Predictors of combat training attrition in Israel Defense Forces soldiers

Abstract

Background Attrition from combat service carries significant organizational and personal ramifications, but predicting factors associated with attrition remains challenging. Aims To evaluate medical and psychosocial factors associated with attrition from basic combat training (BCT) in the Israel Defense Forces (IDF). In addition, we identify subsets of the recruit population which exhibit certain trends in terms of medical corresponding with a high risk of attrition. Methods A cross-sectional study of IDF combat trainees undergoing infantry BCT between 2012 and 2017. Data were collected from the soldiers’ electronic medical and administrative records. We used multivariable logistic regression and the SAS® decision-tree tool to analyse key predictive factors for attrition. Results A total of 46 472 soldiers enlisted to BCT during the research period. The mean body mass index (BMI) was 21.8 (SD 3.54). The overall attrition rate was 10%. The following factors were associated with attrition from BCT: ethnicity (P < 0.01), BMI (P < 0.01), pre-enlisting motivation score (P < 0.01) and the number of mental health officer visits (P < 0.01). Using a decision-tree model, we found a high attrition rate among soldiers who had >5.2 to primary care physician visits (11% attrition rate versus 3%) or more than 11 sick leave days (59% versus 19%). Conclusions This study sheds light on unique measures relating to attrition. Attrition is associated with several demographic and psychosocial factors. Early prediction of motivation and monitoring of healthcare utilization may enable early identification and focused interventions targeting soldiers at high risk for attrition. These findings need to be further translated into actionable directives and further investigations.

Low‐titer group O whole blood in military ground ambulances: Lessons from the Israel Defense Forces initial experience

“…Paramedics manning these teams, underwent dedicated instruction and certification for the administration of LTOWB by a medical officer from the IDF Trauma and Combat Medicine Branch. The instructional sessions included an overview of the rationale for use of whole blood, indications, administration protocols, storage principles and diagnosis and treatment of adverse events, in accordance with the corresponding clinical practice guideline (CPG) 26 . Thereafter, paramedics were required to achieve a passing score in a multiple‐choice examination assessing the principles of LTOWB through a series of knowledge‐based questions and clinical vignettes.…”

“…The IDF‐MC CPGs for Remote Damage Control Resuscitation 26 instruct use of the best available resuscitation fluid in patients deemed to present with one or more signs of profound shock (Figure 1). The primary indication is a systolic blood pressure measurement of ≤90 mmHg in a trauma patient.…”

Adopting a culture of remote damage control resuscitation in the military: Insights from the Israel defense forces decade of experience

“…The indications for the use of TXA have remained relatively unchanged over the last decade, and it is currently indicated for any penetrating torso or junctional injury as well as in trauma patients with signs of profound shock (Figure 3). 26 In contrast to the current Tactical Combat Casualty Care Guidelines (TCCC), 27 traumatic brain injury is not currently a criterion for TXA administration, and our dosage recommendations have remained at 1 g intravenously in the prehospital setting. During the initial rollout of TXA in the IDF, at least 30% of cases in which it was administered had no clear indication per protocol 23 .…”

“…Still, many challenges remain regarding the comprehensive implementation of LTOWB in combat and remote operational scenarios, highlighted by the prerequisite for cold‐chain maintenance from the blood bank to the point of injury 47 . Despite its currently limited rollout, whole blood in trauma resuscitation has been implemented in the IDF‐MC RDCR guidelines (Figure 3) 26 and introduced among physicians and providers in various units to make it a standard practice in future conflicts. As depicted in Figure 4, the proportional use of both FDP and LTOWB became increasingly frequent in the years following their introduction to the IDF‐MC, with an overall downward trend in the proportion of patients receiving fluid resuscitation.…”