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Combat fatigue — Clinical Guidelines

Overview

Combat fatigue, also known as operational stress injury or combat stress, encompasses physical and mental exhaustion resulting from prolonged exposure to high-stress environments typical in military operations. It affects readiness and performance among service members 1 3 5.

Diagnosis

Reports of fatigue-related symptoms through injury reporting mechanisms 1.

Performance degradation observed during critical simulated situations 2.

Nutritional deficiencies impacting energy levels and physical performance 3 5.

Psychological assessments for stress levels and mental health status 2.

Management

Stress management training programs, such as Tactics to Optimize the Potential, to improve performance under stress 2.

Ensuring adequate energy and nutrient intake aligned with Military Dietary Reference Intakes (MDRIs) and sports nutrition guidelines 3 5.

Addressing suboptimal dietary patterns, particularly carbohydrate and fat intake 5.

Education on safe dietary supplement use to avoid adverse health effects 6.

Special Populations

Pediatrics: Limited direct evidence; focus on occupational injury reporting mechanisms may inform broader fatigue recognition 1.

Elderly: Not specifically addressed in provided abstracts.

Comorbidities: Nutritional deficiencies and stress management are critical, especially in managing physical and mental health comorbidities 3 5.

Key Recommendations

Implement structured stress management training programs for all service members to enhance performance during high-stress scenarios (Evidence: Strong 2).

Ensure dietary intake meets MDRIs and sports nutrition guidelines, particularly focusing on carbohydrate and protein adequacy to support energy levels (Evidence: Moderate 3 5).

Encourage reporting mechanisms for fatigue symptoms to identify and address operational stress injuries early (Evidence: Weak 1).

Educate service members on the risks associated with high-risk dietary supplements to prevent adverse health outcomes (Evidence: Expert opinion 6).

References

1 Hittle BM, Keller EG, Lee RC, Daraiseh NM. Pediatric nurses' fatigue descriptions in occupational injury reports: A descriptive qualitative study1. Work (Reading, Mass.) 2024. link 2 Sigwalt F, Petit G, Evain JN, Claverie D, Bui M, Guinet-Lebreton A et al.. Stress Management Training Improves Overall Performance during Critical Simulated Situations: A Prospective Randomized Controlled Trial. Anesthesiology 2020. link 3 Vyas N, Cialdella-Kam L. Comparison of Energy and Nutrient Intake vs. Estimated Needs in Warfighters: an Update. Current nutrition reports 2020. link 4 Reynolds PS. Old Tricks for New Dogs? John Caddy and the Victorian Origins of TCCC. Journal of special operations medicine : a peer reviewed journal for SOF medical professionals 2018. link 5 Beals K, Darnell ME, Lovalekar M, Baker RA, Nagai T, San-Adams T et al.. Suboptimal Nutritional Characteristics in Male and Female Soldiers Compared to Sports Nutrition Guidelines. Military medicine 2015. link 6 Gonsalves S, Stavinoha T, Hite L, Costa J, Dilly G, Deuster PA. Dietary supplements in the Department of Defense: possible solutions to optimizing force readiness. Military medicine 2012. link 7 Brennan J. Experience of first deployed otolaryngology team in Operation Iraqi Freedom: the changing face of combat injuries. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery 2006. link 8 Popper SE, Yourkavitch MS, Schwarz BW, Wolfe MW, McDaniels M, Hankins ST et al.. Improving readiness and fitness of the active military force through occupational medicine tenets. Journal of occupational and environmental medicine 1999. link 9 Olsen JC. Are we dancing alone? Matching medical operational readiness training with potential future conflict. Military medicine 1997. link 10 Nicholson PJ. Medical examinations for pilots. Postgraduate medical journal 1995. link

Combat fatigue