Death among US Air Force basic trainees, 1956 to 1996

Background: Basic military training in the U.S. Air Force exposes recruits to multiple environmental and psychological stressors. Deaths often prompt examination of the training process. Methods: This retrospective case study evaluates recruit deaths at Lackland Air Force Base between 1956 and 1996 in terms of demographic, clinical, and environmental variables. Results: Ei ghty-five deaths occurred, with 81% being natural, 13% suicide, 4% accident al, and 2% not classified. Ninety-four percent of recruits who died were ma le, and 60% were 17 to 19 years of age. The average death rate was 2.8/100, 000 recruits. Seven recruits were sickle cell trait (SCT)-positive. The rel ative risk for nontraumatic deaths between expected SCT-positive and non-SC T-positive populations was 23.53 (confidence interval, 19.55-30.01). Thirty -five percent (30 recruits) died from cardiac causes, resulting in a death rate of 1.0/100,000 trainees. Thirty-three percent (28 recruits) died prima rily from infections. Six deaths were due to heat stroke, 11 to suicide, an d 3 to accidents. Conclusion: As a result of improvements in immunizations, changes in hydration and exercise policies, limited access to vehicles, cl ose supervision, the "buddy system," and the institution of the Navy-Air Fo rce Medical Evaluation Test, only a few deaths occurred in any given year.