Alexander James Rice

Large-scale combat operations (LSCO) represent sustained, high-intensity warfare with near-peer adversaries involving massive casualty volumes. Military projections suggest 3000 casualties per day, approaching World War II intensity levels. LSCO will expose military personnel to continuous confrontation with death, producing psychological effects that threaten force preservation and mission continuity. Traditional centralized behavioral-health systems will be unable to sustain operations effectively under conditions of continuous exposure, contested evacuation, and specialist unavailability. Leadership emerges as the primary mechanism for force preservation, with influence increasing precisely when followers face the greatest threat. This narrative review examines three areas: (1) psychological consequences (stress reactions, grief, moral injury); (2) vulnerable populations (infantry, junior leaders, medics); and (3) leadership interventions including transformational leadership and grief-informed command practices. In contrast to centralized models, we propose a three-level operational framework: immediate unit-level peer support, embedded resource utilization through medics, chaplains, and behavioral health officers, and delayed professional intervention when feasible. This model positions leadership as the central mechanism for sustaining the fighting force amid continuous death exposure.

Objective: Between 2005 and 2022, more than 315,000 grave violations were verified against children in wartime, including killing, physical maiming, exploitation, and forced displacement. While the resulting harm to children is widely recognized, the profound toll on professionals who witness and respond to these tragedies remains under examined. This article explores the psychological and occupational impacts of exposure to child casualties during wartime on healthcare providers, military personnel, journalists, and mortuary affairs workers. Method: Google Scholar, PsycINFO, PsychNET, and PubMed were searched for literature examining the impact of pediatric death and injury on healthcare professionals, service members, journalists, and mortuary affairs workers in wartime settings. Supplementary searches were conducted to identify supportive evidence from literature addressing impacts in non-conflict contexts. Results: Evidence varied across professions, but impacts examined included moral injury, secondary traumatic stress, heightened emotions, including guilt, anger, helplessness, and grief, as well as professional challenges such as self-questioning, and burnout. Potential mechanisms exacerbating distress include loss of trust in the goodness of the world, cynicism, and hopelessness, personal identification with children, and perceived lack of adequate skills or a sense of professional failure. Conclusions: Findings underscore the urgent need for tailored strategies to sustain the well-being and effectiveness of professionals confronted with child casualties in war. In response, the article highlights promising individual-level and organization-level strategies for building resilience and growth, and promising interventions for professionals requiring clinical care.

Firearm-related injuries and fatalities among youth in the United States represent a critical public health crisis. Secure firearm storage (i.e., keeping guns unloaded, locked, and stored separately from ammunition) is a proven strategy to reduce these risks. However, many households do not consistently adopt these practices. This review examines four key family-level factors that influence firearm storage decisions: (a) early firearm socialization, (b) family decision-making dynamics, (c) other household safety practices, and (d) parent understanding of child development and motivations regarding storage. Findings indicate that interventions may benefit from empowering parents to reflect on their early firearm socialization experiences, improving their understanding of children’s development, integrating firearm safety into broader household safety frameworks, and promoting collaborative decision-making in multi-adult households. Future research should further investigate how these factors intersect to shape firearm storage practices, including the long-term effects of early firearm exposure through longitudinal studies, and variations across diverse family structures and contexts, including multigenerational households.