Medic Research

Posttraumatic stress, depression, stigma, and barriers to care among U.S. Army healthcare providers. Chapman, Paula L.; Elnitsky, Christine; Thurman, Ryan M.; Pitts, Barbara; Figley, Charles; Unwin, Brian Traumatology: An International Journal, Vol 20(1), Mar 2014, 19-23. http://dx.doi.org/10.1037/h0099376

The U.S. Army Combat Medic faces enormous stress as both soldier and trauma care provider. This study provides an initial assessment of the mental health attitudes and behaviors of these soldiers. To date, there is no known research assessing Combat Medic behavioral health or their help seeking behavior following deployment. Medics who were 12 months post-deployment from a yearlong deployment to combat were compared with a baseline group of Medics who had never been deployed to war. Participants completed a survey containing measures of mental health service utilization, perceived stigma and barriers to care, depression and posttraumatic stress disorder (PTSD) symptoms. Medics screening positive for a mental health issue were more likely to report concerns about stigma and barriers to care compared to those who screened negative. Medics who had deployed to the combat were more likely to screen positive for major depression, and have sought care for mental health issues compared to the baseline group. There were no differences in PTSD screenings between the deployed group and the baseline group. Findings indicate that depression may be a salient issue for previously deployed Combat Medics.

Killing versus witnessing trauma: Implications for the development of PTSD in combat medics.
Pitts, Barbara L.; Chapman, Paula; Safer, Martin A.; Unwin, Brian; Figley, Charles; Russell, Dale W. Military Psychology, Vol 25(6), Nov 2013, 537-544. http://dx.doi.org/10.1037/mil0000025

. Abstract

Killing in combat uniquely predicts elevated PTSD symptomatology among military veterans. This study investigated the effects of combat killing in a sample of 345 U.S. Army combat medics who had recently returned from operational deployments to Iraq or Afghanistan. Combat medics provide frontline medical care before, during, and after battles but also fight alongside other soldiers when under attack. Attempting to kill in combat was a significant predictor of PTSD symptomatology even after accounting for passively witnessing trauma in fellow soldiers. Medics may be well prepared to cope with the passive experiencing and witnessing of war-zone trauma, but may benefit from training to cope with the negative consequences of taking actions to kill.

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Training, Deployment Preparation, and Combat Experiences of Deployed Health Care Personnel: Key Findings From Deployed U.S. Army Combat Medics Assigned to Line Units
Paula L. Chapman, PhD1 MAJ David Cabrera2 Christina Varela-Mayer3 MAJ Monty Baker4 Christine Elnitsky, PhD1 Charles Figley, PhD5 Ryan M. Thurman, BA1 LTC Paul Mayer6 1 James A. Haley Veterans Administration Center of Excellence 2 Uniformed Services University 3 Tampa VA Research and Education Foundation 4Behavioral Analysis Service, Lackland AFB 5 Tulane University Traumatology Institute 6 Department of Combat Medic Training, AMEDDC&S, Ft. Sam Houston, TX

Abstract

Objective: Describe perceptions of training and deployment preparation and combat experiences and exposures of U.S. Army Combat Medics. Methods: Data were from the first year of a 3-year longitudinal study designed to assess the impact of combat on the behavioral health and resilience of 347 Combat Medics surveyed 3-6 months after returning from a 12-month deployment to OEF/OIF theatre and assigned to Brigade Combat Teams. Results: Analyses indicated that Combat Medics may benefit from better preparation in types of shifts required during deployment; type and intensity of combat likely to be seen and experienced; more adequate training in the area of stress and mental health care management; and easier access to behavioral mental health care. Conclusions: The military has shown considerable progress in addressing and understanding the mental health care needs of Soldiers. However, challenges remain. Additional emphasis should be placed on reducing the stigma and barriers related to mental healthcare both in theatre and garrison; and developing an evidence-based, validated program for Medics and other Soldiers to recognize stress and mental health issues on the battlefield. For Medics, this should be from two perspectives - that of a combat Soldier and that of a medical provider.

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Helping the Combat Medic: Adapting to Both Primary and Secondary Traumatic Stress Down Range and Beyond
David Cabrera, Charles Figley, and Paula Chapman

. Abstract

The paper focuses on a rarely discussed group of combat veterans in an effort to better prepare mental/behavioral health professionals for working with this population and their families. After a description of this military specialty, its history and current functioning, the paper discusses the different contexts of medics and corpsmen with US Army and Marines respectively. The authors will describe the initial findings of the first study of combat medics. Combined with these findings and studies of others functioning in harms way while providing medical services, the paper provides a brief outline for practitioners working with these populations. The outline identifies important matters when establishing a therapeutic relationship, history taking, (presenting) problem formation, establishing and carrying out a treatment plan. Other issues discussed are the importance of self care among medics in order to attend to their soldiers’ medical needs and the need for practitioners to adjust their treatment protocols to match the specialization contexts to facilitate and maintain the therapeutic alliance. Implications for training both medics and practitioners who work with them are discussed.

Found online at: https://sites.google.com/site/charlesfigley/Home/traumatologyinstitute/research/combat-medic-mettle-study/corpsmenmedics/helping-the-combat-medic

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Adapting to Violent Death: The Case of the Combat Medic

It was a pleasure to address my colleagues who study the topic of violent death and help the victims and survivors with great compassion and empathy. I explained that our qualitative research team at the start that I am in the final year of a three-year study of 848 combat medics and video interviews with 17 their colleagues in the same units believe best represent "medic mettle." However, I was unable to share with them our team's and the entire research group's conclusions just some tantalizing facts that make the project even more interesting. No one will be surprised to learn, for example, that combat medics are just that: They see lots of combat (as measured by a dozen or so stressor variables), in both quality and quantity, in comparison with non-medics of the same rank, age, time in service, and in comparison with all officer ranks. Some may be surprised to learn that combat medics also score very differently than all other specialties: Better behavioral health indicators (e.g., post-traumatic stress indicators). Our team was not surprised because medics and corpsmen are revered though out the Army and all other branches of service. That they are referred to by their clients, fellow soldiers form whom they care, as "Doc," a term of endearment. They are perceived and expected to be a Doc and care for others in the unit, including the officers.

This presentation also provided me with a great opportunity to plug my latest cause: PTSI. Elsewhere I have justified changing the designation of PTSD to PTSI or Post-traumatic Stress Injury. Bill Nash, MD and former psychiatrist for deployed Marines helped invent the concept of injury rather than disorder. A recent Washington Post article, a day after this presentation, noted this important movement to correct the over use and misuse of the diagnosis of PTSD.

Thanks for your interest in this issue. Let's help current and future patients diagnosed with PTSD recognize that diagnoses are a double-edged sword and a cage. Let us focus our considerable knowledge as caregivers to do right for our clients and send the in a direction of resilience, thriving, and growth free of life-numbing drugs and the perception of incurability. It's a hope, it's a goal, and it's the kick I've been on since Kuwait 2004.
Charles Figley, May 5, 2012, 945AM

Found online at: https://sites.google.com/site/charlesfigley/2012-presentations/adapting-to-violent-death-the-case-of-the-combat-medic

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Recovery from Moral Injury - visit:

http://projects.huffingtonpost.com/moral-injury/healing

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The data collected so far confirm the grim challenges faced by medics during deployment: • 67 percent saw dead bodies or human remains • 56 percent saw dead or seriously injured Americans • 53 percent saw sick or injured women or children they were unable to help • 26 percent reported shooting or directing fire at the enemy, and about 6 percent said they were directly responsible for the death of an enemy combatant Medics are expected not only to care for their comrades—and for allied troops and civilians—but to function as warriors. In fact, they may need to render care for the same enemy fighter they shot at moments earlier. “The combat medic attached to a foot patrol has to also act as a soldier,” says Chapman. “They may be gunning down an enemy combatant at one point, and then have to go provide aid to him.” “Compassion fatigue” is another concern. By nature, says Chapman, medics want to help other people. When they can’t do so, this causes stress. This is the same problem that was documented among many doctors and nurses who served in Vietnam. “The caretaker begins to be traumatized and fatigued because of the sheer volume of what they have to do and some of what they’re seeing,” says Chapman. “Remember, medics go into this job because they want to help people. When they see ill or injured persons—especially women and children—and can’t help them because the area’s not secure, that’s likely to have an effect on them.” Chapman also points out that combat medics often see more action than other soldiers. “They may go out with one squad one night and another squad the next.” The fact that medics know the foot soldiers they are caring for—unlike doctors or nurses at field hospitals—adds yet another layer of stress. “Not only do they have to help them, but they know these people,” notes Chapman. “They serve side by side with them, and they may have seen how the injuries occurred. So it goes beyond compassion fatigue—there’s a little more to it with a combat medic.” Based on the data they have so far, Chapman and her military colleagues point out that depression symptoms appear to be more common than posttraumatic stress symptoms among medics three months post-deployment. But the researchers are continuing to track study participants to see which symptoms subside over time and which get worse. Chapman’s team is now launching a related study in conjunction with the Army Medical Department Center and School. The effort will focus on traumas that combat medics may have experienced prior to training, as well as baseline risk and protective factors that could reduce or promote resilience. The goal is to learn which risk factors can be ameliorated, and which protective factors enhanced, through combat-medic training. Chapman Article:

http://www.dodlive.mil/index.php/2011/07/care-for-the-combat-medic/#sthash.l4hg7NL6.dpuf

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