Combat Stress Conference

1. California’s Mobilization
Stress Prevention Program
Sheila Dominguez PhD
COL, AN, CAARNG
Guy C. Lamunyon MSN
MAJ, AN, CAARNG
California Army National Guard

2. Task Force Mercy
Combat Stress Control
STEPHEN M. WYMAN
Brigadier General (Ret)
Special Assistant to the Adjutant General
for Medical Readiness
California Army National Guard

3. Research Design
Sheila Dominguez PhD
COL, AN, CAARNG
Deputy State Surgeon
DETACHMENT 8
STATE AREA RESERVE COMMAND
MEDICAL DETACHMENT
OIC - Los Alamitos Physical Examination Station
California Army National Guard

4. Research Design
GOALS:
1. Prevention of acute combat stress
2. Prevent dysfunctional combat stress
behaviors (homicide, fratricide, torture, brutality,
mutilations, rape, looting, desertion, abuse sick call)
2. Prevention of long term consequences (PTSD)
3. Development of a soldier oriented stress scale
4. Contribute to the body of knowledge

5. Research Design
ASSUMPTIONS:
1. Available instruments to measure stress do not
consider unique needs of soldiers.
2. AMC Screening does not consider psychosocial
stressors.
3. A unique soldier oriented stress scale is necessary.
4. Frequent mobilizations provide adequate subjects for
development of a soldier oriented instrument.
5. Human subjects committee review is necessary.

6. Research Design
METHODS:
1. Literature Review
2. Study available stress instruments
3. Development of a soldier oriented stress scale.
4. Field testing (pilot)

7. Research Design
STRESS SCALES:
1. PreDeployment - 23 Questions
2. PostDeployment - 24 Questions

8. MOBILIZATION STATION
Camp Roberts SPR
Central Coast
Mobilization Site
Camp Roberts

9. Research Design
MOBILIZATION TOTALS:
Calguard 3,800
All California Reserve 13,500
All citizen-soldiers 223,000
(17 APR 03 – Press Democrat, Santa Rosa, CA)

10. Research Design
RESULTS: First Group
Total N = 439
Referred for further assessment = 9%
NO GO = 1 (one)

11. Research Design
RESULTS: Second Group
Total N = 270
Referred for further assessment = 34%
NO GO = 16%
(More media exposure –
less restrictive consent form)

12. Clinical Application
Guy C. Lamunyon MSN
Psych/Mental Health Nurse 66C
MAJ, AN, CAARNG
Personnel Officer (S-1)
DETACHMENT 8
STATE AREA RESERVE COMMAND
MEDICAL DETACHMENT
Clinic Manager
Los Alamitos Physical Examination Station
California Army National Guard

13. Background
Vietnam War:
* Jungle to living room in 3 days.
* Debriefing = none!

14. Clinical Application
THREE LEVELS
(similar to AMC)
1. Stress Scale Only
2. Mid-Level Review
3. Psychiatrist Consultation

15. AMC Screening
Annual Medical Certification
(unique to National Guard)
Level 1 - Medic/Corpsman
Level 2 - Mid-Level (PA, AN, NP)
Level 3 - MC (MD) (AR 40-501)

16. Stress Scale
Used as screening tool during Soldier Readiness
Processing (SRP)
Soldiers with high stress scores referred for mid-
level assesment by PhD, MSW, AN66C
Likert Type Scale (1 highly agree – 5 highly
disagree) and Yes-No responses

17. Referrals for Mid-
Level
Assessment
Review by medical NCO
Pattern of high response scores (3’s and 4’s)
Yes responses on Stress factors
Referral by Physical Examination Team

18. Mid-Level Assessment
Determine normal stress reactions
(Faking Good - False Negatives)
Exclude malingerers
(Faking Bad - False Positives)
Problem solving for psychosocial stressors
Refer soldiers with true pathology

19. Family Section (1-5)
1. I am satisfied with my/our current living situation.
2. I have a good network to get emotional support.
3. My family will cope well with 6-9 months of
activation.
4. My family will be able to meet their needs for food,
clothing, shelter, etc.
5. My family knows where to go for help for family
support, medical care, ID cards, PX, etc.
6. I am satisfied with childcare arrangements.

20. Army/Training Section (1-5)
7. I like my Army job.
8. I feel competent in my MOS.
9. I feel my skills are being utilized.
10. I enjoy being a member of the National
Guard.
11. I feel I will cope well with 6-9 months
activation.
12. I have been trained well enough to survive in
the field.

21. Economic Section (1-5)
13. I am satisfied that my employer will be fair
with me upon my return from mobilization.
14. I am satisfied my income will be adequate
upon mobilization.
15. I have adequate emergency savings.
16. My dependents will be able to access bank
accounts and do other financial transactions
during my mobilization.

22. Stress Section (Y-N)
17. I have had severe marital difficulties, or
separation, divorce or relationship breakup.
18. I have experienced serious injury or death in
my family or close relatives/friends.
19. I have legal actions pending.
20. I have been fired, laid off or have a recent job
change.
21. I have married.
22. I have moved.
23. There is a pregnancy or birth in my family.

23. Referrals for
Psychiatric
Evaluation
Determine Mobilization Status – (MOB)
Review/Revise Profile on S (Psychiatric)
Refer for Medical Board (MEB)
(AR 40-501)

24. Psychiatric Evaluation - MOB
Determines fitness for mobilization
according to Standards of Medical Fitness
(AR 40-501).
NO GO = Profile code V (Deployment).
This code identifies a soldier with restrictions
on deployment. Specific restrictions are noted
in the medical record.
NO GO = Profile of 3 or 4 on S (Psychiatric)

25. Psychiatric Evaluation – Profile on S
1 No psychiatric pathology. May have history of
transient personality disorder.
2 May have history of recovery from an acute
psychotic reaction due to external or toxic
causes unrelated to alcohol or drug addiction.
3 Satisfactory remission from an acute psychotic
or neurotic episode that permits utilization
under specific conditions (assignment when
outpatient psychiatric treatment is available or
certain duties can be avoided).
4 Does not meet the above. (AR 40-501)

26. Psychiatric Evaluation - MEB
3-31 Disorders with psychotic features
3-32 Mood disorders requiring extended or recurrent
hospitalizations, limitations of duty/performance
3-33 Anxiety, somatoform, or dissociative disorders requiring
extended or recurrent hospitalizations, limitations of
duty/performance
3-34 Dementia and other cognitive disorders
3-35 Personality, sexual and gender identity, or factitious disorders;
disorders of impulse control; substance- related disorders
3-36 Adjustment disorders – may be the basis for administrative
separation if recurrent and interfering with military duty
3-37 Eating disorders – unresponsive to treatment/interfering with
military duty. (AR 40-501)

27. Questions ? ? ?
Remember - everything rolls downhill
(don’t kill the messenger)
This PowerPoint and the Stress Scales
may be downloaded from:
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