BPSO Calgary 9/91

LEADERS ACTIONS

COMBAT STRESS REACTION IS A NORMAL REACTION TO AN ABNORMAL SITUATION

Exhaustion due to combat stress, if not properly monitored before, during and after a mission, can be a killer. It can cause casualties just as surely as enemy action. Soldiers pinned under fire for a prolonged period of time may withdraw into themselves. They can become isolated and despondent or they may become agitated and needlessly expose themselves to enemy fire. The risk of Combat Stress Reaction (CSR) increases with the intensity and duration of the conflict. Mechanized warfare coupled with advanced night vision equipment allows the enemy to continue operations around the clock. Modern weapon systems can also attack troops in rear areas allowing little respite. Leaders will have to push their subordinates relentlessly, under terrible conditions, to limits far beyond what was ever expected of them before.

Your job is to ensure your subordinates do not succumb to combat stress. In the pamphlet Combat Stress Reaction: What to Do:

Self and Buddies, the normal, common signs of combat stress were described and tips on how to cope with them were given. You, the leader, need to teach this to your subordinates. You also need to know the "more serious" signs and leader actions outlined here.

COMBAT STRESS REACTION: WHAT IS IT

A natural result of heavy mental/emotional work, facing danger in tough conditions. Like physical fatigue:

- it depends on level of fitness, experience, training.

- it can come on quickly or slowly.

- it gets better with rest.

Sleep loss and physical discomfort are often also involved but don't have to be.

NORMAL COMMON SIGNS OF COMBAT STRESS REACTION

Physical Signs:

Tension: headache and backache, trembling, fumbling, jumpy.

Pounding heart, rapid breathing.

Upset stomach (may vomit), diarrhoea, frequent urination.

Emptying bowels and bladder at instant of danger.

Fatigue, weariness, distant, haunted ("1000 metre") stare.

Mental and Physical Signs:

Anxiety, worrying, irritability, swearing, complaining.

Difficulty concentrating, remembering, communication.

Awakened by bad dreams, grieving, feeling guilty.

Angry with group, losing confidence with self and unit.

* Many personnel exhibit these signs and yet still perform all essential duties.

"MORE SERIOUS" COMBAT STRESS REACTION SIGNS

Although more serious and requiring more action, these signs do not necessarily indicate a "casualty" who must be evacuated.

The normal common signs are considered "more serious" if:

- the signs don't improve after the person has had a good rest.

- the person exhibits a change in behaviour (acts funny).

"More Serious" Physical Signs:

Can't keep still, constantly moving around.

Flinching or ducking at sudden movements and sounds.

Shaking (of arms or whole body), cowering in terror.

Part of body won't work right, with no physical reason:

- can't see hand, or arm, or legs, or

- can't see (hear, or feel), partial loss or total.

Prolonged total immobility, freezing.

Physical exhaustion: slowed down, just stands or sits.

Vacant stare: spaced out, staggers, sways when stands.

"More Serious" Mental and Emotional Signs:

Rapid talking, constantly making suggestions.

Arguing, starting fights, deliberately reckless action.

Inattention to self-care, hygiene, indifference to danger.

Memory loss:

- forget orders, technical skills, bad events.

- forget time, place, what's going on.

Severe stuttering, mumbling, can't speak at all.

Afraid to fall asleep for fear of nightmares. Unable to stay asleep.

Seeing or hearing things that are not really there.

Rapid mood shifts: crying spells.

Social withdrawal: silent or sulking, prolonged sadness.

Apathetic: no interest in food or anything.

Hysterical outbursts, frantic or strange behaviour.

LEADER ACTIONS FOR COMBAT STRESS REACTION

Set the example of calmness while feeling normal fear.

Know your job well. Keep the group focused on the task at hand.

Assign an easy task to a person showing signs of CSR.

Remind people to use quick relaxation techniques.

Remind everyone that CSR is normal:

- others have it too (even you).

- encourage friendly joking about it.

Stay in touch with every member of the group, keep them talking.

Keep everyone informed:

- explain the situation and objectives.

- don't hide unpleasant possibilities, rather, present them and explain how the group will handle them.

- remain positive, don't dwell on the things that are not going right. Explain what's being done to correct errors.

- control rumours, get the facts from your leader.

Rotate jobs when possible so that all share danger/hardship.

Ensure the best possible first aid/medical aid and rapid medical evacuation.

Don't underestimate the importance of sleep (for you as well as your men):

- at least four hours per night (six to 10 hours preferred).

- even catnaps (15-30 minutes) will help, but people tend to be temporarily groggy on awakening.

Debrief your group after a traumatic event:

- have everyone tell what they saw and did.

- reconstruct and agree on what really happened.

- resolve any misunderstandings and mistrusts.

- let feelings be expressed and accepted as normal.

- focus positively on lessons learned.

Get people with problems at home to talk about them. Watch for changes in mood after receiving mail or making telephone calls.

LEADER ACTION FOR "MORE SERIOUS" COMBAT STRESS REACTION SIGNS

If the person's behaviour endangers the mission, self or others, do whatever is necessary to control him or her.

If person is upset, calmly try to talk him or her into cooperating. If this is unsuccessful "explain" possible disciplinary action.

If reliability is a problem:

- if person has a personal weapon, unload it.

- take away weapon only if situation is serious.

- physically restrain only for safety or transportation.

Reassure everyone that the signs are probably just Combat Stress Reaction and will go away quickly. Even seemingly very serious signs can improve in minutes if handled correctly on the spot.

If "more serious" signs persist:

- remove person to a safe place.

- don't leave alone, keep them with someone they know.

- tell your supervisor.

- have the person examined by a medical officer, especially if there could be a physical cause for the symptoms.

If it is decided that evacuation for rest or treatment is not required (or if it is not possible):

- treat the same as for normal, common signs (if possible).

- warm the person if cold/wet; cool if overheated.

- make sure the person eats, drinks, sleeps.

- encourage the person to talk in the group debrief, lend support.

- assign tasks which the person can do well.

- keep the supervisor informed.

If it is decided to send the person away for rest or to be examined by the medical officer:

Tell the person you are counting on his/her to get rested and return quickly.

Encourage other members of the group to express continued confidence in the person's ability to perform adequately.

Have group members visit the person, if possible, to encourage him/her to get rested and return soon to help out.

When the person returns welcome back and put him/her to work:

- assign increasingly responsible duties.

- talk openly about what happened before.

- convey confidence in the returnee.

TO PREVENT COMBAT STRESS REACTION

Integrate replacements quickly. Assign buddies, ensure everyone in the group gets to know the replacements quickly.

Ensure people remain physically fit.

Train for war, not for peace, train for it, plan for it.

- impart unit pride.

* Properly managed, casualties will return before a replacement could be obtained. If necessary preventative actions are taken, there will be few stress reaction cases.