Every medic gets asked the same question. It usually comes when working — hands busy, casualty on the ground, the situation still unsettled. The soldier looks up and asks, “Am I going to be okay?”
While the military trains medics relentlessly to treat the wound, we do not train them to handle the question.
I have spent years on both sides of that moment. I am a 68W combat medic instructor and a Tactical Combat Casualty Care instructor with the West Virginia Army National Guard, and I am also an endorsed chaplain.
This role encompasses teaching soldiers how to control hemorrhage and manage an airway to sitting with them months later, when the physical injury has healed, though something else has not.
The Army should close the distance between those two conversations by building trauma-informed care into how we train medics.
I expect the first objection, because I’ve made it myself. There is no time for feelings under fire. A medic has minutes, sometimes seconds, and every one of them belongs to the casualty needing life-saving treatment.
That objection misunderstands what trauma-informed care is. It should not be viewed as a separate task competing for time on the timeline. Instead, it is intertwined in the manner in which a medic performs the tasks.
Telling a casualty what you are about to do before you do it costs three seconds and keeps the individual from experiencing treatment as one more thing being done without warning.
Keeping a level voice and clear instructions is not bedside manner, but a technique that lowers physiological arousal in a patient who is already flooded. These should not be viewed as soft skills bolted onto medicine, but medicine itself.
The reason this matters is simple: soldiers are people first. They come to us carrying whatever burdens were there before the uniform — childhood adversity, losses, things never processed or disclosed. The injury a medic is treating, therefore, may not be that soldier’s first trauma. A medic who understands that will read the situation and respond differently than one taught to see only the wound.
With this approach, there are three key things every medic should be trained to recognize:
- Acute stress reactions: panic, dissociation, a casualty who has gone flat and unreachable.
- Post-traumatic symptoms in the days and weeks that follow: hypervigilance, nightmares, intrusive memories.
- Moral injury: the toll of having done, or failed to prevent, something that violates what you believe about yourself.
That last point is an area in which I have spent most of my career as a chaplain, and it is badly under-recognized in medicine because it does not present as a symptom.
Medics are positioned to catch all three areas earlier than anyone else in the formation. They are often the first medical contact for troops — and sometimes the only one — which makes them the gate to every referral that follows. A medic who has never been taught what to look for will not make the call. We know this is not a deficiency of compassion, but a general lack of awareness about what call to make.
So the ask is concrete. Add trauma-informed care instruction to 68W advanced individual training, and build it into annual recertification alongside TCCC, where it will actually stick.
Teach psychological first aid as a skill with steps: active listening, normalizing the stress response and connecting the soldier to resources. Teach medics how to avoid retraumatizing a patient during treatment. And make the handoff to a chaplain or behavioral health a taught, practiced action rather than something a medic must figure out alone. Doing so will contribute to both wellness and readiness.
The Substance Abuse and Mental Health Services Administration estimates that more than half of Americans have experienced a traumatic event, and the Department of Veterans Affairs reports higher rates of PTSD among women. Our formations reflect those numbers.
Soldiers whose psychological injuries are addressed early are more likely to return to their units and stay there. Every service member we lose downstream is a trained soldier who is not quickly replaced.
As the force plans for prolonged field care and longer evacuation timelines in future fights, medics will hold casualties longer before handing them off. Hours they spend with frightened, injured troops will matter more, not less.
Nothing in this approach is asking medics to become counselors. However, the Army must acknowledge that a medic is already doing psychological work in that moment, competently or not, trained or not. We might as well train to improve it.
Medics are taught to keep a body alive. We should also prepare them to help the soldier who walks away.
Staff Sgt. Jay Kotsko is a 68W combat medic instructor and Tactical Combat Casualty Care instructor with the West Virginia Army National Guard and an ecclesiastically endorsed chaplain. He holds a Doctor of Ministry in chaplaincy and is the author of “Even Here: Finding God in the Fractured Timelines of Trauma and Recovery.” The views expressed are his own and do not reflect the official position of DoD, the Army or the West Virginia National Guard.
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