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Concluding Remarks

Neither military nor civilian health care professionals are immune to the consequences of traumatic events. Military and civilian tragedies are a part of our lives and our chosen professions. Just because we are armed with the knowledge and skill to help others cope with the consequences of trauma, doesn’t mean we will always effectively apply these same skills to ourselves. Sometimes we need to allow others to assist us. I did ultimately need to seek medical care for my orthopedic issues and relationship counseling to facilitate reintegration with my family. While there is often much camaraderie among Service Members who share similar warzone experiences, individual responses to traumatic experiences vary greatly. While personal vulnerability is often uncomfortable, professional and personal growth can result from shared responses and coping strategies. Ultimately, we must learn how to care for ourselves and each other with the same compassion and skillfulness as we do the non-health care professionals who enter our clinics.

Acknowledgments Thank you to my family and friends for their patience, support, and unwavering love. I am grateful also to Lieutenant Colonel Kathleen Yancosek, Ph.D., OTR/L, CHT, Barbara Syler, PT, Lieutenant Colonel, US Army (Ret.), and Lieutenant Colonel Sarah Goldman, Ph.D., OTR/L, CHT for their invaluable mentorship and support. Thank you to Elspeth Cameron Ritchie, M.D., MPH, Colonel, US Army (Ret.), Colonel Matthew St. Laurent, MSOT, OTR/L, Sergeant Major Abuoh Neufville, Staff Sergeant Osuna Castro, OTA, and Mr. Heath Sharp for their assistance with this chapter. My heart goes out to the brave men and women of the 3rd Infantry Brigade Combat Team, 1st Armored Division (3/1 AD), the 173d Airborne Brigade Combat Team (173d ABCT), and the 30th Medical Command with whom I had the privilege of serving.

Disclosure: The views expressed are those of the author and do not necessarily reflect the official views of the US Army Office of the Surgeon General, the Department of Defense, the Department of the Army, the US Army Medical Command, or the US Army Specialist Corps. Mention of trade names, commercial products, or organization does not imply endorsement by the US Government. The names of most of the personnel involved in this incident have been changed.


  • 1. Neufville A. First sergeant of Charlie Medical Company, Brigade Support Battalion, 173d ABCT during the 2012-13 deployment to Afganistan (S. Merkle, Interviewer); 2016, February 2.
  • 2. Montz R, Gonzales FJ, Bash D, Carney A, Bramlett D. Occupational therapy role on the battlefield: an overview of combat and operational stress and upper extremity rehabilitation. J Hand Ther. 2008;21(2):130-5.
  • 3. Headquarters, Department of the Army. Field manual 4-02.51, combat and operational stress control. Washington, DC: Government Printing Press; 2006.
  • 4. Headquarters, Department of the Army. Army techniques publication 4-02.5, casualty care. Washington, DC: GPO; 2013.
  • 5. Smith-Forbes ME, Najera MC, Hawkins CD. Combat operational stress control in Iraq and Afghanistan: army occupational therapy. Mil Med. 2014;179:279-84.

MAJ Shannon Merkle is an active duty Army Occupational Therapist. This chapter focuses on events in Regional Command East, Afghanistan in 2012-2013, while she served as the Officer-In-Charge of the Level II Concussion Care Center on Forward Operating Base Shank.

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