Naval Reserve Officers Training Corps Operational Stress Control Part 2

Objectives Review the common reactions to operational stress in self and others as identified in the Stress Continuum Model. Identify common barriers to successfully navigating stress. Identify methods or tools to help navigate stress. Define the steps involved in Combat and Operational Stress First Aid (COSFA). Identify resources to get help with stress.

Stress Continuum Model Stressor 3

Key Stress Indicators to Watch and Listen for Sources of Information Watch for: Listen for: Recent Stressors Stressors during deployment or training Personal or home-front stressors Levels of Distress Uncharacteristic and intense negative emotions Troubling thoughts like guilt or shame Key Indicators Level of Functioning Changes in job performance, self-care, or getting along with others Physical symptoms, sleep problems, or loss of self control

Operational Stress Control Decision Matrix OSC Decision Matrix Green Zone (Ready): Strengthen Sailors and command through tough, realistic training Build unit cohesion Monitor for signs of distress Are there signs of DISTRESS or LOSS OF FUNCTION? Distress or Loss of Function may include: Difficulty relaxing and sleeping Loss of interest in social or recreational activities Irritability, worry, or anger Cutting corners, lack of focus Any change from normal personality no yes Yellow Zone (Reacting) Ensure adequate sleep & rest Encourage/communicate/listen Do after-action reviews Refer to counselor, chaplain or medical if problems worsen Severe Distress or Loss of Function: Loss of interest in activities Can’t fall or stay asleep; persistent nightmares Social withdrawal; weight changes Loss of emotional control; numbness Panic / rage episodes Loss of concern for usual beliefs / values Substance abuse Is the DISTRESS or loss of function SEVERE? no yes Orange Zone (Injured): Keep safe and calm Rest & recuperation 24-72 hrs. Refer to counselor, chaplain, or medical Mentor back to full duty and function Has the distress or loss of function PERSISTED? Persistent Distress or Loss of Function: Stress problems that last after the stressful event of post-deployment period Stress problems that don’t get better over time Stress problems that get worse over time no yes Red Zone (Ill): Refer to medical Ensure treatment compliance Mentor back to duty if possible Transition to VA if necessary

Personal Experience with Stigma Have you ever had a personal problem you were afraid to tell anyone else about, even though telling the right person might have helped fix the problem, just because you felt embarrassed or ashamed about it? 6

Common Barriers to Navigating Stress Stigma Prejudice Stereotype Understanding

Common Barriers to Navigating Stress Internal Barriers Self Stigma External Barriers Unit or Command level Institutional Barriers Navy or DoD-wide policies

Methods or Tools to Help Navigate Stress Relaxation techniques Deep breathing Deep muscle relaxation Physical activity Stress-reducing activities

What Can You Do to Identify and Reduce Stressors? Identify the cause Monitor your moods Make time for yourself Walk away Set reasonable standards Analyze your schedule 10

Combat and Operational Stress First Aid (COSFA) Aims: Preserve life Prevent further harm Promote recovery Abilities: Quick assessment Matching response to need Ensuring further treatment

COSFA Continuous Aid Primary Aid Secondary Aid Seven C’s of Distress or loss of function due to stress Seven C’s of Stress First Aid Check and Coordinate Stressor COVER Primary Aid Check And Coordinate Check Assess and Observe 2. Coordinate Get help refer as needed 3. Cover Get to safety ASAP 4. Calm Relax, slowdown, refocus Connect Get support from others 6. Competence Restore effectiveness 7. Confidence Restore self esteem and hope CALM Continuous Aid Check and Coordinate CONNECT Secondary Aid Check And Coordinate COMPETENCE Check And Coordinate Continue to Check and Coordinate CONFIDENCE

COSFA Seven Cs Check and Coordinate Check and Coordinate Check And Continue to Check and Coordinate

Cover Continuous Aid Primary Aid Secondary Aid COVER Check and Coordinate COVER Primary Aid Check And Coordinate Continuous Aid Check and Coordinate Secondary Aid Check And Coordinate Check And Coordinate Continue to Check and Coordinate

Calm Continuous Aid Primary Aid Secondary Aid CALM Check and Coordinate Primary Aid Check And Coordinate CALM Continuous Aid Check and Coordinate Secondary Aid Check And Coordinate Check And Coordinate Continue to Check and Coordinate

Connect Continuous Aid Primary Aid Secondary Aid CONNECT Check and Coordinate Primary Aid Check And Coordinate Continuous Aid Check and Coordinate CONNECT Secondary Aid Check And Coordinate Check And Coordinate Continue to Check and Coordinate

Competence Continuous Aid Primary Aid Secondary Aid COMPETENCE Check and Coordinate Competence Primary Aid Check And Coordinate Continuous Aid Check and Coordinate Secondary Aid Check And Coordinate COMPETENCE Check And Coordinate Continue to Check and Coordinate

Confidence Continuous Aid Primary Aid Secondary Aid CONFIDENCE Check and Coordinate Confidence Primary Aid Check And Coordinate Continuous Aid Check and Coordinate Secondary Aid Check And Coordinate Check And Coordinate Continue to Check and Coordinate CONFIDENCE

COSFA Confidence Confidence 19

Ask for Help When: You feel trapped, like there's nowhere to turn. You worry excessively and can't concentrate. The way you feel affects your sleep, your eating habits, your job, your relationships, or your everyday life. 20

Where To Get Help Shipmates Family members Chain of Command Chaplains Medical staff member Student Counseling Center 21

Resources for Help Websites: Navy Operational Stress Control (OSC) blog (www.NavyNavStress.com) Navy & Marine Corps Public Health Center (www-nehc.med.navy.mil) The Naval Center for Combat and Operational Stress Control (http://www.nccosc.navy.mil) USMC COSC (www.usmc-mccs.org/cosc ) Navy Safe Harbor (www.npc.navy.mil/CommandSupport/SafeHarbor ) Military OneSource (www.militaryonesource.com) VA Centers (www.vetcenter.va.gov ) 22

Maintain Resources

Summary Now that you have completed this NROTC – OSC Module, you should be able to: Review the common reactions to operational stress in self. and others as identified in the Stress Continuum Model. Identify common barriers to navigating stress. Identify methods or tools to help navigate stress. Define the steps involved in Combat and Operational Stress First Aid (COSFA). Identify resources to get help with stress. If additional time is available, utilize supplemental COSFA scenarios. 24

Naval Reserve Officers Training Corps Scenarios

Scenario #1 A Sailor or Marine working on antennas in the superstructure of a ship suddenly becomes immobile and begins to shake and cling to whatever is nearby. Using your knowledge of COSFA, what actions would you take?

Scenario #1 cont. Possible actions you might take: Assess the situation. Call for assistance below. Use verbal encouragement to help the Sailor stay calm and decide what to do. If Sailor responds to voice commands, give the Sailor simple directions regarding how to get to a safe position. If necessary, physically assist the Sailor down from superstructure

Scenario #2 An intoxicated military spouse begins waving a kitchen knife while engaged in an angry dispute with her husband at home. How would you deal with this situation using COSFA?

Scenario #2 cont. Possible actions you might take: Calmly, but persistently, urge military spouse to put the knife down. If necessary, call the police to ensure safety.

Scenario #3 A Sailor with a significant Orange Zone life threat stress injury has recently returned to the command and has expressed concerns about his ability to perform his duties. What are some things the command can do to help reintegrate the sailor? 30

Scenario #3 cont. Apply elements of the COSFA model. Restore this individual’s competence and confidence. Restructure the Sailor’s work assignment and responsibilities. Gradually resume the Sailor’s responsibility for doing work that requires clear thinking, planning, and decision making. Continually reassess mental capacity and give the Sailor regular feedback on his or her progress. Mentor Sailor as needed.

Scenario 4: COSFA in Action