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Combat stress techniques help military providers during COVID pandemic

Image of soldier in a hazmat suit with a medical-grade mask. Lt. Tiffany Bradley participates in fit testing for an N95 respirator and survival mask at Naval Hospital Okinawa, Okinawa, Japan March 27, 2020. The wearing of protective gear while battling the COVID-19 pandemic can cause adverse reactions in health care workers. (U.S. Marine Corps photo by 1st Lt. Tori Sharpe)

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Among the images from the heroic response to the coronavirus pandemic are the faces of medical professionals bruised by personal protective equipment worn during long hospital shifts. Anyone in the military who has done field training exercises in protective gear knows that equipment can be uncomfortable and in some cases, cause panic attacks and other claustrophobic symptoms. These symptoms can lead to noncompliance with guidelines for wearing personal protective equipment, or could result in a member of the medical team being temporarily unable to provide medical services to those in need.

Researchers at the Walter Reed Army Institute of Research developed a six-step, peer-based intervention to treat panic attacks or severe claustrophobic symptoms in warfighters wearing protective gear. This protocol, called iCover, helps medical providers on the front lines of the COVID-19 pandemic.

The six steps follow the acronym iCOVER:

  1. Identify the individual experiencing an acute stress reaction.
  2. Connect with the individual by speaking their name, making eye contact, and holding their arm.
  3. Offer commitment by letting them know they are not alone.
  4. Verify facts with two to three simple questions to get their thinking kickstarted (e.g., “What hospital is this?” and “What section of the hospital are you in?”)
  5. Establish an order of events to ground them in the present moment by stating what happened, what is happening, and what needs to happen in three simple sentences. (e.g., “You donned your PPE. You are checking the seal. We are about to check on a patient.”)
  6. Request action of the individual to restore them to purposeful behavior (e.g., “Double check the oxygen saturation on that patient and report back.”)

WRAIR developed the iCOVER protocol for operational units. However, recent events, have caused medical providers across the nation to request use of iCOVER with hospital staff when they begin to feel panic symptoms due to the wearing of personal protective equipment, or when they become acutely overwhelmed for any reason. These experiences from the field suggest that iCOVER may be a rapid, effective way to help medical team members keep their co-workers in the fight. This is a great example of how techniques developed for combat and operational stress control can play a role in the current fight against the coronavirus pandemic.

The iCOVER training video is available on WRAIR’s YouTube channel, and the complete training module with detailed trainer notes is available on request from the Psychological Health Center of Excellence. A specific version of iCOVER training for medical staff is being developed and will be ready soon.

Also, check out the WRAIR COVID19 Leadership Checklist for Mitigating Team Stress.

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