Part 1: From the office to the front lines

Published Aug. 21, 2006
By Master Sgt. Orville F. Desjarlais Jr.
455th AEW public affairs

BAGRAM AIRFIELD, Afghanistan -- EDITOR'S NOTE: This is the first in a series of three articles about Air Force combat stress control teams in Afghanistan treating troops on the front lines.

Air Force mental health professionals here have had to move their practice from the office to the front lines to battle combat stress in troops.

Called a Request for Forces, the Army asked the Air Force to augment its combat stress control teams with psychologists, psychiatrists, social workers and mental health technicians.

The Air Force sent its first teams earlier this year. Today, the teams are late into the second rotation, which began in May.

When the teams arrived, the first thing they asked was "Where's the hospital?", according to Lt. Col. Rhonda Ozanian, Combat Stress Control team leader, Task Force Med. "Being mobile deviates dramatically from the way we do things."

Air Force mental health professionals are used to working from offices in hospitals on large bases, not traveling in convoys and helicopters to forward operating locations that are oftentimes the target of enemy attacks.

However, history has shown that the most effective way to tackle combat stress is from the front.

At war with combat stress
Military surgeons during World War I coined the term "shell shocked" to diagnose psychiatric casualties. Shell shocked described soldiers that were dazed, confused, blind, deaf or paralyzed for no apparent reason. Medics did little to help the soldiers recover. Commanders and medics accepted the manpower loss as an unavoidable cost of war, according to an Air Command and Staff College report done by Maj. David Herres in 1988.

As the war intensified, soldiers experienced loss of breath, anxiety, irritability, confusion, sleep loss and panic. This led to poor duty performance and suspension from combat positions, according to the report.

That's when American medical services began looking into efforts by the French and British in treating psychiatric casualties. Both countries realized they could get good results by simple treatment methods that included rest, food, encouragement, suggestion and persuasion. The two countries' neurosis experience established a foundation for future medical treatment plans that medics have used from World War II until now.

Back then, medical professionals saw mental breakdown in combat as the result of a soldier's inability to cope. It's an observation that still rings true today.

During the Gulf War, the Army recognized combat stress control as a medical department function and mobilized psychiatric teams that helped limit the rate of psychiatric evacuations

"These combat stress teams have attracted media interest during the war in Iraq, but the military has been doing this for years," Colonel Ozanian said.

Air Force helps out
When the Army requested help from the Air Force, called an RFF, the Airmen reported here, Kandahar Airfield and Forward Operating Base Salerno. From these bases, the combat stress teams can extend their services even further by traveling to other forward operating bases, nicknamed FOBs.

Although the medics work for the Army, the Airmen administratively fall under the 755th Expeditionary Mission Support Group headquartered here.

Unlike the Army, the Air Force doesn't forward deploy its mental health professionals. All Air Force mental health treatment occurs in rear areas. However, to support the RFF, the Army expected the Airmen to forward deploy.

At Sheppard Air Force Base, Texas, Capt. Will Moore is involved with family advocacy and suicide prevention, and he's a member of a sexual assault response team and a special needs coordinator. At Sheppard, he spends most of his time in his office or in meetings. At Kandahar, things are different.

"Out here, our teams stay in the FOBs for three to seven days, providing two or three interventions to those who need them," said the clinical social worker. "We give them the tools they need to help cope, and we provide feedback to the commander."

Kandahar team chief Maj. Jocelyn Kilgore said combat stress prevention must be taught to troops at the front lines.

Studies, and history, have shown that providing psychiatric care on the front lines helps reduce the debilitating effects of combat stress, the worst being Post Traumatic Stress Disorder made famous in Vietnam.

(Next, Part II: Meeting the challenge on the front lines)