Meta analysis oct 17 2005 v3

1

“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

“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

The Attrition Gordian Knot:A Meta-Analysis

UnofficialThe presentation represents the author’s

views and do not represent DA or DOD Policy.

Arthur Schopenhauer's three stages of truth:

"First, it is considered absurd and ignored or ridiculed.

Next, it is considered dangerous to the status quo

and viciously attacked.

Lastly, it is considered wholesome, indeed, self-

evident."

Arthur Schopenhauer's three stages of truth:

"First, it is considered absurd and ignored or ridiculed.

Next, it is considered dangerous to the status quo

and viciously attacked.

Lastly, it is considered wholesome, indeed, self-

evident."

2

NG male1,59712%

NG female6345%

USAR female

6155%

USAR male9107%

AC Male7,10151%

AC female2,75920%

DischargesBy Gender &ComponentBy Volume

Inf 11X1,93421%

AIT1,55416%

FLW**1,19112%

Benning3323%

Eng 21B2072%

MP 31B2302%

Chem 74D1461%

RECBN98710%

Jackson**1,63217%

Knox1451%

Arm 19K6226%

Sill2623%

Art 13X6036%

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.

FY05 IET AC-USAR-NG Discharge %

12.6

14.8

10.5

8.3

0

5

10

15

20

25

30

%

FY05 Discharge % 12.6 14.8 10.5 8.3

Total AC-RC AC Only USAR Only NG Only

Where Discharges Occur by Volume12 MRARate By Component

3

-80% -30% 20% 70% 120% 170%

% Change in Risk of IET Attrition

Rec

ruit

Do

mai

n

Organizational

Behavioral

Health

Physical Fitness

Demographic FemaleAFQT IIIB

Not Tier I

Bonus

Never thoughtabout quittingHigh School

Pre-accession

Injury

High BMI

LowBMI

High Initial

FitnessOld

>26 yearsChild-ren

EntryPay

Grade

AfricanAmerican

Hispanic

Hx shortness of breath

Combat ArmsMOS

Hx backpain

Hx chest pain

Current smoker

Hx depression

Ever suspended/expelled

• 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%)

Law Waiver Hx fainting

Young<19 years

Regular Army IET Attrition Risk Profile

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, task-relevant physically fit, mentally resilient, and deployable.

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.

6

0

10

20

30

40

50

60

70

80

90

100

HSDG

Cat I-IIIA

Cat IV

High Q

uality

Some college

First-Term Attrition

FY79

FY02

Facts: Highest Quality Accessions In Army History1979-2002

Yet, first-term attrition remains relatively stable

We have the best Soldiers

Our Soldiers:• Intelligent• Educated• Diverse• Representative cross-section

7

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

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)• 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)

UNITOF

ASSIGNMENT

MTMC(DOD EA)

• Transport• Lodge• Meals

AOTOSUT

MEPCOM (DOD)(MEPS MINUS)

• Med inspect• Enlistment Oath• Travel

(ticket(s)/airport) • E-Packet (medical/

contract)• QC• RON Lodge/meals

USAREC GC• Quality & Status

Check• E-Packet

(Personnel records)

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

RECEPTION CENTER

• E-Packet - Records• Shots• Issue uniforms• Holding• RECBAS/

SIDPERS/ ATRRS• TR 350-6 Appdx.

replaces AR 601-212

USAREC LNO

• MOS renegotiations

RECBN

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 complex system

8

Move (7-8 Tasks)Move (7-8 Tasks)Shoot (16-17 Tasks)Shoot (16-17 Tasks)

Fight (15 Tasks)Fight (15 Tasks)

Communicate (4-5 Tasks)Communicate (4-5 Tasks)

Joint Urban Operations (3 Tasks)

Joint Urban Operations (3 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

• Perform voice communications (SITREP, SPOTREP, Call for Fire, & MEDEVAC)• Use visual signaling techniques

• 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• Select temporary fighting position

• Perform movements techniques during an urban operation• Engage targets during an urban operation• Enter a building during an urban operation

~40 Warrior Tasks

Red untrainedAmber

familiarizedGreen

proficient

Every Soldier …

IET Review Task Force

Core Warrior Tasks 9 Week Improved POI

‘Fighting and Winning’ Training Has Improved

9

IET/IMTSoldier/Leader

Success

MedicalScreening &Treatment

CadreAttitudes & Training

Training POI

Resources/Facilities

PoliciesProcesses

SoldierHealth &Nutrition

• No “smoking gun” in attrition studies.• No “silver bullet” solution.• Determining variance is key to future interventions.

Attrition Variables

10

Applicant Qualifying Events

• 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


Success



Training POI


PoliciesProcesses


11

1. Less applied fitness and experience (CHPPM). 2. 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.


Success



Training POI


PoliciesProcesses


Key issues:• Can we identify who will succeed?• Screen out or develop in?• Etiology: Them or us?• Are “standards” valid?

12Wolfe, J. (1996-2000). Adaptation to First-Term Enlistment Among Women in the Marine Corps. DAMD 17-95-1-5047.

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.


Success



Training POI


PoliciesProcesses


Adverse Childhood Experiences (ACE)

USMC

SampleNational 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

Table shows 2 factors.Probably getting a skewed

population.Having 3 factors does increase

risk somewhat, but does not automatically mean all are

ruined.

13


Success



Training POI


PoliciesProcesses


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).

Recruiting Policies & Processes

I

II

IIIB

IV

IIIA

8%

28%

17%

17%

21%

14

20

36

19

56

24

55

0

10

20

30

40

50

60

%

Caucasion Black Hispanic

Male

Female

% 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

Body Fat Standards Have Significant Impact


Success



Training POI


PoliciesProcesses


15


Success



Training POI


PoliciesProcesses


Attrition Is Not the Only Criteria

I

II

IIIB

IV

IIIA

8%

28%

17%

17%

21%

Strategy Questions:1. Where do you want to make-up shortfalls from?2. What MOS are affected?

Cat IV?

High Cat IIIB?

16

1. Commanders’ and NCOs’ attitudes are important.

2. Challenging POI.3. Attrition and TTHS reduction mutually

exclusive.4. Treatment programs can be highly

effective.


Success



Training POI


PoliciesProcesses


Training Policies & Processes

17

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.

The Dark Side

18

Recruit A Recruit C

Recruit D

A Dark Side Example: Body Hardening (Sept-Oct 04)

NOTthe

Army

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.”

20

USMA Peak Performance ModelManaging the Moment

Attention Control

Setting the GoalVisualization

ImageryPositive/Effective

Thinking

Stress Management

Performance

“Concentration amidst distraction”

“Excellence under pressure”

“Becoming what wethink about most”

“What you see is what you get”

“Eye on the prize”

Managing the Moment

Attention Control

Setting the Goal

Stress Management

Winning Performance

“Concentration amidst distraction”

“Excellence under pressure”

“Becoming what wethink about most”

“What you see is what you get”

“Eye on the prize”

• 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, fast-paced, 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.

21


Success



Training POI


PoliciesProcesses


Trend: BCT Hours Per Day Trend: BCT Hours Per Day

-2

2

6

10

14

18

22

26

1980 1981 1983 1987 1990 1993 1997 2005

PersonalMealsSleepPOI

BCT POI growth (notional data for 2005) affects both Cadre and Soldiers.

Source: MAJ Moten study

22

Degrading sleep degrades learning, mood, and health.Prof Mary Carskadon, Brown University

http://www.sleepfoundation.org/hottopics/index.php?secid=18

Sleep1. 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: • Decreased:

– Vigilance – Cognitive performance

• Inconsistent logical reasoning skills• Reduced short-term memory• Slower learning rate

– Grades– Negative mood (depressive symptoms)– Immunity (more disease)

• Increased risk re:– Stimulant use– Injury and death– Stress hormone levels

Adequate sleep:• Improved:

– Test scores– Retention of knowledge– Disease resistance– Morale

• Decrease in: – Discipline problems– Depression– Attrits

23

0

5

10

15

20

25

%

111PassBCT

111FailPCU

111Fail

PCU-X

111FailNo

PCU

BCT Discharge Rates

0

5

10

15

20

25

%

111PassBCT

111FailPCU

111Fail

PCU-X

111FailNo

PCU

BCT Injury Rates

CHPPM No-PCU and USMA Experimental PCU-X

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.

4. The optimum solution would be a 12 week BCT PCU company to maximize program flexibility, maintain bonding, provide non-PT training, etc.

24

Admiral Nelson 11 March 1804 to Dr. Mosely:

“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”.

• 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


Success



Training POI


PoliciesProcesses


25

0

2

4

6

8

10

12

14

16

MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR APR

Pre CPG (56)

CPG (98)

1. Established a Clinical Practice Guideline for Hip Pain

2. Early effective management3. 75% Increase in FNFF

detectionSource: CPT Short, MAH

Femoral Neck Fracture

1. Even though small numbers, high costs.

2. 100% medical board.3. Lifetime of treatment.

26


Success



Training POI


PoliciesProcesses


Control Group

Standardized PT Program

Week 1 Week 3 Week 5 Week 9

Time (in weeks)

Injury Rates

33% decrease

Injury Control

USAPFS Standardized PT Program

Good design lowers injury rates

27

• 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

Operation AegisInjury Control

If implemented at all IET/AIT sites: $9M/yr & 1.5M limited duty days/yr Potential

Savings

Accumulated Profiles

05

101520253035

1 2 3 4 5 6 7 8 9Week of Training

MS

I P

rofi

les

(%)

Pre-RT

RT

28

USMC Athletic Trainer Initiative

SOIW Discharges Due to Musculoskeletal Injury FY-03 v. FY-04

89

26

115

54

10

64

0

20

40

60

80

100

120

140

Pre-Existing Occurred in Training Total

Disc

harg

e # FY-03

FY-04

39.3% Decrease in FY-04

61.5% decrease in FY-04

44.3% Decrease in

FY-04

• 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)

• 3 trainers for Parris Island (GIT)/1 ATC for San Diego. • 3 Athletic Training Room (ATRs) for Parris Island

RESULTS– Increased Paris Island grad rate (female 68.3% to

74.7%)– 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.

29

NPQ ATTRITION (POST INDUCTION) AT SUMMER OCS CLASSES 2002-2004

5.7%

8.7%

3.8%

12.0%

18.1%

5.9%

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

14.0%

16.0%

18.0%

20.0%

2002 2003 2004

YEAR

NP

Q A

TTR

ITIO

N

MALE

FEMALE

2297 31109 69 11

ATC BEGAN JULY 03


30


Success



Training POI


PoliciesProcesses


•SOI-E MUSCULOSKELETAL DISCHARGES•235

•192

•65

•0

•50

•100

•150

•200

•250

•2003 •2004 •2005

•YEAR

•#

•ATC ARRIVES NOV 04•THROUGH JUN 05


31


Success



Training POI


PoliciesProcesses


• 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

Defence Injury Prevention Program (DIPP)AUSTRALIAN DEPARTMENT OF DEFENCEAUSTRALIAN DEPARTMENT OF DEFENCE

32

0%

20%

40%

60%

80%

100%

1994 1995 1996 1997 1998 1999

Uninjured

1,834 Injuries Prevented

Injured

Results for Army Basic Training: Injury

0%

20%

40%

60%

80%

100%

1994 1995 1996 1997 1998 1999

Training Successes

Discharged

1,260 Discharges Prevented

Results for Army Basic Training: Attrition

Defence Injury Prevention Program (DIPP)AUSTRALIAN DEPARTMENT OF DEFENCEAUSTRALIAN DEPARTMENT OF DEFENCE

1. 95% reduction in rates of pelvic stress fracture in female recruits.2. Elimination of serious knee injuries in recruits negotiating obstacle course3. 70% reduction over 4 years in rates of injury and attrition4. 60% reduction in compensation paid per recruit enlisted

33


Success



Training POI


PoliciesProcesses


0.43

0.116 0.094

0

0.1

0.2

0.3

0.4

0.5 0.43

0.116 0.094

0

0.1

0.2

0.3

0.4

0.5

Results:All Sports; All Knee Injuries per 1,000 Athlete Exposures

1. Females at risk for knee injuries

2. Neuromuscular testing & training is an effective preventative treatment for serious knee injuries in female athletes.

3. Reduces knee injuries by 80%.

Pre-training Post-training

34

What To Do?

35

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.

4. Contributing factors are:

a. Leg muscle imbalances

b. Mild anemia

c. Soft bones

d. Lower fitness levels at entry

e. Smoking hx

5. Female attrition can be reduced by:

a. Restarting & Improving the FTU PCU and PTRP at GIT sites.

b. Implementing injury control measures.

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.

Hypothesis: Preventable Discharge Attrition Can be Reduced

FY05 IET AC-USAR-NG Discharge Male-Female %

10.8

12.8

8.47.2

20.3

24.5

16.7

13.4

0

5

10

15

20

25

30

%

FY05 Discharge % 10.8 12.8 8.4 7.2 20.3 24.5 16.7 13.4

AC-RC Male

AC MaleUSAR Male

NG MaleAC-RC Female

AC Female

USAR Female

NG Female

36

BU

37

• Nutrition- Increase health- Reduce Anemia from 85% to 10%- Authorize vitamins- Authorize protein drinks- Authorize electrolyte beverages

• 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

“Fit To Win:” Health and WellnessInteractive

elements – ex. sleep affects

stress, disease, and

injuries

38

“You Can Make 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

39

Warrior Ethos and ValuesWarrior 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

40

USARIEM BCT Study

• 1993 study of 174 women in an all-female 8-week BCT company at Fort Jackson, SC (158 graduated).

• Serum ferritin (body iron stores) were low pre-BCT (56% females at less than 20 ng/ml iron) and decreased further by graduation (84%)(pg.109).

• Anemia was correlated with poor PT performance (pg. 111)

• Serum folate levels were low normal pre-BCT and “decreased significantly over BCT.” (pg. 2)

• Maternal low folate intake and blood levels have been "associated with (fetal) neural tube defects“ (pg. 39) (note: neural tube defects can be fatal for the fetus).

• Menu was adequate in energy, but inadequate in B6, folic acid, calcium, magnesium, iron, and zinc.

• Source: “Health, Performance, and Nutritional Status of U.S. Army Women during Basic Combat Training,” (1995)(ADA302042)

• NOTE: Study BCT menu governed by the 1985 AR 40-25

USARIEM BCT Study

• 1993 study of 174 women in an all-female 8-week BCT company at Fort Jackson, SC (158 graduated).

• Serum ferritin (body iron stores) were low pre-BCT (56% females at less than 20 ng/ml iron) and decreased further by graduation (84%)(pg.109).

• Anemia was correlated with poor PT performance (pg. 111)

• Serum folate levels were low normal pre-BCT and “decreased significantly over BCT.” (pg. 2)

• Maternal low folate intake and blood levels have been "associated with (fetal) neural tube defects“ (pg. 39) (note: neural tube defects can be fatal for the fetus).

• Menu was adequate in energy, but inadequate in B6, folic acid, calcium, magnesium, iron, and zinc.

• Source: “Health, Performance, and Nutritional Status of U.S. Army Women during Basic Combat Training,” (1995)(ADA302042)

• NOTE: Study BCT menu governed by the 1985 AR 40-25

Meta analysis oct 17 2005 v3

Health & Medicine

iet discharge attrition

ac female

acrc iet discharges

ng discharge

fy05 iet acusar

ng male

ng female

usar male