A historical overview of combat stress control units of the U.S. Army

Military Medicine, Sep 2003 by Bacon, Bryan L, Staudenmeier, James J

Combat stress control units have been deployed to the Gulf War, Somalia, Haiti, Guantanamo Bay, Bosnia, and Kosovo. They have been very flexible and useful mental health tools for commanders in both combat and peacekeeping operations for the past decade. In their operational role they have been effective, but their garrison mission remains unclear. This article summarizes the uses, missions, and lessons learned from the various combat stress control missions around the world.

Introduction

Combat stress control (CSC) units have been used effectively since their fielding in the early 1990s.1-7 This article compiles a decade worth of literature written on the various CSC missions throughout the world and examines the lessons learned from those deployments. Although combat stress casualties were certainly common prior to the 20th century, our current CSC doctrine is rooted in the allied experience in World War I where the core treatment strategies of proximity, immediacy, expectancy, and simplicity were learned. Combat stress casualties make up 0% to 50% of all battlefield casualties depending on a variety of factors, including unit cohesion, training, ferocity of combat, lack of sleep, and total time in continuous combat.8 There is an obvious and consistently demonstrated need for mental health services to accompany troops on deployment.

The Gulf War

The Corps level combat psychiatry asset in the Gulf War was referred to as an "OM team" or officially as a "medical detachment, psychiatric." The OM team was the precursor to the current CSC units of today.9 See Table I for the evolution of the CSC concept. The current CSC doctrine was written in 1986 and revised in 1988. It called for two types of CSC units, one larger and one smaller than the original OM team. On paper, the OM teams consisted of 15 officers and 33 enlisted personnel with nine vehicles, comprising 3 mobile consultation sections and a treatment section with a 20-bed ward.

In 1989, the new CSC doctrine passed the first Training and Doctrine Command board proceeding. Unfortunately, the new doctrine was waiting for approval at the Department of the Army and Major Commands when Iraq invaded Kuwait in August 1990. Consequently, the Army went to war with the old style OM team doctrine.

The 528th Medical Detachment from Fort Benning was the active component OM team deployed to the Gulf. It was augmented by two reserve teams: the 383rd from Boston and the 531st from Baltimore. The 528th was activated in mid-September of 1990 and arrived in theater in late October. The two reserve teams arrived in December just prior to the air offensive in January 1991. The 528th was a Professional Filler System and its officers came mainly from Fort Benning and Fort Gordon. The enlisted personnel were gathered from multiple continental U.S. sites. Upon mobilization, multiple problems came to the forefront including the absence of a commander, equipment in ill repair, and the lack of knowledge about field and combat psychiatry.

Although the OM teams arrived relatively late to the combat theater, they were able to accomplish many things. They trained each other in field craft and combat psychiatry and made informal bonds with the units they would be supporting. During their 171 days in theater, the 528th conducted 811 command consultations and performed 514 psychiatric evaluations. Of these evaluations performed, they held 124 (24%) service members for treatment and evacuated 18 (3.5%).10

Among the many lessons learned from the Gulf War experience was the critical realization that the OM team was the wrong mental health tool to be used, given the current Air-Land Battle Doctrine.10 This was due to the inflexible nature of the OM team and its doctrinal inability to decentralize the patient holding capacity in forward areas. This inability to decentralize deprives combat units the mental health assets they need in the rapidly moving and fluid battlefield envisioned in the Air-Land Battle Doctrine.

Other lessons included:

1. Good leadership is critical in combat medicine.10

2. Occupational therapists can be effective in a CSC function.10,11

3. The greatest mental health impact was made during the Desert Shield buildup phase of the Gulf War.10

4. Mental health assets should be deployed early.10

5. The PROFIS system is not an effective method by which to staff, train, educate, and deploy a CSC unit of any type.10

6. Psychiatrists with strong neurological skills can augment the relatively poor neurology medical assets in combat support hospitals.10

7. Improvements must be made in family support programs of units deployed.10

8. Core combat psychiatric treatment principles of proximity, immediacy, expectancy, and simplicity were confirmed.10

9. In the Gulf War, the most common characteristics of psychiatric casualties were: deployment to Southwest Asia within 90 days of assignment to a new unit, female service members with small children at home, service members with chronic psychiatric disabilities, and senior noncommissioned officers who experienced exacerbations of past combat-related traumas.10