Page 20 - JSOM Spring 2023

Threat Appraisal, Recovery Operations, and
PTSD Symptoms Among US Air Force Rescue Personnel

Craig J. Bryan, PsyD, ABPP *; Stephen C. Rush, MD ;
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Dianna Fuessel-Herrmann, BS ; AnnaBelle O. Bryan, MS ;
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Chad E. Morrow, PsyD, ABPP ; Jeremy Haskell, PsyD, ABPP ;
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Michael J. Jones ; Chris Bowerfind ; James A. Stephenson, PsyD, ABPP 9
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ABSTRACT
Background: Research among military personnel and veter- than combat exposure itself. Subsequent research suggests that
ans indicates that subjective appraisal of warzone stressors subjective threat appraisal explains the association of combat
explains the relation of combat exposure to posttraumatic exposure with subsequent PTSD. 5,10
stress disorder (PTSD), but not the relation of exposure to in-
jury and death to PTSD. Studies have primarily been limited Although the relation of traditional combat-related experi-
to conventional forces using aggregate measures of warzone ences (e.g., small arms fire, being attacked or ambushed, firing
stressor exposure. Threat appraisal may play a different role at the enemy) to PTSD is largely explained by perceptions of
in the emergence of PTSD among military personnel for whom danger, exposure to atrocities (e.g., excessive violence, prisoner
dangerous deployment experiences are more closely associ- abuse) and/or the aftermath of combat (e.g., wounded person-
ated with exposure to injury and death, such as US Air Force nel, mutilated and burned human remains, intense human suf-
Pararescuemen and Combat Rescue officers. Materials and fering) is correlated with PTSD symptomatology even when
Methods: In a sample of 207 rescue personnel, correlations accounting for subjective threat appraisal. 5,8,10 This suggests
among various types of warzone stressor exposure, threat ap- that combat exposure and aftermath exposure may be related
praisal, and postdeployment PTSD symptoms were examined. to PTSD in different ways, with aftermath exposure playing a
Results: The relative strongest correlates of threat appraisal more direct role than combat exposure. Another possibility is
were stressors related to injury, death, and human remains. that perceptions of danger depend on the Servicemember’s job
Although exposure to these stressors was also correlated with duties. Among conventional combatants, the most dangerous
PTSD symptom severity, partial correlations of stressor expo- or threatening deployment experiences occur within the con-
sure and PTSD symptoms were no longer significant when ad- text of combat exposure. Among military personnel engaged
justing for threat appraisal. Conclusion: Results support the in rescue and recovery operations, however, the most danger-
contributing role of threat appraisal to PTSD among military ous and threatening deployment experiences occur within the
personnel whose primary duties entail exposure to injury and context of aftermath exposure. One military subgroup char-
death under hostile and dangerous conditions. acterized by such a mission is US Air Force Combat Rescue,
an elite group specifically organized, trained, and equipped to
Keywords: PTSD; combat; pararescue; threat appraisal conduct full-spectrum personnel recovery and combat rescue
operations. Rescue personnel provide medical care and ensure
safe transportation of patients to higher levels of medical care
in hostile regions, including active combat zones. Their job
Introduction
duties include landing in or near active firefights to retrieve
Although the association of combat with posttraumatic stress casualties, coming under fire while providing medical care, re-
disorder (PTSD) is well-established, an alternative perspec- covering remains from burning vehicles and airframe, rescuing
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tive of deployment-related stress disorders emphasizes the personnel in dangerous locations (e.g., underwater, confined
importance of subjective threat appraisal, which entails the space, high altitude), and transporting and caring for patients
personal assessment of how threatening or harmful an event who may be hostile and/or violent (e.g., enemy forces, host
or circumstance could be. Several decades ago, Hendin and nation civilians). Although the intensity of rescue personnel’s
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Haas noted in a sample of Vietnam veterans that combat- exposure to direct combat has been found to be comparable to
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related stress disorders were influenced by the subjective expe- that of conventional combat arms professionals (e.g., infantry)
rience of combat just as much, if not more, than the objective and their exposure to postcombat or aftermath experiences
experience of combat itself. The importance of subjective threat has been found to be comparable to that of deployed military
appraisal has subsequently been observed and reported across medical professionals at combat support hospitals, the latter
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diverse military samples, 5,7–11 suggesting that subjective threat is more strongly associated with PTSD symptom severity than
appraisal has stronger associations with PTSD symptomology direct combat. These findings align with anecdotal reports
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*Correspondence to Craig.Bryan@osumc.edu
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1 Dr Craig J. Bryan, Ms Dianna Fuessel-Hermann, and TSgt (Ret) AnnaBelle O. Bryan are from the National Center for Veterans Studies and the
University of Utah in Salt Lake City. Lt Col Stephen C. Rush is from the Gabreski Air National Guard Base, Westhampton, NY. Maj Chad E.
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Morrow is from Hurlburt Field in Florida. Maj Jeremy Haskell is from Creech Air Force Base in Clark County, Nevada. CMSgt (Ret) Michael
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J. Jones is from the Pararescue Foundation, Milford, MI. MSgt Chris Bowerfind is from the Joint Base Elmendorf-Richardson, Anchorage, AK.
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9 Col James A. Stephenson is from Ramstein Air Base, Rhineland-Palatinate, Germany.
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