Principles Of Treatment

a. Brevity, Immediacy, Centrality, Expectancy, Proximity, Simplicity. Brevity, Immediacy, Centrality, Expectancy, Proximity, Simplicity (BICEPS) is used as a acronym for the principles of treatment for soldiers suffering from combat stress reaction. Brevity, Immediacy, Centrality, Expectancy, Proximity, Simplicity are explained below.

(1) Brevity. Treatment should be brief, lasting no more than three days. For more extensive treatment, ship the casualty to the rear.

(2) Immediacy. Identify the need for care early. You should not wait for consultant or evacuation to another facility.

(3) Centrality. Treat a casualty in one location separate from the hospital. This is done to maintain military image and to decrease self identification as sick person.

(4) Expectancy. Thorough verbal and nonverbal messages from staff, friends, and chain of command, the casualty should expect to return to duty after several days. The casualty should understand that no illness or lack of character exists, only normal stress reaction to combat exhaustion--recovery is assured.

(5) Proximity. Provide care as close as possible to casualty's unit of assignment in order to maintain bonding with unit and maintain support from friends.

(6) Simplicity. The goal of treatment is to return the casualty to combat, not to perform psychodynamic therapy.

b. Other. In addition to "BICEPS," the casualty should be provided with the following.

(1) Rest. This may include sedation for one or two nights, if necessary.

(2) Nourishing and appetizing food.

(3) Group support. This includes a chance to talk to others, compare feelings, and observe their recovery.

(4) Professional support. This bolsters the individual's defenses; emphasizes unit integrity, acceptance, and reassurance; and appeals to pride and duty.

(5) Military atmosphere. This includes rank, courtesies, field gear, uniform, performing relevant tasks, and quarters in a non-hospital environment.

NOTE: Some physicians, physician assistants (PA), and medics may feel it violates their ethical duty to establish a therapeutic goal of returning a combat fatigue soldier back to the dangers of combat. Remember:

--Somebody will go to the combat area as a replacement.

--The replacement, not psychologically bonded to the unit, will not have the support of friends and will be more at risk than others.

--The casualty being "helped" is being labeled a psychiatric patient. The results of this label may be a life-long chronic psychiatric disability.

NOTE: Seventy to eighty-five percent of casualties will return to duty within 72 hours, treated within division or near unit. An additional 10 to 20 percent of casualties treated in a combat zone will return to some duty within two weeks. Evacuation of a casualty is done only if a true, psychiatric disorder that will not respond within two weeks is evident.

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