Combat and Operational Stress First Aid (COSFA)
There's an APP for that!!!
Current combat and operational demands on the all-volunteer force coupled with occupational challenges for members of Guard and Reserve increases the risk of stress injuries for service members and their families. Historically, military forces have been considered either fit for duty and fully deployable or ill and needing medical treatment. Military leaders have the skills and knowledge to support fit service members and military/VA healthcare provides for those who are ill. One of the major challenges is to provide leaders and unit level caregivers with the knowledge and tools to recognize when a service member is injured; temporarily non-mission ready and not ill. There are well-established first-aid interventions and leader guidance for physical injuries and short-term illnesses. There has been a gap in knowledge, skills and procedures for psychological first-aid and short-term stress injuries.
In 2007, Congress provided focused funding for a broad range of psychological health and traumatic brain injury initiatives. The Department of the Navy invested in strategies to address the stress injury gap. This unit led and medical supported program has three major elements. First is a stress continuum that provides a green to red color-coded framework for leaders, service members, family members, and caregivers to recognize and talk about the injury behaviors that are between ready for duty and ill. Within the stress continuum, there are four sources of orange zone stress injuries; Trauma and life threat, Loss and grief, Moral and ethical dilemmas, and Fatigue.
The second element is called Combat and Operational Stress First Aid (COSFA). COSFA was developed as a flexible, multi-step process for the timely assessment and preclinical care of psychological stress injuries in individuals or units with the goals to preserve life, prevent further harm, and promote recovery. Unlike other acute stress management procedures, COSFA was designed specifically to augment the physical, psychological, social, and spiritual support structures that exist in the military, and to help restore these support structures over time.
Third, actions and leader decisions are based on the five core leader stress control functions: strengthen, mitigate, identify, treat, and reintegrate. The first two of these functions, strengthen and mitigate, have been served by military leadership, training, and unit cohesion since long before scientific concepts of stress management were introduced to the military. The last three leader functions of – identify, treat, and reintegrate – require skills and concepts that may be newer to both military leaders and their intrinsic social and spiritual support personnel. COSFA is designed to provide teachable and practical tools to meet these challenges for leaders to identify, treat, and reintegrate those with stress injuries.
The implementation of COSFA has a two-phase process. Phase 1 focus is on leaders and caregivers. Leaders need an opportunity to explore and challenge how the COSFA principles fit within the military leader paradigm, mission readiness, and force readiness. COSFA does not increase leader responsibility or accountability. Instead, COSFA is a tool that helps leaders execute the responsibility and accountability that they already have to the military, service members, and families. Caregivers need to understand that COSFA is a first aid intervention that can be used by anyone and not a replacement for professional judgment of leaders and clinicians or indicated clinical care. Leaders and caregivers then use the knowledge to draft an organization concept of operations and strategic communication plan.
Phase 2 focuses on a tiered training approach. COSFA training uses a modular curriculum design. The elements of the course can be shaped to meet the knowledge, skills, and attitudes requirements based on mission, roles, and OPTEMPO. The goal of the COSFA instructor’s course is to provide the AZNG with the internal resources to provide training that meet mission demands while conserving the strength and resilience of the force. The tiered training approach includes:
Awareness Brief: 15 minute brief for all personnel to introduce the concepts and develop early recognition skills.
Training Briefs: 1-2 hour briefs for Service Members, family members, community organizations, and partner organizations to increase awareness of COSFA principles and develop a mutual dialog about Service Member, command, and community resources.
COSFA Primary Aid: 2 hour training for all personnel to build knowledge and skills to recognize a stress injury and to act in a way that saves a life, reduces further injury, and facilitates recovery.
COSFA Secondary Aid: 2 hour training for leaders that enhances integration of sound stress first aid knowledge and skills into existing leader skills and to apply COSFA principles at a unit and command level following traumatic events or disruption of mission readiness.
COSFA Basic Course: 8 hour training for first aid responders, caregivers, and members who are the most likely to be a point of service contact for a distressed service member or advise the command on the health and mission readiness of the unit.
