Tuesday , 25 February 2020

Medical Monday: Care for the Combat Medic

Army Sgt. Jesse Rosenfield, a flight medic with Task Force Thunder Brigade, tends to an injured soldier aboard a Blackhawk helicopter in Kandahar province, Afghanistan, in April 2011.

(From www.research.va.gov)

Having graduated at the top of the Army combat medic course atFort Sam Houston in 1989, Paula Chapman, PhD, knows firsthand the risks and challenges of this honored military profession. Today, she is putting that insight to use as a researcher.

“I suffered some of my own military trauma and basically had to work my way through it,” admits Chapman candidly. “I had to battle the demons and come out the other end of the tunnel. So that’s why I study what I study.”

An investigator at the Tampa VA Medical Center, Chapman is part of a Defense-funded study called Combat Medic Mettle. The threeyear study, now in the data-analysis phase, includes some 800 Army combat medics. More than half served in Iraq or Afghanistan.

The researchers hope to pinpoint the factors that create emotional resilience and enable medics to thrive amid harsh conditions. They also want to learn what combat experiences cause the most stress. The next step will be building training programs that incorporate the findings.

The data collected so far confirm the grim challenges faced by medics during deployment: • 67 percent saw dead bodies or human remains

• 56 percent saw dead or seriously injured Americans

• 53 percent saw sick or injured women or children they were unable to help

• 26 percent reported shooting or directing fire at the enemy, and about 6 percent said they were directly responsible for the death of an enemy combatant

Medics are expected not only to care for their comrades—and for allied troops and civilians—but to function as warriors. In fact, they may need to render care for the same enemy fighter they shot at moments earlier.

“The combat medic attached to a foot patrol has to also act as a soldier,” says Chapman. “They may be gunning down an enemy combatant at one point, and then have to go provide aid to him.”

“Compassion fatigue” is another concern. By nature, says Chapman, medics want to help other people. When they can’t do so, this causes stress. This is the same problem that was documented among many doctors and nurses who served in Vietnam.

“The caretaker begins to be traumatized and fatigued because of the sheer volume of what they have to do and some of what they’re seeing,” says Chapman. “Remember, medics go into this job because they want to help people. When they see ill or injured persons—especially women and children—and can’t help them because the area’s not secure, that’s likely to have an effect on them.”

Chapman also points out that combat medics often see more action than other soldiers. “They may go out with one squad one night and another squad the next.”

The fact that medics know the foot soldiers they are caring for—unlike doctors or nurses at field hospitals—adds yet another layer of stress. “Not only do they have to help them, but they know these people,” notes Chapman. “They serve side by side with them, and they may have seen how the injuries occurred. So it goes beyond compassion fatigue—there’s a little more to it with a combat medic.”

Based on the data they have so far, Chapman and her military colleagues point out that depression symptoms appear to be more common than posttraumatic stress symptoms among medics three months post-deployment. But the researchers are continuing to track study participants to see which symptoms subside over time and which get worse.

Chapman’s team is now launching a related study in conjunction with the Army Medical Department Center and School. The effort will focus on traumas that combat medics may have experienced prior to training, as well as baseline risk and protective factors that could reduce or promote resilience. The goal is to learn which risk factors can be ameliorated, and which protective factors enhanced, through combat-medic training.

Chapman and colleagues plan to include experimental tasks to see how trainees respond to emotional stress. The researchers will measure the heart’s electrical activity through electrocardiograms. They will also look at other known indicators of stress: respiration, eye movement, muscle response, and galvanic skin response—changes in the skin’s ability to conduct electricity. Emotions such as fear, anger and startle can activate sweat glands, and the extra moisture increases conductivity.

Chapman plans to also help conduct a trial involving Navy corpsmen, who care for Marines on the battlefield. Yet another study in the works will zero in on the issue of loss—how medics are affected when they “lose” soldiers, versus being able to save their lives. She hopes findings from all the research will guide the way to improved training to better prepare medics for their role, which is succinctly defined in their creed: “These things we do so that others may live.”