Medical Deployment Resilience Study
Alan L. Peterson, PhD, ABPP (Lt Col, US Air Force, Ret.)
Conduct a prospective evaluation of PTSD risk, resilience, natural recovery, and posttraumatic growth in medical personnel deployed to work at a combat theater hospital in Iraq; identify causative and protective factors and make recommendations on actions and training that can be used by the military to enhance resilience among its members.
Why do medical personnel respond differently after exposure to traumatically injured medical patients? What conditions influence why one person remains resilient through the experience, one seems psychologically "wounded" at first but then grows even stronger after a natural recovery period, and one develops posttraumatic stress disorder?
Particularly for our military medical personnel, what kinds of contributing or protective factors are somewhat within the military's control? The military has no influence over a person's genetic make-up or past life experiences, but are there things it can do proactively-such as team-building to strengthen unit cohesion, types of pre-deployment training, or other internal processes, programs, and procedures-that can enhance service members' resilience and help prevent psychological problems such as PTSD?
The study's purpose
These are all questions being asked in a STRONG STAR-affiliated study led by Lt Col (Ret) Alan Peterson, PhD, of The University of Texas Health Science Center at San Antonio, who serves as the principal investigator for the Air Force-funded "Medical Deployment Resilience Study." Dr. Peterson actually initiated the study without funding in 2004 when he was still active duty with the U.S. Air Force. With his collaborators within the Air Force, at Harvard University, and at the VA's National Center for PTSD in Boston, he greatly enhanced study efforts with a grant in 2007 from the U. S. Air Force Operational Medicine Research Program.
The purpose of the study is to conduct a prospective evaluation of risk, resilience, natural recovery, and posttraumatic growth in medical personnel deployed to work at a combat-theater hospital in Iraq. Medical personnel at this location are often exposed to patients with severe traumatic injuries, mass casualties, human remains, and risk of personal injury from attacks by rockets, missiles, and snipers.
Currently, little is known about the effects of this type of high-stress/high-risk environment on military medical personnel, although previous, retrospective studies of military nurses who worked in combat hospitals in Vietnam found rates of PTSD at levels similar to those of Vietnam combat veterans.
How it works
This study is the first large-scale, prospective evaluation of the impact of deployment on Air Force medical personnel. It involves all active- duty Air Force medical personnel since 2004 who have deployed from Wilford Hall Ambulatory Surgical Center, Lackland AFB, to serve as part of the 332 Expeditionary Medical Group (EMDG), as well as Air Force medical personnel from other bases who process through Lackland's Deployment Processing Center to serve in Iraq with the 332 EMDG.
All personnel who volunteer for the study-more than 1,000 to date-are surveyed on five separate occasions: pre-deployment, mid-deployment, one month post-deployment, six months post-deployment, and 12 months post-deployment.
These anonymous surveys contain questions about previous exposure to traumatic life events; PTSD symptoms; health care stressors unique to deployed military settings; general military attitudes and experiences; attitudes and beliefs about working with Iraqi patients; anxiety; depression; resilience; and posttraumatic growth. Some participants also are being recruited when they return to Lackland to voluntarily participate in focus groups. These groups discuss their deployment with investigators and provide direct feedback on both positive and negative experiences during deployment, as well as suggestions for improving the deployment experience.
Together, the surveys and focus groups are allowing investigators to do the following:
- Identify factors that are related to increased risk for the development of PTSD, such as exposure to specific types of medical trauma patients and injuries;
- Evaluate protective factors that are related to resilience, which can be the focus of future studies targeting programs to increase resilience prior to deployment;
- Evaluate the course of natural recovery in individuals who initially show symptoms of PTSD or its precursor, acute stress disorder, but recover without any formal intervention;
- Evaluate the impact of work with Iraqi patients in order to allow for improved training programs for military medical personnel.
Study findings have already resulted in over 20 scientific presentations and publications and are expected to help the military enhance resilience and reduce psychological distress among military medical personnel. These findings also have implications for the deployment of civilian medical personnel who are sent to provide health care after terrorist attacks or natural disasters.