Troubling Call, need to vent

[island emt]

In Maine : Mandated reporter statute covers us as Healthcare providers ,firefighters, law enforcement officers , teachers & school administrators : It means we have to report our suspicions to the receiving hospital ER Doctor personally and file a report over the phone to either the child protective services office for children or the Elder services office of DHS. The system does work and I have made use of it in the past.

Both have a 24/7 hotline and will have a caseworker in touch with you within an hour to get a full report and followup.

[scubanurse]

I'm with Dwayne... Everyone is tossing out mandatory reporting.... the OP did this. She/he reported their suspicions to the ER doc and it sounds like s/he was going to talk to some LEO friends.

Any call like this, I believe should involve a CISM debrief afterwards. Calls involving violence to children should be included under their protocol for a CISM meeting after the call. You should not have to process the events alone. There are resources available through most departments in the US, and possible Canada but I have no clue, to help the OP handle their feelings after calls like this.

To the OP and anyone else who has experienced a call like this, reach out to CISM, to a friend, religious leader, anyone you feel comfortable talking to.

To the OP: Sounds like you did all you could to help this child, unfortunately, a lot of the time things like this fall through the cracks. Not all rapes cause physical damage to the vaginal area that would be evident to a doctor without the training to recognize such an issue. Someone previously mentioned SANE nurses and their value in a case like this a incredible. They can speak with the victim, and often times the victim is more likely to speak to them rather than the MD on the case. Does your area have access to SANE nurses? I am really sorry that you had to experience this call, but I do hope that you reach out and continue to process the events that happened.

Best of luck to you.

[paramedicmike]

Interesting. Everywhere I've worked mandatory reporting has meant to law enforcement, CPS or social services. It has not stopped simply with telling the ER doc. Verifying the process could be as simple as referencing local protocols. Failing that a call to the state/province/regional EMS office to ask about the process should prove helpful. Of course, this is all assuming you don't want to talk to your boss at work about it.

Be wary of this process. Failure to follow established reporting guidelines or laws can come back to bite you in the arse and leave you in a heap of legal trouble. Figure out your reporting responsibilities and get the reporting done correctly.

Be careful with mandatory CISM debriefings. If one is inclined to need to talk something like this out then a professional counselor or therapist, one who has been educated and trained to provide counseling/therapy/psychological services, is probably a better bet. Never mind the potential damage that can be created by forcing someone to attend one of these type of meetings.

[scubanurse]

I've always found that being told to attend gives someone the opportunity to talk...I have never seen someone forced to talk, just strongly urged to attend and have the opportunity to talk... CISM can also refer those who need further assistance to professional therapists and counselors. In my experience, it is meant to be a first step to help get the ball rolling if needed.

[paramedicmike]

Then offer the referrals to involved crew members without the dangerously undertrained, or altogether untrained, "CISM counselors".

These things can do more harm than good. Professionally trained and educated counselors, psychologists or therapists, preferably ones with experience dealing with EMS or first responders, are much better than people who took a couple of weekend classes to be "CISM counselors". Mandating attendance breeds resentment which is not something you want on top whatever issue may be at hand.

[scubanurse]

Our experiences with CISM teams must be very different. The two meetings I attended were ran by professional counselors and a small group of experienced providers. Our meetings with them were mandated but some just showed up said I'm good and left and that was that. Not all CISM programs are great, but not all are bad either.

[paramedicmike]

The literature is mixed on it. Some literature describes some benefit. Other studies show no benefit. I'm not arguing that professional counseling or psychological intervention is bad. My position is that this half assed CISM methodology that so many EMS agencies seem to subscribe to is flawed by nature. That position is based on some review of the literature. Some of it is based on my own "mandatory" attendances. Some of it is based on my increasing skepticism of the entire US EMS system in general. I can't, and won't, deny some personal bias here. But I cannot help but believe that mandating participation (even simply by attending) is poor practice and potentially harmful.

With that being said, please define professional counselors and experienced providers as it applies to your two experiences. I think that will help clear up at least the "who" question involved here.

[scubanurse]

I believe one was a PhD and the other had their masters in social work. I appreciate that there are differences, and if I were really frustrated or upset about a call being told to go talk to someone who had no qualifications or legitimate training I would probably tell them to piss off. I also know that sometimes people are unaware of resources available and can really struggle internally with issues and feel isolated. I don't know what the right answer is regarding after action counseling.

OP: I am sorry for de-railing your post! eek

[paramedicmike]

Yeah. Not trying to further hijack this thread. But Bryan Bledsoe wrote this article in 2003. The research cited is older. But it's a good article overall and still raises a lot of good questions.

Back to the regular discussion.

[Curiosity]

I'm with Dwayne... Everyone is tossing out mandatory reporting.... the OP did this. She/he reported their suspicions to the ER doc and it sounds like s/he was going to talk to some LEO friends.

I would be careful saying this to people. This is not enough in our service. We (all medics who were on the scene, attending and partner) are mandated by law to report to CPS directly. Telling the receiving facility, doctor, nurse, law enforcement isn't enough and can land our butts in a load if trouble should it come up later that everyone on scene did not each contact CPS directly.

To the OP, I would have a look at your local protocols about reporting structures.