Financial Impact of Embedded Injury Prevention Experts in U.S. Army Initial Entry Training
Daniel R. Clifton, D. Alan Nelson, Y. Sammy Choi, Daniel Edgeworth, Donald Shell, Patricia A. Deuster. J Athl Train 2022; doi: https://doi.org/10.4085/1062-6050-0353.22
Take-Home Message
Embedding athletic trainers and certified strength and conditioning specialists in initial entry training for the Army saved the Army at least three times the cost of contracting these professionals for an annual savings of $11 to 20 million.
Background
More than 1 in 4 men and women suffer a musculoskeletal injury during initial entry training for the United States Army. The U.S. Army began embedding teams of athletic trainers and strength and conditioning specialists in 2010 to address the problem of early-career musculoskeletal-related discharge from service. The Army might be able to demonstrate the need for these teams if we knew how much money they saved by preventing and promptly treating injuries.
Study Goals
The author’s objective was to assess if embedded Injury Prevention Experts were associated with fewer training costs for soldiers discharged early from service.
Methods
The authors performed a retrospective analysis of 198,166 active-duty soldiers who began training from January 2014 through May 2017. Soldiers who started training at two locations between April 2015 and November 2015 did not have athletic trainers and strength and conditioning specialists on-site due to a lapse in contracts. The authors categorized these soldiers as having no exposure to injury prevention experts. All other soldiers were categorized as having exposure to injury prevention experts. The authors estimated soldiers’ training costs based on average basic and advanced training costs from 2014-2017 for an average of six months of training. To qualify as an early-career discharge from active duty, the discharge had to occur within six months of starting training and because of a musculoskeletal condition.
Results
Overall, 14,094 soldiers had no exposure to injury prevention experts. 2.8% of these soldiers were discharged early due to musculoskeletal injury. Of the 184,072 soldiers with injury prevention expert exposure, 1.0% were discharged early due to musculoskeletal injury. The authors calculated that the injury prevention experts saved the Army $11 to $20 million/year in lost training costs due to early-career discharges (after subtracting the contracting costs for the experts).
Viewpoints
For a relatively small financial cost (approximately $900,000 per site or $4 Millon total), the Army reduced the chance of an early discharge by ~64%. It also saved significantly in lost training costs due to early-career medical discharges. We should also consider that these costs don’t address other long-term savings. For example, injury prevention or prompt treatment of an injury may decrease the risk of medical discharge later in someone’s life due to chronic pain (e.g., osteoarthritis) or save healthcare expenses related to chronic pain or functional impairments. Furthermore, while costs help justify hiring these experts, we can’t ignore the other benefits that may occur, including better quality of life and function of the soldiers and improved military readiness.
Clinical Implications
Clinicians and administrators can use these data to advocate for athletic trainers and strength and conditioning specialists in the military and possibly industrial or performing arts settings to demonstrate a 3-5x return on investment.
Written by Mitchell Barnhart
Reviewed by Jeffrey Driban
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