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Phillip Gruzalski, Cathy Feltz and John Geier
IL-2 DMAT (MH Specialty Team)
17018 Connor Ct.
Tinley Park, IL 60477
National Disaster Medical System
On September 11, 2001 IL-2 as part of the National Disaster Medical System (NDMS) was put on alert. Two members were deployed to New York City on September 15 and remained until September 30. Their mission was to provide stress control to the FEMA Urban Search and Rescue Task Force (US&R-TF) teams working Ground Zero and billeted at the Javits Center. On September 28 another team member was deployed and was assigned to the Medical Examiner's Office to provide stress control to the DMORTs stationed there. He stayed until October 7. On September 29 the fourth member was deployed and provided stress control to a variety of workers in and around Ground Zero. He returned home on October 14. The service provided by IL-2 was stress control, which was modeled after the US military's Combat Stress Control (CSC).
The goal of CSC is to sustain the readiness and optimal capabilities of a unit's most valuable resource - its members. Extreme stress is a normal reaction to unusual and traumatic events of combat. CSC focuses on responding immediately to the individual's stress, having the expectation that overwhelmed members will recover, and keeping service personnel with their units. These principles were applied to various federal emergency teams at the site of the WTC.
What makes the use of CSC so applicable to civilian teams such as US&R, DMATs, medical specialty teams and DMORTS is that it is designed for teams that deploy over an extended length of time in dangerous or exhausting missions, where keeping experienced service members functioning in their duties is essential. The military demonstrated in WW I that the ratio of stress casualties to wounded in action (WIA) was reduced when psychiatric consults were available to advise the units on resting and restoring their temporarily exhausted members, and to restore those overstressed members who could not remain in their unit as close to that unit as possible. During WWII, " Forward Treatment" was again used by the Allies to cut the rate of stress casualties or Combat Fatigue. Forward Treatment with its four major components of immediacy, proximity, expectancy and simplicity (PIES) became a major component of combat behavioral health and was ultimately assimilated into civilian practice and community mental health through various crisis intervention models. CSC incorporates Forward Treatment with other proactive preventive interventions.
Successful application of CSC clearly mitigates the immediate negative impact of stress and restores functioning in the majority of services members. There is some evidence that it can also lessen long-term deleterious effects including PTSD, substance abuse, and Major Depression.
The assimilation of CSC was recognized as valuable by FEMA's US&R, and will now be incorporated in the next edition of their FOG. CSC has a wide variety of interventions suitable to cover the entire length of a deployment from readiness, to response, to recovery. It will fit well with any emergency team. The increased threat of terrorism and use of WMD underscores the need for adequate stress control for deployed and hospital base teams.
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