Retrospective case series of five nontraumatic deaths among U.S. Air Force basic military trainees (1997-2007).

INTRODUCTION: Basic military training is both physically and mentally demanding. New recruits represent a young and relatively healthy subpopulation of individuals, and premature mortality is rare. The purpose of this retrospective case series is to discuss the causes of nontraumatic deaths among U.S. Air Force Basic Military Trainees (BMTs) at Lackland Air Force Base in San Antonio, Texas. STUDY OBJECTIVE: The study objective is to describe the demographic, environmental, and clinical factors associated with nontraumatic deaths among BMTs. METHODS: Data were extracted from medical records and autopsy reports. RESULTS: During the time period of 1997 to 2007, there were 5 nontraumatic deaths. CONCLUSION: Implementation of new policies or revisions to existing policies has reduced the number of nontraumatic deaths in the U.S. Air Force BMT population.

Pneumonia in military trainees: a comparison study based on adenovirus serotype 14 infection.

BACKGROUND: Adenovirus serotype 14 (Ad-14) recently emerged as a respiratory pathogen in the United States, with studies suggesting higher morbidity and mortality. This study was conducted to determine whether Ad-14 is associated with clinical outcomes in otherwise healthy patients with pneumonia. METHODS: Medical records of military trainees hospitalized with pneumonia during an outbreak of Ad-14 infection were reviewed. Clinical, radiographic, and laboratory parameters were compared on the basis of Ad-14 infection. RESULTS: Two hundred thirty-four trainees received a diagnosis of pneumonia, and 83(35%) were hospitalized. Sixty-one percent of patients with pneumonia were Ad-14 positive; 43% of patients with Ad-14 pneumonia were hospitalized (83% of female patients and 40% of male patients; P = .04), compared with 40% of patients with Ad-14 negative cases. Ad-14 infection was associated with higher admission temperature (38.3°C [interquartile range, (IQR) 37.7, 39.4] vs 37.3°C [IQR (36.7, 38.5)]; P < .01) and lower white blood cell count (8.3 × 1000 cells/µL [IQR, 5.7, 12.4] vs 13 × 1000 cells/µL [IQR, 7.5, 12.9]; P = .01), neutrophil count (6.7 × 1000 cells/µL [IQR, 2.8, 9.7] vs 9.7 × 1000 cells/µL [IQR, 5.6, 12.1]; P = .02), lymphocyte count (0.9 × 1000 cells/µL [IQR, 0.8, 1.1] vs 1.3 × 1000 cells/µL [IQR, 1, 1.9]; P = .001), and platelet count (210 × 1000 cells/µL [IQR, 145, 285] vs 261 × 1000 cells/µL [IQR, 238, 343]; P < .01). Ad-14 pneumonia was not associated with specific radiographic findings, pneumonia severity score, intensive care unit admission, longer hospitalization, or 30-day mortality. CONCLUSIONS: During an outbreak of Ad-14 infection, Ad-14 infection was not associated with excess overall morbidity or mortality. Ad-14 infection was associated with specific laboratory and clinical parameters and higher hospitalization rates in female trainees. These data provide new insight to the epidemiology of Ad-14 infection.

Effect on injuries of assigning shoes based on foot shape in air force basic training.

BACKGROUND: This study examined whether assigning running shoes based on the shape of the bottom of the foot (plantar surface) influenced injury risk in Air Force Basic Military Training (BMT) and examined risk factors for injury in BMT. METHODS: Data were collected from BMT recruits during 2007; analysis took place during 2008. After foot examinations, recruits were randomly consigned to either an experimental group (E, n=1042 men, 375 women) or a control group (C, n=913 men, 346 women). Experimental group recruits were assigned motion control, stability, or cushioned shoes for plantar shapes indicative of low, medium, or high arches, respectively. Control group recruits received a stability shoe regardless of plantar shape. Injuries during BMT were determined from outpatient visits provided from the Defense Medical Surveillance System. Other injury risk factors (fitness, smoking, physical activity, prior injury, menstrual history, and demographics) were obtained from a questionnaire, existing databases, or BMT units. RESULTS: Multivariate Cox regression controlling for other risk factors showed little difference in injury risk between the groups among men (hazard ratio [E/C]=1.11, 95% CI=0.89-1.38) or women (hazard ratio [E/C]=1.20, 95% CI= 0.90-1.60). Independent injury risk factors among both men and women included low aerobic fitness and cigarette smoking. CONCLUSIONS: This prospective study demonstrated that assigning running shoes based on the shape of the plantar surface had little influence on injury risk in BMT even after controlling for other injury risk factors.

Hydration status of Air Force military basic trainees after implementation of the back-mounted hydration system.

The Air Force makes an extraordinary effort to prevent heat-related illnesses associated with basic military training (BMT) in south Texas. However, inadequate hydration can still contribute to lost training time and qualified trainees leaving military service without completing BMT. The purpose of the present study was to determine whether equipping BMTs with back-mounted hydration systems (BM) is better than the standard-issue (SI) canteens with respect to hydration status. Male BMTs were randomly assigned to either BM (n = 40) or SI (n = 38) groups. Baseline values were assessed at week 0 before any physical readiness training (PRT). Subsequent data collection took place in the a.m. before PRT and in the p.m. before dinner the first 3 weeks, and during the 5 weeks of training. BMT total body water (TBW) and body composition were assessed by bioelectrical impedance. Saliva osmolality and total protein concentration were also determined. Hydration status increased daily in BM and SI and was well maintained over the duration of BMT. A significant hydration effect (p < 0.05) was observed for average daily increases in TBW and body weight with BM gaining more compared to SI. Average a.m. TBW was 0.3-0.8 L greater in SI versus BM (p < 0.05). Our findings demonstrate that adequate hydration status is maintained during Air Force BMT in a hot environment using either hydration mode and therefore do not support widespread issuance of the BM system on the premise of improved hydration during USAF BMT military training.