Re: Is it really? was Re: cism needed

[Guest guest]

No, you did not offend me. I truly respect the research and time Dr. B and

the entire team have put into finding out if CISM if harmful or beneficial. I

also read that it is harmful to SOME not all. I only know what I've

experienced in the past with my own career. I know if I would not have been

forced

into some of the cism/cisd sessions I was as a rookie, I wouldn't have stayed in

the profession.

There ARE people out there, like me, who have a hard time talking to others

about feelings and emotions unless I'm absolutely forced to. I know, maybe a

character flaw--but I honestly saw what the cism/cisd could do to help with

that.

I certainly respect your opinion and am not offended by it. Hope I didn't

offend anyone by sending my thoughts and prayers out.

Dana Garrett EMT-I 427

[Guest guest]

Prayer is one thing you can find positive data on.......

TD

Re: Is it really? was Re: cism needed

>COME ON!! I can't believe that you sent this to someone who was asking for

>help from the list. Let them decide what they want cism or no cism. My

prayers

>are with them all.

>

>Dana Garrett EMT-I

>

>

>

>

>

[Guest guest]

It is EXACTLY a time like this, when emotions control behavior--not

logic--that people need honest assistance. That is what the original post

asked. People have made several good comments. CISM, without a doubt, and no

matter who provides it, can be harmful to certain people. Who knows which

will be harmed? Thus, the points made herewith are prudent. Prayer is

usually harmless as long as it is private or if the group is homogeneous

(all Christians, Jews, Muslims). A Christian prayer for a Jew might cause

the individual some distress while a Muslin prayer for a Christian might

likewise cause distress. Religion, though an important aspect of society,

should not be a part of and EMS activities unless each and every member

agree to such activities (such as a prayer at a memorial service or before a

meeting). There is, however, high quality evidence that CISM is

harmful--thus the reason the National Institute of Mental Health

(http://www.nimh.nih.gov/research/massviolence.pdf), the National Center for

Post-Traumatic Stress Disorder

(http://www.ncptsd.org/publications/rq/rqpdf/V12N4.PDF) and numerous others

say that CISM/CISD should not be used. EMS providers should only provide

psychological first aid--meeting the immediate physical and emotional needs

of those involved and not providing " crisis intervention " or psychotherapy

or any other unproven modality. Psychological first aid includes:

Psychological First Aid

Protect survivors from further harm.

Reduce physiological arousal.

Mobilize support for those who are most distressed.

Keep families together and facilitate reunions with loved ones.

Provide information and foster communication and education.

Use effective risk communication techniques.

E. Bledsoe, DO, FACEP

Midlothian, Texas

If you ever get to heaven, leave your dog outside. Heaven goes by favor. If

it went by merit you would stay out and the dog would go in.

Mark Twain

Re: Is it really? was Re: cism needed

COME ON!! I can't believe that you sent this to someone who was asking for

help from the list. Let them decide what they want cism or no cism. My

prayers

are with them all.

Dana Garrett EMT-I

[Guest guest]

Dana, not to offend you a second time (if we did earlier) consider what you

wrote:

" No, you did not offend me. I truly respect the research and time Dr. B and

the entire team have put into finding out if CISM if harmful or beneficial.

I also read that it is harmful to SOME not all. "

That is true. But, there is no way to know who will be harmed. If the

process was ineffective or helpful, then there would be no argument. But,

when it has been shown to harm, then it cannot be ethically applied. Say 10%

of patients reacted negatively to a drug, would you administer the drug to

all ignoring the 10% that may be harmed? As a caring and intelligent EMT-I,

I am sure you would not.

" I only know what I've experienced in the past with my own career. I know

if I would not have been forced into some of the cism/cisd sessions I was as

a rookie, I wouldn't have stayed in the profession. "

There are several problems here. First, CISM/CISD should not be mandatory.

In fact, Drs. and Everly and the CISM loyal all clearly state that

CISM/CISD should never be mandatory. Thus, whoever provided the CISD

violated their own rules. Second, what evidence do you have that you would

have not gotten better without CISD? That is where randomized controlled

trials and similar studies are important (they make the findings objective

at the same time removing as much bias as possible). Anecdote does not make

science--even if and Everly says it does.

" There ARE people out there, like me, who have a hard time talking to others

about feelings and emotions unless I'm absolutely forced to. I know, maybe

a character flaw--but I honestly saw what the cism/cisd could do to help

with that. "

So putting you in a group, with coworkers, and making you talk when it is

uncomfortable is good for you? This does not make sense. Many people are

pleased with the CISD (often an expression of gratitude that people paid

attention and spent time with them). People in doughnut shops tend to like

doughnuts. That does not make them nutritious. I have a hard time talking to

people about feelings and emotions and I have paid a high cost for it. But,

now I know the importance of friends and family with whom I can confide and

not be afraid to show my vulnerability. That is essential for survival in

life--not just EMS.

" I certainly respect your opinion and am not offended by it. Hope I didn't

offend anyone by sending my thoughts and prayers out. "

I respect your opinions and beliefs. All I ask is to take a non-emotional

educated look at the subject. People readily gave up the MAST when they saw

the research. But, people are hesitant to give up CISM because of some

emotional attachment--not objective evidence that it helped. And, your

prayers will even help us heathens.

BEB

[Guest guest]

Dear Sir,

I am not a doctor but the Psychological First Aid you mentioned sounds a lot

like a form of CISM to me even if it does not exactly follow 's plan.

The goal, as I remember it is to allow those who wish to vent by discussing the

incident without fear of reprisal and provide education to them so they can work

through the feelings they have enabling them to get back to work as soon as

possible. Naturally keeping the process completely voluntary and confidential.

Sincerely,

Anita , NREMT-P/LP

Re: Is it really? was Re: cism needed

COME ON!! I can't believe that you sent this to someone who was asking for

help from the list. Let them decide what they want cism or no cism. My

prayers

are with them all.

Dana Garrett EMT-I

[Guest guest]

There is no debriefing in psychological first aid. The other features of

CISM are OK (as long as CISD is dropped). The role of defusing can be

questioned unless attendance is totally voluntary and there is no coercion

to attend. But, most importantly, we do not need special teams or providers

for psychological first aid. Just take care of peoples' immediate needs, not

forcing them to talk, contacting family, and protection from further harm.

This is simply what neighbors do for neighbors.

E. Bledsoe, DO, FACEP

Midlothian, Texas

If you ever get to heaven, leave your dog outside. Heaven goes by favor. If

it went by merit you would stay out and the dog would go in.

Mark Twain

Re: Is it really? was Re: cism needed

Dear Sir,

I am not a doctor but the Psychological First Aid you mentioned sounds a lot

like a form of CISM to me even if it does not exactly follow 's

plan. The goal, as I remember it is to allow those who wish to vent by

discussing the incident without fear of reprisal and provide education to

them so they can work through the feelings they have enabling them to get

back to work as soon as possible. Naturally keeping the process completely

voluntary and confidential.

Sincerely,

Anita , NREMT-P/LP

Re: Is it really? was Re: cism needed

COME ON!! I can't believe that you sent this to someone who was asking for

help from the list. Let them decide what they want cism or no cism. My

prayers

are with them all.

Dana Garrett EMT-I

[Guest guest]

Dear Dr. Bledsoe,

Ok I see the point, it is ok as long as it is strictly voluntary and we drop the

debriefing and maybe the defusion. At what point would we as senior personnel,

supervisors, educators, etc, step in and say to someone, " I think you are still

having a rough time with the call, how can we help? " The person has been back to

work and is not functioning to full capacity more than a month after the

incident. This may compromise crew safety and patient care. Would it be

appropriate to refer him/her for professional counseling, (either before PTSD

sets in or to try to get it in the early stages)? I am not trying to make fun of

the new studies. I am just looking for some answers as this is one of my

functions where I work. Thank you for your assistance.

Anita NREMT-P/LP

Re: Is it really? was Re: cism needed

COME ON!! I can't believe that you sent this to someone who was asking for

help from the list. Let them decide what they want cism or no cism. My

prayers

are with them all.

Dana Garrett EMT-I

[Guest guest]

Anita,

As the supervisor of employees who have been through a tramatic event, if

you perceive that there is a problem with their ability to perform their

job, then it is your responsibility to take steps to ensure that no harm

comes to them or the patients they care for. You also have to protect your

agency. If I'm not performing at the level of expectation then you MUST step

in and deal with that, with whatever may be appropriate for the scenario.

For some it may very well mean that you referr them to counseling. Each case

is different because each medic is different and has specific needs.

Wiseman, EMT-P

Re: Is it really? was Re: cism needed

>

> COME ON!! I can't believe that you sent this to someone who was asking

for

>

> help from the list. Let them decide what they want cism or no cism. My

> prayers

> are with them all.

>

> Dana Garrett EMT-I

>

>

>

>

>

[Guest guest]

What the NIMH and several authorities recommend is that EMS and FDs have

affiliations with licensed, professional mental health professionals who

can help screen personnel who may not be recovering. These mental health

personnel must understand the job and the culture. Also, they must be able

to respond as needed. If people are not recovering as they should, then

these people can be directed to the only thing that seems effective for

stress-related problems--cognitive behavioral therapy. We are past the point

of what not to do (CISM) and to the point of what to do. I will send a paper

to you off-list that details this.

E. Bledsoe, DO, FACEP

Midlothian, Texas

If you ever get to heaven, leave your dog outside. Heaven goes by favor. If

it went by merit you would stay out and the dog would go in.

Mark Twain

Re: Is it really? was Re: cism needed

Dear Dr. Bledsoe,

Ok I see the point, it is ok as long as it is strictly voluntary and we drop

the debriefing and maybe the defusion. At what point would we as senior

personnel, supervisors, educators, etc, step in and say to someone, " I

think you are still having a rough time with the call, how can we help? " The

person has been back to work and is not functioning to full capacity more

than a month after the incident. This may compromise crew safety and

patient care. Would it be appropriate to refer him/her for professional

counseling, (either before PTSD sets in or to try to get it in the early

stages)? I am not trying to make fun of the new studies. I am just looking

for some answers as this is one of my functions where I work. Thank you for

your assistance.

Anita NREMT-P/LP

Re: Is it really? was Re: cism needed

COME ON!! I can't believe that you sent this to someone who was asking

for

help from the list. Let them decide what they want cism or no cism. My

prayers

are with them all.

Dana Garrett EMT-I

[Guest guest]

Dear Dr. Bledsoe,

Thank you. I look forward to reading the paper. We do in our system have a peer

counseling available for those who request it. But as we all know sometimes that

is not enough. Any information on what the rest of the nation is doing will be

appreciated. My concern and that of others is to help those who need it, who

knows it may even be me someday. I went to a CISD debriefing once and was not

real impressed with it but at the time we knew no better. Thanks again.

Anita , NREMT-P/LP

Re: Is it really? was Re: cism needed

COME ON!! I can't believe that you sent this to someone who was asking

for

help from the list. Let them decide what they want cism or no cism. My

prayers

are with them all.

Dana Garrett EMT-I

[Guest guest]

GEEZZ, Larry the guy just asked a question? I agree with everyone signing there

post, but that has been beat to death on here for years. Looks like it's still

more of a chat box that a professional egroup.

Ron

Is it really? was Re: cism needed

I'm not a pundit, but that is probably me you are talking about. I

wrote the message with the subject line you refer to. Yes, I have

personal experience with the CISD Nazis, from both sides of the

equation. The others who replied are well known to most in the

business, and certainly to those on the list. Who are you? I'd be

more inclined to answer your question if you would identify

yourself. I like to know who I am talking to, and maybe your reason

for asking.

Larry Pacchioni - NREMT-P

> One questions for the pundits... How many folks here have had

FORMAL

> CISM training? If so, what models were studied?

>

> I have been reading the posts in response to the deputy fire

chief's

> request and am curious as to the training levels of those who have

> replied.