What's Happening?
Staff Sgt. Jay Kotsko, a 68W combat medic instructor and Tactical Combat Casualty Care instructor with the West Virginia Army National Guard, argues that military medics should receive training in trauma-informed care. While medics are extensively trained
to treat physical wounds, they often lack the skills to address the psychological impact of trauma on soldiers. Kotsko, who is also an endorsed chaplain, emphasizes that trauma-informed care is not a separate task but an integrated approach to medical treatment. He suggests that simple actions, such as explaining procedures to a casualty before performing them or maintaining a level voice, can significantly reduce a patient's physiological arousal and prevent further traumatization. The current training focuses heavily on immediate life-saving interventions, but Kotsko believes it overlooks the crucial psychological support needed by soldiers who may be experiencing multiple layers of trauma.
Why It's Important?
Integrating trauma-informed care into military medic training is crucial for the holistic well-being and readiness of U.S. service members. Many soldiers carry pre-existing burdens, and combat injuries can exacerbate these, making the injury not their first trauma. Medics are often the first and sometimes only medical contact for troops, positioning them uniquely to identify and address acute stress reactions, post-traumatic symptoms, and moral injury early on. Without this training, medics may miss critical signs, delaying necessary referrals to chaplains or behavioral health specialists. Early intervention in psychological injuries increases the likelihood of soldiers returning to their units and remaining in service, thereby preserving trained personnel and reducing the long-term costs associated with untreated mental health issues. As future conflicts may involve prolonged field care and longer evacuation times, medics will spend more time with injured troops, making their ability to provide psychological support even more vital.
What's Next?
Staff Sgt. Kotsko proposes concrete steps to implement trauma-informed care. He recommends adding trauma-informed care instruction to the 68W advanced individual training and integrating it into annual recertification alongside Tactical Combat Casualty Care. This would ensure that the training is reinforced and becomes a standard part of a medic's skill set. Key components of this training should include psychological first aid, teaching active listening, normalizing stress responses, and connecting soldiers to resources. Medics also need to learn how to avoid re-traumatizing patients during treatment and how to effectively hand off patients to chaplains or behavioral health professionals. By formalizing these practices, the Army can ensure that medics are not only equipped to save lives physically but also to support the mental and emotional recovery of soldiers, contributing to both individual wellness and overall force readiness.
Beyond the Headlines
The call for trauma-informed care in military medicine highlights a broader societal shift towards recognizing and addressing the psychological dimensions of trauma. This initiative could influence civilian medical training, particularly in emergency and critical care settings, by demonstrating the effectiveness of integrating psychological support with physical treatment. It also underscores the ethical responsibility of institutions to care for the complete well-being of their personnel, moving beyond a purely physical health model. The concept of 'moral injury,' often under-recognized in traditional medicine, is particularly significant, as it addresses the profound psychological toll of actions or inactions that violate one's moral code. By training medics to identify and respond to moral injury, the military could set a precedent for addressing complex psychological wounds that extend beyond typical PTSD, fostering a more compassionate and effective healthcare system for all. This approach acknowledges that healing involves both body and mind, and that early, integrated care is paramount.
