Page 157 - Journal of Special Operations Medicine - Summer 2016

also discussed the concept of an exportable TC3 train- like burning vehicles/airframes, enemy fire, confined
ing system (TC3X) designed to allow a medic to train 30 space, structural collapse, and swift water.
Soldiers, making use of all of these training modalities. • Prevalence of psychological symptoms among PJs
(e.g., 11% posttraumatic stress disorder (PTSD),
COL Irizarry’s take-aways: 1.5% depression, and 16% insomnia) is comparable
• Effecting lasting changes in the military requires sus- to or lower than overall military estimates. A caveat
tained programs of record. Programs of record insti- about these numbers is that the study was not anon-
tutionalize capabilities and help to secure long-term ymous and the incidence of these disorders may be
funding. under-reported because of reluctance to disclose. Of
• Institutionalizing optimal care of combat casualties note, approximately 30% of PJs who have deployed
on the battlefield requires program of instruction have chronic symptoms of combat stress but do not
changes not in just what we teach, but also in how meet the criteria for PTSD.
we teach. This applies not only to medical training • Risk factors identified for PTSD in order of impor-
programs, but throughout the enterprise. tance are (1) intense exposure to medical injuries,
• To change line officer thinking, you must use line of- death, and other “aftermath of battle” exposures; (2)
ficer processes. the daily frustrations, inconveniences, and adminis-
• Lasting culture change occur through education, but trative aspects of military life; and (3) participation in
can be sparked by technology. combat actions.
• Combat exposure correlated significantly with in-
17. PHTLS TCCC-BASED COURSES: Mr Mark Leuder creased occurrence of depression, whereas medically
is the NAEMT lead on their TCCC-based courses. related exposures correlated with more severe PTSD
TCCC-based courses offered by NAEMT include: symptoms. Removal and handling of dead bodies is
• B-Con (Bleeding Control) is a 2.5- to 3-hour course the strongest predictor of PTSD severity.
focused on tourniquets, hemostatic dressings, and • Unit cohesion and a sense of purpose and mean-
airway control. It is intended for police and schools ing were protective factors against both PTSD and
and is the foundational training course for the Ameri- depression.
can College of Surgeons Hartford Consensus effort as • The incidence of mental health issues in reserve com-
well as the White House “Stop the Bleed” campaign. ponents is reported as 19%, twice that of the active
• LEFR (Law Enforcement First Responder) is an 8-hour component, at 8.5%.
course designed for police officers that emphasizes ex- • Another psychological occurrence in PJs and other
ternal hemorrhage control (tourniquets and hemostatic combat troops is “burnout.” Lt Col Rush described
dressings) as well as tactically appropriate responses to burnout as emotional exhaustion, feeling worn out
injuries sustained in a law enforcement environment. because of your work, a sense of lack of personal
• The NAEMT TCCC course uses the curriculum de- achievement, the feeling that work is meaningless,
veloped by the Joint Trauma System and is 16-hours and the tendency toward cynicism and depersonaliz-
long. This course is taught to US military units at their ing those around you. Burnout is correlated more
request, to civilian and government agencies, and to with the number of deployments that PJs experience
foreign militaries. rather than trauma experience or combat exposure.
• TECC (Tactical Emergency Casualty Care) is a16-
hour course that is based on TCCC concepts but in- Lt Col Rush outlined some measures that may help pre-
corporates wording and scenarios more appropriate vent and/or decrease the adverse impact of PTSD and
to civilian settings. Note that these courses adhere depression in the PJ community:
to the TECC guidelines published by the Committee • Advocate for embedded operational psychologists
for Tactical Emergency Casualty Care and may have when feasible.
some variance from the principles taught in military • Identify/select psychologists in and out of the Air
TCCC courses. Force who are most effective in the treatment of PTSD
and depression in PJs.
18. PTSD in the Pararescue Career Field: Lt Col Steve • Destigmatize the emotional and psychological distress
Rush, Medical Director for the Air Force PJs, presented that is the norm for Servicemembers with combat
key findings from a recent study conducted by a team experience.
Air Force psychologists. • Address the issue of lost pay for men who can still
• PJs report levels of exposure to combat and the af- operate but need treatment.
termath of battle experiences that are comparable to • Establish unit-based internal crisis response teams,
other military personnel in both the combat arms and peer counseling, and support.
medical professions, but the PJ aftermath and medi- • Develop other options for support for psychological
cal exposures often occur in high-threat environments health.

CoTCCC Meeting Minutes 143