by Douglas Stutz
Naval Hospital Bremerton
February 12, 2019
As long as Sailors have sailed the Seven Seas, there has been times of stress, struggle and strain.
Just as noticeable wounds, visible injuries and obvious impairments can bring such tension, so too can hidden concern, mounting pressure, and overwhelming anxiety.
All that stress, struggle, and strain – internally as well as externally - can upset the ballast and balance of even the best.
To help right the ship(s), Navy Medicine has long advocated Tactical Combat Casualty Care (TCCC) training to help prepare Sailors and Marines – externally - for being deployed in a combat environment from shore to the Seven Seas and beyond. Sailors need to know the necessary techniques, abilities and knowledge to conduct rapid emergency medical support and evacuation.
Navy Medicine is also using that same principle to provide Caregiver Occupational Stress First Aid training specifically aimed – internally - to prevent stress-related injury and illness for approximately 63,000 Navy Medicine personnel and support their ability to render safe, quality patient care.
“The concepts of Caregiver Occupational Stress First Aid (COSFA) are derived from the combat equivalent, with aspects falling within the categories of continuous, primary and secondary aid,” explained Cmdr. William Hlavin, Naval Hospital Bremerton Command Chaplain.
COSFA is a key component of Caregiver Occupational Stress Control (CgOSC), a Navy Medicine initiative established to address stress reactions and injuries in health care providers. As a flexible multi-step process, COSFA helps provide timely assessment and preclinical care of psychological stress injuries in individuals as well as units with the goal to preserve life, prevent further harm, and promote recovery.
COSFA is a pre-clinical peer intervention strategy based on the assumption that peers will likely seek out peers for help, and is comprised of the 7Cs: check, coordinate, cover, calm, connect, confidence and competence.
“For example, COSFA is a tool that allows the peer responder to help establish a sense of calm, connect those in need with helping resources and enable their return to the work place competence, confidence, and new connections,” Hlavin said.
For Hospital Corpsman 1st Class (Fleet Marine Warfare) Omar Garcia-Argueta, enrolling in CgOSC has given him the opportunity to improve his stress management skills and leadership ability in caring for his Sailors, as well as patients.
“The training was great. We spent the day learning about stress management methods so that we can use ourselves or help out those around us. The most important aspect of the training was the lesson on resiliency. We might not be able to avoid stress, but we can become more resilient in order to change our perspective and thrive during stressful situations,” said Garcia-Argueta, noting that in hindsight, the course would have improved his listening skills in the past to help others who were going through a tough time.
“What I mean by helping people who were having a tough time is the times when Marines would come to me when they were having personal problems,” continued Garcia-Argueta, who served as senior line corpsman for India Company, 3rd Battalion, 3rd Marines out of Kaneohe Bay, Hawaii, 2013-2016. “If I would have known then what I know now, I would’ve been a better listener and would have been better at promoting stress management techniques. I would definitely say that the skills learned in CgOSC resemble a first-aid tool for stress in the work environment. These skills equip peers with the knowledge to help out co-workers who need help.”
“This is a movement that invites and equips people to become agents of change in the places where they work for the sake of wellness. It’s people with passion that transform organizations and cultures. We owe it to each other to create a healthy community, so we’re inviting people with heart and passion into this movement,” exclaimed Hlavin.
In 2010, Navy Medicine patterned CgOSC after a 2007 Department of Defense focus study to enhance the psychological health of the U.S. military by providing command climate(s) of support, continuum of care, appropriate, time resources and visible, empowered leadership. Doctors, nurses, corpsmen and support staff with stress-related injuries and illness could lead to medical errors, mental and emotional difficulties and poor judgement if not addressed.
According to Hlavin, providing this training was prompted in part by a recent command Defense Equal Opportunity Climate Survey that indicated a rise in staff stress and increased incidents of staff burnouts.
“The idea was to create a tool for prevention of stress related injuries and illness and a mechanism for intervention when injury and illness happen. Stress often comes from some adjustment in the work environment,” said Hlavin.
Hlavin attests that whether it’s a sea change or a surgical site alteration, any variation from the norm can impact anyone.
“Change is the one constant in a healthcare setting with such issues as patient access to care. Change upsets a delicate balance and imbalance creates stress,” Hlavin said.
NHB has 37 staff members – and 15 instructor trainers - who have attended Peer First Responder training, a one-day course that centers on understanding the role of peer-helping relationships, dynamics and effects of caregiver occupational stress, building the resilience needed, along with promoting and practicing stress first aid. The course will be conducted quarterly.
“We're a small team, but growing exponentially. Staff members routinely express interest in joining the team and a desire to help their peers deal with the effects of stress. The most telling evidence of implementation is a new level of conversation about stress and resiliency taking place command-wide. I believe the CgOSC movement has had something to do with that new level of conversation, and will have a great deal to contribute to the solutions as the movement continues to grow and evolve with wellness as the goal,” Hlavin said.
As part of Navy Medicine, NHB continues to provide stress control ballast and balance across the Seven Seas – Arabian Sea, Atlantic Ocean, Bay of Bengal, Mediterranean Sean, Persian Gulf, Red Sea, South China Sea –to help those in need, internally as well as externally.