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Navy Operational Stress Control. Paul S. Hammer CAPT, MC, USN Director, Naval Center for Combat & Operational Stress Control. Background. Hidden costs of war Commissions on Care for Wounded Warriors Overhauling the system of care Access to care Quality of care

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Navy Operational Stress Control


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    1. Navy Operational Stress Control Paul S. Hammer CAPT, MC, USN Director, Naval Center for Combat & Operational Stress Control

    2. Background • Hidden costs of war • Commissions on Care for Wounded Warriors • Overhauling the system of care • Access to care • Quality of care • Transition and Coordination of care • Screening and Surveillance • Promote Resilience • NCCOSC one of a number of BUMED initiatives from PH/TBI Funding

    3. Naval Center for Combat & Operational Stress Control • Established to achieve vision of robust Psychological Health • Enhance resilience • Promote best practices • Navy – Marine Corps Context • A uniquely diverse military culture • Challenge • Responsive to small tactical units • Support peer and unit leaders • Be Evidenced-based • Culturally informed

    4. Mission The mission of the NCCOSC is to improve the Psychological Health of Navy and Marine Corps forces through programs that aid research, educate service members, build resilience and promote best practices in the treatment of Post-traumatic Stress Disorder and Traumatic Brain Injury.

    5. Key Points of OSC Program Stress as a continuum If we only look at stress illnesses, like PTSD, then we miss early stress reactions and stress injuries that are most amenable to intervention Four sources of stress injury. Trauma is not the only harmful exposure Must account for fatigue, loss, and moral conflict Good leaders are the best medicine Leaders actions to Strengthen, Mitigate, Identify, Treat, and Reintegrate One size does not fit all Not everyone is equally affected by any given event and not everyone needs something to “feel better” Training and context matter The best stress inoculation is realistic training that combines stress first-aid practice with other intense training strategies

    6. Stressor • Good to go • Well trained • Prepared • Fit and focused • Cohesive units & ready families • Distress or impairment • Mild and temporary • Anxious, irritable, or sad • Physical or behavioral changes • Stress injuries that don’t heal without help • Symptoms that persist , get worse, or initially get better and then return worse • More severe or persistent distress or impairment • May leave lasting memories, reactions, and expectations Unit Leader Responsibility Individual, Shipmate, Family Responsibility Caregiver Responsibility

    7. Legal problems Life threat Many Causes vs Only Four:Yellow Zone Reactions vs Orange Zone Injuries Family separation Lack of sleep Loss of possessions Loss Money problems Hard work Harsh weather Loss of privacy Moral injury Boredom Relationship problems Conflicts with boss Minor illnesses Wear-and-tear Peer conflicts Physical injuries Orange Zone Stress Yellow Zone Stress

    8. Intense or Prolonged Combat or Operational Stress Life Threat Inner Conflict Loss Wear & Tear • A traumatic injury • Due to an experience of death provoking terror, horror, or helplessness • A grief injury • Due to the loss of cherished people, things, or parts of oneself • A moral injury • Due to behaviors or the witnessing of behaviors that violate moral values • A fatigue injury • Due to the accumulation of stress from all sources over time without sufficient rest and recovery

    9. scenario Competence Cover Calm Connect Confident

    10. Core Leader Functions • Leaders must build resilience in their Sailors and Marines

    11. Strengthen Create confidence / forewarn Expose to realistic stress in training Foster unit cohesion Mitigate Remove unnecessary stressors Ensure adequate sleep and rest After-Action Reviews (AARs) in small groups Identify Know crew stress load Recognize reactions, injuries, illnesses Treat Rest and Restoration (24-72 hours) Chaplain Medical Reintegrate Keep with unit if at all possible Expect return to full duty Don’t allow retribution or harassment Communicate with treating professionals (both ways) OSC Core Leader Functions

    12. Operational Stress Control • Stress as a continuum, not just PTSD • Good leaders are the best medicine • One size does not fit all • Not everyone is equally affected by any given event and not everyone needs something to “feel better” • Training and context matter • The best stress inoculation is realistic training that combines stress first-aid practice with other intense training strategies • Four sources of stress injury. • Trauma is not the only harmful exposure • Must account for fatigue, loss, and moral conflict • Five Core Leader Functions • Strengthen – Create confidence, increase cohesion • Mitigate – Remove unnecessary stressors • Identify – know the load, identify stress injuries early • Treat – actively support treatment • Reintegrate – communicate with providers, support return to duty Unclassified 16