 valid cases
6.5.4 Table 189 shows the CATTs to which the trade-related acute injuries were attributed, and Table 190 shows the physical actions which were involved. These tables show that all 25 high-risk and/or physically demanding CATTs listed on the survey form were reported as contributing to chronic injuries. The most frequently reported, as with acute injury, were Patrol in Marching Order, Patrol in Marching Order and Section Attack. Debussing and Stretcher Carry were the next most commonly cited CATTs. The most common actions associated with chronic injury were running, going to ground and carrying loads on the back. Most injuries were associated with multiple CATTs and multiple actions; on average, each injury was associated with around five CATTs and around five physical actions. Insufficient qualitative data was provided to enable these data to be discussed further.
6.6 Opinions of Respondents
6.6.1 Respondents who had incurred acute injuries or who were carrying chronic injuries during the 12-month survey period were asked three questions about possible systemic factors that might contribute to trade-related injuries. Summaries of weighted responses from the 105 respondents with trade-related injuries1 are presented in Tables 191 to 193. Manning levels was nominated by 25% of respondents, time pressure by 21% and equipment limitations by 26%. Two of these proportions were considerably different from the 2004 survey results (13%, 41%, 19% respectively), but in view of the small sample sizes could not be substantiated (i.e were not statistically significant).
1 Many respondents who had either reported no trade-related injuries, or for whom there was uncertainty as to the trade-related status of their injuries (or in some cases who had reported no injuries at all), also answered these questions, generally in the negative; however a few of these responded in the affirmative. All of these responses were regarded as invalid and were excluded from the analysis.
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Table 191. ADG 2005: Deficiencies in Manning Levels as a Contributing Factor to Acute or Chronic Injury
Cumulative Frequency Percent Valid Percent Percent Valid Yes 7 25.0 25.0 25.0 No 21 75.0 75.0 100.0 Total 28 100.0 100.0
Table 192. ADG 2005: Time Pressure as a Contributing Factor to Acute or Chronic Injury
Cumulative Frequency Percent Valid Percent Percent Valid Yes 6 21.4 21.4 21.4 No 22 78.6 78.6 100.0 Total 28 100.0 100.0
Table 193. ADG 2005: Equipment Limitations as a Contributing Factor to Acute or Chronic Injury
Cumulative Frequency Percent Valid Percent Percent Valid Yes 7 25.0 25.9 25.9 No 20 71.4 74.1 100.0 Total 27 96.4 100.0 Missing System 1 3.6 Total 28 100.0
6.6.2 Considering the three sets of responses together, a three-factor cross-tabulation (not shown here) revealed that of the 28 respondents with trade-related injuries, one (3.6%) answered yes to all three questions, four (14.3%) answered yes to two of the three questions, and a further nine (32.1%) answered yes to one of the three questions. Hence a total of 50.0% of respondents with trade-related injury believed that at least one of these systemic factors contributed to their injury. This compares with 48.5% in the 2004 survey (see paragraph 5.9.2).
6.6.3 The qualitative narrative data collected in 2005 supported those obtained in 2004 where it was reported that low section numbers affected pack weights. This was exacerbated by the number of airmen in the sections with reduced capacity due to long-term medical restrictions: “due to low number & increasing weight carried in sections the amount has to be carried by fewer people than when at full strength”; “there are too many people in my flight with long term medical restrictions”; “due to manning deficiencies weight in pack increases and so did the stress on joints”. Time pressure issues in 2005 highlighted systemic factors related to work scheduling rather than pressure to return to work following injury as in 2004: “trying to do a task in a time frame that is not possible, you tend to put your body on the line and push yourself to get it done ASAP”; “the need for patrolling to be paced with individuals in mind – rest to march ratio to be determined by section to complete in correct timing”. The effect of time on technique was also commented on: “when doing contacts or specific combat training, constraints are put on time hugely which means technique gets thrown out to get the job done.” Equipment concerns in 2005 continued to focus upon poor fitting boots and uncomfortable packs.
6.6.4 Finally, all respondents were asked a number of questions about attitudes to injury within the ADF culture. A summary of weighted responses is presented in Table 194. Key themes which emerge from Table 194 are: awareness of injury prevention measures; variation in levels of risk taking and avoidance of risk; concern about the effect of injury on capacity to do
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the job, including deployment, but not on income or family relationships; and willingness to report injury in spite of some concern about repercussions. These align very closely with the results of the 2004 survey, though there were some indications in 2005 of higher levels of agreement that there are adequate resources available to prevent injuries during physical work tasks, and higher levels of personal steps being taken to prevent injuries.
6.6.5 Differences of opinion between those known to have had trade-related injuries and those known not to have had trade-related injuries in the survey period were also explored, but there were no significant differences in response patterns.
6.6.6 Respondents were also invited to comment about any aspect of the survey or related issues. Nineteen general comments were made. These comments generally reaffirmed those noted previously in other parts of the report, and included statements related to acceptance of injuries as part of the job, low manning levels contributing to injury and increasing the workload, and pressure to return to work before fully recovered. However, another area of concern related to the management of injuries by allied health and medical staff, where relevant comments included: “when making appointments to see specialist medical doctors etc. we have been told to make these appointments to fit with the training program of the flight / unit. Sometimes this delays the timeframe to see these specialists etc. so we don't miss the ‘important’ training, therefore prolonging the injury before it is quickly assessed and therefore getting over the injury quickly”; “sometimes medical seems too busy to want to see you and I did not get to see anyone until the next day. They seemed hurried and quick to palm me off. There is not enough man power in the SQN”; and “I believe the ADF was too slow in getting me to a specialist. As a result it took nearly 3 yrs to get over an ankle injury. Once I got to the surgeon he was surprised that I had not been sent there 12 months earlier”.
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Table 194. ADG 2005: Perceived Attitudes to Injury within the ADF Strongly Strongly Disagree Disagree Uncertain Agree Agree % % % % % It is quite likely that I will suffer an injury in the next month 1.5 17.6 58.8 17.6 4.4 If I had a typical/common injury for my trade I would be unable to do my current job 3.0 20.9 31.3 44.8 If I had a typical/common injury for my trade it would significantly affect my take 19.4 43.3 31.3 4.5 1.5 home income If I had a typical/common injury for my trade it would significantly affect my ability 1.5 5.9 8.8 50.0 33.8 to deploy If I had a typical/common injury for my trade it would significantly affect my ability 10.4 25.4 44.8 19.4 to attend promotion courses If I had a typical/common injury for my trade it would significantly affect my 26.9 38.8 19.4 11.9 3.0 relationship with my close family members If I had a typical/common injury for my trade and reported it to a Defence doctor it 3.0 11.9 41.8 34.3 9.0 is likely that I would be medically downgraded I would report any injury that I suffered to a Defence Health facility 4.5 22.4 19.4 41.8 11.9 It is accepted practice in my work area to prevent injuries during sport or other 1.5 9.0 6.0 59.7 23.9 physical activities (including job related activities) wherever possible It is accepted practice in my work area to report all injuries to Defence medical staff 1.5 19.4 14.9 47.8 16.4 I frequently risk injury during sport and other physical activity, or to achieve work 3.0 26.9 11.9 50.7 7.5 goals It is accepted practice in my work area to risk injuries during sport or other physical 3.0 26.9 22.4 41.8 6.0 activities (including job related activities) I take steps to prevent injuries during sport or other physical activity 1.5 7.5 76.1 14.9 I take steps to prevent injuries during the performance of physical work tasks 6.0 9.0 76.1 9.0 There are adequate resources available to prevent injuries during sport and other 1.5 10.4 44.8 38.8 4.5 physical activity There are adequate resources available to prevent injuries during the performance 7.5 23.9 64.2 4.5 of physical work tasks I am able to avoid risking injury during sport and other physical activities 1.5 28.4 22.4 43.3 4.5 I am able to avoid risking injury during physical work activities 1.5 40.3 22.4 31.3 4.5 I can report any injury that I have to a Defence medical facility without any fear of 4.5 25.4 25.4 32.8 11.9 repercussions N=67-68
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7 SUMMARY OF FINDINGS
7.1 Introduction
7.1.1 This study involved two large-scale retrospective surveys of injuries to Infantry and ADG personnel, designed to identify the characteristics of injured personnel, the characteristics of their acute and chronic injuries, and the trade-related activities contributing to these injuries.
7.1.2 In interpreting and evaluating the key findings reiterated here, the sampling limitations of the two surveys discussed in Section 2.9 must be borne in mind. Some findings are necessarily based on the responses of quite small numbers of survey respondents (such as “ADGs who reported work-related acute injuries”). Whilst all sample sizes have been cited throughout the report, for brevity they have been omitted here.
7.1.3 As outlined in paragraph 2.7.6, all cited percentages for Infantry are based on weighted responses from different units.
7.2 Infantry Survey 2004
Incidence of Acute Injury; Prevalence of Chronic Injury
7.2.1 Forty six percent of Infantry respondents had suffered an acute injury in the 12 month period prior to the survey. Of these personnel, between 16% and 29%1 reported trade-related acute injuries.
7.2.2 Forty six percent of Infantry respondents were carrying chronic injuries at the time of the survey. Of these personnel, around 35%1 reported having trade-related chronic injuries.
7.2.3 The reported incidence of acute injury was 817 acute injuries per thousand persons per year and the reported prevalence of chronic injury was 804 chronic injuries per thousand persons. These are of the same order of magnitude as estimates based on data from the Defence Injury Prevention Program (DIPP) and EpiTrack databases, and an order of magnitude higher than estimates based on data from Defcare. The reported incidence of trade-related acute injury was 359 acute injuries per thousand persons per year, and the reported prevalence of trade-related chronic injury was 382 per thousand persons for chronic injuries attributed wholly to trade-related activities and 583 per thousand persons for chronic injuries attributed wholly or in part to trade-related activities.
Characteristics of Injured Personnel
7.2.4 No significant distinguishing demographic characteristics of respondents with acute injury were identified. In general, the best indicator of both acute and chronic injury – both for injured vs non injured, and in the case of acute injuries, for trade-related vs not trade-related injury – was the number of hours per week of structured activity supervised by someone other than a PTI in the previous four weeks. The association between reported acute and chronic injury and the level of this type of activity may indicate poor quality of supervision leading to the occurrence of acute injuries and the recurrence of chronic injuries. The reason for an association between the level of physical training activity and the occurrence of trade-related acute injury is less obvious. Two possible mechanisms are the effects of fatigue and behavioural effects - the possibility that the more physically active soldiers may tend to undertake trade activities in a manner which increases the risk of injury.
7.2.5 Other statistically significant indicators of chronic injury were age, length of service, weight and BMI.
7.2.6 The number of major and minor exercises undertaken was related to the occurrence of acute trade-related injuries as opposed to non-trade-related injuries. The occurrence of
1 The uncertainty in these percentages is due to incomplete information being supplied by some respondents.
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chronic injury – trade-related injuries or non-trade-related – was related to the number of minor exercises and pre-deployments.
Trade-related Acute Injuries
7.2.7 Forty four percent of acute injuries were trade-related (21% sport; and 27% PT). This profile differs from the profile presented in the ADF Health Status Report (2000).
7.2.8 Trade-related acute injuries reported were mostly sprains (the main injury in 29% of reported incidents, and a secondary injury in 30% of reported incidents) and strains (the main injury in 14% of reported incidents, and a secondary injury in 57% of reported incidents). Fractures, dislocations, bruising and crushing were also common. Predominant bodily locations were hips and lower limbs (44%), shoulders and upper limbs (20%) and lower back (21%).
7.2.9 The most frequently reported activities in which the trade-related acute injury occurred included patrolling (35%), route marching (32%), carrying (22%), assaulting (16%) and lifting (15%).
7.2.10 Actions taken after injury included reporting to a RAP (76% of incidents) or a military health centre or military hospital (21%), and seeking civilian assistance (5%).
7.2.11 In 47% of cases, respondents indicated that they returned to work (in some cases to light duties) before they had fully recovered.
7.2.12 In almost two thirds of cases (62%), the respondent thought that no safeguards or preventative strategies were in place. When safeguards or preventative strategies were in place, they were generally perceived not to have failed (86%). Risk taking was thought to have been a contributing factor in almost one third (30%) of cases.
7.2.13 Lower back injuries were associated with both strength activities (lifting, passing, carrying, pushing/pulling) and strength-endurance activities (route-marching, patrolling), and with both combat and administrative activities. Injuries to the lower limbs were more likely to be associated with combat activities.
7.2.14 The most frequently occurring injuries, strains and bruises, usually had the least serious outcomes; sprains resulted in sick leave in one quarter of cases; and fractures and dislocations resulted in hospitalisation and sick leave in about one third of cases.
7.2.15 Assaulting and urban operations were most likely to lead to injuries with more serious consequences.
7.2.16 The group most generally susceptible to injury across a wide range of activities was 25-29 year-olds with less than 5 years of service, i.e. older recruits, whilst younger recruits tended to be injured mainly in the more physically demanding combat tasks. It was apparent that a complex interaction of exposure, susceptibility and experience influenced injury occurrence.
7.2.17 Soldiers with a BMI of 25 or above (classified as “overweight”) were not represented disproportionately in the injury profile, but they were more likely to have been injured performing administrative tasks than combat tasks. This reflects the positive correlation between BMI, age and length of service.
7.2.18 The profile for non-trade-related acute injuries was markedly different from that for trade- related injuries. Proportions which differed markedly were fractures and muscle strains (higher at 16.8% and 34.5% respectively) and joint dislocations, sprains and bruises (lower at 3.6%, 25.4% and 6.1% respectively). These differences indicate that trade-related injuries were more likely to involve impacts, whilst non-trade-related injuries were more likely to be caused by over-exertion.
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Trade-related Chronic Injuries
7.2.19 In 73% of chronic injuries, trade-related activities were cited as a contributing factor (23% sport, 28% PT); 48% of chronic injuries were entirely trade-related.
7.2.20 Eighty percent of trade-related chronic injuries had persisted for over two years.
7.2.21 Seventy percent of trade-related chronic injuries were sustained to the joints and 24% to soft tissue. Most common bodily locations were lower limbs including hips (55%), lower back (16%) and upper limbs including shoulders (14%).
7.2.22 The most frequently reported activities contributing to trade-related chronic injury included route marching (57%) patrolling (45%), carrying (40%), assaulting (26%) and lifting (20%).
7.2.23 Actions taken included reporting to a RAP (58%), self treatment (40%), military health centre or military hospital (24%) and seeking civilian assistance (17%). Note that different actions might be taken on different occasions of recurrence of the same injury.
7.2.24 Performance of duties was affected in 89% of cases; medical downgrading occurred in 20% of cases, and occasional temporary restrictions in a further 20% of cases. Of those who reported the duration of restrictions, 10% were for the whole year, 33% were for short periods of up to 10 days, and 57% fell somewhere between these extremes.
7.2.25 High impact force activities such as striking, route marching, assaulting and urban operations were most likely to be associated with chronic overuse disorders of the joints. The activities of passing, pushing and pulling had the highest proportion of associated soft tissue injuries.
7.2.26 Lower limb injuries tended to be associated with route marching, patrolling, assaulting and urban operations, and upper limb injuries with climbing and striking.
7.2.27 The MEC levels of those with spinal disorders were relatively evenly spread across all categories, whereas more than two thirds of soft tissue injuries and almost three quarters of joint injuries had not resulted in downgrading from MEC1. Injuries associated with lifting and carrying (i.e. injuries to lower backs, hips and knees) were likely to result in the most serious consequences.
7.2.28 Whilst the prevalence of chronic injury generally increased with age and length of service (and hence cumulative exposure), even in the 20-24 year age group a substantial proportion reported chronic injuries associated with several activities.
7.2.29 With regard to length of service, the relative prevalence of chronic injury peaked at 10-14 years and then declined, which may reflect a tendency for personnel with chronic injuries to leave the service sooner than those without chronic injury
7.2.30 Those with BMI ≥30 (classified as “obese”) were over-represented by a factor of three in the chronically injured group. Those with a BMI of 25-29.99 (classified as “overweight”) were not represented disproportionately in the overall injury profile, but they were over-represented in the profiles for most activities, indicating that they were more likely to associate their injuries with multiple activities than the other groups. These results are consistent with the greater likelihood of chronic injuries among older, longer serving personnel.
7.2.31 The most significant difference in the profiles of trade-related and non-trade-related chronic injuries was that trade-related injuries tended to have persisted for longer periods. There were also indications of a higher proportion of lower back injuries associated with trade activities. In the case of actions taken, higher proportions had reported to a military health centre, military hospital or civilian emergency department for non-trade-related injuries than for trade-related injuries. A higher proportion of non-trade-related injuries led to medical downgrading, whereas trade-related injuries were more likely to have less serious effects or no effect.
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Opinions and Attitudes Regarding Trade-related Injury
7.2.32 When asked about the contribution of three systemic factors to trade-related injuries, 22% of respondents who had incurred acute injuries or who were carrying chronic injuries during the 12-month survey period reported manning levels, 35% reported time pressure, and 29% reported equipment limitations. A total of 60% of respondents with trade-related injury believed that at least one of these systemic factors contributed to their injury. This finding is very important. It is likely that the systemic factors identified in this survey as contributing to injury can be seen as indicators of a more general and pervasive influence of systemic failure upon soldier injury.
7.2.33 Key themes which emerged regarding attitudes to injury within the ADF culture were awareness of injury prevention measures; variation in levels of risk taking and avoidance of risk; concern about the effect of injury on capacity to do the job, including deployment, but no concern regarding income or family relationships; and willingness to report injury in spite of some concern about repercussions. Those with trade-related injuries tended to perceive higher levels of risk taking, less capacity to avoid risks and greater likelihood of being injured, and were less likely to report injury and more likely to fear repercussions of doing so.
7.3 Infantry Survey 2005
Differences between 2004 and 2005 Results
7.3.1 The results of the 2005 survey, conducted in conjunction with normative field testing of physical performance, generally supported and confirmed the 2004 results. A few key differences are summarised in the following paragraphs.
7.3.2 The 2005 sample had higher proportions in the lowest categories of age and length of service than the weighted 2004 sample. This is consistent with the inclusion of IETs in the 2005 survey and the administration of the survey within the battalions in conjunction with physical testing, mainly involving rifle sections within rifle companies. The 2004 survey did not include IETs, but encompassed the full range of personnel in the battalions.
7.3.3 There were also differences between the two samples with regard to rank. IETs were included in the 2005 sample but not in 2004; and there was a much higher proportion of NCOs in 2004 than in 2005. This is in part due to the conjunction with normative field testing in 2005; the pool of volunteers was probably weighted towards other ranks. It is also consistent with the higher proportions of older and longer serving personnel in 2004.
7.3.4 The incidence of acute injury was somewhat lower in the 2005 sample than in the weighted 2004 sample. This difference is attributable to the inclusion of IETs, who had a shorter exposure time, in the 2005 sample, and the exclusion of personnel with recent injuries from the 2005 sample. The proportions of trained soldiers reporting acute injuries were very similar in the two surveys. The prevalence of chronic injury was considerably lower in the 2005 survey. This is attributable partly to the inclusion of IETs in 2005, and partly to self selection bias and consequent over-representation of chronically injured personnel in the 2004 survey. The reported incidence of acute injury was 657 acute injuries per thousand persons per year (817 in 2004) and the reported prevalence of chronic injury was 439 chronic injuries per thousand persons (804 in 2004). For trained soldiers, the 2005 rates were 733 and 508 per thousand persons respectively.
7.3.5 In the 2004 survey, 44% of acute injuries were trade-related; in 2005 the figure was 51%. There was a corresponding reduction in the proportion of PT-related injuries. The proportion of trade-related chronic injuries was similar (around 70%) in both surveys.
7.3.6 Regarding attitudes to injury, the 2004 and 2005 response profiles were very similar, the most apparent difference being a higher level of agreement in 2005 that there are adequate resources available to prevent injuries during sport, other physical activity and physical work tasks. This may be a consequence of the rollout of DIPP in many of the units surveyed.
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Supplementary Information from the 2005 Survey
7.3.7 Of the 25 high-risk and/or physically demanding CATTs listed on the 2005 survey form, eight were not associated with any acute injury. Of the 17 which were, the predominant causes of acute injury were Forced March, Patrol in Marching Order and Section Attack. The predominant associated actions were marching, walking and running; going to ground and crawling; and carrying loads, either in hands/arms but especially on the back.
7.3.8 Of the 25 high-risk and/or physically demanding CATTs listed on the 2005 survey form, all but five were reported as contributing to chronic injuries. The most frequently mentioned, as with acute injury, were Forced March, Patrol in Marching Order and Section Attack. Carriage of stores and stretchers featured more prominently in terms of chronic injury than acute injury. By far the most common actions associated with chronic injury were marching and carrying loads on the back, which were each cited in almost half the reported cases of injury. Most chronic injuries were associated with multiple CATTs and multiple actions; on average, each injury was associated with around two CATTs and three physical actions
7.4 ADG Survey 2004
Incidence of Acute Injury; Prevalence of Chronic Injury
7.4.1 Forty five percent of ADG respondents had suffered an acute injury in the 12 month period prior to the survey. Of these personnel, between 22% and 32%1 reported trade-related acute injuries.
7.4.2 Forty two percent of ADG respondents were carrying chronic injuries at the time of the survey. Of these personnel, around 30%1 reported having trade-related chronic injuries.
7.4.3 The reported incidence of acute injury was 758 acute injuries per thousand persons per year and the reported prevalence of chronic injury was 639 chronic injuries per thousand persons. These are of the same order of magnitude as estimates based on data from the Defence Injury Prevention Program (DIPP) and EpiTrack databases, and an order of magnitude higher than estimates based on data from Defcare. The reported incidence of trade-related acute injury was 349 acute injuries per thousand persons per year, and the reported prevalence of trade-related chronic injury was 183 per thousand persons for chronic injuries attributed wholly to trade-related activities and 396 per thousand persons for chronic injuries attributed wholly or in part to trade-related activities.
Characteristics of Injured Personnel
7.4.4 The only significant distinguishing characteristic of those reporting acute injury was length of service. On average, those reporting acute injury had shorter length of service than those without injury. Length of service was also the strongest indicator of chronic injury; in this case those with chronic injury had on average greater length of service than those who were uninjured.
7.4.5 Other statistically significant indicators of chronic injury were age and BMI (positively associated) and hours per week of structured activity supervised by someone other than a PTI (negatively associated). Hours per week of structured activity supervised by a PTI was the only significant discriminator of trade-related chronic injuries (negatively associated). The negative associations may be indicative of the presence of chronic injury reducing the capacity to undertake physical activity.
7.4.6 With regard to relationships between injury occurrence and work cycle events during the 12- month survey period, the only features significantly associated with patterns of injury occurrence were taking part in courses (fewer trade-related acute injuries and more non- trade-related acute injuries) and taking part in minor exercises (more trade-related chronic injuries and fewer non-trade-related chronic injuries).
1 The uncertainty in these percentages is due to incomplete information being supplied by some respondents.
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Trade-related Acute Injuries
7.4.7 Forty six percent of acute injuries were trade-related (21% sport; and 27% PT). This profile differs from the profile presented in the ADF Health Status Report (2000).
7.4.8 Trade-related acute injuries reported were mostly strains (the main injury in 41% of reported incidents, and a secondary injury in 40% of reported incidents) and sprains (the main injury in 18% of reported incidents, and a secondary injury in 40% of reported incidents). Predominant bodily locations were hips and lower limbs (41%) and lower back (18%).
7.4.9 The most frequently reported activities in which the trade-related acute injury occurred were patrolling (36%) and carrying (32%).
7.4.10 Actions taken after injury included reporting to a military health centre or military hospital (59%) or a RAP (36% of incidents). There were no reported cases of seeking civilian assistance.
7.4.11 In 60% of cases, respondents indicated that they returned to work (in some cases to light duties) before they had fully recovered.
7.4.12 In almost two thirds of cases (59%), the respondent thought that no safeguards or preventative strategies were in place. When safeguards or preventative strategies were in place, they were generally perceived not to have failed (88%). Risk taking was thought to have been a contributing factor in only a small proportion (14%) of cases.
7.4.13 Lower back injuries were associated with both combat and administrative activities, including strength activities (lifting, carrying) and strength-endurance activities (patrolling). Injuries to the lower limbs were associated with a wide range of combat activities, but not with lifting.
7.4.14 The most frequently occurring injuries, sprains and strains, had a wide range of severity of outcomes, though only strains resulted in hospitalisation (in about one quarter of cases).
7.4.15 Injuries with more serious consequences (hospitalisation or sick leave) were associated with both combat and administrative activities (patrolling, assaulting, lifting, carrying).
7.4.16 With regard to age and length of service, the youngest and oldest personnel, and those with the shortest and longest service, were slightly more likely to be injured than those of intermediate age and length of service, who tended to be correspondingly under-represented among the injured.
7.4.17 Airmen with a BMI of 25 or above (classified as “overweight”) were slightly under- represented in the injury profile compared to those with a BMI below 25 (classified as “normal”) particularly in association with lifting, carrying and patrolling.
7.4.18 Whilst some differences were apparent in the characteristics of trade-related and non-trade- related acute injuries, the sample size was too small for any firm conclusions to be drawn.
Trade-related Chronic Injuries
7.4.19 In 62% of chronic injuries, trade-related activities were cited as a contributing factor (31% sport, 57% PT); 29% of chronic injuries were entirely trade-related.
7.4.20 Sixty four percent of trade-related chronic injuries had persisted for over two years.
7.4.21 Forty six percent of trade-related chronic injuries were sustained to soft tissue and 35% to the joints. By far the most common bodily location was lower limbs including hips (69%), with less than 10% of injuries being associated with each other bodily location.
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7.4.22 The most frequently reported activities contributing to trade-related chronic injury included assaulting (54%), route marching (50%), patrolling (31%), carrying (27%), lifting (27%) and urban operations (27%).
7.4.23 Actions taken included reporting military health centre or military hospital (50%), no action (31%), reporting to a RAP (27%) and self treatment (27%). Note that different actions might be taken on different occasions of recurrence of the same injury.
7.4.24 Performance of duties was affected in 94% of cases; medical downgrading occurred in 15% of cases, and occasional temporary restrictions in a further 46% of cases. Of those who reported the duration of restrictions, 8% were for the whole year, 46% were for short periods of up to 10 days, and 46% fell somewhere between these extremes.
7.4.25 High impact force activities such as route marching, patrolling, assaulting and urban operations were most likely to be associated with chronic overuse disorders of the joints. Muscle tendon and other soft tissue injuries were associated with a wide range of activities.
7.4.26 Lower limb injuries tended to be associated with route marching, patrolling, assaulting and urban operations, and upper limb injuries with climbing and striking. The preponderance of lower limb injuries associated with a wide range of activities suggests that many of the soft tissue injuries reported were probably ligament injuries such as twisted ankles.
7.4.27 Disorders of the joints were generally less severe and did not result in downgrading below MEC2, whereas with soft tissue injuries this occurred in over a third of cases. The more serious soft tissue injuries were to the lower back, pelvis and lower limbs. Injuries associated with route marching, patrolling and assaulting (i.e. injuries to lower backs, hips and knees) were likely to result in the most serious consequences.
7.4.28 Whilst the prevalence of chronic injury is much higher in the older age groups (as would be expected, reflecting the effect of cumulative exposure) even in the 20-24 year age group a substantial proportion reported chronic injuries associated with all types of activity listed.
7.4.29 With regard to length of service, whilst the group with less than 5 years service was under- represented as would be expected, even in this group a substantial proportion reported chronic injuries associated with all activities. The relative prevalence then declined through the 5-14 year period (possibly reflecting a tendency for personnel with early chronic injuries to leave the service sooner than those without chronic injury), and then increased to its highest levels among the longest serving airmen, as would be expected.
7.4.30 Airmen with chronic injury tended to have higher than average weight and BMI. The BMI profiles told a similar story of over-representation of airmen with high BMIs among the chronically injured, which is consistent with the greater likelihood of chronic injuries among older, longer serving personnel. The relationship between BMI and chronic injury was in contrast to the pattern for acute injuries (Paragraph 7.4.16), reflecting the interaction of age, bodily strength and exposure in determining injury.
7.4.31 The most significant difference in the profiles of trade-related and non-trade-related chronic injuries was with regard to bodily location, with trade-related injuries more likely to involve lower limbs and less likely to involve upper limbs. Trade-related activities were also more frequently associated with soft tissue injuries, and less with injuries to joints. In the case of actions taken, a higher proportion had reported to a military health centre, military hospital or a civilian facility for trade-related injuries than for non-trade-related injuries, whereas first aid was more likely to have taken place with non-trade-related injuries than with trade-related injuries. In the case of effects on performance of duties, trade-related injuries tended to be more severe, with a higher proportion of trade-related injuries leading to occasional temporary restrictions, whereas non-trade-related injuries were less likely to lead to any restrictions.
This report was accepted by the Department of Defence on 22/9/2006 122 DPESP REPORT 7 Retrospective Surveys of Injuries (2004 & 2005): Infantry and ADG
Opinions and Attitudes Regarding Trade-related Injury
7.4.32 When asked about the contribution of three systemic factors to trade-related injuries, 13% of respondents who had incurred acute injuries or who were carrying chronic injuries during the 12-month survey period reported manning levels, 41% reported time pressure, and 19% reported equipment limitations. A total of 49% of respondents with trade-related injury believed that at least one of these systemic factors contributed to their injury. This finding is very important. It is likely that the systemic factors identified in this survey as contributing to injury can be seen as indicators of a more general and pervasive influence of systemic failure upon airman injury.
7.4.33 Key themes which emerged regarding attitudes to injury within the ADF culture were awareness of injury prevention measures; variation in levels of risk taking and avoidance of risk; concern about the effect of injury on capacity to do the job, including deployment; and willingness to report injury in spite of some concern about repercussions. Those with trade- related injuries tended to perceive a greater likelihood of being injured, and were more likely to fear repercussions of reporting an injury.
7.5 ADG Survey 2005
Differences between 2004 and 2005 Results
7.5.1 The results of the 2005 survey, conducted in conjunction with normative field testing of physical performance, generally supported and confirmed the 2004 results. A few key differences are summarised in the following paragraphs.
7.5.2 The profiles of age and length of service were very similar, although the 2004 sample included a small proportion of older, longer serving personnel. This is consistent with the fact that the 2005 survey was administered in conjunction with normative field testing, whilst the 2004 survey encompassed the full range of personnel in the AFDW. The inclusion of IETs in 2005 might have been expected to increase the proportions in the lowest categories of age and length of service, but this was not the case. In both survey samples the younger, less experienced airmen were over-represented by comparison with the 2 AFDS population profile.
7.5.3 With regard to rank, there was a higher proportion of NCOs in the 2004 sample. With reference to the 2005 2 AFDS population, NCOs were over-represented in both survey samples. There was also a much higher proportion of other ranks in 2004, with IETs apparently displacing much of the “other ranks” category in the 2005 sample.
7.5.4 The incidence of acute injury was somewhat lower in the 2005 sample than in the 2004 sample. This difference is largely attributable to the inclusion of IETs, who had a shorter exposure time, in the 2005 sample, and the exclusion of personnel with recent injuries from the 2005 sample. The prevalence of chronic injury was almost identical in the 2005 and 2004 surveys. The reported incidence of acute injury was 672 acute injuries per thousand persons per year (758 in 2004) and the reported prevalence of chronic injury was 643 chronic injuries per thousand persons (639 in 2004).
7.5.5 In the 2004 survey, 46% of acute injuries were trade-related; in 2005 the figure was 41%. The proportions of trade-related chronic injuries were more similar (62% and 65% respectively).
7.5.6 Regarding attitudes to injury, the 2004 and 2005 response profiles were very similar, though there were some indications in 2005 of higher levels of agreement that there are adequate resources available to prevent injuries during physical work tasks, and higher levels of personal steps being taken to prevent injuries.
This report was accepted by the Department of Defence on 22/9/2006 123 DPESP REPORT 7 Retrospective Surveys of Injuries (2004 & 2005): Infantry and ADG
Supplementary Information from the 2005 Survey
7.5.7 Of the 25 high-risk and/or physically demanding CATTs listed on the 2005 survey form, only six were associated with instances of acute injury. The predominant causes of acute injury were Patrol in Marching Order, Patrol in Patrol Order and Section Attack. The predominant associated actions were patrolling and walking; going to ground; and carrying loads, either in hands/arms or on the back. On average, each injury was associated with two or three physical actions, typically combinations such as patrolling and load carriage.
7.5.8 All of the 25 high-risk and/or physically demanding CATTs listed on the 2005 survey form were reported as contributing to chronic injuries. The most frequently mentioned, as with acute injury, were Patrol in Marching Order, Patrol in Marching Order and Section Attack. Debussing and Stretcher Carry were the next most commonly cited CATTs. The most common actions associated with chronic injury were running, going to ground and carrying loads on the back. Most injuries were associated with multiple CATTs and multiple actions; on average, each injury was associated with around five CATTs and around five physical actions.
This report was accepted by the Department of Defence on 22/9/2006 124 DPESP REPORT 7 Retrospective Surveys of Injuries (2004 & 2005): Infantry and ADG
8 RECOMMENDATIONS
8.1.1 Specific recommendations regarding strategies for mitigating injury risk were provided in Report 5 (Reference Document F). This report provides further evidence regarding the association between the occurrence of injury and the physical demands of particular CATTs, together with the perceived effects of organisational, systemic, cultural and behavioural factors on risk of injury. These factors should be considered by Defence agencies when planning risk mitigation interventions.
8.1.2 Findings from the 2004 survey were considered when decisions were made regarding potential physical employment tests (PETs) at the DPESP Criterion Tasks Workshop (see Reference Document G).
8.1.3 The aim of this work package was to supplement the data already available in ADF databases regarding incidents and injuries, which had been found to be incomplete and unable to be linked to particular trade task activities. Whilst the immediate aim of providing supporting information for the DPESP research project was achieved, the difficulties of survey implementation and the extremely low response rate in the 2004 survey conducted by DSPPR reinforced the need, already identified in the recommendations from DPESP Report 3 (Reference Document D), for a comprehensive and reliable injury surveillance system to provide a more solid evidence base for OH&S management in general and for the identification and evaluation of injury prevention interventions in particular.
This report was accepted by the Department of Defence on 22/9/2006 125 DPESP REPORT 7 Retrospective Surveys of Injuries (2004 & 2005): Infantry and ADG
REFERENCES
Expert Panel on the Identification, Evaluation and Treatment of Overweight and Obesity in Adults. (1998). Executive summary. Archives of Internal Medicine, 158: 1855-1867. Finch, C.F., Valuri, G., & Ozanne-Smith, J. (1999). Injury surveillance during medical coverage of sporting events - development and testing of a standardized data collection form. Journal of Science and Medicine in Sport, 2: 42 - 56. Knapik, J., Ang, P., Reynolds, K. and Jones, B. (1993). Physical fitness, age, and injury incidence in infantry soldiers. Aviation, Space and Environmental Medicine, 35(6): 598-603. National Occupational Health and Safety Commission. (2003). Compendium of Workers' Compensation Statistics Australia, 2001-02. Reason, J. (1998). Achieving a safe culture: theory and practice. Work & Stress, 12 (3): 293-306. Sasoua, K. and Reason, J. (1999). Team errors: definition and taxonomy. Reliability Engineering and System Safety, 65: 1–9 World Health Organisation (2000). Obesity: Preventing and Managing the Global Epidemic. Geneva: World Health Organisation.
This report was accepted by the Department of Defence on 22/9/2006 126 DPESP REPORT 7 Retrospective Surveys of Injuries (2004 & 2005): Infantry and ADG
ANNEXES
This report was accepted by the Department of Defence on 22/9/2006 127 AIR DEFENCE GUARD 45585 Section A - Yourself and Your Activities
1 What is your age as of your last birthday? 5 What is your weight (in kg)?
Enter your age here and also indicate in the table. 0 0 1 1 e.g., if you are 32 as of 2 2 your last birthday 3 3 mark the ovals like this 4 4 5 5 2 6 6 7 7 3 8 8 9 9
2 In total, how many years of service have you 6 What is your current worn rank? completed in the ADF? Recruit O-1 PLTOFF Enter your length of service here and also AC/ACW O-2 FLGOFF indicate in the table. 0 LAC/LACW O-3 FLTLT e.g., if you have served 1 for a total of 12 years 2 CPL O-4 SQNLDR mark the ovals like 3 this 4 SGT O-5 WGCDR 5 FSGT O-6 GPCAPT & above 1 6 7 WOFF 2 8 9 Officer Cadet
3 What is your gender? 7 What is the name of your unit? Male Female
4 What is your height (in cm)? 8 What is the postcode of your unit?
0 0 1 1 2 3 2 4 3 5 4 6 5 7 6 8 9 7 8 9
Page 1 of 37 45585
9 Work cycle during the past 12 months (May 2003-April 2004). There is room to record up to three occurences of any type of activity. It is assumed that any periods not listed involved regular trade activity/training.
To answer this question please write the number corresponding to the calendar month in the boxes below (ie 01 for January, 02 for February, through to 12 for December).
OCCURRENCE 1 OCCURRENCE 2 OCCURRENCE 3 Month Month Month Month Month Month Activities started finished started finished started finished
Major Exercises (longer than 2 wks, multiple units/Services)
Minor Exercises (no longer than 2 weeks, one or a few units) Pre-deployment periods
Deployment periods
Leave periods
Courses (deployed away from unit - high intensity)
Please specify which courses you referred to : Course 1
Course 2
Course 3
10 Fitness tests during the past 12 months Month Month tested tested Physical Fitness Test (PFT) Pass Fail Pass Fail
Battle Efficiency Test (BET) Pass Fail Pass Fail
Page 2 of 37 45585
11 Regular sport and training for sport during the past 12 months
Period (including playing and pre Please mark all that you took part in . . . season training) Average hours From Until Pre-season During per week Sport (including playing (month) (month) training season training Games and training)
Touch football
Rugby Union
Rugby League
Australian Rules Football
Netball
Volleyball
Hockey
Cricket
Soccer
Other sport (please specify below) Other sport:
Page 3 of 37 45585
12 For the following questions please estimate the number of hours per week you have spent participating in the corresponding physical activity during the last 4 weeks (If you have not participated in the activity please leave blank)
Structured activity Structured activity Unstructured/ (eg game, formal PT supervised by unsupervised activity session) supervised someone other than (eg going for a run at by a PTI a PTI home)
Hours per week Hours per week Hours per week
0 0 0 1 1 1 2 2 2 3 3 3 4 4 4 5 5 5 6 6 6 7 7 7 8 8 8 9 9 9
Read the following explanatory notes then answer the questions in the following sections.
This survey is about PHYSICAL INJURIES. It does NOT cover: - Exposure to substances, radiation, etc. - Disease/illness - Mental stress - Mental illness
The next section, Section B, is about ACUTE INJURY INCIDENTS. In Section B, we are interested in any specific incident during the past 12 months which led to a physical injury (including heat stress). This includes: - a new injury - a repeat episode of a previous injury.
Section C is about CHRONIC INJURIES. In Section C, we are interested in ongoing or frequently recurring conditions which are difficult to relate to particular times and places - for example persistent knee joint pain over the past six to twelve months.
Page 4 of 37 45585 Section B - Acute injury incidents during the past year
This section is concerned with any specific incident during the past 12 months which led to a physical injury (including heat stress). This includes: - a new injury - a repeat episode of a previous injury.
1 During the past 12 months did you suffer any acute injury or heat stress incident which made it difficult for you to effectively perform your duties for at least one day after the incident?
Yes No (Please turn to Section C on page 22)
2 How many such incidents occured in the past 12 months?
0 1 2 3 4 5 6 7 8 9
Please answer the following set of questions separately for each incident.
NOTE: There is space on this form for up to four injury incidents - if you had more than four incidents please give details about the four most serious incidents
Page 5 of 37 45585 Injury Incident 1
1 Approximately when did the injury occur? (enter month 2 At approximately what time did the and year if unsure of exact date (dd/mm/yy format)) injury occur? (24hr clock) / / :
3 Where did the injury occur? (Geographical location ,such as town or city, establishment, region (if on an exercise) or country if outside Australia)
4 What job phase were you in at the time?
Major exercise Pre-deployment Deployment Leave Regular trade activity / training
5 Was this a new or a recurring injury? New Recurring
6 Which of the following list best describes the nature of the injury? (Please indicate the main injury in the first column and mark any other associated injuries in the second column)
Main Other injury injuries Fracture/ stress fracture (non spinal)
Fracture/ stress fracture of the spine Joint dislocation Sprain of joint(s) and/or ligaments Strain of muscles and/or tendons
Head injury/concussion Internal injury of chest, abdomen and/or pelvis
Traumatic amputation Open wound, not involving traumatic amputation
Superficial cuts and abrasions
Bruise or crushing injury, not involving fracture
Foreign body on external eye, in ear or nose, or in respiratory, digestive or reproductive system Burn(s) Injury to nerves or spinal cord, without evidence of spinal bone injury
Effects of weather, exposure, air pressure or other external causes (including heat stress) Other or unspecified injuries
Page 6 of 37 45585
7 What region of you body was injured? (Mark one only)
Head Lower back Multiple Locations Neck Pelvis Whole body (e.g. heat stress) Chest/ribs/upper back Upper Limbs (including shoulders) Abdomen Lower Limbs (including hips)
8 Were you engaged in any of the following activities when the injury occured? (Mark only one from the whole list) Authorised Sport Touch Football Rugby Union Rugby League Australian Rules Football Netball
Volleyball Hockey Cricket Soccer Other authorised sport (please specify)
Other Sport (please specify)
Physical Training Physical Training - Supervised by PTI Physical Training - Supervised by someone other than a PTI
(please specify)
Physical Training - unsupervised Other physical exercise (please specify)
Work or Trade Related Trade/employment-related training (excluding physical training) General Military Skills Training (not trade specific) Normal duties of trade (excluding all forms of training) Adventure Training - participation authorised Battle-related activity (on operation) Travelling to/from ADF work Other ADF activity
None of the above
Page 7 of 37 45585
9 If you ticked any of the work or trade related categories in Question 8, were you engaged in any of the following trade-related activities when the injury occurred? If so, please mark all that apply below.
Lifting Striking Assault Passing Digging Urban Operations Carrying Route Marching Pursuit
Climbing Patrolling Other
Pushing/Pulling
10 Explain how the injury occured. Indicate any particular contributing factors, such as fatigue or equipment problems.
11 What actions did you take? (Please mark all that apply)
No action Went outside the military system to get civilian Self treated medical assistance or advice: Received first aid From an emergency department Reported to RAP From another civilian facility Reported to military health centre or military hospital
12 Please indicate below the number of days you were affected in each of the following ways. Please leave blank those that do not apply
Days in hospital Days on light duties
Days on sick leave Days of work program affected
Days off work
13 If you were off work, did you return to full duty before you felt that you had fully recovered from this injury?
Yes No Not applicable - I was not off work
Page 8 of 37 45585
14 Were there any safeguards or preventative strategies in place when this incident occurred?
Yes Please give details below
No Please go to question 16
Unsure Please go to question 16
15 Did the safeguards or preventative strategies fail?
Yes Please give details below
No Please go to question 16
16 In your opinion, did risk taking behavior or acceptance of exessive risk contribute to this incident?
Yes Please give details below
No
If you have another injury incident to report, please continue on the next page. Otherwise please turn to Section C on page 22.
Page 9 of 37 45585 Injury Incident 2
1 Approximately when did the injury occur? (enter month 2 At approximately what time did the and year if unsure of exact date (dd/mm/yy format)) injury occur? (24hr clock) / / :
3 Where did the injury occur? (Geographical location ,such as town or city, establishment, region (if on an exercise) or country if outside Australia)
4 What job phase were you in at the time?
Major exercise Pre-deployment Deployment Leave Regular trade activity / training
5 Was this a new or a recurring injury?
New Recurring
6 Which of the following list best describes the nature of the injury? (Please indicate the main injury in the first column and mark any other associated injuries in the second column)
Main Other injury injuries Fracture/ stress fracture (non spinal)
Fracture/ stress fracture of the spine Joint dislocation Sprain of joint(s) and/or ligaments
Strain of muscles and/or tendons
Head injury/concussion Internal injury of chest, abdomen and/or pelvis
Traumatic amputation Open wound, not involving traumatic amputation
Superficial cuts and abrasions
Bruise or crushing injury, not involving fracture
Foreign body on external eye, in ear or nose, or in respiratory, digestive or reproductive system Burn(s) Injury to nerves or spinal cord, without evidence of spinal bone injury
Effects of weather, exposure, air pressure or other external causes (including heat stress) Other or unspecified injuries
Page 10 of 37 45585
7 What region of you body was injured? (Mark one only)
Head Lower back Multiple Locations Neck Pelvis Whole body (e.g. heat stress) Chest/ribs/upper back Upper Limbs (including shoulders) Abdomen Lower Limbs (including hips)
8 Were you engaged in any of the following activities when the injury occured? (Mark only one from the whole list) Authorised Sport Touch Football Rugby Union Rugby League Australian Rules Football Netball
Volleyball Hockey Cricket Soccer Other authorised sport (please specify)
Other Sport (please specify)
Physical Training Physical Training - Supervised by PTI Physical Training - Supervised by someone other than a PTI
(please specify)
Physical Training - unsupervised Other physical exercise (please specify)
Work or Trade Related Trade/employment-related training (excluding physical training) General Military Skills Training (not trade specific) Normal duties of trade (excluding all forms of training) Adventure Training - participation authorised Battle-related activity (on operation) Travelling to/from ADF work Other ADF activity
None of the above
Page 11 of 37 45585
9 If you ticked any of the work or trade related categories in Question 8, were you engaged in any of the following trade-related activities when the injury occurred? If so, please mark all that apply below.
Lifting Striking Assault Passing Digging Urban Operations Carrying Route Marching Pursuit
Climbing Patrolling Other
Pushing/Pulling
10 Explain how the injury occured. Indicate any particular contributing factors, such as fatigue or equipment problems.
11 What actions did you take? (Please mark all that apply)
No action Went outside the military system to get civilian Self treated medical assistance or advice: Received first aid From an emergency department Reported to RAP From another civilian facility Reported to military health centre or military hospital
12 Please indicate below the number of days you were affected in each of the following ways. Please leave blank those that do not apply
Days in hospital Days on light duties
Days on sick leave Days of work program affected
Days off work
13 If you were off work, did you return to full duty before you felt that you had fully recovered from this injury?
Yes No Not applicable - I was not off work
Page 12 of 37 45585
14 Were there any safeguards or preventative strategies in place when this incident occurred?
Yes Please give details below
No Please go to question 16
Unsure Please go to question 16
15 Did the safeguards or preventative strategies fail?
Yes Please give details below
No Please go to question 16
16 In your opinion, did risk taking behavior or acceptance of exessive risk contribute to this incident?
Yes Please give details below
No
If you have another injury incident to report, please continue on the next page. Otherwise please turn to Section C on page 22.
Page 13 of 37 45585 Injury Incident 3
1 Approximately when did the injury occur? (enter month 2 At approximately what time did the and year if unsure of exact date (dd/mm/yy format)) injury occur? (24hr clock) / / :
3 Where did the injury occur? (Geographical location ,such as town or city, establishment, region (if on an exercise) or country if outside Australia)
4 What job phase were you in at the time?
Major exercise Pre-deployment Deployment Leave Regular trade activity / training
5 Was this a new or a recurring injury?
New Recurring
6 Which of the following list best describes the nature of the injury? (Please indicate the main injury in the first column and mark any other associated injuries in the second column)
Main Other injury injuries Fracture/ stress fracture (non spinal)
Fracture/ stress fracture of the spine Joint dislocation Sprain of joint(s) and/or ligaments
Strain of muscles and/or tendons
Head injury/concussion Internal injury of chest, abdomen and/or pelvis
Traumatic amputation Open wound, not involving traumatic amputation
Superficial cuts and abrasions
Bruise or crushing injury, not involving fracture
Foreign body on external eye, in ear or nose, or in respiratory, digestive or reproductive system Burn(s) Injury to nerves or spinal cord, without evidence of spinal bone injury
Effects of weather, exposure, air pressure or other external causes (including heat stress) Other or unspecified injuries
Page 14 of 37 45585
7 What region of you body was injured? (Mark one only)
Head Lower back Multiple Locations Neck Pelvis Whole body (e.g. heat stress) Chest/ribs/upper back Upper Limbs (including shoulders) Abdomen Lower Limbs (including hips)
8 Were you engaged in any of the following activities when the injury occured? (Mark only one from the whole list) Authorised Sport Touch Football Rugby Union Rugby League Australian Rules Football Netball Volleyball Hockey Cricket Soccer Other authorised sport (please specify)
Other Sport (please specify)
Physical Training Physical Training - Supervised by PTI Physical Training - Supervised by someone other than a PTI
(please specify)
Physical Training - unsupervised Other physical exercise (please specify)
Work or Trade Related Trade/employment-related training (excluding physical training) General Military Skills Training (not trade specific) Normal duties of trade (excluding all forms of training) Adventure Training - participation authorised Battle-related activity (on operation) Travelling to/from ADF work Other ADF activity
None of the above
Page 15 of 37 45585
9 If you ticked any of the work or trade related categories in Question 8, were you engaged in any of the following trade-related activities when the injury occurred? If so, please mark all that apply below.
Lifting Striking Assault Passing Digging Urban Operations Carrying Route Marching Pursuit
Climbing Patrolling Other
Pushing/Pulling
10 Explain how the injury occured. Indicate any particular contributing factors, such as fatigue or equipment problems.
11 What actions did you take? (Please mark all that apply)
No action Went outside the military system to get civilian Self treated medical assistance or advice: Received first aid From an emergency department Reported to RAP From another civilian facility Reported to military health centre or military hospital
12 Please indicate below the number of days you were affected in each of the following ways. Please leave blank those that do not apply
Days in hospital Days on light duties
Days on sick leave Days of work program affected
Days off work
13 If you were off work, did you return to full duty before you felt that you had fully recovered from this injury?
Yes No Not applicable - I was not off work
Page 16 of 37 45585
14 Were there any safeguards or preventative strategies in place when this incident occurred?
Yes Please give details below
No Please go to question 16
Unsure Please go to question 16
15 Did the safeguards or preventative strategies fail?
Yes Please give details below
No Please go to question 16
16 In your opinion, did risk taking behavior or acceptance of exessive risk contribute to this incident?
Yes Please give details below
No
If you have another injury incident to report, please continue on the next page. Otherwise please turn to Section C on page 22.
Page 17 of 37 45585 Injury Incident 4
1 Approximately when did the injury occur? (enter month 2 At approximately what time did the and year if unsure of exact date (dd/mm/yy format)) injury occur? (24hr clock) / / :
3 Where did the injury occur? (Geographical location ,such as town or city, establishment, region (if on an exercise) or country if outside Australia)
4 What job phase were you in at the time?
Major exercise Pre-deployment Deployment Leave Regular trade activity / training
5 Was this a new or a recurring injury?
New Recurring
6 Which of the following list best describes the nature of the injury? (Please indicate the main injury in the first column and mark any other associated injuries in the second column)
Main Other injury injuries Fracture/ stress fracture (non spinal)
Fracture/ stress fracture of the spine Joint dislocation Sprain of joint(s) and/or ligaments Strain of muscles and/or tendons
Head injury/concussion Internal injury of chest, abdomen and/or pelvis
Traumatic amputation Open wound, not involving traumatic amputation
Superficial cuts and abrasions
Bruise or crushing injury, not involving fracture
Foreign body on external eye, in ear or nose, or in respiratory, digestive or reproductive system Burn(s) Injury to nerves or spinal cord, without evidence of spinal bone injury
Effects of weather, exposure, air pressure or other external causes (including heat stress) Other or unspecified injuries
Page 18 of 37 45585
7 What region of you body was injured? (Mark one only)
Head Lower back Multiple Locations Neck Pelvis Whole body (e.g. heat stress) Chest/ribs/upper back Upper Limbs (including shoulders) Abdomen Lower Limbs (including hips)
8 Were you engaged in any of the following activities when the injury occured? (Mark only one from the whole list) Authorised Sport Touch Football Rugby Union Rugby League Australian Rules Football Netball Volleyball
Hockey Cricket Soccer Other authorised sport (please specify)
Other Sport (please specify)
Physical Training Physical Training - Supervised by PTI Physical Training - Supervised by someone other than a PTI
(please specify)
Physical Training - unsupervised Other physical exercise (please specify)
Work or Trade Related Trade/employment-related training (excluding physical training) General Military Skills Training (not trade specific) Normal duties of trade (excluding all forms of training) Adventure Training - participation authorised Battle-related activity (on operation) Travelling to/from ADF work Other ADF activity
None of the above
Page 19 of 37 45585
9 If you ticked any of the work or trade related categories in Question 8, were you engaged in any of the following trade-related activities when the injury occurred? If so, please mark all that apply below.
Lifting Striking Assault Passing Digging Urban Operations Carrying Route Marching Pursuit
Climbing Patrolling Other
Pushing/Pulling
10 Explain how the injury occured. Indicate any particular contributing factors, such as fatigue or equipment problems.
11 What actions did you take? (Please mark all that apply)
No action Went outside the military system to get civilian Self treated medical assistance or advice: Received first aid From an emergency department Reported to RAP From another civilian facility Reported to military health centre or military hospital
12 Please indicate below the number of days you were affected in each of the following ways. Please leave blank those that do not apply
Days in hospital Days on light duties
Days on sick leave Days of work program affected
Days off work
13 If you were off work, did you return to full duty before you felt that you had fully recovered from this injury? Yes No Not applicable - I was not off work
Page 20 of 37 45585
14 Were there any safeguards or preventative strategies in place when this incident occurred? Yes Please give details below
No Please go to question 16
Unsure Please go to question 16
15 Did the safeguards or preventative strategies fail?
Yes Please give details below
No Please go to question 16
16 In your opinion, did risk taking behavior or acceptance of exessive risk contribute to this incident?
Yes Please give details below
No
Page 21 of 37 45585 Section C: Chronic Injuries
This section is concerned with ongoing injuries which are difficult to relate to particular times and places - for example persistent knee joint pain over the past six to twelve months.
1 Are you carrying any chronic injuries that have not been covered in Section B above?
Yes No (Please turn to Section 4 on page 35)
2 How many different chronic injuries are you carrying?
0 1 2 3 4 5 6 7 8 9
Please answer the following set of questions separately for each chronic injury.
NOTE: There is space on this form for up to four chronic injuries - if you are carrying more than four chronic injuries please give details about the four most serious injuries.
Page 22 of 37 45585 Chronic Injury 1
1 How long have you had this injury? (Please indicate duration below, either in years or months.
yearsOR months 0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9
2 What is the nature of the injury? (Please select one response only) Disorder of the joints Disorder of the spinal vertebrae and/or interverterbral discs Disorder of muscles, tendons and or/other soft tissues Other (please specify)
3 What region of your body is affected? (Please select one only) Head Lower back Multiple Locations Neck Pelvis Whole body (e.g. heat stress) Chest/ribs/upper back Upper Limbs (including shoulders) Abdomen Lower Limbs (including hips)
Page 23 of 37 45585
4 Do you consider that any of the following activities were major contributors to the INITIAL occurence of this injury? (Please select all that apply).
Authorised Sport Touch Football Rugby Union Rugby League Australian Rules Football Netball Volleyball Hockey Cricket Soccer Other authorised sport (please specify)
Other Sport (please specify)
Physical Training Physical Training - Supervised by PTI Physical Training - Supervised by someone other than a PTI
(please specify)
Physical Training - unsupervised Other physical exercise (please specify)
Work or Trade Related Trade/employment-related training (excluding physical training) General Military Skills Training (not trade specific) Normal duties of trade (excluding all forms of training) Adventure Training - participation authorised Battle-related activity (on operation) Travelling to/from ADF work Other ADF activity
None of the above
Page 24 of 37 45585
5 If you ticked any of the work or trade related categories in Question 4, were you engaged in any of the following trade-related activities when the injury occurred? If so, please mark all that apply below.
Lifting Striking Assault Passing Digging Urban Operations Carrying Route Marching Pursuit
Climbing Patrolling Other
Pushing/Pulling
6 What actions have you taken during the past 12 months regarding this chronic injury? (Please mark all that apply)
No action Went outside the military system to get civilian Self treated medical assistance or advice: Received first aid From an emergency department Reported to RAP From another civilian facility Reported to military health centre or military hospital
7 To what extent does this chronic injury affect you in the performance of your duties? (Mark any that apply).
Not at all Occasional temporary restrictions Affected, but without restrictions Medically downgraded
8 If you have temporary restrictions, for approximately how many days per year do they apply?
0 1 2 3 4 5 6 7 8 9
9 What is your current Medical Employment Classification (MEC) level?
MEC 1 MEC 2 MEC 3 MEC 4 Temporarily Medically Unfit (TMU)
If you are have another chronic injury to report, please continue on the next page. Otherwise please turn to Section D on page 35.
Page 25 of 37 45585 Chronic Injury 2
1 How long have you had this injury? (Please indicate duration below, either in years or months.
yearsOR months 0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9
2 What is the nature of the injury? (Please select one response only)
Disorder of the joints Disorder of the spinal vertebrae and/or interverterbral discs Disorder of muscles, tendons and or/other soft tissues Other (please specify)
3 What region of your body is affected? (Please select one only) Head Lower back Multiple Locations Neck Pelvis Whole body (e.g. heat stress) Chest/ribs/upper back Upper Limbs (including shoulders) Abdomen Lower Limbs (including hips)
Page 26 of 37 45585
4 Do you consider that any of the following activities were major contributors to the INITIAL occurence of this injury? (Please select all that apply).
Authorised Sport Touch Football Rugby Union Rugby League Australian Rules Football Netball Volleyball Hockey Cricket Soccer Other authorised sport (please specify)
Other Sport (please specify)
Physical Training Physical Training - Supervised by PTI Physical Training - Supervised by someone other than a PTI
(please specify)
Physical Training - unsupervised Other physical exercise please specify
Work or Trade Related Trade/employment-related training (excluding physical training) General Military Skills Training (not trade specific) Normal duties of trade (excluding all forms of training) Adventure Training - participation authorised Battle-related activity (on operation) Travelling to/from ADF work Other ADF activity
None of the above
Page 27 of 37 45585
5 If you ticked any of the work or trade related categories in Question 4, were you engaged in any of the following trade-related activities when the injury occurred? If so, please mark all that apply below.
Lifting Striking Assault Passing Digging Urban Operations Carrying Route Marching Pursuit
Climbing Patrolling Other
Pushing/Pulling
6 What actions have you taken during the past 12 months regarding this chronic injury? (Please mark all that apply)
No action Went outside the military system to get civilian Self treated medical assistance or advice: Received first aid From an emergency department Reported to RAP From another civilian facility Reported to military health centre or military hospital
7 To what extent does this chronic injury affect you in the performance of your duties? (Mark any that apply).
Not at all Occasional temporary restrictions Affected, but without restrictions Medically downgraded
8 If you have temporary restrictions, for approximately how many days per year do they apply?
0 1 2 3 4 5 6 7 8 9
9 What is your current Medical Employment Classification (MEC) level?
MEC 1 MEC 2 MEC 3 MEC 4 Temporarily Medically Unfit (TMU)
If you are have another chronic injury to report, please continue on the next page. Otherwise please turn to Section D on page 35.
Page 28 of 37 45585 Chronic Injury 3
1 How long have you had this injury? (Please indicate duration below, either in years or months.
yearsOR months 0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9
2 What is the nature of the injury? (Please select one response only)
Disorder of the joints Disorder of the spinal vertebrae and/or interverterbral discs Disorder of muscles, tendons and or/other soft tissues Other (please specify)
3 What region of your body is affected? (Please select one only) Head Lower back Multiple Locations Neck Pelvis Whole body (e.g. heat stress) Chest/ribs/upper back Upper Limbs (including shoulders) Abdomen Lower Limbs (including hips)
Page 29 of 37 45585
4 Do you consider that any of the following activities were major contributors to the INITIAL occurence of this injury? (Please select all that apply).
Authorised Sport Touch Football Rugby Union Rugby League Australian Rules Football Netball Volleyball Hockey Cricket Soccer Other authorised sport (please specify)
Other Sport (please specify)
Physical Training Physical Training - Supervised by PTI Physical Training - Supervised by someone other than a PTI
(please specify)
Physical Training - unsupervised Other physical exercise (please specify)
Work or Trade Related Trade/employment-related training (excluding physical training) General Military Skills Training (not trade specific) Normal duties of trade (excluding all forms of training) Adventure Training - participation authorised Battle-related activity (on operation) Travelling to/from ADF work Other ADF activity
None of the above
Page 30 of 37 45585
5 If you ticked any of the work or trade related categories in Question 4, were you engaged in any of the following trade-related activities when the injury occurred? If so, please mark all that apply below.
Lifting Striking Assault Passing Digging Urban Operations Carrying Route Marching Pursuit
Climbing Patrolling Other
Pushing/Pulling
6 What actions have you taken during the past 12 months regarding this chronic injury? (Please mark all that apply)
No action Went outside the military system to get civilian Self treated medical assistance or advice: Received first aid From an emergency department Reported to RAP From another civilian facility Reported to military health centre or military hospital
7 To what extent does this chronic injury affect you in the performance of your duties? (Mark any that apply).
Not at all Occasional temporary restrictions Affected, but without restrictions Medically downgraded
8 If you have temporary restrictions, for approximately how many days per year do they apply?
0 1 2 3 4 5 6 7 8 9
9 What is your current Medical Employment Classification (MEC) level?
MEC 1 MEC 2 MEC 3 MEC 4 Temporarily Medically Unfit (TMU)
If you are have another chronic injury to report, please continue on the next page. Otherwise please turn to Section D on page 35.
Page 31 of 37 45585 Chronic Injury 4
1 How long have you had this injury? (Please indicate duration below, either in years or months.
yearsOR months 0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9
2 What is the nature of the injury? (Please select one response only)
Disorder of the joints Disorder of the spinal vertebrae and/or interverterbral discs Disorder of muscles, tendons and or/other soft tissues Other (please specify)
3 What region of your body is affected? (Please select one only) Head Lower back Multiple Locations Neck Pelvis Whole body (e.g. heat stress) Chest/ribs/upper back Upper Limbs (including shoulders) Abdomen Lower Limbs (including hips)
Page 32 of 37 45585
4 Do you consider that any of the following activities were major contributors to the INITIAL occurence of this injury? (Please select all that apply).
Authorised Sport Touch Football Rugby Union Rugby League Australian Rules Football Netball Volleyball Hockey Cricket Soccer Other authorised sport (please specify)
Other Sport (please specify)
Physical Training Physical Training - Supervised by PTI Physical Training - Supervised by someone other than a PTI
(please specify)
Physical Training - unsupervised Other physical exercise (please specify)
Work or Trade Related Trade/employment-related training (excluding physical training) General Military Skills Training (not trade specific) Normal duties of trade (excluding all forms of training) Adventure Training - participation authorised Battle-related activity (on operation) Travelling to/from ADF work Other ADF activity
None of the above
Page 33 of 37 45585
5 If you ticked any of the work or trade related categories in Question 4, were you engaged in any of the following trade-related activities when the injury occurred? If so, please mark all that apply below.
Lifting Striking Assault Passing Digging Urban Operations Carrying Route Marching Pursuit
Climbing Patrolling Other
Pushing/Pulling
6 What actions have you taken during the past 12 months regarding this chronic injury? (Please mark all that apply)
No action Went outside the military system to get civilian Self treated medical assistance or advice: Received first aid From an emergency department Reported to RAP From another civilian facility Reported to military health centre or military hospital
7 To what extent does this chronic injury affect you in the performance of your duties? (Mark any that apply).
Not at all Occasional temporary restrictions Affected, but without restrictions Medically downgraded
8 If you have temporary restrictions, for approximately how many days per year do they apply?
0 1 2 3 4 5 6 7 8 9
9 What is your current Medical Employment Classification (MEC) level?
MEC 1 MEC 2 MEC 3 MEC 4 Temporarily Medically Unfit (TMU)
Page 34 of 37 45585 Section D: Your opinions
1 In your view, did deficiencies in manning levels contribute to any of the injuries you have reported in sections B and C? Yes (please give details below) No
2 In your view, did time pressure contribute to any of the injuries you have reported in sections B and C?
Yes (please give details below) No
3 In your view, did equipment limitations contribute to any of the injuries you have reported in sections B and C? Yes (please give details below) No
4
The items in this section are designed to help us (and you) understand the attitudes and perceptions of people working for the ADF. Please indicate the degree to which you agree or disagree with the following statements by marking one response option per statement. If you feel more than one option applies to you, please choose the one that comes closest. If you feel that any items do not apply to you at all in your present circumstances or position, leave that item blank. A comments section is provided at the end of the survey form for any comment you may wish to make on any items or on any issue that you think has not been sufficiently covered.
Strongly Strongly Disagree Disagree Uncertain Agree Agree a. It is quite likely that I will suffer an injury in the next month
If I had a typical/common injury for my trade I would be unable b. to do my current job
Page 35 of 37 45585
Strongly Strongly Disagree Disagree Uncertain Agree Agree c. If I had a typical/common injury for my trade it would significantly affect my take home income d. If I had a typical/common injury for my trade it would significantly affect my ability to deploy e. If I had a typical/common injury for my trade it would significantly affect my ability to attend promotion courses f. If I had a typical/common injury for my trade it would significantly affect my relationship with my close family members g. If I had a typical/common injury for my trade and reported it to a Defence doctor it is likely that I would be medically downgraded h. I would report any injury that I suffered to a Defence Health Facility i. It is accepted practice in my work area to try to prevent injuries during sport or other physical activities (including job related activities) wherever possible j. It is accepted practice in my work area to report all injuries to Defence medical staff k. I frequently risk injury during sport and other physical activity, or to achieve work goals l. It is accepted practice in my work area to risk injuries during sport or other physical activities (including job related activities) m. I take steps to prevent injuries during sport and other physical activity n. I take steps to prevent injuries during the performance of physical work tasks o. There are adequate resources available to prevent injuries during sport and other physical activity p. There are adequate resources available to prevent injuries during the performance of physical work tasks q. I am able to avoid risking an injury during sport and other physical activities r. I am able to avoid risking an injury during physical work activities s. I can report any injury that I have to a Defence Medical Facility without any fear of repercussions
Page 36 of 37 45585 Section E: Comments
Please write in the space below any comments you may have about any aspect of the survey or about any aspect of service life that may not be covered by the survey.
As stated in the Privacy and Confidentiality clause on the inside cover, these comments may be fed back anonymously to the survey sponsor or used as an anonymous quote in support of survey findings. If you do not want any of your comments to be made available to the survey sponsor or to be used in any publication of the survey findings, please indicate by filling in the oval below.
I do not want any of my comments to be fed back to the survey sponsor or used in any publication resulting from the survey.
Please place the completed form in the return envelope provided, and return it to your Unit Survey Co-ordinator no later than a week from today. Thank you for your participation in the survey.
Page 37 of 37 39166 Section A - Yourself and Your Activities
1 What is your age as of your last birthday? 5 What is your weight (in kg)?
Enter your age here and also indicate in the table. 0 0 1 1 e.g., if you are 32 as of 2 2 your last birthday 3 3 mark the ovals like this 4 4 5 5 2 6 6 7 7 3 8 8 9 9
2 In total, how many years of service have you 6 What is your current worn rank? completed in the ADF? Recruit Officer Cadet Enter your length of PTE(E) O-1 2LT(E) service here and also LCPL O-2 LT(E) indicate in the table. 0 e.g., if you have served 1 CPL O-3 CAPT(E) 2 for a total of 12 years SGT O-4 MAJ(E) mark the ovals like 3 this 4 SSGT O-5 LTCOL(E) 5 WO2 O-6 COL(E) & above 1 6 7 WO1 2 8 9
3 What is your gender? 7 What is the name of your unit? Male Female
4 What is your height (in cm)? 8 What is the postcode of your unit?
0 0 1 1 2 3 2 4 3 5 4 6 5 7 6 8 9 7 8 9
Page 1 of 37 39166
9 Work cycle during the past 12 months (May 2003-April 2004). There is room to record up to three occurences of any type of activity. It is assumed that any periods not listed involved regular trade activity/training.
To answer this question please write the number corresponding to the calendar month in the boxes below (ie 01 for January, 02 for February, through to 12 for December).
OCCURRENCE 1 OCCURRENCE 2 OCCURRENCE 3 Month Month Month Month Month Month Activities started finished started finished started finished
Major Exercises (longer than 2 wks, multiple units/Services)
Minor Exercises (no longer than 2 weeks, one or a few units) Pre-deployment periods
Deployment periods
Leave periods
Courses (deployed away from unit - high intensity)
Please specify which courses you referred to : Course 1
Course 2
Course 3
10 Fitness tests during the past 12 months Month Month tested tested Basic Fitness Assessment (BFA) Pass Fail Pass Fail
Combat Fitness Assessment (CFA) Pass Fail Pass Fail
Page 2 of 37 39166
11 Regular sport and training for sport during the past 12 months Period Please mark all that you took part in . . . (including playing and pre Average hours season training) Pre-season During per week Sport (including playing From Until training season (month) (month) training Games and training)
Touch football
Rugby Union
Rugby League
Australian Rules Football
Netball
Volleyball
Hockey
Cricket
Soccer
Other sport (please specify below)
Other sport:
12 For the following questions please estimate the number of hours per week you have spent participating in the corresponding physical activity during the last 4 weeks (If you have not participated in the activity please leave blank) Structured activity (eg Structured activity Unstructured/ game, formal PT supervised by unsupervised activity session) supervised by someone other than a (eg going for a run at a PTI PTI home)
Hours per week Hours per week Hours per week
0 0 0 1 1 1 2 2 2 3 3 3 4 4 4 5 5 5 6 6 6 7 7 7 8 8 8 9 9 9
Page 3 of 37 39166
13 What is your Corps and ECN (if applicable)? Corps: RAAC RACT RACMP RAA RAAMC (other) AA Psych RAE RAADC AABC PR RAAOC RAANC RA Sigs RAEME WRAAC RA Inf RAAEC Staff Cadet AAvn AACC OFFR Cadet Aust Int RAAPC RAAMC (MO) RAA Ch D AALC
PRIMARY ECN: SECONDARY ECN (if applicable):
Enter your ECN here - Enter your ECN here - and indicate in the table. and indicate in the table. 0 0 e.g., if your ECN is e.g., if your ECN is 131-2 mark the ovals 1 131-2 mark the ovals 1 like this like this 2 2 1 3 1 2 2 3 4 3 3 4 5 5 6 6 7 7 8 8 9 9
Read the following explanatory notes then answer the questions in the following sections.
This survey is about PHYSICAL INJURIES. It does NOT cover: - Exposure to substances, radiation, etc. - Disease/illness - Mental stress - Mental illness
The next section, Section B, is about ACUTE INJURY INCIDENTS. In Section B, we are interested in any specific incident during the past 12 months which led to a physical injury (including heat stress). This includes: - a new injury - a repeat episode of a previous injury.
Section C is about CHRONIC INJURIES. In Section C, we are interested in ongoing or frequently recurring conditions which are difficult to relate to particular times and places - for example persistent knee joint pain over the past six to twelve months.
Page 4 of 37 39166 Section B - Acute injury incidents during the past year
This section is concerned with any specific incident during the past 12 months which led to a physical injury (including heat stress). This includes: - a new injury - a repeat episode of a previous injury.
1 During the past 12 months did you suffer any acute injury or heat stress incident which made it difficult for you to effectively perform your duties for at least one day after the incident?
Yes No (Please turn to Section C on page 22)
2 How many such incidents occured in the past 12 months?
0 1 2 3 4 5 6 7 8 9
Please answer the following set of questions separately for each incident.
NOTE: There is space on this form for up to four injury incidents - if you had more than four incidents please give details about the four most serious incidents
Page 5 of 37 39166 Injury Incident 1
1 Approximately when did the injury occur? (enter month 2 At approximately what time did the and year if unsure of exact date (dd/mm/yy format)) injury occur? (24hr clock) / / :
3 Where did the injury occur? (Geographical location ,such as town or city, establishment, region (if on an exercise) or country if outside Australia)
4 What job phase were you in at the time?
Major exercise Pre-deployment Deployment Leave Regular trade activity / training
5 Was this a new or a recurring injury? New Recurring
6 Which of the following list best describes the nature of the injury? (Please indicate the main injury in the first column and mark any other associated injuries in the second column)
Main Other injury injuries Fracture/ stress fracture (non spinal)
Fracture/ stress fracture of the spine Joint dislocation Sprain of joint(s) and/or ligaments Strain of muscles and/or tendons
Head injury/concussion Internal injury of chest, abdomen and/or pelvis
Traumatic amputation Open wound, not involving traumatic amputation
Superficial cuts and abrasions
Bruise or crushing injury, not involving fracture
Foreign body on external eye, in ear or nose, or in respiratory, digestive or reproductive system Burn(s) Injury to nerves or spinal cord, without evidence of spinal bone injury
Effects of weather, exposure, air pressure or other external causes (including heat stress) Other or unspecified injuries
Page 6 of 37 39166
7 What region of you body was injured? (Mark one only)
Head Lower back Multiple Locations Neck Pelvis Whole body (e.g. heat stress) Chest/ribs/upper back Upper Limbs (including shoulders) Abdomen Lower Limbs (including hips)
8 Were you engaged in any of the following activities when the injury occured? (Mark only one from the whole list) Authorised Sport Touch Football Rugby Union Rugby League Australian Rules Football Netball Volleyball
Hockey Cricket Soccer Other authorised sport (please specify)
Other Sport (please specify)
Physical Training Physical Training - Supervised by PTI Physical Training - Supervised by Combat Fitness Leader
Physical Training - Supervised by someone other than a PTI or CFL
(please specify)
Physical Training - unsupervised Other physical exercise (please specify)
Work or Trade Related Trade/employment-related training (excluding physical training) General Military Skills Training (not trade specific) Normal duties of trade (excluding all forms of training) Adventure Training - participation authorised Battle-related activity (on operation) Travelling to/from ADF work Other ADF activity
None of the above
Page 7 of 37 39166
9 This question applies only to infantry and Airfield Defence Guard/Ground Defence Officer personnel: If you ticked any of the work or trade related categories in Question 8, were you engaged in any of the following trade-related activities when the injury occurred? If so, please mark all that apply below.
Lifting Striking Assault Passing Digging Urban Operations Carrying Route Marching Pursuit
Climbing Patrolling Other
Pushing/Pulling
10 Explain how the injury occured. Indicate any particular contributing factors, such as fatigue or equipment problems.
11 What actions did you take? (Please mark all that apply)
No action Went outside the military system to get civilian Self treated medical assistance or advice: Received first aid From an emergency department Reported to RAP From another civilian facility Reported to military health centre or military hospital
12 Please indicate below the number of days you were affected in each of the following ways. Please leave blank those that do not apply
Days in hospital Days on light duties
Days on sick leave Days of work program affected
Days off work
13 If you were off work, did you return to full duty before you felt that you had fully recovered from this injury?
Yes No Not applicable - I was not off work
Page 8 of 37 39166
14 Were there any safeguards or preventative strategies in place when this incident occurred?
Yes Please give details below
No Please go to question 16
Unsure Please go to question 16
15 Did the safeguards or preventative strategies fail?
Yes Please give details below
No Please go to question 16
16 In your opinion, did risk taking behavior or acceptance of exessive risk contribute to this incident?
Yes Please give details below
No
If you have another injury incident to report, please continue on the next page. Otherwise please turn to Section C on page 22.
Page 9 of 37 39166 Injury Incident 2
1 Approximately when did the injury occur? (enter month 2 At approximately what time did the and year if unsure of exact date (dd/mm/yy format)) injury occur? (24hr clock) / / :
3 Where did the injury occur? (Geographical location ,such as town or city, establishment, region (if on an exercise) or country if outside Australia)
4 What job phase were you in at the time?
Major exercise Pre-deployment Deployment Leave Regular trade activity / training
5 Was this a new or a recurring injury?
New Recurring
6 Which of the following list best describes the nature of the injury? (Please indicate the main injury in the first column and mark any other associated injuries in the second column)
Main Other injury injuries Fracture/ stress fracture (non spinal)
Fracture/ stress fracture of the spine Joint dislocation Sprain of joint(s) and/or ligaments
Strain of muscles and/or tendons
Head injury/concussion Internal injury of chest, abdomen and/or pelvis
Traumatic amputation Open wound, not involving traumatic amputation
Superficial cuts and abrasions
Bruise or crushing injury, not involving fracture
Foreign body on external eye, in ear or nose, or in respiratory, digestive or reproductive system Burn(s) Injury to nerves or spinal cord, without evidence of spinal bone injury
Effects of weather, exposure, air pressure or other external causes (including heat stress) Other or unspecified injuries
Page 10 of 37 39166
7 What region of you body was injured? (Mark one only)
Head Lower back Multiple Locations Neck Pelvis Whole body (e.g. heat stress) Chest/ribs/upper back Upper Limbs (including shoulders) Abdomen Lower Limbs (including hips)
8 Were you engaged in any of the following activities when the injury occured? (Mark only one from the whole list) Authorised Sport Touch Football Rugby Union Rugby League Australian Rules Football Netball
Volleyball Hockey Cricket Soccer Other authorised sport (please specify)
Other Sport (please specify)
Physical Training Physical Training - Supervised by PTI Physical Training - Supervised by Combat Fitness Leader
Physical Training - Supervised by someone other than a PTI or CFL
(please specify)
Physical Training - unsupervised Other physical exercise (please specify)
Work or Trade Related Trade/employment-related training (excluding physical training) General Military Skills Training (not trade specific) Normal duties of trade (excluding all forms of training) Adventure Training - participation authorised Battle-related activity (on operation) Travelling to/from ADF work Other ADF activity
None of the above
Page 11 of 37 39166
9 This question applies only to infantry and Airfield Defence Guard/Ground Defence Officer personnel: If you ticked any of the work or trade related categories in Question 8, were you engaged in any of the following trade-related activities when the injury occurred? If so, please mark all that apply below.
Lifting Striking Assault Passing Digging Urban Operations Carrying Route Marching Pursuit
Climbing Patrolling Other
Pushing/Pulling
10 Explain how the injury occured. Indicate any particular contributing factors, such as fatigue or equipment problems.
11 What actions did you take? (Please mark all that apply)
No action Went outside the military system to get civilian Self treated medical assistance or advice: Received first aid From an emergency department Reported to RAP From another civilian facility Reported to military health centre or military hospital
12 Please indicate below the number of days you were affected in each of the following ways. Please leave blank those that do not apply
Days in hospital Days on light duties
Days on sick leave Days of work program affected
Days off work
13 If you were off work, did you return to full duty before you felt that you had fully recovered from this injury?
Yes No Not applicable - I was not off work
Page 12 of 37 39166
14 Were there any safeguards or preventative strategies in place when this incident occurred?
Yes Please give details below
No Please go to question 16
Unsure Please go to question 16
15 Did the safeguards or preventative strategies fail?
Yes Please give details below
No Please go to question 16
16 In your opinion, did risk taking behavior or acceptance of exessive risk contribute to this incident?
Yes Please give details below
No
If you have another injury incident to report, please continue on the next page. Otherwise please turn to Section C on page 22.
Page 13 of 37 39166 Injury Incident 3
1 Approximately when did the injury occur? (enter month 2 At approximately what time did the and year if unsure of exact date (dd/mm/yy format)) injury occur? (24hr clock) / / :
3 Where did the injury occur? (Geographical location ,such as town or city, establishment, region (if on an exercise) or country if outside Australia)
4 What job phase were you in at the time?
Major exercise Pre-deployment Deployment Leave Regular trade activity / training
5 Was this a new or a recurring injury?
New Recurring
6 Which of the following list best describes the nature of the injury? (Please indicate the main injury in the first column and mark any other associated injuries in the second column)
Main Other injury injuries Fracture/ stress fracture (non spinal)
Fracture/ stress fracture of the spine Joint dislocation Sprain of joint(s) and/or ligaments
Strain of muscles and/or tendons
Head injury/concussion Internal injury of chest, abdomen and/or pelvis
Traumatic amputation Open wound, not involving traumatic amputation
Superficial cuts and abrasions
Bruise or crushing injury, not involving fracture
Foreign body on external eye, in ear or nose, or in respiratory, digestive or reproductive system Burn(s) Injury to nerves or spinal cord, without evidence of spinal bone injury
Effects of weather, exposure, air pressure or other external causes (including heat stress) Other or unspecified injuries
Page 14 of 37 39166
7 What region of you body was injured? (Mark one only)
Head Lower back Multiple Locations Neck Pelvis Whole body (e.g. heat stress) Chest/ribs/upper back Upper Limbs (including shoulders) Abdomen Lower Limbs (including hips)
8 Were you engaged in any of the following activities when the injury occured? (Mark only one from the whole list) Authorised Sport Touch Football Rugby Union Rugby League Australian Rules Football
Netball Volleyball Hockey Cricket Soccer Other authorised sport (please specify)
Other Sport (please specify)
Physical Training Physical Training - Supervised by PTI Physical Training - Supervised by Combat Fitness Leader
Physical Training - Supervised by someone other than a PTI or CFL
(please specify)
Physical Training - unsupervised Other physical exercise (please specify)
Work or Trade Related Trade/employment-related training (excluding physical training) General Military Skills Training (not trade specific) Normal duties of trade (excluding all forms of training) Adventure Training - participation authorised Battle-related activity (on operation) Travelling to/from ADF work Other ADF activity
None of the above
Page 15 of 37 39166
9 This question applies only to infantry and Airfield Defence Guard/Ground Defence Officer personnel:
If you ticked any of the work or trade related categories in Question 8, were you engaged in any of the following trade-related activities when the injury occurred? If so, please mark all that apply below.
Lifting Striking Assault Passing Digging Urban Operations Carrying Route Marching Pursuit
Climbing Patrolling Other
Pushing/Pulling
10 Explain how the injury occured. Indicate any particular contributing factors, such as fatigue or equipment problems.
11 What actions did you take? (Please mark all that apply)
No action Went outside the military system to get civilian Self treated medical assistance or advice: Received first aid From an emergency department Reported to RAP From another civilian facility Reported to military health centre or military hospital
12 Please indicate below the number of days you were affected in each of the following ways. Please leave blank those that do not apply
Days in hospital Days on light duties
Days on sick leave Days of work program affected
Days off work
13 If you were off work, did you return to full duty before you felt that you had fully recovered from this injury?
Yes No Not applicable - I was not off work
Page 16 of 37 39166
14 Were there any safeguards or preventative strategies in place when this incident occurred?
Yes Please give details below
No Please go to question 16
Unsure Please go to question 16
15 Did the safeguards or preventative strategies fail?
Yes Please give details below
No Please go to question 16
16 In your opinion, did risk taking behavior or acceptance of exessive risk contribute to this incident?
Yes Please give details below
No
If you have another injury incident to report, please continue on the next page. Otherwise please turn to Section C on page 22.
Page 17 of 37 39166 Injury Incident 4
1 Approximately when did the injury occur? (enter month 2 At approximately what time did the and year if unsure of exact date (dd/mm/yy format)) injury occur? (24hr clock) / / :
3 Where did the injury occur? (Geographical location ,such as town or city, establishment, region (if on an exercise) or country if outside Australia)
4 What job phase were you in at the time?
Major exercise Pre-deployment Deployment Leave Regular trade activity / training
5 Was this a new or a recurring injury?
New Recurring
6 Which of the following list best describes the nature of the injury? (Please indicate the main injury in the first column and mark any other associated injuries in the second column)
Main Other injury injuries Fracture/ stress fracture (non spinal)
Fracture/ stress fracture of the spine Joint dislocation Sprain of joint(s) and/or ligaments Strain of muscles and/or tendons
Head injury/concussion Internal injury of chest, abdomen and/or pelvis
Traumatic amputation Open wound, not involving traumatic amputation
Superficial cuts and abrasions
Bruise or crushing injury, not involving fracture
Foreign body on external eye, in ear or nose, or in respiratory, digestive or reproductive system Burn(s) Injury to nerves or spinal cord, without evidence of spinal bone injury
Effects of weather, exposure, air pressure or other external causes (including heat stress) Other or unspecified injuries
Page 18 of 37 39166
7 What region of you body was injured? (Mark one only)
Head Lower back Multiple Locations Neck Pelvis Whole body (e.g. heat stress) Chest/ribs/upper back Upper Limbs (including shoulders) Abdomen Lower Limbs (including hips)
8 Were you engaged in any of the following activities when the injury occured? (Mark only one from the whole list) Authorised Sport Touch Football Rugby Union Rugby League Australian Rules Football Netball Volleyball Hockey Cricket Soccer Other authorised sport (please specify)
Other Sport (please specify)
Physical Training Physical Training - Supervised by PTI Physical Training - Supervised by Combat Fitness Leader
Physical Training - Supervised by someone other than a PTI or CFL
(please specify)
Physical Training - unsupervised Other physical exercise (please specify)
Work or Trade Related Trade/employment-related training (excluding physical training) General Military Skills Training (not trade specific) Normal duties of trade (excluding all forms of training) Adventure Training - participation authorised Battle-related activity (on operation) Travelling to/from ADF work Other ADF activity
None of the above
Page 19 of 37 39166
9 This question applies only to infantry and Airfield Defence Guard/Ground Defence Officer personnel: If you ticked any of the work or trade related categories in Question 8, were you engaged in any of the following trade-related activities when the injury occurred? If so, please mark all that apply below. Lifting Striking Assault Passing Digging Urban Operations Carrying Route Marching Pursuit
Climbing Patrolling Other
Pushing/Pulling
10 Explain how the injury occured. Indicate any particular contributing factors, such as fatigue or equipment problems.
11 What actions did you take? (Please mark all that apply)
No action Went outside the military system to get civilian Self treated medical assistance or advice: Received first aid From an emergency department Reported to RAP From another civilian facility Reported to military health centre or military hospital
12 Please indicate below the number of days you were affected in each of the following ways. Please leave blank those that do not apply
Days in hospital Days on light duties
Days on sick leave Days of work program affected
Days off work
13 If you were off work, did you return to full duty before you felt that you had fully recovered from this injury? Yes No Not applicable - I was not off work
Page 20 of 37 39166
14 Were there any safeguards or preventative strategies in place when this incident occurred? Yes Please give details below
No Please go to question 16
Unsure Please go to question 16
15 Did the safeguards or preventative strategies fail?
Yes Please give details below
No Please go to question 16
16 In your opinion, did risk taking behavior or acceptance of exessive risk contribute to this incident?
Yes Please give details below
No
Page 21 of 37 39166 Section C: Chronic Injuries
This section is concerned with ongoing injuries which are difficult to relate to particular times and places - for example persistent knee joint pain over the past six to twelve months.
1 Are you carrying any chronic injuries that have not been covered in Section B above?
Yes No (Please turn to Section 4 on page 35)
2 How many different chronic injuries are you carrying?
0 1 2 3 4 5 6 7 8 9
Please answer the following set of questions separately for each chronic injury.
NOTE: There is space on this form for up to four chronic injuries - if you are carrying more than four chronic injuries please give details about the four most serious injuries.
Page 22 of 37 39166 Chronic Injury 1
1 How long have you had this injury? (Please indicate duration below, either in years or months.
yearsOR months 0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9
2 What is the nature of the injury? (Please select one response only) Disorder of the joints Disorder of the spinal vertebrae and/or interverterbral discs Disorder of muscles, tendons and or/other soft tissues Other (please specify)
3 What region of your body is affected? (Please select one only) Head Lower back Multiple Locations Neck Pelvis Whole body (e.g. heat stress) Chest/ribs/upper back Upper Limbs (including shoulders) Abdomen Lower Limbs (including hips)
Page 23 of 37 39166
4 Do you consider that any of the following activities were major contributors to the INITIAL occurence of this injury? (Please select all that apply).
Authorised Sport Touch Football Rugby Union Rugby League Australian Rules Football Netball Volleyball Hockey Cricket Soccer Other authorised sport (please specify)
Other Sport (please specify)
Physical Training Physical Training - Supervised by PTI Physical Training - Supervised by someone other than a PTI
(please specify)
Physical Training - unsupervised Other physical exercise (please specify)
Work or Trade Related Trade/employment-related training (excluding physical training) General Military Skills Training (not trade specific) Normal duties of trade (excluding all forms of training) Adventure Training - participation authorised Battle-related activity (on operation) Travelling to/from ADF work Other ADF activity
None of the above
Page 24 of 37 39166
5 This question applies only to infantry and Airfield Defence Guard/Ground Defence Officer personnel:
If you ticked any of the work or trade related categories in Question 4, were you engaged in any of the following trade-related activities when the injury occurred? If so, please mark all that apply below. Lifting Striking Assault Passing Digging Urban Operations Carrying Route Marching Pursuit
Climbing Patrolling Other
Pushing/Pulling
6 What actions have you taken during the past 12 months regarding this chronic injury? (Please mark all that apply)
No action Went outside the military system to get civilian Self treated medical assistance or advice: Received first aid From an emergency department Reported to RAP From another civilian facility Reported to military health centre or military hospital
7 To what extent does this chronic injury affect you in the performance of your duties? (Mark any that apply).
Not at all Occasional temporary restrictions Affected, but without restrictions Medically downgraded
8 If you have temporary restrictions, for approximately how many days per year do they apply?
0 1 2 3 4 5 6 7 8 9
9 What is your current Medical Employment Classification (MEC) level?
MEC 1 MEC 2 MEC 3 MEC 4 Temporarily Medically Unfit (TMU)
If you are have another chronic injury to report, please continue on the next page. Otherwise please turn to Section D on page 35.
Page 25 of 37 39166 Chronic Injury 2
1 How long have you had this injury? (Please indicate duration below, either in years or months.
yearsOR months 0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9
2 What is the nature of the injury? (Please select one response only)
Disorder of the joints Disorder of the spinal vertebrae and/or interverterbral discs Disorder of muscles, tendons and or/other soft tissues Other (please specify)
3 What region of your body is affected? (Please select one only) Head Lower back Multiple Locations Neck Pelvis Whole body (e.g. heat stress) Chest/ribs/upper back Upper Limbs (including shoulders) Abdomen Lower Limbs (including hips)
Page 26 of 37 39166
4 Do you consider that any of the following activities were major contributors to the INITIAL occurence of this injury? (Please select all that apply).
Authorised Sport Touch Football Rugby Union Rugby League Australian Rules Football Netball Volleyball Hockey Cricket Soccer Other authorised sport (please specify)
Other Sport (please specify)
Physical Training Physical Training - Supervised by PTI Physical Training - Supervised by someone other than a PTI
(please specify)
Physical Training - unsupervised Other physical exercise please specify
Work or Trade Related Trade/employment-related training (excluding physical training) General Military Skills Training (not trade specific) Normal duties of trade (excluding all forms of training) Adventure Training - participation authorised Battle-related activity (on operation) Travelling to/from ADF work Other ADF activity
None of the above
Page 27 of 37 39166
5 This question applies only to infantry and Airfield Defence Guard/Ground Defence Officer personnel:
If you ticked any of the work or trade related categories in Question 4, were you engaged in any of the following trade-related activities when the injury occurred? If so, please mark all that apply below.
Lifting Striking Assault Passing Digging Urban Operations Carrying Route Marching Pursuit
Climbing Patrolling Other
Pushing/Pulling
6 What actions have you taken during the past 12 months regarding this chronic injury? (Please mark all that apply)
No action Went outside the military system to get civilian Self treated medical assistance or advice: Received first aid From an emergency department Reported to RAP From another civilian facility Reported to military health centre or military hospital
7 To what extent does this chronic injury affect you in the performance of your duties? (Mark any that apply).
Not at all Occasional temporary restrictions Affected, but without restrictions Medically downgraded
8 If you have temporary restrictions, for approximately how many days per year do they apply?
0 1 2 3 4 5 6 7 8 9
9 What is your current Medical Employment Classification (MEC) level?
MEC 1 MEC 2 MEC 3 MEC 4 Temporarily Medically Unfit (TMU)
If you are have another chronic injury to report, please continue on the next page. Otherwise please turn to Section D on page 35.
Page 28 of 37 39166 Chronic Injury 3
1 How long have you had this injury? (Please indicate duration below, either in years or months.
yearsOR months 0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9
2 What is the nature of the injury? (Please select one response only)
Disorder of the joints Disorder of the spinal vertebrae and/or interverterbral discs Disorder of muscles, tendons and or/other soft tissues Other (please specify)
3 What region of your body is affected? (Please select one only) Head Lower back Multiple Locations Neck Pelvis Whole body (e.g. heat stress) Chest/ribs/upper back Upper Limbs (including shoulders) Abdomen Lower Limbs (including hips)
Page 29 of 37 39166
4 Do you consider that any of the following activities were major contributors to the INITIAL occurence of this injury? (Please select all that apply).
Authorised Sport Touch Football Rugby Union Rugby League Australian Rules Football Netball Volleyball Hockey Cricket Soccer Other authorised sport (please specify)
Other Sport (please specify)
Physical Training Physical Training - Supervised by PTI Physical Training - Supervised by someone other than a PTI
(please specify)
Physical Training - unsupervised Other physical exercise (please specify)
Work or Trade Related Trade/employment-related training (excluding physical training) General Military Skills Training (not trade specific) Normal duties of trade (excluding all forms of training) Adventure Training - participation authorised Battle-related activity (on operation) Travelling to/from ADF work Other ADF activity
None of the above
Page 30 of 37 39166
5 This question applies only to infantry and Airfield Defence Guard/Ground Defence Officer personnel:
If you ticked any of the work or trade related categories in Question 4, were you engaged in any of the following trade-related activities when the injury occurred? If so, please mark all that apply below.
Lifting Striking Assault Passing Digging Urban Operations Carrying Route Marching Pursuit
Climbing Patrolling Other
Pushing/Pulling
6 What actions have you taken during the past 12 months regarding this chronic injury? (Please mark all that apply)
No action Went outside the military system to get civilian Self treated medical assistance or advice: Received first aid From an emergency department Reported to RAP From another civilian facility Reported to military health centre or military hospital
7 To what extent does this chronic injury affect you in the performance of your duties? (Mark any that apply).
Not at all Occasional temporary restrictions Affected, but without restrictions Medically downgraded
8 If you have temporary restrictions, for approximately how many days per year do they apply?
0 1 2 3 4 5 6 7 8 9
9 What is your current Medical Employment Classification (MEC) level?
MEC 1 MEC 2 MEC 3 MEC 4 Temporarily Medically Unfit (TMU)
If you are have another chronic injury to report, please continue on the next page. Otherwise please turn to Section D on page 35.
Page 31 of 37 39166 Chronic Injury 4
1 How long have you had this injury? (Please indicate duration below, either in years or months.
yearsOR months 0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9
2 What is the nature of the injury? (Please select one response only)
Disorder of the joints Disorder of the spinal vertebrae and/or interverterbral discs Disorder of muscles, tendons and or/other soft tissues Other (please specify)
3 What region of your body is affected? (Please select one only) Head Lower back Multiple Locations Neck Pelvis Whole body (e.g. heat stress) Chest/ribs/upper back Upper Limbs (including shoulders) Abdomen Lower Limbs (including hips)
Page 32 of 37 39166
4 Do you consider that any of the following activities were major contributors to the INITIAL occurence of this injury? (Please select all that apply).
Authorised Sport Touch Football Rugby Union Rugby League Australian Rules Football Netball Volleyball Hockey Cricket Soccer Other authorised sport (please specify)
Other Sport (please specify)
Physical Training Physical Training - Supervised by PTI Physical Training - Supervised by someone other than a PTI
(please specify)
Physical Training - unsupervised Other physical exercise (please specify)
Work or Trade Related Trade/employment-related training (excluding physical training) General Military Skills Training (not trade specific) Normal duties of trade (excluding all forms of training) Adventure Training - participation authorised Battle-related activity (on operation) Travelling to/from ADF work Other ADF activity
None of the above
Page 33 of 37 39166
5 This question applies only to infantry and Airfield Defence Guard/Ground Defence Officer personnel:
If you ticked any of the work or trade related categories in Question 4, were you engaged in any of the following trade-related activities when the injury occurred? If so, please mark all that apply below. Lifting Striking Assault Passing Digging Urban Operations Carrying Route Marching Pursuit
Climbing Patrolling Other
Pushing/Pulling
6 What actions have you taken during the past 12 months regarding this chronic injury? (Please mark all that apply)
No action Went outside the military system to get civilian Self treated medical assistance or advice: Received first aid From an emergency department Reported to RAP From another civilian facility Reported to military health centre or military hospital
7 To what extent does this chronic injury affect you in the performance of your duties? (Mark any that apply).
Not at all Occasional temporary restrictions Affected, but without restrictions Medically downgraded
8 If you have temporary restrictions, for approximately how many days per year do they apply?
0 1 2 3 4 5 6 7 8 9
9 What is your current Medical Employment Classification (MEC) level?
MEC 1 MEC 2 MEC 3 MEC 4 Temporarily Medically Unfit (TMU)
Page 34 of 37 39166 Section D: Your opinions
1 In your view, did deficiencies in manning levels contribute to any of the injuries you have reported in sections B and C? Yes (please give details below) No
2 In your view, did time pressure contribute to any of the injuries you have reported in sections B and C?
Yes (please give details below) No
3 In your view, did equipment limitations contribute to any of the injuries you have reported in sections B and C? Yes (please give details below) No
4
The items in this section are designed to help us (and you) understand the attitudes and perceptions of people working for the ADF. Please indicate the degree to which you agree or disagree with the following statements by marking one response option per statement. If you feel more than one option applies to you, please choose the one that comes closest. If you feel that any items do not apply to you at all in your present circumstances or position, leave that item blank. A comments section is provided at the end of the survey form for any comment you may wish to make on any items or on any issue that you think has not been sufficiently covered.
Strongly Strongly Disagree Disagree Uncertain Agree Agree a. It is quite likely that I will suffer an injury in the next month
If I had a typical/common injury for my trade I would be unable b. to do my current job
Page 35 of 37 39166
Strongly Strongly Disagree Disagree Uncertain Agree Agree c. If I had a typical/common injury for my trade it would significantly affect my take home income d. If I had a typical/common injury for my trade it would significantly affect my ability to deploy e. If I had a typical/common injury for my trade it would significantly affect my ability to attend promotion courses f. If I had a typical/common injury for my trade it would significantly affect my relationship with my close family members g. If I had a typical/common injury for my trade and reported it to a Defence doctor it is likely that I would be medically downgraded h. I would report any injury that I suffered to a Defence Health Facility i. It is accepted practice in my work area to try to prevent injuries during sport or other physical activities (including job related activities) wherever possible j. It is accepted practice in my work area to report all injuries to Defence medical staff k. I frequently risk injury during sport and other physical activity, or to achieve work goals l. It is accepted practice in my work area to risk injuries during sport or other physical activities (including job related activities) m. I take steps to prevent injuries during sport and other physical activity n. I take steps to prevent injuries during the performance of physical work tasks o. There are adequate resources available to prevent injuries during sport and other physical activity p. There are adequate resources available to prevent injuries during the performance of physical work tasks q. I am able to avoid risking an injury during sport and other physical activities r. I am able to avoid risking an injury during physical work activities s. I can report any injury that I have to a Defence Medical Facility without any fear of repercussions
Page 36 of 37 39166 Section E: Comments
Please write in the space below any comments you may have about any aspect of the survey or about any aspect of service life that may not be covered by the survey.
As stated in the Privacy and Confidentiality clause on the inside cover, these comments may be fed back anonymously to the survey sponsor or used as an anonymous quote in support of survey findings. If you do not want any of your comments to be made available to the survey sponsor or to be used in any publication of the survey findings, please indicate by filling in the oval below.
I do not want any of my comments to be fed back to the survey sponsor or used in any publication resulting from the survey.
Please place the completed form in the return envelope provided, and return it to your Unit Survey Co-ordinator no later than a week from today. Thank you for your participation in the survey.
Page 37 of 37 INFORMATION SHEET
DEFENCE INJURY PREVENTION PROGRAM (DIPP) DEFENCE PHYSICAL EMPLOYMENT STANDARDS PROJECT (DPESP)
RETROSPECTIVE SURVEY OF INJURIES
The purpose of this Information Sheet is to describe the Survey of Injuries being carried out jointly by the Defence Injury Prevention Program (DIPP) and the Defence Physical Employment Standards Project (DPESP), and to invite you to participate in this study. Please note that we need your participation even if you have had no injury problems, in order to give us an accurate picture of injury experiences in your unit.
Background
As you are well aware, military operational tasks are physically demanding and incur risks for injury. In order to address the issues and costs associated with the high injury rates and focus on ways to reduce the risk of injury to Australian Defence Force personnel, the ADF Chiefs of Service Committee (COSC) has endorsed a number of injury prevention strategies aimed at examining, analysing and evaluating injury-related risks and hazards within the ADF. The DIPP program and the DPESP study are two of these strategies. DIPP is being conducted by Defence Health Services, and DPESP is being conducted by a consortium led by the University of Ballarat. One aspect identified by both DIPP and DPESP is the need for more detailed information than is currently available from ADF databases such as DEFCARE, about the types of injury being sustained, and often carried, by ADF personnel, and the relationship between various physical activities and the occurrence of preventable injuries.
Brief description of the survey
The attached questionnaire has been distributed to around 4500 ADF personnel in particular units in the Army and Air Force. It is designed to obtain details of all acute injuries suffered by members in the 12-month period May 2003 – April 2004, as well as all chronic injuries currently being carried. You are also asked for details of the situations and contexts in which the injuries occurred, together with information about actions taken after the injury, and some opinions regarding contributing factors and about the ADF culture regarding reporting, treatment and management of injuries.
DIPP-DPESP Survey of Injuries Information Sheet Page 1 of 3 Your part in the study
Please note that your involvement in the study is entirely voluntary and if you chose not to participate there will be no detriment to your career or your future health care. However, we would like to encourage you to participate in this important study. We hope that the outcome of this study will assist in reducing preventable injuries suffered by members of the ADF.
Based on preliminary field testing, we have made provision for recording details of up to eight injuries (four acute and four chronic), which makes the form quite long. If you have suffered fewer than eight injuries in the last year you will not need to fill in all sections of the form. Preliminary field testing indicates that most personnel will complete the survey in less than 45 minutes.
Even if you have had little or no injury experience in the last year, it is vitally important for both studies that you participate in the survey, so that we can get a full and accurate picture of the injury experiences in your unit.
Risks of participating
There are no physical risks associated with participation in this study. The issues of privacy and possible distress are dealt with in the following sections.
Statement of Privacy
You will be asked to report details of your injury history and give your opinions about risks of injury and the treatment and reporting of injuries. Steps have been taken to ensure that the privacy and confidentiality of these personal details and opinions will be strictly maintained. Firstly, you will return your completed survey form directly to the researchers, anonymously and separately from your consent form, so it will be impossible to definitively link you and your individual data. Even so, another layer of standard protections will be in place, including: 1. Consent forms will be kept under lock and key by the researchers, so that the fact that you participated in the survey will be kept confidential. 2. All original data will be kept under lock and key by the researchers. 3. Only group data summaries will be used in any reports. 4. The data will only be used for the purposes outlined above. 5. Secure information disposal methods such as document shredding will be used.
Distress
Answering some of the questions on the survey form may cause emotional distress as a result of recalling details of injury events and their consequences. If you feel distressed while completing the form or afterwards and you would like to talk to somebody about it, you are advised to contact the nearest Psychology Support Section (contact details are available on the Defence intranet or from base switchboards) or the chaplain on your base.
DIPP-DPESP Survey of Injuries Information Sheet Page 2 of 3 Names of Investigators Principal Investigator of DIPP: Mr Mike Power Directorate of Strategic Personnel Planning and Research CP2-5-165 Department of Defence Canberra, ACT, 2600 Telephone: (02) 6266 3439 Email: [email protected] Principal Investigators of DPESP: Professor Warren Payne University of Ballarat PO Box 663 Ballarat, Vic 3350 Telephone: (03) 5327 9693 Email: [email protected] Dr. Jack Harvey University of Ballarat PO Box 663 Ballarat, Vic 3350 Telephone: (03) 5327 9273 Email: [email protected]
Should you have any complaints or concerns about the manner in which the project is conducted, please do not hesitate to contact the researchers listed above in person or you may prefer to contact the Australian Defence Human Research Ethics Committee at the following address:
Executive Secretary Australian Defence Human Research Ethics Committee CP2-7-66 Department of Defence CANBERRA ACT 2600 Telephone: (02) 6266 3837 Facsimile: (02) 6266 4982 Email: [email protected]
Executive Officer University of Ballarat Human Research Ethics Committee Office of Research University of Ballarat PO Box 663 Ballarat, 3350 Telephone: (03) 5327 9765 Facsimile: (03) 5327 9602 Email: [email protected]
DIPP-DPESP Survey of Injuries Information Sheet Page 3 of 3 GUIDELINES FOR VOLUNTEERS
AUSTRALIAN DEFENCE HUMAN RESEARCH ETHICS COMMITTEE—GUIDELINES FOR VOLUNTEERS
Thank you for taking part in Defence Research. Your involvement is much appreciated. This pamphlet explains your rights as a volunteer.
What is ADHREC?
• ADHREC is the Australian Defence Human Research Ethics Committee. It was established in 1988, to make sure that Defence complied with accepted guidelines for research involving human beings.
• After World War II (WWII), there was concern around the world about human experimentation. The Declaration of Helsinki was made in 1964, which provided the basic principles to be followed wherever humans were used in research projects.
• The National Health and Medical Research Council (NHMRC) in Australia published the National Statement on Ethical Conduct in Research involving Humans in 1999. This Statement describes how human research should be carried out.
• ADHREC follows both the Declaration of Helsinki and the NHMRC Statement. What Australian Defence Human Research Ethics Committee approval means
• If you are told that the project has ADHREC approval, what that means is that ADHREC has reviewed the research proposal and has agreed that the research is ethical.
• ADHREC approval does not imply any obligation on commanders to order or encourage their service personnel to participate, or to release troops from their usual workplace to participate. Obviously, the use of any particular personnel must have clearance from their commanders but commanders should not use ADHREC approval to pressure personnel into volunteering.
Voluntary participation
• As you are a volunteer for this research project, you are under no obligation to participate or continue to participate. You may withdraw from the project at any time without detriment to your military career or to your medical care.
• At no time must you feel pressured to participate or to continue if you do not wish to do so.
• If you do not wish to continue, it would be useful to the researcher to know why, but you are under no obligation to give reasons for not wanting to continue. Informed consent
• Before commencing the project you will have been given an information sheet which explains the project, your role in it and any risks to which you may be exposed.
• You must be sure that you understand the information given to you and that you ask the researchers about anything of which you are not sure.
• If you are satisfied that you understand the information sheet and agree to participate, you should initial every page of the information sheet and keep a copy.
• Before you participate in the project you should also have been given a consent form to sign. You must be happy that the consent form is easy to understand and spells out what you are agreeing to. Again, you should keep a copy of the signed consent form.
Tracing of research participants
• Media reports of human experimentation during times of conflict, eg WWII, Vietnam War, have raised the issue of being able to trace study participants, some time in the future, should any problems arise that may be related to the research conducted.
• To facilitate this, ADHREC requires that the researcher provide a nominal roll of study participants for safekeeping by ADHREC, where the study is a clinical trial (eg. When the researchers are trialing a new treatment or device). We need to know who you are, only so that we can find you in the future, if there is any suggestion that the research may have been associated with the development of any health problems. Please note that a health study is not a clinical trial, and as such does not require the researcher to provide ADHREC with a nominal roll. • This is consistent with current Occupational Health and Safety and Health Surveillance practices, and is encouraged under the NHMRC Guidelines.
• All ADHREC protocol files are secured in a locked filing cabinet and only the Secretariat has access to these. If you do need to be traced in the future, ADHREC will do this. ADHREC will not pass your contact information to a third party without your permission.
• These records will not be used to consider your medical employment standard or for compensation purposes.
Complaints
• If at any time during your participation in the project you are worried about how the project is being run or how you are being treated, then you should speak to the researchers.
• If you don’t feel comfortable doing this, you can contact the Executive Secretary of ADHREC. Contact details are:
Executive Secretary Australian Defence Human Research Ethics Committee CP2–7–66 Department of Defence CANBERRA ACT 2600 Telephone: (02) 6266 3837 Facsimile: (02) 6266 4982 Email: [email protected] More information
• If you would like to read more about ADHREC, you can look up the following references on the Defence Manager’s Toolbox or on the Defence Intranet (DEFWEB):
– DI(G) ADMIN 24–3—Function, Structure and Procedures for Obtaining Clearance for Research from Australian Defence Medical Ethics Committee (or as amended)
– HPD 205—Australian Defence Medical Ethics Committee (or as amended)
– ADFP 1.2.5.3—Health and Human Performance Research in Defence —Manual for Researchers
Or, visit the ADHREC web site at http://defweb2.cbr.defence.gov.au/dpedhs/ and follow the links. ORIGINAL – TO BE RETURNED
CONSENT FORM
DEFENCE INJURY PREVENTION PROGRAM (DIPP) DEFENCE PHYSICAL EMPLOYMENT STANDARDS PROJECT (DPESP)
RETROSPECTIVE SURVEY OF INJURIES
I,…………………………………………… give my consent to participate in the project mentioned in the attached information sheet on the following basis:
I have had explained to me the aims of this research project, how it will be conducted and my role in it.
I understand that I am participating in this project in a voluntary capacity and can withdraw at any time without penalty or detriment to my career or future health care.
I understand that, as an ADF member, I will be considered to be ‘on duty’ during participation in the study.
I understand the risks involved as described in the subject information sheet.
I am co-operating in this project on condition that:
S The information I provide will be kept confidential.
S The information will be used only for this project.
S The research results will be made available to me at my request (within normal Defence information security constraints) and any published reports of this study will preserve my anonymity.
I have been given a copy of the information/consent sheet, signed by me and by the DPESP principal researcher, Prof. Warren Payne, to keep.
I have also been given a copy of ADHREC’s Guidelines for Volunteers.
……………………………………. ………………………………… Participant’s signature Principal Researcher’s signature
……………………………………. WARREN PAYNE Printed name Printed name
27 April 2004 ……………………………………. ………………………………… Date Date
ORIGINAL – TO BE RETURNED Defence Injury Prevention Program & Defence Physical Employment Standards Survey
This pack contains a survey form, 2 consent forms and information sheets about both the DIPP and the DPESP. PLEASE COMPLETE THE ENCLOSED SURVEY AND INFORMED CONSENT FORMS AND PLACE THEM IN THEIR RESPECTIVE ENVELOPES COMPLETED SURVEYS AND CONSENT FORM SHOULD BE RETURNED TO YOUR UNIT SURVEY COORDINATOR WITHIN ONE WEEK OF THEIR COMPLETION
Instructions for completing the survey form: All forms will be optically scanned and written into a database. To ensure accurate recording, it is important that you follow the instructions as set out below:
Please Do: S Use a black pen or a pencil (2B or softer) to fill in your responses. S Fill in the response ovals as shown in the sample below. S If you make a mistake either erase the error completely or place a cross through the incorrect answer and mark your preferred choice.
Please Do Not: S Use a red, blue or green pen or any pen other than black. S Make stray marks on the survey form. S Fold, staple, or fax your survey form.
SAMPLE ENTRIES Mark ovals like this Not like this
When you have completed the survey, please seal it in the enclosed envelope and return it and your Consent Form to your Unit Survey Co-ordinator within one week of completion. If you have any questions about the survey, please phone Mike Power on (02) 6266 3439 or email [email protected].
Privacy and Confidentiality
We respect your privacy. This survey is administered under the provisions of the Privacy Act 1988. Data collected from this survey is treated as strictly “In-Confidence” and will be stored within the Directorate of Strategic Personnel Planning and Research. The data will be used for research purposes and to inform policy makers. Some data, including aggregated survey responses and any written comments you make, may be fed back to the wider Defence community.
Under no circumstances will individual data be provided that allows the identification of any respondent.
Conducted by the Directorate of Strategic Personnel Planning and Research ANNEX 7
UNIT SURVEY INSTRUCTION
DEFENCE INJURY PREVENTION PROGRAM (DIPP) DEFENCE PHYSICAL EMPLOYMENT STANDARDS PROJECT (DPESP)
RETROSPECTIVE SURVEY OF INJURIES
The purpose of this Instruction is to describe the Survey of Injuries being carried out jointly by the Defence Injury Prevention Program (DIPP) and the Defence Physical Employment Standards Project (DPESP), and to provide instructions for survey administration.
Background As you are well aware, military operational tasks are physically demanding and incur risks for injury. In order to address the issues and costs associated with the high injury rates and focus on ways to reduce the risk of injury to Australian Defence Force personnel, the ADF Chiefs of Service Committee (COSC) has endorsed a number of injury prevention strategies aimed at examining, analysing and evaluating injury-related risks and hazards within the ADF. The DIPP program and the DPESP study are two of these strategies. DIPP is being conducted by Defence Health Services, and DPESP is being conducted by a consortium led by the University of Ballarat. One aspect identified by both DIPP and DPESP is the need for more detailed information than is currently available from ADF databases such as DEFCARE, about the types of injury being sustained, and often carried, by ADF personnel, and the relationship between various physical activities and the occurrence of preventable injuries.
Brief description of the survey The survey questionnaire has been distributed to about 4500 ADF personnel, selected from particular units in the Army and Air Force. It is designed to obtain details of all acute injuries suffered by participants in the 12-month period May 2003 – April 2004, as well as all chronic injuries currently being carried. Participants are also asked for details of the situations and contexts in which the injuries occurred,
ANNEX 7 Page 1 of 3 together with information about actions taken after the injury, and some opinions regarding contributing factors and about the ADF culture regarding reporting, treatment and management of injuries.
Instructions for Survey Administration The survey envelopes should be distributed to all available personnel in your area of responsibility, and these personnel should be instructed as follows:
• This survey asks you questions about your experiences with injury • The results are important to two major Defence projects: the Defence Injury Prevention Program and the Defence Physical Employment Standards Project. • These Projects are major initiatives of the ADF, with full HQ endorsement, and your participation is strongly encouraged • Your participation is requested even if you have had no injuries, so that the research team gets a full picture of injury experiences in the ADF • Please read the ‘Information sheet’ and ‘Guidelines for Volunteers’ contained in the survey envelope, and if you consent to taking part in the survey: • Read and sign the original of the consent form, and seal it in the small envelope provided • Read the instructions and complete the survey – expected time to complete: 45 minutes • Seal the survey in the large envelope provided • Keep the ‘Information Sheet’, ‘Guidelines for Volunteers’ and copy of the ‘Consent Form’ – they are yours to keep • Return the completed survey and consent form, each in its own envelope, to the two mailboxes at …………….. (insert place at which mailboxes will be set up) • Completed surveys must be returned by ……….. (insert date which is one week from administration of the surveys) • I will send the sealed envelopes to the Research Office in Canberra – I will not open the envelopes or read your responses
Instructions for Survey Collection and Handling 1. Two ‘mailboxes’, sealed and secure but with slots through which the completed surveys and consent forms can be deposited, should be set up in a location which can be accessed by all personnel who complete the survey. One mailbox
ANNEX 7 Page 2 of 3 should be labelled ‘Consent Forms for DIPP/DPESP Survey’, and will be designed to receive the small envelopes containing signed consent forms. The second mailbox should be labelled ‘Completed Surveys for DIPP/DPESP’, and will be designed to receive the large envelopes containing completed surveys.
2. Send out reminders throughout the week of the survey, reminding personnel who have consented to participate to complete their surveys and return them.
3. At the end of the week, deliver all sealed envelopes to the person in your unit who is coordinating the survey, and they should box these up and deliver them to:
Mr Mike Power, Research Officer Directorate of Strategic Personnel Planning and Research CP2-5-165 Department of Defence Campbell Park ACT 2600
POC in the event of any queries regarding survey administration:
Mr Mike Power 02 6266 3439 Dr Jack Harvey 03 53279065 Mr John Mathieson 02 6265 1344
ANNEX 7 Page 3 of 3 ANNEX 8 DEFENCE PHYSICAL EMPLOYMENT STANDARDS PROJECT (DPESP)
Survey of Injuries
Army 2005
This form is in three sections, including questions about…
• Any acute injury incidents you have experienced during the past year • Any chronic injuries you are currently carrying • Your opinions about risks of injury on the job
Please enter your name, DPESP ID Code and Unit
Name ______Given name Family name
DPESP ID Code Section: _____ Number: ______
Unit ______
Please read the following explanatory notes then answer the questions in the following sections.
This survey is about PHYSICAL INJURIES. It does NOT cover: • Exposure to substances, radiation, etc. • Disease/illness • Mental stress • Mental illness.
Section A is about ACUTE INJURY INCIDENTS. In Section A, we are interested in any specific incident during the past 12 months which led to a physical injury (including heat stress). This includes: • a new injury • a repeat episode of a previous injury.
Section B is about CHRONIC INJURIES. In Section B, we are interested in ongoing or frequently recurring conditions which are difficult to relate to particular times and places - for example persistent knee joint pain over the past six to twelve months.
ANNEX 8 Page 1 of 30
Section A: Acute injury incidents during the past year
This section is concerned with any specific incident during the past 12 months which led to a physical injury (including heat stress). This includes: • a new injury • a repeat episode of a previous injury
Do not include ongoing chronic injuries which are difficult to relate to particular times and places. These are covered in Section B.
1. During the past 12 months did you suffer any injury or heat stress incident which made it difficult for you to effectively perform your duties for at least one day after the incident?
Yes No (If NO, please turn to section B, Page 19)
2. How many such incidents occurred in the past 12 months? ______
Please answer the following set of questions separately for each incident.
Note: There is space on this form for up to FOUR injury incidents – if you had more than four incidents, please give details about the four most serious incidents.
ANNEX 8 Page 2 of 30
Injury Incident 1
1. Approximately when did the injury occur? (Enter month and year if unsure of exact date)
___ / ___ / ___ dd mm yy
2. At approximately what time did the injury occur? (24 hr clock) ____ : ____
3. Where did the injury occur (Geographical location, such as town or city, establishment, region (if on an exercise) or country if outside Australia)
4. What job phase were you in at the time?
Major exercise Leave Pre-deployment Regular trade activity/training Deployment
5. Was this a new or recurring injury? New Recurring
6. Which of the following list best describes the nature of the injury? (Please indicate the MAIN injury in the first column and mark any other associated injuries in the second column)
Main Other
injury injuries
Fracture/ stress fracture (non-spinal) Fracture/ stress fracture of the spine Joint dislocation Sprain of joint(s) and/or ligaments Strain of muscles and/or tendons Head injury/ concussion Internal injury of chest, abdomen and/or pelvis Traumatic amputation Open wound, not involving traumatic amputation Superficial cuts and abrasions Bruise or crushing injury, not involving fracture Foreign body on external eye, in ear or nose or in respiratory, digestive or reproductive system Burn(s) Injury to nerves or spinal cord without evidence of spinal bone injury Effects of weather, exposure, air pressure or other external causes (including heat stress) Other injuries (Please specify)
ANNEX 8 Page 3 of 30
7. What region of your body was injured? (Tick one only)
Head Lower back Multiple locations Neck Pelvis Whole body Chest/ribs/upper back Upper limbs (including shoulders) (e.g. heat stress) Abdomen Lower limbs (including hips)
8. Were you engaged in any of the following activities when the injury occurred? (Tick one only)
Authorised sport Other sport Physical training Work or trade related: Trade/employment-related training (excluding physical training) General Military Skills Training (not trade-specific) Normal duties of trade (excluding all forms of training) Adventure Training - participation authorised Battle-related activity (on operation) Travelling to/from ADF work Other ADF activity None of the above
9A. If you ticked any of the work or trade-related categories in Question 8, were you engaged in any of the following Combat Arms Trade Tasks (CATTs) when the injury first occurred? (Tick one only)
Bayonet assault Mortar forced march (8 km) Stretcher carry Casualty evacuation drag Patrol in marching order Tunnel crawl Coy. level replenishment Patrol in patrol order Urban rushing Dig to Stage 1, 2 or 3 Population protection & control Wall climb: 1.82 m Forced entry and stair climb Rope climb Wall climb: 2.43 m Forced march Sand bagging Wall climb: 3.66 m Jerry can carry Second storey drop Wiring Ladder lift Section attack Other (please specify) Load and unload UNIMOG Stores carry
9B. If you ticked any of the work or trade-related categories in Question 8, what were the main physical actions you were engaged in when the injury first occurred? (Tick ALL which apply)
Carrying load in hands/arms Going to ground Running Carrying load on back Jumping Sitting Climbing a ladder Lying Sprinting Climbing a rope Lifting Standing Climbing a wall Marching Striking Crawling Passing Walking Crouching Patrolling Other (please specify) Digging Pushing/Pulling Dropping & landing Rising to your feet
ANNEX 8 Page 4 of 30
10. Explain how the injury occurred. Indicate any particular contributing factors such as fatigue or equipment problems.
11. What actions did you take? (Tick ALL that apply)
No action Self treated Received first aid Reported to RAP Reported to military health centre or military hospital
Went to get civilian medical assistance or advice: from an emergency department from another civilian facility
12. Indicate for how many days you were affected in each of the following ways. Write “0” for any which do not apply.
_____ days in hospital _____ days on light duties _____ days on sick leave _____ days of work program affected _____ days off work
13. If you were off work, did you return to full duty before you felt you had fully recovered from this injury?
Yes No Not applicable – I was not off work
ANNEX 8 Page 5 of 30
14. Were there any safeguards or preventative strategies in place when this incident occurred?
Yes (Please give details below) No (Please go to question 16)
Unsure (Please go to question 16)
15. Did the safeguards or preventative strategies fail?
Yes (Please give details below) No (Please go to question 16)
16. In your opinion, did excessive risk-taking behaviour or acceptance of excessive risk, either by yourself, your supervisor or some other person (nominate who in the details below), contribute to this incident?
Yes (Please give details below) No
If you have another injury incident to report, please continue on the next page. Otherwise please turn to Section B on page 19.
ANNEX 8 Page 6 of 30
Injury Incident 2
1. Approximately when did the injury occur? (Enter month and year if unsure of exact date)
___ / ___ / ___ dd mm yy
2. At approximately what time did the injury occur? (24 hr clock) ____ : ____
3. Where did the injury occur (Geographical location, such as town or city, establishment, region (if on an exercise) or country if outside Australia)
4. What job phase were you in at the time?
Major exercise Leave Pre-deployment Regular trade activity/training Deployment
5. Was this a new or recurring injury? New Recurring
6. Which of the following list best describes the nature of the injury? (Please indicate the MAIN injury in the first column and mark any other associated injuries in the second column)
Main Other
injury injuries
Fracture/ stress fracture (non-spinal) Fracture/ stress fracture of the spine Joint dislocation Sprain of joint(s) and/or ligaments Strain of muscles and/or tendons Head injury/ concussion Internal injury of chest, abdomen and/or pelvis Traumatic amputation Open wound, not involving traumatic amputation Superficial cuts and abrasions Bruise or crushing injury, not involving fracture Foreign body on external eye, in ear or nose or in respiratory, digestive or reproductive system Burn(s) Injury to nerves or spinal cord without evidence of spinal bone injury Effects of weather, exposure, air pressure or other external causes (including heat stress) Other injuries (Please specify)
ANNEX 8 Page 7 of 30
7. What region of your body was injured? (Tick one only)
Head Lower back Multiple locations Neck Pelvis Whole body Chest/ribs/upper back Upper limbs (including shoulders) (e.g. heat stress) Abdomen Lower limbs (including hips)
8. Were you engaged in any of the following activities when the injury occurred? (Tick one only)
Authorised sport Other sport Physical training Work or trade related: Trade/employment-related training (excluding physical training) General Military Skills Training (not trade-specific) Normal duties of trade (excluding all forms of training) Adventure Training - participation authorised Battle-related activity (on operation) Travelling to/from ADF work Other ADF activity None of the above
9A. If you ticked any of the work or trade-related categories in Question 8, were you engaged in any of the following Combat Arms Trade Tasks (CATTs) when the injury first occurred? (Tick one only)
Bayonet assault Mortar forced march (8 km) Stretcher carry Casualty evacuation drag Patrol in marching order Tunnel crawl Coy. level replenishment Patrol in patrol order Urban rushing Dig to Stage 1, 2 or 3 Population protection & control Wall climb: 1.82 m Forced entry and stair climb Rope climb Wall climb: 2.43 m Forced march Sand bagging Wall climb: 3.66 m Jerry can carry Second storey drop Wiring Ladder lift Section attack Other (please specify) Load and unload UNIMOG Stores carry
9B. If you ticked any of the work or trade-related categories in Question 8, what were the main physical actions you were engaged in when the injury first occurred? (Tick ALL which apply)
Carrying load in hands/arms Going to ground Running Carrying load on back Jumping Sitting Climbing a ladder Lying Sprinting Climbing a rope Lifting Standing Climbing a wall Marching Striking Crawling Passing Walking Crouching Patrolling Other (please specify) Digging Pushing/Pulling Dropping & landing Rising to your feet
ANNEX 8 Page 8 of 30
10. Explain how the injury occurred. Indicate any particular contributing factors such as fatigue or equipment problems.
11. What actions did you take? (Tick ALL that apply)
No action Self treated Received first aid Reported to RAP Reported to military health centre or military hospital Went to get civilian medical assistance or advice: from an emergency department from another civilian facility
12. Indicate for how many days you were affected in each of the following ways. Write “0” for any which do not apply.
_____ days in hospital _____ days on light duties _____ days on sick leave _____ days of work program affected _____ days off work
13. If you were off work, did you return to full duty before you felt you had fully recovered from this injury?
Yes No Not applicable – I was not off work
ANNEX 8 Page 9 of 30
14. Were there any safeguards or preventative strategies in place when this incident occurred?
Yes (Please give details below) No (Please go to question 16)
Unsure (Please go to question 16)
15. Did the safeguards or preventative strategies fail?
Yes (Please give details below) No (Please go to question 16)
16. In your opinion, did excessive risk-taking behaviour or acceptance of excessive risk, either by yourself, your supervisor or some other person (nominate who in the details below), contribute to this incident?
Yes (Please give details below) No
If you have another injury incident to report, please continue on the next page. Otherwise please turn to Section B on page 19.
ANNEX 8 Page 10 of 30
Injury Incident 3
1. Approximately when did the injury occur? (Enter month and year if unsure of exact date)
___ / ___ / ___ dd mm yy
2. At approximately what time did the injury occur? (24 hr clock) ____ : ____
3. Where did the injury occur (Geographical location, such as town or city, establishment, region (if on an exercise) or country if outside Australia)
4. What job phase were you in at the time?
Major exercise Leave Pre-deployment Regular trade activity/training Deployment
5. Was this a new or recurring injury? New Recurring
6. Which of the following list best describes the nature of the injury? (Please indicate the MAIN injury in the first column and mark any other associated injuries in the second column)
Main Other
injury injuries
Fracture/ stress fracture (non-spinal) Fracture/ stress fracture of the spine Joint dislocation Sprain of joint(s) and/or ligaments Strain of muscles and/or tendons Head injury/ concussion Internal injury of chest, abdomen and/or pelvis Traumatic amputation Open wound, not involving traumatic amputation Superficial cuts and abrasions Bruise or crushing injury, not involving fracture Foreign body on external eye, in ear or nose or in respiratory, digestive or reproductive system Burn(s) Injury to nerves or spinal cord without evidence of spinal bone injury Effects of weather, exposure, air pressure or other external causes (including heat stress) Other injuries (Please specify)
ANNEX 8 Page 11 of 30
7. What region of your body was injured? (Tick one only)
Head Lower back Multiple locations Neck Pelvis Whole body Chest/ribs/upper back Upper limbs (including shoulders) (e.g. heat stress) Abdomen Lower limbs (including hips)
8. Were you engaged in any of the following activities when the injury occurred? (Tick one only)
Authorised sport Other sport Physical training Work or trade related: Trade/employment-related training (excluding physical training) General Military Skills Training (not trade-specific) Normal duties of trade (excluding all forms of training) Adventure Training - participation authorised Battle-related activity (on operation) Travelling to/from ADF work Other ADF activity None of the above
9A. If you ticked any of the work or trade-related categories in Question 8, were you engaged in any of the following Combat Arms Trade Tasks (CATTs) when the injury first occurred? (Tick one only)
Bayonet assault Mortar forced march (8 km) Stretcher carry Casualty evacuation drag Patrol in marching order Tunnel crawl Coy. level replenishment Patrol in patrol order Urban rushing Dig to Stage 1, 2 or 3 Population protection & control Wall climb: 1.82 m Forced entry and stair climb Rope climb Wall climb: 2.43 m Forced march Sand bagging Wall climb: 3.66 m Jerry can carry Second storey drop Wiring Ladder lift Section attack Other (please specify) Load and unload UNIMOG Stores carry
9B. If you ticked any of the work or trade-related categories in Question 8, what were the main physical actions you were engaged in when the injury first occurred? (Tick ALL which apply)
Carrying load in hands/arms Going to ground Running Carrying load on back Jumping Sitting Climbing a ladder Lying Sprinting Climbing a rope Lifting Standing Climbing a wall Marching Striking Crawling Passing Walking Crouching Patrolling Other (please specify) Digging Pushing/Pulling Dropping & landing Rising to your feet
ANNEX 8 Page 12 of 30
10. Explain how the injury occurred. Indicate any particular contributing factors such as fatigue or equipment problems.
11. What actions did you take? (Tick ALL that apply)
No action Self treated Received first aid Reported to RAP Reported to military health centre or military hospital Went to get civilian medical assistance or advice: from an emergency department from another civilian facility
12. Indicate for how many days you were affected in each of the following ways. Write “0” for any which do not apply.
_____ days in hospital _____ days on light duties _____ days on sick leave _____ days of work program affected _____ days off work
13. If you were off work, did you return to full duty before you felt you had fully recovered from this injury?
Yes No Not applicable – I was not off work
ANNEX 8 Page 13 of 30
14. Were there any safeguards or preventative strategies in place when this incident occurred?
Yes (Please give details below) No (Please go to question 16)
Unsure (Please go to question 16)
15. Did the safeguards or preventative strategies fail?
Yes (Please give details below) No (Please go to question 16)
16. In your opinion, did excessive risk-taking behaviour or acceptance of excessive risk, either by yourself, your supervisor or some other person (nominate who in the details below), contribute to this incident?
Yes (Please give details below) No
If you have another injury incident to report, please continue on the next page. Otherwise please turn to Section B on page 19.
ANNEX 8 Page 14 of 30
Injury Incident 4
1. Approximately when did the injury occur? (Enter month and year if unsure of exact date)
___ / ___ / ___ dd mm yy
2. At approximately what time did the injury occur? (24 hr clock) ____ : ____
3. Where did the injury occur (Geographical location, such as town or city, establishment, region (if on an exercise) or country if outside Australia)
4. What job phase were you in at the time?
Major exercise Leave Pre-deployment Regular trade activity/training Deployment
5. Was this a new or recurring injury? New Recurring
6. Which of the following list best describes the nature of the injury? (Please indicate the MAIN injury in the first column and mark any other associated injuries in the second column)
Main Other
injury injuries
Fracture/ stress fracture (non-spinal) Fracture/ stress fracture of the spine Joint dislocation Sprain of joint(s) and/or ligaments Strain of muscles and/or tendons Head injury/ concussion Internal injury of chest, abdomen and/or pelvis Traumatic amputation Open wound, not involving traumatic amputation Superficial cuts and abrasions Bruise or crushing injury, not involving fracture Foreign body on external eye, in ear or nose or in respiratory, digestive or reproductive system Burn(s) Injury to nerves or spinal cord without evidence of spinal bone injury Effects of weather, exposure, air pressure or other external causes (including heat stress) Other injuries (Please specify)
ANNEX 8 Page 15 of 30
7. What region of your body was injured? (Tick one only)
Head Lower back Multiple locations Neck Pelvis Whole body Chest/ribs/upper back Upper limbs (including shoulders) (e.g. heat stress) Abdomen Lower limbs (including hips)
8. Were you engaged in any of the following activities when the injury occurred? (Tick one only)
Authorised sport Other sport Physical training Work or trade related: Trade/employment-related training (excluding physical training) General Military Skills Training (not trade-specific) Normal duties of trade (excluding all forms of training) Adventure Training - participation authorised Battle-related activity (on operation) Travelling to/from ADF work Other ADF activity None of the above
9A. If you ticked any of the work or trade-related categories in Question 8, were you engaged in any of the following Combat Arms Trade Tasks (CATTs) when the injury first occurred? (Tick one only)
Bayonet assault Mortar forced march (8 km) Stretcher carry Casualty evacuation drag Patrol in marching order Tunnel crawl Coy. level replenishment Patrol in patrol order Urban rushing Dig to Stage 1, 2 or 3 Population protection & control Wall climb: 1.82 m Forced entry and stair climb Rope climb Wall climb: 2.43 m Forced march Sand bagging Wall climb: 3.66 m Jerry can carry Second storey drop Wiring Ladder lift Section attack Other (please specify) Load and unload UNIMOG Stores carry
9B. If you ticked any of the work or trade-related categories in Question 8, what were the main physical actions you were engaged in when the injury first occurred? (Tick ALL which apply)
Carrying load in hands/arms Going to ground Running Carrying load on back Jumping Sitting Climbing a ladder Lying Sprinting Climbing a rope Lifting Standing Climbing a wall Marching Striking Crawling Passing Walking Crouching Patrolling Other (please specify) Digging Pushing/Pulling Dropping & landing Rising to your feet
ANNEX 8 Page 16 of 30
10. Explain how the injury occurred. Indicate any particular contributing factors such as fatigue or equipment problems.
11. What actions did you take? (Tick ALL that apply)
No action Self treated Received first aid Reported to RAP Reported to military health centre or military hospital Went to get civilian medical assistance or advice: from an emergency department from another civilian facility
12. Indicate for how many days you were affected in each of the following ways. Write “0” for any which do not apply.
_____ days in hospital _____ days on light duties _____ days on sick leave _____ days of work program affected _____ days off work
13. If you were off work, did you return to full duty before you felt you had fully recovered from this injury?
Yes No Not applicable – I was not off work
ANNEX 8 Page 17 of 30
14. Were there any safeguards or preventative strategies in place when this incident occurred?
Yes (Please give details below) No (Please go to question 16)
Unsure (Please go to question 16)
15. Did the safeguards or preventative strategies fail?
Yes (Please give details below) No (Please go to question 16)
16. In your opinion, did excessive risk-taking behaviour or acceptance of excessive risk, either by yourself, your supervisor or some other person (nominate who in the details below), contribute to this incident?
Yes (Please give details below) No
Please continue to Section B on the next page.
ANNEX 8 Page 18 of 30
Section B: Chronic Injuries
This section is concerned with ongoing injuries which are difficult to relate to particular times and places - for example persistent knee joint pain over the past six to twelve months.
1. Are you carrying any chronic injuries that have not been covered in Section A above?
Yes No (If NO, please turn to Section C on page 28)
2. How many different chronic injuries are you carrying? ______
Please answer the following set of questions separately for each chronic injury.
Note: There is space on this form for up to FOUR chronic injuries – if you are carrying more than four chronic injuries, please give details about the four most serious injuries.
ANNEX 8 Page 19 of 30
Chronic Injury 1
1. How long have you had this injury? (Please indicate the duration in either years or months)
______years OR ______months
2. What is the nature of the injury? (Tick one only)
Disorder of the joints Disorder of the spinal vertebrae and/or intervertebral discs Disorder of muscles, tendons and/or other soft tissues Other (please specify)
3. What region of your body is affected? (Tick one only)
Head Lower back Multiple locations Neck Pelvis Whole body Chest/ribs/upper back Upper limbs (including shoulders) (e.g. heat stress) Abdomen Lower limbs (including hips)
4. Do you consider that any of the following activities were major contributors to the INITIAL occurrence of this injury? (Tick ALL which apply)
Authorised sport Other sport Physical training Work or trade related: Trade/employment-related training (excluding physical training) General Military Skills Training (not trade-specific) Normal duties of trade (excluding all forms of training) Adventure Training - participation authorised Battle-related activity (on operation) Travelling to/from ADF work Other ADF activity None of the above
5A. If you ticked any of the work or trade-related categories in Question 4, were you engaged in any of the following Combat Arms Trade Tasks (CATTs) when the injury first occurred? (Tick one only)
Bayonet assault Mortar forced march (8 km) Stretcher carry Casualty evacuation drag Patrol in marching order Tunnel crawl Coy. level replenishment Patrol in patrol order Urban rushing Dig to Stage 1, 2 or 3 Population protection & control Wall climb: 1.82 m Forced entry and stair climb Rope climb Wall climb: 2.43 m Forced march Sand bagging Wall climb: 3.66 m Jerry can carry Second storey drop Wiring Ladder lift Section attack Other (please specify) Load and unload UNIMOG Stores carry
ANNEX 8 Page 20 of 30
5B. If you ticked any of the work or trade-related categories in Question 4, what were the main physical actions you were engaged in when the injury first occurred? (Tick ALL which apply)
Carrying load in hands/arms Going to ground Running Carrying load on back Jumping Sitting Climbing a ladder Lying Sprinting Climbing a rope Lifting Standing Climbing a wall Marching Striking Crawling Passing Walking Crouching Patrolling Other (please specify) Digging Pushing/Pulling Dropping & landing Rising to your feet
6. What actions have you taken during the past 12 months regarding this chronic injury? (Tick ALL which apply)
No action Self treated Received first aid Reported to RAP Reported to military health centre or military hospital Went to get civilian medical assistance or advice: from an emergency department from another civilian facility
7. To what extent does this chronic injury affect you in the performance of your duties? (Tick one only)
Not at all Occasional temporary restrictions Affected but without restrictions Medically downgraded
8. If you have temporary restrictions, for approximately how many days per year do they apply?
______days
9. What is your current Medical Employment Classification Level?
MEC 1 MEC 3 Temporarily Medically Unfit (TMU) MEC 2 MEC 4
If you have another chronic injury to report, please continue on the next page. Otherwise please turn to Section C on page 28.
ANNEX 8 Page 21 of 30
Chronic Injury 2
1. How long have you had this injury? (Please indicate the duration in either years or months)
______years OR ______months
2. What is the nature of the injury? (Tick one only)
Disorder of the joints Disorder of the spinal vertebrae and/or intervertebral discs Disorder of muscles, tendons and/or other soft tissues Other (please specify)
3. What region of your body is affected? (Tick one only)
Head Lower back Multiple locations Neck Pelvis Whole body Chest/ribs/upper back Upper limbs (including shoulders) (e.g. heat stress) Abdomen Lower limbs (including hips)
4. Do you consider that any of the following activities were major contributors to the INITIAL occurrence of this injury? (Tick ALL which apply)
Authorised sport Other sport Physical training Work or trade related: Trade/employment-related training (excluding physical training) General Military Skills Training (not trade-specific) Normal duties of trade (excluding all forms of training) Adventure Training - participation authorised Battle-related activity (on operation) Travelling to/from ADF work Other ADF activity None of the above
5A. If you ticked any of the work or trade-related categories in Question 4, were you engaged in any of the following Combat Arms Trade Tasks (CATTs) when the injury first occurred? (Tick one only)
Bayonet assault Mortar forced march (8 km) Stretcher carry Casualty evacuation drag Patrol in marching order Tunnel crawl Coy. level replenishment Patrol in patrol order Urban rushing Dig to Stage 1, 2 or 3 Population protection & control Wall climb: 1.82 m Forced entry and stair climb Rope climb Wall climb: 2.43 m Forced march Sand bagging Wall climb: 3.66 m Jerry can carry Second storey drop Wiring Ladder lift Section attack Other (please specify) Load and unload UNIMOG Stores carry
ANNEX 8 Page 22 of 30
5B. If you ticked any of the work or trade-related categories in Question 4, what were the main physical actions you were engaged in when the injury first occurred? (Tick ALL which apply)
Carrying load in hands/arms Going to ground Running Carrying load on back Jumping Sitting Climbing a ladder Lying Sprinting Climbing a rope Lifting Standing Climbing a wall Marching Striking Crawling Passing Walking Crouching Patrolling Other (please specify) Digging Pushing/Pulling Dropping & landing Rising to your feet
6. What actions have you taken during the past 12 months regarding this chronic injury? (Tick ALL which apply)
No action Self treated Received first aid Reported to RAP Reported to military health centre or military hospital Went to get civilian medical assistance or advice: from an emergency department from another civilian facility
7. To what extent does this chronic injury affect you in the performance of your duties? (Tick one only)
Not at all Occasional temporary restrictions Affected but without restrictions Medically downgraded
8. If you have temporary restrictions, for approximately how many days per year do they apply?
______days
9. What is your current Medical Employment Classification Level?
MEC 1 MEC 3 Temporarily Medically Unfit (TMU) MEC 2 MEC 4
If you have another chronic injury to report, please continue on the next page. Otherwise please turn to Section C on page 28.
ANNEX 8 Page 23 of 30
Chronic Injury 3
1. How long have you had this injury? (Please indicate the duration in either years or months)
______years OR ______months
2. What is the nature of the injury? (Tick one only)
Disorder of the joints Disorder of the spinal vertebrae and/or intervertebral discs Disorder of muscles, tendons and/or other soft tissues Other (please specify)
3. What region of your body is affected? (Tick one only)
Head Lower back Multiple locations Neck Pelvis Whole body Chest/ribs/upper back Upper limbs (including shoulders) (e.g. heat stress) Abdomen Lower limbs (including hips)
4. Do you consider that any of the following activities were major contributors to the INITIAL occurrence of this injury? (Tick ALL which apply)
Authorised sport Other sport Physical training Work or trade related: Trade/employment-related training (excluding physical training) General Military Skills Training (not trade-specific) Normal duties of trade (excluding all forms of training) Adventure Training - participation authorised Battle-related activity (on operation) Travelling to/from ADF work Other ADF activity None of the above
5A. If you ticked any of the work or trade-related categories in Question 4, were you engaged in any of the following Combat Arms Trade Tasks (CATTs) when the injury first occurred? (Tick one only)
Bayonet assault Mortar forced march (8 km) Stretcher carry Casualty evacuation drag Patrol in marching order Tunnel crawl Coy. level replenishment Patrol in patrol order Urban rushing Dig to Stage 1, 2 or 3 Population protection & control Wall climb: 1.82 m Forced entry and stair climb Rope climb Wall climb: 2.43 m Forced march Sand bagging Wall climb: 3.66 m Jerry can carry Second storey drop Wiring Ladder lift Section attack Other (please specify) Load and unload UNIMOG Stores carry
ANNEX 8 Page 24 of 30
5B. If you ticked any of the work or trade-related categories in Question 4, what were the main physical actions you were engaged in when the injury first occurred? (Tick ALL which apply)
Carrying load in hands/arms Going to ground Running Carrying load on back Jumping Sitting Climbing a ladder Lying Sprinting Climbing a rope Lifting Standing Climbing a wall Marching Striking Crawling Passing Walking Crouching Patrolling Other (please specify) Digging Pushing/Pulling Dropping & landing Rising to your feet
6. What actions have you taken during the past 12 months regarding this chronic injury? (Tick ALL which apply)
No action Self treated Received first aid Reported to RAP Reported to military health centre or military hospital Went to get civilian medical assistance or advice: from an emergency department from another civilian facility
7. To what extent does this chronic injury affect you in the performance of your duties? (Tick one only)
Not at all Occasional temporary restrictions Affected but without restrictions Medically downgraded
8. If you have temporary restrictions, for approximately how many days per year do they apply?
______days
9. What is your current Medical Employment Classification Level?
MEC 1 MEC 3 Temporarily Medically Unfit (TMU) MEC 2 MEC 4
If you have another chronic injury to report, please continue on the next page. Otherwise please turn to Section C on page 28.
ANNEX 8 Page 25 of 30
Chronic Injury 4
1. How long have you had this injury? (Please indicate the duration in either years or months)
______years OR ______months
2. What is the nature of the injury? (Tick one only)
Disorder of the joints Disorder of the spinal vertebrae and/or intervertebral discs Disorder of muscles, tendons and/or other soft tissues Other (please specify)
3. What region of your body is affected? (Tick one only)
Head Lower back Multiple locations Neck Pelvis Whole body Chest/ribs/upper back Upper limbs (including shoulders) (e.g. heat stress) Abdomen Lower limbs (including hips)
4. Do you consider that any of the following activities were major contributors to the INITIAL occurrence of this injury? (Tick ALL which apply)
Authorised sport Other sport Physical training Work or trade related: Trade/employment-related training (excluding physical training) General Military Skills Training (not trade-specific) Normal duties of trade (excluding all forms of training) Adventure Training - participation authorised Battle-related activity (on operation) Travelling to/from ADF work Other ADF activity None of the above
5A. If you ticked any of the work or trade-related categories in Question 4, were you engaged in any of the following Combat Arms Trade Tasks (CATTs) when the injury first occurred? (Tick one only)
Bayonet assault Mortar forced march (8 km) Stretcher carry Casualty evacuation drag Patrol in marching order Tunnel crawl Coy. level replenishment Patrol in patrol order Urban rushing Dig to Stage 1, 2 or 3 Population protection & control Wall climb: 1.82 m Forced entry and stair climb Rope climb Wall climb: 2.43 m Forced march Sand bagging Wall climb: 3.66 m Jerry can carry Second storey drop Wiring Ladder lift Section attack Other (please specify) Load and unload UNIMOG Stores carry
ANNEX 8 Page 26 of 30
5B. If you ticked any of the work or trade-related categories in Question 4, what were the main physical actions you were engaged in when the injury first occurred? (Tick ALL which apply)
Carrying load in hands/arms Going to ground Running Carrying load on back Jumping Sitting Climbing a ladder Lying Sprinting Climbing a rope Lifting Standing Climbing a wall Marching Striking Crawling Passing Walking Crouching Patrolling Other (please specify) Digging Pushing/Pulling Dropping & landing Rising to your feet
6. What actions have you taken during the past 12 months regarding this chronic injury? (Tick ALL which apply)
No action Self treated Received first aid Reported to RAP Reported to military health centre or military hospital Went to get civilian medical assistance or advice: from an emergency department from another civilian facility
7. To what extent does this chronic injury affect you in the performance of your duties? (Tick one only)
Not at all Occasional temporary restrictions Affected but without restrictions Medically downgraded
8. If you have temporary restrictions, for approximately how many days per year do they apply?
______days
9. What is your current Medical Employment Classification Level?
MEC 1 MEC 3 Temporarily Medically Unfit (TMU) MEC 2 MEC 4
Please continue to Section C on the next page.
ANNEX 8 Page 27 of 30
Section C: Your opinions
1. In your view, did deficiencies in manning levels contribute to any of the injuries you have reported in sections B and C?
Yes (Please give details below) No
2. In your view, did time pressure contribute to any of the injuries you have reported in sections B and C?
Yes (Please give details below) No
3. In your view, did equipment limitations contribute to any of the injuries you have reported in sections 2 and 3?
Yes (Please give details below) No
ANNEX 8 Page 28 of 30
4. The items in this section are designed to help us (and you) understand the attitudes and perceptions of people working for the ADF. Please indicate the degree to which you agree or disagree with the following statements by ticking one box per statement. If you feel more than one option applies to you, please choose the one that comes closest.
If you feel that any item does not apply to you at all in your present circumstances or position, leave that item blank. A comments section is provided at the end of the survey form for any comment you may wish to make on any items or on any issue that you think has not been sufficiently covered.
Strongly Strongly disagree Disagree Uncertain Agree agree a. It is quite likely that I will suffer an injury in the next month b. If I had a typical/common injury for my trade I would be unable to do my current job c. If I had a typical/common injury for my trade it would significantly affect my take home income d. If I had a typical/common injury for my trade it would significantly affect my ability to deploy e. If I had a typical/common injury for my trade it would significantly affect my ability to attend promotion courses f. If I had a typical/common injury for my trade it would significantly affect my relationship with my close family members g. If I had a typical/common injury for my trade and reported it to a Defence doctor it is likely that I would be medically downgraded h. I would report any injury that I suffered to a Defence Health Facility i. It is accepted practice in my work area to try to prevent injuries during sport or other physical activities (including job related activities) wherever possible j. It is accepted practice in my work area to report all injuries to Defence medical staff k. I frequently risk injury during sport and other physical activity, or to achieve work goals l. It is accepted practice in my work area to risk injuries during sport or other physical activities (including job related activities) m. I take steps to prevent injuries during sport and other physical activity n. I take steps to prevent injuries during the performance of physical work tasks o. There are adequate resources available to prevent injuries during the performance of physical work tasks p. There are adequate resources available to prevent injuries during sport and other physical activity q. I am able to avoid risking an injury during sport and other physical activities r. I am able to avoid risking an injury during physical work activities s. I can report any injury that I have to a Defence Medical Facility without any fear of repercussions
ANNEX 8 Page 29 of 30
Section D: Comments
Please write in the space below any comments you may have about any aspect of the survey or about any aspect of service life that may not be covered by the survey.
As stated in the Privacy and Confidentiality clause of the information sheet you have been given, these comments may be used as anonymous quotes in support of survey findings. If you do not want any of your comments to be used in any report or publication of the survey findings, please indicate by ticking the box below.
I do not want any of my comments to be used in any report or publication resulting from the survey. I understand that I may make comments and not permit them to be used, without detriment to my career or future health care.
Please return the form to the field research staff who gave it to you.
Thank you for your participation in the survey.
ANNEX 8 Page 30 of 30
ANNEX 9 DEFENCE PHYSICAL EMPLOYMENT STANDARDS PROJECT (DPESP)
Survey of Injuries
ADG 2005
This form is in three sections, including questions about…
• Any acute injury incidents you have experienced during the past year • Any chronic injuries you are currently carrying • Your opinions about risks of injury on the job
Please enter your name and DPESP ID Code
Name ______Given name Family name
DPESP ID Code Section: _____ Number: ______
Please read the following explanatory notes then answer the questions in the following sections.
This survey is about PHYSICAL INJURIES. It does NOT cover: • Exposure to substances, radiation, etc. • Disease/illness • Mental stress • Mental illness.
Section A is about ACUTE INJURY INCIDENTS. In Section A, we are interested in any specific incident during the past 12 months which led to a physical injury (including heat stress). This includes: • a new injury • a repeat episode of a previous injury.
Section B is about CHRONIC INJURIES. In Section B, we are interested in ongoing or frequently recurring conditions which are difficult to relate to particular times and places - for example persistent knee joint pain over the past six to twelve months.
ANNEX 9 Page 1 of 30
Section A: Acute injury incidents during the past year
This section is concerned with any specific incident during the past 12 months which led to a physical injury (including heat stress). This includes: • a new injury • a repeat episode of a previous injury
Do not include ongoing chronic injuries which are difficult to relate to particular times and places. These are covered in Section B.
1. During the past 12 months did you suffer any injury or heat stress incident which made it difficult for you to effectively perform your duties for at least one day after the incident?
Yes No (If NO please turn to section B, Page 19)
2. How many such incidents occurred in the past 12 months? ______
Please answer the following set of questions separately for each incident.
Note: There is space on this form for up to FOUR injury incidents – if you had more than four incidents, please give details about the four most serious incidents.
ANNEX 9 Page 2 of 30
Injury Incident 1
1. Approximately when did the injury occur? (Enter month and year if unsure of exact date)
___ / ___ / ___ dd mm yy
2. At approximately what time did the injury occur? (24 hr clock) ____ : ____
3. Where did the injury occur (Geographical location, such as town or city, establishment, region (if on an exercise) or country if outside Australia)
4. What job phase were you in at the time?
Major exercise Leave Pre-deployment Regular trade activity/training Deployment
5. Was this a new or recurring injury? New Recurring
6. Which of the following list best describes the nature of the injury? (Please indicate the MAIN injury in the first column and mark any other associated injuries in the second column)
Main Other
injury injuries
Fracture/ stress fracture (non-spinal) Fracture/ stress fracture of the spine Joint dislocation Sprain of joint(s) and/or ligaments Strain of muscles and/or tendons Head injury/ concussion Internal injury of chest, abdomen and/or pelvis Traumatic amputation Open wound, not involving traumatic amputation Superficial cuts and abrasions Bruise or crushing injury, not involving fracture Foreign body on external eye, in ear or nose or in respiratory, digestive or reproductive system Burn(s) Injury to nerves or spinal cord without evidence of spinal bone injury Effects of weather, exposure, air pressure or other external causes (including heat stress) Other injuries (Please specify)
ANNEX 9 Page 3 of 30
7. What region of your body was injured? (Tick one only)
Head Lower back Multiple locations Neck Pelvis Whole body Chest/ribs/upper back Upper limbs (including shoulders) (e.g. heat stress) Abdomen Lower limbs (including hips)
8. Were you engaged in any of the following activities when the injury occurred? (Tick one only)
Authorised sport Other sport Physical training Work or trade related: Trade/employment-related training (excluding physical training) General Military Skills Training (not trade-specific) Normal duties of trade (excluding all forms of training) Adventure Training - participation authorised Battle-related activity (on operation) Travelling to/from ADF work Other ADF activity None of the above
9A. If you ticked any of the work or trade-related categories in Question 8, were you engaged in any of the following Combat Arms Trade Tasks (CATTs) when the injury first occurred? (Tick one only)
Urban operations Bayonet assault Section attack Forced entry & stair climb Casualty evacuation drag Stores carry Ladder lift Debussing Sqn. level replenishment Population protection & control Dig to Stage 1, 2 or 3 Stretcher carry Rope climb Jerry can carry Wiring Second storey drop Load and unload UNIMOG Tunnel crawl Patrol in marching order Other (please specify) Urban rushing Patrol in patrol order Wall climb: 1.82 m Pursuit Wall climb: 2.43 m Sand bagging Wall climb: 3.66 m
9B. If you ticked any of the work or trade-related categories in Question 8, what were the main physical actions you were engaged in when the injury first occurred? (Tick ALL which apply)
Carrying load in hands/arms Going to ground Running Carrying load on back Jumping Sitting Climbing a ladder Lying Sprinting Climbing a rope Lifting Standing Climbing a wall Marching Striking Crawling Passing Walking Crouching Patrolling Other (please specify) Digging Pushing/Pulling Dropping & landing Rising to your feet
ANNEX 9 Page 4 of 30
10. Explain how the injury occurred. Indicate any particular contributing factors such as fatigue or equipment problems.
11. What actions did you take? (Tick ALL that apply)
No action Self treated Received first aid Reported to RAP Reported to military health centre or military hospital
Went to get civilian medical assistance or advice: from an emergency department from another civilian facility
12. Indicate for how many days you were affected in each of the following ways. Write “0” for any which do not apply.
_____ days in hospital _____ days on light duties _____ days on sick leave _____ days of work program affected _____ days off work
13. If you were off work, did you return to full duty before you felt you had fully recovered from this injury?
Yes No Not applicable – I was not off work
ANNEX 9 Page 5 of 30
14. Were there any safeguards or preventative strategies in place when this incident occurred?
Yes (Please give details below) No (Please go to question 16)
Unsure (Please go to question 16)
15. Did the safeguards or preventative strategies fail?
Yes (Please give details below) No (Please go to question 16)
16. In your opinion, did excessive risk-taking behaviour or acceptance of excessive risk, either by yourself, your supervisor or some other person (nominate who in the details below), contribute to this incident?
Yes (Please give details below) No
If you have another injury incident to report, please continue on the next page. Otherwise please turn to Section B on page 19.
ANNEX 9 Page 6 of 30
Injury Incident 2
1. Approximately when did the injury occur? (Enter month and year if unsure of exact date)
___ / ___ / ___ dd mm yy
2. At approximately what time did the injury occur? (24 hr clock) ____ : ____
3. Where did the injury occur (Geographical location, such as town or city, establishment, region (if on an exercise) or country if outside Australia)
4. What job phase were you in at the time?
Major exercise Leave Pre-deployment Regular trade activity/training Deployment
5. Was this a new or recurring injury? New Recurring
6. Which of the following list best describes the nature of the injury? (Please indicate the MAIN injury in the first column and mark any other associated injuries in the second column)
Main Other
injury injuries
Fracture/ stress fracture (non-spinal) Fracture/ stress fracture of the spine Joint dislocation Sprain of joint(s) and/or ligaments Strain of muscles and/or tendons Head injury/ concussion Internal injury of chest, abdomen and/or pelvis Traumatic amputation Open wound, not involving traumatic amputation Superficial cuts and abrasions Bruise or crushing injury, not involving fracture Foreign body on external eye, in ear or nose or in respiratory, digestive or reproductive system Burn(s) Injury to nerves or spinal cord without evidence of spinal bone injury Effects of weather, exposure, air pressure or other external causes (including heat stress) Other injuries (Please specify)
ANNEX 9 Page 7 of 30
7. What region of your body was injured? (Tick one only)
Head Lower back Multiple locations Neck Pelvis Whole body Chest/ribs/upper back Upper limbs (including shoulders) (e.g. heat stress) Abdomen Lower limbs (including hips)
8. Were you engaged in any of the following activities when the injury occurred? (Tick one only)
Authorised sport Other sport Physical training Work or trade related: Trade/employment-related training (excluding physical training) General Military Skills Training (not trade-specific) Normal duties of trade (excluding all forms of training) Adventure Training - participation authorised Battle-related activity (on operation) Travelling to/from ADF work Other ADF activity None of the above
9A. If you ticked any of the work or trade-related categories in Question 8, were you engaged in any of the following Combat Arms Trade Tasks (CATTs) when the injury first occurred? (Tick one only)
Urban operations Bayonet assault Section attack Forced entry & stair climb Casualty evacuation drag Stores carry Ladder lift Debussing Sqn. level replenishment Population protection & control Dig to Stage 1, 2 or 3 Stretcher carry Rope climb Jerry can carry Wiring Second storey drop Load and unload UNIMOG Tunnel crawl Patrol in marching order Other (please specify) Urban rushing Patrol in patrol order Wall climb: 1.82 m Pursuit Wall climb: 2.43 m Sand bagging Wall climb: 3.66 m
9B. If you ticked any of the work or trade-related categories in Question 8, what were the main physical actions you were engaged in when the injury first occurred? (Tick ALL which apply)
Carrying load in hands/arms Going to ground Running Carrying load on back Jumping Sitting Climbing a ladder Lying Sprinting Climbing a rope Lifting Standing Climbing a wall Marching Striking Crawling Passing Walking Crouching Patrolling Other (please specify) Digging Pushing/Pulling Dropping & landing Rising to your feet
ANNEX 9 Page 8 of 30
10. Explain how the injury occurred. Indicate any particular contributing factors such as fatigue or equipment problems.
11. What actions did you take? (Tick ALL that apply)
No action Self treated Received first aid Reported to RAP Reported to military health centre or military hospital Went to get civilian medical assistance or advice: from an emergency department from another civilian facility
12. Indicate for how many days you were affected in each of the following ways. Write “0” for any which do not apply.
_____ days in hospital _____ days on light duties _____ days on sick leave _____ days of work program affected _____ days off work
13. If you were off work, did you return to full duty before you felt you had fully recovered from this injury?
Yes No Not applicable – I was not off work
ANNEX 9 Page 9 of 30
14. Were there any safeguards or preventative strategies in place when this incident occurred?
Yes (Please give details below) No (Please go to question 16)
Unsure (Please go to question 16)
15. Did the safeguards or preventative strategies fail?
Yes (Please give details below) No (Please go to question 16)
16. In your opinion, did excessive risk-taking behaviour or acceptance of excessive risk, either by yourself, your supervisor or some other person (nominate who in the details below), contribute to this incident?
Yes (Please give details below) No
If you have another injury incident to report, please continue on the next page. Otherwise please turn to Section B on page 19.
ANNEX 9 Page 10 of 30
Injury Incident 3
1. Approximately when did the injury occur? (Enter month and year if unsure of exact date)
___ / ___ / ___ dd mm yy
2. At approximately what time did the injury occur? (24 hr clock) ____ : ____
3. Where did the injury occur (Geographical location, such as town or city, establishment, region (if on an exercise) or country if outside Australia)
4. What job phase were you in at the time?
Major exercise Leave Pre-deployment Regular trade activity/training Deployment
5. Was this a new or recurring injury? New Recurring
6. Which of the following list best describes the nature of the injury? (Please indicate the MAIN injury in the first column and mark any other associated injuries in the second column)
Main Other
injury injuries
Fracture/ stress fracture (non-spinal) Fracture/ stress fracture of the spine Joint dislocation Sprain of joint(s) and/or ligaments Strain of muscles and/or tendons Head injury/ concussion Internal injury of chest, abdomen and/or pelvis Traumatic amputation Open wound, not involving traumatic amputation Superficial cuts and abrasions Bruise or crushing injury, not involving fracture Foreign body on external eye, in ear or nose or in respiratory, digestive or reproductive system Burn(s) Injury to nerves or spinal cord without evidence of spinal bone injury Effects of weather, exposure, air pressure or other external causes (including heat stress) Other injuries (Please specify)
ANNEX 9 Page 11 of 30
7. What region of your body was injured? (Tick one only)
Head Lower back Multiple locations Neck Pelvis Whole body Chest/ribs/upper back Upper limbs (including shoulders) (e.g. heat stress) Abdomen Lower limbs (including hips)
8. Were you engaged in any of the following activities when the injury occurred? (Tick one only)
Authorised sport Other sport Physical training Work or trade related: Trade/employment-related training (excluding physical training) General Military Skills Training (not trade-specific) Normal duties of trade (excluding all forms of training) Adventure Training - participation authorised Battle-related activity (on operation) Travelling to/from ADF work Other ADF activity None of the above
9A. If you ticked any of the work or trade-related categories in Question 8, were you engaged in any of the following Combat Arms Trade Tasks (CATTs) when the injury first occurred? (Tick one only)
Urban operations Bayonet assault Section attack Forced entry & stair climb Casualty evacuation drag Stores carry Ladder lift Debussing Sqn. level replenishment Population protection & control Dig to Stage 1, 2 or 3 Stretcher carry Rope climb Jerry can carry Wiring Second storey drop Load and unload UNIMOG Tunnel crawl Patrol in marching order Other (please specify) Urban rushing Patrol in patrol order Wall climb: 1.82 m Pursuit Wall climb: 2.43 m Sand bagging Wall climb: 3.66 m
9B. If you ticked any of the work or trade-related categories in Question 8, what were the main physical actions you were engaged in when the injury first occurred? (Tick ALL which apply)
Carrying load in hands/arms Going to ground Running Carrying load on back Jumping Sitting Climbing a ladder Lying Sprinting Climbing a rope Lifting Standing Climbing a wall Marching Striking Crawling Passing Walking Crouching Patrolling Other (please specify) Digging Pushing/Pulling Dropping & landing Rising to your feet
ANNEX 9 Page 12 of 30
10. Explain how the injury occurred. Indicate any particular contributing factors such as fatigue or equipment problems.
11. What actions did you take? (Tick ALL that apply)
No action Self treated Received first aid Reported to RAP Reported to military health centre or military hospital Went to get civilian medical assistance or advice: from an emergency department from another civilian facility
12. Indicate for how many days you were affected in each of the following ways. Write “0” for any which do not apply.
_____ days in hospital _____ days on light duties _____ days on sick leave _____ days of work program affected _____ days off work
13. If you were off work, did you return to full duty before you felt you had fully recovered from this injury?
Yes No Not applicable – I was not off work
ANNEX 9 Page 13 of 30
14. Were there any safeguards or preventative strategies in place when this incident occurred?
Yes (Please give details below) No (Please go to question 16)
Unsure (Please go to question 16)
15. Did the safeguards or preventative strategies fail?
Yes (Please give details below) No (Please go to question 16)
16. In your opinion, did excessive risk-taking behaviour or acceptance of excessive risk, either by yourself, your supervisor or some other person (nominate who in the details below), contribute to this incident?
Yes (Please give details below) No
If you have another injury incident to report, please continue on the next page. Otherwise please turn to Section B on page 19.
ANNEX 9 Page 14 of 30
Injury Incident 4
1. Approximately when did the injury occur? (Enter month and year if unsure of exact date)
___ / ___ / ___ dd mm yy
2. At approximately what time did the injury occur? (24 hr clock) ____ : ____
3. Where did the injury occur (Geographical location, such as town or city, establishment, region (if on an exercise) or country if outside Australia)
4. What job phase were you in at the time?
Major exercise Leave Pre-deployment Regular trade activity/training Deployment
5. Was this a new or recurring injury? New Recurring
6. Which of the following list best describes the nature of the injury? (Please indicate the MAIN injury in the first column and mark any other associated injuries in the second column)
Main Other
injury injuries
Fracture/ stress fracture (non-spinal) Fracture/ stress fracture of the spine Joint dislocation Sprain of joint(s) and/or ligaments Strain of muscles and/or tendons Head injury/ concussion Internal injury of chest, abdomen and/or pelvis Traumatic amputation Open wound, not involving traumatic amputation Superficial cuts and abrasions Bruise or crushing injury, not involving fracture Foreign body on external eye, in ear or nose or in respiratory, digestive or reproductive system Burn(s) Injury to nerves or spinal cord without evidence of spinal bone injury Effects of weather, exposure, air pressure or other external causes (including heat stress) Other injuries (Please specify)
ANNEX 9 Page 15 of 30
7. What region of your body was injured? (Tick one only)
Head Lower back Multiple locations Neck Pelvis Whole body Chest/ribs/upper back Upper limbs (including shoulders) (e.g. heat stress) Abdomen Lower limbs (including hips)
8. Were you engaged in any of the following activities when the injury occurred? (Tick one only)
Authorised sport Other sport Physical training Work or trade related: Trade/employment-related training (excluding physical training) General Military Skills Training (not trade-specific) Normal duties of trade (excluding all forms of training) Adventure Training - participation authorised Battle-related activity (on operation) Travelling to/from ADF work Other ADF activity None of the above
9A. If you ticked any of the work or trade-related categories in Question 8, were you engaged in any of the following Combat Arms Trade Tasks (CATTs) when the injury first occurred? (Tick one only)
Urban operations Bayonet assault Section attack Forced entry & stair climb Casualty evacuation drag Stores carry Ladder lift Debussing Sqn. level replenishment Population protection & control Dig to Stage 1, 2 or 3 Stretcher carry Rope climb Jerry can carry Wiring Second storey drop Load and unload UNIMOG Tunnel crawl Patrol in marching order Other (please specify) Urban rushing Patrol in patrol order Wall climb: 1.82 m Pursuit Wall climb: 2.43 m Sand bagging Wall climb: 3.66 m
9B. If you ticked any of the work or trade-related categories in Question 8, what were the main physical actions you were engaged in when the injury first occurred? (Tick ALL which apply)
Carrying load in hands/arms Going to ground Running Carrying load on back Jumping Sitting Climbing a ladder Lying Sprinting Climbing a rope Lifting Standing Climbing a wall Marching Striking Crawling Passing Walking Crouching Patrolling Other (please specify) Digging Pushing/Pulling Dropping & landing Rising to your feet
ANNEX 9 Page 16 of 30
10. Explain how the injury occurred. Indicate any particular contributing factors such as fatigue or equipment problems.
11. What actions did you take? (Tick ALL that apply)
No action Self treated Received first aid Reported to RAP Reported to military health centre or military hospital Went to get civilian medical assistance or advice: from an emergency department from another civilian facility
12. Indicate for how many days you were affected in each of the following ways. Write “0” for any which do not apply.
_____ days in hospital _____ days on light duties _____ days on sick leave _____ days of work program affected _____ days off work
13. If you were off work, did you return to full duty before you felt you had fully recovered from this injury?
Yes No Not applicable – I was not off work
ANNEX 9 Page 17 of 30
14. Were there any safeguards or preventative strategies in place when this incident occurred?
Yes (Please give details below) No (Please go to question 16)
Unsure (Please go to question 16)
15. Did the safeguards or preventative strategies fail?
Yes (Please give details below) No (Please go to question 16)
16. In your opinion, did excessive risk-taking behaviour or acceptance of excessive risk, either by yourself, your supervisor or some other person (nominate who in the details below), contribute to this incident?
Yes (Please give details below) No
Please continue to Section B on the next page.
ANNEX 9 Page 18 of 30
Section B: Chronic Injuries
This section is concerned with ongoing injuries which are difficult to relate to particular times and places - for example persistent knee joint pain over the past six to twelve months.
1. Are you carrying any chronic injuries that have not been covered in Section A above?
Yes No (If NO please turn to Section C on page 28)
2. How many different chronic injuries are you carrying? ______
Please answer the following set of questions separately for each chronic injury.
Note: There is space on this form for up to FOUR chronic injuries – if you are carrying more than four chronic injuries, please give details about the four most serious injuries.
ANNEX 9 Page 19 of 30
Chronic Injury 1
1. How long have you had this injury? (Please indicate the duration in either years or months)
______years OR ______months
2. What is the nature of the injury? (Tick one only)
Disorder of the joints Disorder of the spinal vertebrae and/or intervertebral discs Disorder of muscles, tendons and/or other soft tissues Other (please specify)
3. What region of your body is affected? (Tick one only)
Head Lower back Multiple locations Neck Pelvis Whole body Chest/ribs/upper back Upper limbs (including shoulders) (e.g. heat stress) Abdomen Lower limbs (including hips)
4. Do you consider that any of the following activities were major contributors to the INITIAL occurrence of this injury? (Tick ALL which apply)
Authorised sport Other sport Physical training Work or trade related: Trade/employment-related training (excluding physical training) General Military Skills Training (not trade-specific) Normal duties of trade (excluding all forms of training) Adventure Training - participation authorised Battle-related activity (on operation) Travelling to/from ADF work Other ADF activity None of the above
5A. If you ticked any of the work or trade-related categories in Question 4, were you engaged in any of the following Combat Arms Trade Tasks (CATTs) when the injury first occurred? (Tick one only) Urban operations Bayonet assault Section attack Forced entry & stair climb Casualty evacuation drag Stores carry Ladder lift Debussing Sqn. level replenishment Population protection & control Dig to Stage 1, 2 or 3 Stretcher carry Rope climb Jerry can carry Wiring Second storey drop Load and unload UNIMOG Tunnel crawl Patrol in marching order Other (please specify) Urban rushing Patrol in patrol order Wall climb: 1.82 m Pursuit Wall climb: 2.43 m Sand bagging Wall climb: 3.66 m
ANNEX 9 Page 20 of 30
5B. If you ticked any of the work or trade-related categories in Question 4, what were the main physical actions you were engaged in when the injury first occurred? (Tick ALL which apply)
Carrying load in hands/arms Going to ground Running Carrying load on back Jumping Sitting Climbing a ladder Lying Sprinting Climbing a rope Lifting Standing Climbing a wall Marching Striking Crawling Passing Walking Crouching Patrolling Other (please specify) Digging Pushing/Pulling Dropping & landing Rising to your feet
6. What actions have you taken during the past 12 months regarding this chronic injury? (Tick ALL which apply)
No action Self treated Received first aid Reported to RAP Reported to military health centre or military hospital Went to get civilian medical assistance or advice: from an emergency department from another civilian facility
7. To what extent does this chronic injury affect you in the performance of your duties? (Tick one only)
Not at all Occasional temporary restrictions Affected but without restrictions Medically downgraded
8. If you have temporary restrictions, for approximately how many days per year do they apply?
______days
9. What is your current Medical Employment Classification Level?
MEC 1 MEC 3 Temporarily Medically Unfit (TMU) MEC 2 MEC 4
If you have another chronic injury to report, please continue on the next page. Otherwise please turn to Section C on page 28.
ANNEX 9 Page 21 of 30
Chronic Injury 2
1. How long have you had this injury? (Please indicate the duration in either years or months)
______years OR ______months
2. What is the nature of the injury? (Tick one only)
Disorder of the joints Disorder of the spinal vertebrae and/or intervertebral discs Disorder of muscles, tendons and/or other soft tissues Other (please specify)
3. What region of your body is affected? (Tick one only)
Head Lower back Multiple locations Neck Pelvis Whole body Chest/ribs/upper back Upper limbs (including shoulders) (e.g. heat stress) Abdomen Lower limbs (including hips)
4. Do you consider that any of the following activities were major contributors to the INITIAL occurrence of this injury? (Tick ALL which apply)
Authorised sport Other sport Physical training Work or trade related: Trade/employment-related training (excluding physical training) General Military Skills Training (not trade-specific) Normal duties of trade (excluding all forms of training) Adventure Training - participation authorised Battle-related activity (on operation) Travelling to/from ADF work Other ADF activity None of the above
5A. If you ticked any of the work or trade-related categories in Question 4, were you engaged in any of the following Combat Arms Trade Tasks (CATTs) when the injury first occurred? (Tick one only) Urban operations Bayonet assault Section attack Forced entry & stair climb Casualty evacuation drag Stores carry Ladder lift Debussing Sqn. level replenishment Population protection & control Dig to Stage 1, 2 or 3 Stretcher carry Rope climb Jerry can carry Wiring Second storey drop Load and unload UNIMOG Tunnel crawl Patrol in marching order Other (please specify) Urban rushing Patrol in patrol order Wall climb: 1.82 m Pursuit Wall climb: 2.43 m Sand bagging Wall climb: 3.66 m
ANNEX 9 Page 22 of 30
5B. If you ticked any of the work or trade-related categories in Question 4, what were the main physical actions you were engaged in when the injury first occurred? (Tick ALL which apply)
Carrying load in hands/arms Going to ground Running Carrying load on back Jumping Sitting Climbing a ladder Lying Sprinting Climbing a rope Lifting Standing Climbing a wall Marching Striking Crawling Passing Walking Crouching Patrolling Other (please specify) Digging Pushing/Pulling Dropping & landing Rising to your feet
6. What actions have you taken during the past 12 months regarding this chronic injury? (Tick ALL which apply)
No action Self treated Received first aid Reported to RAP Reported to military health centre or military hospital Went to get civilian medical assistance or advice: from an emergency department from another civilian facility
7. To what extent does this chronic injury affect you in the performance of your duties? (Tick one only)
Not at all Occasional temporary restrictions Affected but without restrictions Medically downgraded
8. If you have temporary restrictions, for approximately how many days per year do they apply?
______days
9. What is your current Medical Employment Classification Level?
MEC 1 MEC 3 Temporarily Medically Unfit (TMU) MEC 2 MEC 4
If you have another chronic injury to report, please continue on the next page. Otherwise please turn to Section C on page 28.
ANNEX 9 Page 23 of 30
Chronic Injury 3
1. How long have you had this injury? (Please indicate the duration in either years or months)
______years OR ______months
2. What is the nature of the injury? (Tick one only)
Disorder of the joints Disorder of the spinal vertebrae and/or intervertebral discs Disorder of muscles, tendons and/or other soft tissues Other (please specify)
3. What region of your body is affected? (Tick one only)
Head Lower back Multiple locations Neck Pelvis Whole body Chest/ribs/upper back Upper limbs (including shoulders) (e.g. heat stress) Abdomen Lower limbs (including hips)
4. Do you consider that any of the following activities were major contributors to the INITIAL occurrence of this injury? (Tick ALL which apply)
Authorised sport Other sport Physical training Work or trade related: Trade/employment-related training (excluding physical training) General Military Skills Training (not trade-specific) Normal duties of trade (excluding all forms of training) Adventure Training - participation authorised Battle-related activity (on operation) Travelling to/from ADF work Other ADF activity None of the above
5A. If you ticked any of the work or trade-related categories in Question 4, were you engaged in any of the following Combat Arms Trade Tasks (CATTs) when the injury first occurred? (Tick one only) Urban operations Bayonet assault Section attack Forced entry & stair climb Casualty evacuation drag Stores carry Ladder lift Debussing Sqn. level replenishment Population protection & control Dig to Stage 1, 2 or 3 Stretcher carry Rope climb Jerry can carry Wiring Second storey drop Load and unload UNIMOG Tunnel crawl Patrol in marching order Other (please specify) Urban rushing Patrol in patrol order Wall climb: 1.82 m Pursuit Wall climb: 2.43 m Sand bagging Wall climb: 3.66 m
ANNEX 9 Page 24 of 30
5B. If you ticked any of the work or trade-related categories in Question 4, what were the main physical actions you were engaged in when the injury first occurred? (Tick ALL which apply)
Carrying load in hands/arms Going to ground Running Carrying load on back Jumping Sitting Climbing a ladder Lying Sprinting Climbing a rope Lifting Standing Climbing a wall Marching Striking Crawling Passing Walking Crouching Patrolling Other (please specify) Digging Pushing/Pulling Dropping & landing Rising to your feet
6. What actions have you taken during the past 12 months regarding this chronic injury? (Tick ALL which apply)
No action Self treated Received first aid Reported to RAP Reported to military health centre or military hospital Went to get civilian medical assistance or advice: from an emergency department from another civilian facility
7. To what extent does this chronic injury affect you in the performance of your duties? (Tick one only)
Not at all Occasional temporary restrictions Affected but without restrictions Medically downgraded
8. If you have temporary restrictions, for approximately how many days per year do they apply?
______days
9. What is your current Medical Employment Classification Level?
MEC 1 MEC 3 Temporarily Medically Unfit (TMU) MEC 2 MEC 4
If you have another chronic injury to report, please continue on the next page. Otherwise please turn to Section C on page 28.
ANNEX 9 Page 25 of 30
Chronic Injury 4
1. How long have you had this injury? (Please indicate the duration in either years or months)
______years OR ______months
2. What is the nature of the injury? (Tick one only)
Disorder of the joints Disorder of the spinal vertebrae and/or intervertebral discs Disorder of muscles, tendons and/or other soft tissues Other (please specify)
3. What region of your body is affected? (Tick one only)
Head Lower back Multiple locations Neck Pelvis Whole body Chest/ribs/upper back Upper limbs (including shoulders) (e.g. heat stress) Abdomen Lower limbs (including hips)
4. Do you consider that any of the following activities were major contributors to the INITIAL occurrence of this injury? (Tick ALL which apply)
Authorised sport Other sport Physical training Work or trade related: Trade/employment-related training (excluding physical training) General Military Skills Training (not trade-specific) Normal duties of trade (excluding all forms of training) Adventure Training - participation authorised Battle-related activity (on operation) Travelling to/from ADF work Other ADF activity None of the above
5A. If you ticked any of the work or trade-related categories in Question 4, were you engaged in any of the following Combat Arms Trade Tasks (CATTs) when the injury first occurred? (Tick one only) Urban operations Bayonet assault Section attack Forced entry & stair climb Casualty evacuation drag Stores carry Ladder lift Debussing Sqn. level replenishment Population protection & control Dig to Stage 1, 2 or 3 Stretcher carry Rope climb Jerry can carry Wiring Second storey drop Load and unload UNIMOG Tunnel crawl Patrol in marching order Other (please specify) Urban rushing Patrol in patrol order Wall climb: 1.82 m Pursuit Wall climb: 2.43 m Sand bagging Wall climb: 3.66 m
ANNEX 9 Page 26 of 30
5B. If you ticked any of the work or trade-related categories in Question 4, what were the main physical actions you were engaged in when the injury first occurred? (Tick ALL which apply)
Carrying load in hands/arms Going to ground Running Carrying load on back Jumping Sitting Climbing a ladder Lying Sprinting Climbing a rope Lifting Standing Climbing a wall Marching Striking Crawling Passing Walking Crouching Patrolling Other (please specify) Digging Pushing/Pulling Dropping & landing Rising to your feet
6. What actions have you taken during the past 12 months regarding this chronic injury? (Tick ALL which apply)
No action Self treated Received first aid Reported to RAP Reported to military health centre or military hospital Went to get civilian medical assistance or advice: from an emergency department from another civilian facility
7. To what extent does this chronic injury affect you in the performance of your duties? (Tick one only)
Not at all Occasional temporary restrictions Affected but without restrictions Medically downgraded
8. If you have temporary restrictions, for approximately how many days per year do they apply?
______days
9. What is your current Medical Employment Classification Level?
MEC 1 MEC 3 Temporarily Medically Unfit (TMU) MEC 2 MEC 4
Please continue to Section C on the next page.
ANNEX 9 Page 27 of 30
Section C: Your opinions
1. In your view, did deficiencies in manning levels contribute to any of the injuries you have reported in sections B and C?
Yes (Please give details below) No
2. In your view, did time pressure contribute to any of the injuries you have reported in sections B and C?
Yes (Please give details below) No
3. In your view, did equipment limitations contribute to any of the injuries you have reported in sections 2 and 3?
Yes (Please give details below) No
ANNEX 9 Page 28 of 30
4. The items in this section are designed to help us (and you) understand the attitudes and perceptions of people working for the ADF. Please indicate the degree to which you agree or disagree with the following statements by ticking one box per statement. If you feel more than one option applies to you, please choose the one that comes closest.
If you feel that any item does not apply to you at all in your present circumstances or position, leave that item blank. A comments section is provided at the end of the survey form for any comment you may wish to make on any items or on any issue that you think has not been sufficiently covered.
Strongly Strongly disagree Disagree Uncertain Agree agree a. It is quite likely that I will suffer an injury in the next month b. If I had a typical/common injury for my trade I would be unable to do my current job c. If I had a typical/common injury for my trade it would significantly affect my take home income d. If I had a typical/common injury for my trade it would significantly affect my ability to deploy e. If I had a typical/common injury for my trade it would significantly affect my ability to attend promotion courses f. If I had a typical/common injury for my trade it would significantly affect my relationship with my close family members g. If I had a typical/common injury for my trade and reported it to a Defence doctor it is likely that I would be medically downgraded h. I would report any injury that I suffered to a Defence Health Facility i. It is accepted practice in my work area to try to prevent injuries during sport or other physical activities (including job related activities) wherever possible j. It is accepted practice in my work area to report all injuries to Defence medical staff k. I frequently risk injury during sport and other physical activity, or to achieve work goals l. It is accepted practice in my work area to risk injuries during sport or other physical activities (including job related activities) m. I take steps to prevent injuries during sport and other physical activity n. I take steps to prevent injuries during the performance of physical work tasks o. There are adequate resources available to prevent injuries during the performance of physical work tasks p. There are adequate resources available to prevent injuries during sport and other physical activity q. I am able to avoid risking an injury during sport and other physical activities r. I am able to avoid risking an injury during physical work activities s. I can report any injury that I have to a Defence Medical Facility without any fear of repercussions
ANNEX 9 Page 29 of 30
Section D: Comments
Please write in the space below any comments you may have about any aspect of the survey or about any aspect of service life that may not be covered by the survey.
As stated in the Privacy and Confidentiality clause of the information sheet you have been given, these comments may be used as anonymous quotes in support of survey findings. If you do not want any of your comments to be used in any report or publication of the survey findings, please indicate by ticking the box below.
I do not want any of my comments to be used in any report or publication resulting from the survey. I understand that I may make comments and not permit them to be used, without detriment to my career or future health care.
Please return the form to the field research staff who gave it to you.
Thank you for your participation in the survey.
ANNEX 9 Page 30 of 30
Annex 10 DEFENCE PHYSICAL EMPLOYMENT STANDARDS PROJECT (DPESP) NORMATIVE DATA COLLECTION FIELD TRIALS
PERSONAL INFORMATION FORM – INFANTRY & ARMY FEMALES
Name ______Given name Family name
DPESP ID Code Section: _____ Number: ______
Unit ______
Platoon/Subunit e.g. 8 PL A COY, MOR PL SPT COY ______
ECN Primary ______Secondary (if applicable) ______
Category of your current worn rank
Other rank NCO Officer
Gender
Male Female
Age at last birthday ______years
Length of time in service, current unit and current rank. Use whichever time unit is most appropriate in each case.
Years Months Weeks Days
Length of time in service
Length of time in current unit
Length of time in current worn rank
Fitness tests during the past 12 months
Month Pass or Month Pass or Test tested fail tested fail
Basic Fitness Assessment (BFA)
Combat Fitness Assessment (CFA)
Page 1 of 1 Annex 11 DEFENCE PHYSICAL EMPLOYMENT STANDARDS PROJECT (DPESP) NORMATIVE DATA COLLECTION FIELD TRIALS
PERSONAL INFORMATION FORM – INFANTRY IET
Name ______Given name Family name
DPESP ID Code Section: _____ Number: ______
Gender
Male Female
Age at last birthday ______years
Length of time in service, current unit and current rank. Use whichever time unit is most appropriate in each case.
Weeks Days
Length of time in service
Length of time in current unit
Fitness tests during the past 12 months
Month Pass or Month Pass or Test tested fail tested fail
Basic Fitness Assessment (BFA)
Combat Fitness Assessment (CFA)
Page 1 of 1 Annex 12 DEFENCE PHYSICAL EMPLOYMENT STANDARDS PROJECT (DPESP) NORMATIVE DATA COLLECTION FIELD TRIALS
PERSONAL INFORMATION FORM - ADG
Name ______Given name Family name
DPESP ID Code Section: _____ Number: ______
Squadron ______
Flight ______
Category of your current worn rank
Other rank NCO Officer
Age at last birthday ______years
Length of time in service, current unit and current rank. Use whichever time unit is most appropriate in each case.
Years Months Weeks Days
Length of time in service
Length of time in current unit
Length of time in current worn rank
Fitness tests during the past 12 months
Month Pass or Month Pass or Test tested fail tested fail
Physical Fitness Test (PFT)
Battle Efficiency Test (BET)
Page 1 of 1 Annex 13 DEFENCE PHYSICAL EMPLOYMENT STANDARDS PROJECT (DPESP) NORMATIVE DATA COLLECTION FIELD TRIALS
PERSONAL INFORMATION FORM - ADG IET
Name ______Given name Family name
DPESP ID Code Section: _____ Number: ______
Age at last birthday ______years
Length of time in service and current unit. Use whichever time unit is most appropriate in each case.
Weeks Days
Length of time in service
Length of time in current unit
Fitness tests during the past 12 months
Month Pass or Month Pass or Test tested fail tested fail
Physical Fitness Test (PFT)
Battle Efficiency Test (BET)
Page 1 of 1 ANNEX 14
DEFENCE PHYSICAL EMPLOYMENT STANDARDS PROJECT
NORMATIVE DATA COLLECTION FIELD TRIALS
INFORMATION SHEET
The purpose of this document is to describe the “Defence Physical Employment Standards Project: Normative Data Collection Field Trials” and to invite you to participate in the study.
Brief description of the trials There is no doubt that you have been trained to do a variety of highly skilled tasks that require a range of physical as well as technical skills. It is also well recognised that it is important to make sure that you are physically capable of completing the tasks that you will be required to do.
These trials are part of a larger project that aims to establish a number of clearly justified physical employment standards or fitness tests for the combat arms trades. The project has been endorsed by the Chief of the Defence Force and the Chiefs of Service, and is supported by your commanding officer. These tests should be seen as being separate from the BFA and CFA tests that you currently undertake. In general, the purpose of the tests being developed in this project is to ensure that soldiers allocated to the various parts of the ADF (Infantry and Airfield Defence Guards in the first instance) are physically able to do their job in a safe and effective way.
The purpose of the trials is to determine performance on a set of physical tests for Infantry soldiers, Infantry IETs and female soldiers; and a slightly different set of tests for ADG airmen and IETs. The test tasks have been chosen by a group of experienced soldiers and airmen who believe that the tests represent the most physically demanding parts of the job of being an Infantry soldier or Airfield Defence Guard.
The tests you will be required to undertake are as follows: Tests based on combat arms trade tasks: • Box lift and place (simulates loading a UNIMOG truck) • Jerry can lift and carry • Climbing a 1.8 m (6’) wall from running and standing starts • Leopard crawl (simulates crawling through a tunnel) • Urban rushing (simulates moving through urban terrain) • 10 km and 20 km forced marches • Section attack Predictive tests: • Maximum heaves. • Jump and reach. • Situps. • Multistage shuttle run.
ANNEX 14 Page 1 of 7 • Loaded incremental velocity run. Kinanthropometry • Eight skinfold measurements (triceps, subscapular, biceps, iliac crest, supraspinale, abdominal, front thigh, medial calf). • Five girths (arm - relaxed, arm - flexed and tensed, waist, hip, calf – maximum). • Two bone breadths (humerus, femur).
More details about each test can be found in the attached Test Procedures document.
Brief description of the survey of injuries Associated with the field trials, we are conducting a retrospective survey of work-related injuries. The attached questionnaire is similar to one which was distributed in mid-2004 to almost 3000 personnel throughout selected units in the Army and Air Force. You may have completed a survey form at that time. Even if you did, you should still complete this form, which focuses on the 12 months since the previous survey. Also, we are interested in correlating your current injury history with your performance on the physical tests.
The form is designed to obtain details of acute injuries you have suffered during the past 12-months, as well as any chronic injuries you are carrying. You are also asked for details of the situations in which the injuries occurred, together with information about actions taken after the injury, and some opinions regarding contributing factors and about ADF attitudes and practices regarding reporting, treatment and management of injuries.
Your part in the study I would like to invite you to participate in this study. It is important for you to note that your involvement in the study is entirely voluntary and if you chose not to participate there will be no detriment to your career or future health care. Finally, if you chose to participate and later change you mind and wish to withdraw, you may do so without any detriment to your career or future health care.
The study has been scheduled into your Unit’s work plan and will take approximately two weeks to complete in the period from May to August 2005. If necessary, you will be given an opportunity to rehearse a test in order to familiarise yourself with the procedures and then you will perform the task as part of a 10 person section. The various tests will be organised to make sure that you remain as fresh as possible throughout the study.
Up to 320 Infantry soldiers, 60 Infantry IETs, 60 female soldiers/airwomen, 70 Airfield Defence Guards and 40 Airfield Defence Guard IETs will be recruited to participate in this study.
The soldiers/guards will be experienced and well trained, and will not be asked to do anything that they would not normally do as part of their job. Where required on the advice of ADF specialists, tests to be performed by IETs and female soldiers have been adjusted to take account of the lower physical capacities of these groups.
ANNEX 14 Page 2 of 7
You are asked to do your best in each test. The tests include some fitness tests that are very similar to the Basic Fitness Assessment that will be conducted on all participants at the start of the study. I would also like to point out that in order to try to control for the level of fatigue you experience during the study, your participation in exercise/training outside of the study will be controlled with reasonable limits as will your general diet for the duration of the study.
A number of measurements will be made and records taken while you perform each of the tests. These include measuring heart rate from a heart rate meter strapped around each your chest, video taping each of the tests and asking you to complete a simple ‘pencil and paper’ test to measure the effect of the task on you level of tiredness (rating of perceived exertion). Core temperature measurements may be made during some endurance tasks, by radio monitoring of a signal from a temperature-sensitive pill, which you will take the night before the endurance test.
Risks of participating It is important to point out to you that there will be a number of risks associated with participation in this study. However, as you would expect, a range of safeguards have been put in place to make sure that these risks will be minimised.
The first risk is that you feel that you are being coerced or forced to participate in this study. In order to minimise the potential for coercion, recruitment of volunteers will be conducted by a person who is not in your direct chain of command. As mentioned above, you will also be formally notified of your freedom to withdraw at any time should you change your mind about participating in the study.
Secondly, there is a risk that participation in the study will expose you to an unacceptable degree of injury risk. A number of safguards have been put into place to minimise this risk. 1. You will not be able to participate if you are carrying an injury or have an illness that may be made worse as a result of your involvement in the study. You will be asked to disclose your injury and illness status to a civilian researcher and the information that you report will be kept in confidence within the University of Ballarat research team. 2. You are a well trained soldier or airman/airwoman. Most of the tests are closely related to your job or are designed to allow you to withdraw at an appropriate time without you needing to subject yourself to undue risk. 3. All tasks will be monitored by an experienced SNCO, WO or Officer to make sure that they are done in the safest possible way. 4. The area in which you will perform the tasks will be checked to make sure that there are no unacceptable physical hazards present. 5. Heat injury: Soldiers and airmen performing heavy work tasks experience an increase in body temperature. In some circumstances an increase in body temperature may result in a soldier or airman/airwoman being placed at an unacceptable risk of incurring a heat injury and in rare instances death. A number of preventive and treatment strategies will be implemented to ensure that the risk of
ANNEX 14 Page 3 of 7 heat injury and adverse consequences is minimised during the activities involved in the DPES Project. These strategies will involve the following: o Fitness: Only physically fit soldiers and airmen/airwomen will participate in the study. All male soldiers will have satisfactorily completed the combat arms CFA, airmen the BET, trainees the recruit training exit test, and female participants the relevant BFA, CFA or PFT. Women undertaking endurance tests will have attained a high level on the multistage shuttle run test.
o Heat Acclimatization: It is well accepted that participants acclimatized to the heat will be more able to tolerate work in hot conditions than those who are unacclimatized. In the present study, soldiers and airmen currently work and live in the climate where they are being tested. Trainees will have recently moved from Kapooka to Singleton and from Edinburgh to Amberley. In neither case is the climatic difference in May-July regarded as presenting a significant acclimatization issue. Women participants will be resident in the testing location but will not be as accustomed to the exercise/work regimen as the soldiers/airmen. Women will be provided with a recommended program of preparatory exercise to be undertaken in the period between recruitment and the commencement of testing.
o Minimizing environmental heat load: Exercising in a cool environment obviously will result in a reduced environmental heat load and a increased ability for you to lose the heat produced during exercise. The project has been designed to take advantage of the cooler temperatures experienced in northern Australia from April to August. In addition, the tasks likely to induce the greatest heat load (20 km and 10 km forced marches) will be conducted in the morning with the first group of troops ‘stepping off’ at 0500 hr.
o Core temperature limits: Core body temperature will be measured and a limit of 39.5oC will be set for tests in which there is a risk of unacceptably raised core temperatures. This may include some or all of the endurance tests (20 km forced march, 10 km forced march, section attack, urban rushing, loaded incremental velocity run, extended patrol and pursuit).
o Hydration: You will be advised to ingest 500 ml of fluid up to 2 hr prior to exercise and up to 1.2 litres per hour of cool fluid during exercise.
o Heart rate limits: A heart rate limit of 90% of age predicted maximal heart rate (220 beats/min – age in years) will be applied.
o Signs of heat intolerance: You will be monitored by the research staff and the attending ADF medical staff for signs of heat intolerance. These include the presence of red, hot, dry skin; throbbing headache, dizziness, nausea and confusion.
o Availability of first aid/medical support. An ADF first aid team will be present and able to provide appropriate support during the 20 km and 10 km forced marches and section attack (Infantry) and during the extended patrol, pursuit and section attack activities (ADG). In addition, the activity will be conducted on bases where medical support is immediately available should it be required.
o Recent medical history. You will be required to complete a ‘Confidential Health Status Form’ which includes questions regarding factors that may predispose a participant to heat stress such as medications, viral illness (fever), cardiac conditions and diabetes If you report any of these conditions/factors you will be unable to participate in the project.
ANNEX 14 Page 4 of 7 If you do experience any type of injury, you will be given the first aid or medical treatment necessary by qualified personnel.
This study requires that very little equipment will actually be fixed to your body. The only piece of equipment that will be fixed to your body is a heart rate meter. This consists of a strap placed around your chest (heart rate transmitter) and a receiver that looks like a wrist watch. Both pieces of equipment use watch batteries for power and have been passed as safe for use by humans. Core temperature will be measured using pills which you swallow and which pass through your digestive tract. Use of these pills is not advised if you have particular characteristics or medical conditions. These are listed on the health status form which you will asked to complete before participating in this project. If you have any of these conditions you will not be allowed to participate in tests requiring core temperature monitoring. Other data will be collected from pencil and paper tests such as recording how tired you feel. A video record will also be made of you when you undertake each of the work tasks. Finally, you will be asked to complete the injury survey form.
Statement of Privacy There is a separate risk associated with protecting your privacy. There is a risk that the data collected may be used inappropriately within Defence or within the wider community. Examples of this may include using a photo of you without your permission or quoting your individual results in a Defence report. These risks will be reduced by the following: 0. You will be given a code number specific to this study and all data will be ‘de-identified’ whereby your name will be removed from any sets of records that are used for analysis and reported on to Defence or distributed in the wider community. 0. The information that links your name to your code will held in confidence by the civilian Principal Researcher. 0. Only group data summaries will be used in any reports 0. Any videos or pictures that are included in the reports will be ‘de-identified’ by blurring your face or the Civilian Chief Investigator will seek your written permission to use the original image if this considered desirable. 0. All original data will be kept under lock and key at the University of Ballarat for a period of at least five years. 0. Secure information disposal methods will be used such as document shredding. 0. The data will only be used for the purposes outlined above without your express permission.
On duty All members of the Australian Defence Force who volunteer for this study will be considered to be on duty when participating in the study.
ANNEX 14 Page 5 of 7 Names of Investigators Principal Investigators: Professor Warren Payne School of Human Movement and Sport Sciences University of Ballarat PO Box 663 Ballarat, 3350 Telephone: (03) 5327 9693 Email: [email protected]
Dr. Jack Harvey School of Information Technology and Mathematical Sciences University of Ballarat PO Box 663 Ballarat, 3350 Telephone: (03) 5327 9273 Email: [email protected]
Should you have any complaints or concerns about the manner in which the project is conducted, please do not hesitate to contact the researchers listed above in person or you may prefer to contact the Australian Defence Human Research Ethics Committee or the University of Ballarat Human Research Ethics Committee at the following addresses:
Executive Secretary Australian Defence Human Research Ethics Committee CP2-7-66 Department of Defence CANBERRA ACT 2600 Telephone: (02) 6266 3837 Facsimile: (02) 6266 4982 Email: [email protected]
Executive Officer University of Ballarat Human Research Ethics Committee Office of Research University of Ballarat PO Box 663 Ballarat, 3350 Telephone: (03) 5327 9765 Facsimile: (03) 5327 9602 Email: [email protected]
ANNEX 14 Page 6 of 7
DEFENCE PHYSICAL EMPLOYMENT STANDARDS PROJECT
NORMATIVE DATA COLLECTION FIELD TRIALS
INFORMED CONSENT FORM
I,…………………………………………… give my consent to participate in the project mentioned in the subject information sheet on the following basis:
I have had explained to me the aims of this research project, how it will be conducted and my role in it.
I understand that I am participating in this project in a voluntary capacity and can withdraw at any time without penalty or detriment to my career or future health care.
I understand that, as an ADF member, I will be considered to be ‘on duty’ during participation in the study.
I understand the risks involved as described in the subject information sheet.
I am co-operating in this project on condition that: • The information I provide will be kept confidential. • The information will be used only for this project. • The research results will be made available to me at my request and any published reports of this study will preserve my anonymity.
I have been given a copy of the information/consent sheet, signed by me and by the principal researcher, Prof. Warren Payne, to keep.
I have also been given a copy of ADHREC’s Guidelines for Volunteers.
Video clips and still shots may be used for reports and presentations. If clips or shots are used you may be identifiable. Please tick one of the following options:
I give permission to use video clips or still shots that identify me.
I give permission to use video clips or still shots where my face is pixellated (thus de-identifying me).
I DO NOT give permission to use video clips or still shots of me.
……………………………………. ………………………………… Participant’s signature Principal Researcher’s signature
……………………………………. ………………………………… Printed name Printed name
……………………………………. ………………………………… Date Date
ANNEX 14 Page 7 of 7 ANNEX 15
DEFENCE PHYSICAL EMPLOYMENT STANDARDS PROJECT
NORMATIVE DATA COLLECTION FIELD TRIALS
INFORMATION SHEET
The purpose of this document is to describe the “Defence Physical Employment Standards Project: Normative Data Collection Field Trials” and to invite you to participate in the study.
Brief description of the trials There is no doubt that you have been trained to do a variety of highly skilled tasks that require a range of physical as well as technical skills. It is also well recognised that it is important to make sure that you are physically capable of completing the tasks that you will be required to do.
These trials are part of a larger project that aims to establish a number of clearly justified physical employment standards or fitness tests for the combat arms trades. The project has been endorsed by the Chief of the Defence Force and the Chiefs of Service, and is supported by your commanding officer. These tests should be seen as being separate from the BFA and CFA tests that you currently undertake. In general, the purpose of the tests being developed in this project is to ensure that soldiers allocated to the various parts of the ADF (Infantry and Airfield Defence Guards in the first instance) are physically able to do their job in a safe and effective way.
The purpose of the trials is to determine performance on a set of physical tests for Infantry soldiers, Infantry IETs and female soldiers; and a slightly different set of tests for ADG airmen and IETs. The test tasks have been chosen by a group of experienced soldiers and airmen who believe that the tests represent the most physically demanding parts of the job of being an Infantry soldier or Airfield Defence Guard.
The tests you will be required to undertake are as follows: Tests based on combat arms trade tasks: • Box lift and place (simulates loading a UNIMOG truck) • Jerry can lift and carry • Climbing a 1.8 m (6’) wall from running and standing starts • Leopard crawl (simulates crawling through a tunnel) • Urban rushing (simulates moving through urban terrain) • Sustained patrol • Pursuit • Section attack Predictive tests: • Maximum heaves. • Jump and reach. • Situps. • Multistage shuttle run. • Loaded incremental velocity run.
ANNEX 15 Page 1 of 7 Kinanthropometry • Eight skinfold measurements (triceps, subscapular, biceps, iliac crest, supraspinale, abdominal, front thigh, medial calf). • Five girths (arm - relaxed, arm - flexed and tensed, waist, hip, calf – maximum). • Two bone breadths (humerus, femur).
More details about each test can be found in the attached Test Procedures document.
Brief description of the survey of injuries Associated with the field trials, we are conducting a retrospective survey of work-related injuries. The attached questionnaire is similar to one which was distributed in mid-2004 to almost 3000 personnel throughout selected units in the Army and Air Force. You may have completed a survey form at that time. Even if you did, you should still complete this form, which focuses on the 12 months since the previous survey. Also, we are interested in correlating your current injury history with your performance on the physical tests.
The form is designed to obtain details of acute injuries you have suffered during the past 12-months, as well as any chronic injuries you are carrying. You are also asked for details of the situations in which the injuries occurred, together with information about actions taken after the injury, and some opinions regarding contributing factors and about ADF attitudes and practices regarding reporting, treatment and management of injuries.
Your part in the study I would like to invite you to participate in this study. It is important for you to note that your involvement in the study is entirely voluntary and if you chose not to participate there will be no detriment to your career or future health care. Finally, if you chose to participate and later change you mind and wish to withdraw, you may do so without any detriment to your career or future health care.
The study has been scheduled into your Unit’s work plan and will take approximately two weeks to complete in the period from May to August 2005. If necessary, you will be given an opportunity to rehearse a test in order to familiarise yourself with the procedures and then you will perform the task as part of a 10 person section. The various tests will be organised to make sure that you remain as fresh as possible throughout the study.
Up to 320 Infantry soldiers, 60 Infantry IETs, 60 female soldiers/airwomen, 70 Airfield Defence Guards and 40 Airfield Defence Guard IETs will be recruited to participate in this study.
The soldiers/guards will be experienced and well trained, and will not be asked to do anything that they would not normally do as part of their job. Where required on the advice of ADF specialists, tests to be performed by IETs and female soldiers have been adjusted to take account of the lower physical capacities of these groups.
ANNEX 15 Page 2 of 7 You are asked to do your best in each test. The tests include some fitness tests that are very similar to the Basic Fitness Assessment that will be conducted on all participants at the start of the study. I would also like to point out that in order to try to control for the level of fatigue you experience during the study, your participation in exercise/training outside of the study will be controlled with reasonable limits as will your general diet for the duration of the study.
A number of measurements will be made and records taken while you perform each of the tests. These include measuring heart rate from a heart rate meter strapped around each your chest, video taping each of the tests and asking you to complete a simple ‘pencil and paper’ test to measure the effect of the task on you level of tiredness (rating of perceived exertion). Core temperature measurements may be made during some endurance tasks, by radio monitoring of a signal from a temperature-sensitive pill, which you will take the night before the endurance test.
Risks of participating It is important to point out to you that there will be a number of risks associated with participation in this study. However, as you would expect, a range of safeguards have been put in place to make sure that these risks will be minimised.
The first risk is that you feel that you are being coerced or forced to participate in this study. In order to minimise the potential for coercion, recruitment of volunteers will be conducted by a person who is not in your direct chain of command. As mentioned above, you will also be formally notified of your freedom to withdraw at any time should you change your mind about participating in the study.
Secondly, there is a risk that participation in the study will expose you to an unacceptable degree of injury risk. A number of safguards have been put into place to minimise this risk. 1. You will not be able to participate if you are carrying an injury or have an illness that may be made worse as a result of your involvement in the study. You will be asked to disclose your injury and illness status to a civilian researcher and the information that you report will be kept in confidence within the University of Ballarat research team. 2. You are a well trained soldier or airman/airwoman. Most of the tests are closely related to your job or are designed to allow you to withdraw at an appropriate time without you needing to subject yourself to undue risk. 3. All tasks will be monitored by an experienced SNCO, WO or Officer to make sure that they are done in the safest possible way. 4. The area in which you will perform the tasks will be checked to make sure that there are no unacceptable physical hazards present. 5. Heat injury: Soldiers and airmen performing heavy work tasks experience an increase in body temperature. In some circumstances an increase in body temperature may result in a soldier or airman/airwoman being placed at an unacceptable risk of incurring a heat injury and in rare instances death. A number of preventive and treatment strategies will be implemented to ensure that the risk of heat injury and adverse consequences is minimised during the activities involved in the DPES Project. These strategies will involve the following:
ANNEX 15 Page 3 of 7 o Fitness: Only physically fit soldiers and airmen/airwomen will participate in the study. All male soldiers will have satisfactorily completed the combat arms CFA, airmen the BET, trainees the recruit training exit test, and female participants the relevant BFA, CFA or PFT. Women undertaking endurance tests will have attained a high level on the multistage shuttle run test.
o Heat Acclimatization: It is well accepted that participants acclimatized to the heat will be more able to tolerate work in hot conditions than those who are unacclimatized. In the present study, soldiers and airmen currently work and live in the climate where they are being tested. Trainees will have recently moved from Kapooka to Singleton and from Edinburgh to Amberley. In neither case is the climatic difference in May-July regarded as presenting a significant acclimatization issue. Women participants will be resident in the testing location but will not be as accustomed to the exercise/work regimen as the soldiers/airmen. Women will be provided with a recommended program of preparatory exercise to be undertaken in the period between recruitment and the commencement of testing.
o Minimizing environmental heat load: Exercising in a cool environment obviously will result in a reduced environmental heat load and a increased ability for you to lose the heat produced during exercise. The project has been designed to take advantage of the cooler temperatures experienced in northern Australia from April to August. In addition, the tasks likely to induce the greatest heat load (20 km and 10 km forced marches) will be conducted in the morning with the first group of troops ‘stepping off’ at 0500 hr.
o Core temperature limits: Core body temperature will be measured and a limit of 39.5oC will be set for tests in which there is a risk of unacceptably raised core temperatures. This may include some or all of the endurance tests (20 km forced march, 10 km forced march, section attack, urban rushing, loaded incremental velocity run, extended patrol and pursuit).
o Hydration: You will be advised to ingest 500 ml of fluid up to 2 hr prior to exercise and up to 1.2 litres per hour of cool fluid during exercise.
o Heart rate limits: A heart rate limit of 90% of age predicted maximal heart rate (220 beats/min – age in years) will be applied.
o Signs of heat intolerance: You will be monitored by the research staff and the attending ADF medical staff for signs of heat intolerance. These include the presence of red, hot, dry skin; throbbing headache, dizziness, nausea and confusion.
o Availability of first aid/medical support. An ADF first aid team will be present and able to provide appropriate support during the 20 km and 10 km forced marches and section attack (Infantry) and during the extended patrol, pursuit and section attack activities (ADG). In addition, the activity will be conducted on bases where medical support is immediately available should it be required.
o Recent medical history. You will be required to complete a ‘Confidential Health Status Form’ which includes questions regarding factors that may predispose a participant to heat stress such as medications, viral illness (fever), cardiac conditions and diabetes If you report any of these conditions/factors you will be unable to participate in the project.
If you do experience any type of injury, you will be given the first aid or medical treatment necessary by qualified personnel.
ANNEX 15 Page 4 of 7
This study requires that very little equipment will actually be fixed to your body. The only piece of equipment that will be fixed to your body is a heart rate meter. This consists of a strap placed around your chest (heart rate transmitter) and a receiver that looks like a wrist watch. Both pieces of equipment use watch batteries for power and have been passed as safe for use by humans. Core temperature will be measured using pills which you swallow and which pass through your digestive tract. Use of these pills is not advised if you have particular characteristics or medical conditions. These are listed on the health status form which you will asked to complete before participating in this project. If you have any of these conditions you will not be allowed to participate in tests requiring core temperature monitoring. Other data will be collected from pencil and paper tests such as recording how tired you feel. A video record will also be made of you when you undertake each of the work tasks. Finally, you will be asked to complete the injury survey form.
Statement of Privacy There is a separate risk associated with protecting your privacy. There is a risk that the data collected may be used inappropriately within Defence or within the wider community. Examples of this may include using a photo of you without your permission or quoting your individual results in a Defence report. These risks will be reduced by the following: 1. You will be given a code number specific to this study and all data will be ‘de-identified’ whereby your name will be removed from any sets of records that are used for analysis and reported on to Defence or distributed in the wider community. 2. The information that links your name to your code will held in confidence by the civilian Principal Researcher. 3. Only group data summaries will be used in any reports 4. Any videos or pictures that are included in the reports will be ‘de-identified’ by blurring your face or the Civilian Chief Investigator will seek your written permission to use the original image if this considered desirable. 5. All original data will be kept under lock and key at the University of Ballarat for a period of at least five years. 6. Secure information disposal methods will be used such as document shredding. 7. The data will only be used for the purposes outlined above without your express permission.
On duty All members of the Australian Defence Force who volunteer for this study will be considered to be on duty when participating in the study.
ANNEX 15 Page 5 of 7 Names of Investigators Principal Investigators: Professor Warren Payne School of Human Movement and Sport Sciences University of Ballarat PO Box 663 Ballarat, 3350 Telephone: (03) 5327 9693 Email: [email protected]
Dr. Jack Harvey School of Information Technology and Mathematical Sciences University of Ballarat PO Box 663 Ballarat, 3350 Telephone: (03) 5327 9273 Email: [email protected]
Should you have any complaints or concerns about the manner in which the project is conducted, please do not hesitate to contact the researchers listed above in person or you may prefer to contact the Australian Defence Human Research Ethics Committee or the University of Ballarat Human Research Ethics Committee at the following addresses:
Executive Secretary Australian Defence Human Research Ethics Committee CP2-7-66 Department of Defence CANBERRA ACT 2600 Telephone: (02) 6266 3837 Facsimile: (02) 6266 4982 Email: [email protected]
Executive Officer University of Ballarat Human Research Ethics Committee Office of Research University of Ballarat PO Box 663 Ballarat, 3350 Telephone: (03) 5327 9765 Facsimile: (03) 5327 9602 Email: [email protected]
ANNEX 15 Page 6 of 7
DEFENCE PHYSICAL EMPLOYMENT STANDARDS PROJECT
NORMATIVE DATA COLLECTION FIELD TRIALS
INFORMED CONSENT FORM
I,…………………………………………… give my consent to participate in the project mentioned in the subject information sheet on the following basis:
I have had explained to me the aims of this research project, how it will be conducted and my role in it.
I understand that I am participating in this project in a voluntary capacity and can withdraw at any time without penalty or detriment to my career or future health care.
I understand that, as an ADF member, I will be considered to be ‘on duty’ during participation in the study.
I understand the risks involved as described in the subject information sheet.
I am co-operating in this project on condition that: • The information I provide will be kept confidential. • The information will be used only for this project. • The research results will be made available to me at my request and any published reports of this study will preserve my anonymity.
I have been given a copy of the information/consent sheet, signed by me and by the principal researcher, Prof. Warren Payne, to keep.
I have also been given a copy of ADHREC’s Guidelines for Volunteers.
Video clips and still shots may be used for reports and presentations. If clips or shots are used you may be identifiable. Please tick one of the following options:
I give permission to use video clips or still shots that identify me.
I give permission to use video clips or still shots where my face is pixellated (thus de-identifying me).
I DO NOT give permission to use video clips or still shots of me.
……………………………………. ………………………………… Participant’s signature Principal Researcher’s signature
……………………………………. ………………………………… Printed name Printed name
……………………………………. ………………………………… Date Date
ANNEX 15 Page 7 of 7 ANNEX 16 ACCURACY OF SAMPLE ESTIMATES OF POPULATION PROPORTIONS
Most of the tables in this report include percentages which indicate the proportions of particular injury/incident characteristics or outcomes within the survey sample or particular sub-samples of the survey sample (rank categories, age groups, BMI categories, etc.). These sample proportions provide estimates of the corresponding proportions within the ADF population.
Sample estimates of proportions are subject to two sources of uncertainty or “error” – sampling errors and non-sampling errors.
Sampling error
Sampling error refers to the inevitable uncertainty in a sample estimate because of the variability between individuals.
The first point to be made is that unless the population is small (so that the sample constitutes a substantial fraction of the population) it is the absolute sample size, not the sampling fraction, which determines the accuracy of the estimate.
Assuming: • a random (representative, unbiased) sample • the proportion p is close to 0.5 or 50% (this is the “worst case” with the greatest sampling uncertainty) • the population is large (at least 10 times as large as the sample)
Then the standard error of the estimate from a sample of size n (expressed in percentage points) is given by 50 s.e.( p) ≈ %age points n
A range of two standard errors either side of the sample estimate defines an approximate 95% confidence interval. We can be 95% confident that the true proportion of the whole population lies within this range.
Values of the standard error calculated from the formula above and the corresponding 95% confidence range are summarised in the following table, for various sample sizes. These ranges of uncertainty should be borne in mind when interpreting the percentages presented in this report.
Standard Errors and Approximate 95% Confidence Ranges for a Proportion: for Selected Sample Sizes from a Large Population
Size of sample s.e.(p) 2 s.e. range (or sub-sample) %age points (95% confidence) n %age points 2500 1.00 ± 2 1000 1.58 ± 3 600 2.04 ± 4 300 2.89 ± 6 100 5.00 ± 10 50 7.07 ± 14 25 10.00 ± 20
The sampling fraction becomes important only when sampling from a small population so that the sample constitutes a substantial percentage of the population (more than 10%). In this case, the standard errors and confidence ranges in the table above are reduced by a factor known as the finite population correction factor
n fpc = (1 − f ) where f = is the sampling fraction (usually expressed as a percentage) N
ANNEX 16 Page 1 of 3 1 0.9 0.8 0.7 0.6 0.5 0.4 0.3 Correction factor Correction 0.2 0.1 0 0 102030405060708090100 Sampling fraction %
For example, n = 300 and if N is large (>3000) then the confidence range is ± 6 percentage points.
But if n = 300 and N = 400 then the sampling fraction f = 0.75 or 75%, fpc = 0.5, hence s.e. = 2.89×0.5 = 1.45 and the confidence range is reduced to ± 3 percentage points.
Non-Sampling Error
None of the above includes any effects due to non-sampling errors or biases. To the inherent uncertainties due to sampling must be added the effects of any problems with: • sampling design and implementation: o failure to properly identify the population from which to select the sample; o failure to select a representative sample; o non-response (failure to obtain responses from initially selected subjects); • instruments and procedures o poor design of questionnaire or interview schedule; o inaccurate responses due to lack of knowledge or comprehension; o deliberately misleading responses; o processing errors.
Any such factors will have the effect of producing sample results whose relationship to the true population situation is unknown. Whilst care can be taken to minimise or eliminate such effects, non-sampling errors, unlike sampling errors, cannot be easily quantified.
Note that sampling problems such as non-response only undermine the validity of survey results if the sample obtained is unrepresentative. i.e. if the sample obtained has different relevant characteristics or views from those of the population as a whole. The issue of sampling bias can be indirectly addressed by comparing the demographic profile of the sample obtained with that of the target population if the latter is available, for example from a benchmark such as census data.
Application of the above to the retrospective surveys of injury Sampling error The two populations about whom inferences are to be made are all Infantry personnel (N ≅ 5700) and all ADG personnel (N ≅ 350). Sample sizes were as follows: Infantry 2004: 299; 2005: 249; ADG 2004: 95; 2005: 71. Since the Infantry samples each constituted only around 5% of the population, finite population correction is not necessary. The ADG samples constituted around 27% and 20% of the population respectively; the corresponding finite population correction factors are 0.85 and 0.89, indicating that the standard errors listed in the table above should be reduced by about 15% and 11% respectively.
Non-sampling error
The main sources of non-sampling errors are considered to be non-representativeness of the samples due to sample selection constraints, survey distribution processes, self-selection bias due to non-response, and
ANNEX 16 Page 2 of 3 the failure of many respondents to answer all questions on the survey form. These potential sources of bias have been discussed where appropriate throughout the report.
Some limited evidence as to the representativeness of the sample has been presented by comparing the profiles of age, length of service and rank of survey respondents with the corresponding profiles for Infantry and ADG populations.
ANNEX 16 Page 3 of 3