Stress Management



As a soldier medic, you will be the medical authority for the command to which you are assigned.  You will assist the commander in assessing the impact of sustained operations on his soldiers.  You will recommend which, if any, soldiers need help dealing with emotional problems/battle fatigue due to the extreme situations they may encounter.


Terms and Definitions

Battle fatigue

Caused by overwhelming physical and psychological stress (and usually fear) during combat operations


Combat stress reactions

Normal, temporary emotional reactions, which are experienced by all soldiers during combat


Transient battle reactions

Temporary, debilitating psychological disorders which usually subside following rest and initial treatment



Emotional response aroused by anxiety, panic, fright, terror, horror and apprehension to real danger.  The major stress reaction that causes battle fatigue



Distress or uneasiness caused by danger or situational stress that involves the feelings of apprehension, uncertainty, and insecurity



The feeling of sadness, despair, hopelessness, discouragement, and self-hate which manifests itself in low level of functioning



Refers to the accuracy and killing power of modern weapons, which may increase the level of psychological stress experienced by soldiers in combat

Degrees of Battle Fatigue


(a)        Soldier communicates feelings of fear/anxiety in battlefield environment but there are no signs of anxiety present

(b)        This level does not require removing soldier from combat



(a)        Soldier displays tears, gross trembling, or difficulty in concentrating

(b)        This level may/may not require evacuation of soldier.  The evacuation decision is based on mission, the soldier's effectiveness and the severity of presenting symptoms



(a)        Soldier can no longer relate to his environment and can suffer from hysterical blindness and paralysis

(b)        Requires immediate evacuation.  Symptoms are too disruptive to unit's mission to remain or soldier needs observation to rule out medical or surgical condition


WARNING:     Any soldier has the potential to become a battle fatigue casualty.


Battle Fatigue Reactions, Symptoms and Treatment

Battle Fatigue reactions and Symptoms

(1)        Manageable reactions-"combat stress"

(a)        Muscular tension--headaches, inability to relax, cramps

(b)        Shaking and tremors

(i)         Mild shaking--may appear when undergoing shelling or bombing. Appears and disappears rapidly and is a normal reaction to dangerous conditions.

(ii)        Marked or violent shaking, sometimes incapacitating; may also persist after the cause has ceased.

(c)        Perspiration--it is normal to experience either mild or heavy sweating or chills under combat stress

(d)        Digestive and urinary system reactions

(i)         Nausea and vomiting which may occur during or immediately after a fire fight, shelling or intensive battle conditions

(ii)        Loss of appetite

(iii)       Acute abdominal pain which may occur during battle

(iv)       Urinary frequency, particularly at night, or urinary incontinence during actual battle

(v)        Inability to control bowel functions may occur under catastrophic combat stress

(e)        Circulatory and respiratory system reactions

(i)         Heart palpitations

(ii)        Elevated blood pressure and increased pulse rate

(iii)       Chest pains or pressure

(iv)       Hyperventilation (rapid respirations), shortness of breath, dizziness, and/or choking sensation

(v)        Sensations of faintness or giddiness combined with decreased muscle strength and energy

(f)         Sleep disturbances

(i)         Difficulty in falling asleep or inability to sleep when the tactical situation permits

(ii)        Nightmares, terror dreams, or battle dreams

(iii)       Sleep disturbances in the form of dreams are part of the normal psychological healing

(iv)       This process of "working through" combat experiences is a way to increase tolerance           

(g)        Hyper alertness--frequent startle reactions-(jumping, crying, jerking or other forms of involuntary self-protective motor responses to sudden noises)

(h)        Irritability

(i)         Verbal flare-up, and tears are common overreactions to normal, everyday comments or incidents

(ii)        Sporadic and unpredictable explosions of aggressive behavior with little or no provocation.  The stimulus may be a noise, an accidental bumping or a normal conversation.

(i)         Short attention span

(j)         Depression

(i)         Low energy level

(ii)        Social withdrawal

(iii)       Poor personal hygiene

(k)        Substance abuse

(2)        Disruptive reactions.  

(a)        Soldier or supervisor states that the soldier cannot function on the job

(b)        Soldier or supervisor states that the soldier may compromise their own safety and the safety of others

(c)        Soldier exhibits panic (rushing about without any self-control)

(d)        Soldier may have visual and/or hearing problems (perceived by the individual) and partial paralysis. Paralysis is usually confined to one arm or leg

(e)        Soldier may utter incoherent language.  Soldier may babble, be unable to speak logically, and have a bewildered appearance.

(f)         Soldier or soldiers’ supervisor states loss of appetite, which resulted in loss of 5 pounds per week or more

(g)        Soldier complains of persistent and severe abdominal pain

(h)        Soldier has inability to control bowel function after stress stimulus (combat) has ended


Principles of Battle Fatigue Treatment--(PIES)


CAUTION:      Failing to follow the principles of treatment could result in the soldier not recovering from  battle fatigue and may set him up for a lifetime of problems with a chronic psychiatric  disability.


Proximity--treat soldiers as close as possible to their units and battle. Prevent over evacuation.


Immediacy--identify need for care early and treat immediately


Expectancy--provide positive outlook to combat fatigue casualty.  Casualty should expect full recovery and early return to duty (RTD).  The most important principle of treatment.


Simplicity--use simple, brief straightforward methods to restore physical well being and self-confidence using non-medical terminology and techniques.


Battle Fatigue Treatment Steps and Evacuation Guidelines


CAUTION:      DO NOT refer to the soldier as a "patient", because calling him a patient reinforces to him that he is sick.


(1)        Treatment steps

(a)        Obtain brief medical/mental status exam and rule out serious medical/mental illness or injury

(b)        Provide a place for the soldier to rest.  At least 4 hours rest should be provided in a quiet, secure area

(c)        Provide food, when available

(d)        Provide an opportunity for the soldier to discuss his feelings

(2)        Evacuation guidelines

(a)        Evacuate the soldier if he shows signs of disruptive battle fatigue reactions.  Soldiers who have undergone 48 hours of treatment without resolution of symptoms should be evacuated for definitive psychiatric care.  Carefully apply physical restraints if soldier is at risk of hurting self or others.

(b)        Return the soldier to duty if he is able to function on the job.  Returning him to his original unit (and to his original job) is the best mental health assistance that can be provided and is the "treatment of choice"


Administrative Classifications

(1)        Duty--soldier needs brief time to recuperate in local area (up to 6 hours)

(2)        Rest--soldier needs temporary removal from maneuvering unit for a few days (1 or 2 days)

(3)        Hold--soldier needs medical observation and assistance

(4)        Refer--soldier cannot be safely held or treated at Forward Support Medical Company (FSMC). Normally sent to Division Support Area (DSA) for evaluation and disposition.

Depression and Manic Depression

Symptoms of Depressive Illness

(1)        Loss of energy and interest

(2)        Diminished ability to enjoy oneself

(3)        Decreased -- or increased -- sleeping or appetite

(4)        Difficulty in concentrating; indecisiveness; slowed or fuzzy thinking

(5)        Exaggerated feelings of sadness, hopelessness, or anxiety

(6)        Feelings of worthlessness

(7)        Recurring thoughts about death and suicide


Manic-depressive Illness

Manic Depression causes mood swings creating periods with the following symptoms:

(a)        A high energy level with decreased need for sleep

(b)        Unwarranted or exaggerated belief in one's own ability

(c)        Extreme irritability

(d)        Rapid, unpredictable emotional change

(e)               Impulsive, thoughtless activity, with a high risk of damaging consequences (i.e., stock speculations, sudden love affairs, etc.)




Battle fatigue occurs in units often "all at once".  Stress levels remain high in almost all Army units due to continually changing missions and a potential for terrorist attacks anytime and anywhere in the world.  As a combat medic, one of your jobs is to monitor the mental health of soldiers in your assigned unit and advice the unit command when stress levels are high.  It is both the commands and your responsibility to take the necessary measures to prevent combat fatigue.  You will treat battle fatigue as close to your unit as possible and evacuate only when necessary.