Research Needed on Stress in Combat Medics

by U.S. Medicine

January 22, 2011

BETHESDA, MD—Where do you find resiliency as a healer and a soldier? As the role of combat medics becomes more and more important to the increasing survival rate of combat casualties, that is a question that military psychiatrists are asking. While a host of new studies on the effects of combat trauma on soldiers are currently ongoing, there is little research being done into how combat medics, who see extreme physical trauma close-up, are reacting differently than their non-medic counterparts.

USM_01-11_combat-medics.jpgThe Army trains 7,500 soldiers annually for the combat medic military occupational specialty (MOS)—the largest MOS in the service, often referred to by the call sign 68W, or 68 Whiskey. The Army’s Medical Department Center and School at Fort Sam Houston, San Antonio, TX graduates 17 classes of 68 Whiskey students annually.

Over the course of several months, soldiers receive basic EMT training, a limited course in primary care (basic pharmacology and wound care), and tactical medicine training that progresses from situational training exercises to fully simulated field exercises.

“We have one of the most robust medical simulation exercises in the world,” said Alan Maiers, PsyD, director of combat medic training at the school. “While on field training, students will be exposed to the threat of weapons on the battlefield, live fire range exercises, and learn where their responsibilities lie in convoy operations.”

During training, students will learn how to address battlefield bleeding, put a needle into a chest to inflate a collapsed lung, and even give an intraosseous infusion directly into the bone of a patient if necessary, Maiers said, while describing the program at the recent Trauma Spectrum Conference held on the campuses of NIH. But while the school prepares them for the physical trauma of others, it is unknown how well they are being prepared for the emotional trauma they might suffer themselves.

“The study of combat medics has been a very limited thing. Usually they are rolled up into studies of all deployed medical personnel,” Maiers said. “A UK study found medics were more likely to report psychological distress, multiple physical symptoms and, if men, fatigue than other personnel.”

It is possible that medics are more likely to report symptoms of combat stress because they are more aware of what those symptoms are. However, there could be many other factors. The Air Force recently partnered with VA to look at risk and resiliency in USAF medical personnel. Medics were given surveys looking at psychological well being before they were deployed to help identify whether it could be predicted who would do better during deployment.

The study found that predeployment stresses and potentially traumatic events were both risk factors for combat stress during deployment, while positive military experiences were protective factors. “Did they value what they were doing?” Maiers said. “For those that did, they did better.”

A spin-off of that study asked whether there was a relationship between unit cohesion and PTSD symptom severity. The protective factor of unit cohesion was verified, and was consistent regardless of the level of combat stress exposure. Maiers acknowledged that this might put combat medics at a greater risk, since their mission parameters are different from the rest of their unit.

Another research effort, the Combat Medic Mettle Study being conducted under the Military Operational Medicine Research Program, is tasked with determining the current behavioral health status of combat medics, identifying risk and protective factors, and creating an initial model of resilience for the deployed combat medic. The three-year longitudinal study will be looking at medics deployed in combat in OEF/OIF, as well as those not deployed.

Researchers are just now beginning major analyses on the collected information. Preliminary data shows combat medics reporting traumatic events at high rates, including over half of them reporting seeing ill or injured women and children they were unable to help, and seeing dead or seriously injured Americans they were unable to help.

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