Service-Connected Life Trajectory Comparison of Psychiatric Aeromedical Evacuation and Non-Psychiatric Aeromedical Evacuation Patients From 2001 to 2015

Jan 01, 2022

Numerous epidemiological research studies have been conducted on the military population, but relatively little research has looked at psychiatric aeromedical evacuations from deployed settings. Thus, the long-term impact of these evacuations is not known.

A previous STRONG STAR-affiliated study, OIF/OEF Psychiatric MEDEVACS, examined the career impacts and risk factors for a sample of nearly 10,000 U.S. military personnel who received a psychiatric aeromedical evacuation from Iraq or Afghanistan between 2001 and 2013. That study found that more than half had separated from active duty, were discharged, or were on temporary disability retirement status at the time of the analysis. And it found no relationship between severity of an evacuee’s condition and the reason for separation or discharge. This suggests that psychiatric aeromedical evacuation from the combat zone is often a military career-ending event.

Comparison groups

This new STRONG STAR-affiliated, retrospective study will build on the previous one by adding comparison groups. The research team will analyze the long-term physical and mental health outcomes among active duty service members with and without deployment experience and those with and without history of aeromedical evacuation.

The study team hypothesizes that they will find differences in long-term adverse physical and mental health outcomes between service members aeromedically evacuated from theater for psychiatric reasons, those aeromedically evacuated from theater for non-psychiatric reasons, those never evacuated from combat, and those who never deployed.

The analysis will include data from sample groups of individuals who served in the U.S. military between Jan. 1, 2001, and Dec. 31, 2015. It will be based on data obtained from multiple sources within the U.S. Department of Defense, including the TRANSCOM Regulating and Command & Control Evaluation System, Defense Manpower Data Center, Defense Health Agency, and Air Evacuation Registry.

Clarifying the long-term impact

The investigators believe that the analysis comparing military personnel with a variety of service histories will provide an even clearer picture of the long-term impact of psychiatric aeromedical evacuation. They believe that could influence the military to recommend treatment of some psychiatric patients in theater, which could prevent some evacuations as well as make evacuation flights safer for patients and crews. Results of this study also may help the military to clarify current aeromedical evacuation guidelines, develop improved screening tools and standards of care, and enhance training.

Medical Deployment Resilience Study

Apr 20, 2009

Why do medical personnel respond differently after exposure to traumatically injured medical patients? What conditions influence why one person remains resilient through the experience, one seems psychologically “wounded” at first but then grows even stronger after a natural recovery period, and one develops posttraumatic stress disorder?

Particularly for our military medical personnel, what kinds of contributing or protective factors are somewhat within the military’s control? The military has no influence over a person’s genetic make-up or past life experiences, but are there things it can do proactively-such as team-building to strengthen unit cohesion, types of pre-deployment training, or other internal processes, programs, and procedures-that can enhance service members’ resilience and help prevent psychological problems such as PTSD?

The study’s purpose

These are all questions being asked in a STRONG STAR-affiliated study led by Lt Col (Ret) Alan Peterson, PhD, of The University of Texas Health Science Center at San Antonio, who serves as the principal investigator for the Air Force-funded “Medical Deployment Resilience Study.” Dr. Peterson actually initiated the study without funding in 2004 when he was still active duty with the U.S. Air Force. With his collaborators within the Air Force, at Harvard University, and at the VA’s National Center for PTSD in Boston, he greatly enhanced study efforts with a grant in 2007 from the U. S. Air Force Operational Medicine Research Program.

The purpose of the study is to conduct a prospective evaluation of risk, resilience, natural recovery, and posttraumatic growth in medical personnel deployed to work at a combat-theater hospital in Iraq. Medical personnel at this location are often exposed to patients with severe traumatic injuries, mass casualties, human remains, and risk of personal injury from attacks by rockets, missiles, and snipers.

Currently, little is known about the effects of this type of high-stress/high-risk environment on military medical personnel, although previous, retrospective studies of military nurses who worked in combat hospitals in Vietnam found rates of PTSD at levels similar to those of Vietnam combat veterans.

How it works

This study is the first large-scale, prospective evaluation of the impact of deployment on Air Force medical personnel. It involves all active- duty Air Force medical personnel since 2004 who have deployed from Wilford Hall Ambulatory Surgical Center, Lackland AFB, to serve as part of the 332 Expeditionary Medical Group (EMDG), as well as Air Force medical personnel from other bases who process through Lackland’s Deployment Processing Center to serve in Iraq with the 332 EMDG.

All personnel who volunteer for the study-more than 1,000 to date-are surveyed on five separate occasions: pre-deployment, mid-deployment, one month post-deployment, six months post-deployment, and 12 months post-deployment.

These anonymous surveys contain questions about previous exposure to traumatic life events; PTSD symptoms; health care stressors unique to deployed military settings; general military attitudes and experiences; attitudes and beliefs about working with Iraqi patients; anxiety; depression; resilience; and posttraumatic growth. Some participants also are being recruited when they return to Lackland to voluntarily participate in focus groups. These groups discuss their deployment with investigators and provide direct feedback on both positive and negative experiences during deployment, as well as suggestions for improving the deployment experience.


Together, the surveys and focus groups are allowing investigators to do the following:

  • Identify factors that are related to increased risk for the development of PTSD, such as exposure to specific types of medical trauma patients and injuries;
  • Evaluate protective factors that are related to resilience, which can be the focus of future studies targeting programs to increase resilience prior to deployment;
  • Evaluate the course of natural recovery in individuals who initially show symptoms of PTSD or its precursor, acute stress disorder, but recover without any formal intervention;
  • Evaluate the impact of work with Iraqi patients in order to allow for improved training programs for military medical personnel.

Study findings have already resulted in over 20 scientific presentations and publications and are expected to help the military enhance resilience and reduce psychological distress among military medical personnel. These findings also have implications for the deployment of civilian medical personnel who are sent to provide health care after terrorist attacks or natural disasters.