Page 37 - Journal of Special Operations Medicine - Summer 2014

among military personnel who were deployed with their of experiences while deployed. However, one military
parent units, whereas military personnel deployed with occupation that shares responsibilities with both com-
another unit were less likely to experience symptom re- bat arms and medical personnel is that of the U.S. Air
mission. Although unit support was not explicitly mea- Force (USAF) pararescuemen (referred to as “PJs”). PJs
28
sured in this study, the findings nonetheless indicate that comprise one group of highly trained special duty op-
being deployed with familiar peers and colleagues is as- erators with the unique distinction of being trained as
sociated with better long-term outcomes. Overall, results both combat arms and medical professionals. PJs are
of several studies demonstrate that unit support appears registered paramedics with a primary mission to rescue
to function as a psychological buffer and may ultimately downed aircrew personnel, by providing area security,
decrease the likelihood of PTSD and common mental dis- rendering first aid, and transporting personnel to higher
orders after combat exposure. 29,30 levels of medical care. As U.S. military operations have
continued in both Iraq and Afghanistan, the scope of
Many studies examining the associations among deploy- the PJs’ mission has expanded beyond aircrew person-
ment experiences, psychological morbidity, and unit nel rescue operations to rescue and retrieval, medical
support have focused on military personnel engaged care, and transport of wounded coalition forces, enemy
primarily in combatant roles, 17,25,27,29 but risk for PTSD combatants, and civilians (both adults and children). PJs
and mental health problems are not limited to combat- deployed to Afghanistan may therefore experience more
ants. Military medical professionals and those in other frequent and intense exposure to potentially traumatic
noncombat occupations (e.g., logistics and support), for events that could span across both combat and medical
instance, report comparable incidence rates of PTSD domains. Due to the complex and multifaceted nature of
postdeployment compared with combatants. Although their work as both medical professionals and combat-
31
noncombat personnel may not be directly engaged in ants, PJs—along with Army and Navy Special Opera-
combat, these personnel are nevertheless exposed to tions medics—compose one distinct subgroup of military
po tentially traumatic combat-related events including personnel with a uniquely high exposure to both combat
explosions, attacks, seriously injured personnel, and and medical stressors, which may increase their risk for
processing of human remains. Indeed, medical per- psychological health problems such as PTSD and depres-
32
sonnel deployed to combat zones are significantly more sion. As special duty operators with rigorous training
likely than are medical personnel deployed to noncom- and work demands, PJs are also presumed to have high
bat regions to be exposed to injury and violent death levels of unit support, which should function to protect
and to feel they were in danger of being killed. In light them from emotional distress and the harmful effects of
33
of these findings, it is not surprising that military medi- deployment-related traumas. To date, however, no stud-
cal personnel deployed to combat zones are more than ies have investigated these issues among USAF PJs.
3 times more likely to screen positive for depression and
PTSD. In addition to the potential for experiencing The primary aim of the current study therefore was to
33
combat-related trauma, military medical professionals examine the frequency and experience of combat and
encounter potentially traumatic medical stressors such medical events among PJs; in addition, we sought to
as caring for severely injured and dying service person- explore the impact of deployment events and unit sup-
nel, losing patients, and handling human remains, each port on PTSD and depression symptom severity in this
of which may contribute to psychological morbidity, population. The following hypotheses were specifically
especially PTSD and depression. 34–36 A recent survey of considered in the current project:
military medical providers, for example, found that
35
exposure to direct combat and perceived threats of per- 1. More intense exposure to combat and medical
sonal harm were associated with a significant increase trauma will be associated with more severe PTSD
in the likelihood for probable PTSD but not for depres- and depression symptoms.
sion. Exposure to seriously injured or dead individuals 2. Higher levels of perceived unit support will be
was unrelated to either PTSD or depression, however, associated with less severe PTSD and depression
suggesting that different types of stressors might be dif- symptoms.
ferentially related to emotional distress among military 3. Unit support will moderate the effects of trauma ex-
medical professionals. Because Kolkow et al. included posure on depression and PTSD severity.
35
medical professionals who had not deployed, results of
their study are limited and may not generalize to the
larger community of military medical professionals. Methods

Because the combat arms and medical professions play Participants
very different roles within the context of military op- A total of 194 male Air Force PJs and combat rescue
erations, they are often exposed to very different types officers (CROs) participated in this study. Demographic

Stressors and Unit Support Among U.S. Air Force Pararescuemen 27