OBJECTIVE

Initiate acute symptom management.

BACKGROUND

Acute interventions should be tailored to address the individual service person, unit and military force needs and characteristics. Early interventions should typically seek to address diverse outcomes, with the aim of promoting normal recovery, resiliency, and personal growth. Collective outcomes should also be addressed, such as social order and community / unit cohesion.

RECOMMENDATIONS

1. Maintain sense of unit integrity:
   • Normalization
   • Validation
   • Keep positive approach
   • Set up expectation for recovery and RTD (role)
2. Keep treatment consistent with the “PIES” principle:
   • Proximity: Prevention and treatment are conducted in proximity to the battlefield or the origin of the stressor. Treatment proximate to the member’s unit where he can be visited by fellow military members is ideal. Consider all options for proximate treatment; strive to maintain connection to unit to maintain unit integrity
   • Immediacy: Treatment should begin as soon as tactically and logistically possible
   • Expectancy: From the outset, the expectation is that the SM is experiencing a normal reaction to an abhorrently abnormal situation and will return to duty following resolution, restitution and adaptation
   • Simplicity: All modalities of prevention and treatment are simple and clearly understood. No dynamic therapy. No medical model. The only “model” is the military model—military members caring for military members.
3. Initiate treatment:
   • Treat according to service member’s prior role and not as a “patient;” avoid a hospital setting
   • Assure or provide the following, as needed:
     • Reunion or contact with primary group
     • Respite from intense stress
     • Thermal comfort
     • Oral hydration
     • Oral food
     • Hygiene (toileting, shower, shave, and feminine)
     • Sleep (To facilitate rest and restoration, use anxiolytic medication judiciously and sparingly in the acute setting)
     • Encourage talk about the event with supportive others
4. Reserve group debriefing for members of pre-existing and continuing groups at appropriate time and setting. Attendance should be voluntary and only be conducted by personnel trained in debriefing methods.
5. Assign job tasks and recreational activities that will restore focus and confidence and reinforce teamwork (limited duty).
6. Avoid further traumatic events until recovered for full duty.
7. Evaluate periodically.
8. Consider using a short course of medication targeted for specific symptoms (see Pharmacotherapy for COSR).