Been in a CISD?

[DwayneEMTP]

No matter if your experience was good or bad, if you're pro or con, I'd like to be able to send you some interview questions via PM or email... or we could speak on the phone.

If you're willing to help, please send me a PM and I'll return your message promptly.

City Folks, I appreciate your help.

Rob

As this is an educational paper, on an educational topic, posted on an educational forum, I'm confused why you insist on doing it all in private?

Why not simply post your questions so that all can learn from the answers and debate? It seems that that would give you at minimum the same information, plus you benefit from the conversation concerning thoughts and questions that haven't occurred to you, right?

What's up?

Dwayne

[itku2er]

As this is an educational paper, on an educational topic, posted on an educational forum, I'm confused why you insist on doing it all in private?

Why not simply post your questions so that all can learn from the answers and debate? It seems that that would give you at minimum the same information, plus you benefit from the conversation concerning thoughts and questions that haven't occurred to you, right?

What's up?

Dwayne

My guess would be to keep the people that are willing to help from airing thier expirences out on a public forum. You know as well as I do that some people would rather die than to admit they have been to one of those. But hey I could be wrong. It gives him a chance to ask a more personal level question and probably get a more honest answer. Based some the replies to other questions about CISD I cant't say as I blame him. Just my two cents worth.

[n7lxi]

My guess would be to keep the people that are willing to help from airing thier expirences out on a public forum. You know as well as I do that some people would rather die than to admit they have been to one of those. But hey I could be wrong. It gives him a chance to ask a more personal level question and probably get a more honest answer. Based some the replies to other questions about CISD I cant't say as I blame him. Just my two cents worth.

Exactly right. Many of the details shared in a CISD are private and personal, and usually the process is not conducted out in the open, nor are the details shared. I am also interested in honest individual responses, not a threaded discussion that may be influenced by the other posters in the thread.

Once this paper is complete, I would be more than willing to make it available for the group to read. Of course, any personal information will be redacted to maintain confidentiality.

[Redcell19512]

I'll gladly fill out a survey. I'd prefer an email if you dont mind... jmoyer@wbems.org

[Richard B the EMT]

I recall being in only one, after a member, from the EMD I was then assigned to, committed suicide. I cannot state with any certainty if it helped or not.

It did seem to help another service member, who had apparently helped put a premise history for the member into the Computer Assisted Dispatch system, that had an expiration date for the day after the suicide, to the suicide's address. She had been very "down" on herself for not recognizing "signs and symptoms" of someone planning suicide.

A side-note on that: As I had been met at the door of the EMD by someone from the tour I was coming in to relieve, with the cold statement of "Did you hear? (Name) committed suicide!", the supervisors ordered the off-going tour not to talk to the oncoming tour, and they sequestered us into a conference room to "officially" announce our colleague's death to us, and proceeded directly into the session, with both the department's and union's CISD personnel in attendance (I was friends with both of them, as well as the deceased).

[armymedic571]

Send me a PM. I sill answer your questions if you are still asking.

I happen to agree with DustDevil. Dr. Bledsoe has done a few articles on this topic, with some staggering numbers. Always makes you wonder......... .

[n7lxi]

I was tasked with writing an opinion paper on CISD for my “Well Being of the Paramedic” course that’s part of my medic school’s curriculum.

Names and locations have been redacted.

Thanks to all who replied. I’d like to hear your thoughts.

The line of duty death of a coworker, a tragic accident involving a child or a serious mass casualty incident are all critical events that may trigger powerful emotional responses in the parties involved. Due to the nature of the work it would seem that Fire, Rescue and EMS workers would be at the greatest risk for the development of posttraumatic stress from these incidents. Created as a peer driven stress management tool, Critical Incident Stress Debriefing (CISD) was developed to help those exposed to such incidents deal with their emotions. However, since it’s inception, the idea of critical stress management has polarized many EMS workers. The simple idea behind CISD, to prevent or limit the development of posttraumatic stress in individuals exposed to critical incidents, may in some cases exacerbate the stress these individuals experience. After interviewing several individuals that have taken part in the CISD process and recalling my own personal experience with the CISD process, I can argue that while some I spoke with did receive some emotional benefit from the CISD process, each individual’s emotional coping skills are different, and a “one size fits all” CISD counseling session for stress management may do more harm than good in the long term.

In conducting interviews for research, I used a posting on the popular online EMS forum XXXXX.com to solicit responses from EMS professionals who have been in the field for longer than 5 years and had taken part in a CISD event. I received numerous responses and sent standard interview questionnaires to the individuals. I received four complete responses that met my criteria and used these questionnaires, along with specific follow up questions and telephone interviews, to frame my opinion.

I exchanged email with XXXXX, a ten year EMS veteran, who is employed as flight paramedic for XXXXX. XXXX attended her first CISD in 2003 following an incident where an acoustics manufacturing plant sustained a significant explosion and fire, which injured over 40 people and killing 17 in XXXXX XXXXX. After hearing the details of the incident and how the CISD was planned for the team of emergency responders, I asked XXXXX how she felt about the CISD process as a whole. She replied, “I became frustrated during the CISD process because I felt I was pressured to give responses I hadn’t quite come to grips with yet or really had the chance to sort out for a bit myself. I’m a very private person by nature and didn’t appreciate people trying to pry emotions out of me that I wasn’t comfortable expressing to those I didn’t know, which was ultimately the reason I got up and left. I prefer to deal with a few close people I know rather than a large group. I also wasn’t comfortable with the fact it was a forced attendance.” I was surprised to find that this CISD event had a mandatory attendance requirement and XXXXX agreed, stating, “It seemed almost as if they were forcing us to relive the event when we were discussing things … We also felt we would have been better served by a more informal process with simply the offer of additional help if we needed it rather than being thrown in front of a social worker and told ‘Okay, express yourselves’”. XXXXX went on to say that following the formal, mandatory CISD, she took part in several informal gatherings with her crew members and found that in the informal setting, she was better able to evaluate her performance and actions. XXXXX said it took a long time for the memories of that incident to fade and went on to say, “I have very adverse feelings to a formal CISD as I think it actually intensifies the incident and prolongs the recovery period from it.”

I also received a reply from XXXXX XXXX, an EMT-B from the XXXXX Rescue Squad in XXXX. XXX took part in his first CISD following an unsuccessful pediatric resuscitation. In direct contrast to XXX’s experience, when asked about his experience and why he attended, XXX said, “It was definitely non-mandatory. All of the personnel were invited. I went simply because I felt slightly disturbed by how the family thanked me after I was unable to revive their loved one. I didn’t feel that I should’ve been thanked.” I then asked how he felt about the call and it’s outcome following the CISD event. XXX replied, “I felt more validated and eased in my mind about how I did things.” Even though XXX received some positive feedback and appreciated the opportunity to talk about his feelings following the incident, he was reluctant to recommend the CISD process to other EMS workers, stating, “…simply because what works for me won’t work for everyone else.”

As for my own experience with Critical Incident Stress management, I took part in my first CISD in 1990, following an MVA with multiple fatalities in my hometown in XXXXX. I was the first EMT on the scene and was assigned to triage. It was immediately obvious that two of the patients were DOA and several others would require lengthy extrication. Making this chaotic scene even more emotional was the fact that several of the victims were young adults I knew from High School. The day following the incident, we were all invited to a CISD workshop at the Firehouse. I attended, not because I was having difficulty in dealing with the emotional aftermath, instead I was goaded into attending by the repeated urging of my Chief. During the CISD, I recall being repulsed by several of the other firefighters in my department referring to the trapped occupants as “hamburger” and “DRT” (Dead Right There). The braggadocio and swagger that was on display from my fellow EMS workers upset me more than the actual event. I didn’t say much during the entire event. I recall sitting on my cold metal folding chair, sipping cold coffee from a Styrofoam cup, listening to each member of my crew speak, knowing that it was important for me to listen and my just being there was helping to support the crew. I later spoke with the CISD facilitator about how I was feeling about my crewmembers and he explained that often people covered their shock and emotions with bravado, and that if I had problems I should talk to him. I never did talk to the CISD facilitator again and I continued working in EMS for several years following that incident. After the experience I had, watching my crew, I doubt I would attend a CISD event again. I’d much rather talk it out with my partner, a close friend in EMS or my priest.

As EMS professionals, we will be exposed to critical incidents as a matter of course and it is clear that dealing with Critical Incident Stress is an important part of maintaining the health and well being of the EMS worker. However, I believe that a formal Critical Incident Stress Debriefing, no matter how innocuous or well meaning the intent, may force individuals to attempt to cope with these stressors before they are emotionally ready and willing to face their coworkers. Instead, I feel that department leaders and EMS management should adopt a flexible strategy to deal with traumatic stress situations. A more fluid, less structured and rigid plan, based on the needs of each individual, consisting of informal chats, the freedom to take personal time or the offer of mental health professionals or counselors could be the next step in replacing a regimented, formal, and in some cases mandatory, Critical Incident Stress Debriefing following a traumatic event.

[HERBIE1]

I was tasked with writing an opinion paper on CISD for my "Well Being of the Paramedic" course that's part of my medic school's curriculum.

Names and locations have been redacted.

Thanks to all who replied. I'd like to hear your thoughts.

The line of duty death of a coworker, a tragic accident involving a child or a serious mass casualty incident are all critical events that may trigger powerful emotional responses in the parties involved. Due to the nature of the work it would seem that Fire, Rescue and EMS workers would be at the greatest risk for the development of posttraumatic stress from these incidents. Created as a peer driven stress management tool, Critical Incident Stress Debriefing (CISD) was developed to help those exposed to such incidents deal with their emotions. However, since it's inception, the idea of critical stress management has polarized many EMS workers. The simple idea behind CISD, to prevent or limit the development of posttraumatic stress in individuals exposed to critical incidents, may in some cases exacerbate the stress these individuals experience. After interviewing several individuals that have taken part in the CISD process and recalling my own personal experience with the CISD process, I can argue that while some I spoke with did receive some emotional benefit from the CISD process, each individual's emotional coping skills are different, and a "one size fits all" CISD counseling session for stress management may do more harm than good in the long term.

In conducting interviews for research, I used a posting on the popular online EMS forum XXXXX.com to solicit responses from EMS professionals who have been in the field for longer than 5 years and had taken part in a CISD event. I received numerous responses and sent standard interview questionnaires to the individuals. I received four complete responses that met my criteria and used these questionnaires, along with specific follow up questions and telephone interviews, to frame my opinion.

I exchanged email with XXXXX, a ten year EMS veteran, who is employed as flight paramedic for XXXXX. XXXX attended her first CISD in 2003 following an incident where an acoustics manufacturing plant sustained a significant explosion and fire, which injured over 40 people and killing 17 in XXXXX XXXXX. After hearing the details of the incident and how the CISD was planned for the team of emergency responders, I asked XXXXX how she felt about the CISD process as a whole. She replied, "I became frustrated during the CISD process because I felt I was pressured to give responses I hadn't quite come to grips with yet or really had the chance to sort out for a bit myself. I'm a very private person by nature and didn't appreciate people trying to pry emotions out of me that I wasn't comfortable expressing to those I didn't know, which was ultimately the reason I got up and left. I prefer to deal with a few close people I know rather than a large group. I also wasn't comfortable with the fact it was a forced attendance." I was surprised to find that this CISD event had a mandatory attendance requirement and XXXXX agreed, stating, "It seemed almost as if they were forcing us to relive the event when we were discussing things … We also felt we would have been better served by a more informal process with simply the offer of additional help if we needed it rather than being thrown in front of a social worker and told 'Okay, express yourselves'". XXXXX went on to say that following the formal, mandatory CISD, she took part in several informal gatherings with her crew members and found that in the informal setting, she was better able to evaluate her performance and actions. XXXXX said it took a long time for the memories of that incident to fade and went on to say, "I have very adverse feelings to a formal CISD as I think it actually intensifies the incident and prolongs the recovery period from it."

I also received a reply from XXXXX XXXX, an EMT-B from the XXXXX Rescue Squad in XXXX. XXX took part in his first CISD following an unsuccessful pediatric resuscitation. In direct contrast to XXX's experience, when asked about his experience and why he attended, XXX said, "It was definitely non-mandatory. All of the personnel were invited. I went simply because I felt slightly disturbed by how the family thanked me after I was unable to revive their loved one. I didn't feel that I should've been thanked." I then asked how he felt about the call and it's outcome following the CISD event. XXX replied, "I felt more validated and eased in my mind about how I did things." Even though XXX received some positive feedback and appreciated the opportunity to talk about his feelings following the incident, he was reluctant to recommend the CISD process to other EMS workers, stating, "…simply because what works for me won't work for everyone else."

As for my own experience with Critical Incident Stress management, I took part in my first CISD in 1990, following an MVA with multiple fatalities in my hometown in XXXXX. I was the first EMT on the scene and was assigned to triage. It was immediately obvious that two of the patients were DOA and several others would require lengthy extrication. Making this chaotic scene even more emotional was the fact that several of the victims were young adults I knew from High School. The day following the incident, we were all invited to a CISD workshop at the Firehouse. I attended, not because I was having difficulty in dealing with the emotional aftermath, instead I was goaded into attending by the repeated urging of my Chief. During the CISD, I recall being repulsed by several of the other firefighters in my department referring to the trapped occupants as "hamburger" and "DRT" (Dead Right There). The braggadocio and swagger that was on display from my fellow EMS workers upset me more than the actual event. I didn't say much during the entire event. I recall sitting on my cold metal folding chair, sipping cold coffee from a Styrofoam cup, listening to each member of my crew speak, knowing that it was important for me to listen and my just being there was helping to support the crew. I later spoke with the CISD facilitator about how I was feeling about my crewmembers and he explained that often people covered their shock and emotions with bravado, and that if I had problems I should talk to him. I never did talk to the CISD facilitator again and I continued working in EMS for several years following that incident. After the experience I had, watching my crew, I doubt I would attend a CISD event again. I'd much rather talk it out with my partner, a close friend in EMS or my priest.

As EMS professionals, we will be exposed to critical incidents as a matter of course and it is clear that dealing with Critical Incident Stress is an important part of maintaining the health and well being of the EMS worker. However, I believe that a formal Critical Incident Stress Debriefing, no matter how innocuous or well meaning the intent, may force individuals to attempt to cope with these stressors before they are emotionally ready and willing to face their coworkers. Instead, I feel that department leaders and EMS management should adopt a flexible strategy to deal with traumatic stress situations. A more fluid, less structured and rigid plan, based on the needs of each individual, consisting of informal chats, the freedom to take personal time or the offer of mental health professionals or counselors could be the next step in replacing a regimented, formal, and in some cases mandatory, Critical Incident Stress Debriefing following a traumatic event.

Nice job on the paper. What grade did you get? LOL

As evidenced by the various responses, there is no "right" way of handling tough situations. As you noted, I think that CISD should ALWAYS be voluntary, and the facilitators need to understand that it's perfectly normal and OK for someone may not want to participate. Something that is horrendous for one person does not even register for another. A simple, nontraumatic call can also be a trigger that reminds a person of another incident that WAS a problem. Everyone has their own time frame to deal with tragedies, and I think the onus is on a supervisors and coworkers to keep an eye on someone after a bad situation- a delayed response is not uncommon- whether or not they went through CISD.

A simple cardiac arrest may remind someone of a recently deceased family member and the person could suddenly have trouble coping. (Happened to a former partner-she fell apart after a 85 year old nursing home arrest. Nothing unusually sad or tragic- she's dealt with tons of similar calls, but apparently a beloved grandfather recently died in a nursing home and the emotions came flooding back to her. ) Need for CISD-no, but she just needed to talk out her problem and felt better.

Those who are "old school" were taught that thing like CISD shows signs of weakness, but now we know better. Some people have better coping mechanisms than others, while some need a little extra help. Nothing wrong with that- or with someone who does not want a formal debriefing.

I do know that good supervisors can incorporate a debriefing of a significant event with CISD. As the details of the call are rehashed, the supervisor looks for signs that someone may not be coping well and takes action as needed, but it's still not a formal CISD.

[Richard B the EMT]

I have 2 things that are a kind of trigger for me. One is a burnt teddy bear, as I saw at the scene of the Eastern Air Lines Flight 66 crash, in June of 1995 (113 killed), and sometimes enclosed stairwells, as I and my Lady J were robbed at gunpoint in the stairwell of the housing project she then lived in.

Edited November 18, 2009 by Richard B the EMT

[HERBIE1]

I have 2 things that are a kind of trigger for me. One is a burnt teddy bear, as I saw at the scene of the Eastern Air Lines Flight 66 crash, in June of 1995 (113 killed), and sometimes enclosed stairwells, as I and my Lady J were robbed at gunpoint in the stairwell of the housing project she then lived in.

Horrible about that plane crash, Richard. Must have been a nightmare.

Most everyone has issues with bad calls involving kids- myself included. Responding to a friend's home and finding their little baby girl when she died of SIDS was my worst.

That one shook me up for awhile.