i FM 8-51 ii FM 8-51 iii FM 8-51 iv FM 8-51 V C 1, FM 8-51 Page APPENDIX D. THE GENEVA CONVENTIONS AND COMBAT STRESS- RELATED CASUALTIES........................................................ D-1 D-1. Special Relevance to Medical Combat Stress Control ........................... D-1 D-2. Special Considerations for Medical Combat Stress Control Activities........ D-1 D-3. The Law of War........................................................................ D-5 D-4. Protection of the Wounded and Sick................................................ D-6 D-5. Protection and Identification of Medical Personnel............................... D-9 D-6. Protection and Identification of Medical Units and Establishments, Buildings and Material, and Medical Transports............................... D-10 D-7. Loss of Protection of Medical Units and Establishments........................ D-12 D-8. Conditions Not Compromising Medical Units and Establishments of Protection.............................................................................. D-13 «APPENDIX E. MEDICAL REENGINEERING INITIATIVE FOR MENTAL HEALTH AND COMBAT STRESS CONTROL ELEMENTS IN THE THEATER OF OPERATIONS ................................................. E-1 Section I. Overview of Changes................................................................. E-1 E-1. Unit Mental Health Sections.......................................................... E-1 E-2. Combat Stress Control Units ......................................................... E-2 Section II. Unit Mental Health Sections in the Theater of Operations.................. E-5 E-3. Location and Assignment of Unit Mental Health Sections ...................... E-5 E-4. Utilization in Garrison................................................................. E-5 E-5. Division Mental Health Sections..................................................... E-6 E-6. Area Support Medical Battalion Mental Health Sections........................ E-11 E-7. Mental Health Personnel in the Armored Cavalry Regiments and Separate Brigades.................................................................... E-15 Section III. Combat Stress Control Company ................................................. E-15 E-8. Medical Company, Combat Stress Control (TOE 08467A000) ................ E-15 E-9. Headquarters Section .................................................................. E-17 E-10. Combat Stress Control Preventive Section......................................... E-22 E-11. Combat Stress Control Fitness Section ............................................. E-25 Section IV. Combat Stress Control Detachment .............................................. E-30 E-12. Medical Detachment, Combat Stress Control (TOE 08567AA00)............. E-30 E-13. Detachment Headquarters............................................................. E-31 E-14. Preventive Section...................................................................... E-34 E-15. Combat Stress Control Fitness Section ............................................. E-36 v C 1, FM 8-51 Page GLOSSARY..................................................................................................... Glossary-1 REFERENCES ................................................................................................. References-1 INDEX............................................................................................................ Index-1 PREFACE This field manual (FM) establishes medical doctrine and provides principles for conducting combat stress control (CSC) support operations from forward areas to the continental United States- (CONUS) based medical facilities. This manual sets forth tactics, techniques, and procedures (TTP) for CSC units and elements operating within the theater of operations (TO). This TTP is applicable to operations across the operational continuum. It is important that the users of this manual be familiar with FM 22-51. This manual supports the Army Medical Department(cid:146)s (AMEDD) keystone manual, FM 8-10. Readers should have a fundamental understanding of FMs 8-10-3, 8-10-5, 8-10-6, 8-10-8, 8-10-14, 8-10-24, 8-42, 8-55, 63-20, 63-21, 100-5, and 100-10. The staffing and organizational structure presented in this publication reflects information in the most current living tables of organization and equipment (TOE) as of calendar year 1993. However, staffing is subject to change to comply with manpower requirements criteria outlined in AR 570-2. Your TOE can be subsequently modified. «The Medical Reengineering Initiative (MRI) update has been added to this publication as Change 1, Appendix E. Organizational changes to CSC elements as a result of MRI were incorporated into the A-series TOE. CSC elements will convert from the L-series to the A-series TOE in the near future based on Department of the Army (DA) timelines. This publication is in agreement with the American, British, Canadian, and Australian (ABCA) Quadripartite Standardization Agreement (QSTAG) 909, Principles of Prevention and Management of Combat Stress Reaction, Edition 1. «The proponent of this publication is the United States (US) Army Medical Department Center and School (AMEDDC&S). Send comments and recommendations on DA Form 2028 directly to Commander, AMEDDC&S, ATTN: MCCS-FCD-L, 1400 East Grayson, Fort Sam Houston, Texas 78234-6175. Unless this publication states otherwise, masculine nouns and pronouns do not refer exclusively to men. Use of trade or brand names or trademarks in this publication is for illustrative purpose only, and does not imply endorsement by the Department of Defense (DOD). vi FM 8-51 PREFACE This field manual (FM) establishes medical doctrine and provides principles for conducting combat stress control (CSC) support operations from forward areas to the continental United States- ( CONUS) based medical facilities. This manual sets forth tactics, techniques, and procedures (TTP) for CSC units and elements operating within the theater of operations (TO). This TTP is applicable to operations across the operational continuum. It is important that the users of this manual be familiar with FM 22-51. This manual supports the Army Medical Department’s (AMEDD) keystone manual, FM 8-10. Readers should have a fundamental understanding of FMs 8-10-3,8-10-5,8-10-6, 8-10-8,8-10-14,8-10-24, 8-42,8-55,63- 20, 63-21, 100-5, and 100-10. The staffing and organization structure presented in this publication reflects information in the most current living tables of organization and equipment (TOE) as of calendar year 1993. However, staffing is subject to change to comply with manpower requirements criteria outlined in AR 570-2. Your TOE can be subsequently modified. This publication is in agreement with the American, British, Canadian, and Australian (ABCA) Quadripartite Standardization Agreement (QSTAG) 909, Principles of Prevention and Management of Combat Stress Reaction, Edition 1. The proponent of this publication is the United States (US) Army Medical Department Center and School (AMEDDC&S). Send comments and recommendations on Department of Army (DA) Form 2028 directly to Commander, AMEDDC&S, ATTN: HSMC-FCD, Fort Sam Houston, Texas 78234-6123. Unless this publication states otherwise, masculine nouns and pronouns do not refer exclusively to men. Use of trade or brand names or trademarks in this publication is for illustrative purpose only, and does not imply endorsement by the Department of Defense (DOD). vi FM 8-51 CHAPTER 1 CONTROL OF COMBAT STRESS 1-1. Stress Control Stress is one of the body’s processes for dealing with uncertain changes and danger. Elimination a. Control of Stress. In one’s own of stress is both impossible and undesirable in soldiers and in the soldiers of the enemy, control the Army’s peacetime or combat mission. of stress is often the decisive difference between victory and defeat across the operational con- tinuum. Battles and wars are won more by 1-2. Combat Stress Threat controlling the will to fight than by killing all of the enemy. Soldiers that are properly focused by a. Stressors in Combat. Many stres- training, unit cohesion, and leadership are most sors in a combat situation are due to deliberate likely to have the strength, endurance, and alert- enemy actions aimed at killing, wounding, or ness to perform their combat mission. In these demoralizing our soldiers and our allies. Other soldiers, combat stress is controlled and positive stressors are due to the natural environment. combat stress reactions, such as loyalty, self- Some of these stressors can be avoided or lessness, and acts of bravery, are more likely to counteracted by wise command actions. Still occur. However, uncontrolled combat stress other stressors are due to our own calculated or causes erratic or harmful behavior, impairs miscalculated choice, accepted in order to exert mission performance, and results in disaster and greater stress on the enemy. Sound leadership defeat. works to keep these within tolerable limits and prepares the troops mentally and physically to b. Responsibility For Stress Control. endure them. Some of the most potent stressors Control of stress is the commander’s responsibility can be due to personal or organizational problems (see FM 22-51) at all echelons. The commander in the unit or on the home front. These, too, is aided in this responsibility by the noncom- must be identified and, when possible, corrected missioned officer (NCO) chain of support; the or controlled. See FMs 8-10, 8-10-8, and 22-51 chaplaincy; unit medical personnel; general, for additional information on the overall threat, principal, and special staff, and by specialized medical threat, and combat stress threat. Army CSC units and mental health personnel. b. Stress Casualties. The combat stress c. Control or Management. The word threat includes all those stressors (risk factors) control is used with combat stress (rather than which can cause soldiers to become stress the word management) to emphasize the active casualties. Stress casualties include— steps which leaders, supporting medical per- sonnel, and individual soldiers must take to keep Battle fatigue (BF) cases which stress within an acceptable range. This does not are held for treatment at medical treatment mean that control and management are mutually facilities (MTFs) for more than a day. exclusive terms. Management is by definition the exercise of control. Within common usage, Misconduct stress behaviors however, and especially within Army usage, cases that have committed breaches of discipline management has the connotation of being a which require disciplinary confinement. somewhat detached, number-driven, higher echelon process rather than a direct, inspi- Post-traumatic stress disorder rational, and leadership-oriented process. Control (PTSD) cases which disable the soldier for months of stress does not imply elimination of stress. or years after the battle. 1-1