IRAQ WAR CLINICIAN GUIDE

Iraq War Clinician Guide 120 Appendix D
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Traun~aIIistery Screen
The events below nlay or may not have happened to you. Circle "YES"illhat kind of thing has 1
happened lo you or circle "NO if that kind of thing has not happened lo you. If you circle ''YES" for
any events: put n number in the blank next lo il to show ho\\a.many tinles something like that bappencd.
Nun~hcrof lin>aso#nrtlliq
like the hoppcn~l
A. A really bad cu, boat. train. or airplane accident NO YES B. A really bad accident at work or home NO YES C. A hurricane, flood, eanhquakc, tornado, or fire NO YES -
D. Gcuing heal up or attacked - as a child NO YES -
8. Getling beat up or allacked - a an adult NO YES - 1
F. Forced sex - as n child NO YES -
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G. Forced sex - as an adult NO YFS -
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H. Attack with a gun, knife, or weapon NO YES -
I. During mililary service - seeing so~nctlling
horrible or being badly scared NO YES J. Sudden dzalli of close family or friend NO YES K. Seeing sonleone hadly hurt or killed NO YES L. Some other even1 that scared you badly NO YES -
Did any of tl~fse Ilii~lgs really bother you emotiosally? X0 YES
If you noswered "YES': fill out a box to tell about EVERY event that really bothered you.
The= an nlore boxes on lhe other side of the page. If yon run out of boxes, plcaw ask for another page.
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When this happened, did anyone get hurl or killed? NO YES
Wllen this happened, were you afraid [hat you or someone else nlight get hun or killed? NO YES
Whell this happened, did you feel very afraid, helpless, or horrified? NO YES
When this happened, did you fccl unrcal, spamd oel, disorienled, or strange? NO YES
Describe wllar happened:
Wlle~l this klppened, did anyone get hurl or killed? NO YES
Wilen this happened, were you ahid that you or son~eanc else might gel hun or killed? NO YES
When this happcncd, did you feel very nfixid, helpless, or horrificd' NO YES
When Illis happcncd, did you fccl unreal, spaced oul. diso~.iented, or strange? NO YES
After this Ihappcnal. how long were you bolhcrcd by ill sot at all / I wck 12-3 weeks I a month ar more 1
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GO TO OTHER SIDE IF YOU MARKED "YES'FOR MORE EVENTS.
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