Traumatic Event Management (TEM) is the term utilized by the U.S. Army referencing interventions and support activities in response to potentially traumatizing events (PTE) that occur individually or organizationally to units and organizations. It is a flexible set of interventions specifically focused on stress management for units and individual Soldiers. TEM is one of the nine functional areas of COSC. However, because TEM is routinely addressed during military operations, it deserves specific emphasis in any review of Combat and Operational Stress. The goal of TEM is to enhance Posttraumatic Growth (PTG). PTG describes an adaptive process resulting from exposure to PTEs that include improved relationships, renewed hope for life, an improved appreciation of life, an enhanced sense of personal strength, and spiritual development.
An event is considered a potentially traumatizing event when it causes individual Soldiers or even a whole unit to experience intense feelings of terror, horror, helplessness, and/or hopelessness. Guilt, anger, sadness, and dislocation of world view or faith are potential emotional/cognitive responses to PTEs.
For military units TEM is active in all phases of the deployment cycle and across the continuum of military operations. It is a process that can and should be utilized in garrison and deployed environments. Traumatic event management is a structured unit process designed to mitigate the impact of PTEs and to accelerate normal recovery of those personnel involved. Examples of PTEs that might result in a TEM assessment and intervention include the following: .
- Heavy or continuous combat operations
- Death of unit members
- Serious injury
- Environmental devastation/human suffering
- Significant home-front issues
- Operations resulting in the death of civilians or combatants
TEM is normally conducted by a team composed of trained members, (medical officers, chaplains, behavioral health professionals, trained unit members). TEM's main value is to quickly restore unit cohesion and readiness to return to action, through clarifying what actually happened and clearing up harmful misperceptions and misunderstandings. It may also reduce the possibility of long term distress through sharing and acceptance of thoughts, feelings, and reactions related to the PTE. In the event a unit experiences a PTE, unit leadership may request a TEM assessment to assess potential impact. When requested, the identified TEM team will coordinate a TEM assessment resulting in specific recommendations to address the identified PTE as effectively and efficiently as required.
It is recommended that Leadership request TEM assessments as close to the specific PTE as practically possible, but there are no time limitations to conducting assessments and implementing TEM interventions in response to current or past PTEs that have had a significant impact on the performance, morale and cohesion of the effected unit or organization.
The TEM process incorporates multiple interventions and clinical strategies to aid the military leader in managing and mitigating the impact of PTEs that units and Soldiers may be exposed to while executing military operations. TEM is tailored to the PTE and operational needs and requirements of the effected unit or organization. TEM responses include:
- Unit Needs Assessment of the impact of the identified PTE.
- Command Consultation and Education.
- Unit and Individual Education.
- Individual supportive intervention and counseling.
- Psychological First Aid.
- Psychological Debriefs.
- Leader-led After Action Debriefs (L-LADD)
|STRESS BEHAVIORS IN COMBAT AND OTHER OPERATIONS
AND CRIMINAL ACTS
- Unit cohesion
- Loyalty to "buddies" / peers
- Loyalty to Leaders
- Identification with unit
- Sense of eliteness
- Improved sense of Self
- Enhanced Relationships
- Sense of mission
- Alertness, vigilence
- Exceptional strength and Endurance
- Increased tolerance to hardship, pain, and injury
- Sense of purpose
- Heroic acts
- Hyper alertness
- Fear, anxiety
- Irritability, anger, rage
- Grief, self-doubt, guilt
- Physical stress complaints
- Inattention, carelessness
- Loss of confidence
- Loss of hope and faith
- Depression, insomnia
- Impaired duty performance
- Erratic actions, outbursts
- Freezing, immobility
- Terror, panic
- Total exhaustion
- Loss of skills
- Memory loss
- Impaired speech/muteness
- Impaired vision, touch, and hearing
- Weakness or paralysis
- Hallucinations, delusions
- Mutilating enemy dead
- Killing enemy prisoners
- Not taking prisoners
- Killing noncombatants
- Torture, brutality
- Killing animals
- Fighting with allies
- Alcohol and drug abuse
- Recklessness, indiscipline, looting, pillage
- Excessive sick call use
- Negligent disease, injury
- Shirking, malingering
- Combat refusal
- Self inflicted wounds
- Threatening/killing own Leaders ("Fragging")
- Going absent without leave, desertion
|LONG TERM STRESS REACTIONS (LTSR)
- Adaptive Stress Reaction
- Posttraumatic Growth (PTG)
- Improved relationships
- Renewed hope for life
- Improved appreciation for life
- Enhanced sense of personal strength
- Spiritual development
- Intrusive, painful memories ("flashbacks")
- Trouble sleeping, bad dreams
- Guilt about things done or not done
- Social isolation, withdrawal, alienation
- Jumpiness, startle responses, anxiety
- Alcohol or drug misuse, misconduct
- Problems trusting in intimate as well as social relationships
LEADER-LED AFTER ACTION DEBRIEFING
A leader-led after action debriefing is lead by a platoon, squad, or team leader and is not normally conducted above platoon level. The L-LAAD should be conducted after all missions especially when the maneuvers did not go according to plan. A leader-led after action debriefing may even be sufficient for PTEs involving injury or death. The best time to conduct this debriefing is as soon as is feasible after the team/squad/platoon has returned to a relatively safe place and members have replenished bodily needs and are no longer in a high state of arousal. Usually a well-conducted leader-led after action debriefing is the best option to manage PTEs during a mission. The exception to this type of debriefing is when the event evoked reactions that seriously threaten unit cohesion and/or have a high likelihood of arousing disruptive behavior and emotions. In these situations the leader should ask himself the following
- Should I conduct the debriefing?
- Should a trained facilitator be present?
- Should a request for COSC TEM be submitted for his team/squad/platoon?
CONDUCTING A LEADER LEAD AFTER ACTION DEBRIEFING
These debriefings require the leader to extend the lessons-learned orientation of the standard AAR. He uses the event reconstruction approach or has the individuals present their own roles and perceptions of the event, whichever best fits the situation and time available. Refer to Training Circular (TC) 25-20 for definitive information on AARs. When individuals express or show emotions, the leader and the teammates recognize and normalize them; they agree to talk with them later and support the distressed Soldier through personal interactions. The group then returns to determining the facts. Lessons-learned discussion is deferred until all the facts are laid out. See FM 22-51 for additional information. The leader may provide education about controlling likely reactions or referral information at the end, depending on his knowledge and experience. When a PTE is likely to create individual or collective guilt, distrust, or anger, the unit leader should be encouraged to request COSC assistance. Either a COSC or a UMT person trained in TEM sits in with the leader-led debriefing as a familiar and trusted friend of the unit. The COSC or UMT facilitator helps the unit/team leader rehearse and mentors the leaders on the debriefing process. The leader conducting the debriefing must be attentive to identify individuals needing COSC follow-up. Leaders in positions above platoon level also have a role in leader-led after action debriefing. Company commanders and first sergeants (1SGs) may conduct leader-led after action debriefing with their subordinate leaders.
COOL DOWN MEETINGS
A cool down meeting is referred to as an immediate, short meeting when a team or larger unit/group returns from the battlefield or other missions. These cool down meetings are held after heavy/intense battles with the enemy or a shift in the mission has occurred which is highly arousing and/or distressing. This is especially important after critical events. The cool down meeting is an informal event and occurs before the participants fully replenish their bodily needs and precedes any other activities including more COSC interventions, or return to the mission.
COMPONENTS OF A COOL DOWN MEETING
Components of a cool down meeting may include
- Assembling all of the unit personnel at a safe and relatively comfortable location for a brief period of time (about 15 minutes).
- Receiving or sharing nonstimulating beverages and convenient food (comfort foods if available).
- Providing personnel the opportunity to talk among themselves.
- Giving recognition and praise for the difficult mission they have completed.
- Providing information to unit personnel on where and how they will rest and replenish.
- Previewing the immediate agenda for the unit on what will happen after the cool down meeting including plans for further debriefing and/or other available stress control or morale/welfare intervention.
- Providing announcements pertaining to further preparations and expected time of return to the mission.
Peer Support and Trauma Risk Management
Peer support is a significant factor in the management and control of COSR. Soldiers identify with peers who are viewed as trusted and needed. A determining factor in treating COSR is when soldiers perceive that their peers support them. The higher the level of cohesion and bonding within a unit, the more likely peers are to support each other. Thus, the more successful the unit as a whole is in dealing with combat operational stress reactions.
Battlemind Psychological Debriefs
Battlemind Psychological Debriefings (BMPD) are structured group discussions designed to support military personnel in their transition back to duty after a significant incident (in-theatre) or from the combat environment to the home environment at post deployment. Battlemind Psychological Debriefings use a set of specific questions to guide participants through a series of phases in which combat events or deployment experiences are acknowledged among unit members, common reactions are discussed, and actions that can be taken to facilitate the transition are reviewed. Battlemind Psychological Debriefings are not expected to prevent the development of a psychiatric disorder for any one individual but are expected to reduce the level of mental health symptoms for the unit overall.
Battlemind Psychological Debriefing is designed for use in three different ways:
(1) in-theatre event-driven debriefing that occurs following a potentially traumatizing event
(2) in-theatre time-driven debriefing that occurs at specified time points during deployment to address the cumulative effects of the deployment; and
(3) immediate post-deployment debriefing to facilitate the transition from combat to home.
Leaders should contact their supporting BH or COSC asset to assess the appropriateness and provide BMPDs.