Load Carriage: An integrated risk management approach.

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Bond University epublications@bond Faculty of Health Sciences & Medicine Publications Faculty of Health Sciences & Medicine 8-18-2014 Load Carriage: An integrated risk management approach. Robin M.

1 Bond University Faculty of Health Sciences & Medicine Publications Faculty of Health Sciences & Medicine Load Carriage: An integrated risk management approach. Robin M. Orr Bond University, Follow this and additional works at: Part of the Sports Sciences Commons Recommended Citation Robin M. Orr. (2014) "Load Carriage: An integrated risk management approach." 3rd International Congress on Soldiers' Physical Performance. Boston.Aug This Conference Paper is brought to you by the Faculty of Health Sciences & Medicine at It has been accepted for inclusion in Faculty of Health Sciences & Medicine Publications by an authorized administrator of For more information, please contact Bond University's Repository Coordinator.

2 Load Carriage: An integrated risk management approach A/Prof Rob Orr

4 The Historical Context

5 The Australian Soldier Context OPERATIONAL LOAD CARRIAGE (Marching Order)

6 The Australian Soldier Context OPERATIONAL LOAD CARRIAGE (Marching Order) Mean Marching Order Loads (M only) Mean Load (kg) Armoured Corps* Infantry Corps* Engineering Corps* Artillery Corps* Signals Corps Other Corps

7 The Australian Soldier Context OPERATIONAL LOAD CARRIAGE Gender Differences ABSOLUTE LOADS* FEMALE: M = 26.4 kg MALE: M = 39.0 kg p=.045 RELATIVE LOADS FEMALE: M = 43% MALE: M = 47% p=.55

8 The Australian Soldier Context OPERATIONAL LOAD CARRIAGE BW Differences ABSOLUTE LOADS Light 20%: M = 34.7 kg Heavy 20%: M = 35.7 kg p=.902 RELATIVE LOADS Light 20%: M = 49% Heavy 20%: M = 36% p=.0509

9 The Current Context v History Approximate relative load carried by Roman Legionnaires = 56% and Australian Soldiers in East Timor = 56%

The Scientific Context Impacts of Load Carriage From the Literature in load weight = in the energy cost of standing, walking (forwards and backwards, up and down stairs) and running (Beekley, Alt,

10 The Scientific Context Impacts of Load Carriage From the Literature in load weight = in the energy cost of standing, walking (forwards and backwards, up and down stairs) and running (Beekley, Alt, Buckley, Duffey, & Crowder, 2007; Bhambhani, Buckley, & Maikala, 1997; Bhambhani & Maikala, 2000; Bilzon, Allsopp, & Tipton, 2001; Blacker, Fallowfield, Bilzon, & Willems, 2009; Charteris, Scott, & Nottrodt, 1989; Chung, Lee, Lee, & Choi, 2005; Datta, Chatterjee, & Roy, 1975; Engels, Smith, & Wirth, 1995; Goslin & Rorke, 1986; Lyons, Allsopp, & Bilzon, 2005; Patton, Kaszuba, Mello, & Reynolds, 1991; Pederson, Stokke, & Mamen, 2007; Pimental, Shapiro, & Pandolf, 1982; Polcyn, Bensel, Harman, & Obusek, 2000; Robertson et al., 1982; Samanta & Chatterjee, 1981; Vaz, Karaolis, Draper, & Shetty, 2005).

The Scientific Context Impacts of Load Carriage From the Literature in speed of load carriage = in the energy cost of carrying given load (more than weight)? 0.

11 The Scientific Context Impacts of Load Carriage From the Literature in speed of load carriage = in the energy cost of carrying given load (more than weight)? 0.5km/h= 10kg (Abe, Yanagawa, & Niihata, 2004; Balogun, 1986; Charteris, et al., 1989; Christie & Scott, 2005; Givoni & Goldman, 1971; Goslin & Rorke, 1986; Maloiy, Heglund, Prager, Cavagna, & Taylor, 1986; Robertson, et al., 1982; Samanta & Chatterjee, 1981; Soule & Goldman, 1969; Soule, Pandolf, & Goldman, 1978).

The Scientific Context Impacts of Load Carriage From the Literature in gradient of load carriage = in the energy cost of carrying given load (more than weight)?

12 The Scientific Context Impacts of Load Carriage From the Literature in gradient of load carriage = in the energy cost of carrying given load (more than weight)? 1%= 10kg (Crowder, Beekley, Sturdivant, Johnson, & Lumpkin, 2007; Givoni & Goldman, 1971; Goldman & Jampietro, 1962; Legg, Ramsey, & Knowles, 1992; Lyons, et al., 2005; Pimental & Pandolf, 1979; Scott & Ramabhai, 2000; Vaz, et al., 2005).

13 The Australian Soldier Context Operational Load Carriage Last Decade: Tasks and Terrain Type Grade of Terrain Crossed During Operational Load Carriage Activities Volum e of Tasks (% ) 80% 70% 60% 50% 40% 30% 20% Administration Static Posts Patroling on Foot/Walk Mounted Patrols 10% 0% Flat Mild Hills Steep Hills Terrain

Justin Kalentis, US Army, wounded in Afghanistan, discussing the

14 Risks Associated with LC When you get shot at, you move as fast as you can but it wasn t very fast. You are just tired. So tired. Justin Kalentis, US Army, wounded in Afghanistan, discussing the loads they were carrying quoted in The Seattle Times (14 Feb 11)

15 Risks Associated with LC Injuries Comparison of Reported Load Carriage Injuries Captured By Survey ( ) and By OSCHAR ( ) Survey Data OSCHAR Data 50 % Of injuries Head Upper limb Back Upper Torso Trunk (Abdominal) Pelvis Lower limb Body Site

16 Injuries Risks Associated with LC

Impacted on battle tactics in major conflicts (Lothian, 1921) Impeded

17 Risks Associated with LC RISKS ASSOCIATED WITH LOAD CARRIAGE Decrements in performance: Mobility Assyrian Spearmen (Orr, 2010) Impacted on battle tactics in major conflicts (Lothian, 1921) Impeded mission success Chasing Militia in East Timor (Breen 2000) Marshall, S.L.A. (1980)

18 Risks Associated with LC RISKS ASSOCIATED WITH LOAD CARRIAGE Decrements in performance: Lethality Marksmanship in numerous studies (Knapik et al., 1990:1991:1997: Rice et al., 1999).

19 Risks Associated with LC RISKS ASSOCIATED WITH LOAD CARRIAGE Decrements in performance: Lethality Grenade throw distance and accuracy (Harper et al., 1997: Knapik et al., 1990:1991)

20 Risks Associated with LC Decrements in performance: Lethality Ave soldier grenade throw distance = 40m 40m 10m C B A A. Lethal Radius 6 metres B. Casualty Radius 15 metres C. Danger Radius 30 metres

21 Risks Associated with LC Reduced performance Reduced mobility Reduced lethality

22 Risks Associated with LC Reduced performance Mobility Operational Tasks Marksmanship Grenade Throw Administration Attention to Task Impact of Load Carriage on Performance

23 Risks Associated with LC

24 Challenge

25 Challenge How to mitigate the effects of load carriage on the soldier? Alter the environment? Reduce the speed? Reduce the duration? Reduce the load?

26 Challenge How to mitigate the effects of load carriage on the soldier? Elimination? Substitution? Engineering? Administration? Reduce PPE? the load?

27 Risk Treatments

28 Load Carriage: An integrated risk management approach Dr Rob Orr or

29 References Breen, B. (2000). Mission Accomplished, East Timor: Allen & Unwin. Carbone, P. D., Carlton, S. D., Stierli, M., & Orr, R. M. (2014). The impact of load carriage on the marksmanship of the tactical police officer: A pilot study. Journal of Australian Strength and Conditioning, 22(2), Drain, J., Orr, R., Attwells, R. & Billing, D. (2012). Load Carriage Capacity of the Dismounted Combatant A Commander s Guide, Defence Science and Technology Organisation: Department of Defence Drain, J., Orr, R., Billing, D., & Rudzki, S. (2010). Human Dimensions of Heavy Load Carriage. Paper presented at the Land Warfare Conference 2010 in Brisbane, Australia November Harper, W. H., Knapik, J. J., & de Pontbriand, R. (1997). Equipment compatibility and performance of men and women during heavy load carriage. Paper presented at the Proceedings of the Human Factors and Ergonomics Society 41st Annual Meeting. Knapik, J. J., Bahrke, M., Staab, J., Reynolds, K. L., Vogel, J. A., & O'Connor, J. (1990). Frequency of Loaded Road March Training and Performance on a Loaded Road March. T Military Performance Division. US Army Research Institute of Environmental Medicine, Natick, 52.

30 References Knapik, J. J., Staab, J., Bahrke, M., Reynolds, K. L., Vogel, J. A., & O'Connor, J. (1991). Soldier performance and mood states following a strenuous road march. Mil Med, 156(4), Knapik, J. J., Reynolds, K. L., Staab, J., Vogel, J. A., & Jones, B. (1992). Injuries associated with strenuous road marching. Mil Med, 157(2), Knapik, J. J., Johnson, R. F., Ang, P., Meiselman, H., Bensel, C. K., Johnson, W., et al. (1993). Road March Performance of Special Operations Soldiers Carrying Various Loads and Load Distributions. T Military Performance Division. US Army Research Institute of Environmental Medicine, Natick, 136. Knapik, J. J., Reynolds, K. L., Duplantis, K. L., & Jones, B. (1995). Friction Blisters: Pathophysiology, Prevention and Treatment. Sports Medicine, 20(3), Knapik, J. J., Reynolds, K. L., & Harman, E. (2004). Soldier load carriage: historical, physiological, biomechanical, and medical aspects. Mil Med, 169(1), Lockheed Martin. (2006). MULE / ARV-A(L): Multifunctional Utility / Logistics and Equipment. Vehicle / Armed Robotic Vehicle-Assault (Light) (pp. 2): Lockheed Martin Corporation. Lockheed Martin. (2009). HULC Exoskeletons Enhance Mobility and Increase Endurance (pp. 2): Lockheed Martin Corporation.

31 References Lothian, N. V. (1921). The load carried by the soldier. J R Army Med Corps, 38, 9-24, , , Orr, R. (2010). The history of the soldier s load, Australian Army Journal, vii(2), Orr, R., Pope, R., Johnston, V., & Coyle, J. (2011). Load carriage and its force impact, Australian Defence Journal, 185, Orr, R. (2013), Soldier Load Carriage: A Risk Management Approach. PhD Thesis, University of Queensland Orr, R., Pope, R., Johnston, V., & Coyle, J. (2013). Soldier occupational load carriage: a narrative review of associated injuries. International journal of injury control and safety promotion(ahead-of-print), 1-9. Orr, R., Pope, R., Johnston, V., & Coyle, J. (2013). Soldier self-reported reductions in task performance associated with operational load carriage. Journal of Australian Strength and Conditioning, 21(3), Rice, V. J., Sharp, M., Tharion, W. J., & Williamson, T. (1999). Effects of a Shoulder Harness on Litter Carriage Performance and Post-Carry Fatigue of Men and Women. Military Performance Division. US Army Research Institute of Environmental Medicine, Natick, 76.

32 References Evidence supporting increases in load weight found to increase the energy cost of standing, walking (forwards and backwards, up and down stairs) and running: Beekley, M. D., Alt, J., Buckley, C. M., Duffey, M., & Crowder, T. A. (2007). Effects of heavy load carriage during constant-speed, simulated, road marching. Mil Med, 172(6), Bhambhani, Y., Buckley, S., & Maikala, R. (1997). Physiological and biomechanical responses during treadmill walking with graded loads. Eur J Appl Physiol, 76(6), Bhambhani, Y., & Maikala, R. (2000). Gender differences during treadmill walking with graded loads: biomechanical and physiological comparisons. Eur J Appl Physiol, 81(1-2), Bilzon, J., Allsopp, A., & Tipton, M. J. (2001). Assessment of physical fitness for occupations encompassing load-carriage tasks. Occup Med (Lond), 51(5), Blacker, S. D., Fallowfield, J. L., Bilzon, J. L. J., & Willems, M. E. T. (2009). Physiological responses to load carriage during level and downhill treadmill walking. Medicina Sportiva, 13(2), Charteris, J., Scott, P. A., & Nottrodt, J. W. (1989). Metabolic and kinematic responses of African women head loaded carriers under controlled conditions of load and speed. Ergonomics, 32(12), Chung, M. K., Lee, Y. J., Lee, I., & Choi, K. I. (2005). Physiological workload evaluation of carrying soft drink beverage boxes on the back. Appl Ergon, 36(5),

33 References Evidence supporting increases in load weight found to increase the energy cost of standing, walking (forwards and backwards, up and down stairs) and running: Datta, S. R., Chatterjee, B. B., & Roy, B. N. (1975). Maximum permissible weight to be carried on the head by a male worker from Eastern India. J Appl Physiol, 38(1), Engels, H. J., Smith, C. R., & Wirth, J. C. (1995). Metabolic and hemodynamic responses to walking with shoulder-worn exercise weights: a brief report. Clin J Sports Med, 5(3), Goslin, B. R., & Rorke, S. C. (1986). The perception of exertion during load carriage. Ergonomics, 29(5), Lyons, J., Allsopp, A., & Bilzon, J. (2005). Influences of body composition upon the relative metabolic and cardiovascular demands of load-carriage. Occup Med (Lond), 55(5), Patton, J. F., Kaszuba, J., Mello, R. P., & Reynolds, K. L. (1991). Physiological responses to prolonged treadmill walking with external loads. Eur J Appl Physiol Occup Physiol, 63(2), Pederson, A. V., Stokke, R., & Mamen, A. (2007). Effects of extra load position on energy expenditure in treadmill running. Eur J Appl Physiol, 102(1), Pimental, N., Shapiro, Y., & Pandolf, K. B. (1982). Comparison of uphill and downhill walking and concentric and eccentric cycling. Ergonomics, 25(5),

34 References Evidence supporting increases in speed increasing the energy cost of carrying a given load: Abe, D., Yanagawa, K., & Niihata, S. (2004). Effects of load carriage, load position, and walking speed on energy cost of walking. Appl Ergon, 35(4), Balogun, J. A. (1986). Ergonomic comparison of three modes of load carriage. Int Arch Occup Environ Health, 58(1), Charteris, J., Scott, P. A., & Nottrodt, J. W. (1989). Metabolic and kinematic responses of African women head loaded carriers under controlled conditions of load and speed. Ergonomics, 32(12), Christie, C. J., & Scott, P. A. (2005). Metabolic responses of South African soldiers during simulated marching with 16 combinations of speed and backpack load. Mil Med, 170(7), Givoni, B., & Goldman, R. F. (1971). Predicting metabolic energy cost. J Appl Physiol, 30(3), Goslin, B. R., & Rorke, S. C. (1986). The perception of exertion during load carriage. Ergonomics, 29(5), Maloiy, G. M., Heglund, N. C., Prager, L. M., Cavagna, G. A., & Taylor, C. R. (1986). Energetic costs of carrying loads: have African women discovered an economic way? Nature, 319(6055),

35 References Evidence supporting increases in energy expenditure while carrying loads up an incline: Crowder, T. A., Beekley, M. D., Sturdivant, R. X., Johnson, C. A., & Lumpkin, A. (2007). Metabolic effects of soldier performance on a simulated graded road march while wearing two functionally equivalent military ensembles. Mil Med, 172(6), Givoni, B., & Goldman, R. F. (1971). Predicting metabolic energy cost. J Appl Physiol, 30(3), Goldman, R. F., & Jampietro, P. F. (1962). Energy cost of load carriage. J Appl Physiol, 17, Legg, S. J., Ramsey, T., & Knowles, D. J. (1992). The metabolic cost of backpack and shoulder load carriage. Ergonomics, 35(9), Lyons, J., Allsopp, A., & Bilzon, J. (2005). Influences of body composition upon the relative metabolic and cardiovascular demands of load-carriage. Occup Med (Lond), 55(5), Pimental, N., & Pandolf, K. B. (1979). Energy expenditure while standing or walking slowly uphill or downhill with loads. Ergonomics, 22(8), Scott, P. A., & Ramabhai, L. (2000). Load Carrying: in situ Physiological responses of an infantry platoon. Ergonomics, 2000(1), Vaz, M., Karaolis, N., Draper, A., & Shetty, P. (2005). A compilation of energy costs of physical activities. Public Health Nutr 8(7a),

Bond University Research Repository

Bond University Research Repository Self-reported load carriage injuries of military soldiers Orr, Rob Marc; Coyle, Julia; Johnston, Venerina; Pope, Rodney Published in: International Journal of Injury