An official website of the United States government
Here's how you know
A .mil website belongs to an official U.S. Department of Defense organization in the United States.
A lock (lock ) or https:// means you’ve safely connected to the .mil website. Share sensitive information only on official, secure websites.

News | May 9, 2024

Behavioral Health training adds new GEAR for combat medics

By Lee Osberry Walter Reed Army Institute of Research

The demands of military service profoundly impact the mental readiness of Soldiers, particularly those deployed in challenging field environments. In scenarios of high-intensity warfare or conflict, individuals must operate in austere conditions for extended periods, facing significant psychological stress with limited access to behavioral health and medical resources on the front lines.

Behavioral health issues, such as anxiety, posttraumatic stress disorder, depression, and suicidal behavior, can impede a Soldier's readiness and availability for duty. It is crucial to identify, diagnose, and provide care for Soldiers grappling with behavioral health conditions that necessitate treatment. Deploying a licensed behavioral health provider or even a behavioral health technician with every squad in the field is not feasible. Therefore, providing combat medics with additional tools to address acute concerns can enhance ongoing operations and bolster combatant commanders' capabilities.

Future operational environments will require non-behavioral health providers to assume more responsibilities in preventing, identifying, and managing acute stress reactions and other behavioral health concerns that can affect performance on the battlefield. As the Army modernizes its ground forces to sustain lethality, small teams must be prepared to conduct multidomain operations in remote regions with restricted access to medical resources, limited air evacuation capabilities, and potential communication disruptions.

To better prepare for this evolving battlefield, scientists from the Walter Reed Army Institute of Research's Military Psychiatry Branch have developed and implemented a new training program and study called Behavioral Health Guidelines for mEdic Assessment and Response (BH-GEAR). This program is designed to equip medics without prior behavioral health training to conduct assessments and treatment of behavioral health concerns in far-forward areas.

“The purpose of the BH-GEAR training is to teach basic behavioral health skills to Soldiers without extensive behavioral health training," said Dr. Katie Nugent, a behavioral health epidemiologist at WRAIR and primary investigator of the study. "There are both current and anticipated needs that the training is designed to address."
Nugent emphasized that the number of trained behavioral health experts may be limited when a unit is tasked to deploy, making it virtually impossible for a behavioral health provider to be present at every site. In such situations, combat medics often must assess and manage behavioral health emergencies without prior training in this area.

The Defense Health Agency’s Joint Trauma System developed clinical practice guidelines for the forward management of acute behavioral health conditions by general medical personnel without extensive training. However, the absence of a current mechanism to deliver this material to Service Members effectively is a significant challenge. BH-GEAR serves as a mechanism to meet this requirement.
“Meeting the current behavioral health needs will help units address challenges by giving them additional resources that are otherwise limited,” Nugent said. “Combat medics serve as frontline providers in the absence of a licensed provider and must manage any behavioral health emergencies until contact can be established with a provider or the patient can be evacuated."

The BH-GEAR program, initiated in 2019, involved qualitative research with WRAIR's behavioral health scientists, including interviews with medics deployed to far-forward environments and those assigned to special forces. Over three years, researchers developed, tested, and refined the training curriculum based on empirical data and post-deployment surveys highlighting the limited behavioral health training received by combat medics.

"The BH-GEAR training has definitely prepared me to recognize signs of escalating behavioral health concerns," remarked Pvt. William Gingras, a participant from the 1-2 Stryker Brigade Combat Team. "The behavioral tools I learned, like iCover, were invaluable in responding to acute reactions under fire and supporting fellow Soldiers."

More than 600 Soldiers across six US Army divisions have taken the training, most of whom were trained prior to a deployment. According to Nugent, participants were highly engaged and reported having increased confidence in providing interventions to help with behavioral health challenges.

By equipping medics with critical behavioral health skills, the BH-GEAR program aims to enhance readiness and effectiveness in addressing behavioral health concerns in challenging operational environments, ultimately improving the overall health and performance of deployed Soldiers.

For more information about BH-GEAR, contact the Military Psychiatry Branch at this link. For other Center for Military Psychiatry and Neuroscience data resources and training products, follow us at