Guest guest Posted January 27, 2006 Report Share Posted January 27, 2006 Study Examines EMS Coping Strategies Canada NewsWire The preliminary results of a new study show that emergency medical services (EMS) personnel believe they are much more likely to recover from traumatic critical incidents if given brief time-out periods with peers and expressions of support from supervisors. EMS personnel are two to three times more likely than the general public to suffer from Post-traumatic Stress Disorder (PTSD), a disorder that can cause emotional difficulties as a result of dealing regularly with traumatic calls. These difficulties often lead to increased absenteeism, a troubled family life, and increased drug and alcohol abuse. A team of researchers from Mt. Sinai Hospital, Ryerson University, Sunnybrook-Osler Centre for Pre-Hospital Care, and the University of Toronto, presented the first-year findings of a three-year study at the recent National Association of Emergency Medical Services Physicians, in Tucson, Arizona. The study is funded by The Tema Conter Memorial Trust, an organization dedicated to better understanding the effects of Post Traumatic Stress on emergency services personnel. Using a qualitative interview method with Toronto EMS personnel, the team found that EMS organizations may be able to facilitate employee recovery by implementing simple and straightforward administrative policies such as allowing for brief periods of downtime immediately after an incident. " Paramedics are telling us a brief unwinding with peers is critical, " says principal investigator Dr. Janice Halpern, of Mount Sinai Hospital. " A simple chance to calm down and decompress, combined with a supportive word or expression of support from a supervisor could relieve a lot of suffering. " Past studies have suggested that the commonly used Critical Incident Stress Debriefing (CISD) is not only ineffective in preventing PTSD, but potentially harmful. In those studies, a group intervention was carried out by experts days after a traumatic call or 'critical incident'. The current study aims to develop a new approach to critical incident stress, and the investigators began by interviewing the paramedics themselves. Dr. Halpern and her co-investigators, Dr. Gurevich of Ryerson University, Dr. Schwartz of Sunnybrook-Osler Centre for Pre-Hospital Care, and Ms. ette Brazeau and Dr. Bishop of the University of Toronto, believe these findings could make a tremendous difference in how interventions for coping with critical incidents are structured. The study's initial findings have been well received by Toronto EMS personnel and administration, and they are committed to participating in the next phase of research, which will build on the initial results using a quantitative approach. " These results point to the potentially crucial impact of early, relatively simple interventions within the workplace, relying on personnel with whom they are already familiar, " added Dr. Halpern. " This makes good intuitive sense, and is well worth studying further. What they're talking about is emotional first-aid for paramedics. What could be more appropriate? " " Many paramedics have trouble reaching out for help, " explains Vince Savoia, founder and Executive Director of The Tema Conter Memorial Trust. " If research like this can help alleviate PTSD, we really are in a much better position to understand and help the EMS personnel who help so many of us. " About The Tema Conter Memorial Trust With a mission to better understand the effects of Post Traumatic Stress on emergency services personnel, The Tema Conter Memorial Trust invests not only in important research but also in education and awareness. An important additional component is public education so people understand the sacrifice emergency workers and their families make by serving the community. For more information about The Tema Conter Memorial Trust, visit www.tema.ca <http://www.tema.ca/> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 28, 2006 Report Share Posted January 28, 2006 " E. Bledsoe, DO, FACEP " <bbledsoe@e...> wrote: > > Using a qualitative interview method with Toronto EMS personnel, the team > found that EMS organizations may be able to facilitate employee recovery by > implementing simple and straightforward administrative policies such as > allowing for brief periods of downtime immediately after an incident. I'm curious if the Toronto medics knew they were being used as guinea pigs and signed informed consent acknowledging they had been told of potential dangers of this new method. Considering the disaster that CISD has come to be, you could hardly ignore the fact that other debriefing methods hold the same potential for iatrogenic tramua. Toronto isn't exactly a mecca for critical incidents. They had a street shooting there last month and all of their medics said it was the first they had ever seen, and one of them broke down and freaked out while being interviewed by television reporters a few hours later. So... maybe they're conducting this research in Canada because there are fewer blood sucking lawyers there to sue them if they end up harming the medics? Rob Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 28, 2006 Report Share Posted January 28, 2006 " E. Bledsoe, DO, FACEP " <bbledsoe@e...> wrote: > > Using a qualitative interview method with Toronto EMS personnel, the team > found that EMS organizations may be able to facilitate employee recovery by > implementing simple and straightforward administrative policies such as > allowing for brief periods of downtime immediately after an incident. I'm curious if the Toronto medics knew they were being used as guinea pigs and signed informed consent acknowledging they had been told of potential dangers of this new method. Considering the disaster that CISD has come to be, you could hardly ignore the fact that other debriefing methods hold the same potential for iatrogenic tramua. Toronto isn't exactly a mecca for critical incidents. They had a street shooting there last month and all of their medics said it was the first they had ever seen, and one of them broke down and freaked out while being interviewed by television reporters a few hours later. So... maybe they're conducting this research in Canada because there are fewer blood sucking lawyers there to sue them if they end up harming the medics? Rob Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 29, 2006 Report Share Posted January 29, 2006 So we are told CISD does not work. Are we now making a shift in that statement? Is it one study this and one study that? Will the results be that different individuals have different coping mechanisms? Are EMS professionals different than others exposed to critical stress? I just have to say WOW!!! " E. Bledsoe, DO, FACEP " wrote: Study Examines EMS Coping Strategies Canada NewsWire The preliminary results of a new study show that emergency medical services (EMS) personnel believe they are much more likely to recover from traumatic critical incidents if given brief time-out periods with peers and expressions of support from supervisors. EMS personnel are two to three times more likely than the general public to suffer from Post-traumatic Stress Disorder (PTSD), a disorder that can cause emotional difficulties as a result of dealing regularly with traumatic calls. These difficulties often lead to increased absenteeism, a troubled family life, and increased drug and alcohol abuse. A team of researchers from Mt. Sinai Hospital, Ryerson University, Sunnybrook-Osler Centre for Pre-Hospital Care, and the University of Toronto, presented the first-year findings of a three-year study at the recent National Association of Emergency Medical Services Physicians, in Tucson, Arizona. The study is funded by The Tema Conter Memorial Trust, an organization dedicated to better understanding the effects of Post Traumatic Stress on emergency services personnel. Using a qualitative interview method with Toronto EMS personnel, the team found that EMS organizations may be able to facilitate employee recovery by implementing simple and straightforward administrative policies such as allowing for brief periods of downtime immediately after an incident. " Paramedics are telling us a brief unwinding with peers is critical, " says principal investigator Dr. Janice Halpern, of Mount Sinai Hospital. " A simple chance to calm down and decompress, combined with a supportive word or expression of support from a supervisor could relieve a lot of suffering. " Past studies have suggested that the commonly used Critical Incident Stress Debriefing (CISD) is not only ineffective in preventing PTSD, but potentially harmful. In those studies, a group intervention was carried out by experts days after a traumatic call or 'critical incident'. The current study aims to develop a new approach to critical incident stress, and the investigators began by interviewing the paramedics themselves. Dr. Halpern and her co-investigators, Dr. Gurevich of Ryerson University, Dr. Schwartz of Sunnybrook-Osler Centre for Pre-Hospital Care, and Ms. ette Brazeau and Dr. Bishop of the University of Toronto, believe these findings could make a tremendous difference in how interventions for coping with critical incidents are structured. The study's initial findings have been well received by Toronto EMS personnel and administration, and they are committed to participating in the next phase of research, which will build on the initial results using a quantitative approach. " These results point to the potentially crucial impact of early, relatively simple interventions within the workplace, relying on personnel with whom they are already familiar, " added Dr. Halpern. " This makes good intuitive sense, and is well worth studying further. What they're talking about is emotional first-aid for paramedics. What could be more appropriate? " " Many paramedics have trouble reaching out for help, " explains Vince Savoia, founder and Executive Director of The Tema Conter Memorial Trust. " If research like this can help alleviate PTSD, we really are in a much better position to understand and help the EMS personnel who help so many of us. " About The Tema Conter Memorial Trust With a mission to better understand the effects of Post Traumatic Stress on emergency services personnel, The Tema Conter Memorial Trust invests not only in important research but also in education and awareness. An important additional component is public education so people understand the sacrifice emergency workers and their families make by serving the community. For more information about The Tema Conter Memorial Trust, visit www.tema.ca Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 29, 2006 Report Share Posted January 29, 2006 So we are told CISD does not work. Are we now making a shift in that statement? Is it one study this and one study that? Will the results be that different individuals have different coping mechanisms? Are EMS professionals different than others exposed to critical stress? I just have to say WOW!!! " E. Bledsoe, DO, FACEP " wrote: Study Examines EMS Coping Strategies Canada NewsWire The preliminary results of a new study show that emergency medical services (EMS) personnel believe they are much more likely to recover from traumatic critical incidents if given brief time-out periods with peers and expressions of support from supervisors. EMS personnel are two to three times more likely than the general public to suffer from Post-traumatic Stress Disorder (PTSD), a disorder that can cause emotional difficulties as a result of dealing regularly with traumatic calls. These difficulties often lead to increased absenteeism, a troubled family life, and increased drug and alcohol abuse. A team of researchers from Mt. Sinai Hospital, Ryerson University, Sunnybrook-Osler Centre for Pre-Hospital Care, and the University of Toronto, presented the first-year findings of a three-year study at the recent National Association of Emergency Medical Services Physicians, in Tucson, Arizona. The study is funded by The Tema Conter Memorial Trust, an organization dedicated to better understanding the effects of Post Traumatic Stress on emergency services personnel. Using a qualitative interview method with Toronto EMS personnel, the team found that EMS organizations may be able to facilitate employee recovery by implementing simple and straightforward administrative policies such as allowing for brief periods of downtime immediately after an incident. " Paramedics are telling us a brief unwinding with peers is critical, " says principal investigator Dr. Janice Halpern, of Mount Sinai Hospital. " A simple chance to calm down and decompress, combined with a supportive word or expression of support from a supervisor could relieve a lot of suffering. " Past studies have suggested that the commonly used Critical Incident Stress Debriefing (CISD) is not only ineffective in preventing PTSD, but potentially harmful. In those studies, a group intervention was carried out by experts days after a traumatic call or 'critical incident'. The current study aims to develop a new approach to critical incident stress, and the investigators began by interviewing the paramedics themselves. Dr. Halpern and her co-investigators, Dr. Gurevich of Ryerson University, Dr. Schwartz of Sunnybrook-Osler Centre for Pre-Hospital Care, and Ms. ette Brazeau and Dr. Bishop of the University of Toronto, believe these findings could make a tremendous difference in how interventions for coping with critical incidents are structured. The study's initial findings have been well received by Toronto EMS personnel and administration, and they are committed to participating in the next phase of research, which will build on the initial results using a quantitative approach. " These results point to the potentially crucial impact of early, relatively simple interventions within the workplace, relying on personnel with whom they are already familiar, " added Dr. Halpern. " This makes good intuitive sense, and is well worth studying further. What they're talking about is emotional first-aid for paramedics. What could be more appropriate? " " Many paramedics have trouble reaching out for help, " explains Vince Savoia, founder and Executive Director of The Tema Conter Memorial Trust. " If research like this can help alleviate PTSD, we really are in a much better position to understand and help the EMS personnel who help so many of us. " About The Tema Conter Memorial Trust With a mission to better understand the effects of Post Traumatic Stress on emergency services personnel, The Tema Conter Memorial Trust invests not only in important research but also in education and awareness. An important additional component is public education so people understand the sacrifice emergency workers and their families make by serving the community. For more information about The Tema Conter Memorial Trust, visit www.tema.ca Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 29, 2006 Report Share Posted January 29, 2006 So we are told CISD does not work. Are we now making a shift in that statement? Is it one study this and one study that? Will the results be that different individuals have different coping mechanisms? Are EMS professionals different than others exposed to critical stress? I just have to say WOW!!! " E. Bledsoe, DO, FACEP " wrote: Study Examines EMS Coping Strategies Canada NewsWire The preliminary results of a new study show that emergency medical services (EMS) personnel believe they are much more likely to recover from traumatic critical incidents if given brief time-out periods with peers and expressions of support from supervisors. EMS personnel are two to three times more likely than the general public to suffer from Post-traumatic Stress Disorder (PTSD), a disorder that can cause emotional difficulties as a result of dealing regularly with traumatic calls. These difficulties often lead to increased absenteeism, a troubled family life, and increased drug and alcohol abuse. A team of researchers from Mt. Sinai Hospital, Ryerson University, Sunnybrook-Osler Centre for Pre-Hospital Care, and the University of Toronto, presented the first-year findings of a three-year study at the recent National Association of Emergency Medical Services Physicians, in Tucson, Arizona. The study is funded by The Tema Conter Memorial Trust, an organization dedicated to better understanding the effects of Post Traumatic Stress on emergency services personnel. Using a qualitative interview method with Toronto EMS personnel, the team found that EMS organizations may be able to facilitate employee recovery by implementing simple and straightforward administrative policies such as allowing for brief periods of downtime immediately after an incident. " Paramedics are telling us a brief unwinding with peers is critical, " says principal investigator Dr. Janice Halpern, of Mount Sinai Hospital. " A simple chance to calm down and decompress, combined with a supportive word or expression of support from a supervisor could relieve a lot of suffering. " Past studies have suggested that the commonly used Critical Incident Stress Debriefing (CISD) is not only ineffective in preventing PTSD, but potentially harmful. In those studies, a group intervention was carried out by experts days after a traumatic call or 'critical incident'. The current study aims to develop a new approach to critical incident stress, and the investigators began by interviewing the paramedics themselves. Dr. Halpern and her co-investigators, Dr. Gurevich of Ryerson University, Dr. Schwartz of Sunnybrook-Osler Centre for Pre-Hospital Care, and Ms. ette Brazeau and Dr. Bishop of the University of Toronto, believe these findings could make a tremendous difference in how interventions for coping with critical incidents are structured. The study's initial findings have been well received by Toronto EMS personnel and administration, and they are committed to participating in the next phase of research, which will build on the initial results using a quantitative approach. " These results point to the potentially crucial impact of early, relatively simple interventions within the workplace, relying on personnel with whom they are already familiar, " added Dr. Halpern. " This makes good intuitive sense, and is well worth studying further. What they're talking about is emotional first-aid for paramedics. What could be more appropriate? " " Many paramedics have trouble reaching out for help, " explains Vince Savoia, founder and Executive Director of The Tema Conter Memorial Trust. " If research like this can help alleviate PTSD, we really are in a much better position to understand and help the EMS personnel who help so many of us. " About The Tema Conter Memorial Trust With a mission to better understand the effects of Post Traumatic Stress on emergency services personnel, The Tema Conter Memorial Trust invests not only in important research but also in education and awareness. An important additional component is public education so people understand the sacrifice emergency workers and their families make by serving the community. For more information about The Tema Conter Memorial Trust, visit www.tema.ca Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 29, 2006 Report Share Posted January 29, 2006 EMS people are just as diverse as the population as a whole. We have people of different cultures, religions, beliefs, values, and even sexual identities. We each cope differently and, in fact, most coping styles are healthy. Even " repressing " feelings has been found to be an effective coping style. That is why CISM and other types of structured interventions are problematic. There are people that CISM might help. There are people where prayer might help. There are people where barbecue might help. But, there are people where CISM might harm, prayer might harm and barbecue might harm. But, in the first week of an event, trying to change thinking is problematic. The way we respond to stress is based upon our personality, beliefs, life-experiences, intellect, etc. The vast majority of people who are exposed to EMS stressors do just fine. EMS sort of self-selects. Those who cannot emotionally handle the trials and tribulations of EMS leave the profession. The best indicator of how you will be a year after a critical stress is how you were a year before the event. The trend is to promote the development of pre-existing stress management strategies. CISM consists of 10 components and I only have trouble with two--defusing and debriefing. Remove those, and the model is good. What should we do? 1. Promote the development of healthy behavior and stress-management strategies. 2. Protect people when stress occurs. Remove them from the stress and periodically assess them for problematic response. Alot of the problems we are seeing with FDNY after 9-11 was that nobody made them get off the heap when it was obvious that all survivors had been found. 3. Meet physical needs (warmth, food, fluids, companionship). If people want to talk, let them. If they don't, don't make them. 4. Use the person's personal support system (spouse, friends, clergy, co-workers). Don't force them into a support system in which they are uncomfortable (CISD, prayer session). 5. Provide information and quash rumors. We need to know the facts to know how to feel and respond. 6. Do not debrief or defuse. 7. Monitor people for 4-6 weeks after the stress. For those showing signs of ASD or PTSD, refer for professional assessment and possibly cognitive-behavioral therapy. There are screening systems that supervisors can apply that are sensitive in detecting those who are not responding. Again, instead of treating the whole herd with the same treatment, you identify those that are having problems and customize the treatment, if needed, to the individual animal. E. Bledsoe, DO, FACEP Midlothian, Texas Don't miss the Western States EMS Cruise! http://proemseducators.com/index.html _____ From: [mailto: ] On Behalf Of Danny Sent: Sunday, January 29, 2006 9:59 AM To: Subject: Re: EMS Coping So we are told CISD does not work. Are we now making a shift in that statement? Is it one study this and one study that? Will the results be that different individuals have different coping mechanisms? Are EMS professionals different than others exposed to critical stress? I just have to say WOW!!! " E. Bledsoe, DO, FACEP " wrote: Study Examines EMS Coping Strategies Canada NewsWire The preliminary results of a new study show that emergency medical services (EMS) personnel believe they are much more likely to recover from traumatic critical incidents if given brief time-out periods with peers and expressions of support from supervisors. EMS personnel are two to three times more likely than the general public to suffer from Post-traumatic Stress Disorder (PTSD), a disorder that can cause emotional difficulties as a result of dealing regularly with traumatic calls. These difficulties often lead to increased absenteeism, a troubled family life, and increased drug and alcohol abuse. A team of researchers from Mt. Sinai Hospital, Ryerson University, Sunnybrook-Osler Centre for Pre-Hospital Care, and the University of Toronto, presented the first-year findings of a three-year study at the recent National Association of Emergency Medical Services Physicians, in Tucson, Arizona. The study is funded by The Tema Conter Memorial Trust, an organization dedicated to better understanding the effects of Post Traumatic Stress on emergency services personnel. Using a qualitative interview method with Toronto EMS personnel, the team found that EMS organizations may be able to facilitate employee recovery by implementing simple and straightforward administrative policies such as allowing for brief periods of downtime immediately after an incident. " Paramedics are telling us a brief unwinding with peers is critical, " says principal investigator Dr. Janice Halpern, of Mount Sinai Hospital. " A simple chance to calm down and decompress, combined with a supportive word or expression of support from a supervisor could relieve a lot of suffering. " Past studies have suggested that the commonly used Critical Incident Stress Debriefing (CISD) is not only ineffective in preventing PTSD, but potentially harmful. In those studies, a group intervention was carried out by experts days after a traumatic call or 'critical incident'. The current study aims to develop a new approach to critical incident stress, and the investigators began by interviewing the paramedics themselves. Dr. Halpern and her co-investigators, Dr. Gurevich of Ryerson University, Dr. Schwartz of Sunnybrook-Osler Centre for Pre-Hospital Care, and Ms. ette Brazeau and Dr. Bishop of the University of Toronto, believe these findings could make a tremendous difference in how interventions for coping with critical incidents are structured. The study's initial findings have been well received by Toronto EMS personnel and administration, and they are committed to participating in the next phase of research, which will build on the initial results using a quantitative approach. " These results point to the potentially crucial impact of early, relatively simple interventions within the workplace, relying on personnel with whom they are already familiar, " added Dr. Halpern. " This makes good intuitive sense, and is well worth studying further. What they're talking about is emotional first-aid for paramedics. What could be more appropriate? " " Many paramedics have trouble reaching out for help, " explains Vince Savoia, founder and Executive Director of The Tema Conter Memorial Trust. " If research like this can help alleviate PTSD, we really are in a much better position to understand and help the EMS personnel who help so many of us. " About The Tema Conter Memorial Trust With a mission to better understand the effects of Post Traumatic Stress on emergency services personnel, The Tema Conter Memorial Trust invests not only in important research but also in education and awareness. An important additional component is public education so people understand the sacrifice emergency workers and their families make by serving the community. For more information about The Tema Conter Memorial Trust, visit www.tema.ca Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 29, 2006 Report Share Posted January 29, 2006 EMS people are just as diverse as the population as a whole. We have people of different cultures, religions, beliefs, values, and even sexual identities. We each cope differently and, in fact, most coping styles are healthy. Even " repressing " feelings has been found to be an effective coping style. That is why CISM and other types of structured interventions are problematic. There are people that CISM might help. There are people where prayer might help. There are people where barbecue might help. But, there are people where CISM might harm, prayer might harm and barbecue might harm. But, in the first week of an event, trying to change thinking is problematic. The way we respond to stress is based upon our personality, beliefs, life-experiences, intellect, etc. The vast majority of people who are exposed to EMS stressors do just fine. EMS sort of self-selects. Those who cannot emotionally handle the trials and tribulations of EMS leave the profession. The best indicator of how you will be a year after a critical stress is how you were a year before the event. The trend is to promote the development of pre-existing stress management strategies. CISM consists of 10 components and I only have trouble with two--defusing and debriefing. Remove those, and the model is good. What should we do? 1. Promote the development of healthy behavior and stress-management strategies. 2. Protect people when stress occurs. Remove them from the stress and periodically assess them for problematic response. Alot of the problems we are seeing with FDNY after 9-11 was that nobody made them get off the heap when it was obvious that all survivors had been found. 3. Meet physical needs (warmth, food, fluids, companionship). If people want to talk, let them. If they don't, don't make them. 4. Use the person's personal support system (spouse, friends, clergy, co-workers). Don't force them into a support system in which they are uncomfortable (CISD, prayer session). 5. Provide information and quash rumors. We need to know the facts to know how to feel and respond. 6. Do not debrief or defuse. 7. Monitor people for 4-6 weeks after the stress. For those showing signs of ASD or PTSD, refer for professional assessment and possibly cognitive-behavioral therapy. There are screening systems that supervisors can apply that are sensitive in detecting those who are not responding. Again, instead of treating the whole herd with the same treatment, you identify those that are having problems and customize the treatment, if needed, to the individual animal. E. Bledsoe, DO, FACEP Midlothian, Texas Don't miss the Western States EMS Cruise! http://proemseducators.com/index.html _____ From: [mailto: ] On Behalf Of Danny Sent: Sunday, January 29, 2006 9:59 AM To: Subject: Re: EMS Coping So we are told CISD does not work. Are we now making a shift in that statement? Is it one study this and one study that? Will the results be that different individuals have different coping mechanisms? Are EMS professionals different than others exposed to critical stress? I just have to say WOW!!! " E. Bledsoe, DO, FACEP " wrote: Study Examines EMS Coping Strategies Canada NewsWire The preliminary results of a new study show that emergency medical services (EMS) personnel believe they are much more likely to recover from traumatic critical incidents if given brief time-out periods with peers and expressions of support from supervisors. EMS personnel are two to three times more likely than the general public to suffer from Post-traumatic Stress Disorder (PTSD), a disorder that can cause emotional difficulties as a result of dealing regularly with traumatic calls. These difficulties often lead to increased absenteeism, a troubled family life, and increased drug and alcohol abuse. A team of researchers from Mt. Sinai Hospital, Ryerson University, Sunnybrook-Osler Centre for Pre-Hospital Care, and the University of Toronto, presented the first-year findings of a three-year study at the recent National Association of Emergency Medical Services Physicians, in Tucson, Arizona. The study is funded by The Tema Conter Memorial Trust, an organization dedicated to better understanding the effects of Post Traumatic Stress on emergency services personnel. Using a qualitative interview method with Toronto EMS personnel, the team found that EMS organizations may be able to facilitate employee recovery by implementing simple and straightforward administrative policies such as allowing for brief periods of downtime immediately after an incident. " Paramedics are telling us a brief unwinding with peers is critical, " says principal investigator Dr. Janice Halpern, of Mount Sinai Hospital. " A simple chance to calm down and decompress, combined with a supportive word or expression of support from a supervisor could relieve a lot of suffering. " Past studies have suggested that the commonly used Critical Incident Stress Debriefing (CISD) is not only ineffective in preventing PTSD, but potentially harmful. In those studies, a group intervention was carried out by experts days after a traumatic call or 'critical incident'. The current study aims to develop a new approach to critical incident stress, and the investigators began by interviewing the paramedics themselves. Dr. Halpern and her co-investigators, Dr. Gurevich of Ryerson University, Dr. Schwartz of Sunnybrook-Osler Centre for Pre-Hospital Care, and Ms. ette Brazeau and Dr. Bishop of the University of Toronto, believe these findings could make a tremendous difference in how interventions for coping with critical incidents are structured. The study's initial findings have been well received by Toronto EMS personnel and administration, and they are committed to participating in the next phase of research, which will build on the initial results using a quantitative approach. " These results point to the potentially crucial impact of early, relatively simple interventions within the workplace, relying on personnel with whom they are already familiar, " added Dr. Halpern. " This makes good intuitive sense, and is well worth studying further. What they're talking about is emotional first-aid for paramedics. What could be more appropriate? " " Many paramedics have trouble reaching out for help, " explains Vince Savoia, founder and Executive Director of The Tema Conter Memorial Trust. " If research like this can help alleviate PTSD, we really are in a much better position to understand and help the EMS personnel who help so many of us. " About The Tema Conter Memorial Trust With a mission to better understand the effects of Post Traumatic Stress on emergency services personnel, The Tema Conter Memorial Trust invests not only in important research but also in education and awareness. An important additional component is public education so people understand the sacrifice emergency workers and their families make by serving the community. For more information about The Tema Conter Memorial Trust, visit www.tema.ca Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 29, 2006 Report Share Posted January 29, 2006 EMS people are just as diverse as the population as a whole. We have people of different cultures, religions, beliefs, values, and even sexual identities. We each cope differently and, in fact, most coping styles are healthy. Even " repressing " feelings has been found to be an effective coping style. That is why CISM and other types of structured interventions are problematic. There are people that CISM might help. There are people where prayer might help. There are people where barbecue might help. But, there are people where CISM might harm, prayer might harm and barbecue might harm. But, in the first week of an event, trying to change thinking is problematic. The way we respond to stress is based upon our personality, beliefs, life-experiences, intellect, etc. The vast majority of people who are exposed to EMS stressors do just fine. EMS sort of self-selects. Those who cannot emotionally handle the trials and tribulations of EMS leave the profession. The best indicator of how you will be a year after a critical stress is how you were a year before the event. The trend is to promote the development of pre-existing stress management strategies. CISM consists of 10 components and I only have trouble with two--defusing and debriefing. Remove those, and the model is good. What should we do? 1. Promote the development of healthy behavior and stress-management strategies. 2. Protect people when stress occurs. Remove them from the stress and periodically assess them for problematic response. Alot of the problems we are seeing with FDNY after 9-11 was that nobody made them get off the heap when it was obvious that all survivors had been found. 3. Meet physical needs (warmth, food, fluids, companionship). If people want to talk, let them. If they don't, don't make them. 4. Use the person's personal support system (spouse, friends, clergy, co-workers). Don't force them into a support system in which they are uncomfortable (CISD, prayer session). 5. Provide information and quash rumors. We need to know the facts to know how to feel and respond. 6. Do not debrief or defuse. 7. Monitor people for 4-6 weeks after the stress. For those showing signs of ASD or PTSD, refer for professional assessment and possibly cognitive-behavioral therapy. There are screening systems that supervisors can apply that are sensitive in detecting those who are not responding. Again, instead of treating the whole herd with the same treatment, you identify those that are having problems and customize the treatment, if needed, to the individual animal. E. Bledsoe, DO, FACEP Midlothian, Texas Don't miss the Western States EMS Cruise! http://proemseducators.com/index.html _____ From: [mailto: ] On Behalf Of Danny Sent: Sunday, January 29, 2006 9:59 AM To: Subject: Re: EMS Coping So we are told CISD does not work. Are we now making a shift in that statement? Is it one study this and one study that? Will the results be that different individuals have different coping mechanisms? Are EMS professionals different than others exposed to critical stress? I just have to say WOW!!! " E. Bledsoe, DO, FACEP " wrote: Study Examines EMS Coping Strategies Canada NewsWire The preliminary results of a new study show that emergency medical services (EMS) personnel believe they are much more likely to recover from traumatic critical incidents if given brief time-out periods with peers and expressions of support from supervisors. EMS personnel are two to three times more likely than the general public to suffer from Post-traumatic Stress Disorder (PTSD), a disorder that can cause emotional difficulties as a result of dealing regularly with traumatic calls. These difficulties often lead to increased absenteeism, a troubled family life, and increased drug and alcohol abuse. A team of researchers from Mt. Sinai Hospital, Ryerson University, Sunnybrook-Osler Centre for Pre-Hospital Care, and the University of Toronto, presented the first-year findings of a three-year study at the recent National Association of Emergency Medical Services Physicians, in Tucson, Arizona. The study is funded by The Tema Conter Memorial Trust, an organization dedicated to better understanding the effects of Post Traumatic Stress on emergency services personnel. Using a qualitative interview method with Toronto EMS personnel, the team found that EMS organizations may be able to facilitate employee recovery by implementing simple and straightforward administrative policies such as allowing for brief periods of downtime immediately after an incident. " Paramedics are telling us a brief unwinding with peers is critical, " says principal investigator Dr. Janice Halpern, of Mount Sinai Hospital. " A simple chance to calm down and decompress, combined with a supportive word or expression of support from a supervisor could relieve a lot of suffering. " Past studies have suggested that the commonly used Critical Incident Stress Debriefing (CISD) is not only ineffective in preventing PTSD, but potentially harmful. In those studies, a group intervention was carried out by experts days after a traumatic call or 'critical incident'. The current study aims to develop a new approach to critical incident stress, and the investigators began by interviewing the paramedics themselves. Dr. Halpern and her co-investigators, Dr. Gurevich of Ryerson University, Dr. Schwartz of Sunnybrook-Osler Centre for Pre-Hospital Care, and Ms. ette Brazeau and Dr. Bishop of the University of Toronto, believe these findings could make a tremendous difference in how interventions for coping with critical incidents are structured. The study's initial findings have been well received by Toronto EMS personnel and administration, and they are committed to participating in the next phase of research, which will build on the initial results using a quantitative approach. " These results point to the potentially crucial impact of early, relatively simple interventions within the workplace, relying on personnel with whom they are already familiar, " added Dr. Halpern. " This makes good intuitive sense, and is well worth studying further. What they're talking about is emotional first-aid for paramedics. What could be more appropriate? " " Many paramedics have trouble reaching out for help, " explains Vince Savoia, founder and Executive Director of The Tema Conter Memorial Trust. " If research like this can help alleviate PTSD, we really are in a much better position to understand and help the EMS personnel who help so many of us. " About The Tema Conter Memorial Trust With a mission to better understand the effects of Post Traumatic Stress on emergency services personnel, The Tema Conter Memorial Trust invests not only in important research but also in education and awareness. An important additional component is public education so people understand the sacrifice emergency workers and their families make by serving the community. For more information about The Tema Conter Memorial Trust, visit www.tema.ca Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 29, 2006 Report Share Posted January 29, 2006 EMS people are just as diverse as the population as a whole. We have people of different cultures, religions, beliefs, values, and even sexual identities. We each cope differently and, in fact, most coping styles are healthy. Even " repressing " feelings has been found to be an effective coping style. That is why CISM and other types of structured interventions are problematic. There are people that CISM might help. There are people where prayer might help. There are people where barbecue might help. But, there are people where CISM might harm, prayer might harm and barbecue might harm. But, in the first week of an event, trying to change thinking is problematic. The way we respond to stress is based upon our personality, beliefs, life-experiences, intellect, etc. The vast majority of people who are exposed to EMS stressors do just fine. EMS sort of self-selects. Those who cannot emotionally handle the trials and tribulations of EMS leave the profession. The best indicator of how you will be a year after a critical stress is how you were a year before the event. The trend is to promote the development of pre-existing stress management strategies. CISM consists of 10 components and I only have trouble with two--defusing and debriefing. Remove those, and the model is good. What should we do? 1. Promote the development of healthy behavior and stress-management strategies. 2. Protect people when stress occurs. Remove them from the stress and periodically assess them for problematic response. Alot of the problems we are seeing with FDNY after 9-11 was that nobody made them get off the heap when it was obvious that all survivors had been found. 3. Meet physical needs (warmth, food, fluids, companionship). If people want to talk, let them. If they don't, don't make them. 4. Use the person's personal support system (spouse, friends, clergy, co-workers). Don't force them into a support system in which they are uncomfortable (CISD, prayer session). 5. Provide information and quash rumors. We need to know the facts to know how to feel and respond. 6. Do not debrief or defuse. 7. Monitor people for 4-6 weeks after the stress. For those showing signs of ASD or PTSD, refer for professional assessment and possibly cognitive-behavioral therapy. There are screening systems that supervisors can apply that are sensitive in detecting those who are not responding. Again, instead of treating the whole herd with the same treatment, you identify those that are having problems and customize the treatment, if needed, to the individual animal. E. Bledsoe, DO, FACEP Midlothian, Texas Don't miss the Western States EMS Cruise! http://proemseducators.com/index.html _____ From: [mailto: ] On Behalf Of Danny Sent: Sunday, January 29, 2006 9:59 AM To: Subject: Re: EMS Coping So we are told CISD does not work. Are we now making a shift in that statement? Is it one study this and one study that? Will the results be that different individuals have different coping mechanisms? Are EMS professionals different than others exposed to critical stress? I just have to say WOW!!! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 29, 2006 Report Share Posted January 29, 2006 EMS people are just as diverse as the population as a whole. We have people of different cultures, religions, beliefs, values, and even sexual identities. We each cope differently and, in fact, most coping styles are healthy. Even " repressing " feelings has been found to be an effective coping style. That is why CISM and other types of structured interventions are problematic. There are people that CISM might help. There are people where prayer might help. There are people where barbecue might help. But, there are people where CISM might harm, prayer might harm and barbecue might harm. But, in the first week of an event, trying to change thinking is problematic. The way we respond to stress is based upon our personality, beliefs, life-experiences, intellect, etc. The vast majority of people who are exposed to EMS stressors do just fine. EMS sort of self-selects. Those who cannot emotionally handle the trials and tribulations of EMS leave the profession. The best indicator of how you will be a year after a critical stress is how you were a year before the event. The trend is to promote the development of pre-existing stress management strategies. CISM consists of 10 components and I only have trouble with two--defusing and debriefing. Remove those, and the model is good. What should we do? 1. Promote the development of healthy behavior and stress-management strategies. 2. Protect people when stress occurs. Remove them from the stress and periodically assess them for problematic response. Alot of the problems we are seeing with FDNY after 9-11 was that nobody made them get off the heap when it was obvious that all survivors had been found. 3. Meet physical needs (warmth, food, fluids, companionship). If people want to talk, let them. If they don't, don't make them. 4. Use the person's personal support system (spouse, friends, clergy, co-workers). Don't force them into a support system in which they are uncomfortable (CISD, prayer session). 5. Provide information and quash rumors. We need to know the facts to know how to feel and respond. 6. Do not debrief or defuse. 7. Monitor people for 4-6 weeks after the stress. For those showing signs of ASD or PTSD, refer for professional assessment and possibly cognitive-behavioral therapy. There are screening systems that supervisors can apply that are sensitive in detecting those who are not responding. Again, instead of treating the whole herd with the same treatment, you identify those that are having problems and customize the treatment, if needed, to the individual animal. E. Bledsoe, DO, FACEP Midlothian, Texas Don't miss the Western States EMS Cruise! http://proemseducators.com/index.html _____ From: [mailto: ] On Behalf Of Danny Sent: Sunday, January 29, 2006 9:59 AM To: Subject: Re: EMS Coping So we are told CISD does not work. Are we now making a shift in that statement? Is it one study this and one study that? Will the results be that different individuals have different coping mechanisms? Are EMS professionals different than others exposed to critical stress? I just have to say WOW!!! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 29, 2006 Report Share Posted January 29, 2006 Good response Dr. B., it alls boils down to individuality. And we could call it Dr. B's guide of coping with EMS stress (DBGCES). stephen stephens > EMS people are just as diverse as the population as a whole. We have people > of different cultures, religions, beliefs, values, and even sexual > identities. We each cope differently and, in fact, most coping styles are > healthy. Even " repressing " feelings has been found to be an effective > coping style. That is why CISM and other types of structured interventions > are problematic. There are people that CISM might help. There are people > where prayer might help. There are people where barbecue might help. But, > there are people where CISM might harm, prayer might harm and barbecue might > harm. But, in the first week of an event, trying to change thinking is > problematic. The way we respond to stress is based upon our personality, > beliefs, life-experiences, intellect, etc. The vast majority of people who > are exposed to EMS stressors do just fine. EMS sort of self- selects. Those > who cannot emotionally handle the trials and tribulations of EMS leave the > profession. The best indicator of how you will be a year after a critical > stress is how you were a year before the event. The trend is to promote the > development of pre-existing stress management strategies. CISM consists of > 10 components and I only have trouble with two--defusing and debriefing. > Remove those, and the model is good. What should we do? > 1. Promote the development of healthy behavior and stress- management > strategies. > 2. Protect people when stress occurs. Remove them from the stress and > periodically assess them for problematic response. Alot of the problems we > are seeing with FDNY after 9-11 was that nobody made them get off the heap > when it was obvious that all survivors had been found. > 3. Meet physical needs (warmth, food, fluids, companionship). If people want > to talk, let them. If they don't, don't make them. > 4. Use the person's personal support system (spouse, friends, clergy, > co-workers). Don't force them into a support system in which they are > uncomfortable (CISD, prayer session). > 5. Provide information and quash rumors. We need to know the facts to know > how to feel and respond. > 6. Do not debrief or defuse. > 7. Monitor people for 4-6 weeks after the stress. For those showing signs of > ASD or PTSD, refer for professional assessment and possibly > cognitive-behavioral therapy. There are screening systems that supervisors > can apply that are sensitive in detecting those who are not responding. > > Again, instead of treating the whole herd with the same treatment, you > identify those that are having problems and customize the treatment, if > needed, to the individual animal. > > E. Bledsoe, DO, FACEP > Midlothian, Texas > > Don't miss the Western States EMS Cruise! > http://proemseducators.com/index.html > > > _____ > > From: [mailto:texasems- l ] On > Behalf Of Danny > Sent: Sunday, January 29, 2006 9:59 AM > To: > Subject: Re: EMS Coping > > > So we are told CISD does not work. Are we now making a shift in that > statement? > > Is it one study this and one study that? > > Will the results be that different individuals have different coping > mechanisms? > > Are EMS professionals different than others exposed to critical stress? > > I just have to say WOW!!! > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 29, 2006 Report Share Posted January 29, 2006 Good response Dr. B., it alls boils down to individuality. And we could call it Dr. B's guide of coping with EMS stress (DBGCES). stephen stephens > EMS people are just as diverse as the population as a whole. We have people > of different cultures, religions, beliefs, values, and even sexual > identities. We each cope differently and, in fact, most coping styles are > healthy. Even " repressing " feelings has been found to be an effective > coping style. That is why CISM and other types of structured interventions > are problematic. There are people that CISM might help. There are people > where prayer might help. There are people where barbecue might help. But, > there are people where CISM might harm, prayer might harm and barbecue might > harm. But, in the first week of an event, trying to change thinking is > problematic. The way we respond to stress is based upon our personality, > beliefs, life-experiences, intellect, etc. The vast majority of people who > are exposed to EMS stressors do just fine. EMS sort of self- selects. Those > who cannot emotionally handle the trials and tribulations of EMS leave the > profession. The best indicator of how you will be a year after a critical > stress is how you were a year before the event. The trend is to promote the > development of pre-existing stress management strategies. CISM consists of > 10 components and I only have trouble with two--defusing and debriefing. > Remove those, and the model is good. What should we do? > 1. Promote the development of healthy behavior and stress- management > strategies. > 2. Protect people when stress occurs. Remove them from the stress and > periodically assess them for problematic response. Alot of the problems we > are seeing with FDNY after 9-11 was that nobody made them get off the heap > when it was obvious that all survivors had been found. > 3. Meet physical needs (warmth, food, fluids, companionship). If people want > to talk, let them. If they don't, don't make them. > 4. Use the person's personal support system (spouse, friends, clergy, > co-workers). Don't force them into a support system in which they are > uncomfortable (CISD, prayer session). > 5. Provide information and quash rumors. We need to know the facts to know > how to feel and respond. > 6. Do not debrief or defuse. > 7. Monitor people for 4-6 weeks after the stress. For those showing signs of > ASD or PTSD, refer for professional assessment and possibly > cognitive-behavioral therapy. There are screening systems that supervisors > can apply that are sensitive in detecting those who are not responding. > > Again, instead of treating the whole herd with the same treatment, you > identify those that are having problems and customize the treatment, if > needed, to the individual animal. > > E. Bledsoe, DO, FACEP > Midlothian, Texas > > Don't miss the Western States EMS Cruise! > http://proemseducators.com/index.html > > > _____ > > From: [mailto:texasems- l ] On > Behalf Of Danny > Sent: Sunday, January 29, 2006 9:59 AM > To: > Subject: Re: EMS Coping > > > So we are told CISD does not work. Are we now making a shift in that > statement? > > Is it one study this and one study that? > > Will the results be that different individuals have different coping > mechanisms? > > Are EMS professionals different than others exposed to critical stress? > > I just have to say WOW!!! > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 29, 2006 Report Share Posted January 29, 2006 Good response Dr. B., it alls boils down to individuality. And we could call it Dr. B's guide of coping with EMS stress (DBGCES). stephen stephens > EMS people are just as diverse as the population as a whole. We have people > of different cultures, religions, beliefs, values, and even sexual > identities. We each cope differently and, in fact, most coping styles are > healthy. Even " repressing " feelings has been found to be an effective > coping style. That is why CISM and other types of structured interventions > are problematic. There are people that CISM might help. There are people > where prayer might help. There are people where barbecue might help. But, > there are people where CISM might harm, prayer might harm and barbecue might > harm. But, in the first week of an event, trying to change thinking is > problematic. The way we respond to stress is based upon our personality, > beliefs, life-experiences, intellect, etc. The vast majority of people who > are exposed to EMS stressors do just fine. EMS sort of self- selects. Those > who cannot emotionally handle the trials and tribulations of EMS leave the > profession. The best indicator of how you will be a year after a critical > stress is how you were a year before the event. The trend is to promote the > development of pre-existing stress management strategies. CISM consists of > 10 components and I only have trouble with two--defusing and debriefing. > Remove those, and the model is good. What should we do? > 1. Promote the development of healthy behavior and stress- management > strategies. > 2. Protect people when stress occurs. Remove them from the stress and > periodically assess them for problematic response. Alot of the problems we > are seeing with FDNY after 9-11 was that nobody made them get off the heap > when it was obvious that all survivors had been found. > 3. Meet physical needs (warmth, food, fluids, companionship). If people want > to talk, let them. If they don't, don't make them. > 4. Use the person's personal support system (spouse, friends, clergy, > co-workers). Don't force them into a support system in which they are > uncomfortable (CISD, prayer session). > 5. Provide information and quash rumors. We need to know the facts to know > how to feel and respond. > 6. Do not debrief or defuse. > 7. Monitor people for 4-6 weeks after the stress. For those showing signs of > ASD or PTSD, refer for professional assessment and possibly > cognitive-behavioral therapy. There are screening systems that supervisors > can apply that are sensitive in detecting those who are not responding. > > Again, instead of treating the whole herd with the same treatment, you > identify those that are having problems and customize the treatment, if > needed, to the individual animal. > > E. Bledsoe, DO, FACEP > Midlothian, Texas > > Don't miss the Western States EMS Cruise! > http://proemseducators.com/index.html > > > _____ > > From: [mailto:texasems- l ] On > Behalf Of Danny > Sent: Sunday, January 29, 2006 9:59 AM > To: > Subject: Re: EMS Coping > > > So we are told CISD does not work. Are we now making a shift in that > statement? > > Is it one study this and one study that? > > Will the results be that different individuals have different coping > mechanisms? > > Are EMS professionals different than others exposed to critical stress? > > I just have to say WOW!!! > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 29, 2006 Report Share Posted January 29, 2006 In , " E. Bledsoe, DO, FACEP " <bbledsoe@e...> wrote: > > EMS people are just as diverse as the population as a whole. We have people > of different cultures, religions, beliefs, values, and even sexual > identities. We each cope differently and, in fact, most coping styles are > healthy. .. . . and a whole lot more valuable, solid, common sense stuff--exactly the kind of stuff we need to get back to, now that we've hopefully done the Buffy for ill conceived and problematic prophylactics like CISD. If you step back and look at what the Toronto inquiries revealed, it's that people want a brief interlude to exhale and shake it off after tackling something outside their expectations and experiences, and that most would prefer to do so with folks reasonably connected to their daily encounters and experiences (e.g., supervisors and colleagues). Masquerading this as the results of " qualitative research " is probably gilding the lily more than a tad, but the outcome is very consistent with what many of us who have stopped long enough to listen have clearly heard. And, as Mr. Bledson so rightly noted, it's important that whatever actions are taken be responsive to and supportive of the interests and predilections of the folks actually affected, taking careful and respectful note of the wide diversity of who we are and how we approach our lives. I was interviewing for a position at a Jesuit medical school a couple or three decades back and was asked what I believed would be the three biggest problems facing medicine and the healing arts in the 1980s--I answered without much thought by rattling off, " Ignorance, arrogance, and greed. " Now, that didn't win me any friends in the interview, but I would argue that it has proven to have been both precise and prescient. It's the same combination that doomed the CISD movement to implosion, and it was visible there from the early 1980s, too. We've said many times that the idea caught on because it was built around the kernel of a decent, common sense notion of taking the time to listen to one's colleagues after something rocked their world. Considered at that level, without all the hubris and horse-hockey and Company built around it, it would probably have evolved into pretty much what the Canadian folks describe--but there would have been no catechismic cults, no pecuniary enterprises, no inflated egos or pilfered pockets. It's important not to lose that lesson . . . at the end of the day, the CISD movement was, very sadly, much more about the egos and the enterprises than about defining a problem and devising ways to help. It was pretty clear by 1990 that the approach was flawed, but the effort went into to protecting the product instead of finding and fixing the flaws. Even today, you can visit the ICISF website and download pathetic apologetics that try to twist findings and deny facts when the rest of the world is trying to move on with building better mousetraps. 's list of postulates is, from my experience and that of fellow researchers around the globe, pretty much " on the money " (irony fully intended). Note well that the things recommended there don't require you to venerate any particular protocol, attend any weekend workshops, or send your cash anywhere eastward . . .. they require you to have a level head, a compassionate heart, and open ear, and an eye to what the best evidence reveals at any point in time. Being a decent friend, a empathic supervisor, or a good colleague doesn't take a magic decoder ring and a membership card in Little Orphan Annie's inner circle. Humility is often described as the essence of the true scientist. We know painfully well that our ideas are imperfect and our comprehension is limited in ways we can never fully overcome; accordingly, we put them forward, however passionately, with the full expectation and hope that they will be picked apart at their weak points and become stronger as a result. Victor von enstein's fatal flaw came not from failure to install a fully functional limbic system in his monster--his creation in the original novella was actually nothing like the lumbering culutral icon Boris Karloff left to us. His creation was a sensitive creature filled with the greatest aspirations of all humans, but doomed by the hideous form rendered from a patchwork of pilfered cadaver parts to a life of loneliness and isolation. He turned to torment his creator because, in his arrogant lust to be the man who uncovered the secret of life, Dr. von enstein had paid no heed to the impact of his hubris on its outcome for the creature of his creation. Hubris was the flaw; hubris is the Lucifer of the learned. Run good scenes . . . the best preventative for CIS is ICS. Run good organizations--people are resilient where they work in resilient settings. Take the time to listen and respond--good supervision is helped more by breaking bread then by cracking whips. Stay healthy; keep in shape. Talk when you need to; listen when you can. It's not rocket science, but it actually helps. Go figure. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 29, 2006 Report Share Posted January 29, 2006 In , " E. Bledsoe, DO, FACEP " <bbledsoe@e...> wrote: > > EMS people are just as diverse as the population as a whole. We have people > of different cultures, religions, beliefs, values, and even sexual > identities. We each cope differently and, in fact, most coping styles are > healthy. .. . . and a whole lot more valuable, solid, common sense stuff--exactly the kind of stuff we need to get back to, now that we've hopefully done the Buffy for ill conceived and problematic prophylactics like CISD. If you step back and look at what the Toronto inquiries revealed, it's that people want a brief interlude to exhale and shake it off after tackling something outside their expectations and experiences, and that most would prefer to do so with folks reasonably connected to their daily encounters and experiences (e.g., supervisors and colleagues). Masquerading this as the results of " qualitative research " is probably gilding the lily more than a tad, but the outcome is very consistent with what many of us who have stopped long enough to listen have clearly heard. And, as Mr. Bledson so rightly noted, it's important that whatever actions are taken be responsive to and supportive of the interests and predilections of the folks actually affected, taking careful and respectful note of the wide diversity of who we are and how we approach our lives. I was interviewing for a position at a Jesuit medical school a couple or three decades back and was asked what I believed would be the three biggest problems facing medicine and the healing arts in the 1980s--I answered without much thought by rattling off, " Ignorance, arrogance, and greed. " Now, that didn't win me any friends in the interview, but I would argue that it has proven to have been both precise and prescient. It's the same combination that doomed the CISD movement to implosion, and it was visible there from the early 1980s, too. We've said many times that the idea caught on because it was built around the kernel of a decent, common sense notion of taking the time to listen to one's colleagues after something rocked their world. Considered at that level, without all the hubris and horse-hockey and Company built around it, it would probably have evolved into pretty much what the Canadian folks describe--but there would have been no catechismic cults, no pecuniary enterprises, no inflated egos or pilfered pockets. It's important not to lose that lesson . . . at the end of the day, the CISD movement was, very sadly, much more about the egos and the enterprises than about defining a problem and devising ways to help. It was pretty clear by 1990 that the approach was flawed, but the effort went into to protecting the product instead of finding and fixing the flaws. Even today, you can visit the ICISF website and download pathetic apologetics that try to twist findings and deny facts when the rest of the world is trying to move on with building better mousetraps. 's list of postulates is, from my experience and that of fellow researchers around the globe, pretty much " on the money " (irony fully intended). Note well that the things recommended there don't require you to venerate any particular protocol, attend any weekend workshops, or send your cash anywhere eastward . . .. they require you to have a level head, a compassionate heart, and open ear, and an eye to what the best evidence reveals at any point in time. Being a decent friend, a empathic supervisor, or a good colleague doesn't take a magic decoder ring and a membership card in Little Orphan Annie's inner circle. Humility is often described as the essence of the true scientist. We know painfully well that our ideas are imperfect and our comprehension is limited in ways we can never fully overcome; accordingly, we put them forward, however passionately, with the full expectation and hope that they will be picked apart at their weak points and become stronger as a result. Victor von enstein's fatal flaw came not from failure to install a fully functional limbic system in his monster--his creation in the original novella was actually nothing like the lumbering culutral icon Boris Karloff left to us. His creation was a sensitive creature filled with the greatest aspirations of all humans, but doomed by the hideous form rendered from a patchwork of pilfered cadaver parts to a life of loneliness and isolation. He turned to torment his creator because, in his arrogant lust to be the man who uncovered the secret of life, Dr. von enstein had paid no heed to the impact of his hubris on its outcome for the creature of his creation. Hubris was the flaw; hubris is the Lucifer of the learned. Run good scenes . . . the best preventative for CIS is ICS. Run good organizations--people are resilient where they work in resilient settings. Take the time to listen and respond--good supervision is helped more by breaking bread then by cracking whips. Stay healthy; keep in shape. Talk when you need to; listen when you can. It's not rocket science, but it actually helps. Go figure. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 29, 2006 Report Share Posted January 29, 2006 In , " E. Bledsoe, DO, FACEP " <bbledsoe@e...> wrote: > > EMS people are just as diverse as the population as a whole. We have people > of different cultures, religions, beliefs, values, and even sexual > identities. We each cope differently and, in fact, most coping styles are > healthy. .. . . and a whole lot more valuable, solid, common sense stuff--exactly the kind of stuff we need to get back to, now that we've hopefully done the Buffy for ill conceived and problematic prophylactics like CISD. If you step back and look at what the Toronto inquiries revealed, it's that people want a brief interlude to exhale and shake it off after tackling something outside their expectations and experiences, and that most would prefer to do so with folks reasonably connected to their daily encounters and experiences (e.g., supervisors and colleagues). Masquerading this as the results of " qualitative research " is probably gilding the lily more than a tad, but the outcome is very consistent with what many of us who have stopped long enough to listen have clearly heard. And, as Mr. Bledson so rightly noted, it's important that whatever actions are taken be responsive to and supportive of the interests and predilections of the folks actually affected, taking careful and respectful note of the wide diversity of who we are and how we approach our lives. I was interviewing for a position at a Jesuit medical school a couple or three decades back and was asked what I believed would be the three biggest problems facing medicine and the healing arts in the 1980s--I answered without much thought by rattling off, " Ignorance, arrogance, and greed. " Now, that didn't win me any friends in the interview, but I would argue that it has proven to have been both precise and prescient. It's the same combination that doomed the CISD movement to implosion, and it was visible there from the early 1980s, too. We've said many times that the idea caught on because it was built around the kernel of a decent, common sense notion of taking the time to listen to one's colleagues after something rocked their world. Considered at that level, without all the hubris and horse-hockey and Company built around it, it would probably have evolved into pretty much what the Canadian folks describe--but there would have been no catechismic cults, no pecuniary enterprises, no inflated egos or pilfered pockets. It's important not to lose that lesson . . . at the end of the day, the CISD movement was, very sadly, much more about the egos and the enterprises than about defining a problem and devising ways to help. It was pretty clear by 1990 that the approach was flawed, but the effort went into to protecting the product instead of finding and fixing the flaws. Even today, you can visit the ICISF website and download pathetic apologetics that try to twist findings and deny facts when the rest of the world is trying to move on with building better mousetraps. 's list of postulates is, from my experience and that of fellow researchers around the globe, pretty much " on the money " (irony fully intended). Note well that the things recommended there don't require you to venerate any particular protocol, attend any weekend workshops, or send your cash anywhere eastward . . .. they require you to have a level head, a compassionate heart, and open ear, and an eye to what the best evidence reveals at any point in time. Being a decent friend, a empathic supervisor, or a good colleague doesn't take a magic decoder ring and a membership card in Little Orphan Annie's inner circle. Humility is often described as the essence of the true scientist. We know painfully well that our ideas are imperfect and our comprehension is limited in ways we can never fully overcome; accordingly, we put them forward, however passionately, with the full expectation and hope that they will be picked apart at their weak points and become stronger as a result. Victor von enstein's fatal flaw came not from failure to install a fully functional limbic system in his monster--his creation in the original novella was actually nothing like the lumbering culutral icon Boris Karloff left to us. His creation was a sensitive creature filled with the greatest aspirations of all humans, but doomed by the hideous form rendered from a patchwork of pilfered cadaver parts to a life of loneliness and isolation. He turned to torment his creator because, in his arrogant lust to be the man who uncovered the secret of life, Dr. von enstein had paid no heed to the impact of his hubris on its outcome for the creature of his creation. Hubris was the flaw; hubris is the Lucifer of the learned. Run good scenes . . . the best preventative for CIS is ICS. Run good organizations--people are resilient where they work in resilient settings. Take the time to listen and respond--good supervision is helped more by breaking bread then by cracking whips. Stay healthy; keep in shape. Talk when you need to; listen when you can. It's not rocket science, but it actually helps. Go figure. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 29, 2006 Report Share Posted January 29, 2006 In a message dated 29-Jan-06 16:03:03 Central Standard Time, _Gist@... writes: Run good scenes . . . the best preventative for CIS is ICS. Run good organizations--people are resilient where they work in resilient settings. Take the time to listen and respond--good supervision is helped more by breaking bread then by cracking whips. Stay healthy; keep in shape. Talk when you need to; listen when you can. It's not rocket science, but it actually helps. Go figure. , to add to that, I'd point out that the rate of active PTSD among combat vets rose markedly *after* the switch to the individual replacement system and the institution of air movement from the combat zones back to The World. I believe that just the bonding effects of shared pain over time and time to decompress at individual rates has something to do with the mutual support networks (look how easy it is to find nationwide WWII vet reunions versus Korean and Vietnam era reunions) that allow normal mortals to overcome the unhuman demands of close combat. I suspect that EMS/Fire/Police teams where there is a stable sense of partnership and 'ownership' of the system would have lower burnout and PTSD rate than one where there is high turnover and no sense of ownership...This would go along with your 'resilient people in resilient settings' comment above. does this make sense to you? ck S. Krin, DO FAAFP Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 29, 2006 Report Share Posted January 29, 2006 In a message dated 29-Jan-06 16:03:03 Central Standard Time, _Gist@... writes: Run good scenes . . . the best preventative for CIS is ICS. Run good organizations--people are resilient where they work in resilient settings. Take the time to listen and respond--good supervision is helped more by breaking bread then by cracking whips. Stay healthy; keep in shape. Talk when you need to; listen when you can. It's not rocket science, but it actually helps. Go figure. , to add to that, I'd point out that the rate of active PTSD among combat vets rose markedly *after* the switch to the individual replacement system and the institution of air movement from the combat zones back to The World. I believe that just the bonding effects of shared pain over time and time to decompress at individual rates has something to do with the mutual support networks (look how easy it is to find nationwide WWII vet reunions versus Korean and Vietnam era reunions) that allow normal mortals to overcome the unhuman demands of close combat. I suspect that EMS/Fire/Police teams where there is a stable sense of partnership and 'ownership' of the system would have lower burnout and PTSD rate than one where there is high turnover and no sense of ownership...This would go along with your 'resilient people in resilient settings' comment above. does this make sense to you? ck S. Krin, DO FAAFP Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 29, 2006 Report Share Posted January 29, 2006 In a message dated 29-Jan-06 16:03:03 Central Standard Time, _Gist@... writes: Run good scenes . . . the best preventative for CIS is ICS. Run good organizations--people are resilient where they work in resilient settings. Take the time to listen and respond--good supervision is helped more by breaking bread then by cracking whips. Stay healthy; keep in shape. Talk when you need to; listen when you can. It's not rocket science, but it actually helps. Go figure. , to add to that, I'd point out that the rate of active PTSD among combat vets rose markedly *after* the switch to the individual replacement system and the institution of air movement from the combat zones back to The World. I believe that just the bonding effects of shared pain over time and time to decompress at individual rates has something to do with the mutual support networks (look how easy it is to find nationwide WWII vet reunions versus Korean and Vietnam era reunions) that allow normal mortals to overcome the unhuman demands of close combat. I suspect that EMS/Fire/Police teams where there is a stable sense of partnership and 'ownership' of the system would have lower burnout and PTSD rate than one where there is high turnover and no sense of ownership...This would go along with your 'resilient people in resilient settings' comment above. does this make sense to you? ck S. Krin, DO FAAFP Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 29, 2006 Report Share Posted January 29, 2006 Don't give me the credit. I just summarized and wrote what various organizations and researchers have been saying for the past few years. In EMS we always seem to want to make things complicated when simple is actually better. E. Bledsoe, DO, FACEP Midlothian, Texas Don't miss the Western States EMS Cruise! http://proemseducators.com/index.html _____ From: [mailto: ] On Behalf Of sstephensmedic Sent: Sunday, January 29, 2006 2:35 PM To: Subject: Re: EMS Coping Good response Dr. B., it alls boils down to individuality. And we could call it Dr. B's guide of coping with EMS stress (DBGCES). stephen stephens > EMS people are just as diverse as the population as a whole. We have people > of different cultures, religions, beliefs, values, and even sexual > identities. We each cope differently and, in fact, most coping styles are > healthy. Even " repressing " feelings has been found to be an effective > coping style. That is why CISM and other types of structured interventions > are problematic. There are people that CISM might help. There are people > where prayer might help. There are people where barbecue might help. But, > there are people where CISM might harm, prayer might harm and barbecue might > harm. But, in the first week of an event, trying to change thinking is > problematic. The way we respond to stress is based upon our personality, > beliefs, life-experiences, intellect, etc. The vast majority of people who > are exposed to EMS stressors do just fine. EMS sort of self- selects. Those > who cannot emotionally handle the trials and tribulations of EMS leave the > profession. The best indicator of how you will be a year after a critical > stress is how you were a year before the event. The trend is to promote the > development of pre-existing stress management strategies. CISM consists of > 10 components and I only have trouble with two--defusing and debriefing. > Remove those, and the model is good. What should we do? > 1. Promote the development of healthy behavior and stress- management > strategies. > 2. Protect people when stress occurs. Remove them from the stress and > periodically assess them for problematic response. Alot of the problems we > are seeing with FDNY after 9-11 was that nobody made them get off the heap > when it was obvious that all survivors had been found. > 3. Meet physical needs (warmth, food, fluids, companionship). If people want > to talk, let them. If they don't, don't make them. > 4. Use the person's personal support system (spouse, friends, clergy, > co-workers). Don't force them into a support system in which they are > uncomfortable (CISD, prayer session). > 5. Provide information and quash rumors. We need to know the facts to know > how to feel and respond. > 6. Do not debrief or defuse. > 7. Monitor people for 4-6 weeks after the stress. For those showing signs of > ASD or PTSD, refer for professional assessment and possibly > cognitive-behavioral therapy. There are screening systems that supervisors > can apply that are sensitive in detecting those who are not responding. > > Again, instead of treating the whole herd with the same treatment, you > identify those that are having problems and customize the treatment, if > needed, to the individual animal. > > E. Bledsoe, DO, FACEP > Midlothian, Texas > > Don't miss the Western States EMS Cruise! > http://proemseducators.com/index.html > > > _____ > > From: [mailto:texasems- l ] On > Behalf Of Danny > Sent: Sunday, January 29, 2006 9:59 AM > To: > Subject: Re: EMS Coping > > > So we are told CISD does not work. Are we now making a shift in that > statement? > > Is it one study this and one study that? > > Will the results be that different individuals have different coping > mechanisms? > > Are EMS professionals different than others exposed to critical stress? > > I just have to say WOW!!! > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 29, 2006 Report Share Posted January 29, 2006 Don't give me the credit. I just summarized and wrote what various organizations and researchers have been saying for the past few years. In EMS we always seem to want to make things complicated when simple is actually better. E. Bledsoe, DO, FACEP Midlothian, Texas Don't miss the Western States EMS Cruise! http://proemseducators.com/index.html _____ From: [mailto: ] On Behalf Of sstephensmedic Sent: Sunday, January 29, 2006 2:35 PM To: Subject: Re: EMS Coping Good response Dr. B., it alls boils down to individuality. And we could call it Dr. B's guide of coping with EMS stress (DBGCES). stephen stephens > EMS people are just as diverse as the population as a whole. We have people > of different cultures, religions, beliefs, values, and even sexual > identities. We each cope differently and, in fact, most coping styles are > healthy. Even " repressing " feelings has been found to be an effective > coping style. That is why CISM and other types of structured interventions > are problematic. There are people that CISM might help. There are people > where prayer might help. There are people where barbecue might help. But, > there are people where CISM might harm, prayer might harm and barbecue might > harm. But, in the first week of an event, trying to change thinking is > problematic. The way we respond to stress is based upon our personality, > beliefs, life-experiences, intellect, etc. The vast majority of people who > are exposed to EMS stressors do just fine. EMS sort of self- selects. Those > who cannot emotionally handle the trials and tribulations of EMS leave the > profession. The best indicator of how you will be a year after a critical > stress is how you were a year before the event. The trend is to promote the > development of pre-existing stress management strategies. CISM consists of > 10 components and I only have trouble with two--defusing and debriefing. > Remove those, and the model is good. What should we do? > 1. Promote the development of healthy behavior and stress- management > strategies. > 2. Protect people when stress occurs. Remove them from the stress and > periodically assess them for problematic response. Alot of the problems we > are seeing with FDNY after 9-11 was that nobody made them get off the heap > when it was obvious that all survivors had been found. > 3. Meet physical needs (warmth, food, fluids, companionship). If people want > to talk, let them. If they don't, don't make them. > 4. Use the person's personal support system (spouse, friends, clergy, > co-workers). Don't force them into a support system in which they are > uncomfortable (CISD, prayer session). > 5. Provide information and quash rumors. We need to know the facts to know > how to feel and respond. > 6. Do not debrief or defuse. > 7. Monitor people for 4-6 weeks after the stress. For those showing signs of > ASD or PTSD, refer for professional assessment and possibly > cognitive-behavioral therapy. There are screening systems that supervisors > can apply that are sensitive in detecting those who are not responding. > > Again, instead of treating the whole herd with the same treatment, you > identify those that are having problems and customize the treatment, if > needed, to the individual animal. > > E. Bledsoe, DO, FACEP > Midlothian, Texas > > Don't miss the Western States EMS Cruise! > http://proemseducators.com/index.html > > > _____ > > From: [mailto:texasems- l ] On > Behalf Of Danny > Sent: Sunday, January 29, 2006 9:59 AM > To: > Subject: Re: EMS Coping > > > So we are told CISD does not work. Are we now making a shift in that > statement? > > Is it one study this and one study that? > > Will the results be that different individuals have different coping > mechanisms? > > Are EMS professionals different than others exposed to critical stress? > > I just have to say WOW!!! > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 29, 2006 Report Share Posted January 29, 2006 Don't give me the credit. I just summarized and wrote what various organizations and researchers have been saying for the past few years. In EMS we always seem to want to make things complicated when simple is actually better. E. Bledsoe, DO, FACEP Midlothian, Texas Don't miss the Western States EMS Cruise! http://proemseducators.com/index.html _____ From: [mailto: ] On Behalf Of sstephensmedic Sent: Sunday, January 29, 2006 2:35 PM To: Subject: Re: EMS Coping Good response Dr. B., it alls boils down to individuality. And we could call it Dr. B's guide of coping with EMS stress (DBGCES). stephen stephens > EMS people are just as diverse as the population as a whole. We have people > of different cultures, religions, beliefs, values, and even sexual > identities. We each cope differently and, in fact, most coping styles are > healthy. Even " repressing " feelings has been found to be an effective > coping style. That is why CISM and other types of structured interventions > are problematic. There are people that CISM might help. There are people > where prayer might help. There are people where barbecue might help. But, > there are people where CISM might harm, prayer might harm and barbecue might > harm. But, in the first week of an event, trying to change thinking is > problematic. The way we respond to stress is based upon our personality, > beliefs, life-experiences, intellect, etc. The vast majority of people who > are exposed to EMS stressors do just fine. EMS sort of self- selects. Those > who cannot emotionally handle the trials and tribulations of EMS leave the > profession. The best indicator of how you will be a year after a critical > stress is how you were a year before the event. The trend is to promote the > development of pre-existing stress management strategies. CISM consists of > 10 components and I only have trouble with two--defusing and debriefing. > Remove those, and the model is good. What should we do? > 1. Promote the development of healthy behavior and stress- management > strategies. > 2. Protect people when stress occurs. Remove them from the stress and > periodically assess them for problematic response. Alot of the problems we > are seeing with FDNY after 9-11 was that nobody made them get off the heap > when it was obvious that all survivors had been found. > 3. Meet physical needs (warmth, food, fluids, companionship). If people want > to talk, let them. If they don't, don't make them. > 4. Use the person's personal support system (spouse, friends, clergy, > co-workers). Don't force them into a support system in which they are > uncomfortable (CISD, prayer session). > 5. Provide information and quash rumors. We need to know the facts to know > how to feel and respond. > 6. Do not debrief or defuse. > 7. Monitor people for 4-6 weeks after the stress. For those showing signs of > ASD or PTSD, refer for professional assessment and possibly > cognitive-behavioral therapy. There are screening systems that supervisors > can apply that are sensitive in detecting those who are not responding. > > Again, instead of treating the whole herd with the same treatment, you > identify those that are having problems and customize the treatment, if > needed, to the individual animal. > > E. Bledsoe, DO, FACEP > Midlothian, Texas > > Don't miss the Western States EMS Cruise! > http://proemseducators.com/index.html > > > _____ > > From: [mailto:texasems- l ] On > Behalf Of Danny > Sent: Sunday, January 29, 2006 9:59 AM > To: > Subject: Re: EMS Coping > > > So we are told CISD does not work. Are we now making a shift in that > statement? > > Is it one study this and one study that? > > Will the results be that different individuals have different coping > mechanisms? > > Are EMS professionals different than others exposed to critical stress? > > I just have to say WOW!!! > > > > Quote Link to comment Share on other sites More sharing options...
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