Center for the Study of Traumatic Stress
CSTS | Department of Psychiatry | Uniformed Services University | 4301 Jones Bridge Road, Bethesda, MD 20814-4799 | www.CSTSonline.org

Helping Military Personnel WhoExperience Work-Related Trauma Exposure:
Recommendations for Military Leaders
Many people are exposed tosevere responses can include
The
recommendations…
describe
actions
trauma at some time in their life.
psychological disorders, such as
Service members (SMs) may be
depression, anxiety, PTSD, andmilitary leaders can take to help personnel
repeatedly exposed to trauma in bothcomplicated grief.
before, during, and after occupational
combat and non-combat settings.
The military has a culture ofexposure to trauma.
Their exposure may be throughpride in being able to withstanddirectly witnessing an event, suchtrauma exposure and not seek
as the death of a unit member, orsupport. Military leaders can help
by hearing someone re-tell distressing events. It may also
by debunking myths and encouraging support at all levels,
occur through exposure to the media, such as photographs,
while maintaining performance and accountability, toaudio, or video, or a combination of these. More distressing
promote health and operational readiness. Leaders can help
trauma of longer duration and repeated exposure canSMs who are repeatedly exposed to occupational trauma
increase the risk for adverse effects, which negatively impact through education, training, modeling, and support using
interpersonal relationships and operational readiness.
evidence-based early interventions. These interventions,
Adverse effects of occupational exposure to trauma
called Psychological First Aid (PFA), include enhancing
include distress reactions (insomnia, anger, guilt,
a sense of: 1) safety, 2) calming, 3) individual and unit
scapegoating, anxiety, and decreased perception of safety)
efficacy, 4) unit cohesion, and 5) hope/optimism.
and risky behaviors (increased alcohol and tobacco use,
The recommendations below, based on PFA principles,social isolation and restricted activities, and reduced selfdescribe actions military leaders can take to help personnel
care behaviors). In the unit, lost productivity, absenteeism,before, during, and after occupational exposure to trauma.
and distractibility may also occur. Prolonged and more
BEFORE
Being prepared (mental, physical, and equipment) helps
SMs focus on the task at hand.
1. Obtain information about anticipated trauma exposures(risk analysis).
2. Provide adequate protective equipment and ensure SMs
understand their purpose and proper use.
3. Determine minimum required exposure to performessential tasks.
4. Train SMs about expected trauma exposure and normal
reactions: insomnia, anger, boredom, decreased feelingsof safety, guilt, and helplessness.
5. Educate SMs to monitor for difficulties and when to get
help: persistent difficulty with sleep, increased problems
at home or work, reduced self-care, and thoughts ofharming self or others.

DURING
Efforts to limit the intensity and duration of exposure
to trauma decrease adverse effects. Identifying problems
early and providing prompt and effective interventions canprotect operational performance and overall readiness.
1. Foster buddy-care where SMs support and regularly
check-in with one another.
2. Model self-care, including adequate sleep, hydration,nutrition, stress management, and exercise.
3. Encourage help-seeking, such as taking a break ortalking to someone.
4. Monitor and adhere to exposure limits. Reduce
exposure or temporarily remove those showing
significant adverse effects from further exposure.
5. Conduct team check-ins to enhance cohesion, discusschallenges, dispel misconceptions, and informally assess
personnel.
Continued

6. Use breaks or brief team huddles to facilitate peer
support.
7. Directly encourage and facilitate help-seeking for SMs
having persistent or increasing difficulties at work.
8. When particularly shocking or disturbing exposuresoccur, anticipate, validate, and respond supportively togrief and other distress reactions.
9. Use effective communication strategies: say what isknown and unknown, commit to getting answers when
there is uncertainty, follow through and keep promises,
avoid false reassurances, and always tell the truth. Good
communication builds trust and decreases rumors.
AFTER
Adverse effects of trauma exposure may not be seen
until after the stress of operations are over. Self- andbuddy-aid are important first-line interventions. Screening
and referral are helpful for those with significant problems
or impairment.
1. Remind personnel about normal and expectable
reactions to trauma as well as common patterns ofrecovery.

2. Communicate the value and benefits of buddy-care inmaintaining well-being and recovery.
3. Ensure personnel have access to resources (healthcare,family support, and financial assistance).
4. Continue informal check-ins with SMsl. If concerns
arise, seeking additional information, when possible,from unit members, family, or friends may help inunderstanding.
5. Create opportunities for informal social interactions(coffee and donuts, etc); these can strengthen unit
cohesion and promote informal buddy-care.
6. Engage support programs or other resources for moreformal assessment measures to help SMs struggling
in silence. Offering leadership support and referral totreatment can encourage SMs to seek assistance who
might otherwise feel stigmatized.
ADDITIONAL RESOURCES
Fact sheets to help leaders prepare for and respond tocrisis and disaster events:
https://www.cstsonline.org/fact-sheet-menu/leadershipCenter for the Study of Traumatic Stress
Department of Psychiatry
Uniformed Services University
4301 Jones Bridge Road, Bethesda, MD 20814-4799
www.CSTSonline.org