Treatment of stress reaction prior to combat using the "BICEPS" model.

It has generally been accepted that combat stress reactions are best treated near the war front. The "BICEPS" model is a frequently used model for treating such stress reactions. With the deployment of forces to Saudi Arabia, cases similar to combat stress have occurred during the phase of anticipation of possible combat. The following case report illustrates such a case as well as its successful treatment using the BICEPS model.     

Systematic review of physical fitness testing to evaluate the physical combat readiness of Royal Thai Armed Forces

Physical combat readiness of military personnel ensures maximal effectiveness of combat forces during wartime. Combat readiness has always been linked to the Army Physical Fitness Test (APFT). Each raw score is converted to a standard score and corrected for age and gender. There is no standard measurement to evaluate combat readiness in the Royal Thai Army. To determine standardized criteria for physical combat readiness of Royal Thai Army personnel through systematic review, the APFT was used to determine fitness levels and to promote health. To pass the test, each soldier in each unit must attain a minimal standard score for each individual subtest. At present, each unit in the armed forces derives its own standard, based on different missions. The APFT might be an acceptable method to measure physical combat readiness. However, no studies have established the general measurements to evaluate combat readiness.     

Combat stress disorders and the U.S. Air Force

Air Force fliers and base personnel have unique spheres of vulnerability to combat stress disorders. A number of factors unique to the Air Force heighten combat stress vulnerability: (1) The passive nature of combat duties, (2) relatively small amounts of combat skills training, (3) absence of service-wide training in arms use, (4) lack of experience with mass casualty situations, (5) family proximity to potential operational areas, and (6) base and personnel immobility. The impact of combat stress disorders for both fliers and nonfliers in the Air Force can be minimized. Prevention, diagnosis, and treatment are discussed.     

Eating in combat: a survey of U.S. Marines

A survey of U.S. Marines was conducted in order to investigate the effect of combat, a highly stressful situation, on eating behavior. The results indicate that Marines reduced their food intake, especially during their first combat experience. The principle reason cited for reduced consumption during combat was the lack of time to eat and prepare food. However, fear was important in accounting for reduced consumption during the marines' initial exposure to combat. The results are consistent with other laboratory and survey findings that stress leads to a reduction in food intake.     

武警部队执勤、"处突"、"反恐"条件下军事应激损伤研究

 目的研究军事应激对武警官兵健康的影响,探讨如何提高执行"处突"任务官兵对应激的适应和反应能力.方法采用症状自评量表(SCL-90)、Zung抑郁自评量表(SDS)、焦虑自评量表(SAS)等量表对执行10类不同任务的10 113名官兵进行随机整群测评.并对部分人员行血浆T3、T4检测.采用单光子发射断层显像术(SPECT)研究高强度训练对官兵骨功能的影响.针对官兵出现的应激表现,采取相应干预措施.通过跳台、避暗和Y迷路动物实验,采用心电图(ECG)监测、正电子发射断层显像(PET)脑功能成像研究动物枪击下肢后的远达效应.结果与对照组相比,军事应激严重影响执行不同任务官兵的战斗力生成(P＜0.01),SPECT显示高强度训练可引起多个部位的骨损伤(P＜0.01).初步研究显示针对性的集体健康教育、个体及集体心理治疗以及中药和针刺显著提高官兵的战斗力(P＜0.01).动物实验显示应激环境下动物的适应和反应能力降低(P＜0.01),并且动物下肢枪伤可造成远隔脏器的损伤(P＜0.01).结论军事应激可严重影响官兵的战斗力生成,针对性干预可提高战斗力.     

A knowledge assessment of combat stress reaction in Army Family Practice residents

Combat stress reaction occurs when a soldier's ability to function effectively is impaired by overwhelming stressors in a combat environment. During recent wars, Combat stress reaction has accounted for 30% to 40% of all casualties. Army Family Physicians can expect to be assigned to frontline medical units in time of war and, therefore, should be able to accurately diagnose and treat combat stress reaction. This paper reports an investigation of the knowledge Army Family Practice residents have of combat stress reaction. The results show that Army Family Practice residents are deficient in their knowledge of combat stress reaction.     

The psychologist's role in the Garrison mission of combat stress control units

Active duty psychologists frequently are called upon to provide services that extend beyond the model of direct patient care. Army psychologists in combat stress control teams or division mental health services, Navy psychologists deployed to surgical companies, and Air Force psychologists deployed with air-transportable hospitals or mental health rapid response teams may find themselves acting as organizational consultants as well as clinicians. Psychologists assigned to hospitals and clinics also have opportunities to make contact with their units for purposes of consultation and education. Organizational consultations that offer interventions for improving unit readiness and/or increasing combat effectiveness are often welcomed by commanders and provide a mechanism for the application of training and experience directly to military populations. Transferring skills from patient care to performance enhancement may not be a clear progression for many clinicians. This article describes the strategies and materials developed as part of a combat stress control garrison mission at Fort Lewis, Washington, as an example of one approach to working with combat units. The article also calls for the development of a formal mechanism to train psychologists for such roles and for the maintenance and dissemination of research materials to support organizational interventions.     

军队战斗力生物化趋势的战略研判

战斗力是武装力量遂行作战任务的能力,科学技术是推动战斗力生成模式转变的根本动力。人类战斗力经历了冷兵器化、金属化、火器化、机械化、热核化、信息化的变迁,而随着生物科技的迅猛发展和在军事领域的优势运用,战斗力必将朝着生物化方向发展。因此,对未来军队战斗力生物化趋势做出科学研判并提出生成策略,具有重要的现实意义和战略价值。     

Combat stress reaction and changes in military medical profile

This study examines changes in the military medical profile following participation in war. Two groups of Israeli soldiers who participated in the 1982 Lebanon War were studied: 360 soldiers who were treated for immediate combat stress disorder during the war, and a matched control group of 310 soldiers who participated in the same war and were not identified as combat stress reaction casualties. Significant lowering of the profile after the war was noted for both groups. These changes were much stronger for combat stress reaction casualties. The differences between the groups were especially pronounced with regard to the addition of the psychiatric impairment category to the military medical profile. No background characteristics differentiated between combat stress reaction casualties who lowered their profile and those who did not. The implications of the findings for further research and for military mental health policy are discussed.     

The U.S. Navy's forward resuscitative surgery system during Operation Iraqi Freedom

The forward resuscitative surgery system (FRSS) is the Navy's most forward-deployed echelon II medical unit. Between March and August 2003, six FRSS teams were deployed in support of Operation Iraqi Freedom (OIF). During the combat phase of OIF (March 21 to May 1, 2003), a total of 34 Marine Corps and 62 Iraqi patients underwent treatment at a FRSS. FRSS teams were assigned two distinct missions; "forward" FRSS teams operated with combat service support elements in direct support of regimental combat teams, and "jump" FRSS teams served as a forward element of a surgical company. This article presents the experiences of the FRSS teams in OIF, including a discussion of time to presentation from wounding, time to operation, time to evacuation, and lessons learned from the deployment of the FRSS.     

Physiological decrements during sustained military operational stress

Missions conducted by the U.S. Military during combat involve a multitude of operational stressors that can cause deterioration in physical and military performance of soldiers. Physiological consequences of sustained operational stress include decrements in anabolic hormones, skeletal muscle mass, and loss of bone mineral density. The objective of this review is to examine the current literature and provide commanders with information on the physical and physiological decrements in soldiers conducting sustained operations. The intent is that this will provide commanders with insight on how to plan for missions to incorporate possible countermeasures to enhance or sustain warfighter performance.     

Reactivation of combat stress after a family member's enlistment

Reactivation of traumatic stress syndromes classically occurs in individuals who have recovered from acute stress reactions or from post-traumatic stress disorder. Triggers of traumatic reactivation may resemble the circumstances of the original trauma or may be less specific, connected to life events such as illness or retirement. In Israel, because of the continuous reminders of combat, reactivation of combat stress has been studied closely. A family member's enlistment is a potential trigger for reactivation. This article explores the general meaning of enlistment for family members, and the reactivation that may accompany that enlistment, through the examination of two cases.     

Advising and assisting an Iraqi Army medical clinic: observations of a U.S. military support mission

Medical civil-military operations are important for deployed military medical units engaged in counter-insurgency missions. There are few reports on military support for a host nation's military medical infrastructure, and we describe an initiative of the 21st Combat Support Hospital in 2010 during the postsurge phase of Operation Iraqi Freedom and Operation New Dawn. The goal was to incrementally improve the quality of care provided by Iraqi 7th Army medical personnel using existing clinic infrastructure and a low budget. Direct bedside teaching to include screening and treatment of ambulatory patients (sick call), focused pharmacy and medical supply system support, medical records documentation, and basic infection control compliance were the objectives. Lessons learned include the requirement to implement culturally relevant changes, maintain focus on system processes, and maximize education and mentorship through multiple modalities. In summary, a combat hospital can successfully implement an advise and assist mission with minimal external resources.     

Development of a deployment infection control course

Since the beginning of military operations in Iraq and Afghanistan, multidrug-resistant bacteria have been noted to be infecting and colonizing combat casualties. Studies suggest the primary source of these bacteria is nosocomial transmission. A focus area for improvement has been to enhance infection control (IC) at hospitals in the combat theater. A 5-day IC course was developed and implemented to provide just-in-time training to those personnel who have been identified to lead IC efforts while deployed. Twenty-nine students have attended the first 6 offerings of this course. A pre- and post-course test showed an average 21% improvement in knowledge. A follow-up questionnaire provided to those students who deployed found the course had enhanced performance of their IC duties. We describe the deployment-unique training developed to provide basic IC, emphasizing the unique challenges found in the combat setting.     

Gender differences in subjective distress attributable to anticipation of combat among U.S. Army soldiers deployed to the Persian Gulf during Operation Desert Storm

This study compares perceptions of stress, cohesion, and psychological well-being among 856 male soldiers and 169 female soldiers from combat support and combat service support units deployed to the Persian Gulf during Operation Desert Storm. Three different types of stressors were measured: anticipation of combat, operational stress, and personal stress. Female soldiers scored higher than male soldiers on all three measures of stress but scored lower than males on horizontal and vertical cohesion. In a stepwise discriminant function analysis, anticipation of combat was the most significant discriminator between the genders, followed by horizontal cohesion. Anticipation of combat was a significant predictor of increased psychological symptoms for both genders, but it had a greater effect on the psychological symptoms of female soldiers compared with male soldiers.     

Trends of stress fracture prevalence among Israel Defense Forces basic trainees

Stress fractures (SFs) are a common type of overuse injury encountered in training soldiers. High rates of SF may cause a tremendous negative effect on the military unit capability to perform its missions. In this study, we reviewed the medical registry of Israel Defense Forces (IDF) soldiers assigned to combat basic training programs between the years 1998 and 2007. SF rates among IDF combat basic trainees were as high as 20% in several companies during the first years of the study. Amendments in training programs were targeted to fit the different capability and the qualifications required from combat soldiers. As a result, a steady decline of SF rates was observed, with a yearly average of 5% in the later years of the study. Increasing awareness of both medical and commanding personnel to SF and their prevention led to the gradual decline in their frequency observed in IDF basic training programs during recent years.     

Soldier peer mentoring care and support: bringing psychological awareness to the front

Since the Persian Gulf War of 1990-1991, the operational tempo for soldiers has steadily increased, whereas the numbers of soldiers available to fulfill these missions has decreased. As a result, soldiers and their families are experiencing increased levels of stress that continue to manifest in ways that can often be destructive for the soldiers, their families, and the Army community. Current mitigation and identification support systems such as the Chain of Command, noncommissioned officer leadership, chaplains, and family support systems have all provided critical services, but may not be expected to optimally perform necessary early risk management assessment. Behavioral health care as a self-referral system is often still perceived as career ending, shameful, or even culturally unacceptable. Our allies have also experienced similar family, operational, and combat concerns. In 1996, at the direction of their Commandant General, the British Royal Marines developed and instituted a peer-driven risk management and support system that has experienced a high degree of success and acceptance among its forces-enough so that the Royal Navy is now in the process of implementing a similar program. The Soldier Peer Mentoring and Support program, as part of the proposed deployment Cycle Support Program, is a model for peer group assessment based on the British Royal Marines psychological risk management and support system. This article presents and describes this project, which has been considered for use within the U.S. Army, as a potential augmenter of existing behavioral health support assets as a culturally acceptable, company-level support program in deployment and home stations.     

Regional anesthesia for the management of limb injuries in space

Traumatic injuries continue to present a threat to the success of current and future spaceflight missions. The magnitude of this threat will grow as the frequency of extravehicular activities is increased and missions venture beyond low Earth orbit and further away from terrestrial medical support. The capability to render definitive treatment to crewmembers who suffer a serious traumatic injury while in space is relatively limited at present. While some research has focused on the development of specific surgical techniques for the microgravity environment, little attention has been given to how one might practically provide anesthetic care for injured crewmembers expected to undergo these procedures. While many logistical and practical obstacles exist to the provision of general anesthesia in microgravity, regional anesthesia could be used to overcome many of these problems. A regional anesthetic capability for spaceflight missions could be developed with minimal modifications to existing terrestrial techniques and would provide the ability to manage a wide range of potential injuries while in orbit. The capability to provide reliable regional anesthesia could be further augmented and improved using a range of imaging technologies currently in development; it is expected that these devices would have a range of terrestrial applications, including the ability to provide immediate, safe, and reliable anesthetic care to patients in remote locations, or under austere conditions such as the combat environment.     

Army Ranger casualty, attrition, and surgery rates for airborne operations in Afghanistan and Iraq

INTRODUCTION: Although numerous articles have been published documenting parachute injuries, a search of the medical literature revealed none that detail casualty, attrition, and surgery rates for airborne operations conducted into actual combat. This study examines observed airborne casualty, attrition, and surgery rates in U.S. Army Rangers during combat operations in order to identify risk factors attributed to static-line parachute injuries and provide a comparison to estimated attrition rates. METHODS: Data were recorded on standardized manual casualty cards and tracking forms while treatment was provided during two missions into Afghanistan during Operation Enduring Freedom and two missions into Iraq during Operation Iraqi Freedom, and then consolidated onto an electronic database for further analysis. RESULTS: There were 4 airborne missions totaling 634 jumpers that resulted in 83 injuries sustained by 76 Rangers (12%). Of those, 27 Rangers (4%) were unable to continue the mission and were subsequently evacuated. There were 11 Rangers (2%) who required surgery following evacuation. The overall observed attrition rate differed from the estimated rate (p = 0.04). Although observed attrition rates did not differ from estimations in Afghanistan (p = 0.75), attrition rates in Iraq were greater than estimated rates (p = 0.02) and observed rates in Afghanistan (p = 0.05). DISCUSSION: Many factors impact casualty, attrition, and injury patterns. Terrain and equipment load were notable associations analyzed in this study. CONCLUSIONS: Medical, logistical, and operational personnel can optimize support for airborne forces through improved estimation of casualty, attrition, and surgical rates. Risk factors associated with military parachuting can potentially provide further accuracy in estimating attrition and are recommended for integration into current models.     

Preparing for war: lessons learned from U.S. Army flight nurses of World War II

The combat posture of today's military forces, and more specifically the emphasis on medical readiness for members of the health care professions, shows that the involvement of flight nurses in armed conflict cannot be ruled out. As part of a larger study of how military nurses cope with war, 25 former U.S. Army flight nurses of World War II were interviewed to learn how they coped with wartime situations they perceived as taxing or exceeding their resources. The purpose of this paper is to describe those aspects of wartime nursing that flight nurses interviewed would like to have been different and, subsequently, what advice they would offer today's flight nurses. The responses are examined within the theoretical framework of stress, appraisal, and coping developed by Lazarus and colleagues.