FMST Student Manual - 2008 Web Edition*

1.  OVERVIEW

Shell shock, as combat stress was called during World War I, often was viewed as a coward’s reaction to fighting.  There were little or no selection process to filter out those with psychiatric illnesses before entering the military.  Men were killed by firing squad that today would never have been admitted into the military.  The few men who were diagnosed with combat fatigue were evacuated home often when it was too late for recovery.  Many developed chronic psychiatric conditions.  Put simply, combat stress is defined as the mental, emotional, or physical tension, strain, or distress that results from exposure to combat related conditions.

World War II changed a few things.  In the US there was more pre-recruitment screening.  The problem of combat stress was grudgingly accepted as part of warfare and by the end of WWII, psychiatrists were stationed within many units.  Another major change was men were no longer moved away from the front to receive treatment, except for logistical reasons or in severe cases.  In Korea there was even a mobile psychiatric unit conducting “stress control operations” near the front.

Male culture still had difficulty dealing with man’s emotional response to war.  Vietnam underlined this.  Despite progress, there remained little acknowledgement of combat stress.  Many men turned to drugs such as marijuana, heroin, and alcohol.  The lack of engagement with such a central issue cost many men their lives on the battle field, in conflict zones, and with post traumatic disorders ending in suicide after the war ended. 

2.  IDENTIFY RISK FACTORS

Combat and combat-related military missions can impose combinations of heavy physical work, sleep loss, dehydration, poor nutrition, severe noise, vibration, blasts, exposure to heat, cold or wetness, poor hygiene facilities, and perhaps exposure to infectious diseases, toxic fumes or other substances.  These, in combination with other influences such as concerns about problems back home, affect the ability to cope with the perception of danger and diminish the skills needed to accomplish the mission.  Environmental stressors often play an important part in causing the adverse or disruptive combat stress reaction behaviors.  Box 1 lists several risk factors that may lead to increased combat stress disorders.

Box 1.  Risk factors of Combat Stress

Mild stress reactions may be signaled by changes in behavior and only noticeable by the person himself or by close friends.  Leaders and medical personnel depend on information from the service member or their comrades for early recognition of combat stress reactions to provide prompt and appropriate help.  Box 2 lists mild stress reactions and box 3 lists severe stress reactions that you may see.

Box 2.  Mild Stress Reactions

Box 3.  Severe Stress Reactions*

*The above listed warning signs do not necessarily mean that the person must be relieved from duty.  They do, however, indicate an immediate need for evaluation.

Although most people suffering from combat stress usually improve when they are able to get warm food, rest, and an opportunity to share feelings with comrades, their unit leader, or you as their Corpsman, some do not.  If the symptoms endanger the individual, others, or the mission, or if they do not improve within a day or two, or seem to worsen, you must refer them to the unit Chaplain or Medical Officer.

4.   TREATMENT

Treatment is kept very simple.  Most people experiencing combat stress do not need therapy or psychotherapy.  The goal is to rapidly restore the person's coping skills so that he or she functions and returns to duty.  Sleep, food, water, hygiene, encouragement, work details (to keep them busy), and confidence restoring talk are often all that is needed to restore the person back to full operational readiness. 

This can be done while still attached to their unit (provided that the unit is not actively engaged in combat operations), in rear positions, or at medical companies.  If they are sent to a medical unit, they should not be co-located with patients that have been injured or are sick.  The person experiencing combat stress must be encouraged to continue to think of himself as a warfighter, rather than a “patient” or a “sick person”.

Every effort is made to reinforce the person's identity.  They are required to wear their uniform, keep their normal protective equipment, and flak vests with them.  When possible, they are allowed to keep their weapons after the weapons have been cleared.  These are the biggest factors that aid in returning battle-fatigued members to effective duty.

Guidlelines for treating Marines showing signs of Combat Stress are summarized in the memory aid BICEPS.  It stands for Brevity, Immediacy, Centrality, Expectancy, Proximity, and Simplicity.

Brevity - treatment lasts no more than three days.  Those requiring further treatment are moved to the rear.

Immediacy - provide care as soon as symptoms appear.

Centrality - combat stress cases are treated in one central location near, but separate from, the Battalion Aid Station or field hospital if possible.  In a mobile war requiring rapid and frequent movement, treating combat stress in a single area is impossible.  In these cases, treatment may take place at the BAS or Regimantal Aid Stations.

Expectancy - it is made clear to the individual that once they are reacting normally to stress, they will be returned to full duty.  This should only take a few days.

Proximity - care for the combat stress victim is held in close proximity with the unit and as an intricate part of the entire healing process.  A visit from the members chain of command is very effective in keeping a bond with their organization.

Simplicity - treatment is kept simple.  The goal is to rapidly restore the Marine’s coping skills so that they may return to full duty.

5.  PREVENTION

The old saying that the best offense is a great defense is true in preventing combat stress.  You play a vital role in preventing severe combat related disorders.  Education of your troops is vital.  Use the resources available to you such as your Chain of Command, Medical Officer, and Religious Ministry Team.

Preparation to control stress starts long before you actually reach combat.  The word control has been chosen deliberately.  It is used to emphasize the active steps which leaders, supporting personnel, and the individual must take to keep stress within the acceptable range.  Stress is a fact of life for everyone.  It is controlled combat stress (when properly focused by training, unit cohesion, and leadership) that gives Marines and Sailors the necessary alertness, strength, and endurance to accomplish their mission.  Controlled combat stress can call forth stress reactions of loyalty, selflessness, and heroism.  See box 4 for a general list of preventative measures for each period.

Box 4.  Control of Combat Stress

6.   CONCLUSION