Chapter XI: Section V: Combat Operational Stress Control

5-20. General

When operating under the threat of or under actual NBC conditions, soldiers will be at a high risk of suffering combat operational stress-related conditions. The invisible, pervasive nature of these weapons creates a higher degree of uncertainty and ambiguity, presenting fertile opportunities for false alarms, mass panic, and other maladaptive stress reactions. Therefore, commanders and leaders must take actions to prevent and reduce the numbers of combat operational stress cases in this environment. The symptoms and physical signs caused by excessive stress are similar to some signs of true NBC agent injury. In World War I, inexperienced units initially evacuated two stress cases for every one true chemical casualty. Some minor chemical casualties also had major stress symptoms. Therefore, far forward triage is essential to prevent over evacuation and loss of the individual to the unit. For details on provision of COSC see FM 8-51 and FM 22-51.

5-21. Leadership Actions

_a._ _Keep Personnel Informed of the Situation._ Keep information flowing, dispel myths, and control rumors by--

· Discussing the situation and its possible long-term
implications honestly.

· Maintaining the perspective that the best chance for mission
accomplishment is assured when the unit and the Army stays
mission focused.

_b._ _Train Soldiers to Survive._ Use training procedures that--

· Tell the lessons of history on NBC weapons employment. Show
that the enemy's use of NBC weapons/agents will not give him
enough advantage to justify the risk to his forces.

· Increase the chance of surviving and winning should the enemy
use NBC weapons/agents.

· Emphasize the buddy system as a means of keeping watch
for each other. Personnel must always seek buddy aid before
taking additional antidotes. This will reduce the numbers of
individuals using their antidotes when not needed; and prevent
the increased heat stress caused by the effects of atropine on
the body's cooling capabilities.

_c._ _Put Nuclear, Biological, and Chemical Defense in Realistic Perspective._ Continuously strive to maintain a realistic perspective in the unit by--

· Comparing the risks of the threat with the increased risk
of facing the conventional threat in varying levels of MOPP.
The decision to initiate a MOPP level should be like deciding
how much cover is needed to protect a unit from conventional
weapons.

· Choosing the lowest MOPP level that protects the unit, yet
permits accomplishment of the mission. Do not try to be 100
percent safe from chemical attack if it means that there is--

· Only a small chance of mission accomplishment.

· A high probability of being killed by the enemy.

· A high personnel loss due to heat injury.

_d._ _Train in the Protective Mask._ Train in the protective mask often. It takes repeated wear and time to acclimate and get over the claustrophobic feeling of wearing the mask. The training can be conducted during a variety of activities.

· Have personnel wear the mask often in garrison or during
lulls in other activities, even at desk jobs. If on average,
one person in five wears the mask, on a rotational basis, at
any given time, everyone will quickly become accustomed to
wearing it.

· Periodic prolonged wear (8 hours or more) helps soldiers gain
confidence and realize that they can tolerate the discomfort.

· Have personnel wear the mask while performing combat-related
(mission essential) tasks.

_e._ _Train in Mission-Oriented Protective Posture Level 4._ Training in MOPP Level 4 (or simulated MOPP 4, which is to overdress while wearing the protective mask, overboots, and gloves) will increase personnel confidence in their ability to wear the ensemble.

_f._ _Ensure Sleep Plans are Safely Practiced._ Have everyone practice wearing the mask while sleeping. Ensure personnel only sleep in safe places; do not allow personnel to sleep under or near vehicles or other motorized machinery. Require ground guides for all vehicles in the unit bivouac area. Ensure that each individual get at least 4 hours of uninterrupted sleep during every 24-hour period, mission permitting (See FM 21-10).

5-22. Individual Responsibilities

_a._ _Follow Orders._ By following orders, individuals can increase their ability to cope with and prevent combat operational stress-related conditions. Coping with the stresses of an NBC environment requires extra individual action. Concentrate on the positive aspects of survival, not the negatives of illness or death.

_b._ _Train._ Use every opportunity to wear the protective mask or the entire MOPP ensemble during training, when permitted. You build self-confidence and endurance by frequently training with your protective mask, or at MOPP Level 4. Perform refresher training in basic NBC survival skills.

_c._ _Use Buddy System._ Use the buddy system to increase your ability to survive. Service members looking out for each other give a sense of security that relieves stress. Looking out for each other improves every individual's ability to perform his duties.

5-23. Mental Health Personnel Responsibilities

_a._ _Staffing for Combat Operational Stress Control._ Combat operational stress control is provided by the following activities or units:

· Brigade mental health section.

· Division mental health section.

· Area support medical battalion mental health section.

· Neuropsychiatric ward and consultation service of each CSH,
field hospital, and general hospital.

· Medical detachment, COSC.

· Medical company, COSC.

_b._ _Conduct Preventive Activities._ In an NBC environment, prevention is the most economical means of controlling combat operational stress reactions. Mental health personnel must begin consultation services before NBC weapons/agents have been employed.

_c._ _Control Stress Reactions._ Individuals with combat operational stress reactions require prompt intervention. The evaluation of over-stressed personnel is difficult but not impossible when both the soldier and the evaluator are in MOPP. The primary method of mental health evaluation is the interview and mental status examination. For details on controlling stress reactions, see FM 8-51.