DSOC Program Review

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DSOC Program Review

• Deployment and Operations
• Task Force
• Lt Col Frank Link, DOTF
• and
• Mr. Jay Jennings, 101ST Airborne Division (Air
  Assault)
• Fort Campbell, KY
• April 23, 2009

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DOTF Approach

• Pro-active efforts in mishap data collection,
  safety lessons learned dissemination, and
  information sharing during force deployments and
  operations to improve safety mishap rates
• Collaboration with deployed safety officers, and
  supporting Service and Combatant Command
  organizations
• Advocate awareness, support and commitment of
  safety issues and initiatives by leadership at
  all levels

3
Path Forward

• Continue efforts to monitor deployment mishap
  trends and engage in efforts such as MRAP safety
  where engagement is crucial to fill gaps/seams.
• Ensure lessons learned and best practices
  established in OIF carry over to OEF.
• Collaborate with organizations to retain focus on
  risk mitigation strategies in deployments and
  operations.
• Continue efforts on focus areas where we can have
  an impact
• Information Sharing
• Data Collection and Reporting
• Organization and Manning
• Doctrine and Instruction

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DOTF Initiatives Summary

• 2008
• MRAP Safety
• Identification of Preventable Military Vehicle
  Accident Causes (Joint Military Vehicle Safety
  Working Group)
• 2007
• Causes and Risk Factors for Military and
  Privately Owned Vehicle Accidents (Joint Military
  Vehicle Safety Working Group)
• 2006
• OIF/OEF Medevac Injury Cause Coding (Joint with
  MTTF)
• Demonstration/Validation of Ergonomic Seat Wedge
  in Tactical Vehicles Phase I
• Safety Devices in Tactical Vehicles
• 2005
• HUMVEE Rollover Alert Device (Black Box Tactical
  Vehicles)

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Mine Resistant Ambush Protected (MRAP) Vehicle
Safety Project DOTF (DSOC Year 4 -2008) No
funding needed POC Mr. Al Rice
(Alfred.Rice_at_js.pentagon.mil)

• Results
• MRAP mishap rates have been reduced from 6.5 per
  1,000 fielded vehicles in 2nd QTR FY 08 to 1.5 in
  2nd QTR FY 09
• Next Steps
• Continue engagement in this project.
• Utilize knowledge gained in the Static Stability
  Factor of MRAPs as a measurable attribute in
  rollover propensity for acquisition of future
  tactical vehicles.

• Objectives
• Early engagement in mishap prevention efforts to
  ensure we stay ahead of the bow wave in
  potential MRAP mishaps.
• Champion improved practices and procedures,
  programmatic investment strategies and systemic
  changes to enhance MRAP safety.
• Justification
• With the fielding of the Up-Armored HMMWV in
  theater Tactical Vehicle mishaps proved to be a
  prevalent cause of non-hostile casualties. From
  February 2003 through March 2005, there were 204
  rollover mishaps in OIF/OEF resulting in 64
  fatalities. Approximately 37-47 of tactical
  vehicle mishaps since 2003 resulted in vehicle
  rollovers.
• Accomplishments thru Collaboration
• Periodic (every 10 days) MRAP mishap trend
  tracking and dissemination to program managers
  and users.
• Developed MRAP Rollover Egress Procedures Card
  and MRAP Survival Card.
• Published numerous safety articles, lessons
  learned, and collaborated on the MRAP Smart
  book
• Identified risks for the Program Office.
• Safety Message dissemination.
• Safety information to CENTCOM MRAP Home page
  website.
• Engagement with MNF-I Task Force Rollover.
• Collaborate on with Rollover Prevention and
  Tactical Vehicle Crew Coordination safety class
  development.
• Collaborate on analysis with JTAPIC, USACRC/SC,
  AMSAA, TECOM, USAIC, USACOE and other agencies on
  analysis

• Approach
• Use lessons learned from Up-Armored HMMWVs.
• Develop a methodology for MRAP mishap trend
  tracking.
• Joint vehicle platform requires a joint approach.

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Identification of Preventable Military Vehicle
Accident Causes JMVSWG (DSOC Year 4 FY2008)
POC Dr. Michelle Chervak, USACHPPM
(michelle.chervak_at_us.army.mil)

• Objectives
• Provide a detailed evaluation of the causes and
  circumstances associated with military vehicle
  accidents (e.g. rollovers, backing up, swerving,
  fire, drowsy driving), as reported in safety
  reports.
• Compare causes and circumstances with the highest
  probabilities to existing safety technologies
  identified by the Joint Military Vehicle Safety
  Working Group (JMVSWG) in order to prioritize
  safety technologies to pursue.
• Justification
• Motor vehicle accidents are the second leading
  cause of injury in the DoD and the number one
  cause of fatalities. They are also a leading
  health problem in Operation Iraqi Freedom (OIF),
  resulting in 958 air medical evacuations from 1
  Jan 2003 through 1 Jun 2006. Existing
  technologies (e.g., driver vision enhancement,
  rollover stability control, rear cameras and
  sensors) could be adapted for use on U.S.
  military vehicles to prevent vehicle-related
  injuries and deaths.

• Anticipated ROI
• An epidemiologic analysis of HMMWV and other
  military vehicle crashes during OIF accident
  reports done at the request of the U.S. Army
  Combat Readiness Center showed that Soldiers not
  wearing seat belts were at 6 times higher risk of
  death than Soldiers wearing seat belts.
• Soldiers involved in rollover crashes of HMMWVs
  who were not wearing their seat belts were 3x
  more likely to be killed than those wearing seat
  belts.
• This same analysis indicated that occupants of
  Stryker vehicles were almost 7x more likely to be
  injured in a rollover crash than HMMWV occupants.
  
• The above are examples of insights that can be
  gained from epidemiologic analysis of motor
  vehicle crashes that are not usually acquired
  from routine assessments of accident data.

• Progress
• Subcontractor identified based on recommendation
  of USACHPPM.
• Working to negotiate subcontract language terms
  related to publication. The National Defense
  Center for Energy and Environment (NDCEE)
  Contract Vehicle requires review by the NDCEE
  Program Management Office (DASA ESOH is Executive
  Agent of the NDCEE)
• Identified alternate implementation approaches
  pending resolution of subcontract language.
• Next Steps
• Finalize details for implementation of this
  initiative and commence efforts

• Approach
• Utilize data from an existing epidemiologic
  dataset will be analyzed (DSOC FY2007 Initiative,
  Causes and Risk Factors for Military POV
  Accidents)
• Prepare data for analysis ensure that all
  variables have appropriate labels.
• Obtain information on causes and circumstances
  associated with military vehicle accidents from
  reviews of the narrative data available in the
  data.
• Code narrative data in consultation with USACHPPM
• Conduct Analysis
• Produce a summary of rates, trends over time,
  injury types, and circumstances associated with
  Army military vehicle accidents as reported in
  the safety data.
• Separate data by military vehicle type, if
  possible (to be determined by sample sizes).
• Produce conditional probabilities of death and
  non-fatal injury by circumstance (e.g.,
  rollovers, backing up, swerving, drowsy driving)
  and by selected risk factors available in the
  safety data (e.g., seatbelt use, helmet use).
•  Interpret the analysis results and develop
  tangible conclusions that can be used to
  prioritize safety technologies.
• Develop detailed final report and briefing
• Share results with the DSOC

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Causes Risk Factors for Military Privately
Owned Vehicle Accidents JMVSWG (DSOC Year 3
FY2007) POC Dr. Michelle Chervak, USACHPPM
(michelle.chervak_at_us.army.mil)

• Objectives
• To establish baseline rates/trends of injuries
  associated with military and privately-owned
  motor vehicle accidents.
• To provide an assessment of risk factors/causes
  for the most serious injuries (hospitalizations)
  related to military privately-owned vehicle
  accidents
• Justification
• Motor vehicle accidents are the second leading
  cause of non-fatal injury in the DoD and the
  number one cause of fatalities. Medical
  surveillance data provide the most comprehensive,
  unbiased picture of the DoD injury burden. Rates
  and trends of medical outcomes associated with
  military and privately owned motor vehicle
  accidents have not been described using these
  data.

• Recent Accomplishments
• Descriptive, univariate, and bivariate analysis
  completed of 11,469 motor vehicle accidents that
  occurred between 1999 and 2006.
• 7,637 crashes included military vehicles and
  3,699 involved privately owned vehicles
• Rates of Army motor vehicle accidents hovered
  around 1.5 per 1,000 enlisted personnel between
  1999 and 2006 except for a rate of 2.4 per 1,000
  enlisted personnel in 2005.
• Unadjusted multivariate regression modeling
  indicate that demographic factors (e.g., gender
  and age) are associated with an increased risk of
  severe injury during motor vehicle accidents.
• Next Steps
• Complete adjusted multivariate logistic
  regression modeling.
• Continue writing text for the report.
• Finalize and submit report and present project
  findings.

• Approach
• Obtain Safety and Medical Data from Army Safety
  Management Information System (ASMIS) and the
  Defense Medical Surveillance System (DMSS)
• Obtain deployment and personnel data from the
  Defense Manpower Data Center (DMDC)
• Prepare Data for Analysis
• Use statistical software to produce descriptive
  statistics to include distributions of all
  categorical data variables and means, standard
  deviations, and percent distributions of all
  continuous data variables. Statistics will be
  run on military vehicles (Army motor vehicles and
  Army combat vehicles) and privately-owned
  vehicles separately.
• Produce univariate statistics on the association
  of motor vehicle-accident injury with risk
  factors of interest (e.g., age, gender, recent
  deployment, seat belt use, alcohol use, weather,
  vehicle type, time of day)
• Conduct multivariate analysis to identify
  predictors of the most severe injuries resulting
  from motor vehicle related accidents, controlling
  for factors such as age and gender.
• Develop final report and share results
• Anticipated ROI
• Target risk factor and circumstance information
  to inform policy planning, focusing prevention
  resources on leading modifiable risk factors and
  causes

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Injury Cause Coding of Medical Evacuations from
OIF OEF, 2001-2008 USAF, USMC, USN (DOTF-MTTF
/ DSOC Year 2 - FY2006) POC Mr. Keith Hauret,
USACHPPM (keith.hauret_at_us.army.mil)

• Objectives
• Establish an injury cause coded database for
  service members (USAF USMC, and USN) medically
  air evacuated from CENTCOM with injuries since
  2001.
• Summarize causes and types of nonbattle injuries
  (NBI) requiring air evacuation
• Identify potentially preventable causes of NBI
• Justification
• NBIs are a major cause of morbidity and mortality
  during military deployments and combat
  operations. Though the impact of NBIs during
  military operations is well recognized, the
  epidemiology of these injuries is poorly
  understood. Deployment electronic medical records
  do not capture many medical encounters and do not
  include coded causes of injury.

• Approach
• Air evacuation records for all service members
  (USAF, USMC, USN) air evacuated from CENTCOM
  between October 2001 and May 2008 were obtained
  from USATRANSCOM. These records provided
  demographics, medical diagnosis, and a narrative
  patient history that was used to identify and
  code causes of NBI. Accident reports from the
  Services safety centers were linked to the air
  evacuation records, when available.
• The relational database for this initiative and a
  web-based interface that provide remote access to
  the data were developed using the Defense Safety
  Enterprise System (DSES).
• Descriptive statistics were used to describe the
  relative impact of NBIs, injury rates, injury
  types, and injury causes. Comparisons were made
  between the three services and between OIF and
  OEF. Results were also compared to previously
  reported data for Army air evacuated NBIs.
• Results
• NBI was the leading diagnosis category for air
  evacuations from CENTCOM for the USAF (34), USN
  (37) and USA (34) and the second leading
  diagnosis category for the USMC (31).
• Air evacuated NBI rates for OIF gradually
  decreased for all four services, but OEF rates
  have fluctuated widely.
• Leading causes of NBIs were similar for OIF and
  OEF Sports/PT, falls/jumps, land transport
  vehicle accidents.
• Fractures, sprains/strains/ruptures, inflammation
  and pain (overuse), and dislocations were the 4
  leading types of air evacuated NBIs.
• NBIs most commonly affected the ankle/foot,
  wrist/hand, knee, and back for all services.

• Next Steps/Transition
• Development and Hosting
• Test identified technology solutions to link
  personally identifiable DSES data to other DoD
  data systems in the future.
• Finalize data use agreements to receive casualty
  data (DCIPS)
• Continue to host and support the relational
  database in the DSES
• Continue to code causes of injury for air
  evacuated NBIs during military deployments to
  monitor changes in rates, types, and causes
• Determine Transition
• Work with the Services for potential
  centralization of the cause coding process
• Support on-going DoD initiatives to require cause
  coding in medical records
• Brief TRANSCOM to develop requirement for codes
  causes of injury in the air evacuation records.
• Conduct Further Data Analysis
• Conduct investigations to identify specific
  hazards and risk factors for leading causes of
  NBIs and investigate reasons for differences in
  injury types and causes by Service and military
  deployment
• Develop prevention strategies to target leading
  injury causes
• Communicate Results
• Ensure results continue to be communicated to DoD
  and military leaders so countermeasures can be
  developed and implemented to prevent leading
  causes of injury

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Causes of Air Evacuated Nonbattle Injuries,
OIF/OEF 2001 - 20081-3
1Includes NBIs air evacuated from CENTCOM, 19
March 2003 through May 31, 2008 (USAF, USMC and
USN) 2Causes of injury are listed in decreasing
order based on the Total for all services 3Does
not include 536 cases from the services that did
not have a specified cause of injury 4Twisting/sli
pping as a cause of injury includes 147 injuries
that occurred when the person slipped or tripped,
but did not fall completely to the ground. These
cases are near-falls. There are 8 other
injuries in this cause of injury category
resulted when the person was twisting to lift,
push or pull an object and injured the back,
neck, or arm. These latter injuries from
twisting did not involve a near fall. 5Other
Specified category includes boots/body armor,
marching/drilling, hanging/suffocation/strangulati
on, fighting, foreign body, toxic substances,
water transport (3 were falls), and other causes
not classifiable using STANAG codes.
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Ergonomic Seats For Tactical Vehicles DOTF
(DSOC Year 2 - FY2006) POC LTC Myrna
Callison, USACHPPM (myrna.callison_at_us.army.mil)

• Objectives
• Examine the effectiveness of using SKYDEX
  Ergonomic Seats Pads in tactical vehicles to
  reduce lower back injuries caused by whole body
  vibration (WBV) for long distance drivers and
  passengers in High Mobility Multipurpose Wheeled
  Vehicle (HMMWV) that are used to provide security
  in support of Heavy Equipment Transport Systems
  (HETS) during missions through Kuwait into Iraq.
  
• Justification
• A unit currently based in Kuwait, that conducts
  convoy logistics patrols, experiences 36 of
  their force report to the medical clinic for
  lower and middle back injury. A unit conducting
  lengthy operations in RG31 (an MRAP type vehicle)
  experienced similar problems. The complete
  documentation of lower back injuries from long
  periods of operation in tactical vehicles is
  currently unknown but believed to be extensive
  for personnel that ride tactical vehicles with
  non-adjustable seats for long periods.

• Recent Accomplishments
• Ergo team completed Phase I of this project seat
  and transducer installation and the medical
  pre-screenings for the vehicle operators at the
  4th Sustainment Brigade, 1st Theater Support
  Command Camp Arifjan, Kuwait.
• Initial feedback from the seat users is positive
  however no official conclusions or
  recommendations can be made until the full
  analysis of data from both phases is completed.
• The Team has confirmed the logistics to return to
  Kuwait to complete Phase II of the project.
• Anticipated ROI
• Identify more cost-effective means to mitigate
  the effects of WBV on tactical vehicle operators
• Next Steps
• Commence and complete Phase II and report results
  to DOTF and DSOC

Corrected Posture

• Approach
• PHASE I
• Define the issue
• Develop the approach to collect and analyze the
  data
• Coordinate with a unit in-theatre to support the
  testing
• Manufacture and ship 50 seat wedges to Kuwait
  Install in vehicles with transducer to measure
  WBV
• Develop and complete the initial background
  survey
• PHASE II
• Collection of mission and final background
  surveys
• Completion of in-theatre vibration exposure
  testing
• Analysis of the data by USACHPPM
• Submission of final report by USACHPPM with
  recommendations to the DSOC and tactical vehicle
  program managers regarding the potential of the
  seat pad to eliminate or minimize back injuries.
  

Uncorrected Posture
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Safety Device In Tactical Vehicles DOTF (DSOC
Year 2 - FY2006) POC Mr. Al Rice, Joint Staff
Readiness (alfred.rice_at_js.pentagon.mil)

• Objectives
• Test proof of concept for reducing tactical
  vehicle accidents by installing commercial
  off-the-shelf Sensor Monitoring Devices in
  Tactical Vehicles to deter aggressive driving
  behavior. Following test make a recommendation
  whether the program should be broadened
  theater-wide.
• Justification
• Tactical vehicle rollovers escalated dramatically
  after Highly Mobile Multi-Purpose Vehicles
  (HMMWV) were up-armored. Experts attributed the
  cause of many of the rollovers to inexperienced
  incidental drivers unfamiliar with the elevated
  center of gravity associated with the increased
  weight of these vehicles. Between FY2002 and
  FY2006 in Operation Enduring Freedom (OEF) and
  Operation Iraqi Freedom (OIF), tactical vehicles
  had been involved in nearly 500 accidents183 of
  the accidents were tactical vehicle rollovers
  which killed nearly 100 service members.

• Results
• Video EDR (DriveCam) easily installs in HMMWV
• Computer EDR (RoadSafety) requires complex
  installation process into the HMMWV
• Phase I captured 237 events, 33 were identified
  as risky events, with 1 collision.
• Sporadic problems with video EDR due to cellular
  software malfunction
• Test-site staff indicated the devices seem better
  suited for non-tactical vehicles. The unusual
  gravitational forces that tactical vehicles are
  exposed to cause many "false events" and the
  incorrect calibration of the sensors can also
  cause real events to be missed.
• Challenges in real-time reporting precluded
  timely intervention by leaders to counsel risky
  drivers
• Next Steps
• This technology was not recommended for use in
  tactical vehicles in its current form due to the
  limitations observed during testing.

• Approach
• Work with stakeholders to identify the
  appropriate technology, location and participants
  for a proof of concept demonstration
• Coordinate the testing associated with this proof
  of concept.
• Include products based on recommendations from
  the DOTF DriveCam and RoadSafety.
• Results
• Completed Safety Release Testing
• Completed Phase I Testing which involved 17
  M1097A2 HMMWVs at the US Military Academy at West
  Point using 16 DriveCams and 1 RoadSafety Device.
• Completed Phase II Testing at USMC Base, 29 Palms
  using 8 HMMWV's and 8 DriveCam Units.

DriveCam Device
M1097A2 HMMWV
RoadSafety Device
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Jay Jennings 101ST Airborne Division (Air
Assault) Fort Campbell, KY Joint Logistics
Command Safety Manager Bagram, Afghanistan Jan
2008-Jan 2009 101st Sustainment Bde,
Installation Airfield Safety Mgr Forwarding
Operating Base Qayarrah West, Iraq Aug 2005-Aug
2006
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Deployment Success Tactical Safety Specialist
(TSS) - Permanent Part of US Army Manning
Template At Brigade And Division Level (AUG
TDA) - Deploys With Unit - Continuity And
Expertise - USMC Fielding TSS To Battalion
Level Issues - Pace of Operations and
Turnover - Availability - Full Integration With
Military Staffs
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Deployment Success MRAP OEF Accident Prevention
- 63rd 21st Chemical Companies, Joint
Logistics Command, Afghanistan Jan 08-Jan09 -
No Accidents or Rollovers - All Soldiers Came
Home Safely - Lessons Learned Often From DSOC
Reviewed And Integrated Into Convoy
Briefings - Contractor-Run, Standardized
Instruction - Time For Training Fenced-Off,
Protected - Unit Integrity and Cohesion
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Deployment Concern Weapons Clearing
Procedures - Conflicts Within US Armys
Manuals - Manual of Common Tasks Vs. Training
Manual Vs. Locally Developed Procedures -
Conflicts Between Services - Army, USMC USAF
Clear M-16 Differently Challenge Standardization
In A Joint Environment Hazard Confusion Will
Cause A Negligent Discharge. Systemic Problem
Which Requires Systemic Solution
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• Deployment Concern
• Safety Training Not Institutionalized
• US Army FORSCOM Deployment Task List
• Train On Risk Management
• Not Specific Relies On Safety Officer/NCO or
  Tactical Safety Specialist To Execute
• Lack of Standardization
• Key Making Safety Lessons Learned As Important
  As Weapons Qualification, Mine Awareness, Or
  Other Training Tasks Which Are Always Done Before
  Deployment

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Questions
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Other DOTF Initiative Quads
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HMMWV Roll Over Alert Device Update - DOTF (DSOC
Year 1 2005) POC Mr. Al Rice
(Alfred.Rice_at_js.pentagon.mil)

• Objectives
• Test proof of-concept for reducing tactical
  vehicle accidents by installing commercial
  off-the-shelf rollover alert devices (RAD) in
  HMMWVs to reduce vehicle rollovers in theater.
  Recommend whether the program should be broadened
  theater-wide.
• Justification
• Up-armoring HUMVEEs to protect occupants against
  improvised explosive devices has made the
  vehicles more difficult to control and prone to
  rollovers. Rollovers have been particularly
  prevalent in challenging terrain like Iraq. In
  response, the Army collected data on rollover
  accidents, noting that excessive speed and abrupt
  steering were factors in a majority of rollover
  accidents. Inexperienced drivers were often
  involved in rollovers.

• Next Steps/Transition
• DSOC provided Services with recommendation to use
  RADs as a training tool for up-armored HMMWV and
  variants (Mar 07)
• Continue to publicize process and findings
• Vendor submitted request to Expedited
  Modernization Initiative Procedure (EMIP) Process
• Transition TBD by Program Manager Light
  Tactical Vehicles
• US Army Combat Readiness Center has engaged with
  Program
• Executive Office Combat Support Combat
  Service Support for
• future transition into fleet
• Program Manager Light Tactical Vehicles
  initiating a two phased
• Program with AM General for similar devices

• Approach
• Review available devices and selected RAD based
  on predictive capability.
• Purchase and install eight systems for
  proof-of-concept evaluations at Forts McCoy,
  Polk, and Benning.
• Poll users to determine RAD effectiveness.
• Results
• Completed Safety Release from Army Test and
  Evaluation Command
• Proof of concept demonstration successfully
  conducted at three sites
• Determined the RAD is compatible with tactical
  vehicles
• The RAD was demonstrated to
• Sense lateral and axial acceleration
• Provide audio and visual warning of an impending
  rollover
• Provide a 40 significant improvement in HUMVEE
  handling by inexperienced drivers over the
  control group.
• In the user survey, 95 of respondents felt that
  the device was an effective tool and 82 felt
  that it improved their driving behavior.
• The rollover warning device demonstrated the
  potential to be a useful tool in helping drivers
  to react before a HUMVEE rollover condition
  develops and could serve as an intermediate
  solution to provide rollover early warning.