Article Text

Download PDFPDF
Longitudinal study of medical downgrades in the Royal Air Force
  1. Stefano Capella1,
  2. E Demoulin2,
  3. C Wilkinson3 and
  4. P Hindle4
  1. 1Trauma and Orthopaedics, Frimley Park Hospital, Frimley, UK
  2. 2Trauma and Orthopaedics, Harrogate and District NHS Foundation Trust, Harrogate, North Yorkshire, UK
  3. 3Department of Occupational Medicine, RAF College Cranwell, Sleaford, Lincolnshire, UK
  4. 4Trauma and Orthopaedic Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
  1. Correspondence to SurgLt Stefano Capella, Trauma and Orthopaedics, Frimley Park Hospital, Frimley GU16 7UJ, UK; s.capella{at}nhs.net

Abstract

Introduction As the focus of the Royal Air Force (RAF) shifts from sustained to contingency operations and the number of personnel is reduced, the burden of retained, medically downgraded personnel may affect operational readiness. The main aims were: to define the prevalence of morbidity leading to permanent medical downgrading; to determine at risk populations and identify areas for improvement.

Method Database of personnel referred to the RAF Medical Board was analysed from January 2012 to October 2013 and January 2017 to December 2019. Patients were excluded if they did not require a formal medical board; incomplete and duplicate entries were also excluded. The primary reason for medical downgrade was categorised with an ICD-10 code. Further subanalysis compared musculoskeletal disease with age, individual trade groups and anatomic region.

Results 2% of RAF service personnel were permanently downgraded annually. Musculoskeletal disease was the leading cause for permanent downgrade across both periods: 58% and 49%. Female personnel were at a greater risk of musculoskeletal downgrade compared with males. Spinal and knee pathology were the leading cause for downgrading among ‘high risk’ personnel. Personnel downgraded due to musculoskeletal pathology were often retained in a limited role with 10% and 5% retained as medically fully deployable. 14% and 12% of personnel downgraded due to musculoskeletal pathology were medically discharged.

Conclusion Musculoskeletal disease was the leading cause for permanent medical downgrades in the RAF. A greater proportion of downgraded personnel with musculoskeletal conditions were retained in service with medical limitations rather than medically discharged.

  • occupational & industrial medicine
  • musculoskeletal disorders
  • adult orthopaedics

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

Statistics from Altmetric.com

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

View Full Text

Footnotes

  • Contributors SC: reviewed data analysis for collection period 1 and analysed all data for collection period 2. Researched literature and wrote paper. ED: analysed all data for collection period 1 and reviewed literature. CW: provided expert opinion with reviews of paper and alterations as well as providing further data to assist with analysis. PH: planned project and assisted throughout data collection, analysis and literature research. Multiple revisions and reviews of paper.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.