Combat and Operational Stress

Alan Ogle, Maj, USAF, BSC

Military Psychology PSY4990

University of West Florida, Spring 09

Disclaimer: information in this briefing was compiled from multiple sources in the US military medical services. Many have been modified or shortened to fit the educational purpose, format and training time available. Views expressed are those of the author and do not reflect the official policy or position of the United States Air Force, Department of Defense, or the U.S. Government.

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War

Bad news

There is a psychiatric cost to sending young men

and women to war

Really bad news

No one is immune

Good news

Vast majority survive

Really good news

Resiliency is the norm

The War (OIF/OEF)

Deployers: 1.64 million US Service Members

Casualties: 4,620 77 Air Force

Wounded: 32,409 473 Air Force

Data include dates: 7 Oct 01 – 21 Jun 08

Battlefield

Battlefield

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OIF Combat ExperiencesU.S. Army 2003

Being attacked or ambushed - 89% Receiving incoming fire - 86% Being shot at - 93% Seeing dead bodies or remains - 95% Knowing someone seriously injured or killed - 86%

Three Signature Injuries of OIF/OEF

Extremity amputations 803 (Jul 08)

Traumatic Brain Injury 320,000 (Jan 08)

Post Traumatic Stress Disorder/ Depression 300, 000 (Jan 08)

OEF/OIF TBI and PTSDJan, 2008

Traumatic Brain Injury (TBI) 19.5% report experiencing a probable TBI during deployment Estimated 320,000 cases of TBI Total annual costs of the 2776 cases identified by mid-2007 is

$591-910M. Post Traumatic Stress Disorder (PTSD)

18.5% of veterans meet criteria for PTSD or Major Depressive Disorder (MDD)

14% of returning service members currently meet criteria for PTSD Estimated 300,000 cases of PTSD/MDD Estimated societal costs of PTSD/MDD for the 2 years after

returning from deployment is $4.0 – 6.2B 35% of OIF veterans access MH services after returning home

Occupational Morbidity (Jan, 2008)(six months following hospitalization)

45 - 50% Army AD members psychiatrically hospitalized left military service

11 – 12% Army AD members hospitalized for non-MH diagnoses left military service

Those separated for a MH condition had higher rates of disability than those separated for non-MH medical conditions

Vision: Healthy/Mission Ready Communities

Deployment Behavioral Health

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Combat and Operational Stress Control

Combat stress includes all the physiological and emotional stresses encountered as a direct result of the dangers and mission demands of combat

Combat and operational stress control may be defined as programs developed and actions taken to prevent, identify, and manage adverse combat and operational stress reactions (COSR)

This program optimizes mission performance; conserves the fighting strength; and prevents or minimizes adverse effects of COSR

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Before Deployment of Forces Preparation of Service Members (SM) and Families Command Stress Management

During Deployment Combat and Operational Stress Control (COSC)

After Return of Forces Reintegration with Families PDHRA Education:

Army Battlemind, AF Landing Gear

Treatment

Combat & Operational Stress Prevention and Control

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Basics of Stress Management

Stress is normal part of life, healthy unless either excessive or individual has less developed stress management resources

Sources of potentially excessive stress: Multiple life stressors Deployment and Operational Stress High work stress coupled with poor unit cohesion Isolation from spouse/normal supports

Stress Management is balancing stress load and coping resources

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Healthy Coping

Verbal

Low energy

Head/body aches

Sleep problems

Tension

Behavior

Physical

Harm self or others

Break things

Withdraw from others

Abuse alcohol

Scream

Yell

Curse

Argue

Exercise

Healthy recreation & Fun

Socializing

Good nutrition

Talk with friends,

family, supervisor

See a counselor or chaplain

Write letters, journal

Sleep, Self-care/nurturing

Relaxation Skills

Medication for:

-sleep, depression,

anxiety

DON’T DO THESE DO THESE

SEE MEDICWHEN

NEEDED

High Stress Manifests:

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Deployment Stress Control

Good leadership by officers / noncommissioned officers (NCOs)

Good equipment, supplies etc. Good unit cohesion, confidence, focus Pre-deployment training:

Realistic What to expect What is expected of them Healthy coping strategies Resources for help if needed

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Care for Families

Service members need to know their families are taken care of Needs met—medical, financial, household etc. Ongoing communication-phone, mail, email, video

Healthy coping by families Unit support of families Family Readiness Groups (FRGs) Sample Training for Soldier and Spouse @

https://www.battlemind.army.mil/

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Commanders

Officer and Enlisted leaders are the most important in unit stress management program

Attending to soldiers needs and concerns Good leadership Sample Leaders Training @

https://www.battlemind.army.mil/

Support During Deployment

Trauma Stress Response Teams/Unit Consultation

Mental health services in theater Combat Operational Stress Control Units (COSC) Air Force EMED CASF Theater Hospital

Post-Deployment Health Assessment

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COSC Facilities

“Armor up,

Prevent when you can,

Treat when you must”

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Combat and Operational Stress Control

Its goal is to return Soldiers fit for duty expeditiously

The purpose of COSC is to promote soldier and unit readiness by― Enhancing adaptive stress reactions Preventing maladaptive stress reactions Assisting soldiers with controlling COSRs Assisting soldiers with behavioral disorders

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TRIAGE CATEGORIES FOR COSR CASES

The following are triage categories that may be used for COSR cases: Help-in-place Rest Hold Refer

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TRIAGE CATEGORIES FOR COSR CASES

HELP-IN-PLACE (HIP) Help-in-place is used to identify those cases that do

not have severe COSR or BH disorders They are provided COSC consultation and education,

as appropriate, and remain on duty These interactions may occur in any setting Individual identifying information is not retained or

documented There is no implicit or explicit therapist-patient or

therapist-client relationship in HIP interactions

COSC Principles: BICEPS

Brevity--lasts 48 to 72 hours Immediacy--should be instituted as rapidly as possible Centrality--interventions should be in a central location,

separate from a medical facility Expectancy—Service members should be given a clear and

consistent message that they will return to duty with their unit

Proximity--management occurs near the front with close contact maintained between the member and his or her command

Simplicity--focus on the practical steps to restore function and health; and not on treatment and psychotherapy

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Simplicity

Use brief and straightforward methods to restore physical well-being and self-confidence Reassure of normality Rest (respite from combat or break from the work) Replenish bodily needs (such as thermal comfort, water, food,

hygiene, and sleep) Restore confidence with purposeful activities and contact with his

unit Return to duty and reunite soldier with his unit

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NONPATIENT STATUS

To prevent Soldiers with COSR from adopting the patient role, these guidelines should be followed: Keep the Soldier in uniform and hold him responsible for

maintaining Soldier standards Keep the Soldier separate from seriously ill or injured

patients Avoid giving him medications unless essential to manage

sleep Do not evacuate or hospitalize the Soldier unless

absolutely necessary Do not diagnose the soldier prematurely Transport the soldier via general-purpose vehicles, not

ambulances

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Training Topics:Cont

Working with special populations

Special ops

Contractors

Door bangers

Convoy drivers

Flyers

Re-Deployment Support

Reintegration /Reunion education Landing Gear

Post-Deployment Health Reassessment Mental health services at home station

18 March class presentation: Post Deployment Mental Health Care

Resource Links

https://www.battlemind.army.mil/ PDHealth Predeployment information Air Force predeployment prep--family separations guide Army Behavioral Health predeployment information PDHealth Postdeployment information Postdeployment resources Military Spouse postdeployment information