Rapid response to acute stress reaction: Pilot test of iCOVER training for military units.

Abstract

Objective:The purpose of this study was to pilot the iCOVER curriculum-a training product designed to teach service members how to recognize and respond to acute stress reactions (ASRs) using a simple, 6-step procedure, iCOVER. Three goals guided the pilot: (a) assess training acceptability, (b) assess impact of training on knowledge and performance of the iCOVER procedure, and (c) explore the effects of in-person and computer-simulated practical exercises. Method: Six military squads (N ϭ 66) were randomly assigned to 3 conditions: iCOVER Standard (iCOVER instruction with an in-person practical exercise), iCOVER Tech (iCOVER instruction with a computer-simulated practical exercise), or Control (no iCOVER instruction). Squads in the iCOVER conditions received iCOVER instruction, completed a knowledge test and practical exercise to which they were assigned (i.e., Standard or Tech), demonstrated their iCOVER skills in live-action scenarios, and reported their perceptions of the training. Results: iCOVER training was acceptable to most participants and associated with improved knowledge about iCOVER (M pre ϭ 3.33 vs. M post ϭ 5.15; t[42] ϭ Ϫ7.61, p Ͻ .001, d ϭ 1.41); iCOVER Standard resulted in more iCOVER behaviors during a live-action scenario compared with the other conditions, F(2, 35) ϭ 13.36, p Ͻ .001, 2 ϭ 0.43. Compared with iCOVER Tech, iCOVER Standard had greater acceptability and resulted in better performance of iCOVER. Conclusions: This is the first U.S. demonstration of a training program designed to address ASRs during high-risk operations and offers a potential way ahead for preparing military teams to manage ASRs.

Post-traumatic stress disorder risk and witnessing team members in acute psychological stress during combat

“…20 This training, designed for non-medical unit members, has since been adapted for service members in the USA, and data demonstrate perceived utility and feasibility. 12 Future research should continue to examine the impact of such peer-based training on individual witnesses in terms of their actual behavior and their long-term mental health and examine the impact on their affected team members over time.…”

“…In a high-risk occupation like the military, individuals are trained in combat casualty care and are expected to provide immediate first aid for team members who are physically injured, 11 yet individuals are not formally trained in how to respond to ASRs that they witness. 12 In an exploratory analysis, the present study documented the way in which soldiers spontaneously responded to their team members exhibiting ASR symptoms. This descriptive information can be used to identify potential pathways for intervention training.…”

Examining the development of PTSD symptoms in individuals who witness acute stress reaction on the battlefield

“…Considerations could include methods that will assist the individual experiencing the ASR, and techniques the witness could use to reduce their chances of developing PTSD symptoms (training discussed in the article is currently being adapted and tested for non-medical unit USA service members, and could be expanded to medics and fellow soldiers likely to witness team members experiencing psychological injuries). (f) Adapt ASR management training tools that have already been piloted in the IDF and USA service members, [19][20][21][22] to optimise feasibility and effectiveness among USA service members. (g) Explore the association between ASR and PTSD in other occupations and populations that are at high risk for ASR.…”

“…Validate these tools for widespread use, including semi-structured interviews and systematic observation during military exercises. Examine how we identify and care for individuals who witness an ASR. Consider how to improve training medics receive to treat service members for psychological injuries on the battlefield, and examine the efficacy of these methods to reduce adverse mental health outcomes through rigorous research studies with adequate follow-up time. Develop, study and train service members in structured protocols for actions they can take when they witness an ASR in others. Considerations could include methods that will assist the individual experiencing the ASR, and techniques the witness could use to reduce their chances of developing PTSD symptoms (training discussed in the article is currently being adapted and tested for non-medical unit USA service members, and could be expanded to medics and fellow soldiers likely to witness team members experiencing psychological injuries). Adapt ASR management training tools that have already been piloted in the IDF and USA service members, 19–22 to optimise feasibility and effectiveness among USA service members. Explore the association between ASR and PTSD in other occupations and populations that are at high risk for ASR. Examine whether guidance on psychological injury interventions used in individuals experiencing the injury are effective in reducing long-term mental health symptoms among those who witness the injury. Extend these principles to other civilian medical responders or caregivers who witness severe psychological and physical injury in their occupational or personal community role.…”

“…Adapt ASR management training tools that have already been piloted in the IDF and USA service members, 19 – 22 to optimise feasibility and effectiveness among USA service members.…”