COMBAT STRESS REACTION
NOTES FOR COMMANDING OFFICER
(BASED ON QSTAG 909)
LEADERSHIP PREVENTS COMBAT STRESS REACTION
In combat, stress is inevitable. Incapacitation due to stress is not. While the incidence of stress reaction is highest under extreme conditions, (multiple casualties, chemical attack), casualties can occur even in units not under direct fire. Units in which cohesion among group members is strong and for whom training gives a realistic perspective on combat suffer the least number of stress reaction casualties.
Personnel debilitated by Combat Stress Reaction (CSR) can be returned to duty quickly if rested close to their units and treated positively. This requires planning and coordination. If evacuated too far from the unit, or treated as a medical patient, many personnel suffering stress reaction may never recover. The loss of such trained and experienced personnel could be disastrous. Leadership plays a key role in preventing personnel under stress from becoming casualties and in returning to duty those who do become casualties.
Previous "Aid Memoirs" outlined actions to be taken by junior leaders and the personnel they supervise. This brochure outlines actions commanding officers must take to prevent CSR from decreasing the operational effectiveness of their unit.
HANDLING PROCEDURES
General
As it may be difficult or impossible at first to differentiate psychiatric cases from CSR cases, all psychological cases who do not present a danger to themselves or others should initially be managed as CSR cases. Eventually, unresponsive CSR cases will be referred to the medical system.
Unit Care:
Because it is difficult to predict which CSR cases will recover quickly, all should be held within the unit, where possible, for up to 48 hours, following which those not recovering will be evacuated. At times, holding CSR cases in the unit will, for tactical reasons, be impractical. However, many individuals exhibiting CSR can be assisted by officers and NCMs at the unit. More serious cases would require assessment by a medical assistant or medical officer in order to ensure no physical ailment underlies the CSR.
Assistance at the unit level should consist of rest, short periods of meaningful work, followed by return to duty. The sympathetic ear of a unit NCM will do much to facilitate recovery in the first 48 hours. A Combat Stress Management team will visit units to assist unit personnel, prescribe treatment, and advise on the evacuation of cases not responding to management at the unit level.
Further Care:
Cases not responding to unit management will require care beyond the unit under the supervision of a Combat Stress Management team. Management continues to be simple and includes rest, warmth, and a shower and change of clothing, followed by meaningful work, exercise, reassurance and an opportunity to talk about recent experiences. At all times the expectation of a rapid return to duty is reinforced. Persistence of CSR symptoms beyond 72 hours may require medical evacuation to a treatment facility.
After Recovery:
- a good soldier will be good again.
- a person returned to unit deserves another chance.
- a poor soldier won't be made into a good one by treatment for combat stress.
FACTORS WHICH MAY CONTRIBUTE TO COMBAT STRESS
- Individual personality does NOT predict who may be debilitated by combat stress. Anyone can become a temporary stress case if too many of the following high risk factors occur.
- Problems and Uncertainties at Home:
- Either negative (recent separation) or positive (recently married).
- Rapid mobilization.
- Lack of popular support for the war.
- New in Unit (has not yet established trust, buddies):
- New replacement with little experience.
- New replacement recently promoted to position.
- First Exposure:
- To combat conditions (noise, confusion, death).
- To surprise enemy weapons (chemical, biological).
- To strange terrain (desert, jungle), climate (hot, humid).
- Casualties in Unit (especially if many, in short time):
- Perhaps a trusted leader or friend.
- May feel left alone, guilt, anger, mistrust.
- May feel suddenly vulnerable.
- Under Attack and Can't Strike Back:
- Air attack, missile attack, artillery.
- Losses to friendly fire or accident.
- Lack of Information & Failure of Expected Support:
- Feel forgotten, isolated, tend to fear the worst.
- Lose perspective of the larger mission.
- High Threat of (Actual Use of) NBC Weapons:
- Invisible, pervasive danger, false alarms, rumours.
- Sleep Loss (A Major Contributor):
- Makes person easily confused, overly suggestible.
- Can cause misperceptions and hallucinations.
- Both Sexes in Unit (Effects Unknown)
- Personnel may resist stress to appear strong.
- Death/injury of opposite sex may increase impact.
- Run-Down Physical Condition: Lack of Physical Fitness:
- Not drinking enough water (dehydration).
- Poor diet and hygiene.
TWO COMMON THEMES IN COMBAT STRESS
Theme 1: Loss of Confidence
- In self, training, equipment, comrades, or support.
- In leader's competence, caring, candour, courage.
- In the chance of surviving and winning.
- In whether the cause is worth fighting for.
Theme 2: Conflict Between Motives (four conflicting motives)
- Sense of duty.
- Loyalty to friends.
- Ethical/religious.
- Self-preservation, comfort.
* THE ROLE OF THE LEADER IS TO RAISE THE CONFIDENCE AND HELP RESOLVE THE INNER CONFLICTS OF SUBORDINATES.
LEADER ACTIONS TO PREVENT CSR
Encourage Unit Cohesion:
- Integrate replacements quickly, assign sponsors, allow time to adapt to the new environment.
- Use work details, drills, PT, sports to instill trust among group members.
- Bring whole unit together for awards, ceremonies.
- Encourage unit-centred social activities off-duty (monitor to ensure no alcohol abuse, improper fraternization or divisive subgroups).
Help Families Cope with Separation:
- Involve families in unit social activities. Encourage a "support network" and keep families informed.
- Know each of your people's background. Chat informally. Keep notes if necessary.
- Do all you can to ensure mail is delivered, pay is received, etc.
- Encourage your people to talk to you about family concerns. Help where you can. Make the bureaucracy work for your people.
- Involve the unit chaplain and any available mental health people.
- Weigh personal factors, along with other factors, when assigning tasks so as to share hardship and risk fairly.
Impart Unit Pride:
- Educate personnel in the history and traditions of the unit, branch, Air Force.
- Honour historic examples of initiative, endurance, overcoming heavy odds, and self-sacrifice which led to triumph.
- Ensure Physical Fitness (endurance, strength, agility).
Conduct Realistic Training:
- Train in an environment as similar as possible to the one expected in war.
- Seek challenges to increase the unit's skill and confidence.
- Present reachable goals. Teach success rather than failure.
Practice First Aid and Casualty Evacuation
- Ensure everybody is trained in First Aid.
- Include flight surgeon and other medical officers in unit activities.
Practice Sleep Logistics:
- When possible allow everyone six to 10 hours sleep per 24 hours. Four hours should be the minimum acceptable.
- "Stockpile" sleep before prolonged periods awake.
- Everyone catches up on sleep after going without. Exhausted people cannot "will" themselves awake. Don't expect them to.
Post Operational stress Debriefing
- Encourage unit members to participate in group discussions after operational exercises and training.
- Discussions should centre on what each member saw, did and felt. Feelings should be expressed freely and without censure. Such sharing of personal experiences helps develop group cohesion and inoculates against CSR.
- The assistance of a medical officer or mental health professional may be helpful in this process.
BPSO Calgary 9/91