What Does the Military Health System Need to Support Future Combat Operations? Lessons From Aeromedical Evacuations...

Area of Science:

• Military Medicine
• Aeromedical Evacuation
• Health Systems Research

Background:

• Aeromedical evacuation data from recent conflicts offer insights into the Military Health System's (MHS) patient needs.
• Understanding inpatient and outpatient trends is crucial for optimizing MHS resource allocation.
• Previous assumptions suggested a primary need for inpatient trauma care among evacuees.

Purpose of the Study:

• To evaluate inpatient and outpatient trends in aeromedical evacuations from recent conflicts.
• To characterize evacuee demographics, diagnoses, and care requirements.
• To inform MHS planning for future military operations.

Main Methods:

• Descriptive analysis of aeromedical evacuations from January 2008 to June 2020 using the U.S. Transportation Command database.
• Data stratified by demographics, injury type (battle vs. disease/non-battle), ICD codes, specialty care, and inpatient/outpatient status.
• Analysis focused on evacuations originating from U.S. European Command (EUCOM) to the Continental United States (CONUS).

Main Results:

• 32,485 unique patients were analyzed; 86.9% were male, with a mean age of 29.0 years.
• The majority (96.7%) were active duty military, predominantly from the Army.
• Leading diagnoses included injury/poisoning (33.1%), psychiatric (28.1%), and musculoskeletal (12.1%). Psychiatry was the most common specialty for care (28.1%).
• Most evacuees (65.6%) required outpatient care, while 34.4% needed inpatient care.
• Inpatient care peaked in 2010, with orthopedic surgery (27.3%), psychiatry (21.5%), and general surgery (18.2%) managing the largest shares.

Conclusions:

• Future conflicts will likely see a high volume of evacuations for psychiatric, injury, and musculoskeletal conditions.
• While outpatient care is prevalent, significant inpatient capacity, particularly for surgical and psychiatric cases, must be maintained and planned for.
• The MHS should proactively program resources to address anticipated surgical, injured, and psychiatric patient loads.