DISEASES IN MILITARY PERSONNEL NOT RELATED TO BATTLE INJURY (Surgical profile)

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Valentyn ZINKIVSKY

Major of the medical service

Leading Surgeon of the Medical Forces and Sustainment Group “East”

Roman KUZIV

Lieutenant Colonel of the Medical Service

Commander of the Military Medical Clinical Center of the Eastern Region

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The injuries suffered by soldiers are not just wounds or acute post-traumatic conditions. War has a comprehensive impact on the physical and mental health of soldiers.

In Ukraine's current war, a significant number of injuries in military personnel are classified as non-battle injuries, received outside the direct contact with the enemy. These can result from traffic accidents, falls, violations of safety regulations, exposure to extreme temperatures, everyday household incidents, or industrial accidents in rear conditions. According to domestic and international studies, non-battle injuries account for a major share of the overall percentage of injuries in service members. Consequently, these diseases carry a significant importance for the medical service, as they can lead to a long-term loss of combat effectiveness and require the development of specific preventive measures.

In accordance with the research by the US Army, which covers the period from 2003 to 2014, non-battle injury caused 34.1% of total casualties (10,203 out of 29,958), and 11.5% of all deaths. [4].

Similar data is presented by CNN: about one-third (≈33%) of all injuries were unrelated to combat, and over 10% of all deaths among service members resulted from non-battle incidents. [5]. Within the domain of orthopaedic injuries, the risk of non-battle injury casualties was 2.2 - 3 times higher than the risk of combat casualties - of all the military service members who required air medical transport from theater, 80.5% were for soldiers with a nonbattle injury, not for those wounded in action. [6].

CLASSIFICATION AND DISTRIBUTION OF NON-BATTLE INJURIES IN MILITARY PERSONNEL

Injuries, with their origin as the primary criterion, are divided into two

categories:

BATTLE INJURY

Battle injury – is an injury Sustained by military personnel during combat (operational) missions.

NON-BATTLE INJURY

Non-battle injury – is a trauma sustained outside combat missions, including those received during training (except for those that simulate real combat), in daily life during service, off- duty hours, transportation or official trips not related to combat operations, accidents, injuries resulting from safety violations, drowning, falls, electrical injuries, etc. [1, 2, 3].

Important notice:

In the First Half of 2025, within the Administrative-Territorial Area of Responsibility of the Medical Forces and Sustainment Group “East”, non-battle injuries and somatic disorders consisted of a significant part of surgical sanitary losses. From the total number of wounded, injured, and ill, which was - 36,943 patients, the share of non-battle injuries accounted for 3,503 (9.5% of the total number of patients and 55% of all injured). Surgical somatic diseases were recorded in 10,124 patients, representing 27.4% of the total number of wounded, injured, and ill.

THE STRUCTURE OF NON-BATTLE SURGICAL TRAUMA FOR THE FIRST HALF OF 2025, WITHIN THE ADMINISTRATIVE-TERRITORIAL AREA OF RESPONSIBILITY OF THE MEDICAL FORCES AND SUSTAINMENT GROUP “EAST”

Traffic accident	1349	38,5%
Household trauma (falls, hits, cuts, sprains, bruises, electric shocks, poisoning with household chemicals, acids, alkalis, etc.)	634	18,1%
Injury during service not related to combat missions (construction of fortifications, loading/unloading, trauma during training)	507	14,5%
Thermal trauma: burns not related to combat missions	273	7,8%
Thermal trauma: frostbite, not related to combat missions	122	3,5%
Contact with animals: bite of a dog, cat, rat, insect, snake, etc.	254	7,2%
Other injuries	399	11,4%

In accordance with the above, it is necessary to note a significant share of traffic accidents - nearly 38.5% of all non-battle injuries. Road traffic injuries in the combat zone are taking the form of a “traumatic epidemic” in military personnel, since the combination of combat risks, stress factors, difficult driving conditions, and safety restrictions leads to a systematic increase in the number of traffic accidents with severe consequences for the personnel. In wartime situation, this issue has a strategic significance and requires comprehensive preventive measures no less than battle injuries themselves [7].

MAIN FACTORS OF THE HIGH FREQUENCY OF TRAFFIC ACCIDENTS IN MILITARY PERSONNEL IN THE COMBAT ZONE:

Poor lighting due to switched-off streetlights - as a result of missile strikes on energy facilities and forced energy saving, especially in the evening and at night, which increases the risk of collisions and accidents.

Presence of security checkpoints - frequent stops, changes in traffic directions, and road narrows significantly increase the likelihood of traffic accidents.

Extreme urgency and stressful conditions - rapid movements in dangerous conditions, often with not fully functioning vehicles, increase the risk of losing control of the vehicle.

Traffic rules violation due to overloaded schedules and stress - drowsy driving, speed limit violations, and failure to keep a safe distance, especially at dusk or at night, increases the risk of accidents.

Important notice:

Traffic accidents are a serious but often underestimated threat that causes no less harm than combat actions. They should be considered as becoming a key element of strategic safety planning in order to preserve the lives and health of personnel. Additionally, a relatively large percentage of non-combat injuries were animal bites - 7.2% of all injuries, which is taking the form of a professional risk under conditions of reduced control over animal populations [8, 9].

STRUCTURE OF THE SURGICAL PROFILE MORBIDITY BY NOSOLOGICAL UNITS FOR THE FIRST HALF OF 2025 WITHIN THE ADMINISTRATIVE-TERRITORIAL AREA OF RESPONSIBILITY OF THE MEDICAL FORCES AND SUSTAINMENT GROUP “EAST”

Abdominal diseases	733	7,10%
Anterior abdominal wall hernias	730	7,20%
Rectal diseases	1170	11,80%
Respiratory diseases	98	1,00%
Peripheral artery and veins diseases	362	3,50%
Genitourinary disorders	501	4,90%
Musculoskeletal disorders	2833	28,00%
Purulent-inflammatory diseases	1315	13,00%
Benign tumors of skin and subcutaneous tissue	1517	0,15%
Malignant neoplasms	86	0,008%
Other diseases	779	0,077%

There’re 10,124 patients with surgical profile diseases in military personnel of Medical Forces and Sustainment Group “East” which make up a significant share of the sanitary losses structure. These include acute abdominal inflammatory processes (appendicitis, perforated ulcer, cholecystitis), purulent inflammation lesions of soft tissues, urologic diseases, exacerbations in chronic surgical conditions, etc. In wartime conditions, the frequency of these diseases increases due to the combination of physical overexertion, nutrition disorders, stress, hypothermia, limited access to timely medical care, and the need to perform tasks in field conditions.

Delayed diagnosis and limited access to planned surgical interventions lead to a high risk of complications and prolonged treatment periods, which directly affect the combat readiness of units.

The frequency of abdominal diseases in combat situation can increase dramatically. During peacetime in Ukraine, acute appendicitis was approximately in 20.7 cases per 10,000 population, and acute cholecystitis – in 6.25 cases per 10,000 population.

However, due to intense daily physical exertion, constant stress, irregular eating, hypothermia, limited access to medical care, and evacuation difficulties, the frequency of these diseases largely increases in military personnel, as well as delayed medical treatment increases the risk of complications. For example, a delay in hospitalization (>24 hours after symptoms onset) increases postoperative mortality in appendicitis from 0.05% to 0.15% [10].

Among military personnel in the combat zone, there is an increased prevalence of such diseases as anterior abdominal wall hernias, hemorrhoids, and lower extremity varicose veins. The military contingent is particularly vulnerable to these diseases in combat situations due to a combination of the following factors: intense physical exertion, prolonged static or sitting positions, stress and constant pressure, irregular eating, and limited access to preventive and planned medical care. For instance, prolonged standing or sitting significantly increases the risk of chronic venous insufficiency development - the basis of varicose disease, which affects about 30% of adults in the civilian population.

RISK FACTORS FOR ANTERIOR ABDOMINAL WALL HERNIAS

• Intense physical activity (lifting heavy gear and weapons, wearing body armor)

• Sudden movements with abdominal muscle strain

• Previous injuries or surgeries

• Chronic cough, constipation

• Protein and vitamin deficiency in the diet

RISK FACTORS FOR HEMORRHOIDS

Prolonged sitting (on duty, staying in armored vehicles)

• Limited mobility

• Irregular diet with fiber deficiency

• Chronic constipation or diarrhea

• Stress and increased intra- abdominal pressure

RISK FACTORS FOR VARICOSE VEINS

• Prolonged standing or sitting

• Heavy physical exertion with weightlifting

• Compression of limbs by gear or uniform

• Lower extremity injuries

REFERENCES

1. Order of the Ministry of Defense No. 879 of 12/31/2024 "On approval of forms of primary accounting documentation used when providing tactical pre-hospital care and medical care at the pre-hospital stage during military (combat) operations and training of security forces and defense forces for use as intended.“.

2. Order of the Ministry of Defense No. 253 dated April 18, 2025 "On Amendments to the Order of the Ministry of Defense of Ukraine dated December 31, 2024 No. 879.“.

3. Order of the Ministry of Defense No. 332 dated October 27, 2021 "On approval of the Instructions on the investigation and accounting of accidents involving military personnel, occupational diseases and accidents in the Armed Forces of Ukraine.“.

4. A 12-Year Analysis of Nonbattle Injury Among US Service Members Deployed to Iraq and Afghanistan, Tuan D. Le, Jennifer M. Gurney, Nina S. Nnamani et al. [https://jamanetwork.com/journals/jamasurgery/fullarticle/2681163].

5. CNN Health «One-third of US military injuries in Iraq, Afghanistan weren’t from battle» [https://edition.cnn.com/2018/05/30/health/afghanistan-iraq-war-injuries- study/index.html].

6. Musculoskeletal Injuries in Iraq and Afghanistan Epidemiology and Outcomes Following a Decade of War, Journal of the American Academy of Orthopaedic Surgeons, June 2016, Belmont, Philip J. MD; Owens, Brett D. MD; Schoenfeld, Andrew J.[https://journals.lww.com/jaaos/fulltext/2016/06000/musculoskeletal_injuries_in_iraq_and_afghanistan_.2.aspx].

7. [https://strahovki.kh.ua/statistika-dtp-pid-chas-viyny].

8. A. A. Kozhokaru et al. (2024): Analysis of the situation with animal bite incidents and rabies prevention among the personnel of the Armed Forces of Ukraine in the pre-war and war periods, published by Ukrainian Journal of Military Medicine.

9. Eliminating rabies: Ukraine’s journey from crisis to control, 31 October 2023. [https://www.who.int/news-room/feature-stories/detail/eliminating-rabies-ukraine- journey-from-crisis-to-control].

10. Standards for the organization of medical care for patients with acute inflammatory diseases of the abdominal cavity [https://medstudia.com/medviva/standarti-organizatsiyi-nadannya-medichnoyi-  dopomogi-hvorim-z-gostrimi-zapalnimi-zahvoryuvannyami-organiv-cherevnoyi-  porozhnini].