The document discusses various factors that influence attrition rates during initial entry training (IET). It notes that there is no single cause of attrition, but rather many interrelated variables across the recruiting, screening, and training processes. Key points discussed include: - Applicant health, fitness, nutrition, and childhood experiences can impact their ability to complete IET. Increased rates of injury, especially in women, are a high-value target area. - Recruiting policies aim to balance manpower needs with risk factors, but validation of standards is important. Medical screening relies on self-reported history. - Training policies must ensure challenging standards while also supporting soldier success. Leaders' attitudes towards attrition can

1. The Attrition Gordian
Knot:
A Meta-Analysis
Arthur Schopenhauer's
Arthur Schopenhauer's
three stages of truth:
three stages of truth:
"First, it is considered
"First, it is considered
absurd and ignored or
absurd and ignored or
ridiculed.
ridiculed.
Next, it is considered
Next, it is considered
dangerous to the status
dangerous to the status
quo and viciously attacked.
quo and viciously attacked.
Lastly, it is considered
Lastly, it is considered
wholesome, indeed, selfwholesome, indeed, selfevident."
evident."
Unofficial
The presentation represents the author’s
views and do not represent DA or DOD
Policy.
“Training for warfighting is our number one priority in peace and in war. Warfighting readiness is
derived from tactical and technical competence and confidence. Competence relates to the ability to
fight our doctrine through tactical and technical execution. Confidence is the individual and collective
belief that we can do all things better than the adversary and the unit possesses the trust and will to
accomplish the mission.”
FM 7-0, Training the Force
1

2. FY05 IET AC-USAR-NG Discharge %
30
12 MRA
Rate By Component
25
Where Discharges Occur by Volume
AIT
1,554
16%
%
20
14.8
15
MP 31B
230
2%
12.6
10.5
10
8.3
Total AC-RC
AC Only
USAR Only
NG Only
12.6
14.8
10.5
NG male
1,597
12%
USAR male
910
7%
AC female
2,759
20%
Knox
145
1%
FLW **
1,191
12%
8.3
FY05 Discharge %
USAR
female
615
5%
Ja cks on**
1,632
17%
Eng 21B
207
2%
Che m 74D
146
1%
5
0
R ECB N
987
10%
NG female
634
5%
Discharges
By Gender &
Component
By Volume
AC Male
7,101
51%
Arm 19K
622
6%
Sill
262
3%
Inf 11X
1,934
21%
Be nning
332
3%
Art 13X
603
6%
AC RECBN, BCT, OSUT, and AIT Allocation of Discharges
by ATC, MOS, and Function (RECBN/AIT)
• 84% of IET discharge attrition volume is in BCT &
OSUT.
• 41+% of IET discharge attrition volume is at 2 sites,
even though rates are “good”.
• 30% of AC-RC IET discharges are women.
2

3. Regular Army IET Attrition Risk Profile
Recruit Domain
Organizational
Bonus
Behavioral
Law Waiver
Never thought
about quitting
High School
Current
smoker
Physical Fitness
High
Initial
Fitness
Demographic
African
American
Hispanic
-30%
Ever
suspended
Hx fainting /expelled
Hx chest pain
Preaccession
Injury
Health
-80%
Combat
Arms
MOS
Low
BMI
Entry
Pay ChildGrade ren
High
BMI
Hx depression
Hx backpain
Old
>26 years
Young
<19 years
20%
Hx shortness
of breath
Not
AFQT
Tier I
IIIB
70%
Female
120%
170%
% Change in Risk of IET Attrition
• Base-case IET attrition risk is 15%
• Further left or right of the center line means increased risk (or less risk) of attrition.
• Bubble size is relative size of RA accessions that are associated with that
factor. 20% female bubble is about 1/2 the size of the 33% TSC IIIB bubble.
• Not Tier 1 (10%)
• Female (20%)
• AFQT IIIB (30%)
3

4. Objectives
1. Meet the Army’s mission, manpower and quality
objectives.
2. Soldier graduates who can “mobilize, deploy, fight,
sustain, and win any conflict” as units with Warrior Ethos
and Values.
3. Soldier graduates who are physically healthy, taskrelevant physically fit, mentally resilient, and deployable.
4

5. BLUF
• Highest quality force in history.
• Accessions processes are a complex
system (Six Sigma).
• Important progress in ‘fighting & winning’ in
last 2 years.
• Reducing ‘Preventable attrition’ requires
‘actionable intelligence’ across the
processes.
• High-value target is reducing and/or treating
injuries, especially among women.
5

6. We have the best Soldiers
Facts: Highest Quality Accessions In Army History
1979-2002
100
FY79
FY02
90
80
70
60
50
40
30
Our Soldiers:
• Intelligent
• Educated
• Diverse
• Representative cross-section
20
10
0
ec
A
y
lit
ua
ge
le
ol
Q
V
m
er
t-T
rs
Fi
m
So
h
ig
H
I
at
IA
-II
G
I
at
SD
C
C
H
iti
ttr
Yet, first-term attrition remains relatively stable
6

7. MEPCOM (DOD)
• School ASVAB Plus ‘Interest Finder’
P&P
• Possible dedicated CATASVAB tablet
• Web ASVAB Plus ‘Interest Finder’
• Automate all screening tests
• METS CATASVAB Plus ‘Interest Finder’
• DL sites
• POS contract sites (within 1-2 hours)
UNIT
OF
ASSIGNMENT
RECBN
USAREC
(Station)
(Office,
School, or
Mobile)
• POS: Sells
MOS
• Police check
• Determine
quals
• Waivers
• Submit EPSQ
Programs
• College First
• VOTEC
• ACASP Plus
• STARR Plus
• Hispanic ESL
Plus
• SMART Plus
• Recruiter
Incentives
MEPCOM (DOD)
• POS Physical
Forward
(contract) (within
1-2 hrs of most
stations)
• ‘Functional’
Physical
• Security
Background
Check (electronic
fingerprint/TECH
check)
• Improved medical
screens (R&D)
• Physical Fitness
Screen
USAREC
(Station)
• Contract
• Waivers
• Personnel records
Self-Paced
Training
(DL/P&P)
• Prepare for
Success
• BCT preview
module
(mandatory)
• Success Profiler
(SP)
• Wellness/Success
modules (based on
SP & time)
(JROTC / CHPPM)
• Fitness modules
(based on time)
(JROTC/USAPFS)
• YMCA/YWCA
MWR ‘partnership’
MEPCOM (DOD)
(MEPS MINUS)
MTMC
(DOD EA)
RECEPTION
CENTER
• Med inspect
• Enlistment Oath
• Travel
(ticket(s)/airport)
• E-Packet (medical/
contract)
• QC
• RON Lodge/meals
• Transport
• Lodge
• Meals
• E-Packet - Records
• Shots
• Issue uniforms
• Holding
• RECBAS/SIDPERS
/ ATRRS
• TR 350-6 Appdx.
replaces AR 601212
USAREC GC
• Quality & Status
Check
• E-Packet
(Personnel
records)
USAREC LNO
• MOS renegotiations
AOT
OSUT
TRAINING
Policy
• OSUT emphasis
• Mini-OSUT for VOTEC grad
• Combat survival (more trng pts)
• Prepare for AIT (as needed)
• Prepare for UOA
• TR 350-70 aligned with FM 7.0
• BCT Redesign: Individual &
Collective design & tasks
integrated
• ENDEX is respective squad
ARTEP or ARTEP slice.
• Ranges designed as
Perimeter slice.
Programs
• “You Can Make It”
• Combat Chaplain Values
Sessions
• Injury CM
• Disease CM
• Victory Diet
• Standardized APFT
• Dual Track BCT tracks or Ability
Group units
Six Sigma: Accessions is a complex7system

8. IET Review Task Force
Core Warrior Tasks 9 Week Improved POI
~40 Warrior Tasks
Every Soldier …
Move (7-8 Tasks)
Shoot (16-17 Tasks)
• Qualify w/ assigned weapon
• Correct malfunctions w/ assigned weapon
• Engage targets with M240B MG
• Engage targets with M60 or M249 MG
• Engage targets with M2 Cal. 50 MG
• Engage targets with MK-19 MG
• Correct malfunctions of a MG (M2, M240B,
M249, MK-19)
• Engage targets with weapon using a night
vision sight (AN/PVS-4, AN/PAS-13, AN/TVS-5)
• Engage targets using an aiming light
(AN/PEQ-2A, AN/PAQ-4)
• Employ mines and hand grenades
• Determine location on ground (terrain
association, map, & GPS)
• Navigate from one point to another
(dismounted & mounted)
• Move over, through, or around
obstacles (except minefields)
• Prepare/operate a vehicle in a convoy
Fight (15 Tasks)
• Move under direct fire
• React to indirect fire (dismounted &
mounted)
• React to direct fire (dismounted &
mounted)
• React to unexploded ordnance hazard
• React to man-to-man contact
(Combatives)
• React to chemical or biological
attack/hazard
• Decontaminate yourself & individual
equipment using chemical decontaminating
kits
• Maintain equipment
• Evaluate a casualty
• Perform first aid for open wound
(abdominal, chest, & head)
• Perform first aid for bleeding of
extremity
•
‘Fighting and Winning’ Training Has
Improved
Communicate (4-5 Tasks)
• Perform voice communications (SITREP,
SPOTREP, Call for Fire, & MEDEVAC)
• Use visual signaling techniques
Joint Urban Operations (3
Tasks)
• Perform movements techniques during
an urban operation
• Engage targets during an urban
operation
• Enter a building during an urban
Red untrained
Amber
familiarized
Green
proficient
8

9. Attrition Variables
Cadre
Attitudes &
Training
Medical
Screening &
Treatment
Training POI
IET/IMT
Soldier/Leader
Success
Soldier
Health &
Nutrition
Resources/
Facilities
Policies
Processes
• No “smoking gun” in attrition studies.
• No “silver bullet” solution.
• Determining variance is key to future interventions.
9

10. Cadre
Attitudes &
Training
Medical
Screening &
Treatment
Training POI
IET/IMT
Soldier/Leader
Success
Soldier
Health &
Nutrition
Applicant Qualifying Events
Resources/
Facilities
Policies
Processes
•
•
•
•
•
•
•
•
•
Aptitude (ASVAB)
Education
Physical exam
Background check
AIM (opt)(TTAS)
‘Gold Standard’ is balancing absolute risk and manpower supply.
Relative Risk models distort actual group performance.
Bio-data variables have low predictive validity and are not causal.
Caution: Type I & II error rates: 1% of 400k = 4k
10

11. Cadre
Attitudes &
Training
Medical
Screening &
Treatment
IET/IMT
Soldier/Leader
Success
Soldier
Health &
Nutrition
Key issues:
Training POI
Resources/
Facilities
Policies
Processes
•
•
•
•
Can we identify who will succeed?
Screen out or develop in?
Etiology: Them or us?
Are “standards” valid?
1.
2.
Less applied fitness and experience (CHPPM).
Less group shower experience (TRAC) (demise of fitness in
schools). Privacy big issue for adolescents.
3. Poorer nutrition (NAHANES)(less milk drinking, fast foods in HS
cafeterias, etc.).
4. High rate of entry mild anemias (females)(USARIEM).
5. Osteopenia (varies by race & gender)(Navy).
6. Adverse Childhood Experiences (ACE) (Navy, VA, USMC, CDC)
(high rates of associated high-risk behaviors).
7. Quad-ham imbalances (Sportsmetrics) leading to knee/lower
limb injuries (females).
8. Smoking (linked to attrition, poor bone remodeling, and
injuries).
9. “Emotional Intelligence” (adaptive skill sets)(vary by education)
10. High % “overfat,” especially minorities and females.
11. 10% will have Chlamydia.
11

12. Cadre
Attitudes &
Training
Medical
Screening &
Treatment
Adverse Childhood Experiences (ACE)
Training POI
IET/IMT
Soldier/Leader
Success
Soldier
Health &
Nutrition
Table shows 2 factors.
Probably getting a skewed
population.
Having 3 factors does increase
risk somewhat, but does not
automatically mean all are
ruined.
Resources/
Facilities
Policies
Processes
USMC
Sample
National
Samples
Men
Women
Men
Women
Child
physical
26.7
38.3
3.2
4.8
Child
sexual
14.7
51.0
3-16
12-27
1. More ACE factors increase risk.
2. Associated high-risk behaviors
(sex, drugs, smoking,, etc.)
3. Associated impacts (health,
disease, poor job performance,
depression, etc.)
4. Diminished brain development.
5. Treatable.
12
Wolfe, J. (1996-2000). Adaptation to First-Term Enlistment Among Women in the Marine Corps. DAMD 17-95-1-5047.

13. Cadre
Attitudes &
Training
Medical
Screening &
Treatment
Training POI
IET/IMT
Soldier/Leader
Success
Soldier
Health &
Nutrition
I
Resources/
Facilities
Policies
Processes
8%
II
28%
IIIA
17%
IIIB
17%
IV
Recruiting
Policies & Processes
21%
1. Marketing de-emphasizes incentives.
2. Army MOS needs drive contracts and incentives.
3. ASVAB Interest Inventory not used to align applicant
to MOS.
4. DA PAM 611-21 MOS descriptions not ‘fully
accurate.’
5. MOS entry standards may not be fully validated.
6. Medical exam relies on self-reported history.
7. Recruiting shortfalls lead to short-term Cat IV surges.
8. Ringers.
9. Tattoo standards.
10. BF standards.
11. Recruiter incentive system (ceiling effect).
13

14. Cadre
Attitudes &
Training
Medical
Screening &
Treatment
Training POI
IET/IMT
Soldier/Leader
Success
Soldier
Health &
Nutrition
Body Fat Standards Have
Significant Impact
Resources/
Facilities
Policies
Processes
60
56
55
50
40
36
% 30
20
20
Male
Female
24
19
10
0
Caucasion
Black
Hispanic
% 17-20 y/o Who Do Not Meet Army Accession Weight
Standards
Source: Nolte et al, “U.S. Military Weight Standards: What Percentage of U.S. Adults Meet the Current Standards?” The American Journal of Medicine, Vol 113,
Oct 15, 2002
14

15. Cadre
Attitudes &
Training
Medical
Screening &
Treatment
Training POI
Attrition Is Not the Only Criteria
IET/IMT
Soldier/Leader
Success
Soldier
Health &
Nutrition
Resources/
Facilities
Policies
Processes
I
8%
II
IIIA
28%
17%
High Cat IIIB?
IIIB
IV
17%
21%
Strategy Questions:
1. Where do you want to make-up shortfalls from?
2. What MOS are affected?
15
Cat IV?

16. Cadre
Attitudes &
Training
Medical
Screening &
Treatment
Training POI
IET/IMT
Soldier/Leader
Success
Soldier
Health &
Nutrition
Resources/
Facilities
Training
Policies & Processes
Policies
Processes
1. Commanders’ and NCOs’ attitudes are
important.
2. Challenging POI.
3. Attrition and TTHS reduction mutually
exclusive.
4. Treatment programs can be highly
effective.
16

17. The Dark Side
1.
G1 Insist-Assist Study showed leaders’ attitudes affected attrition
rates.
a. “High Attrition Leaders” believe they were ‘gate guarders.’
b. “Low Attrition Leaders” believed they were developing Soldiers.
2.
Emotional Events (‘high fear events,’ ‘food deprivation’, ‘sleep
deprivation,’ ‘extreme PT,’ etc.) may be mis-perceived as
preparing Soldiers for war, or strengthening them to cope with
stress.
17

18. A Dark Side Example: Body Hardening (Sept-Oct 04)
Recruit A
Recruit C
Recruit D
NOT
the
Army
18

19. “The discipline which makes the
soldiers of a free country reliable in
battle is not to be gained by harsh or
tyrannical treatment. On the
contrary, such treatment is far more
likely to destroy then to make an
Army.
It is possible to impart instruction
and to give commands in such a
manner and such a tone of voice as
to inspire in the soldier no feeling,
but an intense desire to obey, while
the opposite manner and tone of
voice cannot fail to excite strong
resentment and a desire to disobey.
The one mode or the other of dealing
with subordinates springs from a
corresponding spirit in the breast of
the commander. He who feels the
respect which is due to others
cannot fail to inspire in them regard
for himself while he who feels and
hence manifest disrespect towards
others, especially his inferiors,
cannot fail to inspire in them hatred
for himself.”
19

20. USMA Peak Performance Model
Managing the Moment
Attention Control
Concentration amidst distraction”
“
Setting the Goal
“ ye on the prize”
E
Positive/Effective
Thinking
“
Becoming what we
think about most ”
Visualization
Imagery
“What you see is
what you get”
Winning
Performance
Stress Management
Excellence under pressure”
“
• Dr. Scott Graham, ARI – Infantry Forces Research Unit, found time management, command of the
basics, skill mastery, combat focus, visualization, repetition, and the use of job aids to be the most critical
training that prepared Soldiers for efficient and effective task accomplishment under life-threatening, fastpaced, and stressful conditions (ARI Newsletter – Volume 13, Number 3).
•
In 1998, the United States Olympic Committee summarized the survey results from 296 Olympic team
athletes and 46 Olympic team coaches and found concrete confirmation that human performance at elite
levels is heavily dependent upon intangible, mental factors, i.e. confidence despite setbacks,
concentration amidst distractions, and composure during times of stress.
• Bottomline: High fidelity task repetition to standard prepares Soldiers for combat
success. It is why the Combat Training Centers (CTC) and training devices like MILES,
paint balls, etc. are worth the multi-billion dollar investment.
20

21. Cadre
Attitudes &
Training
Medical
Screening &
Treatment
Training POI
IET/IMT
Soldier/Leader
Success
Soldier
Health &
Nutrition
Trend: BCT Hours Per Day
Trend: BCT Hours Per Day
Resources/
Facilities
Policies
Processes
26
22
18
Personal
Meals
Sleep
POI
14
10
6
2
-2
1980
1981
1983
1987
1990
1993
1997
2005
BCT POI growth (notional data for 2005) affects both Cadre and Soldiers.
Source: MAJ Moten study
21

22. Sleep
1. Teens need 8.5-9.25 hours of sleep each night. By mid 20s: 8 hrs.
2. Natural biological sleep period 11 pm – 8 am (Melatonin
secretion).
3. 0400-0600 is peak time for subjective sleepiness.
Inadequate sleep:
Adequate sleep:
• Decreased:
• Improved:
– Vigilance
– Cognitive performance
• Inconsistent logical reasoning skills
• Reduced short-term memory
• Slower learning rate
– Grades
– Negative mood (depressive symptoms)
– Immunity (more disease)
–
–
–
–
Test scores
Retention of knowledge
Disease resistance
Morale
• Decrease in:
– Discipline problems
– Depression
– Attrits
• Increased risk re:
– Stimulant use
– Injury and death
– Stress hormone levels
Degrading sleep degrades learning, mood, and health.
Prof Mary Carskadon, Brown University
http://www.sleepfoundation.org/hottopics/index.php?secid=18
22

23. CHPPM No-PCU and USMA Experimental PCU-X
BCT Injury Rates
25
25
20
%
BCT Discharge Rates
20
15
15
%
10
5
0
10
5
111
Pass
BCT
111
Fail
PCU
111
Fail
PCUX
111
Fail
No
PCU
0
111
Pass
BCT
111
Fail
PCU
111
Fail
PCUX
111
Fail
No
PCU
1. BLUF: The FTU PCU lowers overall discharge attrition by 500-800+ Soldiers (0.4-0.8+%), as well as
lowers course attrition and injury rates.
2. 4%-7% of men and 10%-24% of women fail the RECBN 1-1-1 assessment historically. 50-75% of the
PCU at GIT sites will be women.
3. PCU Results:
a. Lower course attrition: In the “1-1-1 Fail No PCU” group, men are 2.5 times and women are 1.5 times more likely to
attrit from BCT.
b. Lower discharge attrition: In the “1-1-1 Fail No PCU” group, men are 3.0 times and women are 1.9 times more likely to
be discharged from BCT.
c. Lower injury rates.
d. The USMA experimental PCU-X vice the traditional PCU improved female outcomes, but male outcomes were worse
(but still better than no PCU). Recommendation is that USAPFS design a new PCU PT POI.
23
4. The optimum solution would be a 12 week BCT PCU company to maximize program flexibility, maintain
bonding, provide non-PT training, etc.

24. Cadre
Attitudes &
Training
Medical
Screening &
Treatment
IET/IMT
Soldier/Leader
Success
Soldier
Health &
Nutrition
•
•
•
•
Admiral Nelson 11 March 1804 to Dr. Mosely:
Training POI
“The greatest thing in all military service is health; and
you will agree with me that it is easier for an officer to
keep men healthy than it is for a physician to cure them”.
Resources/
Facilities
Policies
Processes
BCT (Ft. Jackson)(CHPPM)
– Males: 19-37% are injured in a 9-wk cycle
– Females: 42-67% are injured in a 9-wk cycle
Most injuries are overuse, compared to traumatic
– Males: 75%
– Females: 78%
Most injuries involve the lower extremity (low back, pelvis,
hip and leg)*
– Males: 83%
– Females: 87%
Activities associated with injuries in BCT
– Weight bearing activity; predominantly running,
marching, walking
24

25. Femoral Neck Fracture
1. Established a Clinical Practice
Guideline for Hip Pain
2. Early effective management
3. 75% Increase in FNFF
detection
Source: CPT Short, MAH
1. Even though small numbers,
high costs.
2. 100% medical board.
3. Lifetime of treatment.
16
14
12
10
8
Pre CPG (56)
6
CPG (98)
4
2
0
MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR APR
25

26. USAPFS Standardized PT Program
Cadre
Attitudes &
Training
Medical
Screening &
Treatment
Injury
Rates
Soldier
Health &
Nutrition
Training POI
IET/IMT
Soldier/Leader
Success
Resources/
Facilities
Policies
Processes
Good design
lowers injury rates
Control Group
33% decrease
Standardized PT Program
Injury Control
Week 1
Week 3
Time (in weeks)
Week 5
Week 9
26

27. Operation Aegis
Injury Control
•
•
•
BCT grads arrived at AIT with high injury rates.
Epidemiological research identified PT running as the primary cause of
musculoskeletal injuries
Changing the running program
– Reduced Clinic Visits - 36.5%
– Reduced Profiles - 48.6%
– No difference in APFT Scores
– Reduced APFT retakes - 50%
– Saved 612 limited duty days/week/BN
If implemented at all IET/AIT sites:
$9M/yr & 1.5M limited duty days/yr Potential
Savings
27

28. USMC Athletic Trainer Initiative
• Treat Marines forward as Warrior Athletes.
• Sports Medicine Physicians.
• Certified Athletic Trainers (ATC’s)
– Contracted civilians who work for USMC commands.
– GREEN ASSETS (NCAA model)
– aligned with SMART rehab clinic operations
– clinically supervised by Navy Sports Med MDs when dealing with injuries
– emphasis on prevention, education, and treatment
– Collect/enter injury data into TIMS (injury database)
RESULTS
– Increased Paris Island grad rate (female 68.3% to
• 3 trainers for Parris Island (GIT)/1 ATC for San Diego.
74.7%)
SOIW Discharges Due to
• 3 Athletic Training Room Musculoskeletal Injury FY-03 v. FY-04 Island
(ATRs) for Parris
140
115
120
44.3%
Decrease in
FY-04
100
89
39.3% Decrease in FY-04
Discharge #
80
64
60
54
61.5% decrease in FY-04
40
26
20
FY-03
FY-04
– Increase in BCT Return to Full Duty (RTFD) rates
(male 55.5% to 64.3%; female 37.5% to 52.2%) from
rehab.
– Increase in BCT recycle grad rates (female 63.5% to
75%).
– Decrease in BCT rehab discharge rates (male 13%;
female 24%)
– Decreased musculo/skeletal discharges at Infantry
School (see chart at left).
– Decreased attrition at OCS
(male 8.7% to 3.8%; female 18.1% to 5.9%)
– Greater cadre knowledge
– Critical feedback on sources of injuries leading to
fixes.
– Conservative estimate of $3.5M in cost avoidance
and $2.9M in Return on Investment in FY04 v. FY03.
10
0
Pre-Existing
Occurred in Training
Total
28

29. USMC Athletic Trainer Initiative
NPQ ATTRITION (POST INDUCTION) AT SUMMER OCS CLASSES 2002-2004
20.0%
18.1%
18.0%
16.0%
NPQ ATTRITION
14.0%
12.0%
12.0%
10.0%
MALE
8.7%
FEMALE
8.0%
6.0%
5.9%
5.7%
3.8%
4.0%
2.0%
97
22
109
31
ATC BEGAN
JULY 03
69
11
0.0%
2002
2003
YEAR
2004
29

30. USMC Athletic Trainer Initiative
Cadre
Attitudes &
Training
Medical
Screening &
Treatment
Training POI
IET/IMT
Soldier/Leader
Success
•250
•235
Resources/
Facilities
Policies
Processes
•192
•200
•150
•#
Soldier
Health &
Nutrition
•SOI-E MUSCULOSKELETAL DISCHARGES
•100
•65
•50
•THROUGH JUN 05
•ATC ARRIVES NOV 04
•0
•2003
•2004
•YEAR
•2005
30

31. Cadre
Attitudes &
Training
Medical
Screening &
Treatment
Defence Injury Prevention Program (DIPP)
Training POI
IET/IMT
Soldier/Leader
Success
AUSTRALIAN DEPARTMENT OF DEFENCE
Soldier
Health &
Nutrition
Resources/
Facilities
Policies
Processes
• Effective, reduced injury rates by 20-70%.
• Gives CDRs the tools; harnesses local personnel’s
knowledge and skills working together to address their own
injury problems.
• Reflects world best-practice from leading injury prevention
experts.
• Consistent with Defence policy and approaches to risk
management and injury prevention
31

32. Defence Injury Prevention Program (DIPP)
AUSTRALIAN DEPARTMENT OF DEFENCE
Results for Army Basic Training: Injury
100%
Results for Army Basic Training: Attrition
80%
100%
Uninjured
60%
80%
40%
20%
Injured
60%
1,834 Injuries
Prevented
Training
Successes
40%
0%
1994
1995
1996
1997
1998
1999
20%
0%
1,260 Discharges Prevented
Discharged
1994
1995
1996
1997
1998
1. 95% reduction in rates of pelvic stress fracture in female recruits.
2. Elimination of serious knee injuries in recruits negotiating obstacle course
3. 70% reduction over 4 years in rates of injury and attrition
4. 60% reduction in compensation paid per recruit enlisted
32
1999

33. Pre-training
Cadre
Attitudes &
Training
Medical
Screening &
Treatment
1.
Soldier
Health &
Nutrition
2.
3.
Post-training
Training POI
IET/IMT
Soldier/Leader
Success
Females at risk for knee
injuries
Neuromuscular testing &
training is an effective
preventative treatment for
serious knee injuries in female
athletes.
Reduces knee injuries by 80%.
Resources/
Facilities
Policies
Processes
0.5
0.43
0.4
0.3
0.2
0.116
0.094
0.1
0
Results:All Sports; All Knee Injuries per 1,000 Athlete
33

34. What To Do?
34

35. Hypothesis: Preventable Discharge Attrition Can be Reduced
1. Female discharge attrition rates generally runs almost 2x male attrition rates and are 29.4% of all
AC-RC discharges by volume. 46.7% of all AC BCT discharges.
2. Female rates vary by component from AC at 24.5% to USAR at 8.4% to NG at 13.4%.
3. Females enter the FTU PCU and PTRP at higher rates than males and have 3-5x higher injury
rates than men.
FY05 IET AC-USAR-NG Discharge
Male-Female %
4. Contributing factors are:
a. Leg muscle imbalances
30
b. Mild anemia
25
c. Soft bones
20
d. Lower fitness levels at entry
15
24.5
20.3
%
16.7
10.8
10
e. Smoking hx
8.4
7.2
5
5. Female attrition can be reduced by:
a. Restarting & Improving the FTU PCU and PTRP at GIT sites.
b. Implementing injury control measures.
13.4
12.8
0
FY05 Discharge %
AC-RC
AC Male
Male
10.8
12.8
USAR
AC-RC
AC
NG Male
Male
Female Female
8.4
7.2
20.3
c. Researching application of bone screening.
d. Improving the IET diet (Surgeon study underway in fall).
6. Fixing female preventable attrition also fixes male preventable attrition.
35
24.5
USAR
Female
NG
Female
16.7
13.4

36. BU
36

37. “Fit To Win:” Health and Wellness
• Nutrition
-
Increase health
Reduce Anemia from 85% to 10%
Authorize vitamins
Authorize protein drinks
Authorize electrolyte beverages
Interactive
elements – ex.
sleep affects
stress,
disease, and
injuries
• Injury Countermeasures
- Reduce injuries by 50% (milestones TBD)
- Standardized PT (first phase)(move to group tailoring next)
-(DEP, FTU, DSS, PTRP, etc. POIs)
- Marching SOP
- SOP
- Heat Injury prevention & treatment (Cdr Mission TSP: Safety Ctr)
- New Active Profile Form
• Disease Countermeasures
-
Reduce disease by 50% (milestones TBD)
New vaccination program
SCT Program
Handwashing (retrofit sinks, etc.)
Building design standards (02/contamination, etc.)
• Stress Countermeasures (FM 22-51 re Combat Stress)
- Sleep standards
- Homesickness countermeasures
- Link to “You Can Make-It” Program
37

38. “You Can M ake It” Program
1. Positive Command Climate
2. See a BCT graduation early
3. Combat Stress countermeasures (FM 22-51)
4. Positive Jody/Cadence Calls (TR 350-6)(already changed)
5. Combat Chaplain revival-style ‘values’ sessions
6. BCT & DSS POI redesign
38

39. Warrior Ethos and Values
1. Redesign BCT POI around Future Soldier Warfighting Skills
•
•
•
Flexible and adaptable
Resilient
Warfighting Collective tasks (ex. Squad defensive perimeter)
2. Redesign supporting elements:
•
•
•
•
Ranges (multiple tasks & collective slice)
Targets (reactive and shoot-back)
Combat PT test/program (STO underway)
System changes
•
•
•
•
•
•
•
•
TR 350-70 (TD policies & standards)
SMCT
CTT
AR 350-1
NCOES
OES
EER/OER?
Transition Plan: Upgrade Army-wide skills by FY09
39

40. USARIEM BCT Study
USARIEM BCT Study
•• 1993 study of 174 women in an all-female 8-week BCT company at
1993 study of 174 women in an all-female 8-week BCT company at
Fort Jackson, SC (158 graduated).
Fort Jackson, SC (158 graduated).
•• Serum ferritin (body iron stores) were low pre-BCT (56% females
Serum ferritin (body iron stores) were low pre-BCT (56% females
at less than 20 ng/ml iron) and decreased further by graduation
at less than 20 ng/ml iron) and decreased further by graduation
(84%)(pg.109).
(84%)(pg.109).
•• Anemia was correlated with poor PT performance (pg. 111)
Anemia was correlated with poor PT performance (pg. 111)
•• Serum folate levels were low normal pre-BCT and “decreased
Serum folate levels were low normal pre-BCT and “decreased
significantly over BCT.” (pg. 2)
significantly over BCT.” (pg. 2)
•• Maternal low folate intake and blood levels have been "associated
Maternal low folate intake and blood levels have been "associated
with (fetal) neural tube defects“ (pg. 39) (note: neural tube defects
with (fetal) neural tube defects“ (pg. 39) (note: neural tube defects
can be fatal for the fetus).
can be fatal for the fetus).
•• Menu was adequate in energy, but inadequate in B6, folic acid,
Menu was adequate in energy, but inadequate in B6, folic acid,
calcium, magnesium, iron, and zinc.
calcium, magnesium, iron, and zinc.
•• Source: “Health, Performance, and Nutritional Status of U.S.
Source: “Health, Performance, and Nutritional Status of U.S.
Army Women during Basic Combat Training,” (1995)(ADA302042)
Army Women during Basic Combat Training,” (1995)(ADA302042)
•• NOTE: Study BCT menu governed by the 1985 AR 40-25
NOTE: Study BCT menu governed by the 1985 AR 40-25
40