Battle Fatigue
*GTA 21-3-5
Warning Signs: Leader Actions

Headquarters
Department of the Army,
Washington, D.C.,

Controlling Battle Fatigue Is Basic Good Leadership
To accomplish your team's mission in combat, in either low or high intensity conflict, you must help your soldiers to withstand the extreme stresses of war. Tough, realistic training will help a lot, but in war, real enemies will be trying to kill you or stress you until you break. Winning may require your team to push continuously, under terrible conditions, to limits far beyond those you've ever reached before. At other times you may face only tension, waiting, loneliness, and boredom.

Whether your unit has a combat, combat support, or combat service support mission, your soldiers (and you) may still have battle fatigue. This can happen even when not under direct attack. Physical and mental signs of normal, common battle fatigue and how to live with them are outlined in GTA 21-3-4 (Battle fatigue: What To Do for Self & Buddy). You, as leader, need to teach that. You also need to know the warning signs and leader actions outlined here.

Normal, Common Signs Of Battle Fatigue (Review)
Battle Fatigue is a natural result of heavy mental/emotional work facing danger in tough conditions. Like physical fatigue it depends on the level of fitness/training, it can come on quickly or slowly, and it gets inner with rest and replenishment The following are normal common signs of battle fatigue (Note: Many soldiers have these signs yet still function normally):

• Tension head and back ache, trembling, tumbling, jumpiness

• Pain in old healed wounds before combat.

• Pounding heart; may breathe too rapidly

• Upset stomach (may vomit), diarrhea, frequent urination

• Emptying bowels and bladder at instant of danger.

• Fatigue weariness, distant haunted ("1000 yard'') stare

• Anxiety worrying, irritability, swearing, complaining.

• Awakened by bad dreams: grieving, feeling guilty.

• Anger at own team; losing confidence in self/unit.

Warning Battle Fatigue Signs
Warning signs deserve special action but do not necessarily mean casualty must be evacuated. Even normal, common signs become warnings if:

• They still disrupt the mission after you take action

• They don't improve somewhat after good rest

• Soldier is acting very differently from his/her normal behavior.

Warning Physical Signs

• Can't keep still, constantly moving around

• Flinching or ducking at sudden sounds and movement

• Shaking (of arms or whole body): cowering in terror.

• Body part(s) or sensory organ(s) won't work with no physical reason.

• Prolonged, total immobility

• Physical exhaustion; slowed down, just stands or sits

• Vacant stare, "spaced out," staggers, sways when standing.

Warning Mental/Emotional Signs

• Rapid talking, constantly making suggestions

• Arguing; starting lights; deliberately reckless action.

• Inattention to self-care, hygiene: indifference to danger.

• Memory loss.

• Severe stuttering, mumbling; can't speak at all.

• Afraid to fall asleep; unable to stay asleep.

• Seeing/hearing things which aren't really there

• Rapid emotional shifts; crying spells; wishing for death.

• Social withdrawal silent or sulking prolonged sadness

• Apathetic; no interest in food or anything else

• "Hysterical" outburst, frantic or strange behavior.

• Panic running under fire; freezing under fire.

Leader Actions For Common (And Warning) Battle Fatigue

• Set example of being in control while feeling normal fear

• Remind everyone that BF is normal--others (even you!) have it, too.

• Know your job well; keep team focused on mission, get everyone to think and talk about succeeding

• Stay in touch with team members, leader, and other teams.

• Keep everyone informed:

  • Explain situation and objectives.

  • Don't hide unpleasant possibilities but put them in perspective of how the team will handle them

  • Tell what is expected, but prepare team for unexpected.

  • Explain reversals and delays in support positively

  • Control rumors; get true facts from your leaders.

  • Allow team members to vent fears, feelings.

• Rotate soldiers' jobs when you can. (May need to cross-train).

• Assign easy tasks to soldiers showing BF.

• Assure best possible medical aid and rapid evacuation of wounded (and

• respect for dead)

• When tactical mission and safety permit have team:

  • Drink from canteens; prepare hot or cool drinks

  • Pass around snacks; prepare food and share it.

  • Dry off, cool down, or warm up when needed

  • Clean up; change clothes; clean weapons.

  • Use rapid relaxation techniques to unwind

  • Stay away from alcohol/drugs.

  • Keep busy (maintenance, recreation) if not resting.

• Provide sleep opportunities for everyone (even you) according to SOP:

  • Safe from accidents, vehicles, enemy attack.

  • 4+ hours if possible (6- 10+ hrs ideally)

  • Even 15-30 min. catnaps help, but may be groggy upon awakening.

• "Debrief" the unit after a hard action to:

  • Have everyone tell what they saw and did.

  • Reconstruct and agree on what really happened

  • Resolve any misunderstandings and mistrust

  • Let feelings be expressed and accepted as normal

  • Focus positively on lessons learned.

• Get soldier with home front problems to talk them out watch reactions after mail call; give emotional support.

Leader Actions For Warning Battle Fatigue Signs

• If soldier's behavior endangers the mission, self, or others, do whatever you must to control him or her,

  • If soldier is upset, calmly try to talk him/her into cooperating

  • If concerned about soldier's reliability, unload soldier s weapon: take weapon away if seriously concerned.

  • Physically restrain soldier only when necessary (safety/transportation).

• Reassure everyone that signs will probably improve quickly with rest.

• (Even seemingly serious BF can improve in minutes if handled correctly).

• If warning signs continue:

  • Get soldier to a safer place alert senior NCO or officer.

  • Don't leave alone; keep with someone known to soldier.

  • Have medic examine, especially if there could be a physical cause.

• If your leader and medic decide soldier doesn't need to be sent away for rest/medical exam (or can't be):

  • Treat same as for normal, common signs.

  • Warm soldier if weather cold, cool soldier if weather hot.

  • Ensure soldier eats, drinks, and sleeps (4 to 12 + hr).

  • Encourage soldier to talk in team debrief; give support.

  • Assign soldier to group tasks he/she can do well.

  • Reassign to full duty and responsibility when able.

  • Have leader or medic check again if no improvement.

• If your leader or medic decides to send soldier for rest in a

• supporting unit or to be checked by a physician:

  • Tell soldier you are counting on him/her to get rested and return.

  • Encourage teammates to express trust and confidence.

Leader Actions For "Rest" Battle Fatigued Soldier (Sent To Your Unit For Rest)

• Integrate into your unit as a newcomer:

  • Evaluate, give orientation, introduce to everyone.

  • Assign buddies (pick good listeners), get gear (or share).

  • Assign to work details include in recreation.

  • Encourage soldier to talk about experiences.

  • Provide food, sleep, hygiene opportunities

• Maintain expectations of return to own unit.

• If soldier doesn't improve or shows more warning signs, tell NCO or senior officer and send for medical evaluation. 

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Operational Medicine 2001

Health Care in Military Settings

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