If we acknowledge that rhabdomyolysis (rhabdo) is dangerous, how should we assess the risk during military training when fatalities are rare?

One of my favorite books, The Black Swan by Nassim Taleb, offers insight. Taleb argues that humans often fail to account for rare, high-impact events—so-called “Black Swans.” He suggests that we need to consider both the frequency and magnitude of improbable events. In the case of rhabdo, the risk may seem low, but its potential for high impact is well known—electrolyte disturbances can lead to life-threatening cardiac arrhythmias.

From this perspective, we should aim to minimize unnecessary, low-likelihood, but high-impact events. Military leaders should adapt to changing demographics and varying fitness levels among recruits by involving physicians and athletic trainers in their planning.

By understanding medical risk through this lens, leaders can better address the impact of these demographic changes while maintaining military standards. Thoughtful medical risk management can achieve both goals and protect the young men and women who volunteer for military service.