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Military Care for War-Zone Stress

According to the Department of Veterans Affairs (2004), the Military’s guiding principle in responding to symptoms of war-zone stress is captured in the acronym, PIES:  proximity, immediacy, expectancy, and simplicity.  Interventions are as brief as possible and take place as close to the Unit and as soon as possible.  The first-tier response to an apparent challenge occurs within the Unit and includes rest;  nourishment;  and opportunities to discuss one’s experiences with medical personnel, chaplains, etc. 

The military has developed five echelons of care for Service Members with combat stress effects:

  • Echelon I:  Intervention by the medical assets within the combat unit
  • Echelon II:  Care at the Brigade and Division level, by the farthest-forward (toward the place where the Unit is stationed) Combat Stress Control Teams
  • Echelon III:  Forward deployed Combat Support Hospitals in the Corps Support Area  (If the Service Member is not expected to respond to treatment there within seven days, he or she is usually evacuated out of theater.  More than 90 percent of Service Members are treated and returned to duty.)
  • Echelon IV:  Hospital facilities generally outside the combat zone (e.g., in Germany or Spain)
  • Echelon V:  Continental U.S. Military and VA medical centers.

At each echelon, the Service Member is evaluated for return to duty.  With each level of evacuation, the Service Member is more removed from the Unit and tends to be more apprehensive about being re-exposed and less likely to return to combat duty (VA, 2004).

Next: Challenges in Demobilization and Homecoming


The material on all of the Clinical Pages is taken directly from the draft version of Finding Balance After the War Zone:  Considerations in the Treatment of Post-Deployment Stress Effects, a manual under development for the Great Lakes Addiction Technology Transfer Center and Human Priorities.  This draft is copyright © 2008, Pamela Woll.  Reprint permission is universally granted, but attribution is requested.
Click here for References and Other Resources.
Click here to link to a PDF file of the current version of the clinician’s manual draft.
Click here to link to a PDF file of the accompanying booklet for veterans.






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