title: Impact of combat events on first responders: experiences of the armed conflict in Uruzgan, Afghanistan.
abstract: BACKGROUND
  Care for battle casualties demands special skills from medics, nurses, and tactical commanders. To date, no inventory has been performed evaluating the first responders (medics, nurses and tactical commanders) around battle casualties.
  
  
  METHODS
  This observational cohort study was conducted amongst the first responders (n=195) who were deployed to Southern Afghanistan (2009-2010) in three Marine companies. The survey focused on four main topics: (1) participants general background, (2) exposure to combat (casualty) situations, (3) self-perceived quality of care (1 [low]-10 [high]) in the pre-hospital phase, and (4) the effects of combat stressors on professional skills and social environment using the Post Deployment Reintegration Scale (PDRS) and the Impact of Event Scale-Revised (IES-R).
  
  
  RESULTS
  71% of the eligible Dutch tactical commanders, medics, and nurses participated in this survey. Most (14/16) medics and nurses scored their pre-deployment training as sufficient The overall self-perceived quality of care score was above average (7.8). Most (80%) of the participants were exposed to battle casualties. There were no significant differences regarding rank, gender, age and military task using the impact of event scale and PDRS, except for a worse score on the work negative, family positive and personal positive subscales (p<0.05) in the PDRS for the first responders in comparison to the armed forces norm score.
  
  
  CONCLUSIONS
  The quality of care in the pre-hospital phase was considered adequate, symptoms of post-traumatic stress in this group was low. Active involvement of co-combatants and the social support network are essential in adaption after exposure to combat events. Further research is necessary to identity predisposing preventable high stress factors, and to compose a "waterproof" aftercare programme.
authors.affiliation: Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands. Electronic address: r.hoencamp@lumc.nl.
authors.forename: Rigo
authors.initials: R
authors.lastname: Hoencamp
authors.affiliation: Department of Surgery, Medical Centre Haaglanden, The Hague, The Netherlands. Electronic address: f.idenburg@mchaaglanden.nl.
authors.forename: Floris J
authors.initials: FJ
authors.lastname: Idenburg
authors.affiliation: Leiden University Medical Centre; Military Mental Health Research, Utrecht, The Netherlands. Electronic address: hgjm.vermetten@mindef.nl.
authors.forename: Eric
authors.initials: E
authors.lastname: Vermetten
authors.affiliation: Department of Surgery-Trauma surgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. Electronic address: edward.Tan@radboudumc.nl.
authors.forename: Edward
authors.initials: E
authors.lastname: Tan
authors.affiliation: Force Health Protection, Expert Centre Force Health Protection Ministry of Defense, The Netherlands. Electronic address: mj.plat@mindef.nl.
authors.forename: Marie-Christine
authors.initials: MC
authors.lastname: Plat
authors.affiliation: Leiden University Medical Centre, The Netherlands. Electronic address: erik@hoencamp.net.
authors.forename: Erik
authors.initials: E
authors.lastname: Hoencamp
authors.affiliation: Department of Surgery, University Medical Centre, Utrecht, The Netherlands. Electronic address: l.p.h.leenen@umcutrecht.nl.
authors.forename: Luke P H
authors.initials: LP
authors.lastname: Leenen
authors.affiliation: Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands. Electronic address: j.f.hamming@lumc.nl.
authors.forename: Jaap F
authors.initials: JF
authors.lastname: Hamming
mesh_terms: D000328:Adult; D055826:Afghan Campaign 2001-; D004634:Emergency Medical Technicians / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008887:Military Medicine; D009426:Netherlands / Q000453:epidemiology; D011787:Quality of Health Care; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D014218:Triage; D014947:Wounds and Injuries / Q000453:epidemiology* / Q000628:therapy
keywords: Combat; Dutch Armed Forces; Post traumatic stress disorder; Pre-hospital care