Combat and Operational Stress Control: Application in a Burn Center

Occupational therapy has been integral to the holistic recovery of soldiers since its origin. The positive psychosocial and physiological effects of occupation-based interventions, fundamental to the profession, have long justified its relevance to the military. As such, occupational therapy has been written into US Army doctrine as an integral component of the Combat and Operational Stress Control (COSC) program. The focus of a COSC unit is to prevent, identify, reduce, and manage combat and operational stress reactions resulting from physical and mental stressors in a combat environment. COSC centers around the recognition and resolution of functional problems and the development of enhanced coping skills. Recognizing that burn patients are, like combatants, also at high risk of stress-related illness, we applied COSC concepts to peacetime burn care. In this paper we describe the theoretical basis for COSC in a burn center. The COSC model supports holistic, functional recovery of the burn casualty and can augment psychosocial recovery, particularly in times of limited resources.