• Linda M Hughes and John Clarke.
• Naval Submarine Medical Research Laboratory, Trout Avenue, Naval Submarine Base New London, Groton, CT.
• Mil Med. 2019 Mar 1; 184 (Suppl 1): 476-487.

AbstractPressurized Submarine Escape Training (PSET) physically prepares submariners to safely escape a submarine at depth. Failure to complete PSET is not a submarine service disqualification. Serious medical incidents are rare, but the safety record tradeoff has been low throughput. From 2009 to 2015, only 34% of students screened completed PSET. Students may be medically screened out of the training altogether (disqualified), or dropout during the physical training (attrite). Training records from 12,122 U.S. Navy students were used to identify factors contributing to training disqualification and attrition. Multivariate logistic regression model predictors included demographic and screening items. Association to PSET disqualification included cold/congestion/cough (ORadj 12.34), limited duty status (ORadj 4.29), Physical Readiness Test failure (ORadj 3.37), pneumonia or bronchitis in last 2 years (ORadj 3.17) and nervousness or anxiety in tight spaces (ORadj 2.37). Basic Enlisted Submarine School students were more likely to be disqualified and attrite than other submariner groups, and black/African American (ORadj 1.53) students were more likely to attrite than white students. Only cold/congestion/cough (ORadj 1.52), trouble swimming (ORadj 1.53), and screening during cold/flu season (ORadj 1.28), were associated with training attrition. Recommendations to modify screening requirements are listed in conclusions.Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2019.

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