Notes on Air Force Study Guides, 1 Nov 21, Chapter 21, Fitness and Readiness


15 Feb 2022. The 2021 Air Force Handbook does not exist. The E-5 and E-6 Study Guides were released and posted to the official Air Force website (https://www.studyguides.af.mil/) on 1 Feb 2022. This website was updated using the content from the E-6 Study Guide under the assumption that because both study guides were taken from the Air Force Handbook, the content would be the same. However, there are differences between the two study guides as noted below. Questions related to these differences have been removed or edited, as necessary, to avoid conflict between the two versions and ensure accuracy.

The phrase, "Air Force" was replaced globally by "USAF" in the E-5 Study Guide. The phrase, "Regular Air Force", was replaced by "RegAF".

Only Section E, Readiness State of Mind, is testable. Although the content in the E-5 and E-6 Study Guides for this section is the same, the paragraph numbering for all paragraphs is different.


2021 E5 Study Guide

21.31. USAF Suicide Prevention Program

When suicides occur in the USAF, they result in a number of serious consequences: the loss of human life; grief and loss to the deceased's family, friends, co-workers, and military community; and a direct impact on mission capability through loss of the deceased's skills, experience, and productivity. While suicide prevention is the responsibility of every Airman or Guardian, the USAF has identified that leadership support and action across all levels of command are critical to the goal of reducing suicide in the USAF. Military and civilian leaders will build an environment that promotes healthy and adaptive behaviors, fosters the wingman culture, and encourages responsible help-seeking actions of all Airmen or Guardians.

Note: In an effort to promote help-seeking actions by Airmen or Guardians who are experiencing legal or administrative problems, the USAF instituted the Limited Privilege Suicide Prevention Program in accordance with AFI 44-172, Mental Health, 13 November 2015, which provided an added layer of confidentiality that allows Airmen or Guardians who are under investigation to receive mental health care without the risk of information disclosed during treatment being used to incriminate them in the future. This is important since Airmen or Guardians who are under investigation for legal problems are at significantly elevated risk for suicide and other negative outcomes. Mental health providers are required by DoDI 6490.08, Command Notification Requirements to Dispel Stigma in Providing Mental Health Care to Service Members, 17 August 2011, to disclose safety (suicidal or violent thoughts or self-injurious behavior) and fitness for duty issues to commanders, but all other information is confidential.

2021 E6 Study Guide

21.9. Air Force Suicide Prevention Program

When suicides occur in the Air Force, they result in a number of serious consequences: the loss of human life; grief and loss to the deceased's family, friends, co-workers, and military community; and a direct impact on mission capability through loss of the deceased's skills, experience, and productivity. While suicide prevention is the responsibility of every Airman or Guardian, the Air Force has identified that leadership support and action across all levels of command are critical to the goal of reducing suicide in the Air Force. Military and civilian leaders will build an environment that promotes healthy and adaptive behaviors, fosters the wingman culture, and encourages responsible help-seeking actions of all Airmen or Guardians.

Note: In an effort to promote help-seeking actions by Airmen or Guardians who are experiencing legal or administrative problems, the Air Force instituted the Limited Privilege Suicide Prevention Program in accordance with AFI 44-172, Mental Health, which provided an added layer of confidentiality that allows Airmen or Guardians who are under investigation to receive mental health care without the risk of information disclosed during treatment being used to incriminate them in the future. This is important since Airmen or Guardians who are under investigation for legal problems are at significantly elevated risk for suicide and other negative outcomes.

Note: Mental health providers are required by DoD Instruction 6490.08, Command Notification Requirements to Dispel Stigma in Providing Mental Health Care to Service Members, to disclose safety (suicidal or violent thoughts or self-injurious behavior) and fitness for duty issues to commanders, but all other information is confidential.




2021 E-6 Study Guide and 2019 Air Force Handbook Compared

This chapter's content was taken from the 2019 Air Force Handbook's Chapter 22, Fitness and Readiness, Section E, Readiness State of Mind.


Section 21E, Readiness State of Mind

Paragraph 21.1. Mental Preparedness: minor editing; no change

Paragraph 21.2. Psychological First Aid: minor editing; no change

Paragraph 21.3. Mental Strength and Resilience: minor editing; no change

Paragraph 21.4. Stress Reactions: minor editing; no change

Paragraph 21.5. Individual Stress Management: no changes

Paragraph 21.6. Post-Traumatic Stress Disorder: minor editing and website changed from www.wingmanonline.org to www.resilience.af.mil

Paragraph 21.7. Redeployment, Recovery, and Reconstitution: minor editing; no change

Paragraph 21.8. Psychological Services: minor editing; no change

Paragraph 21.9. Air Force Suicide Prevention Program: minor editing; no change

Paragraph 21.10. Recognition: minor editing, the "Protective Factors" paragraph was edited and "sense of purpose" was added as a protective factor.

Paragraph 21.11. Ask, Care, and Escort Model: minor editing, no significant changes

Paragraph 21.12. Comprehensive Airman or Guardian Fitness: minor editing, no significant changes

Paragraph 21.13. Support Agencies: Under the Support Agencies Quick Reference list, four agencies were deleted and one was added (see below)

Paragraph 21.14. Medical Care: no changes

Paragraph 21.15. Air Force Medical Service: no changes


2021 E6 Study Guide

21.1. Mental Preparedness

One of the telltale signs of a military professional is preparation. When the time comes to use the skills we've learned, military professionals are ready. Most experience is gained by accepting opportunities as they come, even when conditions are not perfect. Through experience, professionals build the confidence, judgment, courage, and integrity needed to continue developing professionally. The Air Force is committed to taking care of Airmen or Guardians and families, and has a wide-range of support capabilities available to address issues and take care of the Total Force. Despite how ready we may feel, demands of the mission can sometimes increase stressors affecting well-being and resiliency.

2019 Air Force Handbook

22.23. Mental Preparedness

One of the telltale signs of a military professional is preparation. When the time comes to use the skills we've learned, military professionals are ready. Most experience is gained by accepting opportunities as they come, even when conditions are not perfect. Through experience, professionals build the confidence, judgment, courage, and integrity needed to continue developing professionally. The Air Force is committed to taking care of Airmen and families, and has a wide-range of support capabilities available to address issues and take care of the Total Force. Despite how ready we may feel, demands of the mission can sometimes increase stressors affecting well-being and resiliency.

2021 E6 Study Guide

21.2. Psychological First Aid

Psychological first aid is a way of reducing initial and ongoing stress by developing adaptive coping and recovery skills. Airmen or Guardians who take care of themselves by getting adequate sleep, eating a balanced diet, and making time for rest and relaxation, combined with the use of positive stress management skills, can reduce actual and perceived stress in their lives. Whether deployed or in garrison, we all need a place to reset and recharge. Consider the following aspects of coping with stress, for yourself and for others.

- Have a physically and emotionally safe place to recuperate or to relax.

- Know (or be) someone who understands, listens, and is compassionate.

- Find opportunities to connect with others while at the gym, dining facility, or local events.

- Provide or demonstrate coping skills that empower others to return to 'normal' state.

- Seek supportive services, such as religious affairs, first sergeants, or mental health providers.

- Contact Military and Family Life Counselors for counseling and supportive services.

2019 Air Force Handbook

22.24. Psychological First Aid

Psychological first aid is a way of reducing initial and ongoing stress by developing adaptive coping and recovery skills. Airmen who take care of themselves by getting adequate sleep, eating a balanced diet, and making time for rest and relaxation, combined with the use of positive stress management skills, can reduce actual and perceived stress in their lives. Whether deployed or in garrison, we all need a place to reset and recharge. Consider the following aspects of coping with stress, for yourself and for others.

- Have a physically and emotionally safe place to recuperate or to relax.

- Know (or be) someone who understands, listens, and is compassionate.

- Find opportunities to connect with others while at the gym, dining facility, or local events.

- Provide or demonstrate coping skills that empower others to return to 'normal' state.

- Seek supportive services, such as religious affairs, first sergeants, or mental health providers.

- Contact Military and Family Life Counselors for counseling and supportive services.

2021 E6 Study Guide

21.3. Mental Strength and Resilience

All people experience stressors (challenges or problems) and distress (negative feelings associatedwith stressors). Long work days, increased deployments, and financial issues are just a few of the conditions that cause stress. The frequency of stress and the significant negative effect stress can have on people and organizations make this a major concern for Airmen or Guardians at all levels. As an organizational concern, stress can negatively affect performance, organizational effectiveness, and mission accomplishment. As a personal concern, experiencing stress over an extended period of time can lead to health problems and affect overall quality of life. Therefore, it is important to personally and professionally recognize stress and learn how to manage it effectively.

2019 Air Force Handbook

22.25. Mental Strength and Resilience

All people experience stressors (challenges or problems) and distress (negative feelings associated with stressors). Long work days, increased deployments, and financial issues are just a few of the conditions that cause stress. The frequency of stress and the significant negative effect stress can have on people and organizations make this a major concern for Airmen at all levels. As an organizational concern, stress can negatively affect performance, organizational effectiveness, and mission accomplishment. As a personal concern, experiencing stress over an extended period of time can lead to health problems and affect overall quality of life. Therefore, it is important to personally and professionally recognize stress and learn how to manage it effectively.

2021 E6 Study Guide

21.4. Stress Reactions

For Airmen or Guardians today, stressors occur within the work environment as well as outside the work environment, often involving family, relationship, and financial issues. We know when we feel stressed, but recognizing some of the key signs of stress can help deal with issues before they evolve into bigger problems. Stress reactions typically appear in four different categories: cognitive, emotional, behavioral, and physical. Reactions associated with these categories are provided here so they may be recognized and addressed early by minimizing, adjusting, or successfully coping with the cause.

Cognitive Stress. Cognitive stress can manifest as memory problems, an inability to concentrate, poor judgment, seeing only the negative, anxious or racing thoughts, or constant worrying.

Emotional Stress. Emotional stress can manifest as apathy, anxiety, depression, irritability, job dissatisfaction, memory problems, or mental fatigue.

Behavioral Stress. Behavioral stress can manifest as appetite changes, increased arguments, increased smoking, neglecting self-care, social withdrawal, substance abuse, or violence.

Physical Stress. Physical stress can manifest as frequent illness, headaches, high blood pressure, increased heart rate, physical exhaustion, sleep disturbances, or weight gain or loss.

2019 Air Force Handbook

22.26. Stress Reactions

For Airmen today, stressors occur within the work environment as well as outside the work environment, often involving family, relationship, and financial issues. We know when we feel stressed, but recognizing some of the key signs of stress can help deal with issues before they evolve into bigger problems. Stress reactions typically appear in four different categories: cognitive, emotional, behavioral, and physical. Reactions associated with these categories are provided here so they may be recognized and addressed early by minimizing, adjusting, or successfully coping with the cause.

Cognitive Stress. Cognitive stress can appear through memory problems, an inability to concentrate, poor judgment, seeing only the negative, anxious or racing thoughts, or constant worrying.

Emotional Stress. Emotional stress can appear through apathy, anxiety, depression, irritability, job dissatisfaction, memory problems, or mental fatigue.

Behavioral Stress. Behavioral stress can appear through appetite changes, increased arguments, increased smoking, neglecting self-care, social withdrawal, substance abuse, or violence.

Physical Stress. Physical stress can appear through frequent illness, headaches, high blood pressure, increased heart rate, physical exhaustion, sleep disturbances, or weight gain or loss.

2021 E6 Study Guide

21.5. Individual Stress Management

The key to recognizing stress is knowing what feels normal so you can recognize when something feels off. The earlier stress can be identified, the earlier stress reduction techniques can be applied. Each of the following steps can help in developing a well-rounded stress management plan.

Make Adjustments. Reduce stress by identifying potential stressors before they arise. For example, if you are stressed by crowds and long lines, adjust your plans so that you may minimize the exposure to crowded environments. While planning can't prevent all stress, it is extremely valuable in minimizing or preparing for exposure to stress before a stressor occurs.

Time Management. Not having enough time to complete a task can be a significant stressor for some people. If time management is an issue, reduce stress by using effective time management skills and tools, like developing a task list and prioritizing tasks.

Overload Avoidance. For most people to eliminate or reduce the effects of overload-related stressors is relatively simple. For a start, identify and avoid busy work, delegate or empower others when possible, learn to say no, and attempt to negotiate unreasonable deadlines.

Relaxation. Relaxation can help manage stress and help you stay alert, energetic, and productive. Relaxation techniques, such as meditation, reading, and listening to music can improve your heart rate, regulate your blood pressure, and decrease your respiratory rate. By incorporating relaxation skills into your daily routines, you can train your body to respond differently to stress.

Exercise and Nutrition. Regular exercise combined with a healthy diet is an effective stress management technique. Exercise can provide an outlet for excess energy and tension caused by stress. Eating nutritious foods ensures your body has the nutrients needed to manage stress and helps prevent overeating. Exercising and eating a balanced diet help your body become more resistant to the negative results of stress, such as high blood pressure, heart attacks, and frequent illness.

Social Support. Having a strong social support network, such as family, friends, social groups, and peers, can help manage stress. Being able to discuss problems with people who care about you and your well-being can help reduce stress by providing a more positive outlook, suggesting solutions to your problems, or just listening.

Prioritize. On the job, identify potential sources of stress, determine the importance of each task, and eliminate tasks that are not necessary or productive. If a job requires long hours, consider using elements of job enrichment, like adequate time off or periodic breaks to help reduce potential stress. If possible, restructure the job to accommodate individual needs to help reduce stress and enhance productivity.

2019 Air Force Handbook

22.27. Individual Stress Management

The key to recognizing stress is knowing what feels normal so you can recognize when something feels off. The earlier stress can be identified, the earlier stress reduction techniques can be applied. Each of the following steps can help in developing a well-rounded stress management plan.

Make Adjustments. Reduce stress by identifying potential stressors before they arise. For example, if you are stressed by crowds and long lines, adjust your plans so that you may minimize the exposure to crowded environments. While planning can't prevent all stress, it is extremely valuable in minimizing or preparing for exposure to stress before a stressor occurs.

Time Management. Not having enough time to complete a task can be a significant stressor for some people. If time management is an issue, reduce stress by using effective time management skills and tools, like developing a task list and prioritizing tasks.

Overload Avoidance. For most people to eliminate or reduce the effects of overload-related stressors is relatively simple. For a start, identify and avoid busy work, delegate or empower others when possible, learn to say no, and attempt to negotiate unreasonable deadlines.

Relaxation. Relaxation can help manage stress and help you stay alert, energetic, and productive. Relaxation techniques, such as meditation, reading, and listening to music can improve your heart rate, regulate your blood pressure, and decrease your respiratory rate. By incorporating relaxation skills into your daily routines, you can train your body to respond differently to stress.

Exercise and Nutrition. Regular exercise combined with a healthy diet is an effective stress management technique. Exercise can provide an outlet for excess energy and tension caused by stress. Eating nutritious foods ensures your body has the nutrients needed to manage stress and helps prevent overeating. Exercising and eating a balanced diet help your body become more resistant to the negative results of stress, such as high blood pressure, heart attacks, and frequent illness.

Social Support. Having a strong social support network, such as family, friends, social groups, and peers, can help manage stress. Being able to discuss problems with people who care about you and your well-being can help reduce stress by providing a more positive outlook, suggesting solutions to your problems, or just listening.

Prioritize. On the job, identify potential sources of stress, determine the importance of each task, and eliminate tasks that are not necessary or productive. If a job requires long hours, consider using elements of job enrichment, like adequate time off or periodic breaks to help reduce potential stress. If possible, restructure the job to accommodate individual needs to help reduce stress and enhance productivity.

2021 E6 Study Guide

21.6. Post-Traumatic Stress Disorder

Post-Traumatic Stress Disorder (PTSD) is a mental health condition that can occur after someone has gone through a traumatic event, such as war-related combat, sexual or physical assault, or a natural or man-made disaster. The Air Force strongly encourages Airmen or Guardians to seek treatment early or encourages early intervention. Because this disorder impacts not only the person who suffers from it, but those who are close to them, it is important for all military members to be educated about PTSD. With enhanced awareness, many people may be prevented from developing this condition, and those who suffer from PTSD may receive treatment before symptoms become disabling and chronic.

Symptoms of Post-Traumatic Stress Disorder. Symptoms of PTSD include: (1) intrusive or unwanted thoughts, such as distressing memories, nightmares, or flashbacks; (2) avoidance behavior in the form of efforts to avoid reminders of the traumatic event; (3) negative thoughts and moods, such as feeling disconnected from others or believing that the world is a dangerous place; and (4) hyper-arousal symptoms, including difficulty sleeping and irritability. Approximately seven to eight percent of the United States population will have PTSD at some point during their lives. Fortunately, within the last decade researchers have developed highly effective treatments that can lead to symptom reduction and even loss of the diagnosis of PTSD.

Helpful Actions to Take. Knowing how to respond to someone with an invisible wound, such as PTSD, is challenging because there is so much going on inside the individual that is not visible on the outside. Some of their behaviors or moods may make you feel uncomfortable, confused, or even annoyed. However, it is important to remember that a person with PTSD may be so distracted by painful thoughts, memories, or physical injuries, that they are not fully able to focus and concentrate as well as they would like to.

A great way to determine how to respond to a person with an invisible wound is to put yourself in their shoes, to practice empathy:

- Try to imagine how you would feel in their situation, even if you don't know all of the details of what they've experienced.

- Remind yourself and those around you of the sacrifice that has been made in service of our country.

- Don't be afraid to ask about what is going on. Give yourself permission to intervene if you think they need help, and make the time to have a sincere conversation with them. Question starters to help you talk about this topic are:

"What's going on in your life? I've noticed you seem upset."

"I'm concerned about you. Can we talk about it?"

"Is there something I can do to help you?"

"What do you think might help?"

- Once you've asked a question, allow time and space for the answer. Encourage them to share without fear of judgment or interruption. Listening shows you care, will help you understand, and builds rapport.

- Acknowledge the distress. It is not helpful to tell them they shouldn't feel a certain way. PTSD is a real condition that produces measurable changes in brain function. Acknowledging distress is a key step in dispelling myths about invisible wounds and removing the stigma associated with getting help.

- Discuss needs and offer to help make a plan to address them. Often, this means suggesting a helping resource. Offering to accompany them can be a good way to make getting help seem less difficult.

Additional training on how to interact with Airmen or Guardians with invisible wounds, such as PTSD, can be found in the invisible wounds videos located at: www.resilience.af.mil.

2019 Air Force Handbook

22.28. Post-Traumatic Stress Disorder

Post-Traumatic Stress Disorder (PTSD) is a mental health condition that can occur after someone has gone through a traumatic event, such as war-related combat, sexual or physical assault, or a natural or man-made disaster. The Air Force strongly encourages Airmen to seek treatment early or encourages early intervention. Because this disorder impacts not only the person who suffers from it, but those who are close to them, it is important for all military members to be educated about PTSD. With enhanced awareness, many people may be prevented from developing this condition, and those who suffer from PTSD may receive treatment before symptoms become disabling and chronic.

Symptoms of Post-Traumatic Stress Disorder. Symptoms of PTSD include: (1) intrusive or unwanted thoughts, such as distressing memories, nightmares, or flashbacks; (2) avoidance behavior in the form of efforts to avoid reminders of the traumatic event; (3) negative thoughts and moods, such as feeling disconnected from others or believing that the world is a dangerous place; and (4) hyper-arousal symptoms, including difficulty sleeping and irritability. Approximately seven to eight percent of the United States population will have PTSD at some point during their lives. Fortunately, within the last decade researchers have developed highly effective treatments that can lead to symptom reduction and even loss of the diagnosis of PTSD.

Helpful Actions to Take. Knowing how to respond to someone with an invisible wound, such as PTSD, is challenging because there is so much going on inside the individual that is not visible on the outside. Some of their behaviors or moods may make you feel uncomfortable, confused, or even annoyed. However, it is important to remember that a person with PTSD may be so distracted by painful thoughts, memories, or physical injuries, that they are not fully able to focus and concentrate as well as they would like to.

A great way to determine how to respond to a person with an invisible wound is to put yourself in their shoes, to practice empathy:

- Try to imagine how you would feel in their situation, even if you don't know all of the details of what they've experienced.

- Remind yourself and those around you of the sacrifice that has been made in service of our country.

- Don't be afraid to ask about what is going on. Give yourself permission to intervene if you think they need help, and make the time to have a sincere conversation with them. Question starters to help you talk about this topic are:

"What's going on in your life? I've noticed you seem upset."

"I'm concerned about you. Can we talk about it?"

"Is there something I can do to help you?"

"What do you think might help?"

- Once you've asked a question, allow time and space for the answer. Encourage them to share without fear of judgment or interruption. Listening shows you care, will help you understand, and builds rapport.

- Acknowledge the distress. It is not helpful to tell them they shouldn't feel a certain way. PTSD is a real condition that produces measurable changes in brain function. Acknowledging distress is a key step in dispelling myths about invisible wounds and removing the stigma associated with getting help.

- Discuss needs and offer to help make a plan to address them. Often, this means suggesting a helping resource. Offering to accompany them can be a good way to make getting help seem less difficult.

Additional training on how to interact with Airmen with invisible wounds, such as PTSD, can be found in the invisible wounds videos located at: www.wingmanonline.org.

2021 E6 Study Guide

21.7. Redeployment, Recovery, and Reconstitution

Deploying Airmen or Guardians receive just-in-time training on stress reactions, psychological first aid, and referral resources through pre-deployment mental health training. While preparation, deployment, and post-deployment support are all important, receiving continued support upon return from deployment is an emphasized aspect of readiness. The intent of the ongoing redeployment support process is to provide continuous, integrated support from the deployed area to home station while assisting with the transition from the deployed environment to family life and worksite. Taking leave after arduous duty and deployment can have a beneficial effect on an individual's psychological and physical status, and an immediate recovery period allows returning Airmen or Guardians to tend to personal needs neglected during lengthy periods away from home. Sometimes readjustment from deployment requires participation in structured recovery time and activities for members and families prior to leave. The redeployment support timeline identifies activities at the critical redeployment, recovery, reintegration, and reconstitution junctures.

2019 Air Force Handbook

22.29. Redeployment, Recovery, and Reconstitution

Deploying Airmen receive just-in-time training on stress reactions, psychological first aid, and referral resources through pre-deployment mental health training. While preparation, deployment, and post-deployment support are all important, receiving continued support upon return from deployment is an emphasized aspect of readiness. The intent of the ongoing redeployment support process is to provide continuous, integrated support from the deployed area to home station while assisting with the transition from the deployed environment to family life and worksite. Taking leave after arduous duty and deployment can have a beneficial effect on an individual's psychological and physical status, and an immediate recovery period allows returning Airmen to tend to personal needs neglected during lengthy periods away from home. Sometimes readjustment from deployment requires participation in structured recovery time and activities for members and families prior to leave. The redeployment support timeline identifies activities at the critical redeployment, recovery, reintegration, and reconstitution junctures.

2021 E6 Study Guide

21.8. Psychological Services

Mental health services are designed to strengthen the readiness capability of the force and ensure Airmen or Guardians are equipped for peak performance. Seeking care for a mental health problem is a sign of strength, not a sign of weakness. Seeking help early increases the likelihood of recovery and reducing risk for subsequent negative consequences of mental health symptoms. More than 12 percent of Air Force personnel voluntarily seek mental health services each year. Willingness to seek help when needed is a sign of good self-awareness and judgment. The fear of having a negative impact on one's career for seeking care at the mental health clinic is diminishing across the Air Force. Time has proven that seeking help appropriately often does not have a long-term negative career impact. In fact, seeking help can improve performance and enable people to better solve problems. In many cases, seeking mental health treatment early can actually save one's Air Force career.

2019 Air Force Handbook

22.30. Psychological Services

Mental health services are designed to strengthen the readiness capability of the force and ensure Airmen are equipped for peak performance. Seeking care for a mental health problem is a sign of strength, not a sign of weakness. Seeking help early increases the likelihood of recovery and reducing risk for subsequent negative consequences of mental health symptoms. More than 12 percent of Air Force personnel voluntarily seek mental health services each year. Willingness to seek help when needed is a sign of good self-awareness and judgment. The fear of having a negative impact on one's career for seeking care at the mental health clinic is diminishing across the Air Force. Time has proven that seeking help appropriately often does not have a long-term negative career impact. In fact, seeking help can improve performance and enable people to better solve problems. In many cases, seeking mental health treatment early can actually save one's Air Force career.

2021 E6 Study Guide

21.9. Air Force Suicide Prevention Program

When suicides occur in the Air Force, they result in a number of serious consequences: the loss of human life; grief and loss to the deceased's family, friends, co-workers, and military community; and a direct impact on mission capability through loss of the deceased's skills, experience, and productivity. While suicide prevention is the responsibility of every Airman or Guardian, the Air Force has identified that leadership support and action across all levels of command are critical to the goal of reducing suicide in the Air Force. Military and civilian leaders will build an environment that promotes healthy and adaptive behaviors, fosters the wingman culture, and encourages responsible help-seeking actions of all Airmen or Guardians.

Note: In an effort to promote help-seeking actions by Airmen or Guardians who are experiencing legal or administrative problems, the Air Force instituted the Limited Privilege Suicide Prevention Program in accordance with AFI 44-172, Mental Health, which provided an added layer of confidentiality that allows Airmen or Guardians who are under investigation to receive mental health care without the risk of information disclosed during treatment being used to incriminate them in the future. This is important since Airmen or Guardians who are under investigation for legal problems are at significantly elevated risk for suicide and other negative outcomes.

Note: Mental health providers are required by DoD Instruction 6490.08, Command Notification Requirements to Dispel Stigma in Providing Mental Health Care to Service Members, to disclose safety (suicidal or violent thoughts or self-injurious behavior) and fitness for duty issues to commanders, but all other information is confidential.

2019 Air Force Handbook

22.31. Air Force Suicide Prevention Program

When suicides occur in the Air Force, they result in a number of serious consequences: the loss of human life; grief and loss to the deceased's family, friends, co-workers, and military community; and a direct impact on mission capability through loss of the deceased's skills, experience, and productivity. While suicide prevention is the responsibility of every Airman, the Air Force has identified that leadership support and action across all levels of command are critical to the goal of reducing suicide in the Air Force. Military and civilian leaders will build an environment that promotes healthy and adaptive behaviors, fosters the wingman culture, and encourages responsible help-seeking actions of all Airmen.

Note: In an effort to promote help-seeking actions by Airmen who are experiencing legal or administrative problems, the Air Force instituted the Limited Privilege Suicide Prevention Program in accordance with AFI 44-172, Mental Health, which provided an added layer of confidentiality that allows Airmen who are under investigation to receive mental health care without the risk of information disclosed during treatment being used to incriminate them in the future. This is important since Airmen who are under investigation for legal problems are at significantly elevated risk for suicide and other negative outcomes.

Note: Mental health providers are required by DoD Instruction 6490.08, Command Notification Requirements to Dispel Stigma in Providing Mental Health Care to Service Members, to disclose safety (suicidal or violent thoughts or self-injurious behavior) and fitness for duty issues to commanders, but all other information is confidential.

2021 E6 Study Guide

21.10. Recognition

Airmen or Guardians must know the importance of recognizing that anyone can become suicidal, regardless of how well they have previously managed military or personal stress. Warning signs can be sudden, may signify a person is in distress, and require immediate support. Sudden changes,such as sleep difficulties or discipline problems, may be warning signs. Those most likely to spot a person at risk for suicide are the ones with whom an individual interacts on a daily basis (friends, coworkers, and immediate supervisors). These individuals are best positioned to notice changes in behavior, mood, or performance. If you hear someone comment or indicate they're considering suicide, take it seriously, get involved, and get them the help they need. Even if there appears to be no real indication of a serious problem, be observant for any sudden changes in behavior or attitude that could be a sign that they need help. Find out what caused the observed changes, assist in choosing resources to resolve stressors, and communicate concerns with the chain of command, as appropriate.

Leaders and Airmen or Guardians of all ranks have a vested interest in knowing the people they work with, investing in their professional and personal development, and quickly addressing issues whenever they arise. The following actions can be taken to support and help resolve life's challenges and reduce the number of suicides: (1) know co-workers, their usual moods and behaviors, and how they are functioning; (2) be able to recognize early signs of risk, stress, and distress; (3) engage with Airmen or Guardians to determine what may be stressful or problematic; (4) assist Airmen or Guardians with choosing the most appropriate resource to help resolve the problem; and (5) follow-up with Airmen or Guardians to ensure the stressors are resolving and new ones are not taking their place.

Risk Factors. Risk factors for suicide can include, but are not limited to: relationship difficulties, problems at work, legal and financial problems, mental health diagnosis, substance misuse, and previous suicide attempts. Some factors leaders should watch for and address to ensure effective supervision and open communication exist in the organization are: (1) tunnel vision on the mission; (2) not engaging with Airmen or Guardians; (3) difficulty recognizing risk factors and warning signs; (4) lack of knowledge of Air Force supported resources and the true impact of seeking help on an Air Force career; and (5) inappropriately sheltering Airmen or Guardians from the consequences of their actions or failing to take proper action.

Protective Factors. Protective factors include: social support, connectedness, sense of belonging, sense of purpose, effective individual coping skills, and cultural norms that promote and protect responsible help-seeking behavior.

2019 Air Force Handbook

22.32. Recognition

Airmen must know the importance of recognizing that anyone can become suicidal, regardless of how well they have previously managed military or personal stress. Warning signs are sudden, may signify a person is in distress, and require immediate support. Sudden changes, such as sleep difficulties or discipline problems, may be warning signs. Those most likely to spot a person at risk for suicide are the ones with whom an individual interacts on a daily basis (friends, coworkers, and immediate supervisors). These individuals are best positioned to notice changes in behavior, mood, or performance. If you hear someone comment or indicate they're considering suicide, take it seriously, get involved, and get them the help they need. Even if there appears to be no real indication of a serious problem, be observant for any sudden changes in behavior or attitude that could be a sign that they need help. Find out what caused the observed changes, assist in choosing resources to resolve stressors, and communicate concerns with the chain of command, as appropriate.

Leaders and Airmen of all ranks have a vested interest in knowing the people they work with, investing in their professional and personal development, and quickly addressing issues whenever they arise. The following actions can be taken to support and help resolve life's challenges and reduce the number of suicides: (1) know co-workers, their usual moods and behaviors, and how they are functioning; (2) be able to recognize early signs of risk, stress, and distress; (3) engage with Airmen to determine what may be stressful or problematic; (4) assist Airmen with choosing the most appropriate resource to help resolve the problem; and (5) follow-up with Airmen to ensure the stressors are resolving and new ones are not taking their place.

Risk Factors. Risk factors for suicide can include, but are not limited to: relationship difficulties, problems at work, legal and financial problems, mental health diagnosis, substance misuse, and previous suicide attempts. Some factors leaders should watch for and address to ensure effective supervision and open communication exist in the organization are: (1) tunnel vision on the mission; (2) not engaging with Airmen; (3) difficulty recognizing risks and warning signs; (4) lack of knowledge of Air Force supported resources and the true impact of seeking help on an Air Force career; and (5) inappropriately sheltering Airmen from the consequences of their actions or failing to take proper action.

Protective Factors. Protective factors include: social support, interconnectedness, sense of belonging, effective individual coping skills, and cultural norms that promote and protect responsible help-seeking behavior.

2021 E6 Study Guide

21.11. Ask, Care, and Escort Model

Suicide prevention is everyone's responsibility. The Ask, Care, and Escort (ACE) Model was developed to assist Airmen or Guardians in intervening when an Airman or Guardian experiences stress, distress, or faces challenges. Understanding the appropriate steps to suicide risk prevention and the available Air Force approved resources can aid in saving the career and life of a fellow Airman or Guardian. The acronym ACE is one that people can easily remember.

Ask. When you see or hear any of the warning signs discussed in this section, or are aware of risk factors in someone's life, ask questions to learn more about the person's situation. If you have any uncertainty about someone's safety, calmly but directly ask the question, "Are you thinking of killing/hurting yourself?" Asking about suicide gives people permission to talk about a subject that may otherwise be difficult to bring up. It lets the Airman or Guardian know you are ready to discuss what they are experiencing. Do not promise to keep thoughts of suicide a secret. Airmen or Guardians need to remember the importance of sharing these concerns with leaders and professionals who can help.

Care. Showing care and concern for those at risk is important. Simply taking the time to ask about problems, and asking specifically about suicide, shows caring and concern. If someone acknowledges thoughts of suicide, listen and allow them to share what is troubling them. Avoid making judgmental statements, immediately trying to solve their problem, or trying to talk them out of suicide. If they share thoughts of suicide with you, accept that they are in distress, listen to their concerns, and begin getting them help. Determine if they have a plan for suicide, what the plan is, and take reasonable steps to secure the potential means of suicide, but do not put yourself in harm's way. Airmen or Guardians in distress who are seeking access to lethal means, such as a firearm, should be considered at risk for self-harm. If you are not able to secure the potential means of self-harm, or you have significant concern about the individual's safety, then contact command and emergency services. Building time and space between Airmen or Guardians in distress and access to lethal means (including firearms and medications) can reduce the risk of suicide attempts and deaths.

Escort. After asking about suicide and showing concern, the final step is to escort the person to command or professional support that can provide appropriate assistance. Do not leave the person in distress alone. At most bases, professionals are on call through the command post, and evaluations can be conducted in local emergency rooms if on-base services are not accessible. If a distressed Airman or Guardian will not agree to go with you and you have significant concern about the individual's safety you should contact your chain of command, contact emergency services; local, civilian, or national resources; dial 911; go to the emergency room or mental health clinic; or call the Veterans Crisis Line (1-800-273-8255). The most important step is to get the individual the help they need if they are in distress.

2019 Air Force Handbook

22.33. Ask, Care, and Escort Model

Suicide prevention is everyone's responsibility. The Ask, Care, and Escort (ACE) Model was developed to assist Airmen in intervening when an Airman experiences stress, distress, or faces challenges. Understanding the appropriate steps to suicide risk prevention and the available Air Force approved resources can aid in saving the career and life of a fellow Airman. The acronym ACE is one that people can easily remember.

Ask. When you see or hear any of the warning signs discussed in this section, or are aware of risk factors in someone's life, ask questions to learn more about the person's situation. If you have any uncertainty about someone's safety, calmly but directly ask the question, "Are you thinking of killing/hurting yourself?" Asking about suicide gives people permission to talk about a subject that may otherwise be difficult to bring up. It lets the Airman know you are ready to discuss what they are experiencing. Do not promise to keep thoughts of suicide a secret. Airmen need to remember the importance of sharing these concerns with leaders and professionals who can help.

Care. Showing care and concern for those at risk is important. Simply taking the time to ask about problems, and asking specifically about suicide, shows caring and concern. If someone acknowledges thoughts of suicide, listen and allow them to share what is troubling them. Avoid making judgmental statements, immediately trying to solve their problem, or trying to talk them out of suicide. If they share thoughts of suicide with you, accept that they are in distress, listen to their concerns, and begin getting them help. Determine if they have a plan for suicide, what the plan is, and take reasonable steps to secure the potential means of suicide, but do not put yourself in harm's way. If you are not able to secure the potential means of self-harm, or you have significant concern about the individual's safety, then contact command and emergency services.

Escort. After asking about suicide and showing concern, the final step is to escort the person to command or professional support that can provide appropriate assistance. Do not leave the individual alone, and do not send them alone to seek help, as he or she may change his or her mind on the way. At most bases, professionals are on call through the command post, and evaluations can be conducted in local emergency rooms if on-base services are not accessible. If an Airman reveals that he or she is thinking about suicide, this is a life or death emergency, and your chain of command must be contacted. If a distressed Airman will not agree to go with you or is in crisis, contact your chain of command, contact emergency services; local, civilian, or national resources; dial 911; go to the emergency room or mental health clinic; or call the Veterans Crisis Line (1-800-273-8255).

2021 E6 Study Guide

21.12. Comprehensive Airman or Guardian Fitness

Comprehensive Airman or Guardian Fitness (CAF) is a holistic approach to build and sustain a thriving and resilient Air Force Community by taking care of each other and ourselves through wellness in four domains - mental, physical, social, and spiritual. The intent is to equip Airmen or Guardians and families with the tools and skills needed to continually assess and adjust to the unique challenges of a military lifestyle. The Wingman concept is a core element of CAF essential to building fit, resilient, and ready Airmen or Guardians by dedicating time to focus on individual and unit wellness, and fostering a culture of Airmen or Guardians taking care of Airmen or Guardians.

Mental Domain. The mental domain is defined as the ability to effectively cope with unique mental stressors and challenges needed to ensure mission readiness. The tenets of the mental domain are: awareness, adaptability, positive thinking, and decision-making.

Physical Domain. The physical domain is defined as the ability to adopt and sustain healthy behaviors needed to enhance health and wellness. The tenets of the physical domain are: endurance, strength, nutrition, and recovery.

Social Domain. The social domain is defined as the ability to engage in healthy social networks that promote overall well-being and optimal performance. The tenets of the social domain are: connectedness, teamwork, social support, and communication.

Spiritual Domain. The spiritual domain is defined as the ability to strengthen a set of beliefs, principles, or values that sustain an individual's sense of well-being and purpose. The tenets of the spiritual domain are: purpose, core values, perseverance, and perspective.

Additional information, tools and programs designed to strengthen individual and unit CAF can be found by visiting www.resilience.af.mil.

2019 Air Force Handbook

22.34. Comprehensive Airman Fitness

Comprehensive Airman Fitness is an approach to equipping Airmen with the tools and skills required to continually assess and adjust to the environment by maintaining the necessary balance of cognitive skill, physical endurance, emotional stamina, and spiritual well-being. There are four domains that can be used to address and foster a culture of Airmen taking care of Airmen.

Mental Domain. The mental domain is defined as the ability to effectively cope with unique mental stressors and challenges needed to ensure mission readiness. The tenets of the mental domain are: awareness, adaptability, positive thinking, and decision-making.

Physical Domain. The physical domain is defined as the ability to adopt and sustain healthy behaviors needed to enhance health and wellness. The tenets of the physical domain are: endurance, strength, nutrition, and recovery.

Social Domain. The social domain is defined as the ability to engage in healthy social networks that promote overall well-being and optimal performance. The tenets of the social domain are: connectedness, teamwork, social support, and communication.

Spiritual Domain. The spiritual domain is defined as the ability to strengthen a set of beliefs, principles, or values that sustain an individual's sense of well-being and purpose. The tenets of the spiritual domain are: purpose, core values, perseverance, and perspective.

2021 E6 Study Guide

21.13. Support Agencies

Commanders, supervisors, wingmen, and individuals have many resources to help resolve problems and challenges for themselves, their families, and others, in healthy, safe, and constructive ways. A few of the sources are provided here for a quick reference screenshot.

Support Agencies Quick Reference:

Air Force Integrated Resilience Program https://www.resilience.af.mil/

Military One Source Online: http://www.militaryonesource.mil/.

Military One Source Help Line: 1-800-342-9647.

Veterans Crisis Line: 1-800-273-8255 (Press 1).

Veterans Crisis Line Chat: https://www.veteranscrisisline.net/.

Veterans Crisis Line Text: 838255.


2019 Air Force Handbook

22.35. Support Agencies

Commanders, supervisors, wingmen, and individuals have many resources to help resolve problems and challenges for themselves, their families, and others, in healthy, safe, and constructive ways. A few of the sources are provided here for a quick reference screenshot.

Support Agencies Quick Reference:

Air Force Suicide Prevention Program: http://www.af.mil/suicide-prevention.

Military One Source Online: http://www.militaryonesource.mil/.

Military One Source Help Line: 1-800-342-9647.

DoD BeThere Support Call and Outreach Center Online: www.betherepeersupport.org.

DoD BeThere Support Call and Outreach Center: 1-844-357-7337.

DoD BeThere Support Call and Outreach Center Text: 1-480-360-6188.

Veterans Crisis Line: 1-800-273-8255 (Press 1).

Veterans Crisis Line Chat: https://www.veteranscrisisline.net/.

Veterans Crisis Line Text: 838255.


2021 E6 Study Guide

21.14. Medical Care

The military health system supports all uniformed service personnel, retirees, and their families. It provides the direction, resources, health care providers, and other means necessary for promoting the health of the beneficiary population. Military health support includes developing and promoting health awareness issues to educate customers, discovering and resolving environmentally based health threats, providing health services (including preventive care, problem intervention services, pastoral care, and religious support), and improving the means and methods for maintaining the health of the beneficiary population by constantly evaluating the performance of the health support. Army, Navy, and Air Force medical professionals help ensure those in uniform are medically ready to deploy anywhere around the globe on a moment's notice.These medical professionals not only send service members on their way, they're with them.

Defense Health Agency. The Defense Health Agency is a joint, integrated combat support agency within the military health system that enables the Army, Navy, and Air Force medical services to provide a medically ready force and ready medical force to combatant commands in both peacetime and wartime. The defense health agency supports the delivery of integrated, affordable, and high quality health services to military health system beneficiaries and is responsible for driving greater integration of clinical and business processes across the military health system.

2019 Air Force Handbook

22.36. Medical Care

The military health system supports all uniformed service personnel, retirees, and their families. It provides the direction, resources, health care providers, and other means necessary for promoting the health of the beneficiary population. Military health support includes developing and promoting health awareness issues to educate customers, discovering and resolving environmentally based health threats, providing health services (including preventive care, problem intervention services, pastoral care, and religious support), and improving the means and methods for maintaining the health of the beneficiary population by constantly evaluating the performance of the health support. Army, Navy, and Air Force medical professionals help ensure those in uniform are medically ready to deploy anywhere around the globe on a moment's notice. These medical professionals not only send service members on their way, they're with them.

Defense Health Agency. The Defense Health Agency is a joint, integrated combat support agency within the military health system that enables the Army, Navy, and Air Force medical services to provide a medically ready force and ready medical force to combatant commands in both peacetime and wartime. The defense health agency supports the delivery of integrated, affordable, and high quality health services to military health system beneficiaries and is responsible for driving greater integration of clinical and business processes across the military health system.

2021 E6 Study Guide

21.15. Air Force Medical Service

Specifically, the Air Force Medical Service's mission is to enable medically fit forces, provide expeditionary medics, and improve the health of all who serve to meet our Nation's needs. The Air Force Medical Service's vision is to ensure that patients are the "Healthiest and Highest Performing Segment of the United States by 2025." The service's four primary objectives are: promote and sustain a healthy and fit force, prevent illness and injury, restore health, and optimize human performance. It is increasingly called upon to deliver medical capabilities throughout the range of military operations, consisting of civil-military operations, global health engagement, or humanitarian assistance/disaster relief, as part of joint or multinational operations.

Operation Live Well. Several programs can be found at: https://health.mil/. Particularly relevant to fitness and readiness is Operation Live Well. This program provides information on focus areas, such as integrative wellness, mental wellness, nutrition, physical activity, sleep, and tobacco-free living.

2019 Air Force Handbook

22.37. Air Force Medical Service

Specifically, the Air Force Medical Service's mission is to enable medically fit forces, provide expeditionary medics, and improve the health of all who serve to meet our Nation's needs. The Air Force Medical Service's vision is to ensure that patients are the "Healthiest and Highest Performing Segment of the United States by 2025." The service's four primary objectives are: promote and sustain a healthy and fit force, prevent illness and injury, restore health, and optimize human performance. It is increasingly called upon to deliver medical capabilities throughout the range of military operations, consisting of civil-military operations, global health engagement, or humanitarian assistance/disaster relief, as part of joint or multinational operations.

Operation Live Well. Several programs can be found at: https://health.mil/. Particularly relevant to fitness and readiness is Operation Live Well. This program provides information on focus areas, such as integrative wellness, mental wellness, nutrition, physical activity, sleep, and tobacco-free living.