Aim To identify reasons for inappropriate deployment of soldiers with chronic conditions to an operational environment.

Setting Two British Army field hospitals in Kuwait, 08 February to 17 March 2003, during the period of troop concentration prior to war-fighting (Operation Telic).

Population All British military personnel on land during the concentration phase, rising to an estimated 28,000 troops.

Methods Real-time electronic record maintained of all cases presenting to 22 and 33 Field Hospitals judged to be inappropriately deployed.

Results 50 sequential cases were analysed. 34% were downgraded prior to deployment. Of those who were P2 FE, 85% were judged to have required protection from deployment by downgrading. 20% of all cases had a history of chronic asthma, and of the asthmatics 60% (6/10) were not downgraded. 18% of all cases were deployed while waiting for secondary care investigation or review that should have ensured protection from deployment. No patient had an existing “FT” (forward temperate) or “LT” (lines of communication temperate) grading: but in four cases it was predictable that the patient’s underlying condition would be adversely affected by deployment to a desert environment. In 5 cases it was identified that the inappropriate deployment could be attributed to clinical management within the civilian sector, with a consequent failure to institute the necessary downgrading process.

Conclusions Review of the medical grading process is needed to protect those soldiers who are awaiting outpatient opinion or definitive diagnosis from investigation, and to provide an employability grading that matches a soldier’s fitness for operational role.