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
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Bledsoe. CISM: A Rational Perspective.
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