Cisd
- Thread starter NJEMT95
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wadford
Forum Crew Member
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Most partners will have their own sort of debriefing after each call, and sometimes this will take a while (days or weeks) on really bad calls or calls that just seem to get to you. I think that CISD as a whole is a good program and can potentially be great resource to have on hand post mass casualty incidents. With everything that we see out in the field it can be difficult sometimes to leave everything at work. Sometimes there isn't anything we can do about it and some of it makes it through the front door into our homes and our personal lives.
I don't see a situation where having a CISD program in place would be a bad thing.
I don't see a situation where having a CISD program in place would be a bad thing.
Bullets
Forum Knucklehead
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DesertMedic66
Forum Troll
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Some people find it helpful to either relive the call or to talk with others who were on the call.
CALEMT
The Other Guy/ Paramaybe?
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From personal experience CISD's are great. It gives you a chance to just "vent" your emotions, will sometimes create a peace of mind for you, and to know that everyone else who was on that call or incident feels the same way. It also creates a better bond between coworkers.
firetender
Community Leader Emeritus
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Making room for the human experience.
"Working through" traumatic experiences is not a part of the culture of Emergency services. It's a shame because not only does it relieve the immediate anxiety of living and working on the edge of life and death but it allows the individual to gain a better perspective on his or her relationship with life itself, and, if handled properly, empowers the individual to find joy amongst the chaos.
I have heard of many "souless" approaches in CISD, mostly offered by those with no experience looking death in the face. My impression is they have caused more trauma than they have relieved. Too many such systems are geared toward being pressure relief valves that do no more than slap a bandaid on bleeding arteries so the warrior can get back to work.
I am more convinced than ever that EMS needs to begin developing a broad array of "safety nets" to anticipate and catch affected medics before they hit the ground. Too many are doing nosedives and far worse, suffering in silence. One day, they're on the job and go home to a normal family life and you blink and their lives have fallen apart.
I've always promoted the idea that the ones best able to counsel are the medics themselves; if only they were given permission to break the "Code of Silence" in the profession, the "Don't ask, don't tell" of burnout where traumas keep adding up and find no safe place for exploration or closure.
This means a re-orientation of the culture and it's up to each of you to be available to each other; to take your peers seriously when they are hurting and offer your honest, heart-felt experience and, at the same time to be willing to face your own demons.
CISD has its place, but it is only a starting point. You all need to be willing to take the risks it will take to provide the immediate and essential interventions that it takes to help your peers work through trauma close to when it happens rather than having it grow inside like Cancer until it's too late.
"Working through" traumatic experiences is not a part of the culture of Emergency services. It's a shame because not only does it relieve the immediate anxiety of living and working on the edge of life and death but it allows the individual to gain a better perspective on his or her relationship with life itself, and, if handled properly, empowers the individual to find joy amongst the chaos.
I have heard of many "souless" approaches in CISD, mostly offered by those with no experience looking death in the face. My impression is they have caused more trauma than they have relieved. Too many such systems are geared toward being pressure relief valves that do no more than slap a bandaid on bleeding arteries so the warrior can get back to work.
I am more convinced than ever that EMS needs to begin developing a broad array of "safety nets" to anticipate and catch affected medics before they hit the ground. Too many are doing nosedives and far worse, suffering in silence. One day, they're on the job and go home to a normal family life and you blink and their lives have fallen apart.
I've always promoted the idea that the ones best able to counsel are the medics themselves; if only they were given permission to break the "Code of Silence" in the profession, the "Don't ask, don't tell" of burnout where traumas keep adding up and find no safe place for exploration or closure.
This means a re-orientation of the culture and it's up to each of you to be available to each other; to take your peers seriously when they are hurting and offer your honest, heart-felt experience and, at the same time to be willing to face your own demons.
CISD has its place, but it is only a starting point. You all need to be willing to take the risks it will take to provide the immediate and essential interventions that it takes to help your peers work through trauma close to when it happens rather than having it grow inside like Cancer until it's too late.
Summit
Critical Crazy
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There are no mixed results in the studies, including Cochrane (the highest regarded medical evidence metanalysis organization). CISD is a discredited model from the 1980s, and the studies clearly show that it does not work, and is more likely to cause harm than good. The solution is to make help available to EMS personnel from professional mental healthcare providers. The "big guys" like NATO, US Military, Red Cross, FEMA, VA, APA, etc long ago dumped the CISM fad.
The bottom line is that I am not the authority. I am relating what the evidence says, what the experts in many fields say, what the consensus and professional organizations state, and that is the best practice we should follow. WE cannot let well meaning persons with big hearts and a history of dedicated service cause us to be stuck in time because that is what they know. We cannot let anecdotes guide away from overwhelming evidence. We cannot let a dinosaur plod on. The CISM industry had great intentions, but was a good idea shown to be not such a good idea.
CISM is supposed to be an inoculation of sorts against PTSD and ASR by intervening early in a presumed acute stress reaction. The studies show clearly that it does not work in this role and may actually cause PTSD or worsened PTSD. This appears related to the basic philosophy that all rescuers are alike in personality, have the same coping mechanisms, coping timeframes, and all experienced an event similarly. These assumptions are patently false. Thus persons with different coping mechanisms, with different experiences, with different personalities, and at different points in their recovery are placed in theoretically therapeutic environment where they are actually exposed to more emotional trauma and experiences. This is an older treatment philosophy, though well meaning, that attempts to fit the patients to the treatment rather than fitting the treatment to the patient. The evidence seems to show that there might be a short term positive feeling about the debrief by slightly more providers than providers who have a negative feeling about the debrief. Providers with negative feelings feel discouraged from reporting. In the long term, there is no improvement in outcomes and some studies have shown increased negative outcomes for rescuers! Rescuers have diverse personalities, differing coping mechanisms, and coping timelines because they experience events differently. Most rescuers do not have acute stress reactions to each event; who does is not predictable. Blanket preemptive self-selection is not a sufficient determinant for the CISM intervention. It is a great determinant for individual assistance.
Cochrane is essentially the highest standard out there for analysis of studies and best practices:
http://summaries.cochrane.org/CD006...-prevention-of-post-traumatic-stress-disorder
http://onlinelibrary.wiley.com/doi/...ionid=2F636A4148B6CC53AA90644173DB4678.d04t01
http://www.massey.ac.nz/~trauma/issues/2005-2/wagner.htm
http://www.emtlife.com/showthread.php?t=9785&highlight=CISM
http://publicsafety.com/print/Emergency--Medical-Services/EMS-Myth-3--Critical-Incident-Stress-Management-CISM-is-effective-in-managing-EMS-related-stress/1$2026
http://www.jems.com/news_and_articles/columns/Bledsoe/Killing_Vampires.html
http://www.who.int/mental_health/media/en/note_on_debriefing.pdf
http://www.emtcity.com/topic/21020-who-single-session-psychological-debriefing-not-recommended/
American Psychological Association’s recommendation against single session debriefing/CISM.
http://www.div12.org/PsychologicalTreatments/treatments/ptsd_debriefing.html
British Journal of Psychology: “Debriefing does not reduce PTSD”
http://www.rxpgnews.com/research/psychiatry/anxiety/ptsd/article_4806.shtml
http://www.stish.org/home/advice/health/professional-help/debriefing
NICE - the trusted, independent UK body that provides health advice - is a chief culprit. Based on seven randomly controlled trials (RCTs) comparing psychological debriefing against control groups, NICE recommended in 2005 that brief, single-session interventions not be routinely offered to individuals who have experienced a traumatic event.
http://www.thepsychologist.org.uk/archive/archive_home.cfm?volumeID=21&editionID=155&ArticleID=1290
I think we have more than sufficient evidence to avoid 'debriefing' after disasters for the general population. Consequently, it is now being specifically not recommended by everyone from the World Health Organisation to the National Center for Child Traumatic Stress.
However, I'm not sure the authors' argument for the utility of debriefing for aid workers is convincing either.
They spend a lot of time highlighting the problems in two trials in meta-analyses that reported a harmful effect of debriefing but don't tackle the other trials which showed the intervention to be ineffective. Deploying ineffectual interventions is not to be recommended either.
But the two harmful trials they critique are not on aid workers and neither are the meta-analyses in which they appear. Meanwhile, comparative trials specifically on aid workers also show harmful effects of debriefing...
http://dx.doi.org/10.1348/000711200160327
http://dx.doi.org/10.1080/10811440290057639
http://dx.doi.org/10.1002/(SICI)1099-1700(199807)14:3<143::AID-SMI770>3.0.CO;2-S
or report no effect:
http://www.ingentaconnect.com/content/routledg/ulat/2002/00000007/00000003/art00004
http://www.ncbi.nlm.nih.gov/pubmed/10473306
http://bps-research-digest.blogspot.com/2012/01/is-it-time-to-resurrect-post-trauma.html
http://www.ptsd.va.gov/PTSD/professional/pages/helping-survivors-after-disaster.asp
http://www.bryanbledsoe.com/data/pdf/journals/CISM (Bledsoe).pdf
Bledsoe BE, Barnes DE. The Traction Splint: An EMS Relic
Journal of Emergency Medical Services (JEMS). 2004; 29(8):64-78
Bledsoe BE. CISM: A Rational Perspective.
Lifeline. 2003; Spring:2-5
Bledsoe BE. EMS Mythology Part 3: Critical Incident Stress Management.
Emergency Medical Services (EMS). 2003; 32(5):77-80
Bledsoe BE. CISM: A Rational Perspective.
EMS Professionals. 2003; May-June:32-36
Bledsoe. CISM: A Rational Perspective.
Journal of Maine EMS. 2003; 14(2):18-22
Bledsoe BE. Uncover Hidden Trauma (Case of the Month).
Journal of Emergency Medical Services (JEMS). 2003; 28(1):16
Bledsoe BE. Searching for the Evidence Behind EMS.
Emergency Medical Services (EMS). 2003; 31(1):63-67
The bottom line is that I am not the authority. I am relating what the evidence says, what the experts in many fields say, what the consensus and professional organizations state, and that is the best practice we should follow. WE cannot let well meaning persons with big hearts and a history of dedicated service cause us to be stuck in time because that is what they know. We cannot let anecdotes guide away from overwhelming evidence. We cannot let a dinosaur plod on. The CISM industry had great intentions, but was a good idea shown to be not such a good idea.
CISM is supposed to be an inoculation of sorts against PTSD and ASR by intervening early in a presumed acute stress reaction. The studies show clearly that it does not work in this role and may actually cause PTSD or worsened PTSD. This appears related to the basic philosophy that all rescuers are alike in personality, have the same coping mechanisms, coping timeframes, and all experienced an event similarly. These assumptions are patently false. Thus persons with different coping mechanisms, with different experiences, with different personalities, and at different points in their recovery are placed in theoretically therapeutic environment where they are actually exposed to more emotional trauma and experiences. This is an older treatment philosophy, though well meaning, that attempts to fit the patients to the treatment rather than fitting the treatment to the patient. The evidence seems to show that there might be a short term positive feeling about the debrief by slightly more providers than providers who have a negative feeling about the debrief. Providers with negative feelings feel discouraged from reporting. In the long term, there is no improvement in outcomes and some studies have shown increased negative outcomes for rescuers! Rescuers have diverse personalities, differing coping mechanisms, and coping timelines because they experience events differently. Most rescuers do not have acute stress reactions to each event; who does is not predictable. Blanket preemptive self-selection is not a sufficient determinant for the CISM intervention. It is a great determinant for individual assistance.
Cochrane is essentially the highest standard out there for analysis of studies and best practices:
http://summaries.cochrane.org/CD006...-prevention-of-post-traumatic-stress-disorder
http://onlinelibrary.wiley.com/doi/...ionid=2F636A4148B6CC53AA90644173DB4678.d04t01
http://www.massey.ac.nz/~trauma/issues/2005-2/wagner.htm
http://www.emtlife.com/showthread.php?t=9785&highlight=CISM
http://publicsafety.com/print/Emergency--Medical-Services/EMS-Myth-3--Critical-Incident-Stress-Management-CISM-is-effective-in-managing-EMS-related-stress/1$2026
http://www.jems.com/news_and_articles/columns/Bledsoe/Killing_Vampires.html
http://www.who.int/mental_health/media/en/note_on_debriefing.pdf
http://www.emtcity.com/topic/21020-who-single-session-psychological-debriefing-not-recommended/
American Psychological Association’s recommendation against single session debriefing/CISM.
http://www.div12.org/PsychologicalTreatments/treatments/ptsd_debriefing.html
British Journal of Psychology: “Debriefing does not reduce PTSD”
http://www.rxpgnews.com/research/psychiatry/anxiety/ptsd/article_4806.shtml
http://www.stish.org/home/advice/health/professional-help/debriefing
NICE - the trusted, independent UK body that provides health advice - is a chief culprit. Based on seven randomly controlled trials (RCTs) comparing psychological debriefing against control groups, NICE recommended in 2005 that brief, single-session interventions not be routinely offered to individuals who have experienced a traumatic event.
http://www.thepsychologist.org.uk/archive/archive_home.cfm?volumeID=21&editionID=155&ArticleID=1290
I think we have more than sufficient evidence to avoid 'debriefing' after disasters for the general population. Consequently, it is now being specifically not recommended by everyone from the World Health Organisation to the National Center for Child Traumatic Stress.
However, I'm not sure the authors' argument for the utility of debriefing for aid workers is convincing either.
They spend a lot of time highlighting the problems in two trials in meta-analyses that reported a harmful effect of debriefing but don't tackle the other trials which showed the intervention to be ineffective. Deploying ineffectual interventions is not to be recommended either.
But the two harmful trials they critique are not on aid workers and neither are the meta-analyses in which they appear. Meanwhile, comparative trials specifically on aid workers also show harmful effects of debriefing...
http://dx.doi.org/10.1348/000711200160327
http://dx.doi.org/10.1080/10811440290057639
http://dx.doi.org/10.1002/(SICI)1099-1700(199807)14:3<143::AID-SMI770>3.0.CO;2-S
or report no effect:
http://www.ingentaconnect.com/content/routledg/ulat/2002/00000007/00000003/art00004
http://www.ncbi.nlm.nih.gov/pubmed/10473306
http://bps-research-digest.blogspot.com/2012/01/is-it-time-to-resurrect-post-trauma.html
http://www.ptsd.va.gov/PTSD/professional/pages/helping-survivors-after-disaster.asp
http://www.bryanbledsoe.com/data/pdf/journals/CISM (Bledsoe).pdf
Bledsoe BE, Barnes DE. The Traction Splint: An EMS Relic
Journal of Emergency Medical Services (JEMS). 2004; 29(8):64-78
Bledsoe BE. CISM: A Rational Perspective.
Lifeline. 2003; Spring:2-5
Bledsoe BE. EMS Mythology Part 3: Critical Incident Stress Management.
Emergency Medical Services (EMS). 2003; 32(5):77-80
Bledsoe BE. CISM: A Rational Perspective.
EMS Professionals. 2003; May-June:32-36
Bledsoe. CISM: A Rational Perspective.
Journal of Maine EMS. 2003; 14(2):18-22
Bledsoe BE. Uncover Hidden Trauma (Case of the Month).
Journal of Emergency Medical Services (JEMS). 2003; 28(1):16
Bledsoe BE. Searching for the Evidence Behind EMS.
Emergency Medical Services (EMS). 2003; 31(1):63-67