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Combat stress casualties are not necessarily higher in city operations than operations on other types of terrain. Commanders and NCOs in the U.S. military should develop the necessary skills to treat and prevent stress casualties and understand their implications for urban operations. Consequently, the authors provide an overview of combat stress reaction (CSR) in the form of a review of its known precipitants, its battlefield treatment, and the preventive steps commanders can take to limit its extent and severity. In addition, to enhance the understanding of the risks that urban operations pose to the development of CSR, the authors interviewed participants in former urban operations and reviewed historical and contemporary documents. Many of those interviewed suggest that urban operations are inordinately stressful and that the risk of CSR may be high. But historical data from the battles of Brest, Manila, and Hue, as well as others, show no evidence of increased rates of stress casualties. The authors also review treatment and prevention steps from the perspective of military operations on urbanized terrain.

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